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Toly VB, Blanchette JE, Alhamed A, Musil CM. Mothers' Voices Related to Caregiving: The Transition of a Technology-Dependent Infant from the NICU to Home. Neonatal Netw 2019; 38:69-79. [PMID: 31470369 DOI: 10.1891/0730-0832.38.2.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge. DESIGN A qualitative, descriptive, longitudinal design was employed. SAMPLE Nineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU. MAIN OUTCOME VARIABLE Description of mothers' transition experience. RESULTS Three themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.
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Plata-Menchaca EP, Ferrer R. Life-support tools for improving performance of the Surviving Sepsis Campaign Hour-1 bundle. Med Intensiva 2018; 42:547-550. [PMID: 30224188 DOI: 10.1016/j.medin.2018.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 12/29/2022]
Affiliation(s)
- E P Plata-Menchaca
- Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Ferrer
- Department of Intensive Care, Vall d'Hebron University Hospital, Barcelona, Spain; Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
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Liantonio J, Liquori M, Lakhtman L, Parks S. Advance care planning: Making it easier for patients (and you). J Fam Pract 2017; 66:487-491. [PMID: 28783768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Helpful resources, many of them online, are available to facilitate the process. And this time-intensive service is now billable under 2 CPT codes.
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Affiliation(s)
- John Liantonio
- Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | | | - Lilia Lakhtman
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Susan Parks
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Russell J. The Role of Health Care Provider Goals, Plans, and Physician Orders for Life-Sustaining Treatment (POLST) in Preparing for Conversations About End-of-Life Care. J Health Commun 2016; 21:1023-1030. [PMID: 27442346 DOI: 10.1080/10810730.2016.1204380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) × 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals. Findings suggested that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggested that the utility of the POLST surfaced with provider responses to patient misunderstanding, in which differences in conditions were identified. Significant differences in goals reported as most important in driving conversational engagement emerged. Implications for findings are discussed.
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Affiliation(s)
- Jessica Russell
- a Department of Communication Studies , California State University , Long Beach , California , USA
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Abstract
Organ procurement coordinators must treat various cardiac dysrhythmias (arrhythmias), including rhythm disturbances that may cause or follow a cardiac arrest, in about 15% to 50% of donors. Treatment decisions should be based on the particular dysrhythmia and its effect on donor blood pressure. Medications selected should be effective but short acting. In this article, data available in publications located through a PubMed search are reviewed and specific dysrhythmias that are likely to occur during donor care are described. Treatment recommendations are based on guidelines from the American Heart Association.
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Affiliation(s)
- David J Powner
- The University of Texas Health Science Center at Houston, USA
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7
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Affiliation(s)
- Fun Gee Chen
- a Department of Anaesthesia , Yong Loo Lin School of Medicine, National University of Singapore , Singapore , and
| | - Lian Kah Ti
- a Department of Anaesthesia , Yong Loo Lin School of Medicine, National University of Singapore , Singapore , and
| | - Chaoyan Dong
- b Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore , Singapore
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McCarthy M. Massachusetts requires doctors to inform patients about end of life options. BMJ 2014; 349:g7817. [PMID: 25547658 DOI: 10.1136/bmj.g7817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Seamon MJ, Doane SM, Gaughan JP, Kulp H, D'Andrea AP, Pathak AS, Santora TA, Goldberg AJ, Wydro GC. Prehospital interventions for penetrating trauma victims: a prospective comparison between Advanced Life Support and Basic Life Support. Injury 2013; 44:634-8. [PMID: 23391450 DOI: 10.1016/j.injury.2012.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 12/01/2012] [Accepted: 12/28/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Advanced Life Support (ALS) providers may perform more invasive prehospital procedures, while Basic Life Support (BLS) providers offer stabilisation care and often "scoop and run". We hypothesised that prehospital interventions by urban ALS providers prolong prehospital time and decrease survival in penetrating trauma victims. STUDY DESIGN We prospectively analysed 236 consecutive ambulance-transported, penetrating trauma patients an our urban Level-1 trauma centre (6/2008-12/2009). Inclusion criteria included ICU admission, length of stay >/=2 days, or in-hospital death. Demographics, clinical characteristics, and outcomes were compared between ALS and BLS patients. Single and multiple variable logistic regression analysis determined predictors of hospital survival. RESULTS Of 236 patients, 71% were transported by ALS and 29% by BLS. When ALS and BLS patients were compared, no differences in age, penetrating mechanism, scene GCS score, Injury Severity Score, or need for emergency surgery were detected (p>0.05). Patients transported by ALS units more often underwent prehospital interventions (97% vs. 17%; p<0.01), including endotracheal intubation, needle thoracostomy, cervical collar, IV placement, and crystalloid resuscitation. While ALS ambulance on-scene time was significantly longer than that of BLS (p<0.01), total prehospital time was not (p=0.98) despite these prehospital interventions (1.8 ± 1.0 per ALS patient vs. 0.2 ± 0.5 per BLS patient; p<0.01). Overall, 69.5% ALS patients and 88.4% of BLS patients (p<0.01) survived to hospital discharge. CONCLUSION Prehospital resuscitative interventions by ALS units performed on penetrating trauma patients may lengthen on-scene time but do not significantly increase total prehospital time. Regardless, these interventions did not appear to benefit our rapidly transported, urban penetrating trauma patients.
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Affiliation(s)
- Mark J Seamon
- Department of Surgery, Cooper University Hospital, USA.
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Lund V, Valli J, Hallikainen J, Sainio A, Niskanen T. Tactical EMS revisited - analysing the benefits needs a wider perspective. Acta Anaesthesiol Scand 2012; 56:931; author reply 932. [PMID: 22571235 DOI: 10.1111/j.1399-6576.2012.02714.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rey JW, Backhaus E, Wirges U, Hesse A. [The process of organ donation: nurses are assigned a key role]. Pflege Z 2010; 63:652-656. [PMID: 21086668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, Field B, Luinstra-Toohey L, Maloney J, Dreyer J, Lyver M, Campeau T, Wells GA. The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ 2008; 178:1141-52. [PMID: 18427089 PMCID: PMC2292763 DOI: 10.1503/cmaj.071154] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established METHODS The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge. RESULTS Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16). INTERPRETATION The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.
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Affiliation(s)
- Ian G Stiell
- The Department of Emergency Medicine, University of Ottawa, and the Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ont
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Abstract
Advanced Trauma Life Support (ATLS) is a concept for rapid initial assessment and primary management of an injured patient, starting at the time of injury and continuing through initial assessment, lifesaving interventions, re-evaluation, stabilization and, when needed, transfer to a trauma centre. Despite some shortcomings, it is the only standardized concept for emergency room management, which is internationally accepted. Because of its simple and clear structure, it is flexible and can be universally integrated into existing emergency room algorithms under consideration of local, regional as well as national and international peculiarities in the sense of a "common language of trauma". Under these aspects ATLS also seems to be a valid concept for Europe.
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Affiliation(s)
- M Helm
- Abteilung für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89070 Ulm.
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Birnkrant DJ, Noritz GH. Is there a role for palliative care in progressive pediatric neuromuscular diseases? The answer is "Yes! J Palliat Care 2008; 24:265-269. [PMID: 19227018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The consequences of prolongation of survival can be oversimplified, for example, by equating technologically prolonged survival with indefinitely prolonged high quality of life. When this oversimplified view is embraced, the prognosis of ultimately fatal diseases like DMD may be viewed with unrealistic optimism and palliative care may seem irrelevant or misguided. However, we have shown that the sequelae of prolonged survival are complex. For example, NPPV does not protect prolonged survivors of progressive NMDs from potentially debilitating medical complications that can cause elevated burden of disease, high burden of care, and the potential for impaired quality of life. Also, the sequelae of prolonged survival can negatively affect a wide variety of stakeholders, including patients and their families, medical professionals, and society. It is our view that, when the implications of prolonged survival are examined carefully, their complexity is revealed, and the potential for palliative care to provide support and to relieve suffering in prolonged survivors of progressive NMDs becomes apparent. Thus, we advocate development of an integrative care model for patients with progressive NMDs, blending technological therapies with adoption of palliative strategies as patients approach end of life.
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Affiliation(s)
- David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
The aim of this study was to examine physicians' and nurses' preferences regarding the use of life-sustaining treatments (LST) for severely ill elderly patients, and the patient- and social-centered factors that influence them. Physicians and nurses working in Israeli general hospitals completed structured questionnaires referring to their preferences for using LST in three severe health conditions (metastatic cancer, mental illness and being bedridden/incontinent). The participants were also asked about factors influencing these preferences, including patients' wishes, quality of life, religiosity and the current law. Both physicians and nurses indicated that they would use less LST for patients with metastatic cancer than with those suffering from the other two health conditions. Our findings indicate that the attitudes of professionals involved in these processes are influenced not only by the patient's condition but also by their professional orientations and personal values. Open communication among professionals for clarifying the various beliefs, as well as the antecedents of these beliefs, is important for the benefit of professional teams, patients and families.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Attitude of Health Personnel
- Choice Behavior/ethics
- Cross-Sectional Studies
- Female
- Health Knowledge, Attitudes, Practice
- Hospitals, General
- Humans
- Israel
- Jews/psychology
- Life Support Care/ethics
- Life Support Care/organization & administration
- Life Support Care/psychology
- Male
- Medical Futility
- Medical Staff, Hospital/ethics
- Medical Staff, Hospital/organization & administration
- Medical Staff, Hospital/psychology
- Multivariate Analysis
- Nursing Methodology Research
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/organization & administration
- Nursing Staff, Hospital/psychology
- Patient Rights/ethics
- Patient Rights/legislation & jurisprudence
- Patient Selection/ethics
- Religion and Psychology
- Severity of Illness Index
- Surveys and Questionnaires
- Withholding Treatment/ethics
- Withholding Treatment/legislation & jurisprudence
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Affiliation(s)
- Sara Carmel
- Center for Multidisciplinary Research in Aging, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Abstract
Over the last 30 years the Advanced Trauma Life Support (ATLS) course has become the most successful training program in the world for the early care of severely injured patients. It has shaped trauma care systems in many countries and is now on the verge of being introduced into Germany by the German Society of Trauma Surgery (DGU). However, after publication of the latest edition in 2004 there are rising concerns regarding the lack of multi-disciplinarity, out-dated contents and lack of adaptability to regional needs. This article questions the beneficial effect of ATLS on the advanced German trauma care system and concludes that ATLS is not likely to improve trauma care in Germany.
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Affiliation(s)
- K-C Thies
- Anaesthetics Department, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
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Treece PD, Engelberg RA, Shannon SE, Nielsen EL, Braungardt T, Rubenfeld GD, Steinberg KP, Curtis JR. Integrating palliative and critical care: description of an intervention. Crit Care Med 2007; 34:S380-7. [PMID: 17057602 DOI: 10.1097/01.ccm.0000237045.12925.09] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.
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Affiliation(s)
- Patsy D Treece
- Harborview Medical Center, Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, Washington, USA
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Mularski RA, Curtis JR, Billings JA, Burt R, Byock I, Fuhrman C, Mosenthal AC, Medina J, Ray DE, Rubenfeld GD, Schneiderman LJ, Treece PD, Truog RD, Levy MM. Proposed quality measures for palliative care in the critically ill: a consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med 2007; 34:S404-11. [PMID: 17057606 DOI: 10.1097/01.ccm.0000242910.00801.53] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For critically ill patients and their loved ones, high-quality health care includes the provision of excellent palliative care. To achieve this goal, the healthcare system needs to identify, measure, and report specific targets for quality palliative care for critically ill or injured patients. Our objective was to use a consensus process to develop a preliminary set of quality measures to assess palliative care in the critically ill. We built on earlier and ongoing efforts of the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup to propose specific measures of the structure and process of palliative care. We used an informal iterative consensus process to identify and refine a set of candidate quality measures. These candidate measures were developed by reviewing previous literature reviews, supplementing the evidence base with recently published systematic reviews and consensus statements, identifying existing indicators and measures, and adapting indicators from related fields for our objective. Among our primary sources, we identified existing measures from the Voluntary Hospital Association's Transformation of the ICU program and a government-sponsored systematic review performed by RAND Health to identify palliative care quality measures for cancer care. Our consensus group proposes 18 quality measures to assess the quality of palliative care for the critically ill and injured. A total of 14 of the proposed measures assess processes of care at the patient level, and four measures explore structural aspects of critical care delivery. Future research is needed to assess the relationship of these measures to desired health outcomes. Subsequent measure sets should also attempt to include outcome measures, such as patient or surrogate satisfaction, as the field develops the means to rigorously measure such outcomes. The proposed measures are intended to stimulate further discussion, testing, and refinement for quality of care measurement and enhancement.
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Affiliation(s)
- Richard A Mularski
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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Abstract
Until recently, the intensive care unit has largely escaped the withering criticism of those bent on measuring and improving the quality of care. The evidence base for practice in the intensive care unit is growing, as is the pressure to measure and improve this practice. Viewed as an important part of critical care, the process of eliciting patients' values for life-sustaining treatment, clarifying whether current care fulfills these wishes, resolving conflicts about these assessments, and easing the physical and emotional suffering of patients, families, and staff during critical care would probably qualify as one of the most frequently provided "treatments" in the intensive care unit. Therefore, as a routinely provided medical therapy, palliative care is certainly an appropriate target for quality improvement activities in critical care. This article considers, from the point of view of a clinical intensivist, the similarities and differences between improving palliative care in the intensive care unit and implementing other practice change to improve the quality of critical care.
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Affiliation(s)
- Gordon D Rubenfeld
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Abstract
My sister was admitted to the intensive-care-unit (ICU) five months before she died. At the time of admission her life-support wishes were not discussed with her. During her time in the ICU, we, the family, were given hope that she may survive. As with most families, we wanted my sister to live. During her progression from ICU to step-down unit to ward unit, the plan of care was not discussed, and goals were not set. Many medical teams were involved in my sister's care, and many looked at individual body parts instead of the whole person. I am a Registered Nurse at the same hospital where my sister was being cared for. Through many family meetings I was regarded as a medical professional, not as a sister. Knowing the medical system yet going through this as a family member has given me the opportunity to gain insight into what should have happened. If code status had been discussed we would have known my sisters wishes. If relevant literature pertaining to her disease and her slim chance of recovery had been brought to our attention, my sister could have died at home as she wished, and perhaps could have lived her final days in comfort.
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Heightman A. Economies of scale vs. quality of care. JEMS 2006; 31:20; discussion 20; author reply 20. [PMID: 16690393 DOI: 10.1016/s0197-2510(06)70373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
The goal of palliative care is to provide the alleviation or reduction of suffering and the support for the best possible quality of life for patients regardless of the stage of the disease. Palliative care can be provided in any patient care setting, including intensive care units. Death in intensive care units is a common occurrence, with literature suggesting that approximately 20% of deaths in the United States occur after a stay in the intensive care unit. Other studies suggest that approximately half of all chronically ill patients who die in a hospital receive care in the intensive care unit within 3 days of their deaths. Critical care nurses who work in neurological intensive care units are at the forefront of integrating palliative and critical care.
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Affiliation(s)
- Darrell Owens
- Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
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Pamerneckas A, Macas A, Blazgys A, Pilipavicius G, Toliusis V. The treatment of multiple injuries: prehospital emergency aid. Medicina (Kaunas) 2006; 42:395-400. [PMID: 16778467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To evaluate initial (prehospital) assessment and management of high-energy blunt polytrauma patients. MATERIAL AND METHODS Prehospital assessment and management of high-energy blunt polytrauma patients was analyzed. The extent of initial assessment and management was compared with Advanced Trauma Life Support recommendations. RESULTS Altogether, 101 (63.05%) of 159 polytrauma patients (mean Injury Severity Score was 28.04) were admitted to Kaunas University of Medicine Hospital by the Emergency Aid Service after motor vehicle traffic accidents. In comparison with Advanced Trauma Life Support recommendations initial assessment (ABCDE) reached 14% and management reached 10.6%. CONCLUSIONS Initial assessment of high-energy blunt polytrauma patients reached 14% and management reached 10.6% of that recommended by Advanced Trauma Life Support.
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Affiliation(s)
- Algimantas Pamerneckas
- Clinic of Orthopedics and Traumatology, Kaunas University of Medicine Hospital, Kaunas, Lithuania.
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Carter G, Morris GM, VandeKieft GK, Owens D. Ethics roundtable. Am J Hosp Palliat Care 2006; 23:59-64. [PMID: 16450664 DOI: 10.1177/104990910602300110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Greg Carter
- Rehabilitation Services, Providence Healthcare System, Centralia, Washington, USA
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Fedder AM, Schønemann NK, Christensen AJM, Christensen EF. [Advanced prehospital care in patients with life-threatening conditions--survival rate, health status and functional level]. Ugeskr Laeger 2005; 167:4465-8. [PMID: 16305767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION In Aarhus, Denmark, advanced prehospital care was carried out by anaesthetists working in a rendezvous model with ordinary ambulances. The effect on the patient was evaluated by the physician on scene. The purpose of the study was to evaluate survival rate, health status and functional level in patients after lifesaving prehospital care. MATERIALS AND METHODS Consecutive data were reported to a prehospital database and the National Patient Registry. Data on survival from 1998 to 2000 were retrieved. Functional level was studied in lifesaving cases in the year 2000. We interviewed the general practitioners (GPs) involved according to EuroQol. The EuroQol interview concerned health status and function level. RESULTS In 1998-2000, prehospital anaesthetists attended a total of 11,684 patients. Treatment was described as lifesaving in 238 (2%) of the cases, and 63% of the patients (151/238) were alive one year later. In the year 2000, 79 patients were identified as having had lifesaving treatment, and 48 were alive one year later; 67% (32/48) were without functional impairment according to EuroQol. The most frequent diagnoses were self-intoxication and cardiovascular and respiratory diseases. CONCLUSION Lifesaving prehospital care, as evaluated by the prehospital physician on scene, was performed in 2 percent of all cases attended by a prehospital anaesthetist. Of these patients, the majority were alive after one year and without functional impairment, according to their GP. The diagnoses were varied.
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Abstract
There is a critical mismatch between available organs for transplant and acutely or critically ill patients with end-stage organ disease. Patients who may benefit from organ transplantation far outnumber available organs. The causes for this imbalance are multiple. One cause is family refusal to donate. A second cause is nonrecognition or delay in determination of brain death. A third cause is donor loss due to profound cardiopulmonary and metabolic instability consequent to brain-stem herniation and brain death. Family refusal may be addressed by education, public awareness, as well as close attention to social, cultural and ethical issues, and optimal communication with donor families. Brain death may be consequent to traumatic brain injury, ischemic versus hemorrhagic stroke, as well as massive cerebral anoxia/ischemic following cardiac arrest. Nonrecognition or delay in brain death determination may be addressed by clinician education and frequent clinical assessment to detect early stages of brain-stem herniation refractory to aggressive measures for control of intracranial pressure. Donor loss due to profound cardiopulmonary and metabolic instability may be addressed by aggressive, mechanism-based treatment for clinical instability based on affected body system, as well as measures to support metabolic activity at the cellular and tissue level in the brain-dead organ donor. This article explores cerebral physiology related to impending brain death and catastrophic intracranial pressure elevations. In addition, physiologic consequences of brain death are correlated with affected body systems and mechanism-based therapies to support organ function pending transplantation. Ethical/legal issues are explored as related to patient autonomy and optimal family outcomes. Effective family communication, astute clinical assessment, and optimal clinical management of the organ donor are illustrated using a case study approach, highlighting the role of the advanced practice nurse in donor management.
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Affiliation(s)
- Richard Arbour
- Medical Intensive Care Unit, Albert Einstein Healthcare Network, Philadelphia, PA 19141-3211, USA.
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Abstract
The purpose of this pilot study was to describe decision making and the decision support needs of parents, physicians, and nurses regarding life support decisions made over time prenatally and postnatally for extremely premature infants. Using the collective case study method, one prenatal, one postnatal, and one postdeath, if the infant had died, tape-recorded interviews were conducted with each parent. With parents' permission, prenatal interviews were done with the physicians and nurses who talked to them about life support decisions for their infants. Twenty-five tape-recorded interviews were conducted with six cases (six mothers, two fathers, six physicians, and two nurses). Hospital records were reviewed for documentation of life support decisions. Results of this pilot study demonstrated that most parents wanted a model of shared decision making and perceived that they were informed and involved in making decisions. Parents felt that to be involved in decision making they needed information and recommendations from physicians. Parents also stressed the importance of encouragement and hope. In contrast, physicians informed parents but most physicians felt that parents were the decision makers. Physicians used parameters to offer options or involve parents in decisions and became very directive at certain gestational ages. Nurses reported that they believed that parents needed information from the physician first, then they would reinforce information. The results of this study offer an initial understanding of the decision support needs of parents.
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Affiliation(s)
- Karen Kavanaugh
- University of Illinois at Chicago College of Nursing, 60612, USA.
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Abstract
A qualitative investigation characterized as an exploratory study of individual case. The guiding point was inquiring into how the Public Health System (SUS) provides intensive home-based care. The study was aimed at analyzing how this health support is made available--that is, what kind of assistance is given and what is the equipment maintenance and warranty like--and at examining how the subject of this study obtained this service, that is, how the service reached him/her and how long it usually takes to do so. The results show that the paths to get life support are full of obstacles and that this path in search of home-based care through the SUS dynamics involves bureaucracy, professionals, and equipment that often make it difficult for the population to have access to public health services.
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Affiliation(s)
- Tatiane da Costa Lima
- Enfermeira da Unidade de Terapia Intensiva do Pavilhao Santa Clara (UTI Central) no Complexo Hospitalar Santa Casa
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Abstract
An individual's preparation to manage an incident involving chemical, biologic, radiologic, nuclear, or explosive events requires a thorough and prepared understanding of the nature of these events. The purpose of this article is to discuss the preparation required to successfully manage the field and pre-hospital phases of a mass casualty event involving intentional weapons. The range of available response teams as well as the role of the United States military is discussed, including recent innovative educational programs initiated to meet this need.
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Affiliation(s)
- Jay A Johannigman
- Department and the Division of Trauma and Critical Care, University Hospital, Cincinnati, OH, USA
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Abstract
STUDY OBJECTIVE Out-of-hospital hypotension may signify need for intensive resuscitation and rapid diagnosis on emergency department (ED) arrival. We hypothesized that nontraumatic out-of-hospital hypotension confers risk of inhospital mortality. METHODS This was a multicenter study of ambulance-transported, nontrauma, non-cardiopulmonary resuscitation patients conducted at 2 venues: (1) a cross-sectional risk assessment study of high-priority medical transports at a US metropolitan county; and (2) a Canadian prospective multicenter cohort study of patients with respiratory distress. Data at both venues were extracted from prospectively recorded, standardized run sheets by either a physician or a paramedic. Data extraction and analysis at each venue were conducted independently. Exposures to hypotension were defined as age older than 17 years old, systolic blood pressure less than 100 mm Hg during transport, and 1 or more of 10 predefined symptoms of circulatory insufficiency. Nonexposures to hypotension had the same definition as exposures, except the systolic blood pressure had to be more than 100 mm Hg during the entire out-of-hospital transport. The main outcome variable was inhospital mortality. RESULTS At venue 1, of 3,128 transports, 395 (13%) exposures and 395 nonexposures were identified. Inhospital mortality of exposures was 26% versus 8% for nonexposures (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] 2.0 to 5.9). At venue 2, of 7,679 transports, 532 exposures (7%) and 7,147 nonexposures were identified. Out-of-hospital exposure to hypotension conferred a mortality rate of 32% versus 11% for nonexposures (OR 3.0; 95% CI 2.4 to 3.7), representing a sensitivity of 18% and a specificity of 95%. CONCLUSION The inhospital mortality rate after out-of-hospital, nontraumatic hypotension is high and reproducible. Future research should focus on ED clinical protocols to ensure appropriate resuscitation and investigation of etiology of out-of-hospital hypotension.
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Affiliation(s)
- Alan E Jones
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA
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Schmidt TA, Hickman SE, Tolle SW, Brooks HS. The Physician Orders for Life-Sustaining Treatment Program: Oregon Emergency Medical Technicians' Practical Experiences and Attitudes. J Am Geriatr Soc 2004; 52:1430-4. [PMID: 15341542 DOI: 10.1111/j.1532-5415.2004.52403.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate emergency medical technicians' (EMTs) experiences with the Physician Orders for Life-Sustaining Treatment (POLST) program and learn about attitudes regarding its effectiveness. DESIGN Anonymous survey mailed to a stratified random sample. SETTING Tri-County Portland, Oregon, area. PARTICIPANTS A total of 572 Oregon EMT respondents (out of 1,048 surveys) were included in the analysis. MEASUREMENTS Survey questions about experiences with the POLST form and opinions about POLST. RESULTS Respondents were mostly male (76%) and paramedics (66%). Most respondents (73%) had treated a patient with a POLST, and 74% reported receiving education about POLST. EMTs reported that POLST, when present, changed treatment in 45% of cases. Seventy-five percent of the respondents agreed that the POLST form provides clear instructions about patient preferences, and 93% agreed that the POLST form is useful in determining which treatments to provide when the patient is in cardiopulmonary arrest. Fewer (63%) agreed that the form is useful in determining treatments when the patient has a pulse and is breathing. CONCLUSION Most respondents have experience with the POLST program. EMTs find the POLST form useful and often use it to change treatment decisions for patients.
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Affiliation(s)
- Terri A Schmidt
- Center for Ethics in Health Care, Oregon Health and Science University, Portland, Oregon 97239, USA.
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Hickman SE, Tolle SW, Brummel-Smith K, Carley MM. Use of the Physician Orders for Life-Sustaining Treatment Program in Oregon Nursing Facilities: Beyond Resuscitation Status. J Am Geriatr Soc 2004; 52:1424-9. [PMID: 15341541 DOI: 10.1111/j.1532-5415.2004.52402.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life-Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms. DESIGN Telephone survey; on-site POLST form review. SETTING Oregon nursing facilities. PARTICIPANTS One hundred forty-six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review. MEASUREMENTS A telephone survey; onsite POLST form reviews. RESULTS In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do-not-resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (> or = 85, n=167) were more likely than the young old (65-74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration. CONCLUSION The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life-extending treatment, and advanced age was associated with orders to limit treatments.
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Affiliation(s)
- Susan E Hickman
- School of Nursing, Oregon Health & Science University, Portland, Oregon 97239, USA.
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Deutchman M, Carter CJ, Apgar B. The ALSO article series. Am Fam Physician 2004; 69:1610, 1612-3. [PMID: 15086033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
STUDY OBJECTIVE We determine the effect of emergency department (ED) crowding on paramedic ambulance availability. METHODS This was a prospective longitudinal study from April 2001 through March 2002 in Los Angeles, CA. All incidents in which a Los Angeles Fire Department ambulance was out of service for more than 15 minutes while waiting to transfer a patient because of the lack of open ED beds were captured and analyzed. Data included the total time each ambulance was out of service and the hospital where paramedics were waiting for an open gurney. Analysis was performed to determine weekly and seasonal variations and preponderance at various hospitals. RESULTS There were a total of 21,240 incidents in which ambulances were out of service while waiting to transfer their patients to an open ED gurney, which accounted for 1 of every 8 transports. Of these, 8.4% were in excess of 1 hour. The median waiting time per incident was 27 minutes, with an interquartile range of 20 to 40. There was a statistically significant difference in the monthly number of out-of-service incidents during the study (P<.0001), with the highest levels during the winter (January through March). CONCLUSION ED crowding has resulted in delays for paramedics waiting to transfer patients. This decrease in ambulance availability may have a significant effect on emergency medical services systems' abilities to provide timely response.
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Affiliation(s)
- Marc Eckstein
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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36
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Abstract
Many people die in emergency departments (EDs) across the United States from sudden illnesses or injuries, an exacerbation of a chronic disease, or a terminal illness. Frequently, patients and families come to the ED seeking lifesaving or life-prolonging treatment. In addition, the ED is a place of transition-patients usually are transferred to an inpatient unit, transferred to another hospital, or discharged home. Rarely are patients supposed to remain in the ED. Currently, there is an increasing amount of literature related to end-of-life care. However, these end-of-life care models are based on chronic disease trajectories and have difficulty accommodating sudden-death trajectories common in the ED. There is very little information about end-of-life care in the ED. This article explores ED culture and characteristics, and examines the applicability of current end-of-life care models.
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Affiliation(s)
- Garrett K Chan
- University of California, San Francisco, Department of Physiological Nursing, San Francisco, CA 94143-0610, USA.
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McDonald A, Ali J, Mitchell DI, Newnham MS, Barnett A, Williams E, Martin A. Potential role for advanced trauma life support programme in improving trauma care in Jamaica. W INDIAN MED J 2003; 52:208-12. [PMID: 14649101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Data from the Road Safety Unit in the Ministry of Transport and Works, Jamaica, show an increase in road traffic accidents from 7861 in 1991 to 11,010 in 1999. The average number of deaths annually was 380 +/- 48 (SD) while injuries averaged 3320 +/- 262 per year. This represents an injury to death ratio of 8.7 compared with 24.9 for Trinidad and Tobago and 40 for Canada. During the period 1991 to 2000, an average of 796 +/- 159 (SD) murders were committed annually. The number of murders increased by over 280 per cent between the decade of the seventies and the nineties. Data from the trauma registry of the University Hospital of the West Indies showed that 29.6 per cent of all admissions to the surgical ward between January 1998 and December 31, 2000, were due to injuries. There were 97 deaths (3%) during this period and 33 occurred in the Accident and Emergency Department with 70 per cent occurring within 120 minutes of their arrival. The Advanced Trauma Life Support (ATLS) Programme emphasizes the resuscitation and stabilization of injured patients in the first few hours after injury. Most Emergency Departments in Jamaica are staffed by relatively junior medical officers and the low injury to death ratio among victims of motor vehicle accidents may be due to suboptimal care. Introduction of an ATLS programme in Jamaica may reduce the number of preventable deaths and also stimulate interest in trauma care thus increasing preventative measures to decrease the high incidence of trauma in Jamaica.
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Affiliation(s)
- A McDonald
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston 7, Jamaica, West Indies.
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Abstract
Clinical algorithms can divide sophisticated treatment concepts for blunt trauma care into logical, systematic and easy to follow sequences. The presented algorithm for prehospital management of major and suspected blunt trauma will assure appropriate trauma care within narrow time windows. The risk of over- or undertreatment is reduced for both, the suspected and confirmed diagnosis of polytrauma. Due to the lack of evident data the algorithm was confirmed via consent expert opinion of trauma surgeons, incorporating the ABC priorities and also the concept of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.
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Affiliation(s)
- K G Kanz
- Chirurgische Klinik und Poliklinik, Innenstadt-Klinikum, Universität München, Germany.
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Wynne R, Lodder T, Trapani T, Hanlon G, Cleary C. The initiation and administration of drugs for advanced life support by critical care nurses in the absence of a medical practitioner. Aust Crit Care 2002; 15:94-100. [PMID: 12371382 DOI: 10.1016/s1036-7314(02)80049-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Current legislation does not permit the administration of first line resuscitation medications by suitably qualified Division 1 registered nurses (RNs) in the absence of a medical officer. This omission by the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and the Drugs, Poisons and The Controlled Substances Regulations 1995 (Vic) leaves many critical care nurses in a vulnerable legal position. The primary aim of this study was to gauge the view of critical care nurses with respect to lobbying for change to the current legislation. In addition, the study aimed to explore and describe the educational preparation, practice perceptions and experiences of RNs working in critical care regarding cardiopulmonary resuscitation and the administration of first line advanced life support (ALS) medications in the absence of a medical officer. It was anticipated that data collected would demonstrate some of the dilemmas associated with the initiation and administration of ALS medications for practising critical care nurses and could be used to inform controlling bodies in order for them to gain an appreciation of the issues facing critical care nurses during resuscitation. A mailout survey was sent to all members of the Victorian Branch of the Australian College of Critical Care Nurses (ACCCN). The results showed that the majority of nurses underwent an annual ALS assessment and had current ALS accreditation. Nurses indicated that they felt educationally prepared and were confident to manage cardiopulmonary resuscitation without a medical officer; indeed, the majority had done so. The differences in practice issues for metropolitan, regional and rural nurses were highlighted. There is therefore clear evidence to suggest that legislative amendments are appropriate and necessary, given the time critical nature of cardiopulmonary arrest. There was overwhelming support for ACCCN Vic. Ltd to lobby the Victorian government for changes to the law.
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Abstract
Emergency medicine is developing rapidly in southern Brazil, where elements of both the Franco-German and the Anglo-American models of emergency care are in place, creating a uniquely Brazilian approach to emergency care. Although emergency medical services (EMS) in Brazil have been directly influenced by the French mobile EMS (SAMU) system, with physicians dispatched by ambulances to the scenes of medical emergencies, the first American-style emergency medicine residency training program in Brazil was recently established at the Hospital de Pronto Socorro (HPS) in Porto Alegre. Emergency trauma care appears to be particularly developed in southern Brazil, where advanced trauma life support is widely taught and SAMU delivers sophisticated trauma care en route to trauma centers designated by the state.
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Affiliation(s)
- R D Tannebaum
- Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, IL, USA.
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Ryan WA. Overview of American Heart Association Protocols. Part 1--B.L.S. Tex Dent J 2000; 117:30-6. [PMID: 11857838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Abstract
This is a report on our first 2 years' experience of operating a helicopter emergency medical service in the Canary Islands, Spain. The two advanced life-support helicopters are staffed full time by a physician and a nurse. For the transport protocol, inter-hospital transport patients (secondary missions) were classified into three groups: group A, minor illnesses or injuries; group B, modified or middle critical condition; and group C, critical condition. On-scene patients (primary missions) were also divided into critical and non-critical condition. Cardiovascular and respiratory stabilization were necessary before transport. One thousand and fifty-four patients were transported, 19% of whom were primary missions and 81% of whom were secondary missions. Thirty per cent of the first group were in critical condition. The distribution of secondary missions was group A 16%, group B 44% and group C 40%. In group C, 60% of patients were mechanically ventilated, 70% needed cardiovascular drug support and 84% needed stabilization before transport. Thirty-two per cent were trauma patients and 12% neonates. The overall mortality rate was 0.8%. The cost per mission was US$2300. In the interests of safety and rationalization of the use of resources, transport of non-critical patients should be reduced. The presence of a trained physician and nursing crew and stabilization before transport could be responsible for the low mortality rate.
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Affiliation(s)
- S Lubillo
- Critical Care, Hospital Universitario Ntra. Sra. del Pino, Universidad de Las Palmas de Gran Canaria, Spain
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Abstract
AIM The purpose of this study was to determine the relationship between leadership behaviour, team dynamics and task performance. METHODS This was as an observational study, using video recordings of 20 resuscitation attempts. The Leadership Behaviour Description Questionnaire (LBDQ) was used to measure the level of structure built within the team. Interpersonal behaviour and the tasks of resuscitation were measured with a team dynamics and a task performance scale. The degree to which the leader actively participated, 'hands on', with the tasks of resuscitation, and their previous training in advanced life support (ALS), and experience of resuscitation attempts, were evaluated against the leadership rating. RESULTS The degree to which the leader built a structure within the team was found to correlate significantly with the team dynamics (P = 0.000) and the task performance (P = 0.013). Where the leaders participated 'hands on' they were less likely to build a structured team (P = 0.005), the team were less dynamic (P = 0.028) and the tasks of resuscitation were performed less effectively (P = 0.099). Experience gained over a 1-year period did not enhance leadership performance, but leaders who had up to 3 years experience were more likely to be effective in this role (P = 0.072). Interestingly, ALS training did not enhance leadership performance per se. However those leaders who had had recent ALS training were more likely not to participate 'hands on' (P = 0.035). There were some notable shortcomings in the performance of the task and some interesting correlations relating to duration of resuscitation, survival rate estimations, the leaders' attitudes and the teams' level of experience. CONCLUSION Leaders must build a structure within a resuscitation team in order for them to perform effectively. An emergency leadership training programme is essential to enhance the performance of leaders and their teams.
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Affiliation(s)
- S Cooper
- Resuscitation Training, Derriford Hospital, Plymouth, UK
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Affiliation(s)
- P J Baskett
- Department of Anaesthesia, Frenchay Hospital, Bristol, UK
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46
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Pinington-Webb I. Life support and first aid in a mental health setting. Nurs Times 1999; 95:46-7. [PMID: 10437493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
While there is much talk of holistic care in psychiatric care settings, emphasis on physical care is rare. Emergency aspects of care are always considered but their effectiveness is never certain until tested by real situations. With this in mind, and with some recent experiences to provide a focus, St Andrew's Hospital, Northampton, a national charity providing mental health services, implemented a review of life-support and first-aid provision. With financial and skills investment, the new systems and their associated maintenance and training are now in place.
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Holmquist M, Chabalewski F, Blount T, Edwards C, McBride V, Pietroski R. A critical pathway: guiding care for organ donors. Crit Care Nurse 1999; 19:84-98; quiz 99-100. [PMID: 10401306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Husum H. Effects of early prehospital life support to war injured: the battle of Jalalabad, Afghanistan. Prehosp Disaster Med 1999; 14:75-80. [PMID: 10558320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To study the effects of early, advanced prehospital life support on the survival rate of war casualties during the battle of Jalalabad, Afghanistan from 1989-1992. METHOD The outcomes of simple trauma care administered from 1989-1990 were compared to the outcomes of advanced trauma care administered from 1991-1992 in the combat zone. The outcomes were measured by the number of deaths at admission to the referral surgical hospitals in Pakistan. RESULTS A total of 3,890 war casualties were treated in the combat zone by paramedics, and were evacuated through light, forward, field clinics to surgical hospitals in Pakistan. Advanced trauma care that was administered in the combat zone reduced the prehospital mortality rate from 26.1% to 13.6% (95% CI for difference = 9.7-15.4%). CONCLUSION In scenarios with protracted evacuation, early and advanced trauma care should be included in the chain of survival. Local paramedics can provide such trauma care with a minimum of resources.
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Affiliation(s)
- H Husum
- Mujahed Medical Centre, University Town, Peshawar, Pakistan
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The role of a hospital-based flying squad in out-of-hospital cardiac arrest. Eur J Emerg Med 1998; 5:283. [PMID: 9827828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Havill JH, Cranston D. The place of the high dependency unit in a modern New Zealand hospital. N Z Med J 1998; 111:203-5. [PMID: 9673633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM To describe the concept of, and the benefits which come from having, a high dependency unit (HDU), based on the 24 years experience of Waikato Hospital. DESCRIPTION The HDU (9 beds/1600 patients per year) is part of the Critical Care Unit which also contains an adult intensive care unit (ICU) (11 beds/1000 patients per year), and a paediatric ICU/HDU (3 beds/250 patients per year). The regular care in the HDU is given by the specialist teams, aided by input from the ICU team. Over three years, 4390 patients were admitted having an average stay of 34 hours (61% < 24 hours). Forty eight percent of patients were over 60 years of age. The main sources of admissions were the theatre (66%), emergency department (18%), ICU (14%) and wards (11%). The main destinations were the wards (92%) and ICU (4%), with a mortality of 0.6%. The reasons for admission, specialist teams and post-operative diagnoses are described. Clinicians value the area highly, and have used it extensively. The average cost was $NZ800 per day. CONCLUSIONS Large hospitals in New Zealand should be planning an HDU to allow adequate care for those patients too complicated for the ward but not needing the ICU. Smaller hospitals can usefully combine the functions of ICU and HDU within one area.
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