2012 July 26

The relationship between in-hospital mortality, readmission into the intensive care nursing unit and/or operating theatre and nurse staffing levels.

Jul 262012

The relationship between in-hospital mortality, readmission into the intensive care nursing unit and/or operating theatre and nurse staffing levels.

J Adv Nurs. 2012 May;68(5):1073-81

Authors: Diya L, Van den Heede K, Sermeus W, Lesaffre E

Abstract

AIM: ? The aim of this article was to assess the relationship between (1) in-hospital mortality and/or (2) unplanned readmission to intensive care units or operating theatre and nurse staffing variables.

BACKGROUND: ? Adverse events are used as surrogates for patient safety in nurse staffing and patient safety research. A single adverse event cannot adequately capture the multi-dimensional attributes of patient safety; hence, there is a need to consider composite measures. Unplanned readmission into the postoperative Intensive Care nursing unit and/or operating Theatre and in-hospital mortality can be viewed as measures that incorporate the effects of several adverse events.

METHODS: ? We conducted a Bayesian multilevel analysis on a subset of the 2003 Belgian Hospital Discharge and Nursing Minimum Data sets. The sample included 9054 patients who underwent coronary artery bypass surgery or heart valve procedures from 28 Belgian acute hospitals. Two proxies of patient safety were considered, namely postoperative in-hospital mortality in the first postoperative intensive care unit and unplanned readmission into the intensive care and/or operating theatre (including mortality beyond the first postoperative intensive care unit) after the first-operative intensive care nursing unit.

RESULTS: ? There is an association between in-hospital mortality and/or unplanned readmissions and nurse staffing levels, but the relationship is moderated by volume and severity of illness respectively. In addition, the relationship differs between the two endpoints.

CONCLUSION: ? Higher nurse staffing levels on postoperative general nursing cardiac surgery units protected patients from unplanned readmission to intensive care units or operating theatre and in-hospital mortality.

PMID: 21883408 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Blood utilization: fostering an effective hospital transfusion culture.

J Clin Anesth Start a Discussion »

Jul 262012

Blood utilization: fostering an effective hospital transfusion culture.

J Clin Anesth. 2012 Mar;24(2):155-63

Authors: Sherman CH, Macivor DC

Abstract

An effective hospital transfusion culture should encourage clinicians to consider the possibility of transfusion in their patients well before the need actually arises, and to plan ahead in an attempt to use blood products most efficiently. Strategies for improved blood utilization include timely and adequate preoperative assessment of risk, optimization of baseline hemoglobin, anticipation of potential transfusion problems, intraoperative techniques to minimize blood loss, blood conservation technologies, transfusion guidelines and targeted therapy, point of care testing, and massive transfusion protocols. Attention to these elements promotes a safe and cost-effective transfusion culture.

PMID: 22414711 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

The dos and do knots of central venous catheterization.

J Clin Anesth Start a Discussion »

Jul 262012

The dos and do knots of central venous catheterization.

J Clin Anesth. 2012 Mar;24(2):148-50

Authors: Vetrugno L, Piccoli G, Costa MG, Pompei L, Chiarandini P, Morelli A, Della Rocca G

Abstract

Central venous catheterization plays an important role in patients with end-stage renal disease undergoing hemodialysis. Placement of a right subclavian hemodialysis catheter was complicated by looping and entrapment of the guidewire. Computed tomographic and three-dimensional scans were essential in locating and determining that the guidewire was outside the vessel.

PMID: 22414709 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease.

Aliment Pharmacol Ther Start a Discussion »

Jul 262012

Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease.

Aliment Pharmacol Ther. 2012 Jul 25;

Authors: Anderson JL, Edney RJ, Whelan K

Abstract

BACKGROUND: The intestinal microbiota is involved in the pathogenesis of inflammatory bowel disease (IBD). Faecal microbiota transplantation (FMT) has been used for the management of IBD as well as infectious diarrhoea. AIM: To undertake a systematic review of FMT in patients with IBD. METHODS: The systematic review followed Cochrane and PRISMA recommendations. Nine electronic databases were searched in addition to hand searching and contacting experts. Inclusion criteria were reports (RCT, nonrandomised trials, case series and case reports) of FMT in patients with IBD. RESULTS: Of the 5320 articles identified, 17 fulfilled the inclusion criteria, none of which were controlled trials. There were nine case series/case reports of patients receiving FMT for management of their IBD, and eight where FMT was for the treatment of infectious diarrhoea in IBD. These 17 articles reported on 41 patients with IBD (27 UC, 12 Crohn's, 2 unclassified) with a follow-up period of between 2 weeks and 13 years. Where reported, FMT was administered via colonoscopy/enema (26/33) or via enteral tube (7/33). In patients treated for their IBD, the majority experienced a reduction of symptoms (19/25), cessation of IBD medications (13/17) and disease remission (15/24). There was resolution of C. difficile infection in all those treated for such (15/15). CONCLUSIONS: Whilst the available evidence is limited and weak, it suggests that FMT has the potential to be an effective and safe treatment for IBD, at least when standard treatments have failed. Well-designed randomised controlled trials are required to investigate these findings.

PMID: 22827693 [PubMed - as supplied by publisher]

Link to Article at PubMed

Role of the pharmacist on a general medicine acute care for the elderly unit.

Am J Geriatr Pharmacother Start a Discussion »

Jul 262012

Role of the pharmacist on a general medicine acute care for the elderly unit.

Am J Geriatr Pharmacother. 2012 Apr;10(2):95-100

Authors: Reilly T, Barile D, Reuben S

Abstract

BACKGROUND: The prevalence of prescription medication use increases with age, and older adults are at increased risk of harm from medication use.

OBJECTIVE: To describe the role of a pharmacist on a General Medicine Acute Care of the Elderly (GM-ACE) Unit.

METHODS: A job description was prepared, and a clinical pharmacist specializing in internal medicine was re-assigned to participate in multidisciplinary rounds on the ACE unit twice weekly and to work with a unit-based pharmacist assigned to multiple units. The clinical pharmacist also provided formal education on geriatric pharmacotherapy for other health care providers. Interventions were defined as changes in the medical record and provision of drug information. Interventions were tracked with an existing form and sorted by category. Data on interventions were presented to the pharmacy and therapeutics committee routinely.

RESULTS: After 3 months, the clinical pharmacist accomplished 76 interventions in the areas of agent selection, dose optimization, addition of therapy, deletion of therapy, medication reconciliation, intravenous to oral conversion, technology improvements, and drug information/patient education.

CONCLUSION: Expanding the role of the pharmacist in a GM-ACE unit has improved the medication use process in a high-risk population through improvements in medication overuse, medication underuse, dosing, medication reconciliation, patient education, and health care provider education.

PMID: 22387106 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

An update on biomarkers of heart failure in hypertensive patients.

J Hypertens Start a Discussion »

Jul 262012

An update on biomarkers of heart failure in hypertensive patients.

J Hypertens. 2012 Jul 22;

Authors: Gluba A, Bielecka A, Mikhailidis DP, Wong ND, Franklin SS, Rysz J, Banach M

Abstract

Biomarkers should have high sensitivity, specificity, reproducibility, be cost-effective, and provide incremental predictive or diagnostic utility over standard risk factors or tests. Despite numerous studies investigating biomarkers in heart failure (HF), there are only a few that predict HF in hypertensive patients. This article summarizes data from numerous studies concerning possible biomarkers of HF in hypertensive patients such as: serum uric acid (SUA), interleukins, monocyte chemoattractant protein one (MCP-1), cardiotrophin-1 (CT-1), carboxy-terminal propeptide of procollagen type I (PICP), type I collagen telopeptide (CITP) and N-terminal propeptide of type III procollagen (PIIINP), metalloproteinases (MMPs), B-type natriuretic peptide (BNP) and its derivatives, glycoprotein CA125 and cystatin C. Early detection of patients of increased risk of hypertensive heart disease may result in early implementation of effective preventive strategies. Therefore, there is need to identify newer biomarkers, if they can improve risk prediction, identifying patients, in which earlier or more aggressive intervention will improve clinical outcomes.

PMID: 22828089 [PubMed - as supplied by publisher]

Link to Article at PubMed

July 2012
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