9,694 research outputs found

    Practice of switch from intravenous to oral antibiotics

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    Frequency Analysis of Atrial Fibrillation From the Surface Electrocardiogram

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    Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Neither the natural history of AF nor its response to therapy are sufficiently predictable by clinical and echocardiographic parameters. Atrial fibrillatory frequency (or rate) can reliably be assessed from the surface electrocardiogram (ECG) using digital signal processing (filtering, subtraction of averaged QRST complexes, and power spectral analysis) and shows large inter-individual variability. This measurement correlates well with intraatrial cycle length, a parameter which appears to have primary importance in AF domestication and response to therapy. AF with a low fibrillatory rate is more likely to terminate spontaneously, and responds better to antiarrhythmic drugs or cardioversion while high rate AF is more often persistent and refractory to therapy. In conclusion, frequency analysis of AF seems to be useful for non-invasive assessment of electrical remodeling in AF and may subsequently be helpful for guiding AF therapy

    The Hospital Antimicrobial Use Process: From Beginning to End

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    Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient’s treatment course. Hence, approaching AMS through the framework of a hospital’s AUP is essential to improving appropriate antimicrobial use

    Improving the Transition from Intravenous to Subcutaneous Insulin in Critically Ill Hospitalized Patients

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    Many critically ill patients experience hyperglycemia as a result of physiological stress or as a consequence of diabetes mellitus. Once the condition of the critically ill hospitalized patient has stabilized, it is imperative to transition this patient from intravenous to subcutaneous insulin. The American Association for Clinical Endocrinologists, the American College of Endocrinologists and the American Diabetes Association have all provided guidelines for this transition process.A quality improvement project was conducted by a team of Master of Science in Nursing (MSN) students from the University of San Francisco at a metropolitan medical center in California. The team created and implemented an evidence-based protocol for transitioning hospitalized patients from intravenous to subcutaneous insulin. Due to time limitations and the vast scope of the project, the team was unable to fully implement the protocol. The team did conduct a microsystem assessment, root cause analysis, and literature review, and authored a final draft of the evidence-based transition protocol. Future MSN cohorts will engage in full implementation and evaluation of the protocol, which will include staff education and training, integration into the electronic health record and data collection regarding the protocol’s effectiveness

    A Comparison of Two Teaching Methods for Pediatric Medication Administration: Multimedia and Text-Based Modules

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    A Comparison of Two Teaching Methods for Pediatrics: Multimedia and Text-based Modules to Teach Pediatric Medication Administration Nurse educators are in a position to design and develop effective methods that consider the cognitive structures and how the mind processes information to teach pediatric medication content to nursing students. The majority of methods teaching medication administration use only one mode: the visual mode. One mode to present leaning material does not take advantage of the additive effects of using two modes to present learning material. The purpose of the study was to compare the effectiveness of two teaching methods to present learning material for teaching pediatric medication administration content: multimedia and text-based modules. The multimedia and text-based modules included worked examples with a step-by-step explanation and solution on how to calculate pound to kilogram, safe-dose ranges, intravenous flow rates, and fluid maintenance. The dependent variable was knowledge acquisition of mathematical calculation skills for medication administration. Calculation skills were defined operationally as a student\u27s ability to calculate (a) weight-based safe-dose ranges, (b) intravenous flow rates for primary and secondary (intravenous piggy-back) medication infusion, (c) conversions from pounds to kilograms, and (d) fluid maintenance. The results indicated that there were no statistically significant differences between the multimedia and the text-based module with regard to the pass rates and the four subtest items, pound-to-kilogram conversions, safe- dose calculations, intravenous flow rates, and fluid-maintenance calculations. The results also suggest that both modules were not as effective for teaching pediatric medication administration content for the participants in the study, as one would expect. As for additional findings, the majority of errors made by both groups were similar with the exception of three types of errors. The differences between the two groups were related to correctly setting-up the problem, mathematical functions, and calculation errors. The majority of the questions that were answered incorrectly were related to mathematical functions, for example, dividing, adding, or multiplying when not necessary. The text-based group made more mathematical functions errors and calculation errors compared with the multimedia group. All of other types of errors that were made between the two groups were similar

    The nurse of the Mediterranean

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    During the First World War Malta did not take an active part in the fighting. Britain was joined in an ‘entente’ a friendship agreement with France since 1904 and later with Russia in 1907. On the other hand Germany was allied to the Austrian- Hungerian Empire, hence when the Great War started in July 1914 there were France, Britain and Russia on one side and Germany and Austria-Hungary on the other. The British fleet “ruled the waves”, hence with France and Britain as allies, to be joined later by Italy, the Mediterranean was more or less an allied lake, with Malta in the centre.peer-reviewe

    Anti-platelet therapy: ADP receptor antagonists.

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    The P2Y(12) receptor on platelets with which ADP interacts has an important role in promoting platelet function and thereby platelet involvement in both haemostasis and thrombosis. Agents that act as antagonists at this receptor are thus likely to provide effective antithrombotic therapy, provided that there are no adverse effects on haemostasis. Here we describe the ADP receptor antagonists that are available and in development. We also consider their mode of action and ask whether there are additional mechanisms through which they exert their inhibitory effects on platelet function

    Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection

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    Although the pathogenesis of human immunodeficiency virus (HIV) infection and the general virologic and immunologic principles underlying the use of antiretroviral therapy are similar for all HIV-infected persons, there are unique considerations needed for HIV-infected infants, children, and adolescents, including; A acquisition of infection through perinatal exposure for many infected children, In utero, intrapartum, and/or postpartum neonatal exposure to zidovudine (ZDV) and other antiretroviral medications in most perinatally infected children, Requirement for use of HIV virologic tests to diagnose perinatal HIV infection in infants under age 15 to 18 months old, Age-specific differences in immunologic markers (i.e., CD4+ T cell count), Changes in pharmacokinetic parameters with age caused by the continuing development and maturation of organ systems involved in drug metabolism and clearance, Differences in the clinical and virologic manifestations of perinatal HIV infection secondary to the occurrence of primary infection in growing, immunologically immature persons, and Special considerations associated with adherence to antiretroviral treatment for infants, children and adolescents. This report addresses the pediatric-specific issues associated with antiretroviral treatment and provides guidelines to health care providers caring for infected infants, children, and adolescents. It is recognized that guidelines for antiretroviral use in pediatric patients are rapidly evolving. The Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children will review new data on an ongoing basis and provide regular updates to the guidelines
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