On the ground electronic states of copper silicide and its ions

The low-lying electronic states of SiCu, SiCu^+, and SiCu^− have been studied using a variety of high-level ab initio techniques. As expected on the basis of simple orbital occupancy and bond forming for Si(s^2p^2)+Cu(s^1) species, ^2Π_r, ^1Σ^+, and ^3Σ^− states were found to be the ground electronic states for SiCu, SiCu^+, and SiCu^−, respectively; the ^2Π_r state is not that suggested in most recent experimental studies. All of these molecules were found to be quite strongly bound although the bond lengths, bond energies, and harmonic frequencies vary slightly among them, as a result of the nonbonding character of the 2π-MO (molecular orbital) [composed almost entirely of the Si 3p-AO (atomic orbital)], the occupation of which varies from 0 to 2 within the ^1Σ^+, ^2Π_r, and ^3Σ^− series. The neutral SiCu is found to have bound excited electronic states of ^4Σ^−, ^2Δ, ^2Σ^+, and ^2Π_i symmetry lying 0.5, 1.2, 1.8, and 3.2 eV above the ^2Π_r ground state. It is possible but not yet certain that the ^2Π_i state is, in fact, the “B state” observed in the recent experimental studies by Scherer, Paul, Collier, and Saykally

Are hygiene standards useful in assessing infection risk?

We monitored the surface level cleanliness of a five-bedded surgical intensive care unit (SICU) over a ten-week period in order to evaluate proposed hygiene standards.Ten environmental sites within SICU were sampled twice weekly along with collection of clinical and patient activity data. The standards designate aerobic colony counts (ACCs) >2.5cfu/cm2 from hand-touch sites and the presence of Staphylococcus aureus as hygiene failures. Nearly a quarter of 200 samples failed the standards, mostly from hand-touch sites on curtains, beds and medical equipment. The total number of fails each week was associated with bed occupancy (p=0.04), trending towards association with SICU-acquired infections (p=0.11). Environmental S.aureus was associated with the proportion of beds occupied (p = 0.02). Indistinguishable genotypes were found between patient and environmental staphylococci, with timescales supporting staphylococcal transmission in both directions. Hygiene standards based on microbial growth levels and the presence of S.aureus reflect patient activity and provide a means to risk manage infection. They also exposed a staphylococcal reservoir that could represent a more tangible risk to patients. Standards for surface level cleanliness deserve further evaluation

Utilization of a Palliative Care Trigger in the Surgical Intensive Care Unit

Our project aims to expand palliative care availability in the SICU by implementing a consult trigger program. We also aim to learn about and measure compassion fatigue of providers within the SICU

Gastric intramucosal pH-guided therapy in patients after elective repair of infrarenal abdominal aneurysms: is it beneficial?

Objective: To determine if gastric intramucosal pH (pHi)-guided therapy reduces the number of complications and length of stay in the intensive care unit (ICU) or the hospital after elective repair of infrarenal abdominal aortic aneurysms. Design: Prospective, randomized study. Setting: Surgical intensive care unit (SICU) of a University Hospital. Patients: Fifty-five consecutive patients randomized to group 1 (pHi-guided therapy) or to group 2 (control). Interventions: Patients of group 1 with a pHi of lower than 7.32 were treated by means of a prospective protocol in order to increase their pHi to 7.32 or more. Measurements and results: pHi was determined in both groups on admission to the SICU and thereafter at 6-h intervals. In group 2, the treating physicians were blinded for the pHi values. Complications, APACHE II scores, duration of endotracheal intubation, fluid and vasoactive drug treatment, treatment with vasoactive drugs, length of stay in the SICU and in the hospital and hospital mortality were recorded. There were no differences between groups in terms of the incidence of complications. We found no differences in APACHE II scores on admission, the duration of intubation, SICU or hospital stay, or hospital mortality. In the two groups the incidence of pHi values lower than 7.32 on admission to the SICU was comparable (41 % and 42 % in groups 1 and 2, respectively). Patients with pHi lower than 7.32 had more major complications during SICU stay (p<0.05), and periods more than 10 h of persistently low pHi values (< 7.32) were associated with a higher incidence of SICU complications (p<0.01). Conclusions: Low pHi values (<7.32) and their persistence are predictors of major complications. Treatment to elevate low pHi values does not improve postoperative outcome. Based on these data, we cannot recommend the routine use of gastric tonometers for pHi-guided therapy in these patients. Further studies are warranted to determine adequate treatment of low pHi values that results in beneficial effects on the patient's postoperative course and outcom

Efficacy of Handoff Education for ICU Nurses When Transferring Patients to the Operating Room

Background: The transition of care from the Surgical Intensive Care Unit (SICU) to the Anesthesia team in the Operating Room (OR) is a vulnerable time for patients. There is currently no formal process for the patient transitioning from the Surgical ICU to the OR. The disarray of this transition can lead to serious omissions in communication and be harmful to the patient. Purpose: Currently, there is no formalized or universal process for handoff communication between the SICU team and the Anesthesia team. This project aimed to provide handoff education for SICU nurses when sending a patient from the OR. This project utilized the IPASS method of handoff to formalize the ICU-to-OR handoff. Methods: The project utilized a quasi-experimental design with pre- and post-education. A sample size of 30 RNs (n=30) was obtained. The RNs were given a pre-test for baseline knowledge assessment, followed by the education and a post-test. Results: A paired t-test was used to compare pre-and post-intervention results. There was noted to be a 40% increase in mean test scores following education of SICU RNs. Conclusions: The IPASS method of handoff can easily be taught to SICU RNs as a means of improving bedside handoff when patients are being sent from the SICU to the OR. The data collected indicates that in-service education is an effective means of disseminating information to SICU RNs

APACHE II analysis of a surgical intensive care unit population in a tertiary care hospital in Karachi (Pakistan)

Purpose: Performance of prognostic models deteriorates over time by changes in case-mix and clinical practice. This study was conducted to describe the case-mix of a surgical intensive care unit (SICU) and assess the performance of APACHE II scoring system in this cohort. Methodology: We analyzed 213adult patients admitted to the surgical intensive care unit (SICU) of Aga Khan University Hospital, from January 2011 to December 2012 and the performance of APACHE II scoring system was assessed in this population. Results: The mean age of patients was 46.31 years (SD ±18.43), 67.1% patients were male and mean length of ICU stay was 6.54 days (SD ± 7.18).Admissions to SICU were from seven service departments with the highest admissions from general surgery followed by trauma and neurosurgery. The mean APACHE II score of this SICU population was 15.89 (SD ±8.06), 12.88 (SD ±6.29) in survivors and 22.24 (SD ±7.66) in non-survivors (p Conclusion: APACHE II scoring system allows meaningful analysis of SICU population, therefore, it is recommend, that this simple and cost effective scoring system should be used to identify patients with high risk of death to justify the decisions of withholding expensive therapies in resource limited settings

Telemedicine coverage for post-operative ICU patients.

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47-69) versus 58 (IQR 44-70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7-14) versus 15 (IQR 11-21), p \u3c 0.001). The average amount of time patients spent in the VICU was 13.7 + /-9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation

Prevalence of qacA/B genes and mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) isolates in the setting of chlorhexidine bathing without mupirocin

OBJECTIVE: We aimed to determine the frequency of qacA/B chlorhexidine tolerance genes and high-level mupirocin resistance among MRSA isolates before and after the introduction of a chlorhexidine (CHG) daily bathing intervention in a surgical intensive care unit (SICU). DESIGN: Retrospective cohort study (2005–2012) SETTING: A large tertiary-care center PATIENTS: Patients admitted to SICU who had MRSA surveillance cultures of the anterior nares METHODS: A random sample of banked MRSA anterior nares isolates recovered during (2005) and after (2006–2012) implementation of a daily CHG bathing protocol was examined for qacA/B genes and high-level mupirocin resistance. Staphylococcal cassette chromosome mec (SCCmec) typing was also performed. RESULTS: Of the 504 randomly selected isolates (63 per year), 36 (7.1%) were qacA/B positive ( + ) and 35 (6.9%) were mupirocin resistant. Of these, 184 (36.5%) isolates were SCCmec type IV. There was a significant trend for increasing qacA/B (P= .02; highest prevalence, 16.9% in 2009 and 2010) and SCCmec type IV (P< .001; highest prevalence, 52.4% in 2012) during the study period. qacA/B( + ) MRSA isolates were more likely to be mupirocin resistant (9 of 36 [25%] qacA/B( + ) vs 26 of 468 [5.6%] qacA/B(−); P= .003). CONCLUSIONS: A long-term, daily CHG bathing protocol was associated with a change in the frequency of qacA/B genes in MRSA isolates recovered from the anterior nares over an 8-year period. This change in the frequency of qacA/B genes is most likely due to patients in those years being exposed in prior admissions. Future studies need to further evaluate the implications of universal CHG daily bathing on MRSA qacA/B genes among hospitalized patients

Outcomes Associated With Delirium in Older Patients in Surgical ICUs

BACKGROUND: We previously noted that older adults admitted to surgical ICUs (SICUs) are at high risk for delirium. In the current study, we describe the association between the presence of delirium and complications in older SICU patients, and describe the association between delirium occurring in the SICU and functional ability and discharge placement for older patients. METHODS: Secondary analysis of prospective, observational, cohort study. Subjects were 114 consecutive patients \u3eor= 65 years old admitted to a surgical critical care service. All subjects underwent daily delirium and sedation/agitation screening during hospitalization. Outcomes prospectively recorded included SICU complication development, discharge location, and functional ability (as measured by the Katz activities of daily living instrument). RESULTS: Nearly one third of older adults (31.6%) admitted to an SICU had a complication during ICU stay. There was a strong association between SICU delirium and complication occurrence (p = 0.001). Complication occurrence preceded delirium diagnosis for 16 of 20 subjects. Subjects with delirium in the SICU were more likely to be discharged to a place other than home (61.3% vs 20.5%, p \u3c 0.0001) and have greater functional decline (67.7% vs 43.6%, p = 0.023) than nondelirious subjects. After adjusting for covariates including severity of illness and mechanical ventilation use, delirium was found to be strongly and independently associated with greater odds of being discharged to a place other than home (odds ratio, 7.20; 95% confidence interval, 1.93 to 26.82). CONCLUSIONS: Delirium in older surgical ICU patients is associated with complications and an increased likelihood of discharge to a place other than home