Nursing considerations to complement the Surviving Sepsis Campaign guidelines

Objectives: To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis. Design: Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus. Methods: We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding. Results: Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points. Conclusion: Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care

Can the Heinrich ratio be used to predict harm from medication errors?

The purpose of this study was to establish whether, for medication errors, there exists a fixed Heinrich ratio between the number of incidents which did not result in harm, the number that caused minor harm, and the number that caused serious harm. If this were the case then it would be very useful in estimating any changes in harm following an intervention. Serious harm resulting from medication errors is relatively rare, so it can take a great deal of time and resource to detect a significant change. If the Heinrich ratio exists for medication errors, then it would be possible, and far easier, to measure the much more frequent number of incidents that did not result in harm and the extent to which they changed following an intervention; any reduction in harm could be extrapolated from this

Jefferson Alumni Bulletin – Volume 59, Number 1, Winter 2010

Jefferson Alumni Bulletin – Volume 59, Number 1, Winter 2010 Dean\u27s Message, page 2 Findings: Study Targets Scourge of U.S. Military, page 4 The Rewards and Challenges of Translational Medicine: The Patient-Centered Medical Home, page 6 Beyond the Office Visit: Jefferson Focuses on Advocacy, page 12 Eakins Scholar Follows Her Own Path, page 16 Jefferson Faculty Compile First Medical Professionalism Textbook, page 18 Faculty Profile: Karen Knudsen: Piecing Together the Prostate Cancer Puzzle, page 20 On Campus, page 22 Class Notes, page 28 In Memoriam, page 34 By the Numbers, page 3

Ergonomics of the Operative Field in Paediatric Minimal Access Surgery

Imperial Users onl

Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU

BACKGROUND: Thousands of children experience cardiac arrest events every year in pediatric intensive care units. Most of these children die. Cardiac arrest prediction tools are used as part of medical emergency team evaluations to identify patients in standard hospital beds that are at high risk for cardiac arrest. There are no models to predict cardiac arrest in pediatric intensive care units though, where the risk of an arrest is 10 times higher than for standard hospital beds. Current tools are based on a multivariable approach that does not characterize deterioration, which often precedes cardiac arrests. Characterizing deterioration requires a time series approach. The purpose of this study is to propose a method that will allow for time series data to be used in clinical prediction models. Successful implementation of these methods has the potential to bring arrest prediction to the pediatric intensive care environment, possibly allowing for interventions that can save lives and prevent disabilities. METHODS: We reviewed prediction models from nonclinical domains that employ time series data, and identified the steps that are necessary for building predictive models using time series clinical data. We illustrate the method by applying it to the specific case of building a predictive model for cardiac arrest in a pediatric intensive care unit. RESULTS: Time course analysis studies from genomic analysis provided a modeling template that was compatible with the steps required to develop a model from clinical time series data. The steps include: 1) selecting candidate variables; 2) specifying measurement parameters; 3) defining data format; 4) defining time window duration and resolution; 5) calculating latent variables for candidate variables not directly measured; 6) calculating time series features as latent variables; 7) creating data subsets to measure model performance effects attributable to various classes of candidate variables; 8) reducing the number of candidate features; 9) training models for various data subsets; and 10) measuring model performance characteristics in unseen data to estimate their external validity. CONCLUSIONS: We have proposed a ten step process that results in data sets that contain time series features and are suitable for predictive modeling by a number of methods. We illustrated the process through an example of cardiac arrest prediction in a pediatric intensive care setting

Epidemiology of blood component use in Finland

Previously reported differences in transfusion practices suggest that transfusion protocols and clinical transfusion decisions may often be inappropriate. To change and monitor practices requires a follow-up system. A healthcare-integrated data-gathering system could provide the required information about blood use. The purpose of this observational study was to create a follow-up system for blood use and to gather information about transfused patients and transfusion practices in Finland. Data came from ten Finnish hospital districts (five university and five tertiary-care hospital districts) between the years 2002 and 2005. The collection process involved combining data from pre-existing electronic medical records applied for different purposes. This information was combined from these electronic systems by use of personal identification numbers and data expressed as hospital episodes. Variation in blood-use practices still existed between hospitals. For example, the percentage of red blood cell (RBC) receivers ranged in Finnish hospitals from 12% to 57% during primary knee-arthroplasty surgery. The most typical blood-transfused patient was an over 65-year-old woman receiving 2 units of RBCs. RBC products were usually transfused in pairs (such as in two-four-six units). In over 30% of FFP transfusions, plasma was given without any guidance from coagulation tests. Among moderately anemic parturients, transfusion of 0 to 2 units of RBC had no effect on length of hospitalization. Duration of hospitalization was, however, considerably longer in these anemic patients than for average Finnish mothers (5.2 days versus 3.5 days). Most of the platelet (PLT) products were transfused to hematological patients (43%). Only 1% of surgical patients received PLTs. Severity of underlying condition in surgical patients had an effect on prevalence of blood transfusions. Variability in blood-use practices suggests inappropriate blood use. Moreover, RBC transfusion in paired units is a questionable practice. FFP transfusions, not based on coagulation tests, suggest inappropriate use of plasma as well. In parturients, mild anemia treated with 1 to 2 units of RBCs does not shorten hospitalization time. This supports the current recommended thresholds for RBC transfusion. Improvement efforts concerning PLT-use practices may be directed to users of high doses of PLTs; to hematological patients, but also to digestive tract surgery and cardiac surgery patients. Knowledge of severity of the underlying disease as affecting the transfusion requirement may facilitate optimization of blood use.Sairaaloiden välillä on todettu aikaisemmissa tutkimuksissa, myös Suomessa, moninkertaisia eroja verivalmisteiden käytössä samanlaisilla potilasryhmillä. Löydös viittaa siihen, että verensiirtokäytännöt eivät ole kaikkialla optimaalisia. Tämän tutkimuksen tarkoituksena oli luoda sairaaloiden eri tietojärjestelmiä hyväkseen käyttävä tietojenkeräysjärjestelmä, jolla suomalaisia verensaajia ja verensiirtokäytäntöjä voitaisiin seurata ja tutkia. Tutkimukseen osallistui yhteensä 10 suomalaista sairaanhoitopiiriä (5 yliopisto ja 5 keskussairaalajohtoista sairaanhoitopiiriä). Tiedot kerättiin vuosien 2002-2005 välillä. Tietovarastoon kerättiin tietoja verivalmisteiden käytöstä sairaaloiden jo olemassa olevista tietojärjestelmistä. Tietojärjestelmien tiedot yhdistettiin sairaalahoitojaksoiksi henkilötunnuksen avulla. Sairaaloiden välillä todettiin edelleen vaihtelua verensiirtojen määrissä ja verivalmisteita saaneiden potilaiden osuuksissa leikkauspotilailla. Esimerkiksi punasoluja saaneiden polviproteesileikkauspotilaiden osuus vaihteli 12% ja 57% välillä sairaalasta riippuen. Verivalmisteita saaneet potilaat olivat tavallisesti iäkkäitä; yli 50% verivalmisteista annettiin yli 65-vuotiaille. Punasoluja annettiin kahden yksikön erissä. Hyytymistekijätutkimuksia ei tehty kaikkien jääplasmasiirtojen yhteydessä ja kolmasosa käytetystä jääplasmasta annettiin ilman tietoa hyytymistekijäpitoisuuksista. Lievästi aneemisilla synnyttäjillä 0-2 yksikön punasolusiirto ei vaikuttanut sairaalahoitojakson pituuteen. Näiden aneemisten äitien sairaalahoidon pituus oli kuitenkin keskimääräistä huomattavasti pidempi (5.2 päivää verrattuna 3.5 päivää). Suurin osa verihiutaleista (43%) annettiin veritautipotilaille. Vain 1% leikkauspotilaista sai verihiutaleita. Kuitenkin yli puolet (54%) verihiutaleita saaneista potilaista oli kirurgisesti hoidettuja. Leikkauspotilailla perussairauksien puolesta sairaimmat saivat eniten verivalmisteita leikkausten yhteydessä. Verivalmisteiden käyttö Suomessa ei ole tällä hetkellä optimaalista. Verensiirtokäytännöt vaihtelevat edelleen merkittävästi leikkauspotilailla terveydenhuollon eri yksiköiden välillä ja lisäksi punasolujen siirto kahden yksikön erissä on kyseenalaista. Usein tapahtuva jääplasman siirto ilman hyytymistekijätutkimuksia ei ole nykyohjeiden mukaista. Lievästi aneemisilla, mutta muuten terveillä synnyttäjillä 1-2 yksikön punasolusiirto ei lyhentänyt heidän jo normaalia pidempää sairaalahoitoaikaansa. Nämä potilaat voivat hyötyä punasolusiirroista pidättäytymisestä. Tietoa siitä, kenelle verivalmisteita siirretään usein, voidaan käyttää hyväksi verensiirtokäytäntöjä optimoitaessa

Intellectual Property Management in Health and Agricultural Innovation: A Handbook of Best Practices, Vol. 1

Prepared by and for policy-makers, leaders of public sector research establishments, technology transfer professionals, licensing executives, and scientists, this online resource offers up-to-date information and strategies for utilizing the power of both intellectual property and the public domain. Emphasis is placed on advancing innovation in health and agriculture, though many of the principles outlined here are broadly applicable across technology fields. Eschewing ideological debates and general proclamations, the authors always keep their eye on the practical side of IP management. The site is based on a comprehensive Handbook and Executive Guide that provide substantive discussions and analysis of the opportunities awaiting anyone in the field who wants to put intellectual property to work. This multi-volume work contains 153 chapters on a full range of IP topics and over 50 case studies, composed by over 200 authors from North, South, East, and West. If you are a policymaker, a senior administrator, a technology transfer manager, or a scientist, we invite you to use the companion site guide available at http://www.iphandbook.org/index.html The site guide distills the key points of each IP topic covered by the Handbook into simple language and places it in the context of evolving best practices specific to your professional role within the overall picture of IP management