Editorial - East and Central African Journal of Surgery: The Canadian connection

No Abstract

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

© 2015 Elsevier Ireland Ltd. Aim: To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA). Methods: We undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. Results: 1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively,

Increasing Bedside Medication Safety in an Intensive Care Setting

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center. However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues. Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which read that 100% of the time all medications would be secured. Since the implementation of the unit’s medication safety and quality improvement project, metrics have demonstrated an improvement in medication safety knowledge and practice. Next steps include continued improvement in medication handling practices to ensure a culture of safety and increased perception of safety by staff, patients & visitors

Improving Revenue Capture and Patient Safety in an ICU Setting

IMPROVING REVENUE CAPTURE AND PATIENT SAEFTY IN AN INTENSIVE CARE SETTING Materials management department is responsible for restocking chargeable supplies in an intensive care unit (ICU) at an academic tertiary medical center. Staff confusion as to what items were considered chargeable often led to low supply par levels resulting in delays of critical patient care. Using baseline metrics, a team of caregivers created several performance improvement goals to increase nursing compliance with appropriate supply charging. The results of a root cause analysis spearheaded the development of a KPI that encompassed staff education, lost charge tracking and charge supply labeling. Post KPI inception, a significant increase in compliance was realized. The next step is to complete a two year retrospective cost benefit analysis to determine lost revenue and compare that to the cost of three automate

Reduction of Catheter Associated Urinary Tract Infections (CAUTI) in a Critical Care Setting

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs. Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of a special care quality team. As a result of the countermeasure implementations, the number of CAUTIs has decreased. Next steps includes development and rollout of best practice indwelling urinary catheter maintenance

“How we do it”: A qualitative study of strategies for adopting an exercise routine while living with type 1 diabetes

IntroductionFor people living with type 1 diabetes (T1D) the challenge of increasing daily physical activity (PA) is compounded by the increased risks of hypoglycemia and glucose variability. Little information exists on the lived experience of overcoming these barriers and adopting and maintaining an active lifestyle while living with T1D.Research Design and MethodsWe conducted a patient-led qualitative study consisting of semi-structured interviews or focus groups with 22 individuals at least 16 years old living with T1D. We used existing patient co-researcher networks and snowball sampling to obtain a sample of individuals who reported being regularly physically active and had been diagnosed with T1D for at least one year. We used an interpretive description analysis to generate themes and strategies associated with maintaining an active lifestyle while living with T1D. We involved patient co-researchers in study design, data collection, and interpretation.Results14 self-identified women and 8 self-identified men (ages 19-62, median age 32 years) completed the study, led by either a researcher, or a patient co-researcher and research assistant regarding their strategies for maintaining an active lifestyle. We identified five themes that facilitate regular sustained PA: (1) Structure and organization are important to adopt safe PA in daily life “I can’t do spontaneous exercise. I actually need a couple hours of warning minimum”; (2) Trial and error to learn how their body responds to PA and food “Once you put the time and effort into learning, you will have greater success”; (3) Psychosocial aspects of PA “…because it’s not just your body, it’s your soul, it’s your mind that exercise is for”; (4) Diabetes technology and (5) Education and peer support. Strategies to overcome barriers included (1) Technology; (2) Integrating psychosocial facilitators; (3) Insulin and carbohydrate adjustments; and (4) Planning for exercise.ConclusionsLiving an active lifestyle with T1D is facilitated by dedicated structure and organization of routines, accepting the need for trial and error to understand the personalized glycemic responses to PA and careful use of food to prevent hypoglycemia. These themes could inform clinical practice guidelines or future trials that include PA interventions

1600 RN

Due to a changing employment arena, healthcare organizations are hiring more new graduate RNs into acute care units. MMC’s usual process is to put new hires into night shift. Historically, night shifts have less resource availability. These combined factors left staff feeling unsupported; patient care could be compromised when less support is available to those in the beginning of their careers

A high density recombination map of the pig reveals a correlation between sex-specific recombination and GC content

<p>Abstract</p> <p>Background</p> <p>The availability of a high-density SNP genotyping chip and a reference genome sequence of the pig (<it>Sus scrofa</it>) enabled the construction of a high-density linkage map. A high-density linkage map is an essential tool for further fine-mapping of quantitative trait loci (QTL) for a variety of traits in the pig and for a better understanding of mechanisms underlying genome evolution.</p> <p>Results</p> <p>Four different pig pedigrees were genotyped using the Illumina PorcineSNP60 BeadChip. Recombination maps for the autosomes were computed for each individual pedigree using a common set of markers. The resulting genetic maps comprised 38,599 SNPs, including 928 SNPs not positioned on a chromosome in the current assembly of the pig genome (build 10.2). The total genetic length varied according to the pedigree, from 1797 to 2149 cM. Female maps were longer than male maps, with a notable exception for SSC1 where male maps are characterized by a higher recombination rate than females in the region between 91–250 Mb. The recombination rates varied among chromosomes and along individual chromosomes, regions with high recombination rates tending to cluster close to the chromosome ends, irrespective of the position of the centromere. Correlations between main sequence features and recombination rates were investigated and significant correlations were obtained for all the studied motifs. Regions characterized by high recombination rates were enriched for specific GC-rich sequence motifs as compared to low recombinant regions. These correlations were higher in females than in males, and females were found to be more recombinant than males at regions where the GC content was greater than 0.4.</p> <p>Conclusions</p> <p>The analysis of the recombination rate along the pig genome highlighted that the regions exhibiting higher levels of recombination tend to cluster around the ends of the chromosomes irrespective of the location of the centromere. Major sex-differences in recombination were observed: females had a higher recombination rate within GC-rich regions and exhibited a stronger correlation between recombination rates and specific sequence features.</p

Strategies to Improve Resource Availability for New Graduate Nurses in a Critical Care Setting

STRATEGIES TO IMPROVE RESOURCE AVAILABILITY FOR NEW GRADUATE NURSES Due to changes in the employment arena, health care organizations are hiring new graduate RNs into acute care. At an academic tertiary medical center, new hires typically are assigned into a night shift, which traditionally has less resource availability. The results of a recent AHRQ hospital survey on patient culture safety demonstrated that new graduates were feeling unsupported and that patient safety could be potentially compromised. A team of caregivers developed several goals to provide increased support, encouragement and education to night shift new hires. Improvement in overall patient care and safety was an additional objective. A root cause analysis was conducted and the results prompted the creation of night shift resource nursing position. Expectations for this position were delineated followed by recruitment and training. Subsequent tracking demonstrated a marked increase in the percentage of availability of this designated nurse over a period of 6 months, approaching the goal of 100%. Next steps include repeating the AHRG hospital survey as well as to sustain and spread concept

Chandra X-ray Observations of 12 Millisecond Pulsars in the Globular Cluster M28

We present a Chandra X-ray Observatory investigation of the millisecond pulsars (MSPs) in the globular cluster M28 (NGC 6626). In what is one of the deepest X-ray observations of a globular cluster, we firmly detect seven and possibly detect two of the twelve known M28 pulsars. With the exception of PSRs B1821-24 and J1824-2452H, the detected pulsars have relatively soft spectra, with X-ray luminosities 10^30-31 ergs s^-1 (0.3-8 keV),similar to most "recycled" pulsars in 47 Tucanae and the field of the Galaxy, implying thermal emission from the pulsar magnetic polar caps. We present the most detailed X-ray spectrum to date of the energetic PSR B1821-24. It is well described by a purely non-thermal spectrum with spectral photon index 1.23 and luminosity 1.4x10^33Theta(D/5.5 kpc)^2 ergs s^-1 (0.3-8 keV), where Theta is the fraction of the sky covered by the X-ray emission beam(s). We find no evidence for the previously reported line emission feature around 3.3 keV, most likely as a consequence of improvements in instrument calibration. The X-ray spectrum and pulse profile of PSR B1821--24 suggest that the bulk of unpulsed emission from this pulsar is not of thermal origin, and is likely due to low-level non-thermal magnetospheric radiation, an unresolved pulsar wind nebula, and/or small-angle scattering of the pulsed X-rays by interstellar dust grains. The peculiar binary PSR J1824-2452H shows a relatively hard X-ray spectrum and possible variability at the binary period, indicative of an intrabinary shock formed by interaction between the relativistic pulsar wind and matter from its non-degenerate companion star.Comment: 9 pages, 6 figures. Accepted for publication in the Astophysical Journa