Enhanced recovery after surgery: An opportunity to improve fractured neck of femur management

ABSTRACT INTRODUCTION Approximately 67,000 hip fractures occurred in England, Wales and Northern Ireland in 2014, and annual hospital costs for fracture are around £1.1 billion. We review the potential scope for improving length of stay (LOS). METHODS Hospital Episode Statistics data on non-elective admissions to 137 hospital trusts between November 2013 and October 2014 with a primary diagnosis of fractured neck of femur were analysed. The primary outcome was superspell LOS, which is the total LOS for all related spells for a single patient during an episode of care. Secondary outcomes were discharge to home, readmission at 28 days and in-hospital mortality. RESULTS The mean observed LOS was 22.1±3.8 days (range 12.3–33.7 days). The range for case mix-adjusted expected LOS was 21.5–24.4 days. On average, 6.7±1.5% (range 3.6%–10.9%) of patients died while in hospital, at a relative risk of in-hospital mortality of 28.2–182.9. A mean of 12.3±3.2% (range 3.9% to 23.0%) of patients were readmitted at 28 days, at a relative relative risk of 34.8–203.2. CONCLUSIONS The wide range of observed LOS in our study is unlikely to be due to the case mix, as the case mix-adjusted range of LOS is less than 3 days, but rather due to local processes and pathways. There is therefore considerable scope for quality and efficiency of care improvements in our hospitals. We propose this could be best achieved if clinicians experienced in enhanced recovery focused on FNOF pathways

Family-centered bereavement practices in Danish intensive care units: a cross-sectional national survey

publisher: Elsevier articletitle: Family-centered bereavement practices in Danish intensive care units: a cross-sectional national survey journaltitle: Intensive and Critical Care Nursing articlelink: http://dx.doi.org/10.1016/j.iccn.2017.10.003 content_type: article copyright: © 2017 Elsevier Ltd. All rights reserved

Evidence characterizing skills, competencies, and policies in advanced nursing practice in intensive care in Europe: a scoping review protocol

Scoping Review for protocol undertaken as part of the International Nursing Advanced Competency-based Training for Intensive Care (INACTIC) project. Co-funded by the Erasmus+ Programme of the European Union

Elements of intensive care bereavement follow-up services: A European survey

Background: Despite technological innovations and continuous improvement in evidence-based treatments, mortality in the intensive care unit remains high. Consequently, a large group of family members may be in need, and benefit from bereavement follow-up support. Aim: To explore elements, organization, and evaluation of ICU bereavement services in European countries. Specific objectives were to investigate: 1) the model of bereavement follow-up services (elements of support), 2) the workforce model (organization of staff), 3) the evaluation model (evaluation strategies). Study design: Cross-sectional survey of conference delegates. Methods: A paper and pen questionnaire including a cover letter assuring the respondents of anonymity and confidentiality was distributed to 250 delegates during the opening ceremony of the 2017 European federation of Critical Care Nurses associations (EfCCNa) Congress in Belfast. The questionnaire was developed from a previously validated tool describing bereavement care practices in intensive care units including questions about the content and organization of bereavement follow-up services. Frequencies were calculated in yes/no questions and content analysis was applied in additional free text comments. Results: We received 85 responses from publicly employed nurses, mainly in mixed adult ICUs. Respondents were 48 (56.5%) bedside nurses and the rest represented clinical nurse specialists, researchers, managers, or academic nurses. Bereavement follow-up had existed about 1-15 years. Important follow-up elements were: viewing the deceased in the unit 77 (90.6%), providing follow-up information 67 (79.8%), sending a letter of sympathy 17 (20%), and calling the family to arrange a meeting 27 (31%). Conclusion: Bereavement follow-up is common, but variable at European intensive care units. We recommend the development, implementation, and evaluation of evidence-based, but culture-specific, bereavement follow-up guidelines for European intensive care units. Relevance to Clinical Practice: More critical care nurses are realizing the need for bereavement follow-up guidelines. This paper provides an overview of common elements that might be considered

International nursing advanced competency-based training for intensive care: a europe-wide survey.

This article is freely available via Open Access. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published (Open Access

Neuropeptide Receptor Transcriptome Reveals Unidentified Neuroendocrine Pathways

Neuropeptides are an important class of molecules involved in diverse aspects of metazoan development and homeostasis. Insects are ideal model systems to investigate neuropeptide functions, and the major focus of insect neuropeptide research in the last decade has been on the identification of their receptors. Despite these vigorous efforts, receptors for some key neuropeptides in insect development such as prothoracicotropic hormone, eclosion hormone and allatotropin (AT), remain undefined. In this paper, we report the comprehensive cloning of neuropeptide G protein-coupled receptors from the silkworm, Bombyx mori, and systematic analyses of their expression. Based on the expression patterns of orphan receptors, we identified the long-sought receptor for AT, which is thought to stimulate juvenile hormone biosynthesis in the corpora allata (CA). Surprisingly, however, the AT receptor was not highly expressed in the CA, but instead was predominantly transcribed in the corpora cardiaca (CC), an organ adjacent to the CA. Indeed, by using a reverse-physiological approach, we purified and characterized novel allatoregulatory peptides produced in AT receptor-expressing CC cells, which may indirectly mediate AT activity on the CA. All of the above findings confirm the effectiveness of a systematic analysis of the receptor transcriptome, not only in characterizing orphan receptors, but also in identifying novel players and hidden mechanisms in important biological processes. This work illustrates how using a combinatorial approach employing bioinformatic, molecular, biochemical and physiological methods can help solve recalcitrant problems in neuropeptide research

第753回 千葉医学会例会・第一外科教室談話会 29.

Preliminary search strategy. Preliminary search strategy, including all queried databases, search parameters, and key words. (DOCX 112 kb

Developing and testing a nurse-led intervention to support bereavement in relatives in the intensive care (BRIC study): a protocol of a pre-post intervention study

BACKGROUND: When a patient is approaching death in the intensive care unit (ICU), patients' relatives must make a rapid transition from focusing on their beloved one's recovery to preparation for their unavoidable death. Bereaved relatives may develop complicated grief as a consequence of this burdensome situation; however, little is known about appropriate options in quality care supporting bereaved relatives and the prevalence and predictors of complicated grief in bereaved relatives of deceased ICU patients in the Net

Dysphagia in Intensive Care Evaluation (DICE): An International Cross-Sectional Survey.

Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three emails and a final telephone reminder. Responses were received from 746 ICUs (26 countries). In patients intubated > 48 h, 17% expected a > 50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated > 7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP. Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 h of intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs. There seems to be limited awareness among ICU practitioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment, and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs