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

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

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

Development of A Technique for Computer Simulation of the Stress State of the Drive Drum Shell of A Belt Conveyor to Optimize Its Design Parameters

The paper considers the method of computer simulation of the stress-strain state of the drive drum shell in the NASTRAN integrated environment. Due to the complexity of determining stresses and deformations in the drum sections by the analytical method, it is proposed to solve this important problem using the numerical finite-element method. At the preliminary stage of computer modeling, a mechanical design scheme was developed, including a variable pressure that changes depending on the angle of rotation of the drum, the deterministic relations describing the variable force factors are based on the Euler ratio. It is also proposed to take into account the pressure from the variable friction force, which depends on the changing coefficient of adhesion of the belt to the drum. As a result of the computer calculation, the equivalent Mises stresses of 65 MPa were determined, the safety factor was 4.2 and the components of the tangential stresses were determined using the stress tensor marker, the shear stress reached the level τ=16 MPa for fabric tape and τ=3.14 MPa for rubber tape. According to the results of the calculation, the dependence of the tangential stresses on the angle of rotation of the drum was constructed. A diagram of the change in the component of tangential stresses along the forming shell of the drum was constructed. Analysis of stress-strain state allowed us to determine the factor of safety of the drum shell. Based on the analysis of equivalent stresses, it is proposed to further calculate the durability of the drum using the method of long-term fatigue. The computer calculation of shear stresses in the component allows choosing the rational parameters of the lining, based on such indicators as peel strength and break, as well as determining the angle 61° of the slab lining required to improve the reliability and traction ability of the pipelin

Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: a systematic review and meta-analysis

Anne Sophie Mathiesen,1 Ingrid Egerod,2 Tonny Jensen,1 Gudrun Kaldan,3 Henning Langberg,4 Thordis Thomsen3 1Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 2Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 3Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 4CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Abstract: Diabetes distress (DD) disproportionately affects vulnerable people with type 2 diabetes mellitus and interventions targeting this population are therefore relevant. A systematic review and meta-analysis was performed to assess the evidence for an effect of psychosocial interventions for reducing DD, and, secondly HbA1c, depression, and health-related quality of life in vulnerable people with type 2 diabetes mellitus. Vulnerability encompasses poor glycemic control (HbA1c >7.5%) and at least one additional risk factor for poor diabetes outcomes such as low educational level, comorbidity, and risky lifestyle behavior. The interventions should be theoretically founded and include cognition- or emotion-focused elements. We systematically searched four databases for articles published between January 1995 and March 2018. Eighteen studies testing a variety of psychosocial interventions in 4,066 patients were included. We adhered to the Cochrane methodology and PRISMA guidelines. Review Manager 5.3 was used for data extraction and risk of bias assessment, and Grades of Recommendation, Assessment, Development and Evaluation for assessing the quality of the evidence. Data were pooled using the fixed or random effects method as appropriate. We investigated effects of individual vs group, intensive vs brief interventions, and interventions with and without motivational interviewing in subgroup analyses. To assess the robustness of effect estimates, sensitivity analyses excluding studies with high risk of bias and attrition >20% were conducted. We found low to moderate quality evidence for a significant small effect of psychosocial interventions on DD, and very low to moderate quality evidence for no effect on HbA1c, both outcomes assessed at 3, 6, 12, and 24 months follow-up. The effect on depression was small, while there was no effect on health-related quality of life. Exploratory subgroup analyses suggested that interventions using motivational interviewing and individual interventions were associated with incremental effects on DD. Likewise, intensive interventions were associated with significant reductions in both DD and HbA1c. Keywords: diabetes distress, HbA1c, meta-analysis, psychosocial interventions, type 2 diabetes, vulnerable population