4 research outputs found
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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
The Evolution of Ethylene Signaling in Plant Chemical Ecology
Ethylene is a key hormone in plant development, mediating plant responses to abiotic environmental stress, and interactions with attackers and mutualists. Here, we provide a synthesis of the role of ethylene in the context of plant ecology and evolution, and a prospectus for future research in this area. We focus on the regulatory function of ethylene in multi-organismal interactions. In general, plant interactions with different types of organisms lead to reduced or enhanced levels of ethylene. This in turn affects not only the plant's response to the interacting organism at hand, but also to other organisms in the community. These community-level effects become observable as enhanced or diminished relationships with future commensals, and systemic resistance or susceptibility to secondary attackers. Ongoing comparative genomic and phenotypic analyses continue to shed light on these interactions. These studies have revealed that plants and interacting organisms from separate kingdoms of life have independently evolved the ability to produce, perceive, and respond to ethylene. This signature of convergent evolution of ethylene signaling at the phenotypic level highlights the central role ethylene metabolism and signaling plays in plant interactions with microbes and animals