Evaluation of Printable Sepsis Patient Education Material for Usability and Actionability

Sepsis is common, costly, and is a leading cause of death worldwide. During the past decade, quality improvement efforts in sepsis management have led to increased survival. Many sepsis survivors experience sequelae that contribute to unplanned hospital readmission associated with poor outcomes. Despite ongoing efforts to improve sepsis patient care, methods for reducing sepsis readmissions is limited. Additionally, public and patient knowledge regarding sepsis is lacking. Improving sepsis patient outcomes requires early diagnosis and treatment. Increasing patient and caregiver knowledge of sepsis and when to seek medical care is essential, particularly for patients at risk for readmission. No current standards exist regarding effective methods or tools to provide sepsis patient/caregiver discharge education. An evaluation of an available sepsis education tool using a validated measure to assess printable patient education material for understandability and actionability was conducted. An electronic survey was completed by nine national sepsis content experts, with a 90% response rate. Mean usability and actionability scores were above 80% with fair to moderate agreement across 24 survey items. Areas for improvement include providing a summary, modification of images and simplifying language. Results from this project may be useful for future sepsis patient education material.D.N.P., Nursing Practice -- Drexel University, 201

Chatten kann jede/r ;-). Integration von informellen Lern- und Kommunikationswegen und Social Software in ein Blended-Learning-Konzept für Lehramtsstudierende im Bereich Englische Kulturwissenschaft

Das ELAN (E-Learning Academic Network Niedersachsen) III Projekt CELEB (Content-Entwicklung für die Lehrerbildung im Bereich Englische Kultur und Fachdidaktik unter besonderer Berücksichtigung interaktiv-multimedialer Mehrwerte) zielt auf eine Verbesserung der Lehrqualität durch Ergänzung/ Verschränkung der Präsenzlehre mit zielgruppenspezifischen E-Learning-Modulen ab. Entlastung stark frequentierter obligatorischer Einführungsveranstaltungen, Bündelung der fachwissenschaftlichen Expertise der beteiligten Universitäten und zeit- und ortsunabhängiger Zugang zu den Lernressourcen für Studierende sind weitere Ziele des Projektes. Authentizität und Aktualität erhalten die Inhalte durch multimediale Elemente, kollaborative Wissensgenerierung und Interaktivität. Die Universität Hildesheim bietet im Bereich Cultural Studies nach diesem Blended-Learning-Konzept zwei Kurse an, die ständig ausgebaut und erweitert werden. In beiden Kursen kommt Social Software zum Einsatz, da großer Wert auf kollaborativen Wissenserwerb gelegt wird. Informelle Lern- und Kommunikationswege sollen in diesen Kursen Einbettung in formelle Anerkennungsstrukturen finden. (DIPF/ Orig.

Do psychosocial conditions contribute to hospital readmission in patients with sepsis?

•Sepsis is the most expensive condition in hospitalized patients, recently reported to cost more than $23.7 billion per year (1). •Despite a decrease in mortality, the number of severe sepsis/septic shock (sepsis) cases have increased (2). •Sepsis survivors are at risk for unplanned readmissions, which are associated with increased mortality and discharge to hospice (2). •Psychiatric and social disorders have been associated with increased readmission rates in patients with heart failure, myocardial infarction, and pneumonia (3). •Ascertaining variables associated with sepsis readmissions may aid in identification of risk factors and opportunities for improvement (4, 5). •The purpose of this study is to evaluate if psychosocial conditions may be correlated with increased risk for readmission after a sepsis hospitalization

Timing of Invasive Mechanical Ventilation and Death in Critically Ill Adults With Covid-19: A Multicenter Cohort Study

PURPOSE: To investigate if the timing of initiation of invasive mechanical ventilation (IMV) for critically ill patients with COVID-19 is associated with mortality. MATERIALS AND METHODS: The data for this study were derived from a multicenter cohort study of critically ill adults with COVID-19 admitted to ICUs at 68 hospitals across the US from March 1 to July 1, 2020. We examined the association between early (ICU days 1-2) versus late (ICU days 3-7) initiation of IMV and time-to-death. Patients were followed until the first of hospital discharge, death, or 90 days. We adjusted for confounding using a multivariable Cox model. RESULTS: Among the 1879 patients included in this analysis (1199 male [63.8%]; median age, 63 [IQR, 53-72] years), 1526 (81.2%) initiated IMV early and 353 (18.8%) initiated IMV late. A total of 644 of the 1526 patients (42.2%) in the early IMV group died, and 180 of the 353 (51.0%) in the late IMV group died (adjusted HR 0.77 [95% CI, 0.65-0.93]). CONCLUSIONS: In critically ill adults with respiratory failure from COVID-19, early compared to late initiation of IMV is associated with reduced mortality

The fallacy of the BUN:creatinine ratio in critically ill patients

Abstract Background and objectives. Acute kidney injury (AKI) is common in critically ill patients and is associated with a high mortality rate. Pre-renal azotemia, suggested by a high blood urea nitrogen to serum creatinine (BUN:Cr) ratio (BCR), has traditionally been associated with a better prognosis than other forms of AKI. Whether this pertains to critically ill patients is unknown. Methods. We conducted a retrospective observational study of two cohorts of critically ill patients admitted to a single center: a derivation cohort, in which AKI was diagnosed, and a larger validation cohort. We analyzed associations between BCR and clinical outcomes: mortality and renal replacement therapy (RRT). Results. Patients in the derivation cohort (N ¼ 1010) with BCR >20 were older, predominantly female and white, and more severely ill. A BCR >20 was significantly associated with increased mortality and a lower likelihood of RRT in all patients, patients with AKI and patients at risk for AKI. Patients in the validation cohort (N ¼ 10 228) with a BCR >20 were older, predominantly female and white, and more severely ill. A BCR >20 was associated with increased mortality and a lower likelihood of RRT in all patients and in those at risk for AKI, BUN correlated with age and severity of illness. Conclusions. A BCR >20 is associated with increased mortality in critically ill patients. It is also associated with a lower likelihood of RRT, perhaps because of misinterpretation of the BCR. Clinicians should not use a BCR >20 to classify AKI in critically ill patients

Awareness with paralysis and symptoms of post-traumatic stress disorder among mechanically ventilated emergency department survivors (ED-AWARENESS-2 Trial): study protocol for a pragmatic, multicenter, stepped wedge cluster randomized trial.

BACKGROUND: Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3-7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a platform to test an intervention aimed at reducing AWP. The overall objective is to test the hypothesis that limiting ED rocuronium exposure will significantly reduce the proportion of patients experiencing AWP. METHODS: This is a pragmatic, stepped wedge cluster randomized trial conducted in five academic EDs, and will enroll 3090 patients. Per the design, all sites begin in a control phase, under observational conditions. At 6-month intervals, sites sequentially enter a 2-month transition phase, during which we will implement the multifaceted intervention, which will rely on use of nudges and defaults to change clinician decisions regarding ED NMB use. During the intervention phase, succinylcholine will be the default NMB over rocuronium. The primary outcome is AWP, assessed with the modified Brice questionnaire, adjudicated by three independent, blinded experts. The secondary outcome is the proportion of patients developing clinically significant symptoms of post-traumatic stress disorder at 30 and 180 days after hospital discharge. We will also assess for symptoms of depression and anxiety, and health-related quality of life. A generalized linear model, adjusted for time and cluster interactions, will be used to compare AWP in control versus intervention phases, analyzed by intention-to-treat. DISCUSSION: The ED-AWARENESS-2 Trial will be the first ED-based trial aimed at preventing AWP, a critical threat to patient safety. Results could shape clinical use of NMB in the ED and prevent more than 10,000 annual cases of AWP related to ED care. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT05534243 . Registered 06, September 2022

The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis

Objective: The Surviving Sepsis Campaign (SSC or “the Campaign”) developed guidelines for management of severe sepsis and septic shock. A performance improvement initiative targeted changing clinical behavior (process improvement) via bundles based on key SSC guideline recommendations on process improvement and patient outcomes. Design and setting: A multifaceted intervention to facilitate compliance with selected guideline recommendations in the ICU, ED, and wards of individual hospitals and regional hospital networks was implemented voluntarily in the US, Europe, and South America. Elements of the guidelines were “bundled” into two sets of targets to be completed within 6 h and within 24 h. An analysis was conducted on data submitted from January 2005 through March 2008. Main results: Data from 15,022 subjects at 165 sites were analyzed to determine the compliance with bundle targets and association with hospital mortality. Compliance with the entire resuscitation bundle increased linearly from 10.9% in the first site quarter to 31.3% by the end of 2 years (P < 0.0001). Compliance with the entire management bundle started at 18.4% in the first quarter and increased to 36.1% by the end of 2 years (P = 0.008). Compliance with all bundle elements increased significantly, except for inspiratory plateau pressure, which was high at baseline. Unadjusted hospital mortality decreased from 37 to 30.8% over 2 years (P = 0.001). The adjusted odds ratio for mortality improved the longer a site was in the Campaign, resulting in an adjusted absolute drop of 0.8% per quarter and 5.4% over 2 years (95% CI, 2.5–8.4%). Conclusions: The Campaign was associated with sustained, continuous quality improvement in sepsis care. Although not necessarily cause and effect, a reduction in reported hospital mortality rates was associated with participation. The implications of this study may serve as an impetus for similar improvement efforts.Electronic supplementary material The online version of this article (doi:10.1007/s00134-009-1738-3) contains supplementary material, which is available to authorized users

Mittelalter im Labor

Mit diesem Band präsentiert das Schwerpunktprogramm 1173 der Deutschen Forschungsgemeinschaft „Integration und Desintegration der Kulturen im europäischen Mittelalter“ erste Ergebnisse seiner Arbeit. Von Anfang an war ihm die Aufgabe gestellt, das mittelalterliche Europa in transkultureller Perspektive und auf Wegen einer transdisziplinären Wissenschaft zu erforschen und zu begreifen. Immer ging es darum, die disziplinär verfassten Einzelwissenschaften durch transdisziplinäre Arbeit zu ergänzen. Das wissenschaftliche Anliegen des Programms ist es, das europäische Mittelalter von seinen geografischen Rändern und seinen kulturellen Differenzen her zu erforschen und zu beschreiben. Der holistischen Frage nach der Einheit Europas wird die innere Vielfalt als gegenständlicher Ausgangspunkt entgegengesetzt. Europa wird nicht als abgeschlossenes, kohärentes Gebilde verstanden, sondern als ein Kontinent, dessen permanente Austausch- und Wechselbeziehungen zwischen den verschiedenen Regionen und Kulturen überhaupt erst zur Ausbildung seiner charakteristischen Merkmale geführt haben