Using Shock Index as a Predictor of ICU Readmission: A Quality Iimprovement Project

Background: Adverse events will occur in one-third of patients discharged from the intensivecare unit (ICU) and evidence shows that ICU readmissions increase a patient’s length of stay,mortality, hospital costs, and nosocomial infections, as well as decrease long-term survival.Specific predictive factors that will accurately predict which patients are at risk of adverseevents requiring readmission are needed.Aim: The specific aim of this project was to identify if shock index (SI) values higher than 0.7at the time of transfer from the ICU are a useful predictor of ICU readmission.Methods: Using the Plan, Do, Study, Act (PDSA) framework, a retrospective chart review wasperformed using a matched cohort of 34 patients readmitted with 72 hours of discharge from theICU and 34 controls to obtain SI values at admission, transfer from and readmission to the ICU.A second PDSA cycle looked for SI trends within 24 hours prior to discharge from the ICU.Results: An odds ratio calculating the risk of readmission of patients with an elevated SI was2.96 (Confidence Interval (CI) 1.1 to 7.94, p-value=0.03). The odds ratio for an 80% SIelevation over 24 hours prior to discharge was 1.56 (CI 0.36 to 6.76, p-value=0.55).Conclusion and Implications for CNL Practice: Patients with elevated SIs at the time oftransfer are three times more likely to be readmitted to the ICU. Patients with elevations in atleast 80% of the 24 hour pre-discharge SIs showed no significant differences between thecontrol and readmitted cohorts. Implications of these results for the clinical nurse leader will bediscussed

Immunodeficiencies caused by infectious diseases.

Immunodeficiencies caused by infectious agents may result from disruption of normal host barriers or dysregulation of cellular immunity, the latter serving to promote survival of the infectious agent through immune evasion. Such infections may be followed by opportunistic infections with a variety of other microorganisms. Classic infectious causes of immunodeficiency in companion animals are the immunodeficiency retroviruses, including feline immunodeficiency virus and feline leukemia virus. Other important causes include canine distemper virus; canine parvovirus 2; feline infectious peritonitis virus; rickettsial organisms that infect leukocytes; Leishmania; and fungal pathogens, such as Cryptococcus. Considerable research effort has been invested in understanding the mechanisms of pathogen-induced immunosuppression, with the hope that effective therapies may be developed that reverse the immunodeficiencies developed and in turn assist the host to clear persistent or life-threatening infectious diseases

Environmentally stable polymers and coatings for space application: CH-5, supplement 10

High molecular weight, randomly coupled poly(imide siloxane) soluble block copolymers were synthesized from bis(amino propyl) polydimethylsiloxane equilibrates of various molecular weights, aromatic metalinked diamines, and 3,3'-4,4'-benzophenone tetracarboxylic dianhydride (BTDA). Two synthetic procedures were successfully used to synthesize the poly(amic acid siloxane) intermediates. For both synthetic procedures, a cosolvent system was employed to achieve complete solvation of all components throughout the polymerization. Physical property characterization is continuing

Experimenting with Cooperative learning to enhance non-academic outcomes in Interior Design education

Journal articles investigating peer and cooperative learning from1997-2001 are used here to inform an experimental teaching session with undergraduate students from an Interior Design course. The vocational nature of the discipline suggested that more peer interaction could enhance the non-academic aspects of student learning. Emphasis is placed on exploring the benefits to students and considering how a community of practice can be enhanced

Defining And Managing The Historic Urban Landscape: Reflections On The English Experience And Some Stories From Liverpool

The period since the 1960s has been characterised by growing societal concern with urban heritage protection and the development of legislative, fiscal and urban planning instruments that seek to ensure the protection and enhancement of historic buildings and environments. International organisations such as UNESCO and European level documents such as the European Spatial Development Perspective (ESDP) have stressed the cultural and economic value of the ‘wise management of natural and cultural heritage’. Since the 1970s many cities have sought to redefine and regenerate themselves through a revalorisation of their past and the protection and enhancement of their historic urban landscapes. Urban heritage has thus often come to be seen as a component of the territorial capital of places, and often had a symbiotic relationship with the objective of urban regeneration. However, urban heritage is not a static concept and ideas about what constitutes heritage, the value of different historic urban environments, and the contribution they can make to city development and regeneration continue to evolve. This paper reflects on this evolution in the context of the English planning system and illustrates some key trends and issues surrounding urban heritage through a consideration of recent and ongoing heritage related planning episodes in the northern English city of Liverpool

MARKET STRATEGY

Agribusiness,