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1
Power, Kevin J. "How are ethical problems resolved in a paediatric intensive care unit?" Thesis, De Montfort University, 2012. http://hdl.handle.net/2086/7880.
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Few studies have explored how medical ethics works in practice specifically in terms of the social processes that result in a decision regarding an ethical problem. This is particularly so in the case of children’s intensive care. More than a decade of teaching healthcare ethics to both nurses and doctors prompted a study to examine how ethical problems are resolved in a children’s intensive care unit. This qualitative study addressed this question in a single large children’s intensive care unit in England. The study was guided by grounded theory in examining via individual face to face unstructured and semi-structured interviews what ethical problems were encountered and how they were resolved. Interviews were conducted mainly with doctors and nurses working on an intensive care unit. Two admitting consultant doctors and three parents were also interviewed. The analysis of data gathered in 20 interviews was developed using Strauss and Corbin’s (1998) framework. A theory emerged from the analysis of the data that revealed the most prominent ethical problems in children’s intensive care related to end-of-life situations. Most significant among these was the decision to withdraw life-preserving interventions from a child. The theory outlines a process by which health professionals involved in the care and treatment of a child in intensive care negotiated a consensus on the point at which it was no longer appropriate to continue life-preserving interventions. This consensus was then presented to parents. Parental assent to withdrawal was facilitated, when not immediately forthcoming, by a process of persuasion.
2
Slaymaker, Lora. "A CHILD'S-EYE VIEW OF THE PEDIATRIC INTENSIVE CARE UNIT (ETHNOGRAPHY, ACUTE ILLNESS)." Thesis, The University of Arizona, 1985. http://hdl.handle.net/10150/291273.
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Legro, Amanda B. R. "Nutrition support and clinical outcomes of children in a pediatric intensive care unit." Thesis, California State University, Long Beach, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=1527973.
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The purpose of this thesis was to investigate the impact of enteral nutrition (EN) support factors on days of mechanical ventilation (MV) and length of stay (LOS) in a pediatric intensive care unit (PICU) among subjects age 3 7 weeks to 21 years. Specifically, nutrition support factors included a) days to reach prescribed calories, b) days to reach prescribed protein, c) percentage of prescribed calories received, and d) percentage of prescribed protein received through the use of EN.
Purposive sampling was used to select subjects that received nutrition support in the PICU. Data was collected via chart review within the time frame January 1, 2011 to August 1, 2013.
The results demonstrated MV days and LOS were significantly different for patients who reached prescribed calories and protein within 72 hours of admission. LOS was also significantly different for patients who received at least 80% prescribed calories.
4
Prentiss, Andrea S. "Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit." FIU Digital Commons, 2014. http://digitalcommons.fiu.edu/etd/1633.
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Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce.
Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures.
Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained.
Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures.
Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.
5
Fitzwanga, Kaiser. "Transfusion practices among children undergoing cardiac surgery admitted to the Red Cross War Memorial Children's Hospital Paediatrics Intensive Care Unit." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29879.
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Objective- We aimed to describe the use of blood products following cardiac surgery, as well as the outcomes and factors associated with post-operative blood product use
Design- Prospective, single centre observational study
Setting- Paediatric intensive care unit (PICU) in Cape Town, South Africa
Patients- One hundred and twenty-six children <18 years old admitted to the PICU following cardiac surgery between July 2017 and January 2018
Interventions- None
Measurements and Main Results- The data was prospectively obtained from blood bank charts, intraoperative and PICU observation charts. Demographic data, intraoperative details and post-operative blood product use were extracted from patient records and entered in a standardised case record form. Fifty three percent of children received blood products following cardiac surgery. The blood products transfused included cryoprecipitate (30.9%), packed red cells (22.2%), albumin (18.3%), fresh frozen plasma FFP (15.9%) and platelet concentrate (15.1%). Low haemoglobin level was commonest indication (86%) for red cell use. Bleeding was the commonest indication for FFP (70%) and cryoprecipitate (67%) use. Thrombocytopenia was the commonest indication (84%) for platelet use while hypotension episodes were predominant (95%) in those who received albumin. The standardized mortality ratio was 3.1 vs 0, respectively, among transfused versus non-transfused patients (p<0.0001). The median (IQR) duration of PICU stay was 5 (3-11) vs 2 (2-5) days, respectively in those transfused versus non-transfused (p<0.0001). The median (IQR) ventilation duration was 47(22-132) hours vs 20 (6-27) hours, respectively among the transfused versus non-transfused (p=<0.0001). The factors associated with blood-product use post cardiac surgery include previous cardiac surgery, younger age, lower weights, and prolonged coagulation parameters (p=<0.05).
Conclusion- There is high usage of blood products among children post cardiac surgery. The children transfused had a longer ICU stay, ventilation duration, and higher standardized mortality ratio compared to the non-transfused.
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Salie, Mogamat Shamiel. "Outcomes of Human Immunodeficiency Virus infected children admitted to a paediatric intensive care unit in Cape Town, South Africa." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19900.
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During the mid to late 1990's, nearly all HIV infected children admitted to South African paediatric intensive care units died. This was in the context of an increasing HIV epidemic in Sub-Saharan Africa, a limited number of intensive care beds in public hospitals and the South African government refusing to supply antiretroviral medication to public sector patients. HIV infected children all die without ARV medication, and it resulted in an increase in the South African under-5 mortality rate. In this context critically ill HIV infected children were often denied PICU admission. Developed countries introduced ARV medication in the early 1990's and the South African government only started supplying ARV medication in late 2003. When ARV medication became available in South Africa, it was started on the basis of the individual child's clinical and immunological status and there was not much published data on initiation of ARV therapy in critical ill children in intensive care units. Many HIV infected children had recurrent hospital admissions and many children died before initiating ARV medication. HIV infected children are not only susceptible to the normal bacteria and viruses, but at increased risk of opportunistic and mycobacterial infections. CMV has increasingly been recognized as a common co-infection with PCP, but has been difficult to diagnose and treat effectively. We retrospectively reviewed all HIV exposed and infected children admitted to our PICU in 2009. In addition to our standard treatment, we initiated ARV medication as soon as logistically possible and children with suspected CMV infections were empirically treated with gancyclovir.
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Wu, Yanlan, and 吴艳兰. "Risk factors for death in pediatric intensive care unit of a tertiary children's hospital in Guangzhou city." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206970.
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Background:
Most of the previous studies about risk factors associated with death in pediatric intensive care unit (PICU) were done in western countries and focused on physiological and laboratorial indexes. Some of them had inconsistent results. There were few studies about the epidemiologic profile of mortality and risk factors associated with death in the PICU in China. Compared with other countries, China has different health care policy, insurance system, population, culture, and socioeconomic situation that may affect disease outcomes differently. Some data showed that Chinese PICUs had higher mortality. It is important to know more about the possible factors associated with excess death in PICU in a Chinese setting.
Objectives:
The objectives of this study were to estimate mortality (incidence proportion of death) in pediatric intensive care unit (PICU) in a tertiary hospital and identify the main risk factors associated with death in PICU.
Methods:
This was a case-control study. We retrospectively investigated the clinical data of patients who were admitted to the PICU during January 2010 to December 2013 in a tertiary hospital in Guangzhou, China. All the dead cases in PICU during the studied period were chosen as cases, and the controls were randomly selected from the patients who were alive when they were discharged from the PICU during the same period. The incidence proportion of death was estimated, and then logistic regression model was carried out to explore the risk factors for death.
Results:
The overall mortality in this PICU was 6.5% (95% CI 5.6 % - 7.4%) during January 2010 to December 2013. The following factors were found to have significant association with higher risk for death: middle level socioeconomic status (OR 2.51, 95% 1.07 - 5.87) and low level socioeconomic status (OR 5.86, 95% CI 2.32 - 14.77) compared with the high level socioeconomic status; admission from pediatric emergency observation unit (OR 2.08, 95% CI 1.10 - 3.91) compared with admission from transfer system (i.e. other hospital); critical severity of disease (OR 2.62 , 95% CI 1.48 - 4.64), and seriously critical severity of disease (OR 8.41, 95% CI 3.26 - 21.67) compared with non-critical severity of disease ; existence of multiple organ dysfunction syndrome (OR 3.64, 95% CI 1.91- 6.91) compared with absence of multiple organ dysfunction syndrome; existence of comorbidity (OR 3.14, 95% CI 1.68 - 5.86) compared with absence of comorbidity; infectious disease (OR 2.42, 95% CI 1.07- 5.49), neoplasm (OR 4.53, 95% CI 1.63 - 12.62), neurological disease ( OR 4.21, 95% CI 1.85 - 9.59) and endocrine, immune and nutritional disease (OR 7.56,
95% CI 2.10 - 27.20 ) compared with respiratory disease .
Conclusion:
Our study was the first one to comprehensively investigate the risk factors for death in PICU of a tertiary hospital in China. We described profile of dead cases, estimated the mortality and investigated the risk factors associated with death in PICU. During January 2010 to December 2013 the mortality in the PICU was found to be 6.5%, and risk factors for higher mortality in PICU included lower level socioeconomic status, admission from the pediatric emergency observation unit, more severe conditions of disease, presence of comorbidity and multiple organ dysfunction syndrome, and disease categories of infectious diseases, neoplasm, neurological disease, and endocrine, immune and nutritional disease. Our study provided information for developing preventive strategy to reduce the mortality in PICU.published_or_final_version
Public Health
Master
Master of Public Health
8
Wege, Martha Helena. "Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?" Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32382.
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Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.
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Garza, Diane Milliken. "Psychosocial responses and needs of parents of infants with disabilities in the neonatal intensive care unit /." Digital version accessible at:, 1999. http://wwwlib.umi.com/cr/utexas/main.
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Ameer, Ahmed. "Safety measures to reduce medication administration errors in Paediatric Intensive Care Unit." Thesis, University of Hertfordshire, 2015. http://hdl.handle.net/2299/16352.
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Objective: Medicine administration is the last process of the medication cycle. However, errors can happen during this process. Children are at an increased risk from these errors. This has been extensively investigated but evidence is lacking on effective interventions. Therefore, the aim of this research is to propose safety measures to reduce medication administration errors (MAE) in the Paediatric Intensive Care Unit (PICU). Method: The research was carried out over five studies; 1) systematic literature review, 2) national survey of PICU medication error interventions, 3) retrospective analysis of medication error incidents, 4) prospective observation of the administration practice, and 5) survey of PICU healthcare professionals' opinions on MAE contributory factors and safety measures. Results: Hospital MAE in children found in literature accounted for a mean of 50% of all reported medication error reports (n= 12552). It was also identified in a mean of 29% of doses observed (n= 8894). This study found MAE retrospectively in 43% of all medication incidents (n= 412). Additionally, a total of 269 MAEs were observed (32% per dose observation). The characteristics of the interventions used to reduce MAE are diverse but it illustrated that a single approach is not enough. Also for an intervention to be a success it is fundamental to build a safety culture. This is achieved by developing a culture of collaborative learning from errors without assigning blame. Furthermore, MAE contributing factors were found to include; interruptions, inadequate resources, working conditions and no pre-prepared infusions. The following safety measures were proposed to reduce MAE; 1) dose banding, 2) improved lighting conditions, 3) decision support tool with calculation aid, 4) use of pre-prepared infusions, 5) enhance the double-checking process, 6) medicine administration checklist, and 7) an intolerant culture to interruption. Conclusion: This is one of the first comprehensive study of to explore MAE in PICU from different perspectives. The aim and objectives of the research were fulfilled. Future research includes the need to implement the proposed safety measures and evaluate them in practice.
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Yuan, Yuan, and 袁媛. "Incidence and factors associated with nosocomial infections in a neonatal intensive care unit (NICU) of an urban children hospital inChina." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2012. http://hub.hku.hk/bib/B48427287.
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Background:
With the increasing survival rate of early preterm infants and the extensive use of invasive health care procedures, the nosocomial infection rate is on the rise in the past decade in the neonatal intensive care unit (NICU). The patients in NICU are a unique and highly vulnerable population, including preterm infants and infants requiring surgery. Nosocomial infection (NI) is associated with the majority of infectious complications of infants, resulting in morbidity and mortality. Close surveillance, accurate measurement, and promotion of full awareness of the risk factors of infection are essential to nosocomial infection control. Previous research had pointed out some factors related to the NI in other countries, and further research is still much needed to reveal the incidence of NI and further analyze the risk factors in China.
Objectives:
The objectives of this study were to assess incidence and epidemiologic profile of nosocomial infection in NICU of China, and to identify the main risk factors of nosocomial infections.
Methods:
This was a retrospective cohort with a nested case control study. All data were collected from the database of the medical records of all the patients who were admitted to the Guangzhou Women and Children’s Medical Center (N=1653) during December 2009 to May 2012.Infection rate, infection density and central line-associated bloodstream infection rate were estimated. Stepwise regression model yielded adjusted odds ratio (OR) of potential risk factors for NI.
Results:
The infection rate in NICU during the study period was 6.2 episodes per 100 patients (6.0-6.4 episodes per 100 patients). Infection density was 4.2 episodes per 1000 patient-days each year (95%CI=3.4-5.0 episodes per 1000 patient-days). The infection rate of ventilation-related pneumonia was 3.4 episodes per 1000 Mechanical Ventilation (MV) days. (95%CI= 3.2-3.5 episodes per MV patient-days).Central line-associated bloodstream infection rate was 5.4 episodes per 1000 central line days (95%CI= 5.1-5.6episodes per central line days). Overall, infants with gestational age >32weeks, longer duration of receipt of parenteral nutrition and longer duration of receipt of probiotics were significantly less likely to have NI (adjusted ORs= 0.35, 0.94 and 0.88, respectively). Congenital malformation, multiple birth, receipt of vein or arterial catheter, receipt of surgical operation and gastric tube feeding were significantly more likely to have NI(adjusted ORs=4.43,3.24 and 3.88, respectively). And longer duration of using prophylactic antibiotic was significantly more likely to have NI (adjusted OR=1.13).
Conclusion:
Our study provided information to the prevention strategies of nosocomial infections and improvement of health care service.We described the nosocomial infection rate, infection density and device-related infection rate, seasonal distribution, the type of infection and the pathogens identified to reveal the profile of nosocomial infection of NICU in Guangzhou, China.Andwe identified the association between intrinsic factors of infants and health care procedures with NI. Multicenter prospective study can be conducted in the future to investigate the specific risk factors on different birth weight or gestational age in China.published_or_final_version
Public Health
Master
Master of Public Health
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Dubuc, Alexandra. "Assessing the Nutritional Status and Adequacy of Energy and Protein Intakes of Children Admitted to the Pediatric Intensive Care Unit." Thesis, Université d'Ottawa / University of Ottawa, 2020. http://hdl.handle.net/10393/40404.
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Children admitted to the pediatric intensive care unit (PICU) are at high risk of malnutrition due to the stress of critical illness, and challenges with meeting nutrient needs. The objectives of this study were to describe the prevalence of malnutrition (undernutrition) at admission and discharge from the PICU and the adequacy of dietary intakes during PICU stay according to current practice guidelines. Sixty patients (median age 1.8y) were enrolled. Malnutrition (moderate-severe) was identified in 12% of patients at admission and 15% at discharge using weight-for-length and BMI-for-age z scores. Mid-upper arm circumference z score declined significantly (p=0.002) during PICU stay. Median (IQR) delivery of enteral energy and protein during the first 10 days was 64 (50-73)% and 62 (40-82)%, respectively, of prescribed goal. A total of 174 feeding interruptions were noted in 36 enterally fed patients. Malnutrition was present in the PICU and areas for improvement in nutrient delivery were identified.
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Kjörrefjord, Linda. "När vården byter riktning : Palliativ vård på barnintensiven." Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2248.
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Bakgrund: År 2012 skapades Sveriges första nationella program och kunskapsstöd för palliativ vård. Den palliativa vården finns beskriven av Socialstyrelsen utifrån fyra hörnstenar, symtomlindring, multiprofessionellt samarbete, stöd till anhöriga samt kommunikation och relation. Det är oftast sjuksköterskan som identifierar behovet av palliation, men läkaren är den som fattar beslutet om palliation ska påbörjas. Detta kan vara en lång process och orsaka barnet onödigt lidande. Syfte: Att beskriva sjuksköterskans erfarenheter av att avsluta livsuppehållande behandling för att övergå till palliativ vård på barnintensiven. Metod: Studien genomfördes som en kvalitativ intervjustudie. Sex individuella semistrukturerade intervjuer med utbildade intensivvårdssjuksköterskor på en barnintensivvårdsavdelning i Sverige genomfördes. Dessa analyserades med utgångspunkt från Elo och Kygnäs metod för kvalitativ innehållsanalys och utmynnade i tre huvudkategorier. Resultat: Sjuksköterskornas erfarenheter av att avbryta livsuppehållande vård för att övergå till palliativ vård presenterades i resultatet utifrån tre huvudkategorier, Det oåterkalleliga livet, Sista tiden av livet samt Vad kan sjuksköterskan göra för anhöriga?. Slutsats: Att avbryta livsuppehållande vård för att övergå till palliativ vård är ett komplext och etiskt svårt beslut.Background: In 2012 Sweden created its first natinal program and knowledge base for palliative care. Palliative care is described by the Swedish National Board through four bases, symptom relifes, multi-professional cooperation, support to relatives, and communication and relationship. It is usually the nurse that identifies the need for palliation, but the doctor is the one that makes the decision to begin palliative care. This can be a long process and cause the child unnecessary suffering. Aim: To describe the intensive care nurses experiences in ending life support and the transition to palliative care of children intensive care. Method: The study was conducted as a qualitative interview study. Six individual semi-structured interviews with intensive care nurses at a childrens intensive care unit in Sweden was carried out . These interviews were analyzed on the basis of Elo and Kygnäs method of qualitative content analysis and resulted in three main categories. Result: The nurses' experiences of withdrawing lifesustaining treatment and the transition to palliative care was presented in the result within three main categories, ”The irrevocable life”, ”The end of life” and ”What can the nurse do for the family?”. Conclusion: To discontinue life-sustaining care and transition to palliative care is a complex and difficult ethical decision.
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Heyns, Louis. "The clinical presentation and outcome of tuberculosis in children admitted to a paediatric intensive care unit in an area with a high incidence of pulmonary tuberculosis." Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/26249.
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The purpose of this study was to measure and evaluate the clinical presentation, outcome and longterm effects of tuberculosis in children admitted to the paediatric intensive care unit at Tygerberg Hospital. A retrospective, descriptive study was conducted among 57 children admitted to the paediatric intensive care unit between January 1991 to December 1994. The sample comprised all the children with tuberculosis aged one month to twelve years who were admitted to the paediatric intensive care unit. Audit measures were taken to ensure that all the children with tuberculosis were identified. Data was collected by means of a structured working sheet and questionnaire that was sent to the clinics. Respondents completed the questionnaire in the clinics. There was an increase in the incidence of children suffering from pulmonary or disseminated tuberculosis who required admission to the PICU, although the incidence of HIV was low. None of the index cases had MDR-TB. Fifty-one percent of children were admitted to the PICU because of primary tuberculosis or complications of the disease. Of these children 69 % had respiratory failure who required ventilation. Thirty percent were admitted to the PICU for respiratory failure and were subsequently diagnosed as having tuberculosis. Tuberculosis was incidently found amongst 4 children when they were routinely examined in the PICU. Due to the difficulty in confirming the diagnosis of tuberculosis in children, a large proportion of cases go unrecognised. The chest radiographs demonstrated that hilar ( 40 % ) and paratracheal (32 % ) adenopathy was the most common findings. Bronchial compressions was present in 12 % of cases. A significantly positive Mantoux skin test was reported in 35 % of cases and 53 % had a positive Tine skin test. Gastric aspirates positive for M. tuberculosis were obtained in 42 % of cases and of cultures other than gastric aspirates, 44 % were positive. Other special investigations to confirm the diagnosis of tuberculosis included CT scan and bronchoscopies. Bronchoscopies were performed on 13 children and found to be abnormal in 12 cases. The most common finding was nodal compression of the airways. Overall the diagnosis of confirmed tuberculosis was made in 47% and of probable tuberculosis in 53 % of cases. The length of stay in the PICU was 10.2 + 22.4 days. The PICU mortality was 23%, with a total hospital mortality of 26%. The mortality for the TBM subgroup was 75 % . Although a good compliance (82 % ) was recorded by the clinics in the follow-up study, they experienced problems with the notifications. The follow-up study pointed out that communication was a problem between the referring hospital and the clinics. Thirty-one percent of the clinics made suggestions for improving the communication. The findings demonstrates that in an area with a high incidence of TB, children do develop severe disease requiring admission to the PICU. This places a considerable clinical and financial burden on the already limited health system. Early diagnosis of TB should prevent severe disease and subsequent admission to the PICU. The increasing incidence of HIV and MDR-TB will undoubtedly pose a major risk to ICU staff and the prevention of infection is of primary concern for those who may be exposed in this area. Due to this, certain recommendations regarding guidelines for admission to the PICU, investigations of patients exposed of having TB in the PICU, prevention of infection and detection of disease in staff in the PICU, the need for increase beds in the PICU and recommendations post discharge from the PICU were made.
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Ismail, Ahmad. "The Influence of Context on Utilizing Research Evidence for Pain Management in Jordanian Pediatric Intensive Care Units." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/38503.
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Background: Little is known about the use of pain management evidence in Jordanian Pediatric Intensive Care Units (PICUs). Purpose: To assess the existence, content, and the factors influencing the use of pain management evidence in Jordanian PICUs. Methods: Three studies were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. 1. A scoping review of the literature to identify pain management interventions in the PICU; 2. A cross-sectional and multisite survey to determine the current pain management practices, and the availability and content of practice guidelines in Jordanian PICUs; 3. A correlational and multisite survey to examine the relationship between the contextual factors and nurses’ use of pain management research evidence in Jordanian PICUs. Results: 1. Twenty-seven studies were included in the scoping review. The majority of the studies focused mainly on pharmacological interventions (n= 21, 78%). Morphine and fentanyl were the most commonly used pharmacological agents for pain management in the PICUs. The use of non-pharmacological interventions was limited. 2. Four of six eligible PICUs participated in the cross-sectional study. All four units had written pain management guidelines. Fentanyl was the most commonly used pharmacological agent in two units. Intravenous infusions of opioids were not administered for patients on mechanical ventilation in two units. The use of non-pharmacological interventions was reported in one unit. 3. From the four participating units, 73 nurses completed the correlation study survey. Social capital predicted both the instrumental and conceptual research use for pain management by Jordanian PICU nurses. Structural and electronic resources predicted the instrumental research use for pain management by Jordanian PICU nurses. Conclusions: Pain management practices and supporting guidelines varied in Jordanian PICUs. Context influences Jordanian PICU nurses’ use of research for pain management. Not all of the pain management practices in Jordan are evidence informed. There is an opportunity for improvement in pain management in Jordanian PICUs.
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Elisabeth, Wimo. "Kritiskt sjuka barns delaktighet : En studie om sjuksköterskans omvårdnad på BIVA." Thesis, Röda Korsets Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-2253.
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Gidlöf, Madeleine, and Lisbeth Hansson. "Jag är också närstående : Barns upplevelser av att vara närstående till en svårt sjuk person." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16866.
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Då någon drabbas av allvarlig sjukdom eller skada som hotar livet påverkas inte bara den sjuke utan också alla i den sjukes närhet. Att som närstående vara barn i denna situation kan vara oerhört traumatiskt. För att vi som vårdpersonal ska kunna hjälpa och stötta barnen och familjen behövs kunskap om hur barn upplever denna situation och vilka behov som finns hos dem. Syftet med studien är att beskriva barns upplevelse av att vara närstående till en svårt sjuk person. Med svår sjukdom/skada valdes i denna uppsats någon som vårdas på en intensivvårdsavdelning eller drabbats av cancersjukdom. Metoden som använts är litteraturstudie av vårdvetenskapliga kvalitativa artiklar där barnens upplevelse tydligt framkommer. I resultatet framgår det att barnen upplever oro och osäkerhet över vad som händer, förändrat vardagsliv, otrygghet och utanförskap. Dessa känslor och upplevelser har samlats under tre teman: Berätta för mig, Jag vill att det ska vara som vanligt och Ser ni mig? Med kunskap om barns upplevelser och känslor när någon närstående drabbats av svår sjukdom/skada kan vi som vårdpersonal informera och stötta barn och föräldrar för att möjliggöra en situation där barnen känner delaktighet och trygghet. Studien visar på vikten av att barnen är välinformerade om vad som hänt och hur sjukdomen/skadan utvecklar sig, att vardagen fortsätter i möjligaste mån med trygga rutiner och att barnen får känna delaktighet och blir sedda. Studien visar på hur viktigt det är att vi som vårdpersonal ser och informerar de närstående barnen med tanke på ålder, utveckling och erfarenhet och uppmuntrar och stöttar föräldrarna till att göra barnen delaktiga.Program: Fristående kurs
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Brassica, Sandra Cristina. "Perfil da utilização de medicamentos não licenciados e sem indicação para crianças em UTI neonatal de Hospital Universitário de média complexidade." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/9/9139/tde-17112009-121720/.
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Introdução. Medicamentos não licenciados e sem indicação são utilizados com grande frequência em pediatria por razões éticas e econômicas. A utilização destes medicamentos não constitui um preceito ilegal, mas pode oferecer risco aos pacientes, sendo responsabilidade do médico e do farmacêutico qualquer evento adverso ocasionado. Alguns estudos nesta população sugerem aumento do risco de reações adversas relacionadas ao uso de medicamentos fora das indicações licenciadas. Objetivo. Analisar a exposição a medicamentos não licenciados e sem indicação em neonatos admitidos em Unidade de Terapia Intensiva (UTINEO) em hospital universitário de média complexidade de São Paulo, Brasil. Método. Estudo descritivo transversal dos medicamentos prescritos nas primeiras 24 horas de internação para 79 pacientes admitidos na Unidade de Terapia Intensiva Neonatal, do Hospital Universitário da Universidade de São Paulo (HU-USP), campus de São Paulo, no período de 12/03/08 a 03/11/08. Os medicamentos foram classificados em não licenciados e sem indicação para utilização por população neonatal de acordo com critérios de registro brasileiros e americanos. Resultados: foram prescritos 346 medicamentos. De acordo com os critérios brasileiros de licenciamento 58% não estavam licenciados, 9,5% não eram indicados, sendo que 66 % dos pacientes foram expostos a ao menos 1 item não licenciado e 18% a pelo menos 1 item sem indicação. A avaliação com base nos critérios americanos demonstrou que 53% dos medicamentos não estavam licenciados, 10,9% não tinham indicação, sendo que 63% dos pacientes foram expostos a ao menos 1 item não licenciado e 20% a pelo menos 1 item sem indicação.Conclusões: Os neonatos brasileiros estão expostos a medicamentos não licenciados e sem indicação nas primeiras 24 horas de internação. Embora esforços tenham sido empregados em diversos países para diminuir tal prática, o problema não foi equacionado. No Brasil, ainda, há informações distintas em bulas de medicamentos licenciados e, em relação, aos medicamentos não licenciados ou sem indicação não há nenhuma política estabelecida.Introduction. In pediatrics utilization of unlicensed an off-label drugs are a common practice and this account for ethical and economic reasons. The utilization of unlicensed and off label drugs is not illegal, but can expose patients to risk of harm. Physicians and pharmacists have legal responsibility for any adverse event that may result from this use. Some studies in the pediatric field suggest an increased risk to adverse reactions related to unlicensed and off label use. Objective. To assess the exposure to unlicensed and off-label medicines in neonates admitted to the Neonatal Intensive Care Unit (NICU) in a Brazilian medium complexity University Hospital. Materials and Methods. A cross sectional descriptive study was conducted of prescribed medicines in the first 24 hours of admission for 79 patients admitted to the Neonatal Intensive Care Unit (NICU) in the University Hospital of the University of São Paulo (HU-USP), campus of São Paulo in the period of 12/03/08 to 03/11/08. The medicines were classified as unlicensed and off-label for use in neonatal population according to the criteria for licensing of medicines in Brazil and US. Results: There were a total of 346 medicines prescribed and according to the established criteria in Brazil 58% were unlicensed, 9.5% were off-label; 66% of patients were exposed to at least 1 item unlicensed and 18% at least 1 item off-label. In relation to the criteria in USA 53% were not licensed, 10.9% were off-label, and 63% of patients were exposed to at least 1 item unlicensed and 20% at least 1 item off-label. Conclusions: Brazilian neonates are exposed to unlicensed and off-label medicines already in the first 24 hours of hospitalization. Although efforts have been employed in several countries to reduce this practice, the problem was not solved. In Brazil, there is even different information in leaflets for medicines licensed in and, in relation, to unlicensed or off-label medicines there is no established policy.
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Thompson, Andrew Paul. "Whanau/family meetings in the paediatric intensive care unit: content, process, and family satisfaction : a thesis presented in fulfilment of the requirements for the degree of Master of Philosophy, Social Work, Massey University, Auckland, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1102.
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Family Meetings occur frequently in the Paediatric Intensive Care Unit (PICU) yet little data existed to guide clinicians in the conduct of these meetings. The medical team is required to deliver complex medical information and navigate complex decision-making with a traumatised family during a meeting. The objectives of this study were to describe the content and process of 15 whanau/family meetings in the PICU, identify family meeting characteristics and patient and family attributes that influence family satisfaction and recommend guidelines for health professionals working in the PICU. The study was conducted in a PICU in a university-affiliated children’s hospital in New Zealand (NZ). The process and content of 15 family meetings were analysed using a coding framework previously developed through a qualitative study of family meetings in the adult intensive care unit (Curtis, 2002a). A questionnaire providing a quantitative assessment of family satisfaction drawn from the same study was administered to 30 family members. Demographic data for the study were collected from the patient’s hospital record and these were combined with data relating to the meeting recording and transcript to identify family meeting characteristics and attributes that might influence family satisfaction. The content and process of family meetings in the PICU were described using a framework detailing 28 codes from the six domains: introductions, informational exchange, discussions of the future, decisions, discussions about death and dying, and closings. A comparison of family meeting characteristics and patient and family attributes revealed that longer meetings (40 minutes plus) were associated with lower family satisfaction and should therefore prompt clinicians to consider whether there are unresolved conflicts, difficulties or misunderstandings between the medical team and the family. Recommendations are proposed to guide health professionals in family meetings in the PICU. This is the first study to record and code the content of family meetings in the PICU. The findings from this study will assist clinicians in their meetings with families. The description of the family meeting content will also provide a foundation for future communication training and research in the health environment.
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Gonçalves, Heloisa Amaral Gaspar. "Ecocardiografia em terapia intensiva: avaliação de treinamento voltado para intensivistas e emergencistas pediátricos." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-29102014-151645/.
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Introdução: O exame ecocardiográfico direcionado realizado por médicos intensivistas e emergencistas pode ser uma ferramenta valiosa para a avaliação e manejo do estado hemodinâmico de crianças gravemente doentes. O objetivo do presente estudo foi avaliar o aprendizado de médicos pediatras de setores de emergência submetidos a um programa de treinamento teórico e prático supervisionado em ecocardiografia de emergência. Método: Treinamento com componente teórico e prático foi realizado por dois ecocardiografistas experientes e teve como alvo 16 médicos intensivistas/emergencistas pediátricos. O programa incluiu análises qualitativas de função do ventrículo esquerdo (VE) e ventrículo direito (VD), avaliação de derrame pericárdio/tamponamento cardíaco, regurgitação valvar e avaliação de variação respiratória de veia cava inferior através do índice de distensibilidade da veia cava inferior (dVCI), além de medidas objetivas de fração de ejeção (FE) e índice cardíaco (IC). As aulas práticas foram realizadas na unidade de terapia intensiva pediátrica do Instituto da Criança do Hospital das Clínicas e cada aluno realizou 24 exames direcionados de ecocardiograma durante o treinamento. Os alunos foram avaliados de forma prática, sendo os resultados dos exames realizados pelos alunos comparados com os exames realizados pelo ecocardiografista experiente. As avaliações ocorreram após 8, 16 e 24 exames práticos. Resultados: A taxa de concordância entre o aluno e ecocardiografista na análise subjetiva da função do VE foi de 81,3% na primeira avaliação, 96,9% na segunda avaliação e 100% na terceira avaliação (p < 0,001). Para o dVCI, observou-se uma concordância de 46,7% na primeira avaliação, 90,3% na segunda avaliação e 87,5% na terceira avaliação (p = 0,004). As médias das diferenças entre os alunos e ecocardiografista na medida de fração de ejeção e índice cardíaco foram 7% e 0,56 L/min/m2, respectivamente, após a terceira etapa do treinamento. Conclusões: O treinamento proposto demonstrou ser suficiente para capacitar os médicos pediatras na análise de função do VE de forma subjetiva e também para as medidas objetivas de dVCI, FE e IC. Este modelo de curso pode facilitar o desenho de outros treinamentos médicos em ecocardiografia de emergência e auxiliar na implementação destes cursos de forma isolada ou inserido em programas de residência médica, gerando melhoria nas habilidades técnicas dos médicos dos setores de emergência e desta forma culminando com melhor cuidado dos pacientes criticamente enfermosBackground: Focused echocardiographic examinations performed by intensivists and emergency room physicians can be a valuable tool for diagnosing and managing the hemodynamic status of critically ill children. The aim of this study was to evaluate the learning curve achieved using a theoretical and practical training program designed to enable pediatric intensivists and emergency physicians to conduct targeted echocardiograms. Methods: Theoretical and practical training sessions were conducted with 16 pediatric intensivist/emergency room physicians. The program included qualitative analyses of the left ventricular (LV) and right ventricular (RV) functions, evaluation of pericardial effusion/cardiac tamponade and valvular regurgitation and measurements of the distensibility index of the inferior vena cava (dIVC), ejection fraction (EF) and cardiac index (CI). The practical training sessions were conducted in the intensive care unit; each student performed 24 echocardiograms. The students in training were evaluated in a practical manner, and the results were compared with the corresponding examinations performed by experienced echocardiographer. The evaluations occurred after 8, 16 and 24 practical examinations. Results: The concordance rates between the students and echocardiographers in the subjective analysis of the LV function were 81.3% at the first evaluation, 96.9% at the second evaluation and 100% at the third evaluation (p < 0.001). For the dIVC, we observed a concordance of 46.7% at the first evaluation, 90.3% at the second evaluation and 87.5% at the third evaluation (p=0.004). The means of the differences between the students\' and echocardiographers\' measurements of the EF and CI were 7% and 0.56 L/min/m2, respectively, after the third stage of training. Conclusions: The proposed training was demonstrated to be sufficient for enabling pediatric physicians to analyze subjective LV function and to measure dIVC, EF and CI. This training course should facilitate the design of other echocardiography training courses that could be implemented in medical residency programs to improve these physicians\' technical skills and the care of critically ill patients
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Brossier, David. "Élaboration et validation d'une base de données haute résolution destinée à la calibration d'un patient virtuel utilisable pour l'enseignement et la prise en charge personnalisée des patients en réanimation pédiatrique Perpetual and Virtual Patients for Cardiorespiratory Physiological Studies Creating a High-Frequency Electronic Database in the PICU: The Perpetual Patient Qualitative subjective assessment of a high-resolution database in a paediatric intensive care unit-Elaborating the perpetual patient's ID card Validation Process of a High-Resolution Database in a Pediatric Intensive Care Unit – Describing the Perpetual Patient’s Validation Evaluation of SIMULRESP©: a simulation software of child and teenager cardiorespiratory physiology." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC428.
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La complexité des patients de réanimation justifie le recours à des systèmes d’aide à la décision thérapeutique. Ces systèmes rassemblent des protocoles automatisés de prise en charge permettant le respect des recommandations et des simulateurs physiologiques ou patients virtuels, utilisables pour personnaliser de façon sécuritaire les prises en charge. Ces dispositifs fonctionnant à partir d’algorithmes et d’équations mathématiques ne peuvent être développés qu’à partir d’un grand nombre de données de patients. Le principal objectif de cette thèse était la mise en place d’une base de données haute résolution automatiquement collectée de patients de réanimation pédiatrique dont le but sera de servir au développement et à la validation d’un simulateur physiologique : SimulResp© . Ce travail présente l’ensemble du processus de mise en place de la base de données, du concept jusqu’à son utilisationThe complexity of the patients in the intensive care unit requires the use of clinical decision support systems. These systems bring together automated management protocols that enable adherence to guidelines and virtual physiological or patient simulators that can be used to safely customize management. These devices operating from algorithms and mathematical equations can only be developed from a large number of patients’ data. The main objective of the work was the elaboration of a high resolution database automatically collected from critically ill children. This database will be used to develop and validate a physiological simulator called SimulResp© . This manuscript presents the whole process of setting up the database from concept to use
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Goldsborough, Jennifer. "Palliative Care Integration in the Intensive Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4787.
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Palliative health care is offered to any patient experiencing a life limiting or life changing illness. The palliative approach includes goals of care, expert symptom management, and advance care planning in order to reduce patient suffering. Complex care can be provided by palliative care specialists while primary palliative care can be given by educated staff nurses. However, according to the literature, intensive care unit (ICU) nurses have demonstrated a lack of knowledge in the provision of primary care as well as experiencing moral distress from that lack of knowledge. In this doctor of nursing practice staff education project, the problem of ICU nurses' lack of knowledge was addressed. Framed within Rosswurm and Larrabee's model for evidence-based practice, the purpose of this project was to develop an evidence-based staff education plan. The outcomes included a literature review matrix, an educational curriculum plan, and a pretest and posttest of questions based on the evidence in the curriculum plan. A physician and a master's prepared social worker, both certified in palliative care, and a hospital nurse educator served as content experts. They evaluated the curriculum plan using a dichotomous 6-item format and concluded that the items met the intent of the objectives. They also conducted content validation on each of the pretest/posttest items using a Likert-type scale ranging from 1 (not relevant) to 4 (very relevant). The content validation index was 0.82 indicating that test items were relevant to the educational curriculum objectives. Primary palliative care by educated ICU nurses can result in positive social change by facilitating empowerment of patients and their families in personal goal-directed care and reduction of suffering.
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Tanner, Lisa. "Effects of early acoustic stimulation of prepulse inhibition in mice [electronic resource] / by Lisa Tanner." University of South Florida, 2003. http://purl.fcla.edu/fcla/etd/SFE0000070.
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Professional research project (Au.D.)--University of South Florida, 2003.Title from PDF of title page.
Document formatted into pages; contains 20 pages.
Includes bibliographical references.
Text (Electronic thesis) in PDF format.
ABSTRACT: The purpose of this study was to determine the effects of an atypical pattern of early acoustic stimulation on auditory development. Previous human research suggests that the acoustic environment of pre-term human infants in the Neonatal Intensive Care Unit (NICU) negatively affects some aspects of auditory development. Animal research suggests that premature auditory stimulation interrupts auditory development. Because mice are born before their auditory systems are developed, they make an excellent model for research on fetal and postnatal plasticity of the auditory system. The premature auditory state of newborn mice is similar to that of the NICU pre-term infant, albeit, natural for mice C57 mouse pups were exposed to an augmented acoustic environment (AAE) of a nightly 12-hour regiment of 70 dB SPL noise burst, beginning before age 12 days (onset of hearing) and lasting for one month.
ABSTRACT: The prepulse inhibition (PPI) of mice exposed to the AAE was compared to that of non-exposed mice to observe short-term and long-term effects. Results showed that the prepulse inhibition of the AAE exposed mice did not differ significantly from that of the non-exposed mice. However, it is possible that the measurement used, PPI, may not have been appropriate or that the AAE may not have been an appropriate simulation of the NICU environment.
System requirements: World Wide Web browser and PDF reader.
Mode of access: World Wide Web.
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郭子琪 and Chi-ki Priscilla Kwok. "Nurse-controlled intensive insulin infusion in adult intensive care unit." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720858.
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Kwok, Chi-ki Priscilla. "Nurse-controlled intensive insulin infusion in adult intensive care unit." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720858.
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Stadd, Karen. "Initiating Kangaroo Care in the Neonatal Intensive Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5267.
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Kangaroo care (KC) is a cost-efficient method to increase infant-parent bonding and neonatal health outcomes worldwide. Despite evidence supporting KC in critically ill infants, nursing perceptions regarding patient safety and interrupted work flow continued to impede practice in the local high-tech neonatal intensive care unit (NICU). Their current policy failed to address the 2-person transfer method recommended for safe practice. In addition, both staff and parents lacked training and education regarding the benefits and feasibility of KC. This doctoral project aimed to decrease practice barriers and promote earlier and more frequent KC by developing and integrating an evidence-based clinical pathway within a multifaceted champion-based simulated educational training program for NICU staff and parents. Published outcomes and generated organizational data for program synthesis connected the gap in practice. Kolcaba's comfort theory served as the guiding framework to ensure a partnership in care. This quasi-experimental quantitative study used the generalized liner model for data analysis. Study findings indicated that KC occurred 2.4 more times after the intervention compared to before (p = 0.001). Descriptive data revealed that KC episodes for intubated patients nearly doubled after implementation (11.1% from 6.2%). Post-survey scores for nursing knowledge and comfort level also improved after the intervention. Although earlier KC practice was non-conclusive (p = 0.082), future trials should control groups for day of life since admission. Disseminating the KC pathway can have a positive social change on family-centered care by increasing NICU nurses' knowledge, comfort, and adoption of this evidence-based practice as an expected routine standard of care.
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Saab, Emile. "A database for an intensive care unit." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23376.
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The rapid growth of medical sciences and technologies created the need to manage data generated by sophisticated medical equipment (e.g. lab results, vital signs, etc.). This class of equipment, especially in the modern Intensive Care Unit (ICU), emits large quantities of latient data which medical staff usually records on log sheets.This thesis presents a database design that allows abstract definition of data types, and offers a unified view of data during the development phase, distinct levels of data management and a higher degree of system flexibility. This database model is an implementation of a database for a Patient Data Management System (PDMS) developed for use in the ICU of the Montreal Children's Hospital. The PDMS has a variety of application modules that handle and process various types of data according to functionality requirements.
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Price-Lloyd, Naomi. "Stochastic models for an intensive care unit." Thesis, Cardiff University, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434007.
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Foronda, Flavia Andrea Krepel. "Duração da ventilação mecânica em pediatria: impacto da introdução de avaliações diárias e teste de respiração espontânea." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-08082013-095322/.
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Introdução: Ventilação mecânica (VM) é frequente em crianças com insuficiência respiratória aguda e está associada a complicações, sendo, portanto, necessários esforços para encurtar a sua duração. Objetivos: Verificar se a realização de avaliações diárias e testes de respiração espontânea (TRE), poderiam encurtar a duração da VM em crianças, quando comparado ao desmame habitualmente realizado em pediatria. Objetivos secundários incluíram a avaliação da taxa de falha de extubação e a necessidade de ventilação não invasiva (VNI). Desenho: Estudo prospectivo, randomizado, controlado. Ambiente: Duas unidades de cuidados intensivos pediátricos, em Hospitais Universitários no Brasil. Pacientes: Crianças entre 28 dias e 15 anos de idade que estavam recebendo VM por pelo menos 24 horas no período de julho 2007 a julho 2009. Intervenções: Os pacientes foram aleatoriamente designados para um dos dois protocolos de desmame. No grupo de teste, as crianças foram submetidas a avaliações diárias para verificar prontidão para desmame, depois foi realizado TRE com pressão de suporte de 10 cm H2O e PEEP de 5 cm H2O por um período de 2 horas. O TRE foi repetido no dia seguinte nas crianças que não passaram no primeiro teste. No grupo controle, o desmame foi realizado por critérios clínicos e laboratoriais como de rotina nas unidades. Resultados: 294 crianças elegíveis foram randomizadas, sendo 155 para o grupo de teste e 139 para o grupo controle. O tempo de VM foi menor no grupo de teste onde a duração mediana foi de 3,5 dias (95% intervalo de confiança [IC]: 3,0-4,0) em comparação com o grupo controle onde a mediana do tempo de VM foi de 4,7 dias (95% IC: 4,1-5,3) (p = 0,013). Esta redução significativa na duração da VM não foi associada a um aumento das taxas de falha de extubação ou VNI e representa uma redução de 30% no risco de permanecer em VM (Risco Relativo: 0,70). Conclusões: A avaliação diária para verificar a prontidão para o desmame combinada ao TRE reduziu a duração de VM em crianças, sem aumentar a taxa de falha de extubação ou a necessidade de VNIIntroduction: Mechanical ventilation (MV) is common in children with acute respiratory failure and is associated with several complications requiring efforts to shorten its duration. Objectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test (SBT) could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation (NIV).Design: A prospective, randomized, controlled trial. Setting: Two pediatric intensive care units at university hospitals in Brazil. Patients: The trial involved children between 28 days and 15 years of age who were receiving MV for at least 24 hours. Interventions: Patients were randomly assigned to one of two weaning protocols. In the test group, the children underwent a daily evaluation to check readiness for weaning and then submitted to an SBT with 10 cm H2O pressure support and a PEEP of 5 cm H2O for 2 hours. The SBT was repeated the next day for children who failed it. In the control group, weaning was performed according to standard care procedures. Measurements and main results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. The time to extubation was shorter in the test group, where the median MV duration was 3.5 days (95% confidence interval [CI], 3.0 to 4.0) as compared to 4.7 days (95% CI, 4.1 to 5.3) in the control group (p=0.0127). This significant reduction in the MV duration for the intervention group was not associated with increased rates of extubation failure or NIV. It represents a 30% reduction in the risk of remaining on MV (hazard ratio: 0.70). Conclusions: A daily evaluation to check readiness for weaning combined with a SBT reduced the MV duration for children on MV for more than 24 hours, without increasing the extubation failure rate or the need for NIV
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Llano-Diez, Monica. "Mechanisms Underlying Intensive Care Unit Muscle Wasting : Intervention Strategies in an Experimental Animal Model and in Intensive Care Unit Patients." Doctoral thesis, Uppsala universitet, Klinisk neurofysiologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-173466.
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Critically ill patients admitted to the intensive care unit (ICU) commonly develop severe muscle wasting and weakness and consequently impaired muscle function. This not only delays respirator weaning and ICU discharge, but has deleterious effects on morbidity, mortality, financial costs, and quality of life of survivors. Acute Quadriplegic Myopathy (AQM) is one of the most common neuromuscular disorders underlying ICU muscle wasting and paralysis, and is a consequence of modern intensive care interventions, although the exact causes remain unclear. Muscle gene/protein expression, intracellular signalling, post-translational modifications, muscle membrane excitability, and contractile properties at the single muscle fibre level were explored in order to unravel the mechanisms underlying the muscle wasting and weakness associated with AQM and how this can be counteracted by specific intervention strategies. A unique experimental rat ICU model was used to address the mechanistic and therapeutic aspects of this condition, allowing time-resolved studies for a period of two weeks. Subsequently, the findings obtained from this model were translated into a clinical study. The obtained results showed that the mechanical silencing of skeletal muscle, i.e., absence of external strain (weight bearing) and internal strain (myosin-actin activation) due to the pharmacological paralysis or sedation associated with the ICU intervention, is likely to be the primary mechanism triggering the preferential myosin loss and muscle wasting, features specifically characteristic of AQM. Moreover, mechanical silencing induces a specific gene expression pattern as well as post-translational modifications in the motor domain of myosin that may be critical for both function and for triggering proteolysis. The higher nNOS expression found in the ICU patients and its cytoplasmic dislocation are indicated as a probable mechanism underlying these highly specific modifications. This work also demonstrated that passive mechanical loading is able to attenuate the oxidative stress associated with the mechanical silencing and induces positive effects on muscle function, i.e., alleviates the loss of force-generating capacity that underlie the ICU intervention, supporting the importance of early physical therapy in immobilized, sedated, and mechanically ventilated ICU patients.
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Wolak, Eric S. "Perceptions of an intensive care unit mentorship program." Greensboro, N.C. : University of North Carolina at Greensboro, 2007. http://libres.uncg.edu/edocs/etd/1492Wolak/umi-uncg-1492.pdf.
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Thesis (M.S.N.)--University of North Carolina at Greensboro, 2007.Title from PDF t.p. (viewed Mar. 3, 2008). Directed by Susan Letvak; submitted to the School of Nursing. Includes bibliographical references (p. 53-58).
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Brundage, Janice Kay. "Maternal attachment in the neonatal intensive care unit." Diss., The University of Arizona, 1987. http://hdl.handle.net/10150/184255.
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The purpose of this study was to describe the phenomenon of maternal attachment as it specifically relates to moderate premature delivery. The study investigated the impact of educational, counseling and therapeutic interventions on mothers who delivered premature infants. Research hypotheses were that mothers who participated in the treatment group would demonstrate significant increases in the independent variables of self esteem, social networking and family function strategies. This study also hypothesized that there would be a significant positive relationship between treatment and the dependent variable of maternal attachment. The sample consisted of 30 mother-infant dyads between the ages of 15 and 38 years of age. Infants' gestational age ranged from 32 to 36 weeks. Data were gathered using three measures: (1) a demographic profile of the subjects; (2) a questionnaire including the Tennessee Self Concept Scale, Sarason's Life Event Survey, Norbeck's Social Support Questionnaire, Feetham's Family Function Index; and (3) Barnard's Nursing Child Assessment Feeding Scale (NCAFS). The research study consisted of a field experiment. Fifteen subjects were assigned to the experimental and control group via a modified randomized block procedure. A questionnaire was issued during infant's hospitalization and at 4 months post infant discharge from the hospital to measure the independent variable. The dependent variable was measured at 1 month, 2-1/2 months and 4 months using the NCAFS. Treatment consisted of a minimum of seven sessions during the infant's hospitalization and discharge to home. Statistical analyses were conducted in the form of frequency distributions, means, standard deviations, t-tests and correlation scores. Stepwise multiple regression techniques were used for predictor variables. Results indicated that mothers who participated in the treatment group demonstrated significantly improved maternal attachment processes than those mothers who did not receive intervention. The results did not indicate that there was a significant difference between the two groups on self esteem, social support, life events or family function. Implications for the study were noted. Recommendations for medical and mental health practitioners and future areas of research were discussed.
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Koontz, Victoria S. "Parental satisfaction in a pediatric intensive care unit." Huntington, WV : [Marshall University Libraries], 2003. http://www.marshall.edu/etd/descript.asp?ref=346.
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Chudleigh, Jane. "Infection control in the neonatal intensive care unit." Thesis, London South Bank University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.618660.
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The literature review highlighted the continuing problem of hospital acquired infection. This study examined this problem in depth, in a high-risk area, the Neonatal Intensive Care Unit. A multi-centre study was conducted using multi-methods in order to capture data regarding nurses' infection control practices in neonatal units. Ninety nurses/ nursery nurses from six neonatal units were included in the study. Non-participant observation was used to investigate nurses' existing infection control practices, interviews were used to explore nurses' opinions of infection control, questionnaires were used to collect demographic data about the sample and assess nurses' knowledge of infection control issues and a Likert-type scale was developed to investigate the unit atmosphere/environment. Microbiological laboratory work was undertaken to compare the efficacies of three products (soap, alcohol hand rub and chlorhexidine) at removing/reducing the numbers of bacteria found on the hands. The effectiveness of gloves at preventing contamination of the hands was also assessed. Finally, the numbers of bacteria recovered from the hands of university administrative staff and nurses were compared to determine whether or not nurses had higher numbers of bacteria on their hands due to the number of organisms they are exposed to and their increased frequency of hand hygiene. Overall, nurses' hand hygiene practices were found to be relatively poor. However, there was some evidence that length of shift, as a proxy indicator of fatigue, and unit atmosphere/environment may influence nurses' infection control practices. Opinions and knowledge were not associated with observed practice. Nursery nurses had lower hand hygiene scores and knowledge scores than nurses and increased experience in the neonatal unit was associated with increased infection control knowledge. The number of bacteria recovered from the hands of nurses was significantly higher than the numbers of bacteria recovered from the hands of administrative staff. In the clinical setting, chlorhexidine was found to be the only product that consistently removed significant numbers of bacteria from the hands. Indeed, the alcohol hand rub was found to increase the numbers of bacteria on the hands. The number of bacteria recovered from the hands did not differ when gloves were worn. This suggests the inside of gloves may be providing a medium for the multiplication of bacteria. However, the number of bacteria recovered from the surface of used gloves was significantly lower than the numbers of bacteria recovered from nurses' hands after nursing activities. The use of gloves for all procedures on the neonatal unit may be advantageous.
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Phillips, Raylene May. "Supporting parents in the neonatal intensive care unit." CSUSB ScholarWorks, 1996. https://scholarworks.lib.csusb.edu/etd-project/1163.
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Njenje, Charles Chukwuemeka. "Improving Hand Hygiene in an Intensive Care Unit." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5914.
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Health-care-associated infections (HCAIs) affect hundreds of millions of people worldwide, causing morbidity and mortality among hospitalized patients. About 2 million patients suffer from HCAIs in the United States, and it is estimated that 99,000 of them die each year. Studies have indicated that transmission of health-care-associated microorganisms occurs through contaminated hands of health care workers. Hand hygiene (HH) is the single most effective way to prevent health-care-associated infections, yet health care workers' hand hygiene compliance remains low. One factor responsible for poor compliance with hand hygiene guide-lines are lack of knowledge of good hand hygiene and lack of hand hygiene techniques. This project evaluated the effect of educational program on hand hygiene for intensive care unit (ICU) healthcare workers. The Health Belief Model was applied as the framework in this project. Key components of the model are perceived susceptibility, perceived severity, perceived benefit, and perceived barriers. A convenience sample of 25 ICU healthcare workers participated in the educational program. Pre- and post- education surveys and tests were assessed using descriptive statistics. Results were consistent with existing findings indicating that education is needed to improve HH compliance and that effective HH reduces infections. The findings from this project may contribute to positive social change by promoting increased HH knowledge and infection prevention while decreasing complications of treatments, costs, morbidity, and mortality, thereby promoting a healthy and safe community.
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Menon, Prema Ramachandran. "Telemedicine Enhances Communication in the Intensive Care Unit." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/574.
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Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients' goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers.
This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences.
This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention.
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Ferreira, Josà Hernevides Pontes. "Team perception of nursing care humanized in intensive care unit neonatal." Universidade Federal do CearÃ, 2016. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16481.
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CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel SuperiorHospitalization of the newborn is necessary when health conditions require immediate assistance for their recovery. Humanized actions in the neonatal unit have been developed in order to make it less painful separation parent-child when it needs technological support and team of trained professionals. It was aimed to analyze the perception and knowledge of the nursing team on the promotion of humanized care for newborn in a Neonatal Intensive Care Unit . It is a qualitative study conducted in a public hospital, large, tertiary level, in Fortaleza, Brazil, in the months October and November 2015, after approval by the Research Ethics Committee, under Protocol N. 1,191,339. The subjects were 14 nurses and 20 nursing technicians working in neonatal care. The data collected through semi-structured interviews consist identification data and five guiding issues that permeate the knowledge of the nursing team about the care and promotion of humanized care in the UTIN. In addition, we used no-participant observation and field diary. For analysis, we sought to Bardin technique that extracted the three categories lines: âTaking care of the human personâ, ânursing contributions to the humane careâ and âFactors that affect the quality of humanized care.â The results showed that the nursing team understands humanization as an indispensable element for the comprehensive care to the baby and family, which was observed from the speeches of welcome, restoring health and disease of the newborn process. The professionals had knowledge of the humanized care, played their actions conscious, oriented and appreciative way about the quality of neonatal care and parents who face the challenges inherent in the admission process. We conclude that the performance of these professionals permeates compliance with the regulations of the National Humanization Policy regarding humanized care to the newborn, family and neonatal ambience. It is believed that such actions minimize the impact caused by the characteristics of the disease treatment as well as stressors.
A hospitalizaÃÃo do recÃm-nascido faz-se necessÃria, quando as condiÃÃes de saÃde requerem assistÃncia imediata para o seu restabelecimento. As aÃÃes humanizadas na unidade neonatal tÃm sido desenvolvidas, a fim de tornar menos dolorosa à separaÃÃo pais-filho, quando este necessita de suporte tecnolÃgico e equipe de profissionais capacitados. Objetivou-se analisar a percepÃÃo e conhecimentos da equipe de enfermagem sobre a promoÃÃo do cuidado humanizado ao recÃm-nascido internado na Unidade de Terapia Intensiva Neonatal (UTIN). Trata-se de estudo qualitativo, realizado em hospital pÃblico, de grande porte, nÃvel terciÃrio, em Fortaleza-CE-Brasil, nos meses outubro e novembro de 2015, apÃs aprovaÃÃo pelo Comità de Ãtica em Pesquisa, sob Protocolo n 1.191.339. Os sujeitos foram 14 enfermeiros e 20 tÃcnicos de enfermagem atuantes na assistÃncia ao neonato. Os dados coletados, por meio de entrevista semiestruturada, consistem dados de identificaÃÃo e cinco questÃes norteadoras, que permeiam o conhecimento da equipe de enfermagem acerca do cuidado e a promoÃÃo da assistÃncia humanizada na UTIN. Ademais, utilizou-se observaÃÃo nÃo participante e diÃrio de campo. Para anÃlise, sÃntese e descriÃÃo, buscou-se a tÃcnica de Bardin, que se extraÃram das falas trÃs categorias: âCuidar do ser humanoâ, âContribuiÃÃes de enfermagem para o cuidado humanizadoâ e âFatores que interferem na qualidade do cuidado humanizadoâ. Os resultados revelaram que a equipe de enfermagem compreende a humanizaÃÃo como elemento indispensÃvel para o cuidado integral ao bebà e famÃlia, o que se observou desde as intervenÃÃes de acolhimento, ao restabelecimento do processo saÃde-doenÃa do neonato. Os profissionais apresentaram conhecimentos acerca do cuidado humanizado, desempenharam suas aÃÃes de forma consciente, orientada e sensibilizada, quanto à qualidade da assistÃncia ao neonato e aos pais que enfrentam os desafios inerentes ao processo de internaÃÃo. Percebe-se, portanto, que a atuaÃÃo desses profissionais permeia o cumprimento aos regulamentos da PolÃtica Nacional de HumanizaÃÃo. Conclui-se que o cuidado humanizado aplicado nessa ambiÃncia à essencial ao recÃm-nascido e famÃlia, uma vez que minimiza o impacto causado pelas caracterÃsticas da doenÃa, tratamento, bem como os fatores estressantes da UTIN.
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Torres, Nicole Marie, and Nicole Marie Torres. "Palliative Care Utilization in the Intensive Care Unit: A Descriptive Study." Diss., The University of Arizona, 2018. http://hdl.handle.net/10150/626674.
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Objective: The Patient Self-Determination Act of 1990 (PSDA) protects a patient’s right to predetermine the level of life-supporting care they are willing to receive (U.S. Department of Health and Human Services, 1993). In Arizona, the advance directive (AD) complies with the PSDA and is used to guide care in the event of cardiopulmonary failure. The AD may indicate “do not resuscitate” (DNR), which prohibits cardiopulmonary resuscitation in the event of cardiac arrest. In the institution used for this project, a palliative care team assists with identifying goals of care and helps guide interventions consistent with the AD. The purpose of this Doctor of Nursing Practice (DNP) project was to complete a retrospective chart review and identify patients admitted to the medical intensive care unit (ICU) with a DNR as indicated by a copy of the AD in the electronic health record (EHR) and determine if they received a palliative care consultation. This information could support a quality improvement project led by the DNP-prepared AGACNP focused on ensuring a palliative care consultation within 48 hours of admission for patients admitted to the ICU with a DNR.
Methods: A search of the EHR identified patients admitted to the medical ICU over a 12-month period. The EHR of patients admitted with a DNR were reviewed to determine if they received a palliative care consultation during the ICU stay and the patient’s final disposition.
Findings: A total of 38 patients had an AD indicating DNR status on admission to the medical ICU. Of those patients, 26 (68.4%) received a palliative care consultation. Twelve patients (31.6%) with a DNR status on admission did not receive a palliative care consultation. Additionally, five patients with a DNR (13.16%) died in the ICU without receiving a palliative care consultation.
Conclusion: Twelve patients with an AD indicating a DNR did not receive a palliative care consultation, and five of those patients died in the ICU. The findings from this project support a quality improvement project to implement palliative care consults to review goals of care for patients with a pre-existing AD indicating a DNR code status.
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Smith, Jennifer Hale. "Prevalence of Pain in the Medical Intensive Care Unit." Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-143554/.
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Sun, Kwok Wai. "A nursing workload scheduler in an intensive care unit /." Thesis, McGill University, 1994. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=68055.
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This thesis presents the design and implementation of an automated task scheduler developed for the Patient Data Management System (PDMS) of the Pediatric Intensive Care Unit of the Montreal Children's Hospital. The principal objective of the Nursing Workload Scheduler (NWS) is to automatically generate schedules for the condition of multiple patients and multiple nurses.This thesis begins with a literature review of computerized medical information systems. It follows with a description of the design and the implementation of the NWS. Evaluation and performance results are then presented and discussed. An outline of future extensions for the system are discussed before the conclusion.
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Sackey, Peter V. "Inhaled sedation with isoflurane in the intensive care unit /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-962-9/.
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Lawhon, Gretchen. "Facilitation of parenting within the newborn intensive care unit /." Thesis, Connect to this title online; UW restricted, 1994. http://hdl.handle.net/1773/7195.
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Romesberg, Tricia L. "Midline Catheter Use in the Newborn Intensive Care Unit." UNF Digital Commons, 2014. http://digitalcommons.unf.edu/etd/544.
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Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs.
The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.
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Crawford, Kathryn J. "Assessment of noise in a medical intensive care unit." Thesis, University of Iowa, 2016. https://ir.uiowa.edu/etd/2061.
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Exposure to noise in hospital intensive care units (ICUs) can disrupt patients’ sleep and delay their recovery. In this intervention study, noise levels were measured in eight patient rooms of a medical ICU (MICU) every minute with sound level meters for eight weeks before and after an intervention. Implemented over six weeks, the intervention was designed to educate nurses and other staff members to reduce noise levels through behavior modification, including instituting a “quiet time” in the afternoons, encouraging patients to keep televisions off or at lower volumes, and speaking more quietly during conversations. Sound equivalent levels (Leq) were calculated from one-minute measurements for each hour in each room. These hourly Leq (Leq-H) values were compared by pod (group of rooms within the MICU), room position (in proximity to a central nurses’ station), occupancy status, and time of day. Days with more than ten hours of one-minute noise levels above 60 dBA were flagged as the loudest time periods and compared to MICU activity logs. The intervention was ineffective with Leq-H values always above World Health Organization guidelines for ICUs (35 dBA in day; 30 dBA at night) before and after the intervention. Leq-H values frequently exceeded more modest project goals during the day regardless of the intervention (50% of Leq-H > 55 dBA both pre- and post-intervention) and at night (68% and 62% of Leq-H > 50 dBA pre- and post-intervention). Statistical analysis of the Leq-H suggests a general source is contributing to the high baseline noise in the MICU, most likely the heating, ventilation, and air-conditioning (HVAC) system. Our analysis of one-minute data indicated that high noise was often associated with high-volume respiratory-support devices. We concluded that our intervention focusing on administrative controls (e.g., education and training) was not enough to reduce noise in the MICU but that an intervention designed with engineering controls (e.g., shielding, substitution) would be more effective.
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Probst, Piper. "Alarm Safety in a Regional Neonatal Intensive Care Unit." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1655.
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Alarm fatigue is a practice problem that applies to hospitalized patients and the nurses who care for them. Addressing alarm fatigue is important to promote alarm safety and to decrease the risk of patient harm or death. The purpose of this study was to decrease alarm fatigue and improve alarm safety in a regional neonatal intensive care unit (RNICU). Guided by the conceptual model for alarm fatigue and alarm safety, this study addressed whether or not alarm management protocols designed to decrease false and nuisance alarms in the physiological monitoring of neonates improve alarm safety via decreased alarm burden and alarm fatigue as evidenced by statistically significant reductions in false and nuisance alarms. A quantitative, time series quasi-experimental design was used with 4 waves of data collection. One wave was baseline data collected preintervention, and 3 waves of data were postprotocol implementation to obtain an initial indication of sustainability. Alarm observation data collection sheets were developed and used to track numbers and types of alarms pre- and post-protocol implementation. The data analysis showed statistically significant decreases in both false alarms and nuisance alarms related to the physiological monitoring protocol and lead changing protocol. Overall, high protocol adherence was noted, and the total number of alarms per hour per bed was reduced by 42% (p < .001), 46% (p < .001), and 50% (p < .001) from baseline at Weeks 2, 4, and 6, respectively. Implications from this study include impact on practice and policy, direction for future study, and a call for social change to promote alarm safety in the care of neonates.
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Park, Joseph Seung Young. "Predicting intensive care unit patient outcomes through patient similarity." Thesis, Massachusetts Institute of Technology, 2019. https://hdl.handle.net/1721.1/123036.
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This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Thesis: M. Eng. in Computer Science and Molecular Biology, Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2019
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 85-86).
An ICU stay involves invasive treatments, and frequently, the decision to continue therapy is made with limited information based on the physician's personal experience. This thesis proposal describes a tool to assist this decision by identifying similar patients and using their outcomes for prediction. We used the eICU Collaborative Research Database (eICU-CRD) v2.0 for the project. Different time varying and time constant features about the patient's demographics and clinical trajectory was used as input data, such as patient age and longitudinal blood pressure measurement. Using this information, a Cox Proportional Hazards model was built to map the multivariate time series of input data to a univariate time series, which was used to match the patient to a cohort of similar patients. Based on the cohort, this model predicted the probability of a healthy discharge by using the aggregate outcome of the cohort for prediction.
by Joseph Seung Young Park
M. Eng. in Computer Science and Molecular Biology
M.Eng.inComputerScienceandMolecularBiology Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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McNett, Molly M. "Intensive Care Unit Nurse Judgments About Secondary Brain Injury." Kent State University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=kent1205339970.
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Crosbie, Brian. "Nurses' understanding of technology in the Intensive Care Unit." Thesis, University of Sheffield, 2014. http://etheses.whiterose.ac.uk/7607/.
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The aim of this thesis is to explore nurses’ understanding of technology in the intensive care unit. The study brings together empirical data gathered from nurses’ practice in the ICU environment, along with theoretical insights from science and technology studies, to illuminate how nurses’ understanding informs their use of technology in their care activities. The empirical data was gathered through intensive fieldwork over a period of 5 months in an ICU department within a large teaching hospital. In addition, recorded in-depth interviews were carried out with ICU nursing staff. The interviews uncover themes such as nurses’ practice with technology; nurses’ ambivalence around the use of technology in relation to patient care; and nursing identity and professional status. Current theories of technological determinism, social essentialism and technology-in-practice within science and technology studies are examined for their usefulness in illuminating the world of ICU nursing research. In particular, Actor-Network Theory, as an example of technology-in-practice, is utilised as a theoretical lens to explore the contingent nature of social and technological relations on the ICU, where nurses’ understanding of technology emerges as an effect of multiple associations between human and non-human actors. The thesis informs existing research by offering further empirical insight into the ICU world through in depth analysis of the semiological and material qualities of technology in the ICU, and develops a number of conceptual themes such as ‘balancing patients,’ ‘chasing numbers’ and the ‘technology vigil’ to frame nurses’ understanding of technology. The study also adds insight into the construction of nursing identity, suggesting it is an emergent property of nurses’ interactions with technology. The thesis concludes by indicating that knowledge of how nurses understand, use and frame their identity in relation to technology can inform current research into technology adoption and diffusion in healthcare environments.
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Reader, Thomas W. "Teamwork and Team Cognition in the Intensive Care Unit." Thesis, University of Aberdeen, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.485379.
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The intensive care unit (ICU) is one of the most complicated areas' of a hospital, with multidisciplinary teams providing life-saving care to critically ill patients. Root-cause analyses of medical errors in the rcu have indicated that poor teamwork and a lack of shared understanding between team members for aspects of patient care are important causal factors in medical errors. This thesis investigated teamwork and team cognition in the intensive care unit. Study 1 found teamwork to be important for sa'ty in the ICU. An analysis of critical incident studies showed that approximately 43% of the contributory factors underlying critical incidents in the ICU were related to 'non-technical skills'. Of those, 16% were associated with teamwork. Studies 2 investigated the influence of team structures upon the perceptions of ICU team members in the UK. The survey showed ICU staff at four ICUs to have positive perceptions of communication and leadership in the rcu. However, team member roles were found to influence perceptions, with nurses and junior doctors having less positive perceptions (compared to senior doctors) of communication and leadership in the rcu. Study 3 investigated a facet of team cognition known as team situation awareness (team SA). Regression analysis found minimal support for the hypothesis that the involvement and contributions of team members during patient reviews would predict the degree to which team members formed similar anticipations of future patient conditions (i.e. team SA). However, the involvement of trainee doctors in the patient decision-making process was found to predict the degree to which they formed similar anticipations with the senior doctor on two measures of situation awareness. The data presented in this thesis indicates the importance of teamwork for safety in the ICU, and identifies the factors (e.g. team hierarchies) that influence team process and team performance. Keywords: ICU, patient safety, medical error, teamwork, team cognition, team situation awareness.