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Levine, Jason M. (Jason Michael) 1981. "De-identification of ICU patient records." Thesis, Massachusetts Institute of Technology, 2003. http://hdl.handle.net/1721.1/28460.
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Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2003.<br>Includes bibliographical references (leaf 34).<br>The creation of systems for assembling and analyzing medical data is currently one of the major factors in advancing the speed of medical research. To ensure patient privacy, legal limitations have been placed on these systems. The Health Insurance Portability and Accountability Act requires that certain types potential identifiers be removed from the data before it can be shared freely. The process of removing the identifiers is called de-identification. The purpose of this project is to create a de-identification filter for the MIMIC database, a system that retrieves and organizes data from the intensive care unit at the Beth Israel Deaconess Medical Center.<br>by Jason M. Levine.<br>M.Eng.
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Olszewski, Arnold K. "Laryngeal injury in the intubated ICU patient." Connect to resource, 2008. http://hdl.handle.net/1811/32142.
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Sweeney, Jennifer. "Adherence to the ICU Liberation ABCDEF Bundle Improves Patient Outcomes in the ICU." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5041.
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Delirium is a frequent complication of intensive care unit (ICU) admissions manifesting as acute confusion with inattention and disordered thinking. Patients in the ICU who develop acute delirium are more likely to experience long term disability and mortality. The purpose of this doctoral project was to evaluate an existing organizational quality improvement project to guide recommendations on improving care in the ICU. The practice-focused research question was: Does improving adherence to the ICU Liberation ABCDEF bundle for patients admitted to the ICU decrease incidence of delirium compared to outcomes prior to implementation? The Program Logic Model served as a framework for analysis of the organization's planning and implementation of this quality improvement project. Benchmark data from an organization's participation in the ICU Liberation Collaborative served as the primary source of evidence for analysis of outcomes. In addition, baseline data on current practice and outcomes in the organization's trauma ICU was analyzed and compared to the benchmark data. Analyses of data revealed strengths and opportunities for improvement in both the organization's project management and in current practices supporting adherence to the ABCDEF bundle guidelines. Incidence of delirium remained unchanged and far below national averages indicating need for further investigation into practices to verify this finding. Better prevention, identification, and management of delirium will lead to a positive impact on society, as patients who develop delirium rarely return to their baseline level of functioning.
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Christensen, Benjamin A. (Benjamin Arthur). "Improving ICU patient flow through discrete-event simulation." Thesis, Massachusetts Institute of Technology, 2012. http://hdl.handle.net/1721.1/73436.
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Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2012.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (p. 105-107).<br>Massachusetts General Hospital (MGH), the largest hospital in New England and a national leader in care delivery, teaching, and research, operates ten Intensive Care Units (ICUs), including the 20-bed Ellison 4 Surgical Intensive Care Unit (SICU), a versatile unit which has a major role in perioperative and emergency care. 90% of SICU patients are eventually transferred to another unit in the hospital. Frequent and sometimes lengthy non-clinical delays in this transfer process can be primarily attributed to congestion in downstream units. Multivariable regression analysis demonstrates that additional nonclinical SICU time yields negligible downstream time savings, while consuming an average of 2.4 SICU beds per day, or 12% of total SICU capacity. In addition to exacerbating the delays of patients requiring admission to the SICU, these non-clinical SICU exit delays are responsible for a yearly attributable annual cost in excess of $2.5M. Possible ameliorating approaches include prioritizing SICU transfers, or modifying the care of delayed SICU patients to begin preparing for discharge from the hospital. Any such choices affecting capacity and resource allocation in the ICU environment involve high cost as well as potentially high risks related to quality of care. To evaluate the impact of potential operational changes, the SICU and its six primary downstream units are modeled in a highly detailed discrete event simulation. Patients are divided into ~2,700 procedural and diagnostic types. Entries (admissions) for each patient type are characterized as inhomogeneous Poisson processes, with lengths of stay drawn from probability distributions. Transfer practices and priorities are encoded in simulation logic. A simulation of twenty replication periods, each one year long, allows for calibration and validation by detailed comparison with historical data. Simulated average hourly census values are within 1% of historical averages and RMSE is below 4% for each of the five modeled areas, indicating high accuracy and low bias. The validated simulation is applied to evaluate the impact of several possible operational adjustments, including changes to discharge timing, transfer priorities, and resource allocation. Two approaches prove most promising: 1) Transferring patients as soon as possible after medical clearance, eliminating the current practice of waiting to see if other patients might need downstream beds. 2) Implementing a 24- hour rolling medical clearance process in the SICU. These interventions are predicted to lower average and peak SICU utilization by ~6%, cut SICU entrance delays by -35%, and decrease SICU exit delays by -50%, with relatively little impact on downstream floors and no additional capital expenditures. These relatively simple policy changes can save -$1 M in non-reimbursed expenditures while reducing overcrowding. If capital expenditures are approved, the simulation indicates that adding beds to downstream units would be more beneficial to the system than adding the same number of intensive care beds (at a much higher cost). Similar results are likely to be applicable to other ICUs at MGH, multiplying the potential impact of these findings several times over.<br>by Benjamin A. Christensen.<br>S.M.<br>M.B.A.
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Hamilton, Virginia. "Patient Discomfort in the ICU: ETT movement effects." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3419.
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Critically ill patients who require MV are at risk for a number of complications, including the development of ventilator-associated events (VAE) and agitation that may require the use of sedation. Patients experience anxiety and discomfort during mechanical ventilation from a variety of sources including unfamiliar breathing assistance and an inability to communicate anxiety and pain verbally, but a primary cause of discomfort identified by these patients is the simply the presence of the endotracheal tube (ETT). Discomfort often leads to agitation and may be exacerbated by ETT movement. Management of agitation typically involves the use of sedative therapy and has been shown to increase the length of stay in the hospital. Additionally, when ETT cuff pressure is not adequately maintained, risk of microaspiration increases and these microaspirations increase the risk of ventilator-associated events. ETT movement may adversely affect the cuff seal against the tracheal mucosa, increasing leakage around the cuff and microaspiration. To date, no studies have described the effect of ETT movement on patient comfort and agitation. Noting the frequency of ETT movement during the provision of nursing care and plausible inadvertent consequences on discomfort and agitation, a research model was created and specific instruments selected in order to study this topic. This dissertation will provide a review of the literature regarding the role of the ETT in microaspiration, as well as detail a study that explores the frequency and amount of ETT movement and its potential effect on agitation.
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Stahl, John. "Implementation of an ICU Antibiotic Formulary Improves Patient Outcome." The University of Arizona, 2007. http://hdl.handle.net/10150/624436.
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Class of 2007 Abstract<br>Objectives: The purpose of this study is to determine if an antibiotic formulary is beneficial in an inpatient ICU setting. The main goal, of course, is to ensure patients receive the most appropriate antimicrobial therapy resulting in the least amount of resistance, by using an antibiotic formulary and ICU antibiotic intervention.
Methods: This project will use a retrospective design in which one-year post-intervention antibiotic resistant trends will be compared with pre-intervention trends at Yuma Regional Medical Center (YRMC).
As is common at YRMC, patients started on antibiotic therapy had susceptibility testing performed to determine the best treatment for the patient. This susceptibility data will be the data used for comparison. Comparison of patient charges and hospital costs associated with these patients will also be performed. YRMC employed an ICU antibiotic intervention documentation form that was used to monitor and extrapolate intervention data.
Hospital lab percent susceptibility data will be looked at to determine isolate susceptibility data to determine if any trends are present in antibiotic resistance between the time period when the antibiotic formulary was implemented and the previous corresponding period of time before the formulary. This data will also be compared with the hospital trends in resistant isolates as a whole. The data is desensitized, as individual patient data is not being reviewed.
In looking at patient charges and hospital costs, charts will be reviewed. These charts will be de-identified to the investigators of this study. Of further note, YRMC placed the intervention in action in February 2006 and began collecting post-intervention data at that time. This study will be using post intervention data collected from February 2006 thru February 2007.
Results: Conclusions:
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Sipola, S. (Seija). "Colectomy in an ICU patient population:clinical and histological evaluation." Doctoral thesis, Oulun yliopisto, 2014. http://urn.fi/urn:isbn:9789526203706.
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Abstract Colectomy is performed in critically-ill patients who, for example, experience colonic ischemia following cardiac surgery or reconstruction of a ruptured aortic aneurysm, nonocclusive mesenteric ischemia with severe sepsis, or toxic megacolon due to Clostridium difficile infection. The present retrospective study was conducted in the mixed intensive care unit (ICU) of the Oulu University Hospital to clarify the clinical picture, effects of surgical treatment on organ functions and outcome in critically-ill patients treated with colectomy during 2000-2009. Their histologic and immunohistologic findings were compared with histologically normal colon walls of 34 controls operated for colon tumors. The annual incidence of colectomy in our ICU varied from 0.08% to 0.4%. The mean age of the study patients was 68.8 (sd 9.7) yrs. They had multiple organ failure in 60% and one-year mortality was 62%. One-year surivial from the hospital discharged patients was 91% (29/32). During preoperative period, increasing levels of serum lactate, an increase in the need for higher doses of norepinephrine, and neurologic SOFA subscore were associated with mortality. The histopathologic damage involves all layers of the colon wall being largely similar in sepsis, fulminant clostridium difficile infection and in ischemia after cardiovascular operations. The extent of epithelial damage of colonic epithelium correlated with clinical severity and outcome in the patients. Tight junction protein claudin-1 was down-regulated thoroughly of colonic epithelium, whereas claudin-2 was up-regulated only in the least affected areas. The number of proliferating epithelial cells of colonic epithelium, analyzed by Ki-67 expression, was higher in the worst affected areas in the study patients as compared to results of controls. The proportion of apoptotic cells analyzed by expression of M30 was larger in the worst damage area than in controls. Up-regulation of Toll-like receptor 9, as a part of innate immunity mechanism, in worst areas of colonic epithelium was higher in the surface epithelium compared with least affected areas and in crypts compared with control specimens. Colon ischemia in critically-ill patients is a pancolic phenomenon with life-threatening consequences. Histologic damage in the colon wall was similar irrespective of the underlying cause. Immunohistochemical characteristics resembled those described earlier in inflammatory bowel disease<br>Tiivistelmä Leikkaukseen johtavaa tehohoitopotilaan koliittia esiintyy esimerkiksi sydän- ja verisuonileikkauksen jälkeen, yleistyneessä tulehdusreaktiossa sekä Clostridium difficile- infektiossa. Takautuvasti kerätyn tutkimuksen tavoitteena oli selvittää vuosina 2000–2009 Oulun Yliopistollisen sairaalan päivystysteho-osastolla hoidettujen potilaiden koliitin kliininen taudinkuva, kirurgisen hoidon vaikutus elinvaurioihin, ennuste ja histologiset ja immunohistologiset löydökset. Leikkauksella hoidettujen potilaiden histopatologisia ja immunohistologisia tutkimustuloksia verrattiin 34:ään histologisesti normaaliin suolinäytteeseen, jotka oli otettu paksusuolisyövän vuoksi tehdyissä leikkauksissa. Päivystysteho-osaston vuosittainen tehohoitopotilaan koliitin esiintyvyyden vaihteluväli oli 0.08 %–0.4 %. Tutkimuspotilaiden keski-ikä oli 68.8 (sd 9.7) vuotta. 60 %:lla heistä todettiin monielinvaurio, ja 62 % heistä menehtyi ensimmäisen vuoden aikana. Sairaalasta kotiutetuista potilaista 91 % oli elossa vuoden kuluttua. Leikkausta edeltävä kohonnut valtimoveren laktaattipitoisuus, verenpainetta tukeva noradrenaliinitarpeen nousu sekä neurologisen toimintakyvyn heikkeneminen olivat yhteydessä potilaiden kuolleisuuteen. Histopatologiset muutokset ulottuivat kaikkiin paksunsuolen kerroksiin ja olivat samankaltaisia eri koliiteissa. Epiteelivaurion laajuus oli yhteydessä potilaiden kliiniseen taudinkulkuun ja ennusteeseen. Immunohistologisissa tutkimuksissa paksusuolen epiteelin klaudiini-1:n esiintyminen oli alentunut, kun taas klaudiini-2:sta oli runsaammin vähemmän vaurioituneella alueella. Vaikeimmin vaurioituneilla suolen alueilla solujen uudistumista kuvaavan merkkiaineen, Ki-67:n, määrä oli suurempi kuin kontrollipotilaiden värjäyksissä. Samanlainen ero vaikeimmin vaurioituneiden alueiden ja kontrollinäytteiden välillä todettiin myös M30-värjäyksen perusteella apoptoosin osalta. Välittömään puolustusmekanismiin kuuluvan Tollin kaltaisen reseptori (TLR) 9:n värjäytyvyys oli vaikeimmin vaurioituneilla epiteelialueilla voimakkaampi kuin vähemmän vaurioituneella alueella. Myös kryptan alueella oli enemmän TLR 9 värjäytyvyyttä kuin kontrollinäytteissä. Tehohoitopotilaan koliittia esiintyy koko paksusuolen alueella. Histopatologiset muutokset ovat samankaltaisia eri tautitilojen aiheuttamissa koliiteissa. Immunohistokemialliset tutkimuslöydökset vastaavat aikaisemmin tulehduksellisten suolistosairauksien yhteydessä kuvattuja muutoksia
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Eriksson, Thomas. "Närståendes besök hos patienter som vårdas på intensivvårdsavdelning." Doctoral thesis, Göteborgs universitet, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-3631.
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Aim: The overall objective of the present thesis was to describe and assess the importance and impact of visits by the patients’ families in an ICU, from patient and family perspectives, and to develop, from a hermeneutic perspective, a research method to study the interplay between patient and family during the visit. Method: The comprehensive methodology of the thesis was hermeneutic. Qualitative as well as quantitative methods were applied to elucidate the issues at stake. In paper I, 198 patients were consecutively included, and data were statistically analysed to establish patient mortality and length of stay at the hospital, in relation to visits of families in the ICU. In paper II, ten patients and 24 visitors were observed during visits. In paper III, seven patients and five relatives were interviewed about their memories of the visits in the ICU. Field notes from the observations, and the interviews with patients and relatives, were interpreted and analysed inspired by Gadamer’s hermeneutic philosophy. Paper IV represents a theoretical discourse, and presents methodological aspects of the hermeneutic interpretation of data from the observations. Results: There were no significant differences between the patients having visitors and those who did not. The patient group with no visits comprised 25 %; they were older, and lived in single households, which contrasted to the patient group having visitors. Analyses of the three clinical studies revealed four themes. The themes relate to the meaning of visiting for patients and their relatives, and are as follows: the visit means to see and realize, to guard and watch, to meet, and to sacrifice. The caring entails that you witness and see with your own eyes, and that you feel a communion with the sick. From the patient perspective, the visit signifies that you are confirmed, empowering you to fight to get back to life. Communion and availability in conjunction enable an individual to achieve a thorough involvement with another being. The results of study IV disclosed that what you observe is depending on your theoretical view. If you see from your heart, you interpret from your heart. Conclusions: The conclusions drawn from the studies of the present thesis are that opportunities to create a presence in the community - a communion - between patients, relatives, and carers, are at want. The present fundamental view of caring in intensive care units is in need of change, in order to create optimal conditions for a communion. Visits need to be regarded as an essential part of caring, and relatives’ visits ought to be facilitated and encouraged. Furthermore, visits are important both for patients and their relatives, as sharing the event of critical illness, in the sense of sharing the suffering, the healing, and the restoration of health, is considered a precondition for their recovery. Care should be organized around the patients and their families. Families and patients bring their fellow stories of life, including values and beliefs, thereby increasing the probability of dignified individualized care.<br><p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin vid Göteborgs universitet kommer att offentligt försvaras i hörsal 2118, Institutionen för vårdvetenskap och hälsa, Arvid Wallgrens backe, Hus 2, Göteborg, fredagen den 19 oktober 2012 kl. 09.00</p>
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Yien, Chris Tak Ming. "Vital signs monitoring for a patient data management system in an ICU." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69721.
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This thesis presents the design and implementation of a Vital Signs Monitoring System for a Patient Data Management System in an intensive care unit. The Vital Signs Monitoring System provides graphical display of patient data to assist medical decision making. It performs real-time patient data acquisition, and supports data management. Visual coding of information has been investigated to ensure effective graphical representation of patient data, to reduce screen clutter, and to enhance interpretability of graphical displays. A survey of existing patient monitoring systems, and patient data management systems is presented to give an overview of the recent advancements in these medical systems. Emphasis is placed on the design of the user interface. Important interface design considerations are discussed, and a survey of interactive hardware, interaction tasks, and dialog style is presented.<br>The Vital Signs Monitoring System was developed in C language under the Presentation Manager window environment, and the operating system environment is OS/2 version 2.0.
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Templeton, Karen Jobe. "In tandem or in tension? Patient-nurse negotiations from ICU to hospital discharge." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/292039.
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Using grounded theory methodology, six intensive care patients were interviewed regarding their perceptions of their own needs, concerns and wants and how nurses responded to those. Each patient was interviewed three times to detect any change in responses during the hospitalization. A theme of patient-nurse negotiation emerged. Patients came into the health care setting with a "generative source," the issues and beliefs they had regarding health-care and nurses in general. This affected patients' definition of themselves, their situation, the caregiver, their relationship with the caregiver, and their own needs and expectations. When a patient's definitions of self or situation varied form the nurse's, negotiation would occur. Two main categories of negotiation were used by both patient and nurse: Personal knowledge & Strategies. If negotiation failed to bring consensus, resulting actions were negative feelings and dissatisfaction, and a sense of vulnerability for the patient. This in turn impacted negatively on the patient's generative source and definitions. As the patient progressed through the hospital system toward discharge, the greatest changes were noted in how they defined themselves and the caregiver, and in the style of negotiation they used.
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Hsieh, Hsiu-Fang. "Deductive content analysis of end-of-life decision-making in the ICU /." Thesis, Connect to this title online; UW restricted, 2004. http://hdl.handle.net/1773/7191.
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You, Shu-Chyng. "Validating the therapy prediction model through a breakdown analysis on ICU patient medical records." Thesis, Massachusetts Institute of Technology, 2006. http://hdl.handle.net/1721.1/42122.
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Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2006.<br>Includes bibliographical references (p. 81-83).<br>With the rapid advancement of computational data analysis tools, medical informatics has emerged as a discipline that explores the use of medical information in clinical practice. It searches for ways to effectively integrate as much information as is available to physicians when they make clinical decisions and represent the information in the most intelligent way possible. As part of an overall effort to develop a program that assists physicians in making clinical decisions on patients with heart disease, we developed a model for predicting therapy effects in heart disease using signal flow analysis that describes constraint relations among physiological parameters. In order to accurately describe and predict the therapy effects on a patient in heart failure, the model needs to be tested and analyzed with real-life patient data including any cardiovascular parameters measurable in the patient. This thesis will present methods for extracting hemodynamic relations and drug effects from patients in the intensive care unit. In this thesis, we propose to test our hypothesis that significant relationships between hemodynamic parameters can be derived from certain classifications of patients and sectioning of hospital stays, and explore the effects of drugs on patients with different sets of diseases.<br>by Chu-Chyng You.<br>M.Eng.
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Jens, Rehammar. "Next generation ventilator : Outlining a future product platform and designing a ventilator for an ICU context." Thesis, Umeå universitet, Designhögskolan vid Umeå universitet, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-140016.
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The overall aim throughout the project was to outline a new modular platform for a future generation of ventilators as well as designing a ventilator based on the defined platform. Doing so through a conceptual approach, looking at enabling cost efficient development, manufature and product scalability as well as taking the users needs for flexibility, improved usability, cable management and transport into consideration. The project used a traditional user centric design approach while also having a strong manufacturers focus when it came to looking at modularity and the company’s product offering. The main insights throughout the project revolved around looking at the entire ecosystem of products and how they worked together in the intensive care unit (ICU). Understanding the core struggles and time consuming tasks in order further improve the workflow in the ICU. A big part of the ideation and concept development process was spent on building rough mock-ups for fast evaluation together with users and the collaborating partner. The result was a combined, highly modular, ventilator and monitoring system called Servo One. With a new tubing system that incorporated both humidifier and patient filter in a flexible way, together with an external sensor system, the concept drastically improved cable and tubing management - one of the biggest challenges in the ICU.
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Sanders, Carolyn L. "Clinical antecedents of a medical emergency team response as predictors of ICU transfer /." Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2008.
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Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008.<br>Typescript. Includes bibliographical references (leaves 100-107). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;
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Dolcetti, Sara A. "Analyzing the impact of delays for patient transfers from the ICU to general care units." Thesis, Massachusetts Institute of Technology, 2015. http://hdl.handle.net/1721.1/99330.
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Thesis: S.M., Massachusetts Institute of Technology, Engineering Systems Division, 2015. In conjunction with the Leaders for Global Operations Program at MIT.<br>Thesis: M.B.A., Massachusetts Institute of Technology, Sloan School of Management, 2015. In conjunction with the Leaders for Global Operations Program at MIT.<br>Title as it appears in MIT Commencement Exercises program, June 5, 2015: Analyzing and reducing the impact of delays for patient transferring out of the ICU. Cataloged from PDF version of thesis.<br>Includes bibliographical references (pages 104-105).<br>Patients at Massachusetts General Hospital (MGH) face significant non-clinical transfer delays out of adult intensive care units (ICUs) and into general care units. In each of the years 2010 through to 2013, approximately 28% of MGH ICU patients experienced a transfer delay of over 12 hours. Transfer delays from the ICU impact several aspects of a patient's hospital stay, in that transfer delays: i) Increase the cost of the stay; ii) Increase ICU utilization; iii) May contribute to additional disruptions to patient flow, such as congested access to the ICU from various locations in the hospital; iv) May have clinical implications given that delayed ICU access for critically ill emergency department and operating room patients may affect the clinical care for these patients. In addition to these impacts, this study identifies a new, additional impact that is central to this work. This finding is that transfer delays from ICUs extend a patient's total hospital length-of-stay (LOS). Specifically, our analyses show that patients spend approximately the same amount of time in the hospital after their ICU stay (i.e., in a general care unit), regardless of whether or not they were delayed in the ICU. Essentially, this implies that for each day a patient is delayed in the ICU, an additional day is added to the patient's total LOS in the hospital. For certain patients, this additional amount of time, which is added to the patient's LOS, may be more than one day. Note that this phenomenon accentuates the other adverse consequences outlined above, since longer patient LOSs further increase congestion in units (both in the ICUs themselves and in general care units), and further impede access into ICUs, disrupting patient care and increasing overall hospital costs. This work studies non-clinical transfer delays from ICUs, and in doing so: 1) Develops a methodology to identify and quantify the magnitude of non-clinical transfer delays from ICUs; 2) Estimates the impact that non-clinical transfer delays from ICUs have on the total patient length of stay (LOS); 3) Identifies the reasons why delays in transfers from ICUs impact patient length of stay; 4) Proposes potential interventions to reduce the impact that delays in transfers from ICUs have on hospital operations.<br>by Sara A. Dolcetti.<br>S.M.<br>M.B.A.
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Everingham, Kirsty Lynn. "Phenomenological exploration of clinical decision making of Intensive Care Unit (ICU) nurses in relation to sedation management." Thesis, University of Edinburgh, 2012. http://hdl.handle.net/1842/7773.
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Driven by research studies and national targets, sedation practices in Intensive care Units (ICU) are undergoing change. Traditionally, ventilated patients in ICUs were kept deeply sedated and only gradually ‘weaned off’ sedation. However, current evidence supports a more ‘wakeful’ patient with the introduction of ‘sedation holds’ encouraging them to regain consciousness (Kress et al. 2000). There is little research exploring ICU nurses’ assessment and management of sedation. Employing a Heideggerian, hermeneutic phenomenological approach to enquiry, the study sought to provide insights into the world of the critical care nurse, nursing with technology, and specifically their beliefs surrounding sedation practices and how organisational factors, knowledge and personal experiences influence their clinical decisions in the care of the ventilated patient. The setting was the Royal Infirmary of Edinburgh, ICU and the purposive sample consisted of 16 ICU nurses with diverse critical care nursing experience. Bedside interviews, utilising an aide memoir, elicited narratives about the nurses’ experiences of sedation practice and a novel sedation monitor (responsiveness). The phenomenological analysis drew upon a number of existing frameworks to guide enquiry. The researcher engaged with the ‘hermeneutic circle’, acknowledging her pre-understandings and using these as a platform to move between the whole of the research and the parts, the descriptions and narratives offered, to develop new knowledge. Themes emerged that demonstrated patients’ sedation status directly impacted upon the nurses’ ICU lived experiences and left them in a state of disequilibrium regarding the requirement to deliver research based care, the desire to deliver holistic care and the duty to deliver safe care. The nurses perceived sedation holds and ‘wakefulness’ as resulting in patient agitation and distress which affected patient safety and comfort. However, the nurses equally felt a pressure of obligation to the doctors to perform such evidence based sedation holds. They described the struggling to maintain patient safety and manage their own fears and anxieties and organisational constraints, whilst experiencing guilt, blame and failure associated with their behavioural discordance with the prescribed decisions and their own clinical decision making processes and strategies. Team work between the two professions and effective leadership is evidently less than ideal. Consequently the implementation of changes in sedation practice is failing to meet either the national targets or to respond to the nurses’ concerns regarding their patient’s short term wellbeing. On both counts this potentially impairs the pursuit of best practice.
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Bernsand, Veronica, and Hanna Strömberg. "Hur intensivvårdssjuksköterskor skapar trygghet för lätt sederade patienter vårdade i respirator." Thesis, Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-41137.
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Introduktion: I dag ska patienter som vårdas på intensivvårdsavdelning vara så lätt sederade som möjligt. Detta kan vid samtidig respiratorvård inge känslor av panik, rädsla och otrygghet. Det är därför av stor vikt att intensivvårdssjuksköterskor vet hur de ska skapa trygghet hos patienterna, då trygghetskänslan även reducerar känslorna av panik och rädsla. Syfte: Syftet med examensarbetet var att belysa hur intensivvårdssjuksköterskor skapar trygghet för lätt sederade patienter vårdade i respirator. Metod: En kvalitativ metod användes och data samlades in genom intervjuer med 14 intensivvårdssjuksköterskor på 3 olika sjukhus. Data bearbetades utifrån Elo och Kyngäs kvalitativa innehållsanalys. Huvudresultat: I resultatet framkom fyra huvudkategorier; Genom att finnas där, Genom upprepad och anpassad information, Genom en bra miljö och yttre resurser samt Genom individanpassad vård. Diskussion: Det framkom att intensivvårdssjuksköterskorna skapade trygghet genom att involvera patienterna och de anhöriga i vården genom en god kommunikation och information. Miljön spelade även en viktig roll i trygghetsskapandet genom att minska störande ljud och inte själva vara stressade. Att skapa trygghet för lätt sederade patienter som vårdas i respirator är viktigt, då trygga patienter kan släppas upp snabbare från sederingen och ändå uppleva välbefinnande.<br>Introduction: The aim of caring for today’s intensive care patient is to have the patient sedated so light as possible. This can induce a sense of panic, fear and insecurity for the patient, when cared for in a mechanical ventilation. It is therefore very important that the intensive care nurse has the ability to create a sense of security for the patient, thus reducing feelings of fear and panic. Aim: The aim of this study was to illustrate how the intensive care nurses creates a sense of security when caring for light sedated patients in mechanical ventilation. Method: A qualitative method was selected and data collected through interviews with 14 intensive care nurses at 3 different hospitals. The data was processed by using Elo and Kyngäs qualitative content analysis. Main Results: The result of the study presents with four main categories; Being there, Through repeating and adapting information, Through a good climate and outer resources as well as Through individually modified care. Conclusions: It showed that the intensive care nurses created a sense of security through involve the patients and their near ones in the care of the patient through good communication and information. The environment also played a critical role through minimizing distracting noise and not to appear stressed themselves. To create sense of security for light sedated patients in mechanical ventilation is important, as when the patients experience a sense of security they could be more quickly weaned of the sedation and yet still experience a sense of wellbeing.
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Guo, Fei. "Development of the real-time data acquisition system for Philips Patient Monitor." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1405963966.
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Chandler, Michelle G. "The Effects of eICU Technology on Clinical Outcomes of ICU Patients: Analysis of the Relationship of Patient, Hospital, and Unit Characteristics to Proximal and Distal Outcomes." Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3694.
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ABSTRACT Each year approximately five million people are treated in the nation's intensive care units making intensive care one of the most expensive components of the U.S. healthcare system. Of these patients, 400,000-500,000 will die annually giving the ICU the distinction of having the highest rate of mortality and complications in the hospital setting. Studies have demonstrated that one in ten patients who die each day in ICUs might survive if intensivists were present to manage clinical care and direct treatment plans (Randolph & Pronovost, 2002; Dimick, Pronovost, Heitmiller & Lipsett, 2001; Pronovost et al., 2002). The utilization of supplemental remote telemedicine has been investigated as a means of compensating for the limited resource of intensivists (Breslow et al., 2004; Rosenfeld et al., 2000). One specific use of this technology, the electronic intensive care unit or eICU®, has previously demonstrated the potential to improve physiological and economic outcomes in ICU patients through the use of integrated decision-support and patient data systems. The present study focuses on the eICU® as a 21st century technology capable of improving the quality of patient care and identifies those factors most likely to impact the success of this clinical intervention. This research utilizes a non-experimental pre-and post-intervention study design and examines patient data collected on all admissions to five ICUs managed by two regional tertiary care hospitals during a 36-month time period. Each ICU is equipped with eICU® software systems that allow intensivist surveillance of patients from a remote facility. The data is analyzed using both structural equation modeling and decision tree regression modeling to statistically evaluate the effects of patient, hospital and unit characteristics on proximal and distal outcomes in ICU patients. As the development of clinical complications subsequently affects patient length of stay, cost of stay, and mortality, it becomes increasingly imperative to seek interventions capable of reducing the risk of unfavorable patient outcomes. This study closely examines one such intervention, the eICU®.<br>Ph.D.<br>Department of Public Administration<br>Health and Public Affairs<br>Public Affairs PhD
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Baning, Karla M. "Outcomes of a Comprehensive Patient and Family-Centered Program in an Adult Intensive Care Unit." Diss., The University of Arizona, 2012. http://hdl.handle.net/10150/228151.
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Background: Intensive care unit (ICU) admission is often life threatening, and may cause severe anxiety within the family system. Anxiety can impair decision-making ability. A majority of ICU patients cannot direct their own treatment; therefore, family members are often required to make major decisions under stressful conditions. Patient and family-centered care (PCFF) has been shown to reduce anxiety, improve decision-making, and improve outcomes for patients and their families. However, no published study has examined outcomes of a comprehensive PFCC program in the ICU. Purpose: The study purposes were to evaluate a comprehensive program to improve PFCC within an adult ICU, and to determine the usefulness of specific PFCC interventions. Methods: An exploratory comparative design was used. Data from ICU patients' family members and ICU nurses, before and after implementation of a PFCC program, were compared using the 30-item combined Critical Care Family Needs Inventory/Needs Met Inventory (CCFNI/NMI). Convenience samples of 49 adult family members of patients admitted to the ICU for at least 36 hours and 85 nurses employed in the ICU full-time for at least six months were recruited from an adult ICU in a 337-bed tertiary care hospital in the southwestern region of the United States. The program was conducted in 3 stages: baseline assessment, program development and implementation, and evaluation. Results: After the PFCC implementation statistically significant differences between nurses' and family members' responses were reported for18 items on the CCFNI and 20 items on the NMI. Five of the10 items family members ranked highest at baseline remained in the top 10 after PFCC implementation, and 3 needs ranked lowest at baseline moved up to the top 10. Conclusions: The results show that the nurses' education was likely the most efficacious program intervention. There may be a hierarchy of needs specific to ICU patients' family members, similar to those described by Maslow. Further study is needed to determine the effectiveness of the CCFNI/NIM in measuring outcomes before and after a PFCC intervention.
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Galozy, Alexander. "Towards Understanding ICU Procedures using Similarities in Patient Trajectories : An exploratory study on the MIMIC-III intensive care database." Thesis, Högskolan i Halmstad, CAISR Centrum för tillämpade intelligenta system (IS-lab), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-37416.
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Recent advancements in Artificial Intelligence has prompted a shearexplosion of new research initiatives and applications, improving notonly existing technologies, but also opening up opportunities for newand exiting applications. This thesis explores the MIMIC-III intensive care unit database and conducts experiment on an interpretable feature space based on sever-ty scores, defining a patient health state, commonly used to predict mortality in an ICU setting. Patient health state trajectories are clustered and correlated with administered medication and performed procedures to get a better understanding of the potential usefulness in evaluating treatments on their effect on said health state, where commonalities and deviations in treatment can be understood. Furthermore, medication and procedure classification is carried out to explore their predictability using the severity subscore feature space.
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Borgatta, Barzé Bárbara. "Clinical impact of colonization and infection by multidrug-resistant pseudomonas aeruginosa in the critically Ill patient." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/462877.
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clínico de pacientes con Pseudomonas aeruginosa multirresistente (PA-MR) y para el
control de su propagación. Es el primer estudio sobre las implicaciones clínicas de la neumonía en
pacientes críticos adultos que albergan PA-MR en aislamientos respiratorios.
Nuestra hipótesis fue: a) Se pueden identificar los factores de riesgo para el desarrollo de la
infección por PA-MR son identificables y los predictores de mortalidad en neumonía; b) Las
infecciones respiratorias por PA-MR están asociadas con elevada morbi-mortalidad. Realizamos un
estudio retrospectivo de casos y controles en 4 UCI médico-quirúrgicas en el Hospital Universitario
Vall d'Hebron. La población comprendió todos los pacientes adultos consecutivamente ingresados
en UCI entre enero de 2010 y abril de 2015. Se incluyeron todas las muestras obtenidas bajo
sospecha de infección. Se excluyeron los pacientes con aislamientos de PA-MR antes de la
admisión en UCI y las muestras de vigilancia. En la primera parte se analizaron todas las muestras
incluidas en el estudio. En la segunda parte se analizaron las muestras respiratorias y se clasificó la
cohorte en dos grupos: uno de casos, formado por pacientes con neumonía nosocomial y uno
control, compuesto por pacientes con muestras respiratorias sin evidencia de neumonía ni posterior
infección.
La población total fue de 5.667 pacientes. Se aisló PA en 504 pacientes (8,8%) y se
identificó PA-MR en 142 muestras clínicas de 104 pacientes (20,6% de todos los aislamiento). El
aislamiento de PA-MR en pacientes críticos no es un evento terminal: más del 50% de los episodios
ocurrieron en pacientes menores de 50 años con una supervivencia predicha de al menos 10 años.
La mitad de la cohorte era inmunocomprometida y un tercio tenía enfermedad pulmonar crónica. El
aislamiento se produjo después de una estancia prolongada en la UCI y la mayoría estaban
traqueostomizados.
Se aisló principalmente en el tracto respiratorio (76,1%) y el aislamiento en múltiples sitios
se produjo en el 22%. Las infecciones representaron el 43,6% de todas las muestras. Veintitrés
porciento de los pacientes presentaron más de una infección. Los hemocultivos fueron positivos en
el 32,3%, predominantemente en infecciones no-respiratorias.
La gran mayoría de los aislamientos fueron susceptibles sólo a amikacina y colistina
(83,1%). La resistencia a betalactámicos de muestras respiratorias fue 45%. El 92,3% de todos los
aislamientos tuvieron una MIC para meropenem> 8ug/mL. Esto resultó en un alto porcentaje de
terapia empírica inapropiada (77,4%). Aunque la terapia combinada se asoció con menos terapia
inadecuada que la monoterapia, no hubo diferencias en la supervivencia. Todas las cepas siguieron
siendo susceptibles a la colistina a pesar de ésta ser utilizada en para la descontaminación digestiva
selectiva.
El análisis de regresión logística identificó como predictores independientes de infección
por PA-MR: fiebre/hipotermia (OR 6,65), PIRO>2 (OR 5,81), vasopresores (OR 5,89) y
tratamiento reciente con cefalosporina anti-pseudomónica (OR 5,71).
La neumonía se asoció con una alarmante morbi-mortalidad. El shock, la hipoxemia
moderada-severa y/o la insuficiencia renal aguda se produjeron en dos tercios de los casos, y
distrés respiratorio en 19,4%. La mortalidad a 30 días fue 67,7% y la mortalidad atribuible
estimada 54,5%. Más de dos tercios de los adultos con neumonía por PA-MR murieron después de
una mediana de 4 días y todas las muertes ocurrieron a las dos semanas. El modelo de regresión
proporcional de Cox identificó la neumonía PA-MR como predictor de la mortalidad a 30 días en
UCI (aHR 5,92).
Podemos concluir que la restricción del uso de cefalosporina anti-pseudomónica podría
ayudar a reducir el aislamiento PA-MR en UCI. Se necesitan urgentemente nuevos antibióticos y
terapias adyuvantes para prevenir y tratar la neumonía por PA-MR.
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Helmersson, Anna, and Mandana Rostampour. "Empowerment hos intensivvårdspatienten - hur svårt kan det vara? : En systematisk litteraturstudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352319.
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Bakgrund: Patienter som drabbas av svår sjukdom och vårdas på intensivvårdsavdelning upplever känslor av total förlust av kontroll, förstärkt av oförmågan att kommunicera. Att få kunskap, kontroll och inflytande över sin vård leder till mindre smärtlindring och kortare vårdtid. Patientcentrering i vården brister dock, vilket kan leda till ökade kostnader för såväl samhället som patienter. Syfte: Att identifiera och beskriva hinder mot empowerment till patienter inom intensivvård samt vilka möjligheter som finns för att överbrygga dessa hinder. Metod: En systematisk litteraturstudie analyserad i två steg med meta-syntes enligt Evans samt meta-aggregation, inspirerad av Joanna Briggs’ Institute. Resultat: Både hinder och lösningar för empowerment till intensivvårdspatienten finns på flera plan. Sjukdomen gör att patienten förlorar förmåga till empowerment, vårdmiljön känns skrämmande, vårdpersonal upplevs vara avvisande och brister i arbetsmiljön leder till sämre möjlighet till delaktighet. Specialistsjuksköterskan inom intensivvård behöver ge patienten indirekt delaktighet, förklara vårdmiljön, skapa en ömsesidig relation och uppmuntra delaktighet. Ett stödjande ledarskap och goda arbetsvillkor är andra nödvändiga förutsättningar för detta. Slutsats: Genom en ökad medvetenhet om de hinder som finns för empowerment till intensivvårdspatienten kan specialistsjuksköterskor och arbetsgivare aktivt arbeta för att komma över hindren och istället stärka patientens möjligheter att bli en del av vårdteamet.<br>Background: To become critically ill and be cared for at an ICU involves feelings of total loss of control, reinforced by the inability to communicate. Gaining knowledge, control and influence over the nursing care results in reduced need for pain relief and shorter stay in hospital. Patient centered care is however lacking. This might incur a higher cost for society, as well as the patient in the form of suffering.Aim: To identify and describe barriers to patient empowerment in critical care and what means there are to overcome these barriers. Method: Systematic literature review, analysed in two steps with meta synthesis according to Evans and meta aggregation, inspired by the Joanna Briggs’ Institute. Results: Barriers as well as possibilities for patient empowerment in ICU were found on various levels. Being critically ill disables the patient from feeling or receiving empowerment, the nursing environment is frightening, staff is perceived as dismissive and working conditions impede patient participation. The specialist nurse in intensive care needs to give the patient indirect participation, explain the nursing environment, create a mutual relationship and encourage participation. Good working conditions and a supportive workplace leadership are also required. Conclusion: By being aware of what the barriers to patient empowerment in the ICU are, specialist nurses and employers can actively engage in the work to overcome them, as well as engaging in the support of the patient to become part of the care team.
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Shatri, Maida, and Anna Garmefelt. "Patienters upplevelse av vårdmiljö på operations- och intensivvårdsavdelning : Systematisk litteraturstudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-73200.
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Abstrakt Bakgrund: Vårdmiljön på operations- och intensivvårdsavdelningen är avancerad och högteknologisk. Att vara patient och behöva vårdas på sjukhus innebär att komma till en främmande miljö med risk att förlora kontroll över sig själv och behöva överlämnas till andra. Förhållandet mellan patient, vårdpersonal, närstående, teknik, omgivning samt omvärld anses vara avgörande för hur patienten kommer att uppleva vårdmiljön. Syfte: Att beskriva patienters upplevelser av vårdmiljön på operations- och intensivvårdsavdelning. Metod: Systematisk litteraturstudie med induktiv och kvalitativ ansats. Analysen utfördes genom att syntetisera och summera innehållet i 17 kvalitativa primärstudier. Resultat: Resultatet består av 3 huvudteman och 8 underteman. Tema nr 1: Att vara patient i en främmande och teknisk vårdmiljö - patienternas förändrade upplevelser av sig själva, att befinna sig mellan fantasi och verklighet, att ha och inte kontroll över sin situation samt familjens betydelse för patienternas upplevelser. Tema nr 2: Patienternas upplevelser av rädsa - att vara rädd samt rädsla mot existensen. Tema nr 3: Personalens betydelse för patienternas upplevelser - att vara väl eller icke väl omhändertagen samt att behandlas som subjekt eller objekt. Slutsats: Patienternas upplevelser av vårdmiljön på operations- och intensivvårdsavdelningen beskrevs som både positiva och negativa, betryggande och skrämmande men var framförallt individuella. Relationen med vårdpersonalen och att som patient känna sig väl omhändertagen samt att bli bemött och behandlad med respekt, där patientens integritet och individualitet låg till grund för vårdandet, var den viktigaste aspekten i patienternas möte med vården.
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Auren, Karlgren Birgitta. "Från intensivvård till vårdavdelning : En systematisk litteraturstudie ur ett patientperspektiv." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-17863.
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Inledning: Patienter som varit svårt sjuka och vårdats på intensivvårdsavdelning, upplever ofta oro och ångest, när de ska överflyttas till vårdavdelning. Dessa patienter har stort vårdbehov, eftersom flertalet inte återhämtat sig, från sitt svåra sjukdoms tillstånd. Patienterna är fortfarande mycket trötta, har nedsatt muskelkraft och svårt att klara sig själva. Målet med studien är, att med kunskap om hur patienter upplever överflyttningen, försöka finna former för hur vi ska kunna underlätta denna för patienten. Syftet med studien är att beskriva patienters upplevelser i samband med överflyttning från intensivvårdsavdelningen till vårdavdelningen. Metoden var systematisk litteraturstudie av vetenskapliga artiklar. Materialet granskades med kvalitativ innehållsanalys. Resultatet visar att flertalet patienter upplever överflyttningen positivt och de tolkar den, som att de blivit bättre. Ett antal patienter upplever överflyttningen med omedvetna känslor, antingen har de minnesluckor, eller ser de överflyttningen som en normal händelse i vårdkedjan. Ett fåtal patienter upplever överflyttningen som mycket traumatisk, de drabbas av oro och ångest, sk”flyttstress”. De oroar sig över hur de ska klara sig på vårdavdelning, känner sig enormt hjälplösa och har en rädsla över att bli ”glömda” på sitt rum och inte få den hjälp, de anser att de behöver. Slutsatsen av litteratur studien är att ett fåtal patienter upplever stor oro och ångest, när de ska lämna intensivvårdsavdelningen (IVA). Det är de patienter som varit svårast sjuka, oftast med multiorgansvikt och en lång vårdtid på IVA. Det är dessa patienter vi måste hjälpa till bättre livskvalitet vid en överflyttning till vårdavdelning. Förslagsvis utarbetas ett samarbete mellan mottagande vårdavdelning och intensivvårdsavdelning. Information upplever patienterna, som enormt viktig. En väl informerad patient är också en trygg patient. Anhöriga görs mer delaktiga i vården och är de välinformerade blir de ett stort stöd för patienten.
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Guldberg, Jolanta, and Härle Anna Lind. "Säker vård vid byte av vårdnivå : hur sjuksköterskan på vårdavdelning upplever förflyttning av patient från intensivvårdsavdelning till vårdavdelning." Thesis, Högskolan Väst, Avdelningen för omvårdnad - avancerad nivå, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-15391.
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Intensivvårdsplatserna är få och behövs till de mest kritisk sjuka. Patienten på intensivvårdsavdelningen (IVA) är kontinuerligt övervakad och personalen är ständigt nära. På vårdavdelningen lämnas patienten ensam i större utsträckning då färre personal vårdar fler patienter. Otillräcklig kommunikation vid förflyttning kan leda till att viktig information missas. Det leder till brister i patientsäkerheten. Frågan är om det finns något i förflyttningsprocessen som kan förbättras för att öka patientsäkerheten? Syftet med denna kvalitativa intervjustudie var att belysa hur sjuksköterskan på vårdavdelning upplevde förflyttning av patient från intensivvård till vårdavdelning. Studien gjordes i form av fokusgruppsintervjuer och nio sjuksköterskor deltog. Resultatet redovisades i fyra huvudkategorier. Det som framkom var att sjuksköterskan på vårdavdelningen inte upplevde sig delaktig i förflyttningsprocessen. Det resulterade i att det blev kort tid för förberedelser och svårt att hinna ordna en plats på avdelningen. Det var oftast en bra rapport från IVA- sjuksköterskan men det saknades behandlingsplan och mål vilket försvårade arbetet och gjorde sjuksköterskan osäker på hur hon/han skulle agera. Ordinationerna var många gånger bristfälliga och resulterade i att mycket tid gick åt att reda ut oklarheter. Arbetsbördan ökade för sjuksköterskan på vårdavdelningen när IVA- patienten överlämnades. Patienten var inte alltid tillräckligt stabil medicinskt och krävde ständig tillsyn. Sjuksköterskorna skrev sällan avvikelser på oönskade händelser i samband med förflyttningen. Slutsatsen var att samarbete och stöd mellan IVA och vårdavdelning förstärkte patientsäkerheten.<br>The beds in the Intensive Care Unit (ICU) are few and are for the most critically ill people. The patient in the ICU is under constant supervision and the personnel are close at all times. The patients in the general ward are often left alone for longer periods of time, because a small amount of personnel is treating large number of patients. Inadequate communication during transformation can lead to missing information. It leads to deficiencies in the patient safety. The question is if there is something that can make the transfer process better to increase the patient safety? The purpose with this qualitative interview study was to illustrate how the ward nurse experience the transfer of a patient from the ICU to the general ward. Data was collected from focus group interviews. A total of nine nurses participated. The result was declared in four different main categories. It was shown that the nurse on the ward did not feel assessorial in the transfer process. The result of that makes it harder to prepare a place for the patient, there is not enough time. Most of the time the nurse would get a good report from the ICU- nurse but there was some missing information. The missing information was a plan and what the goal was. It made the work harder and it made the nurse unsure of how she/he should act. The ordinations were often inaccurate. It resulted in a lot of time spent to sort out obscurities. The workload increased for the nurse on the ward when the ICU-patient was delivered. The patient was not always fully stable medically and it claimed constant supervision. The nurses rarely wrote deviations on the unwished incidence associated with the transfer. The conclusion was that a good collaboration and support between the ICU and the ward increased the patient safety.
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Bagge, Laura. "An investigation of the economic viability and ethical ramifications of video surveillance in the ICU." Honors in the Major Thesis, University of Central Florida, 2013. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/943.
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The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.<br>B.S.N.<br>Bachelors<br>Nursing<br>Nursing
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Åkesson, Helene. "Betydelsen av patientdagbok på IVA. En litteraturstudie." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-24393.
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Patienter på IVA är utsatta för obehagliga upplevelser, både genom sjukdom, behandling och vårdmiljö. Närstående beskriver känslor av overklighet och skräck. Patienter minns drömmar, mardrömmar och faktiska händelser lång tid efter intensivvårdsvistelsen. Dagbok används på många IVA-avdelningar för att ge patienten ett underlag att bearbeta händelser och eventuella minnesluckor från vårdtiden. Syftet med litteraturstudien är att belysa betydelsen av dagbok för IVA-patienter och deras närstående. Studien grundas på nio utvalda och granskade artiklar. I analysen identifierades fem kategorier: kommunikation, trygghet, känslor, förståelse och acceptans samt värdefullt tids- och minnesdokument.<br>Patients at intensive care units are exposed for unpleasant experiences through illness, treatment and environment. The relatives describe feelings of unreality and fear. Patients remember dreams, nightmares and factual events a long time after discharge from intensive care. Diaries are used at many intensive care units, as a tool for understanding memories and loss of memories. The aim of this literature review is to illustrate the meaning of diaries for intensive care patients and their relatives. Nine articles were chosen and examined. Five categories were identified through the analyze: communication, security, feelings, understanding/accepting and a valuable document over time and memory.
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Puertas, Monica A. "Statistical and Prognostic Modeling of Clinical Outcomes with Complex Physiologic Data." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5106.
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Laboratory tests are a primary resource for diagnosing patient diseases. However, physicians often make decisions based on a single laboratory result and have a limited perspective of the role of commonly-measured parameters in enhancing the diagnostic process. By providing a dynamic patient profile, the diagnosis could be more accurate and timely, allowing physicians to anticipate changes in the recovery trajectory and intervene more effectively.
The assessment and monitoring of the circulatory system is essential for patients in intensive care units (ICU). One component of this system is the platelet count, which is used in assessing blood clotting. However, platelet counts represent a dynamic equilibrium of many simultaneous processes, including altered capillary permeability, inflammatory cascades (sepsis), and the coagulation process. To characterize the value of dynamic changes in platelet count, analytical methods are applied to datasets of critically-ill patients in (1) a homogeneous population of ICU cardiac surgery patients and (2) a heterogeneous group of ICU patients with different conditions and several hospital admissions.
The objective of this study was to develop a methodology to anticipate adverse events using metrics that capture dynamic changes of platelet counts in a homogeneous population, then redefine the methodology for a more heterogeneous and complex dataset. The methodology was extended to analyze other important physiological parameters of the circulatory system (i.e., calcium, albumin, anion gap, and total carbon dioxide). Finally, the methodology was applied to simultaneously analyze some parameters enhancing the predictive power of various models.
This methodology assesses dynamic changes of clinical parameters for a heterogeneous population of ICU patients, defining rates of change determined by multiple point regression and by the simpler fixed time parameter value ratios at specific time intervals. Both metrics provide prognostic information, differentiating survivors from non-survivors and have demonstrated being more predictive than complex metrics and risk assessment scores with greater dimensionality.
The goal was to determine a minimal set of biomarkers that would better assist care providers in assessing the risk of complications, allowing them alterations in the management of patients. These metrics should be simple and their implementation would be feasible in any environment and under uncertain conditions of the specific diagnosis and the onset of an acute event that causes a patient's admission to the ICU.
The results provide evidence of the different behaviors of physiologic parameters during the recovery processes for survivors and non-survivors. These differences were observed during the first 8 to 10 days after a patient's admission to the ICU. The application of the presented methodology could enhance physicians' ability to diagnose more accurately, anticipate changes in recovery trajectories, and prescribe effective treatment, leading to more personalized care and reduced mortality rates.
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Mellqvist, Cathrine, and Anders Franzon. "Intensivvårdssjuksköterskors uppfattningar av ett webbaserat utbildningsverktyg för medicinteknisk utrustning- ur ett patientsäkerhetsperspektiv." Thesis, Karlstad University, Karlstad University, Karlstad University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-4475.
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<p>Inom intensivvården har utvecklingen av medicinteknisk utrustning de senaste tio åren gått mycket fort framåt och blivit allt mer avancerad. Utbildning och kompetensutveckling inom medicinsk teknik skaar en trygg och säker miljö för både patient och vårdpersonal och är ett led i patientsäkerhetsarbetet. Utbildning inom medicinsk teknik har sett olika ut genom åren och webbaserad utbildning är ett inlärningssätt. Syftet med examensarbetet var att beskriva intensivvårdssjuksköterskors uppfattningar av webbaserat utbildningsverktyg för medicinteknisk utrustning ur ett patientsäkerhetsperspektiv. Datainsamlingen skedde genom semistrukturerade intervjuer av åtta intensivvårdssjuksköterskor på ett sjukhus i Mellansverige. En fenomenografisk ansats användes i analysen och utfallsrummet presenterades utifrån tre kategorier som beskrev sjuksköterskornas uppfattningar. Resultatet visade att sjuksköterskorna uppfattade webbaserad utbildning TILDA som ett arbetsredskap för att inhämta kunskap och förståelse om den medicintekniska utrustningen, vilket ledde till att de kände sig tryggare och säkrare med handhavandet av medicinsk teknik i patientvården. Sjuksköterskorna uppfattade även att utbildningsmöjligheterna med TILDA påverkades av tid och miljö. Verksamheter som står inför valet att införa webbaserad utbildning bör noggrant tänka igenom hur deras organisation ser ut för att på bästa sätt ge vårdpersonalen möjlighet till en tillfredsställande kompetensutveckling.</p><br><p>The last decade the development of technology within intensive care have proceed very fast and become more advanced. Education and professional development within technology creates a safe and secure environment for both patient and healthcare staff wich is a part of the patient safety work. Education within technology has varied over the years and web-based education is one way of learning. The aim of this project was to describe ICU nurses conceptions of a web-based learning tool for medical technology from a patient safety perspective. Data was collected by semi structured interviews with eight ICU nurses in a hospital in Sweden. A phenomenographic approach was used in the analysis and the outcome space consisted of three categories which described the nurses conceptions. The results showed that nurses conceived web-based learning TILDA as a work tool to acquire knowledge and understanding about the medical technology which led to a safe and secure handle with the technology in patient care. The nurses also conceived that web-based learning TILDA was influenced by time and environment. Organisations who consider implementing web-based learning have to carefully consider how they best can provide the healthcare staff an opportunity to a satisfactory professional development.</p>
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Taba, Sheila. "Visita de criança em Unidade de Terapia Intensiva em um Hospital Público: elaboração de protocolo." Pontifícia Universidade Católica de São Paulo, 2012. https://tede2.pucsp.br/handle/handle/15239.
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Previous issue date: 2012-12-20<br>Conselho Nacional de Desenvolvimento Científico e Tecnológico<br>Child visitation in Intensive Care Unit (ICU) is a conflicting situation in which the multidisciplinary team bears the responsibility of deciding upon allowing or not the child to visit a relative who is hospitalized. The reflections are individual, and the decisions are based on the professional's subjectivity. The growing demand ofvisitation ofchildren under the age established in hospital norms requires a more accurate reflection on the theme and the systematizing of a processo Thus, this study aims to create a 2-12-year-old child visitation protocol at Adult and Child Intensive Care Units in public hospitaIs. Considering the rights of the child, the patient, and the family as well as the dynamics of this hospital unit, child visitation to critical patients will be understood as a step forward in healthcare improvement, in agreement with healthcare policies of the Sistema Único de Saúde (SUS), the Brazilian public healthcare system within the HumanizaSus program guidelines. The child visitation to her hospitalized relative aims to align ethics with the needs emerging in modern society. In one year, 11 evaluations of child visitation at adult and child Intensive Care Units, for SUS paiients only, were performed. The requirements for visitation were spontaneous and the evaluation of permission or restriction included observation and intervlew by the researcher with the patient, the child, and the farnily, in addition to the team's judgment andinformation collected in the files. From the 17 children evaluated, 13 were allowed entrance and were followed in the visitation. Afterwards, inforrnation on their behavior and adverse reactions during the visit was collected with the relatives. The results showed that the visits occurred without incidents or problems. The entrance of the four children who were not allowed was denied by their families. The protocol was improved throughout the research and has proven adequate in helping on the decision by professionals involved<br>A visita de criança em Unidades de Terapia Intensiva é uma situação conflitante, na qual recai sobre a equipe multidisciplinar a responsabilidade na tomada de decisão quanto a permitir ou restringir a visita da criança a seu familiar internado nesta unidade. As reflexões
são individualizadas e as decisões são baseadas na subjetividade do profissional. Há uma
crescente demanda solicitando a visita de crianças menores do que a idade estabelecida nas normativas hospitalares, o que justifica a necessidade de uma reflexão mais acurada sobre o tema e. a sistematização desse processo. Assim, o presente estudo tem como objetivo criar um protocolo de visita de criança de 02 a 12 anos em Unidade de Terapia Intensiva Adulta e/ou Pediátrica em hospitais públicos. Considerando os direitos da, criança, do paciente e da família, e a dinâmica desta unidade hospitalar, a visita de criança a pacientes críticos será compreendida como um passo a mais na melhoria da assistência prestada, em conformidade com as políticas de saúde do nosso Sistema Único de Saúde (SUS) inseridas diretrizes do programa HumanizaSus. A visita da criança a seu familiar internado em uma unidade de cuidados intensivos busca alinhar a ética às necessidades emergentes na sociedade moderna.
No período de um ano, foram realizadas 17 avaliações de visita de criança em UTls (Adulto e
Pediátrica) de um hospital Universitário, que atende exclusivamente pacienÜ sldo SUS. As
solicitações de visita foram espontâneas e a avaliação para permissão ou restrição da visita da criança incluiu observação e entrevista pelo pesquisador com o paciente, criança e família, além do parecer da equipe e informações colhidas no prontuário. Das 17 avaliações, 13 crianças entraram e foram acompanhadas nas visitas e, posteriormente, colheu-se informações
com os familiares sobre seu comportamento e reações adversas em razão da visita feita, verificando-se que as visitas ocorreram sem qualquer intercorrência ou problemas posteriores. Das quatro crianças que não entraram para visita, foi por decisão da própria família. O protocolo foi sendo aperfeiçoado no decorrer da pesquisa e se mostrou adequado no auxílio à tomada de decisão feita pelos profissionais envolvidos
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Goldberg, Miriam A. "Design and Testing of a Novel Communication System for Non-Vocal Critical Care Patients With Limited Manual Dexterity." eScholarship@UMMS, 2020. https://escholarship.umassmed.edu/gsbs_diss/1095.
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Nonvocal alert patients in the intensive care unit setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. A novel communication tool, the Manually-Operated Communication System (MOCS), was developed for use in intensive care settings for patients unable to speak due to mechanical ventilation. It is a speech-generating device designed for patients whose limited manual dexterity precludes legible writing.
In a single-arm device feasibility trial, 14 participants (11 with tracheostomies, 2 with endotracheal tubes, and 1 recently extubated) used MOCS. Participants, family members, and observing nurses were interviewed whenever possible. Interviews included a modified version of the System Usability Scale (SUS) as well as open-ended questions; a qualitative immersion/crystallization approach was used to evaluate these responses.
Participants with a tracheostomy and their family members/care providers rated MOCS on the SUS questions as consistently “excellent” (average rating across all groups was 84 +/- 17; all subgroups also rated the device highly). Through a qualitative interview process, these stakeholders expressed support for the use of MOCS in the ICU. Based on these data, MOCS has the potential to improve communication for nonvocal patients with limited manual dexterity.
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Gil, Juliá Beatriz. "Afectación emocional asociada al ingreso en una Unidad de Cuidados Intensivos." Doctoral thesis, Universitat Jaume I, 2012. http://hdl.handle.net/10803/386520.
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Las Unidades de Cuidados Intensivos presentan características diferenciales que junto a la gravedad médica del paciente pueden contribuir a que el ingreso en las mismas constituya una experiencia estresante y disruptiva para las personas implicadas.
Desde este marco, la presente tesis doctoral se centra en el análisis del grado de afectación psicológica de pacientes y familiares de UCI, valorando el posible papel modulador de distintos factores en dicha afectación.
De esta manera se pretende mejorar el bienestar y calidad de vida de las personas que, por diversas circunstancias, se ven sometidas al impacto de la experiencia del ingreso en una Unidad de Cuidados Intensivos, bien como pacientes bien como familiares.<br>Differentiating characteristics of the Intensive Care Units and the medical severity of the patient in this context could contribute to become the admission to these units in a very stressful and disruptive experience for those involved.
Within this framework, the thesis focuses on the analysis of the psychological distress of ICU patients and families, assessing the possible modulatory role of different factors in such distress.
In this sense, our objective would be to improve the welfare and the quality of life of people who, for various reasons, suffer the impact of this experience being patient or relative in an ICU.
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Gilson, Sheryl L. "Promoting Early Mobility of Patients in the Intensive Care Unit." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6433.
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Deconditioning occurs in critically ill patients as early as 4 days after entering the intensive care unit (ICU) resulting in a loss of up to 25% peripheral muscle tone and 18% body weight by the time the patient is discharged. Early mobility (EM) has been shown to reduce complications such as neuromuscular weakness, muscle wasting, pneumonia, and the effects of prolonged periods of time on the ventilator. No formal education on EM had been provided to nurses at the clinical site. The purpose of this project was to develop an educational program on EM to promote early ambulation of critically ill ICU patients. The theory of knowledge to action was used to guide the development of the educational program. The practice-focused question addressed whether an educational program would improve nurses' perceptions of their knowledge of EM and if they would promote the use of EM among ICU patients. After a literature review to identify evidence-based practices and a protocol on EM, an educational program was developed that included a 25-item Likert-style pretest and posttest to measure percent agreement with perceptions of knowledge gained and likelihood of behavior change related to the practice of EM. Participants included 60 ICU nurses. Results demonstrated improvement in perceptions of knowledge of EM (from 74% before education to 88% after) and in likelihood of behavior change related to EM (from 69% before education to 91% after). Findings may be used to integrate EM into the ICU setting to reduce complications such as neuromuscular weakness, muscle wasting, and pneumonia. Results may also include improved patient outcomes, reduced length of stay, and increased quality of life for patients and their families, and thereby promote positive social change.
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Berg, Agneta. "Glutamine to ICU patients /." Stockholm, 2007. http://diss.kib.ki.se/2007/978-91-7357-423-5/.
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Olsson, Linda, and Helen Erneholm. "Sjuksköterskors kommunikation med patienter som vårdas i respirator : Nurses’ communication with patients during mechanical ventilation." Thesis, Umeå universitet, Institutionen för omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-99699.
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Aim: The aim of this study was to describe intensive care nurses’ experiences communicating with patients during mechanical ventilation. Methods/design: A qualitative interview study. Interviews where analyzed using descriptive content analysis Setting: Nine intensive care nurses from two different intensive care units were interviewed using a semi structured interview guide. Background: Past research has shown that patients during mechanical ventilation in the intensive care unit, feel very vulnerable and the helplessness of being unable to speak. These patients feels that they are completely dependent on the nurses and their competence. It has been shown to be very important that the patient feels included, acknowledged and respected. Results: The analyzed data resulted in a theme; through communication strive to preserve patients´ dignity and three main categories; create relationship to the patient, minimize patients´ vulnerability and don´t give up. These main categories consist of nine subcategories Conclusion: Critical ill patients during mechanical ventilation have a very limited opportunity to communicate. Therefore the patient is put in a very vulnerable position and is completely dependent on the nurse. This study shows that the nurse by communicating with the patient strive to preserve the patients dignity.
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Walker, Rita L. "Reducing CLABSI Rate Among ICU Patients." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/6144.
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Approximately 55% of intensive care unit (ICU) patients require the use of a central venous catheter (CVC). CVCs are often an essential component of care; however, CVCs can create avenues for pathogens to enter the bloodstream and cause a central line-associated bloodstream infections (CLABSI), which can lead to increased mortality and morbidity, prolonged length of stay, increased cost of care, decreased patient satisfaction, and increased workload. In 2017, the CLABSI rate at the project site was 4.3 per 1,000 catheter days as compared to the national rate of 0.8 per 1,000 catheter days. Based on Piaget's theory of constructivism, a simulation-based staff educational program was developed and implemented by ICU staff (n=20). Following the implementation of the simulation-based program, adherence to CVC maintenance guidelines improved from 41.5% to 87.9%. A sample t-test showed that this improvement was statistically significant and the CLABSI rate declined to 1.24 per 1,000 catheter days in the 4-week period following implementation of the program. Findings show that introducing a simulation-based training program might help to reduce CLABSI rates in the ICU setting and contribute to positive social change by improving health outcomes in ICU patients with a CVC.
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Nolen, Kalie. "Meeting the Needs of Family Members of ICU Patients." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/honors/120.
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The intensive care unit is an extreme environment which houses the most critically ill patients in a hospital. As a result, an array of equipment, IV lines, medications, and sounds that are unfamiliar to the general public can be found. These factors, added to the fragile emotional state of families and friends who have recently admitted a loved one, can be overwhelming. This rush of unforeseen stimuli often leads to feelings of fear and powerlessness (Farrell, Joseph, & Schwartz-Barcott, 2005).
The patients in Intensive Care Units (ICU) are the primary focus of staff; some need virtually continuous care. As a result, the needs of family and friends often go unnoticed. Reasons for this include the supposition that family is bothersome, disruptive, and a distraction from the patient’s care (Farell et al., 2005). Factors such as high patient acuity or limited staffing contribute to this phenomenon as well (Farell et al., 2005).
This lack of attention to family members is often overlooked in the health care environment as families are not given high priority. However, families are expected to make essential decisions regarding their loved one’s care, as well as provide the patient with continuous love and support. The family’s ability to provide love and support for the patient, as well as make decisions about the patient’s care is hindered during periods of emotional distress, especially in situations where patients cannot speak for themselves (Bailey, Sabbagh, Loiselle, Boileau, McVey, 2009). When arriving on the unit for the first time, family and friends are exposed to a high acuity environment as well as circumstances foreign to them, with little education by the nursing staff. For nurses who work in this type of environment daily, it is easy to become desensitized. Desensitization results in a lack of sensitivity to patients and their families, causing increased anxiety due to fear of the unknown. Without effective orientation to the unit, family and friends may assume the worst (Azoulay et al. 2002). Previous research has shown that family satisfaction and understanding of patients’ treatment leads to a better experience for the family, encouraging them to be present and supportive of the patient (Azoulay et al., 2002).
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Vitor, André Luiz. "Protótipo de um sistema especialista para organizações de saúde: Sistema Integrado Orientado a Eventos para Tratamento de Pacientes Críticos." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17157/tde-30032017-104901/.
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O objetivo desse estudo é o desenvolvimento de um sistema especialista em um ambiente hospitalar para apoiar o diagnóstico médico de pacientes críticos com suspeita de Sepse em unidades de terapia intensiva. Como objetivos específicos, a plataforma desenvolvida emitirá alerta após o processamento em tempo real de todas as informações conforme protocolo de sepse da unidade referente a cada paciente como: exames laboratoriais, monitoramentos, integração com o prontuário eletrônico, indicando assim ao médico quais pacientes necessitam de prioridade naquele momento. Os pacientes serão classificados de acordo as informações processadas acima e identificados no sistema com as cores: vermelho (risco eminente), amarelo (médio risco), verde (baixo risco). Tais informações não devem ser tomadas como únicas, mas como técnica auxiliar e principalmente necessárias para as organizações hospitalares que buscam melhorias de desempenho através de soluções integradas orientadas a eventos. Com base na epidemiologia e um estudo longitudinal, o estudo se ocupa a avaliar o sistema desenvolvido identificando através de gráficos e indicadores as seguintes informações: tempo de tratamento na unidade, tempo de decisão do médico, tempo de iniciação com antibiótico, tempo médio de resultados laboratoriais, altas clínicas e mortalidade. Serão utilizadas no estudo duas amostras de grupo de pacientes adultos maiores de 18 anos em uma unidade de terapia intensiva com suspeita de sepse que chegam à Rede Pública de Saúde, comparando através de um estudo epidemiológico longitudinal, pacientes que passaram pela unidade nos três meses com o sistema implantado e outra amostra com pacientes nos três meses anteriores ao sistema.<br>The aim of this study is to develop an expert system in a hospital environment to support the medical diagnosis of critically ill patients with suspected sepsis in intensive care units. The specific objectives, the developed platform will issue warning after real-time processing of all information as unit sepsis protocol for each patient as laboratory tests, monitoring, integration with electronic medical records, thus indicating to the physician which patients need priority at that time. Patients will be classified according the information processed above and identified in the system with the colors: red (imminent risk), yellow (medium risk), green (low risk). Such information should not be taken as single, but as a technical assistant and mainly needed for hospital organizations seeking performance improvements through integrated solutions oriented events. Based on the epidemiology and a longitudinal study, the study is concerned to evaluate the system developed by identifying through graphs and indicators the following information: the unit treatment time, doctor\'s decision time, start time antibiotic, average time results laboratory, clinical and high mortality. Will be used to study two largest group of adult patients samples of 18 years in an intensive care unit with suspected sepsis arriving to the Public Health Network, comparing through a longitudinal epidemiological study, patients who had the unit in the three months to the implanted system and another sample of patients in the three months prior to the system.
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Hawryluck, L. "Consensus guidelines on analgesia and sedation in dying ICU patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0006/MQ46112.pdf.
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Lim, Marilyn Adeline Mei. "Artificial speech for intensive care unit (ICU) patients and laryngectomees." Thesis, University of Canterbury. Electrical and Computer Engineering, 2005. http://hdl.handle.net/10092/6515.
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A method and prototype device to provide artificial speech for intensive care unit (ICU) patients and laryngectomees is presented. The method assists these patients to produce natural sounding speech by "mouthing the words". A review of the current communication techniques for these patients is presented. The limitations of these techniques suggests that there is a need for a device that produces natural sounding speech (pitch variation and glottal sound source that resembles the actual glottal pulse generated by the vibrating vocal folds) and a device that is user friendly. As vocal folds only vibrate during vowel production, only vowel sounds are considered.
Since pitch variation plays a major role in the naturalness of a person's voice, a number of alternative (automatic) pitch control techniques were explored. A unique pitch control technique utilising the changes in jaw height when a person "mouth the words" is presented.
The electroglottographic (EGG) signal is used as the glottal sound source signal for this research as the properties of the EGG signal offers a number of advantages compared with other glottal sound source measurement techniques. A new glottal source model known as the twin-bar model, based on EGG measurements from normal volunteers, is also introduced. This model changes the shape of the glottal pulse based on a single parameter: pitch. Perceptual testing of the simulated voice using the twin-bar glottal model and two other well-known models on volunteers showed that the twin-bar model produces more natural sounding voice than the other two models.
A new artificial speech system combining the automatic pitch control technique (jaw height) and the glottal sound source (twin-bar model) was constructed. It also includes a number of extra functions that would further improves the speech produced with this system. Existing technology on a laptop (e.g. serial port communication, bluetooth transceivers and USB port) is utilised for the construction of the prototype, with the laptop as the signal processing unit. The prototype was tested on a normal subject.
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Sridharan, Mathura J. "Risk stratification of ICU patients using arterial blood pressure waveforms." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/85506.
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Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2013.<br>Cataloged from PDF version of thesis. "May 24, 2013."<br>Includes bibliographical references (pages 109-110).<br>Identifying patients at high risk for adverse events is very important to the practice of clinical medicine. Non-invasive ECG-based methods of risk stratification such as T wave Alterans, Morphological Variability, and Heart Rate Variability extract prognostic information from the electrocardiograph. However, there is still a wealth of data collected from ICU patients and left unused every year that can augment risk-stratification methods. This thesis extends non-invasive risk stratification to Arterial Blood Pressure (ABP) Waveforms. We derive and analyze classifiers based on the morphological distance time series (derived from beat-to-beat morphology changes in the ABP waveform) including ASDNNmd, SDANNmd, rMSSDmd, the MVABP score etc. We also derive and analyze classifiers based on the Downstroke Time Series (derived from the decay from peak systole to diastole) including ASDNNDownstroke, SDANNDownstroke, rMSSDDownstroke, etc. While this body of work suggests the classifiers we developed are not effective in risk stratification of ICU patients, we discuss other methods which may extract prognostic information from the ABP waveform more effectively.<br>by Mathura J. Sridharan.<br>M. Eng.
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Arocha, Doramarie. "Characteristics of Adult ICU Patients with Device Associated Nosocomial Infections." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3135.
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Nosocomial infections are a cause of concern for hospital patients and the incidence rates of these infections are greater in intensive care units (ICUs) due to the invasive nature of treatments, additional risk factors and comorbidities, and therapies used. Invasive devices, such as vascular central lines, Foley catheters, and mechanical ventilators pose a risk for critically ill patients in the ICUs to develop device-related, healthcare-associated infections (HAI). The purpose of this study was to describe the epidemiological characteristics of patients who developed device-related HAIs within 3 ICU units (medical-surgical, cardiovascular, and neurosurgical) of an academic medical facility. The ecosocial theory of disease distribution provided the theoretical framework for the study to describe how ecological and social determinants interact and affect health variances. Secondary data were analyzed using analysis of variance (ANOVA), Pearson correlations, and chi-square statistical tests. A total of 4,213 patients admitted to the 3 ICUs from 2010-2014 were identified. According to the chi-square analysis, there was significant association between race/ethnicity and type of device-associated infection; between gender and types of infection; and between risk factors (diabetes, obesity, smoking habits) and kinds of infection, all of which the statistical significance had varied for each individual ICU. Bacterial differences were noted between device-associated infections. The potential positive social change from this study could be insight on possible new processes and interventions to reduce nosocomial infections and improve adult ICU patient outcomes such as decreased HAIs, decreased length of stay, comorbidities, and cost for both the patient and the hospital.
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Luciano, Gina Maria ACNP-BC. "Oral Health and Ventilator-Associated Pneumonia in Older ICU Patients." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1397511790.
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Skoglund, Aline, and Kelly Thai. "Omvårdnadsbehov hos patienter som lever med implanterbar hjärtstimulator." Thesis, Högskolan i Halmstad, Akademin för hälsa och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-43515.
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Bakgrund: Idag lever många med kardiovaskulära sjukdomar framförallt hjärtarytmier och / eller hjärtstillestånd vilket är en av de vanligaste dödsorsakerna globalt. En hjärtstimulator vars funktion är att stimulera hjärtat till att återgå till en normal hjärtfrekvens. Personer som lever med en implanterbar hjärtstimulator upplever rädsla, oro och ångest relaterat till vardagen då man fruktar för elektriska störningar eller enhetsfel. En personcentrerad omvårdnad är viktig då det underlättar för patienter att leva ett normalt liv som möjligt.Syftet: Syftet med litteraturstudien var att belysa omvårdnadsbehov i form av stöd hos patienter som lever med implanterbar hjärtstimulator. Metod: En litteraturstudie med induktiv ansats och kritisk granskning av 11 artiklar. Resultat: Resultatet delas in i tre teman: Iformation, socialt och professionellt stöd samt Kontinuerlig uppföljning. Information skapar större förståelse samt trygghet hos patienter. Stöd från omvårdnaspersonal och närstående ökade förmågan av sjävlkännedom och självskänsla. Kontinuerliga uppföljningar förbättrade fysiska och psykologiska faktorer, som ökade livskvaliteten. Slutsats: I studien framkom det att information, stöd och kontinuerliga uppföljningar var av stor betydelse för den personcentrerade omvårdnaden. Studien redogör att utterligare kunskaper behövs inom sjuksköterskeprofessionen för att berdiva en god vård- och omsorg.<br>Background: Today many people live with cardiovascular disease, especially cardiac arrhythmias and / or cardiac arrest, which is one of the most common causes of global death. A pacemakers function is to stimulate the heart to return to a normal heart rate. People who live with an implantable cardiac stimulator experience fear, concerns and anxiety related to electrical disturbances and device error in everyday life. Person-centered nursing is important as it makes it easier for patients to live a normal life as possible. Purpose/aim: The aim of the literature study was to highlight the nursing needs in the form of support in patients living with the implantable cardiac defibrillator. Method: A literature study using an inductive approach and 11 articles was critically reviewed. Result: The results are divided into three themes: Information, social and professional support and Continuous follow-up. Information created greater understanding and safety for the patient. Support from nursing staff and relatives increased the ability of self-awareness and self-esteem. Continuous follow-up improved physical and psychological factors that increased the quality of life. Conclusion: The findings of the study were that information, support and continuous follow up were of great importance concerning person-centered nursing. The study reports that additional knowledge is needed in the nursing profession to be able to conduct good care and nursing.
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Trubshaw, Elizabeth Ann. "Implicit emotional memory and post traumatic stress in adult ICU patients." Thesis, University of Leicester, 2016. http://hdl.handle.net/2381/36271.
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Part One: Literature Review: Purpose: Treatment in an ICU is a psychologically traumatic event yet it is unclear what factors independently or cumulatively lead to PTSD in some patients. Method: Electronic databases were searched for articles published between 1960 and 2013. 21 articles were reviewed. Results: The institution that is ICU and memories of the experience contributes to the development of PTSD; however, ecological validity was compromised in many studies. Conclusion: Memory of ICU in PTSD development warrants further exploration. Part Two: Research Report: Introduction: ICU care can result in PTSD, with memories disrupted by sedative and/or analgesic drugs. We examine if a trigger for PTSD flashbacks is an emotionally salient sensory stimulus that occurred whilst sedated. Method: 24 general ICU patients were screened at 1-2 weeks and 4-5 weeks post ICU with commonly used screening tools (PTSS-14, HADS, ICUMT). Skin conductance responses to ICU and other sounds measured implicit memory. Patients’ relatives (n=15) and a non-clinical sample (n=35) also participated. Results: A mixed ANOVA failed to find a significant difference within groups, but did find between group differences F(2,69) = 6.82, p < .05. Positive correlations approaching significance were found for sedation and analgesia with delusional and factual memories. A trend was found for ICU sounds and PTSS. Nine patients reached caseness on the HADS subscales and/or PTSS-14. Conclusion: Replication in a larger sample, ICU-specific screening tools, and intra-ICU and follow up psychological support is recommended. Part Three: Critical Appraisal: Appraisal of the research process was undertaken. Reflections on conducting an independent research project are presented, and learning points highlighted. Part Four: Service Evaluation: A community tenancy of an adult with extremely challenging behaviour was evaluated using a single case study design. The intervention was the package of care. Over time, the frequency and duration of challenging behaviour decreased, tactile and play behaviours increased, and antipsychotic medication significantly reduced. Suggestions for service improvement were made.
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Barker, Tina M. "The Use of Clinical Pathways in Patients with Thoracic Injuries." Kent State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=kent1586891718248184.
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Hebeshy, Mona Ibrahim. "ATTITUDE, SUBJECTIVE NORMS, PERCEIVED BEHAVIORAL CONTROL, AND INTENTION OF EGYPTIAN NURSES TOWARDS PREVENTION OF DEEP VEIN THROMBOSIS AMONG CRITICALLY ILL PATIENTS IN INTENSIVE CARE UNITS." Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1524226281287546.
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Dyer, Annabella. "ICU psychosis : the patient's experience : an investigation of patients' understanding of hallucinations and delusions whilst in intensive care and post-discharge." Thesis, University of East London, 2005. http://roar.uel.ac.uk/3761/.
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This study explores how patients understand their hallucinatory and delusional type experiences whilst in intensive care and how they feel about these experiences after they have been discharged from hospital. The aims were to elicit their subjective accounts in order to gain further insights into the phenomena and to improve clinical practice. The study employed a qualitative methodology and eight participants took part in the research. Participants were interviewed using a semi-structured interview design and the interviews were tape-recorded. The transcripts were analysed using an interpretative phenomenological approach. The analysis revealed four super-ordinate categories: awareness of self and surroundings, dream-like experiences, understanding of dreamlike experiences and adjustment after hospital discharge. These contained several subordinate categories. Participants labelled their hallucinatory and delusional experiences as 'dream-like experiences'. These consisted of various sequences that evoked torturous, threatening and persecutory themes or less frightening themes such as escape and adventure. All participants reported their experiences during intensive care as highly distressing. The participants thought that their dream-like experiences were related to parts of themselves that had been incorporated into their dream sequences. They also acknowledged the role of medication and the intensive care unit context. These experiences had a profound effect on some participants in that they felt it had altered their sense of self whereas others felt they were not disturbed by these experiences. The implications of these findings for future research and clinical practice are discussed.
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Simonpietri, Caroline. "Acquisition et circulation du savoir « profane » et médical pour la prise en charge des maladies chroniques, en France, à l'essor du numérique et de la « démocratie sanitaire »." Thesis, Sorbonne Paris Cité, 2017. http://www.theses.fr/2017USPCB180/document.
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Dans le cadre d'une convention CIFRE, ce travail de thèse porte sur l'acquisition et la circulation d'un savoir "profane" et médical pour la prise en charge des maladies chroniques. Sous la direction de Dominique Desjeux, Professeur émérite, expert en consommation et innovation, nous avons analysé le processus de diffusion de trois "innovations" du système de santé français portées par les institutions depuis le début du 21ème siècle : les associations de patients, l’Éducation Thérapeutique du Patient (ETP), et enfin les NTIC, et plus précisément les serious games. Respectivement sociale, symbolique et matérielle, ces trois solutions ont pour enjeu institutionnel diminuer les coûts de santé en améliorant l'apprentissage de vie des patients avec leur maladie mais également celui des professionnels de santé en formation initiale et continue. Pour chaque solution, dans une démarche qualitative, compréhensive et inductive, nous nous sommes interrogés sur les rugosités pouvant freiner leur réception par l'usager final, des patients ou des médecins. Avec un angle de vue assez original, un regard "socio-anthropologique" au coeur du secteur industriel, nous avons finalement reconstruit une partie du système d'action impliqué dans la circulation de savoirs en santé, profane et médical en cette période de crise sanitaire et d'explosion technologique<br>Within the framework of a "CIFRE convention, this work concerns the acquisition and the circulation of a " lay" and medical knowledge for the care of people who suffer from chronic diseases. Supervised by Dominique Desjeux, emeritus Professor, specialised in consumption and innovation, we have analyzed the diffusion process of three "innovations" of the French health system since the beginning of the 21th century: patients' associations, Therapeutic Education, and finally the ICT, and more exactly the serious games. Respectively social, symbolic and material, these three solutions have, for institutional issues, to decrease the costs of health care and management, by improving the "apprenticeship of life with disease" of patients, but also the professionnals trainning, initial as continuous. For each solution, in a qualitative, comprehensive and inductive approach, we wondered about the roughnesses which can slow down their "reception" by the final user, the patients or the doctors. With a rather original viewpoint, a "socio-anthropological" look at the heart of the branch of occidental industry, we finally reconstructed a part of the "action system" (Crozier, 1963) involved in the circulation of knowledges in health, from patients or medical way, in this transitory period of sanitary crisis and technological explosion