Повышение качества медицинской помощи путем разработки и внедрения протокола интенсивного сестринского ухода в практику отделения анестезиологии-реанимации и интенсивной терапии

IntroductionDiabetes mellitus is a chronic metabolic disorder characterized by elevated blood glucose levels, affecting millions worldwide. Among the various complications associated with diabetes, skin-related problems represent a significant concern, particularly for newly diagnosed patients. Altered blood circulation, compromised immune responses and nerve damage increase the risk of skin issues in this vulnerable population. Effective nursing interventions are crucial in managing and preventing diabetes-related skin problems. A nursing skin care protocol tailored to the unique needs of newly diagnosed diabetic patients has the potential to reduce the incidence and severity of skin complications, leading to improved patient outcomes and enhanced quality of life. This study aims to assess the efficacy of a nursing skin care protocol in preventing skin-related problems among newly diagnosed diabetic patients. By analyzing the impact of the protocol on patient outcomes and exploring the significance of early intervention and patient education, this research seeks to provide valuable insights into the importance of proactive skin care management in diabetes care.MethodsA randomized controlled trial was conducted at Acharya Vinoba Bhave Rural Hospital in India to evaluate the efficacy of a nursing skin care protocol in preventing skin problems among newly diagnosed diabetic patients. The study included 30 patients who met specific inclusion criteria and excluded those with critical illness or undergoing skin treatment. Data was collected using a questionnaire and standardized tools. Statistical analysis demonstrated the protocol's effectiveness in reducing skin-related issues. The results highlight the importance of early intervention and personalized nursing care in diabetic management, promoting better patient outcomes and overall well-being.ResultsThe results of the study demonstrate the efficacy of the nursing skin care protocol in reducing pruritus and dry skin problems among newly diagnosed diabetic patients. The experimental group showed a substantial improvement, with higher efficacy gains for both pruritus (66.70%) and dry skin (86.70%) compared to the control group (pruritus: 26.70%, dry skin: 33.30%). These findings highlight the potential benefits of implementing the nursing skin care protocol to alleviate skin-related issues in this patient population. The study supports the importance of early intervention and tailored nursing care in managing diabetic skin problems, which could improve patient outcomes and overall well-being.ConclusionIn conclusion, the nursing skin care protocol effectively prevented and reduced skin-related problems among newly diagnosed diabetic patients. The experimental group showed significant improvements in pruritus and dry skin compared to the control group. Early intervention and personalized nursing care are crucial in managing diabetic skin issues and enhancing patient well-being. Implementing the nursing skin care protocol can lead to a better quality of life for diabetic patients by addressing skin concerns. Further research and application of this protocol hold promise for managing skin-related complications in diabetes effectively.

Objective To explore the influence of prospective nursing quality management on the indicators of intensive medicine nursing quality. Methods 446 patients hospitalized into the ward of intensive medicine at our hospital from January, 2014 to December, 2015 were selected and randomly divided into a control group and an observation group, 223 for each group. The control group were cared using traditional nursing care quality management mode and the observation group prospective nursing quality management mode. The indicators of nursing quality were compared between these two groups. Results The incidences of high-risk drug extravasation, unexpected extubation, skin lesions in patients with incontinence, transfusion reaction, and ventilator associated pneumonia were significantly lower in the observation group than in the control group, with statistical differences (P<0.05). Conclusions Applying prospective nursing quality management in ICU can decrease the incidences of adverse events, improve nursing quality, and guarantee the nursing safety of critically ill patients, so it is worth being clinically generalized. Key words: Prospective nursing intervention; Quality management; Intensive care unit; Quality Indicators

Objective: Both critical illness and current care have been hypothesized to upset daily rhythms and impair molecular circadian function. However, the influence of critical illness on clock function in different tissues and on circadian output genes are unknown. Here we evaluate the effect of critical care and illness on transcription, focusing on the functional organization of the core circadian oscillator. Methods: We downloaded RNAseq count data from the Genotype-Tissue Expression (GTEx) project. Treating mechanical ventilation as a marker for intensive care, we stratified samples into acute death (AD) and intensive care (IC) groups based on the documented Hardy Death Scale. We restricted our analysis to the 25 tissues with >50 samples in each group. Using the edgeR package and controlling for collection center, gender, and age, we identified transcripts differentially expressed between the AD and IC groups. Overrepresentation and enrichment methods were used to identify gene sets modulated by intensive care across tissues. For each tissue, we then calculated the delta clock correlation distance (ΔCCD), a comparative measure of the functional organization of the core circadian oscillator, in the both the AD and IC groups. The statistical significance of the ΔCCD was assessed by permutation, modifying a pre-existing R package to control for confounding variables. Results: Intensive care, as marked by ventilation, significantly modulated the expression of thousands of genes. Transcripts that were modulated in ≥75% of tissues were enriched for genes involved in mitochondrial energetics, cellular stress, metabolism, and notably circadian regulation. Transcripts that were more markedly affected, in ≥10 tissues, were enriched for inflammation, complement and immune pathways. Oscillator organization, as assessed by ΔCCD, was significantly reduced in the intensive care group in 11/25 tissues. Conclusion: Our findings support the hypothesis that patients in intensive care have impaired molecular circadian rhythms. Tissues involved in metabolism and energetics demonstrated the most marked changes in oscillator organization. In adipose tissue, there was a significant overlap between transcripts previously established to be modulated by sleep deprivation and fasting with those modulated by critical care. This work suggests that intensive care protocols that restore sleep/wake and nutritional rhythms may be of benefit.

Despite several advances in resuscitation care over the last decade, in-hospital cardiac arrest (IHCA) remains common and is linked to poor survival. Approximately 200 000 hospitalized patients suffer IHCA and undergo cardiopulmonary resuscitation in the United States annually, with fewer than 20%

The aim of the present study was to evaluate the effects of the intensive dental care protocol in preventing oral complications in acute leukemia patients. Thirty-four patients hospitalized for induction remission therapy for acute leukemia were randomly assigned to one of two groups, whether to receive intensive dental care protocol or not. The intensive dental care group of patients received dental treatment and plaque and calculus removal prior to chemotherapy and supervised oral hygiene measures during chemotherapy. The limited dental care group of patients did not receive prechemotherapy dental care. Groups were comparable in age, sex, and antineoplastic treatment received. Patients were examined after admission to the hospital; at the initiation of the chemotherapy; and 7, 14, 21, and 28 days after initiation of therapy. Positive data about subjective difficulties were taken by anamnesis. Oral hygiene index (OHI) and gingival index (GI) were used to assess the periodontal status of the patients. The severity of mucositis was evaluated according to WHO classification. The results of this study pointed out lower mean values of GI and lower mean values of mucositis score in the intensive dental care group of patients during the whole period of examination. Although the differences in mean values were not statistically significant on most of the examination days, intensive dental care group of patients developed less severe and less painful oral complications compared to the limited dental care group of patients. We conclude that proper dental care and preventive measures both before and during chemotherapy can be beneficial to these patients.

Comparison of ventilator-associated pneumonia (VAP) rates between different ICUs: Implications of a zero VAP rate

The increase in prevalence of liver disease globally will lead to a substantial incremental burden on intensive care requirements. While liver transplantation offers a potential life-saving intervention, not all patients are eligible due to limitations such as organ availability, resource constraints, ongoing sepsis or multiple organ failures. Consequently, the focus of critical care of patients with advanced and decompensated cirrhosis turns to liver-centric intensive care protocols, to mitigate the high mortality in such patients. Provide an updated and comprehensive understanding of cirrhosis management in critical care, and which includes emergency care, secondary organ failure management (mechanical ventilation, renal replacement therapy, haemodynamic support and intensive care nutrition), use of innovative liver support systems, infection control, liver transplantation and palliative and end-of life care. We conducted a structured bibliographic search on PubMed, sourcing articles published up to 31 March 2024, to cover topics addressed. We considered data from observational studies, recommendations of society guidelines, systematic reviews, and meta-analyses, randomised controlled trials, and incorporated our clinical expertise in liver critical care. Critical care management of the patient with cirrhosis has evolved over time while mortality remains high despite aggressive management with liver transplantation serving as a crucial but not universally available resource. Implementation of organ support therapies, intensive care protocols, nutrition, palliative care and end-of-life discussions and decisions are an integral part of critical care of the patient with cirrhosis. A multi-disciplinary approach towards critical care management is likely to yield better outcomes.

A 2‐month‐old labrador retriever diagnosed with progressive polyradiculoneuritis was anaesthetised and mechanically ventilated with the aid of pressure control ventilation due to severe hypoventilation and hypoxaemia. Anaesthesia was maintained with propofol and midazolam constant‐rate infusions (CRIs). Over time, once the patient was showing spontaneous breathing attempts and arterial partial pressure of carbon dioxide was within normal range, ventilatory mode was switched to pressure support ventilation. The anaesthetic protocol was modified to maintain an appropriate level of anaesthesia with a minimum amount of fluid administered. The midazolam CRI was substituted by a sufentanil CRI, followed by a change to a dexmedetomidine CRI. An intensive nursing care protocol was established. Intermittent hyperthermia and peripheral oedema were the main complications observed. Ventilatory support was reduced until the patient was successfully weaned from the ventilator at the third attempt, after 116 hours of ventilatory support.

In December 2019, a new Corona virus (SARS-CoV-2) was identified as responsible for outbreak of viral pneumonia in Wuhan, Hubei Province, China. The World Health Organization has announced a pandemic of COVID-19 (Coronavirus disease 2019) on March 2nd 2020. COVID-19 is a respiratory infection where majority of patients have mild clinical symptoms. About 14% of patients require hospitalization and oxygen therapy and 5% of patients require admission to the intensive care unit. The most severe clinical cases include ARDS, sepsis and septic shock, acute renal failure, multiorgan dysfunction, and myocardial damage. Spread of the infection so far indicates that the number of patients requiring hospital admition and intensive care treatment will significantly burden the health care system in all countries. Several intensive and critical care protocols, based on the first experiences in treatment of viral pneumonia and severe COVID-19 illness, have already been published. Here we present the first version of a suggested protocol in our country, with an attached flowchart for the initial management of the COVID-19 patients in need for mechanical ventilation. The protocol is based on the worldwide existing experience in treatment of COVID-19 patients. The intention is not to replace the clinical experience and critical judgment of the attending doctors, but to strengthen their decisions and tailor treatment according to the recourses existing in our country.

Improving the quality of the intensive care follow-up of ventilated patients during a national registration program

National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for Quality Palliative Care, Executive Summary

Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study

Proven Impact of an Advanced Air Purification System in the Reduction of Infectious Airborne and Surface Pathogens, Concomitant Reduction of Hospital-acquired Infections and Length of Stay, and Improvement in Health-care Economics.

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

The results of treatment of overweight patients according to the ERAS-program are presented. We compared different intensive care protocols and proved that it is best to add colecalciferol and sodium D-fructose-l,6-diphosphate hydrate to the main protocol. An increase in the amount of secretory active adipose tissue in the body is accompanied by a decrease in the bioavailability of vitamin D, a decrease in the level of 25(OH)D in the blood increases the level of parathyroid hormone. This leads to secondary changes in calcium-phosphorus metabolism, which makes it impossible to meet the mandatory conditions of the ERAS-program. Among the most important of them is the motor regime, which makes it necessary to fulfill the conditions of physical activity by the patient for at least 8 hours out of bed with full self-care. It was found that the addition of a solution of colecalciferol and a solution of D-fructose-l,6-diphosphate sodium salt of hydrate to the main protocol of perioperative intensive care directly affects the effect of rapid recovery after elective surgery, the quality of motor activity of patients by restoring lost muscle function. This is due to improving the quality of muscle activity as a powerful energy-dependent process against the background of improving the body’s adaptation to exercise, which promotes faster recovery of the cardiovascular response (heart rate) motor activity for 8 hours daily postoperatively. Keywords: overweight, intensive care, ERAS-program, colecalciferol, D-fructose-1,6-diphosphate, motor activity’, heart rate, prognosis.