Acute Care Management Research Articles

Spinal cord injuries: acute care management and rehabilitation

Spinal cord injury can have a devastating effect on patients and their families. An understanding of the mechanism of injury and how this can relate to functional ability assists healthcare professionals to anticipate the care that is required and any difficulties that the patient may encounter. Knowledge of spinal cord injury and the effects on the cardiorespiratory, gastrointestinal and genitourinary systems enables clinicians to provide effective care tailored to actual and potential complications, such as spinal shock and autonomic dysreflexia.

Spinal cord injuries:acute care management and rehabilitation

Spinal cord injuries:acute care management and rehabilitation

Children who harm themselves: development of a paediatric emergency department triage tool

Introduction:Children who harm, hurt or kill themselves are a significant issue for health professionals in emergency departments (ED), with over 60 000 young people presenting to ED in the UK...

A primary care provider’s guide to preventive and acute care management of adults and children with sickle cell disease

To familiarize primary care providers (PCPs) with the pathophysiological processes, diagnostic evaluation, and medical management of sickle hemoglobinopathies and their complications. Current standards of care, clinical research advances, and new treatment options will also be addressed to assist PCPs in the management of sickle cell disease (SCD). A selective search and review of the current literature on SCD and the authors' experience. Management of individuals with SCD is very complex, requiring a multidisciplinary approach that includes the patient or parent, PCP, specialist, nurse, and social worker. More patients living with SCD are relying on PCPs in nonspecialty practices for comprehensive disease management. Newborn screening detects new cases of SCD annually. The median life expectancy has more than doubled for individuals with sickle cell anemia. Healthcare providers are now in an era of increased routine screening, assessment, and management of chronic complications from this illness not previously seen in the care of adults with SCD.

Towards a basic endoscopic evaluation of swallowing in acute stroke – identification of salient findings by the inexperienced examiner

BackgroundDysphagia is common after stroke. Fiberoptic endoscopic evaluation of swallowing (FEES) is a powerful tool for dysphagia assessment. The purpose of this study was to assess whether a previously established endoscopic examination protocol based on the identification of typical findings indicative of stroke – related dysphagia may be learned and adopted by clinicians so far inexperienced in this field.MethodsAfter receiving a structured lecture on this topic, participants were asked to rate video sequences of endoscopic swallowing examinations of acute stroke patients. The first part of the testing ("single findings-rating") comprised of 16 single sequences, the second part ("complete examination-rating") presented the key sequences of 8 complete examinations. Before the second part was started, results of the first were discussed.ResultsAt the "single findings-rating" 88.8% of video-sequences were assessed correctly, while at the "complete examination-rating" the average performance had improved to 96%. Furthermore, no overlooking of relevant pathologies was noted in the second part of the testing.ConclusionThis study suggests that the presented endoscopic examination protocol is reliably interpreted by inexperienced clinicians after a short lecture and may therefore easily and successfully be adopted in dysphagia management of acute stroke care.

Clinical management of acute behavioural disturbance associated with volatile solvent intoxication

Summary This case study reports on the management of a 20-year old girl who presented to an Emergency Department (ED) in a combative and drug affected state. Her acute care management is described. Salient learning tips are presented in respect to some of the dangers associated with substance abuse, the use of physical restraint and pharmacological interventions in managing such patients. The importance of maintaining patient dignity in the physical environment of ED and issues in managing people with ‘challenging behaviours' in EDs are explored. The positive role that appropriately trained mental health nurses can have in these situations is highlighted.

Nontraumatic spinal cord injury part 5: Vascular causes and syringomyelia

Nontraumatic spinal cord injury can be caused by vascular compromise, where the blood supply to the spinal cord is disrupted by haemorrhage, embolism or surgical procedures. Cavitation of the spinal cord (syringomyelia) from a range of causes can also compromise its neurological functioning. In either case the result is often pain and disability with an uncertain prognosis. Rapid diagnosis and treatment may reverse the neurological deficits but for some patients disability is likely to be permanent. Nurses therefore have an important role to play both in the acute care and rehabilitation management of these patients within a specialist health team.

Abdominal obesity: The cholesterol of the 21st century?

Cardiovascular disease (CVD) is a leading cause of morbidity and death in many countries worldwide. With the help of epidemiological, metabolic and clinical studies conducted over the past decades, the key factors contributing to the development of CVD have been identified. In this regard, several modifiable (hypertension, smoking, elevated cholesterol or low-density lipoprotein-cholesterol concentrations, reduced levels of high-density lipoprotein-cholesterol, type 2 diabetes) and nonmodifiable (age, sex, genetic predisposition) CVD risk factors have been recognized. Although better acute care and chronic pharmacological management have contributed to reduce CVD mortality, CVD morbidity remains very high. It has been proposed that this situation could be the consequence of the evolving landscape of CVD risk factors, which include, among others, poor nutritional habits and a reduction in physical activity contributing to the epidemic of obesity sweeping the world. However, obesity is heterogeneous both in terms of its etiology and its metabolic complications. Body fat distribution, especially visceral adipose tissue accumulation, has been found to be a major correlate of a cluster of diabetogenic and atherogenic abnormalities that has been described as the metabolic syndrome. The importance of abdominal obesity in association with the development of CVD and type 2 diabetes has been recognized in several studies, beyond the contribution of overall obesity. Additional evidence also suggests that the CVD risk related to the hyperglycemic state observed in subjects with the metabolic syndrome or type 2 diabetes is largely explained by the high prevalence of the metabolic complications of abdominal obesity. Although the presence of the metabolic syndrome clearly increases CVD risk, its clinical diagnosis is not sufficient to classify a patient at high risk for a cardiovascular event because attention must also be paid to the presence of traditional risk factors in the calculation of global CVD risk. The additional information provided by the metabolic syndrome to the risk attributed to traditional risk factors in the calculation of global CVD risk has been defined as global cardiometabolic risk. The fight against abdominal obesity as a major cause of CVD morbidity and mortality will require major societal changes and the involvement of dieticians, kinesiologists and behaviour modification specialists in clinical practice to reshape our physical activity and dietary habits. Finally, the early prevention of overweight/obesity/abdominal obesity in children, starting as early as conception, and the identification of key drivers of unhealthy nutritional and sedentary behaviours are the cornerstone of a successful comprehensive plan to fight CVD morbidity.

Equivalence of a single saline nebulised dose of formoterol powder vs three doses of nebulised Albuterol every twenty minutes in acute asthma in children: a suitable cost effective approach for developing nations

BackgroundAn increase in asthma prevalence is reported from developed as well as developing nations, with rising costs from acute asthma and great expenditures to health care systems. Venezuela's Ministry of Health ambulatory facilities care for 80% or more of a mostly urban and impoverished population of 26 million inhabitants, registering close to a million acute asthma visits per year; a nebulised fixed fenoterol-ipratropium bromide combination (Berodual®, Boehringer-Ingelheim) in repeated dosing is the standard treatment. Objectivesto simplify acute asthma care and management in a cost effective manner employing Formoterol Fumarate powder, a long acting beta agonist with immediate bronchodilator effects. MethodologyFifty acute asthmatic children (5-12 years old) were randomly assigned (25 patients in each group) to receive either a nebulised single dose (US $1.35) of two 12 μg Formoterol Fumarate capsules (Foradil® 12 μg/cap, Novartis Pharma AG, Basel, Switzerland) diluted in 2.5 ml of sterile saline solution; or 3 doses of Albuterol (US $ 6.73) every twenty minutes for one hour (Glaxo Smith Kline Albuterol ampoules, 2.5 mg/2.5 ml, at a dose of 0.15 mg/kg/dose, maximum dose 2.5 mg). Symptoms score, oxygen saturation and lung function testing were recorded before and one hour after commencing treatments. ResultsBoth groups improved significantly on all parameters, except for FEV 1 in the Albuterol group. ConclusionsSingle dose nebulised Formoterol Fumarate (dry powder) in sterile saline solution, as depicted in this trial, is equivalent to three doses of Albuterol every twenty minutes for one hour in acute asthma in children, simplifying acute care management and at one fifth of medication costs. A pursuit of simpler and more cost effective approaches is found wanting in developing nations with depressed economies and unique cultural and socio-medical contexts; also, in countries where pharmaco-economics orients quality of health policies, novel approaches like this are worth exploring.

Prevention and Management of Outpatient Pediatric Burns

Burns are common injuries in the pediatric population, with an estimated 250,000 pediatric burn patients seeking medical care annually. A relative few require inpatient management. This article discusses suggestions for burn prevention, as well as acute burn care and long-term management of small burns.

Equivalence of a single saline nebulised dose of formoterol powder vs three doses of nebulised Albuterol every twenty minutes in acute asthma in children: a suitable cost effective approach for developing nations

An increase in asthma prevalence is reported from developed as well as developing nations, with rising costs from acute asthma and great expenditures to health care systems. Venezuela's Ministry of Health ambulatory facilities care for 80 % or more of a mostly urban and impoverished population of 26 million inhabitants, registering close to a million acute asthma visits per year; a nebulised fixed fenoterol-ipratropium bromide combination (Bero-dual, Boehringer-Ingelheim) in repeated dosing is the standard treatment. to simplify acute asthma care and management in a cost effective manner employing Formoterol Fumarate powder, a long acting beta agonist with immediate bronchodilator effects. Fifty acute asthmatic children (5-12 years old) were randomly assigned (25 patients in each group) to receive either a nebulised single dose (US $1.35) of two 12 microg Formoterol Fumarate capsules (Foradil 12 microg/cap, Novartis Pharma AG, Basel, Switzerland) diluted in 2.5 ml of sterile saline solution; or 3 doses of Albuterol (US $ 6.73) every twenty minutes for one hour (Glaxo Smith Kline Albuterol ampoules, 2.5 mg/2.5 ml, at a dose of 0.15 mg/kg/dose, maximum dose 2.5 mg). Symptoms score, oxygen saturation and lung function testing were recorded before and one hour after commencing treatments. Both groups improved significantly on all parameters, except for FEV(1) in the Albuterol group. Single dose nebulised Formoterol Fumarate (dry powder) in sterile saline solution, as depicted in this trial, is equivalent to three doses of Albuterol every twenty minutes for one hour in acute asthma in children, simplifying acute care management and at one fifth of medication costs. A pursuit of simpler and more cost effective approaches is found wanting in developing nations with depressed economies and unique cultural and socio-medical contexts; also, in countries where pharmaco-economics orients quality of health policies, novel approaches like this are worth exploring.

Irish voluntary hospitals: an examination of a theory of voluntary failure

This paper examines the success and failure of voluntary hospital organisations in Ireland during the twentieth and twenty-first centuries. The study draws on (and extends) Salamon's theory of voluntary failure by examining the activities of religious organisations responsible for the ownership, management and delivery of acute hospital care. This theoretical perspective identifies a number of dimensions of organisational life for voluntary organisations, which precipitated the demise of organisations as voluntary sector entities, particularly issues of resource-dependency. This study shows that in the Irish hospital context many religiously owned voluntary hospitals have followed the predictable route to failure – culminating either in closure or transfer to public sector ownership, although some others have withstood the difficulties commonly encountered by voluntary organisations (VOs) as outlined by Salamon.

Rehabilitation of the Spine: A Practitioner's Manual, ed 2

Liebenson C, ed. Philadelphia, PA 19106, Lippincott Williams & Wilkins, 2007, hardcover (with DVD-ROM), 972 pp, illus, ISBN: 0-7817-2997-1, $99.95 The purpose of this book, according to its editor, is to provide health care professionals with an evidence-based and active approach to the care of patients with musculoskeletal spinal pain. If the reader allows for the few chapters without primary, peer-reviewed evidence and accepts that an active approach also has a role for manual techniques, the reference work succeeds admirably with its purpose. In the foreword, Waddell reports that this edition builds on the success of the now-classic first edition and features updated evidence, rewritten chapters, new authors, and a DVD that shows readers how to understand and integrate an active approach into clinical practice. The 39 chapters, written by an international and prestigious group of 55 contributors, are organized into the following parts: “Overview,” “Basic Science,” “Assessment,” “Acute Care Management,” “Recovery Care Management,” “Practical Application by …

Development and Evaluation of High-Fidelity Simulation Case Scenarios for Pediatric Resident Education

Pediatric residency programs need objective methods of trainee assessment. Patient simulation can contribute to objective evaluation of acute care event management skills. We describe the development and validation of 4 simulation case scenarios for pediatric resident evaluation. We created 4 pediatric simulation cases: apnea, asthma, supraventricular tachycardia, and sepsis. Each case contains a scenario and an unweighted checklist. Case and checklist development began by reaching expert consensus about case content followed by 92 pilot simulation sessions used for content revision and rater training. After development, 54 first-and second-year pediatric residents participated in 108 simulation test cases to assess the validity of data from these tools for our population. We report outcomes for interrater reliability, discriminant validity, and the impact of potential confounding factors on validity estimates. Interrater reliability (kappa) ranged from 0.75 to 0.87. There were statistically and educationally significant differences in summary scores between first-and second-year residents for 3 of the 4 cases. Neither previous simulation exposure nor the order in which the cases were performed were found to be significant factors by multivariate analysis. Simulation can be used to reliably measure and discriminate resident competencies in acute care management. Rigorous measurement development work is difficult and time-consuming. Done correctly, measurement development yields tangible and lasting benefits for trainees, faculty, and residency programs. Development studies that use systematic procedures and large trainee samples at multiple sites are the best approach to creating measurement tools that yield valid data.

Spinal Cord Injury Medicine. 2. Acute Care Management of Traumatic and Nontraumatic Injury

Wuermser LA, Ho CH, Chiodo AE, Priebe MM, Kirshblum SC, Scelza WM. Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury. This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Decompression of the neural elements, stabilization of the spine, and maintenance of tissue perfusion are fundamental to optimizing outcomes. SCI patients are at high risk of pressure ulcers, venous thromboembolism, stress ulceration, bowel impaction, dysphagia, and pulmonary complications. Physiatric interventions are needed to prevent these complications. Prognostication of neurologic outcome based on early examination is an important skill to aid in creating a rehabilitation plan and to test for efficacy of early interventions. Nontraumatic SCI is an increasing population in rehabilitation centers. Establishing a diagnosis and treatment plan is essential, in conjunction with prevention of complications and early physiatric intervention. Overall Article Objectives (a) To describe the diagnostic evaluation of traumatic and nontraumatic spinal cord injuries and (b) to summarize the medical, surgical, and physiatric interventions during acute hospitalization for these injuries.

Ethical imperatives in staffing and managing a trauma intensive care unit

As U.S. trauma surgery evolves to embrace the concept and practice of acute care surgery, the organization and management structure of the intensive care unit must also grow to reflect new challenges and imperatives faced by trauma surgeons. Key issues to be explored in light of acute care surgery include the role of the traumatologist/intensivist in the intensive care unit, as opposed to the traumatologist without specific critical care training, and a potentially expanded role for nonsurgical intensivists as the critical care time available for trauma/intensivists wanes due to increased surgical and non-critical care patient volume. Each of these changes to the practice of trauma/surgical critical care and acute care surgery are evaluated in light of the primacy of appropriately trained intensivists in the critical care unit. The ethics of providing the best care possible is interrogated in light of different service models in both the university and community settings. The roles of residents, fellows, and midlevel practitioners in supporting the goal of the intensivist and the critical care team is similarly explored. A recommendation for an ethical organizational and management structure is presented.

A New Perspective: A Vulnerable Population Framework to Guide Research and Practice for Persons With Traumatic Brain Injury

Recovery from traumatic brain injury (TBI) can be a tumultuous lifelong and expensive process. Guided therapies for community integration within community systems are a focus of treating therapists around the world, yet there are no published discussions concerning the most fitting community context. We propose a theoretical approach for practice and research using Flaskerud and Winslow's conceptual model of vulnerable populations. Using the model constructs of health status, resource availability, and increased relative risk, we offer empirical support for proposed construct relationships applied to persons with traumatic brain injury. We then propose that interventions for health promotion, acute care, and rehabilitation or chronic disease management have a community focus, and we identify relevant goals for community-based practice and research.

Vaso-occlusion in Children With Sickle Cell Disease: Clinical Characteristics and Biologic Correlates

Vaso-occlusive pain is a frequent manifestation of sickle cell disease, but most clinical studies have documented only those pain episodes for which patients seek acute care or require hospitalization. Based on limited previous studies, the authors suggest that pain episodes managed at home are more frequent then those resulting in acute care management but likely share a common pathophysiology. The authors determined the characteristics of vaso-occlusive pain managed at home in 30 subjects (ages 6-19 years) using a self-report diary daily for 6 months. A total of 175 pain episodes were reported in 4,885 days, with 51% lasting 1 day or less. Severe pain, rated as 7 to 10 on a 10-point scale, was reported on 12% of pain days, but most pain was of mild to moderate intensity. A combination of baseline hematologic parameters and biomarkers assessing erythrocyte/endothelial cell adhesion, including hematocrit, fetal hemoglobin, and adhesion ratio, were statistically significant predictors of pain frequency in statistical analyses. Given the overlap in clinical features and predictive hematologic parameters of home-managed and acute care-managed pain, both likely represent a continuum of frequency and severity rather than distinct clinical entities. The higher frequency of these home-managed episodes suggests their potential utility as additional outcome measures in studies of vaso-occlusive pain.

Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills*

To determine whether full-scale simulation (SIM) is superior to interactive problem-based learning (PBL) for teaching medical students acute care assessment and management skills. Randomized controlled trial. Simulation center at a U.S. medical school. Thirty-one fourth-year medical students in a week-long acute care course. After institutional review board approval and informed consent, eligible students were randomized to either the SIM or PBL group. On day 1, all subjects underwent a simulator-based initial assessment designed to evaluate their critical care skills. Two blinded investigators assessed each student using a standardized checklist. Subsequently, the PBL group learned about dyspnea in a standard PBL format. The SIM group learned about dyspnea using the simulator. To equalize simulator education time, the PBL group learned about acute abdominal pain on the simulator, whereas the SIM group used the PBL format. On day 5, each student was tested on a unique dyspnea scenario. Mean initial assessment and final assessment checklist scores and their change for the SIM and PBL groups were compared using the Student's t-test. A p < .05 was considered significant. The SIM and PBL groups had similar mean (PBL 0.44, SIM 0.47, p = .64) initial assessment scores (earned score divided by maximum score) and were deemed equivalent. The SIM group performed better than the PBL group on the final assessment (mean, PBL 0.53, SIM 0.72, p < .0001). When each student's change in score (percent correct on final assessment minus percent correct on the initial assessment) was compared, SIM group students performed better (mean improvement, SIM 25 percentage points vs. PBL 8 percentage points, p < .04) For fourth-year medical students, simulation-based learning was superior to problem-based learning for the acquisition of critical assessment and management skills.

58 Is Current Acute Skin Care Management in Radiotherapy Evidence-Based?

58 Is Current Acute Skin Care Management in Radiotherapy Evidence-Based?