Care Unit Of Hospital Research Articles

Evaluation of Patient Safety Measures in the ICCU at Pune: A Comparative Study Against ISCCM Guidelines

Introduction: This cross-sectional descriptive study evaluated patient safety measures in the Intensive Coronary Care Unit (ICCU) of a tertiary care hospital in Pune, India, over 90 days. Methodology: A validated checklist from the Indian Society of Critical Care Medicine (ISCCM) was used to assess compliance with established guidelines. Result: The ICCU demonstrated high adherence to infrastructure standards and environmental controls. However, gaps were identified, including the absence of a portable CT scanner and inadequate counselling room size, emphasizing the need for further improvements to align with global best practices. Recommendations include investing in a portable CT scanner and expanding the counselling room. This study underscores the importance of adhering to standardized safety protocols in critical care settings to enhance patient outcomes and reduce adverse events.

The development of an intradisciplinary staff training intervention on the optimal management of behavioural and psychological symptoms of dementia: A qualitative study

Introduction: Behavioural and psychological symptoms of dementia (BPSDs) are a group of highly prevalent symptoms in residents with a neurocognitive disorder (NCD), including agitation and depressive symptoms. Caregiving staff often mention knowledge and skills deficits regarding optimal BPSD management. While several staff trainings on BPSDs management exist internationally, their transferability to other clinical contexts is limited, owing to methodological challenges. Therefore, to address this implementation gap, there is a strong need for trainings based on high-quality research to strengthen existing evidence, ensure feasibility and reproducibility. Methods: This qualitative study, part of a larger research project, occurred in 2022 on a long-term care (LTC) center unit and an alternate level of care (ALT) hospital unit located in the Province of Quebec, Canada. This study aimed to: 1) evaluate the needs and perceptions of staff caregivers regarding BPSD management, 2) identify the training content and modalities to prioritize according to experts, 3) develop an intradisciplinary training on BPSD management, and 4) pretest the preliminarily version of the training. Objectives one and two were evaluated using focus groups and objective four using individual cognitive interviews. Qualitative interview data was audio-recorded with participants’ consent, transcribed verbatim, and thematically content analyzed using an established method. Results: Overall, thirteen caregivers participated in objective one (8 from the LTC unit, and 6 from the ALT unit). The main staff training need identified on each site was the management of resident’s aggressive behaviours. Staff verbalized a preference for a virtual training. Objective 2 involved a panel of eight experts. Experts recommended the use of an online training platform, and certain training models and indicators. Based on caregivers and experts’ input, five interactive online staff training capsules lasting from 20-25 minutes each and an algorithm guiding the evaluation and management of BPSDs were created. The training capsules and the algorithm were iteratively improved following cognitive interviews with 4 caregivers from the participating sites. Conclusion: An interactive virtual staff training on BPSD management was created based on staff and expert consultation. The next step in investigation will be to evaluate the feasibility and acceptability of the training.

Evaluation of ventilator-associated pneumonia care practice in the intensive care units of a comprehensive specialized hospital in Northwest Ethiopia: a 1.5-year prospective observational study.

Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

The effect of using low dose norepinephrine before hypotensive resuscitation in hemorrhagic shock; a randomized controlled trial

Background & Objectives: Hemorrhagic shock is not a very rare occurrence in big hospitals. It might be encountered in the emergency room (ER) or in the operating rooms (OR). A rapid response and systematic management will save the life of the victim. The objective of this research was to investigate the impact of a low dose of norepinephrine (NE) administered prior to the initiation of hypotensive resuscitation in patients with hemorrhagic shock. Methodology: This randomized controlled trial was conducted on 200 participants, at least 18 years old, classified as severely traumatized and had significant hemorrhage with mean arterial pressure ranging from 65 to 75 mmHg. We divided the patients into two equal groups. Group I received a low dose of NE (< 0.3 µg/kg/min) concurrently with resuscitation fluids. Group II received resuscitative fluids only. If the resuscitative fluids failed to keep mean arterial pressure (MAP) > 65 mmHg, the patient was progressively administered NE even with high doses (0.05 to more than 0.3 µg/kg/min). The primary outcome was 24-hour mortality. In-hospital mortality, incidence of acute kidney injury (AKI), and duration of hospital and intensive care unit (ICU) stay constituted the secondary outcomes. Results: Group I had lower 24-hour mortality compared to Group II (3% vs 13%; P < 0.05). Compared to Group II, Group I needed reduced amount of fluid resuscitation within 24 h, had lower serum lactate levels at 6 and 12 h, and lower serum creatinine at 6, 12, and 18 h (P < 0.001). Group I had a lower incidence of mechanical ventilation (13% vs 27%), hospital and ICU stays, and in-hospital mortality (9% vs 21%) (P < 0.05). There was a lack of disparity seen in the incidence of AKI and duration of mechanical ventilation. Conclusion: Low-dose norepinephrine infusion during the early period of hypotensive resuscitation reduces resuscitative fluid requirement, improves tissue perfusion, preserves renal function, and lowers mortality in hemorrhagic shock patients. Abbreviations: AKI - acute kidney injury; APACHE III - Acute Physiology And Chronic Health Evaluation III; HS - hemorrhagic shock; ICU - intensive care unit; MAP - mean arterial pressure; NE - Norepinephrine Keywords: Hemorrhagic Shock; Hypotensive Resuscitation; Norepinephrine; Fluid Therapy; Renal Protection; Mortality; Low Dose Citation: Mohamed RM, Anwar AG, Eid AA. The effect of using low dose norepinephrine before hypotensive resuscitation in hemorrhagic shock; a randomized controlled trial. Anaesth. pain intensive care 2024;28(5):914−921; DOI: 10.35975/apic.v28i5.2560 Received: April 17, 2024; Reviewed: August 03, 2024; Accepted: September 04, 2024

Efficacy and Safety of Andexanet Alfa Versus Four Factor Prothrombin Complex Concentrate for Emergent Reversal of Factor Xa Inhibitor Associated Intracranial Hemorrhage: A Systematic Review and Meta-Analysis.

Factor Xa inhibitors (FXaI) are increasingly used for anticoagulation therapy, yet their association with intracranial hemorrhage poses a significant challenge. Although andexanet alfa (AA) and four-factor prothrombin complex concentrate (4F-PCC) have shown promise in reversing FXaI effects, their comparative efficacy and safety remain uncertain. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a literature search on electronic databases to obtain the relevant studies until May 16, 2024. Our primary outcomes were successful anticoagulation reversal, overall mortality (including 30-day and in-hospital mortality), and thromboembolic events. Secondary outcomes were length of hospital and intensive care unit stay and hematoma volume expansion. Data were pooled using a random-effects model. We included 16 eligible studies with a total of 2,977 patients. A statistically significant improvement in hemostatic efficacy rates was in favor of the AA group (risk ratio [RR] 1.10, 95% confidence interval [CI] 1.01-1.20, P = 0.02). Lower overall mortality rates were found in the AA group (RR 0.67, 95% CI 0.51-0.88, P = 0.004). However, no difference was found in 30-day mortality rates (RR 0.82, 95% CI 0.58-1.16, P = 0.26). In terms of thromboembolic events, more events were found in the AA group (RR 1.47, 95% CI 1.01-2.15, P = 0.046). AA was associated with a longer duration of hospital stay compared to 4F-PCC (mean difference [MD] 0.64, 95% CI 0.07-1.22, P = 0.03). Neither a significant difference in length of intensive care unit stay (MD 0.25, 95% CI - 0.36 to 0.86, P = 0.41) nor a significant difference in hematoma volume expansion was reported (MD - 0.89, 95% CI - 3.11 to 1.34, P = 0.435). Our results suggest that AA is superior to 4F-PCC in enhancing the hemostatic efficacy and reducing the overall and in-hospital mortality rates. More thromboembolic events are thought to be associated with the use of AA. However, more studies are required to validate whether the better results of AA in improving hemostatic efficacy are enough to make up for their higher cost and their possible risk of thromboembolic events.

Antifungal susceptibility, molecular epidemiology, and clinical risk factors of Candida glabrata in intensive care unit in a Chinese Tertiary Hospital.

The increasing incidence and high mortality rate of Candida glabrata infection in ICU patients is an important issue. Therefore, it is imperative to investigate the antifungal susceptibility profiles and epidemiological characteristics in local regions. Herein, antifungal susceptibility testing was conducted to determine the minimum inhibitory concentrations (MICs) of eight antifungal drugs. Multilocus sequence typing (MLST) was used to study the strain genotype, geographical distribution, and susceptibility to antifungal agents among C. glabrata isolates. The mechanism of echinocandin resistance was explored by sequencing the FKS1 and FKS2 genes (encoding 1,3-β-D-glucan synthases) of echinocandin-resistant C. glabrata strains. Moreover, we further investigated the clinical manifestations and the various risk factors of patients infected with C. glabrata in the ICU. We selected 234 C. glabrata isolates from 234 patients in the ICU randomly for the follow-up study. Cross-resistance was found among the ICU C. glabrata isolates. Analysis using MLST showed that the genetic diversity among the C. glabrata isolates was low. Furthermore, sequence type showed no correlation with the antifungal resistance profiles, but was associated with geographical distribution. We also revealed novel mutations in FKS1 (S629P) and FKS2 (W1497stop) that mediated high-level echinocandin resistance (MIC >8 µg/mL). More than 14 days' stay in ICU (P=0.007), Acute Physiology and Chronic Health Evaluation II (APACHE-II) score (P=0.024), prior antifungal exposure (P=0.039) and lung disease (P=0.036) were significantly associated with antifungal resistant/non-wild-type C. glabrata infection. Our study shed light on the antifungal susceptibility, molecular epidemiology, and clinical risk factors of C. glabrata in the ICU of a Chinese Tertiary Hospital. Importantly, we revealed the molecular mechanism of echinocandin resistance. These results highlight the significance of continued surveillance in ICUs and provide data support for the treatment of C. glabrata in clinics.

Hepatitis B and C viral infections and correlates among pregnant women in Ilorin, Nigeria: a cross-sectional study

Background: Hepatitis B and C are significant viral infections in pregnancy with high risk of maternal and neonatal complications. This study was conducted to determine the prevalence of hepatitis B and C viral infections and correlates among pregnant women who attended antenatal care (ANC) unit of General and Civil Service Hospitals, Ilorin, Nigeria. Methodology: This was a descriptive cross-sectional study of 282 consented pregnant women randomly selected from the ANC units of two hospitals in Ilorin. Blood samples were collected from the pregnant women and tested for hepatitis B virus (HBV) surface antigen (HBsAg) and anti-hepatitis C virus (HCV) antibody using Enzyme Linked Immunosorbent Assay (ELISA) technique. Socio-demographic and obstetrics information of the pregnant women and potential risk factors for HBV and HCV infections were collected using a pretested structured questionnaire. Statistical analysis was done using SPSS version 22.0 Results: Majority of the women were married (78.4%), from monogamous families (57.8%), do not share sharp objects (65.6%), have not received blood transfusion (65.3%), have no history of organ transplantation (91.1%), and multigravida (61.4%,) in their first (36.9%), second (37.2%) and third (25.9%) trimesters of pregnancy. Overall, 22.3% and 1.4% tested positive for HBsAg and anti-HCV respectively. Family background of the study participants showed significant (p˂0.05) association with HBsAg positivity. None of the other analysed variables showed any significant association with both HBsAg and anti-HCV positivity. Conclusion: This result showed high prevalence of HBV but low prevalence of HCV infections among pregnant women in the study setting. Improved surveillance and routine screening for HBV and HCV for women attending ANC is recommended to reduce disease burden and help achieve WHO goal of eliminating viral hepatitis as a major public health threat by 2030.

The frequency, risk factors, onset time, and outcome of acute kidney injury induced by vancomycin, colistin, and liposomal amphotericin B in hospitalized patients

Introduction: Medications are among the major causes of acute kidney injury (AKI) in hospitalized patients. Objectives: This study aimed to explore the frequency, characteristics, risk factors, and clinical outcomes of AKI induced by vancomycin, colistin, and liposomal amphotericin B (L-AmB) in hospitalized patients across various wards of two educational hospitals in Shiraz, Iran. Patients and Methods: From October 2022 to May 2023, an observational cross-sectional study was conducted in both intensive care unit (ICU) and non-ICU wards of Namazi and Shahid Faghihi hospitals, Shiraz, Iran. Patients aged 18 and older, without a documented history of AKI or chronic kidney disease, scheduled to receive treatment with vancomycin, colistin, or L-AmB for at least one week, were considered eligible. Relevant data, including demographic, clinical, and laboratory findings, were collected. Results: AKI was observed in 36 (34.3%) out of 105 patients during treatment. The incidence rates of AKI were 29%, 55%, and 31.1% in vancomycin, colistin, and L-AmB recipients, respectively. The mean ± SD time to AKI onset was 5.44 ± 2.04 days (range; 3 to 13 days). Dehydration at admission significantly increased the risk of antibiotic-induced AKI (odds ratio [OR] = 3.686, 95% confidence interval [CI] = 1.226–11.081, P = 0.020). Co-administration of aminoglycosides (OR = 8.422, 95% CI = 1.846 – 38.426, P = 0.006), diuretics (OR = 3.763, 95% CI = 1.092–12.965, P = 0.036), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 7.149, 95% CI = 1.534–33.308, P = 0.012) were also identified as independent risk factors. The in-hospital mortality rate was significantly higher in patients with AKI than in those without AKI (8.6% vs. 6.7%; P < 0.044). Conclusion: AKI induced by vancomycin, colistin, and L-AmB occurred in about one-third of our study population, primarily within five days of initiating treatment. Dehydration and co-administration of nephrotoxic medications were significantly associated with AKI. Clinicians should explicitly address these factors in preventive strategies to reduce antibiotic-induced AKI in hospitalized patients.

The relationship between positive end-expiratory pressure (PEEP) and intra-abdominal pressure (IAP) in mechanically ventilated patients: A prospective observational study.

Positive end-expiratory pressure is a crucial mechanical breathing parameter. Intra-abdominal hypertension is well defined as a sustained increase in the intra-abdominal pressure ≥12 mmHg. There are still controversies about mechanical ventilation's effect and use of positive end-expiratory pressure on intra-abdominal pressure. We aimed to delineate the relationship between positive end-expiratory pressure and intra-abdominal pressure in mechanically ventilated patients admitted to the intensive care units of a large tertiary hospital in Upper Egypt. This study was a prospective observational study. The study was conducted at a university hospital from October 2023 to February 2024. The enrolled adult patients were allocated into two groups based on their positive end-expiratory pressure: group I, low pressure (<8 cm H2O) and group II, high pressure (8-10 cm H2O). A total of 120 patients were enrolled, 60 patients in each group. The most commonly encountered diagnoses were pneumonia (32/120, 26.7%) and acute respiratory distress syndrome (ARDS) (31/120, 25.8%), respectively. There was a significant difference between the intra-abdominal pressure mean values of the two patient groups, 18.9 ± 3.3 versus 24.4 ± 5.9 mmHg in the group of low versus high pressure (correlation value of .454, p < .001), respectively. There were highly significant correlations between intra-abdominal pressure categories and the patient groups (correlation value of .495, p < .001). There were 24 (40%) versus 0 (0%) patients of high pressure versus low pressure within the category IV group of intra-abdominal hypertension (>25 mmHg). We observed a significant relationship between positive end-expiratory pressure and intra-abdominal pressure in mechanically ventilated patients. The patient group with high pressure had higher mean values compared with the group with low pressure. The study highlights the importance of closely monitoring intra-abdominal pressure in mechanically ventilated patients who receive positive end-expiratory pressure. Further studies are warranted. The relationship between positive end-expiratory pressure and intra-abdominal pressure is an essential issue in daily critical care nursing clinical practice. Considering the occurrence of multiple organ dysfunction as a result of a non-detected increase in intra-abdominal pressure, critical care nurses should pay attention to measuring this pressure to maintain intra-abdominal pressures that are safe for mechanically ventilated and critically ill intensive care unit patients, thereby preventing these undue effects.

Profile of antimicrobial use and potential use of the defined daily dose in neonatology

One of the measures for monitoring microbial resistance is the calculation of the defined daily dose of antimicrobial agents. For this calculation, the weight of an adult of 70 kg is used as a standard, so that application in neonatology is not possible. The aim of this study is to describe the use profile and calculate the defined daily dose (DDD) of antimicrobials in a neonatal intensive care unit (NICU) of a public hospital in the interior of Bahia, Brazil. From March 2020 to December 2021, the medical records of 712 newborns admitted to a NICU between September 2018 and June 2020 were analyzed. A total of 410 newborns diagnosed with neonatal sepsis were included. The most used antimicrobials per patient were gentamicin (408/410; 99.5%), ampicillin (407; 99.3%), amikacin (29; 7.1%) and oxacillin (21; 5.1%), with a mean (SD) treatment duration of 9.8 (3.9) days. The most commonly used combination of antimicrobials was ampicillin with gentamicin, which was used in 406 patients (99.0%). The values for neonatal DDDs were on average 26 times lower than those for adult DDDs. The neonatal DDDs were similar to those observed in other studies. Ampicilin and cefepime were the antimicrobials for which the greatest differences were observed in neonatal DDDs compared with adult DDDs, which differed mainly between maintenance doses, reflecting the lack of international standards in neonatology. Standardization of DDDs as a surveillance measure has the potential to clarify the pattern of antimicrobial use in neonatal patients worldwide and, in particular, to prevent indiscriminate use and bacterial resistance.

The influence of job enrichment on job embeddedness and sick presenteeism among nurses.

To understand how job enrichment influences job embeddedness and sick presenteeism among nurses. Job satisfaction and retention are critical issues in healthcare, particularly among nurses. Job enrichment has been identified as a potential strategy to enhance job satisfaction and reduce turnover rates. Understanding its impact on job embeddedness and sick presenteeism can inform policies to improve nurse well-being and organizational effectiveness. A cross-sectional descriptive design following STROBE guidelines was used. Data were collected from 360 nurses working in critical care units of a large university hospital. Three scales were used to measure job enrichment, job embeddedness, and sick presenteeism. Nurses reported high job enrichment and embeddedness levels. However, a significant proportion also exhibited high levels of sick presenteeism. Strong positive correlations existed between job enrichment, job embeddedness, and sick presenteeism. Regression analyses revealed that job enrichment significantly predicted job embeddedness and sick presenteeism. The findings highlight the complex interplay between job characteristics, organizational commitment, and employee health behaviors among nurses. Job enrichment emerged as a critical factor influencing job satisfaction, organizational commitment, and sick presenteeism. The study underscores the need for health policies that promote job enrichment strategies, as they can contribute to nurse retention, reduce sick presenteeism, and enhance productivity in healthcare settings. Nurse retention and job satisfaction can be improved by implementing job enrichment practices in healthcare organizations. Policies to reduce sick presenteeism should prioritize creating healthier work environments and promoting employee well-being. Understanding the cost-effectiveness and productivity gains associated with job enrichment can inform workforce planning and staffing policies, ensuring adequate nurse staffing levels and quality patient care.

Postoperative Complications in Lingual Versus Palatine Tonsillectomies.

The aim of this study was to investigate the risks of lingual tonsillectomy (LT) in a large cohort and compare these risks to those of palatine tonsillectomy (PT). A retrospective cohort study was conducted using data from the United States collaborative network within TriNetX. The LT group was defined using Current Procedural Terminology (CPT) code 42870 and PT group using CPT codes 42820, 42821, 42825, or 42826. Groups were further subdivided into pediatric and adult populations and matched based on propensity scores within the cohorts. Complications occurring within 14 days of procedure were compared within each cohort. There were 1,357 adult patients (mean age, 42.9 years) and 863 pediatric patients (mean age, 8.1 years). Adults who had LT were more likely to experience postoperative dysphagia (OR = 2.6, p < 0.001) and require admission to the hospital (OR = 4.3, p < 0.001) or intensive care unit (OR = 6.1, p < 0.001). There was no significant difference in bleeding between adult PT and LT groups, occurring at rates of 3.8% and 4.4%, respectively (p = 0.50). Pediatric patients who had LT were also more likely to experience postoperative dysphagia (OR = 2.4, p = 0.017) and require admission to the hospital (OR = 8.2, p < 0.001) or intensive care unit (OR = 2.7, p = 0.012). The postoperative bleed rate was 3.2% in the pediatric PT cohort, which was 2.4 times higher compared to those who underwent LT (1.5%, p = 0.016). Postoperative complications after lingual tonsillectomy are more common than after palatine tonsillectomy in both adults and children. III Laryngoscope, 2024.

The effectiveness of early mobilisation on physical function in patients after heart valve surgery: a systematic review

Background/Aims Literature suggests that early mobilisation, defined as the initiation of physical activity within 48 hours following surgery, improves outcomes after cardiac surgery. This systematic review assessed the effectiveness of early mobilisation on physical function and other outcomes, including length of hospital stay and cost following heart valve surgery. Methods The Physiotherapy Evidence Database, MEDLINE, EMBASE, CINAHL and Cochrane Library were systematically searched from inception until May 2022 using relevant key words. Randomised controlled trials comparing early mobilisation and usual care for patients who had received heart valve surgery were included in the review. Methodological quality was assessed using the Physiotherapy Evidence Database scale and risk of bias using the Cochrane Risk of Bias 2 tool. The data were narratively synthesised. Results The search identified 210 articles, with 98 remaining after duplicates were removed. Upon screening for eligibility, nine articles were assessed in full and three randomised controlled trials involving 161 patients were included in the review. Early mobilisation protocols varied across trials. Two trials (n=124) reported significantly greater improvement in physical function with early mobilisation compared to usual care, including handgrip strength (P=0.001). One study (n=41) found early mobilisation significantly reduced the length of hospital stay (P=0.000), in-hospital care costs (P=0.000) and intensive care unit stay (P=0.000) compared to usual care. Methodological quality scores ranged from six to nine on the Physiotherapy Evidence Database scale. The risk of biased judgement was ‘low’ in one study and ‘some concerns’ in two studies. Conclusions Early mobilisation may improve physical function and reduce hospital and intensive care unit stays after heart valve surgery. However, differences in protocols and limited studies indicate further high-quality research is needed, particularly regarding cost-effectiveness. Establishing clear early mobilisation protocols could enhance recovery in this population. Implications for practice Early mobilisation may require the coordinated effort of a multidisciplinary team of physiotherapists, nurses and possibly other medical professionals. For its seamless and effective implementation, it is essential to understand whether this intervention falls under the domain of physiotherapists or requires broader team collaboration. Given these complexities, strategies targeting early mobilisation that balance both safety and resource considerations are advised to improve physical function after heart valve surgery, especially among patients who are frail.

Evaluation of efficacy of oral calcium phosphate as an adjunct to standard-of-care regular phototherapy in cases of neonatal jaundice: a hospital-based double-blind, randomised, placebo-controlled trial

ObjectiveNeonatal jaundice is the most common cause of neonatal morbidity and rehospitalisation in the first week of life, affecting approximately 60% of term and 80% of preterm neonates, with 10%...

Should I Stay or Should I go? Resilience, Intention to Quit and Job Satisfaction among Nurses in Intensive Care Units

Addressing the global nursing shortage is crucial to both national and international public health efforts. This paper aims to highlight the importance of resilience and its impact on primary care nurses' job satisfaction and intentions to quit, especially in the face of current challenges. The study utilized a mixed methods design involving nurses in intensive care units of a university hospital in Austria. In the first phase of data collection, qualitative focus group interviews were conducted to gather insights on the current challenges and stressors faced by nursing professionals. Building on relevant literature, a quantitative survey was then administered to all nurses, using scales measuring resilience, intention to quit, and job satisfaction in order to examine the relationships between these variables. In addition, a data structuring of the resilience scale by factors was achieved with the help of confirmatory factor analysis. Subsequently, the correlations of the resilience factors with the other variables were examined by means of an additional correlation, regression and mediation analysis. The results showed negative correlations with regard to resilience and intention to quit as well as with regard to job satisfaction and intention to quit. In contrast, job satisfaction and resilience correlated significantly positively with each other. The negative correlation between resilience and the intention to quit was confirmed, but only for the factors "goal focus" and "pride and commitment". A closer examination of the two factors and their associated items revealed a connection to both professional identity and organizational identity. This study provides valuable insights for health care leaders and health care decision makers to effectively lead, develop, and thereby retain primary care nurses. The authors argue that improving resilience and strengthening organizational identity are important influencing factors in increasing job satisfaction and reducing nurses' intention to quit.

Serratia marcescens outbreak at a neonatal intensive care unit in an acute care tertiary hospital in Singapore

To report the epidemiological, diagnostic, and genetic investigation of an outbreak of neonatal patients infected or colonized with Serratia marcescens (S. marcescens) including the infection control interventions. Outbreak investigation report. 28-bedded neonatal unit in an acute care tertiary hospital in Singapore divided into three areas: two negative-pressure airborne infection isolation rooms with a shared anteroom, 10 neonatal intensive care unit (NICU) beds, and 16 high dependency beds. A total of five neonates were involved in this outbreak. Screening of in-flight patients and their immediate environment for S. marcescens to determine probable environmental sources, whole genome sequencing (WGS) analysis of resulting isolates to determine clone-relatedness and possible transmission patterns. Implementation of infection control interventions included prompt isolation of cases, enhanced equipment and environmental disinfection, use of alcohol-based hand rub as the preferred hand hygiene mode, enhanced infection prevention orientation for parents, review of practices, audits, and immediate feedback on non-compliance. Five neonates infected or colonized with S. marcescens were involved in this outbreak. Four were infection cases whilst one identified through contact tracing. Three NICU sinks and the milk preparation room sink were tested positive for S. marcescens. WGS confirmed clonality of strains from two NICU sinks, and milk preparation room sink with that of the five neonates. Multiprong strategy was required to contain this outbreak. WGS analysis showed association of biofilms in sinks with the outbreak.

Fluid bolus resuscitation with hypertonic saline albumin solution in critically ill children: a prospective observational pilot study

To evaluate the hemodynamic effects and the safety profile of fluid bolus resuscitation with hypertonic saline albumin (HSA) in critically ill children, we performed a prospective observational pilot study between October 2018 and May 2021 in the pediatric intensive care unit (PICU) in a tertiary hospital in Madrid, Spain. Sixty-four HSA boluses were analyzed in 23 patients. A mean volume of 5.7 ml/kg (Standard Deviation, SD 2.3 ml/kg) per bolus was infused. Acute hypotension was the main indication. 91% of the patients had a cardiac disease, 56% of them had undergone cardiac surgery in the previous 72 h, and 47.8% associated right ventricular dysfunction. A significant increase in systolic, mean, and diastolic blood pressure and a decrease in the vasoactive index was observed after the infusion of HSA. This effect lasted for twenty-four hours (p < 0.05). Moreover, the amount of fluid requirements decreased significantly in the 6 h following HSA infusion [8.7 ml/kg (SD 9.6) vs. 15.1 ml/kg (SD 13.6) in the previous 6 h (p < 0.05)]. Serum levels of sodium and chloride increased after the infusion, reaching their peak concentration after one hour (143 mEq/L (SD 3.5) and 109.7 mEq/L (SD 6) respectively). HSA-related metabolic acidosis or acute kidney injury were not observed in this study. Hypertonic saline albumin is safe and effective when infused at a dose of 5 ml/kg in critically ill children. However, further research is required to confirm our findings.

Early Tracheostomy in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation

BackgroundEarly tracheostomy (ET) can decrease length of stay and mortality. The benefits of ET in patients requiring venovenous (VV) extracorporeal membrane oxygenation (ECMO) remain contentious. We assessed the influence of ET on outcomes in patients requiring VV ECMO. MethodsWe queried a multiinstitutional ECMO registry to evaluate patients requiring VV ECMO for severe acute respiratory distress syndrome and compared outcomes between ET and late tracheostomy (LT) groups. Outcomes of interest included time to decannulation, extubation, discharge, survival, hospital, and intensive care unit length of stay (LOS). Univariate analyses of continuous and categorical variables were performed using t tests and χ2 tests where appropriate. Multistate Cox proportional hazards models and generalized linear models were used for multivariable analysis. ResultsOur sample comprised 133 patients, 88 who underwent ET and 45 who underwent LT. Patients who underwent ET were younger (P = .046), had a higher body mass index (P = .046), and had higher respiratory ECMO survival prediction (RESP) scores (P < .001). The number of days from ECMO to tracheostomy was 1.65 ± 1.26 days in the ET group and 13.6 ± 10 days in the LT group. There were no statistically significant differences in time to decannulation between the 2 groups. Univariate analysis demonstrated that patients with ET had a shorter interval and higher survival to extubation. Multivariable analysis demonstrated that patients with ET had a shorter duration to extubation (P = .03), time to discharge (P = .013), intensive care unit LOS (P = .012), and hospital LOS (P = .044). There was no significant difference in survival (P = .83) or time to decannulation (P = .12) between the 2 cohorts. ConclusionsExtracorporeal support involves high-intensity resource use. ET in patients requiring VV ECMO may improve outcomes and decrease resource consumption.

Diagnostic Approach to the Patient with Altered Mental Status.

Acute encephalopathy is a common presenting symptom in the emergency room and complicates many hospital and intensive care unit admissions. The evaluation of patients with encephalopathy poses several challenges: limited history and examination due to the patient's mental status, broad differential diagnosis of systemic and neurologic etiologies, low yield of neurodiagnostic testing due to the high base rate of systemic causes, and the importance of identifying less common neurologic causes of encephalopathy that can be life-threatening if not identified and treated. This article discusses the differential diagnosis of acute encephalopathy, presents an approach to the history and examination in a patient with encephalopathy, reviews the literature on the yield of neurodiagnostic testing in this population, and provides a diagnostic framework for the evaluation of patients with altered mental status.

Clinical profile of newborns admitted in Special Newborn Care Unit of a tertiary teaching hospital of Arunachal Pradesh: A Retrospective Cross Sectional Study

Introduction: The neonatal period presents the greatest daily risk of death compared to any other stage of childhood. Objective: To study the clinical profile of neonates admitted in Special Newborn Care Unit (SNCU) in a tertiary teaching hospital of a tribal area. Materials and Methods: A retrospective case record analysis of all admissions between January 2017 to December 2022 was done based on medical record data. The neonates with complete record were included in the study. Results: Total of 1476 newborns were admitted from the year 2017 to 2022 in SNCU of TRIHMS, out of which, 860 (58.3%) patients were male and 612 (41.5%) were females. 84.4% admissions were inborn and 15.6% were outborn patients. Major causes of admission were neonatal jaundice (22.4%) followed by prematurity (15.4%), neonatal sepsis (15.1%) and birth asphyxia (11.4%). The outcome rates for survival, referral, deaths and LAMA were 79.3%, 9.7%, 5.8% and 5.1% respectively. The leading causes of mortality were birth asphyxia (22.3%), prematurity (21.2%) and sepsis (11.8%). Conclusion: In our SNCU, common causes of deaths are birth asphyxia, prematurity, sepsis respiratory distress syndrome and congenital heart disease. Enhancing antennal care, improving access to healthcare facilities, ensuring timely referral of high risk cases, building capacity and providing intensive interventional management can significantly reduce neonatal mortality and its associated complications. Surveillance and training interventions for managing these causes should be established and reinforced. Keywords: Neonates, morbidity, mortality, preterm, sepsis.