...Australasian Medical Journal [AMJ 2012, 5, 2, 135-140] Outcome of ventilator-associated pneumonia: Impact of antibiotic therapy and other factors Noyal Mariya Joseph1, Sujatha Sistla1, Tarun Kumar Dutta2, Ashok Shankar Badhe3, Desdemona Rasitha1, Subhash Chandra Parija1 1. Department of Microbiology, 2. Department of Medicine, 3. Department of Anaesthesiology and Critical Care Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605006, India RESEARCH Please cite this paper as: Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Outcome of ventilatorassociated pneumonia: impact of appropriate therapy and other factors. AMJ 2012, 5, 2, 135-140. http//dx.doi.org/10.4066/AMJ.2012.1004. Corresponding Author: Dr. Noyal Mariya Joseph, Assistant Professor, Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Pondicherry – 607 402 (India) Email: noyaljoseph@yahoo.com Please use these fonts and font sizes only. Abstract inappropriate therapy (defined as lack of coverage of one or all the significant VAP pathogens) were at significantly high risk for death (Relative risk, 2.00; 95% confidence interval, 1.14 to 3.52; P 0.0008). A delay of > 2 days in administering the first dose of appropriate antibiotic therapy significantly prolonged the duration of ventilation (P < 0.0001). Infection by multi-drug resistant pathogens, polymicrobial infection and time of onset of VAP did not...
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...Professionals: Weaning from Mechanical Ventilation Samantha Madrid Grand Canyon University Abstract This paper will discuss the weaning of patients off of a mechanical ventilator. It will look at the problems associated with prolonged intubation vs. premature extubation, and what healthcare professionals can do to assess a patients readiness to begin the weaning process. A patient care scenario will be given and an explanation of how nursing practice can evolve with the knowledge from this study will be shown. The accountability of the nursing professional in regards to mechanical ventilation will be visited as well. Accountability of Nursing Professionals: Weaning from Mechanical Ventilation “Mechanical ventilation refers to the use of life-support technology to perform the work of breathing for patients who are unable to do so on their own.” This is the definition of mechanical ventilation according to Cook, Meade, and Guyatt (2000). They performed a study to determine the optimal time to wean a patient off of mechanical ventilation. When weaning a patient you have to find the right time to extubate. Prolonged mechanical ventilation can lead to nosocomial pneumonia, cardiac associated morbidity, and possible death. However, extubating a patient too soon may result in having to reintubate which can result in the same illnesses as prolonged intubation. “Research to date suggests that the best answer to ‘when to start weaning’ is to develop a protocol implemented by nurses...
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...Change in Practice: Preventing Hospital Associated Infections April Shannon Walden University NURS 4000 Section 04, Research and Scholarship for Evidence-Based Practice November 18, 2012 Change in Practice: Preventing Hospital Associated Infections Benjamin Franklin was quoted as saying “an ounce of prevention is worth a pound of cure.” With the increasing costs of healthcare and the emergence of multi-drug resistant organisms this truth still resonates today. Hospital associated infections (HAIs), have been a complication in hospitals for many years. The purpose of this assignment is to address this problem in nursing practice, and discuss evidence on practices that will address this issue. The problem Hospital associated infections (HAIs) can be defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (central line associated bloodstream infections, catheter associated urinary tract infections, surgical site infections, ventilator associated pneumonia, etc.) (World Health Organization, 2002). HAI’s have become one of the leading caused of hospital related deaths in the United States. However, these infections...
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...The accreditation process is designed to assist healthcare establishment to identify and enhance the patient’s safety and the quality of service delivery. This paper presents a review of the readiness Nightingale Community Hospital for accreditation audit. The paper comprises of a periodic performance review of the establishment. The review has focus of several priority areas. These areas include; assessment and care; quality improvement; patient safety, and staffing effectiveness. Trend within the hospital indicates the Nightingale has made significant progress towards fulfilling the standards of the Joint Review Commission. However, the trends in staffing effectiveness are limiting the organization’s compliance. Periodic Performance Review (PPR) The PPR is based on data collected in the Joint Commission Survey. The survey utilized the priority focus methodology to evaluate the compliance of Nightingale Community Hospital. The priority focus process is a methodology that makes use of data to establish priority areas for reviewing compliance. This process has utilized of both external and internal data to evaluate the compliance of Nightingale Community Hospital. This methodology identified several priority areas. These include; assessment and care services; quality improvement activities, and patient safety. This paper evaluates Nightingale’s compliance in these three priority areas. Compliance Status The PPR process has also focused on assess the activities that Nightingale...
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...Title: differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level. Patient Care Scenario Barbara Doherty Grand Canyon University: NRS-430-O102 September 21, 2014 Differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level. Patient Care Scenario “BSN- prepared nurse have a positive impact on lowering mortality rate.” (Tourangeau et. al. , 2007 p.6). As the health care industry is constantly evolving at a fast pace, education is with no doubt one of the most influential aspect that nurses have to conquer to be able to give the best patient care. This paper will argue with solid evidence-based research the differences in educational preparation between a Baccalaureate degree nurse, BSN, and an associate degree nurse, ADN. Different approaches in decision making and patient care will be explained, using a clinical situation, amongst a BSN nurse and ADN nurse showing that BSN nurses make better decisions concerning patient care. Associate Degree Nursing and Baccalaureate Degree Nursing There are three possibilities to become a registered nurse and those are: a 3- year diploma, a 3-year associate degree, which is the equivalent of an ADN degree, and a 4-year baccalaureate degree which is the equivalent of a BSN degree. The ADN program was created by Mildred Montag due to scarcity on nurses. Mildred created a new type of nurse as she explained it...
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...health related states and event of diseases in specified populations and the application of this study to control of health problems”. Severe acute respiratory syndrome (SARS) is contagious and potentially life threatening form of pneumonia which was first detected in February 2003 in Asia and it spread to various countries in Europe, North America and South America before it was declared as SARS 2003 global outbreak (Centers for Disease Control and Prevention, 2004). SARS is an acute respiratory tract illness caused by an infectious virus transmitted from person to person. Various pathogens that cause acute respiratory diseases are respiratory syncytical virus, parainfluenza virus, influenza virus and severe acute respiratory syndrome-associated coronavirus (SARS-CoV) (WHO, 2007). In 2003, various scientists across the world started investigating the virus with the help of electron microscopy and virus discovery microarrays. The new coronavirus was inoculated in monkeys which caused interstitial pneumonia similar to SARS (Holmes, 2003). This newly identified acute viral respiratory syndrome caused by a novel coronavirus is a positive-stranded RNA virus with genome containing nucleocapsid protein, membrane proteins and spike protein which forms the typical “coronavirus” structure (Lashley & Durham, 2007). Spreading of the SARS virus is due to close human-to-human contact such as direct contact with respiratory secretions or body fluids of a patient infected with SARS and...
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...Evidence-Based Practice and Applied Nursing Research Joyce Windham Western Governors University Article Larson, E., Quiros, D., Lin, S. (2007). Dissemination of the CDC’s Hand Hygiene Guidelines and Impact on Infection Rates. American Journal Infection Control, 35, 666-675. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2137889. Graphic BackgroundInformation|This study examines the implementation of the Center for Disease Control and Prevention (CDC) hand hygiene guidelines and analyzes whether compliance impacts patient outcomes, especially hospital acquired infections (HAI). The correlation of hand hygiene (HH) and HAI is very well described in this study. Rates for HAI were determined both pre and post implementation of the guidelines. A structural abstract is included with this study. There is an introduction which explains the intent of the study is to and examine how the CDC guidelines are implemented, the compliance rates for HH and how that relates to HAI rates.| Review of Literature|There have been numerous clinical practice guidelines by federal and professional organizations which were intended to improve quality of patient care and minimize variances in clinical practices. There have been three versions of the HH guidelines with the last version in 2002. There have been few studies done to correlate the practices of HH with HAI rates. This study was conducted in 2007 but is still relevant today. Compliance with HH guidelines...
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...Quinlan School of Business MBA in Healthcare Management program. David A. Moreno, MBA, is a biotechnology business analyst and graduate of the Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at dmoreno1@gmail.com. Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality...
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...mechanism of the disease consists of manifestation as pancreatic insufficiency leading to malabsorbtion and failure to thrive and impaired mucocillary clearance leading to reoccurring chest infections and bronchiestasis (Savage et al. 2011). With the recent advances in treatment of CF which have resulted in increased life span and survival rates, individuals can now expect to live into their fourth decade. Stats from the UK show that CF affects over 9000 people with 4000 under the age of 16 (Williams and Stevens, 2013). Irish stats show a similar pattern where 1200 individuals suffer from CF with 45% being under the age of 18. According to the CF trust (2010) the primary cause of death in individuals with CF is respiratory failure. CF is a progressive respiratory disease which results in an abnormal ventilator response to exercise for individuals with CF (Bradley and Moran, 2008). This contributes to dyspnoea which is a shortness of breath and is a major limiting factor to exercise tolerance in people with CF (O’ Neill, 1987). These exercise limits can add to compliance issues which will be discussed in further detail in later sections. Even though there is clear limiting factors to the benefits of exercise for the treatment of CF, Williams and Stevens (2013) report that rehabilitative exercise programmes form an important component of treatment and...
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...any other Organisation for Economic Co-operation and Development (OECD) country as reported in the March 2009, “Trends in Healthcare Costs and Spending” by Kaiser Family Foundation. Given the unusual relationships in healthcare between consumers, payers, and providers, the ethical implications involved in healthcare decisions, it is nearly impossible to define the “right” amount to be spend in healthcare. As our nation is debating what the appropriate amount to be spend on healthcare is, this project aims on understanding the drivers for this high cost and possible ways to control them. One of the important drivers for this high healthcare cost that we identified and will discuss in this paper is unnecessary care. Although there are number of factors contributing to unnecessary care, this paper focuses on four key issues mainly sterilization, hospital acquired infections, medical errors and hospital readmissions. Sterilization: Background of the issue Hospitals are hygienic paradoxes. It is where patients are cured from diseases and acquire a new one. Hospital hygiene is difficult to achieve. According to the World Health Organization estimates, “more than 1.4 million people worldwide are affected by infections acquired in hospitals” (Cleanhospitals.net). Why are there so many unclean hospitals and what body of people holds them accountable for medical negligence? How do you eliminate hospital-acquired infections (HAIs) and improve hospital hygiene standards? ...
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...Anatomy and Physiology 2, SCI 136 Research project # 40904000 Muscular Dystrophy Definition Muscular dystrophy (MD) refers to a group of more than 30 genetic diseases that cause progressive weakness and degeneration of skeletal muscles used during voluntary movement. The word dystrophy is derived from the Greek dys, which means "difficult" or "faulty," and troph, or "nourish." These disorders vary in age of onset, severity, and pattern of affected muscles. All forms of MD grow worse as muscles progressively degenerate and weaken. Many patients eventually lose the ability to walk (“National Institute,” 2011). Some types of MD also affect the heart, gastrointestinal system, endocrine glands, spine, eyes, brain, and other organs. Respiratory and cardiac diseases may occur, and some patients may develop a swallowing disorder. MD is not contagious and cannot be brought on by injury or activity (“National Institute,” 2011). Method(s) of diagnosis Muscular dystrophies are diagnosed through both the patient’s medical history and a complete family history to determine if the muscle disease is secondary to a disease affecting other tissues or organs or is an inherited condition. It is also important to rule out any muscle weakness resulting from prior surgery, exposure to toxins, current medications that may affect the patient's functional status, and any acquired muscle diseases. Thorough clinical and neurological exams can rule out disorders of the central and/or...
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...Chapter 1 Nursing Images throughout History 1) The angle of mercy 2) The handmaiden 3) The battle-ax 4) The naughty nurse 5) The military image A. Nurses on the battlefield * Hospitalers – specialized soldiers who at the end of battle returned to the outposts to care for the sick and injured * Army nursing service – organize nurses and hospitals and coordinate supplies for the soldiers during the Civil War * Clara Barton a. Provided care in tents set up close to the fighting b. Did not discriminate c. Establishment of the American Red Cross * Harriet Tubman – helped slaves escape to freedom on the underground railroad * Walt Whitman – a poet * Louisa May Alcott – an author * Dorothea Dix – union’s superintendent of female nurses during the Civil War B. Nurses fighting diseases * Florence Nightingale d. Epidemiology – the study of the distribution and origins of disease e. Air, light, nutrition, and adequate ventilation and space assist the patient to recuperate * Lillian Wald & Mary Brewster f. Founded the Henry Street Settlement in NY to improve the health and social conditions of poor immigrants g. Improve health and prevent illness by promoting safe drinking water, adequate sewage facilities, and proper sanitation Florence Nightingale (1820-1910) ...
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...XXXX-XXXXX XXXXXXXXX RECOGNIZING AND ACTING ON CLINICAL DETERIORATION Assignment NUR2100 Due date: April 29, 2013 Computer word count: 1,913 XXXX-XXXXX XXXXXXXXX RECOGNIZING AND ACTING ON CLINICAL DETERIORATION Introduction Nursing has always been a profession that embraces diversity towards rendering holistic patient care. However, with the constant changes in nursing practice; patient safety has been at risk due to nurse’s competence towards detecting impending patient deterioration that may lead to further complications or even death. It is said that the most important practical lesson that can be given to nurses, is to teach them what to observe (Nightingale 1969). Having the ability to observe and interpret critical situations are the essential key features applied in clinical practice. Effective observation of ward patients is the first step in identifying the deteriorating patient and effectively managing their care (Odell, Victor & Oliver 2009, p. 1993). Studies have shown that poor vital sign recording, lack of knowledge, failure to respond to abnormal signs, lack of knowledge, lack of supervision and failure to report deterioration or seek advice, have all contributed to the suboptimal care of ward patients (Odell, Victor & Oliver, cited in McGloin et al. 1999; McQuilla et al. 1998; Smith & Wood 1998; Hodgetts et al. 2002, p. 1993). With constant observation established, patient safety is implemented and surveillance is then incorporated to be able to...
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...Utilization of Continuous Electroencephalography in the Intensive Care Unit TCP1 – Task 2 – Research Paper Patients are admitted to the intensive care unit (ICU) of a hospital for a myriad of disease and injury conditions. Critically ill patients often present with a specific serious health issue that needs to be addressed, however, can often evolve to include secondary problems. Secondary cardiac issues develop from a long list of unrelated heart conditions, and as such, all ICU patients today are placed on bedside electrocardiogram (EKG) monitoring. Years of research, advancements in technology, and international implementation of the service has led to bedside EKG being the standard of care for all ICU patients, regardless of the primary diagnosis. The heart is not the only organ that can often have secondary issues. For decades physicians have tracked and noted secondary neurologic changes in their critically ill patients, but lacked research-based evidence on what caused the neurologic change onset, and how best to monitor and watch for those changes. Over the past two decades, a lot of research has been conducted looking into this specific issue. Research now suggests that the use of continuous electroencephalography (cEEG) for patient populations in the ICU is an effective, affordable, valuable, and prognostic diagnostic tool to evaluate cerebral function, detection of epileptic activity, and to monitor neurologic changes. Electroencephalography (EEG) is...
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...An APIC Guide 2008 Guide to the Elimination of Catheter-Associated Urinary Tract Infections (CAUTIs) Developing and Applying Facility-Based Prevention Interventions in Acute and Long-Term Care Settings About APIC APIC’s mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. The Association’s more than 12,000 members have primary responsibility for infection prevention, control and hospital epidemiology in healthcare settings around the globe. APIC’s members are nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health professionals. APIC advances its mission through education, research, consultation, collaboration, public policy, practice guidance and credentialing. Look for other topics in APIC’s Elimination Guide Series, including: • • • • Catheter-Related Bloodstream Infections Clostridium difficile Mediastinitis MRSA in Long-Term Care Copyright © 2008 by APIC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the publisher. All inquires about this document or other APIC products and services may be addressed to: APIC Headquarters 1275 K Street, NW Suite 1000 Washington, DC 20005 Phone: 202.789.1890 Email: APICinfo@apic.org Web: www.apic.org ISBN: 1-933013-39-7 ...
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