Notes

Results of upkeep dredging around the macrofauna of the h2o line within a turbid estuary.
Upon emergency department/hospital presentation, 62 patients (52.5%) had a worsening qSOFA score and/ or vital signs and 27 (22.9%) had worsening of multiple parameters. Median time lapse from clinic to emergency department/hospital evaluation was 3.2 hours.

One in 10 patients hospitalized for sepsis had been evaluated in a clinic within 1 day of admission. At that clinic visit, most patients had an elevated qSOFA score or abnormal vital signs and a majority were sent directly to the emergency department/hospital. Half experienced clinical deterioration between the clinic visit and arrival in the emergency department/hospital.
One in 10 patients hospitalized for sepsis had been evaluated in a clinic within 1 day of admission. At that clinic visit, most patients had an elevated qSOFA score or abnormal vital signs and a majority were sent directly to the emergency department/hospital. Half experienced clinical deterioration between the clinic visit and arrival in the emergency department/hospital.
Prone positioning is a standard treatment for moderate to severe acute respiratory distress syndrome (ARDS), but the outcomes associated with manual versus automatic prone positioning have not been evaluated.

To retrospectively evaluate outcomes associated with manual versus automatic prone positioning as part of a pronation quality improvement project implemented by a multidisciplinary team.

A retrospective, descriptive-comparative approach was used to analyze data from 24 months of a prone positioning protocol for ARDS. Vps34-IN-1 The study involved 37 patients, with 16 undergoing manual and 21 undergoing automatic prone positioning. Descriptive and nonparametric statistical analyses were used to evaluate outcomes associated with manual versus automatic prone positioning.

Outcomes were similar between the 2 groups regarding time to initiation of prone positioning, discharge disposition, and length of stay. Manually pronated patients were less likely to experience interruptions in therapy (P = .005) and complications (P = .002). Pressure injuries were the most common type of complication, with the most frequent locations in automatically pronated patients being the head (P = .045), thorax (P = .003), and lower extremities (P = .047). Manual prone positioning resulted in a cost avoidance of $78 617 per patient.

Manual prone positioning has outcomes similar to those of automatic prone positioning with less risk of interruptions in therapy, fewer complications, and lower expense. Further research is needed to determine whether manual prone positioning is superior to automatic prone positioning in patients with ARDS.
Manual prone positioning has outcomes similar to those of automatic prone positioning with less risk of interruptions in therapy, fewer complications, and lower expense. Further research is needed to determine whether manual prone positioning is superior to automatic prone positioning in patients with ARDS.
Patients in intensive care units are 5 times more likely to have skin integrity issues develop than patients in other units. Identifying the most appropriate assessment tool may be critical to preventing pressure injuries in intensive care patients.

To validate the Cubbin-Jackson skin risk assessment in the critical care setting and to compare the predictive accuracy of the Cubbin-Jackson and Braden scales for the same patients.

In 5 intensive care units, the Cubbin-Jackson and Braden assessments were completed by different clinicians within 61 minutes of each other for 4137 patients between October 2017 and March 2018. Bivariate correlations and the Fisher exact test were used to check for associations between the scores.

The Cubbin-Jackson and Braden scores were significantly and positively correlated (r = 0.80, P < .001). Both tools were significant predictors of skin changes and identified as "at risk" 100% of the patients who had a change in skin integrity occur. The specificity was 18.4% for the Cubbin-Jackson scale and 27.9% for the Braden scale, and the area under the curve was 0.75 (P < .001) for the Cubbin-Jackson scale and 0.76 (P < .001) for the Braden scale. These findings show acceptable construct validity for both scales.

The predictive validities of the Cubbin-Jackson and Braden scales are similar, but both are sub-optimal because of poor specificity and positive predictive value. link2 Change in practice may not be warranted, because there are no differences between the 2 scales of practical benefit to bedside nurses.
The predictive validities of the Cubbin-Jackson and Braden scales are similar, but both are sub-optimal because of poor specificity and positive predictive value. Change in practice may not be warranted, because there are no differences between the 2 scales of practical benefit to bedside nurses.
Interest in the pulmonary microbiome is growing, particularly in patients undergoing mechanical ventilation.

To explore the pulmonary microbiome over time in patients undergoing prolonged mechanical ventilation and to evaluate the effect of an oral suctioning intervention on the microbiome.

This descriptive subanalysis from a clinical trial involved a random sample of 16 participants (7 intervention, 9 control) who received mechanical ventilation for at least 5 days. Five paired oral and tracheal specimens were evaluated for each participant over time. Bacterial DNA from the paired specimens was evaluated using 16S rRNA gene sequencing. Bacterial taxonomy composition, α-diversity (Shannon index), and β-diversity (Morisita-Horn index) were calculated and compared within and between participants.

Participants were predominantly male (69%) and White (63%), with a mean age of 58 years, and underwent mechanical ventilation for a mean of 9.36 days. Abundant bacterial taxa included Prevotella, Staphylococcus, Streptococcus, Stenotrophomonas, and Veillonella. Mean tracheal α-diversity decreased over time for the total group (P = .002) and the control group (P = .02). β-Diversity was lower (P = .04) in the control group (1.905) than in the intervention group (2.607).

Prolonged mechanical ventilation was associated with changes in the pulmonary microbiome, with the control group having less diversity. The oral suctioning intervention may have reduced oral-tracheal bacterial transmission.
Prolonged mechanical ventilation was associated with changes in the pulmonary microbiome, with the control group having less diversity. The oral suctioning intervention may have reduced oral-tracheal bacterial transmission.
Findings from 3 nurse-led research studies conducted in a large pediatric institution resulted in a call to action to support intensive and progressive care nurses experiencing moral and ethical challenges.

To evaluate the feasibility of and satisfaction with implementation of a Nurse Education and Support Team (NEST) coach role.

An interdisciplinary work group identified solutions for just-in-time support, including a new NEST coach role. This role was implemented in January 2017 to provide peer-to-peer support for nurses. The NEST coaches provide coverage 5 days per week in 4 intensive care units and 1 progressive care unit. Feasibility of the role was evaluated by assessing the number, type, length, and outcome of NEST coach consultations. Staff satisfaction was evaluated 6 months and 1.5 years after implementation.

A total of 6262 NEST coach consultations occurred across the units from January 2017 through November 2019. At both evaluation periods, more than 85% of respondents indicated that they were satisfied with their interactions with the NEST coach and nearly 80% indicated that they would seek consultation again.

Pediatric intensive and progressive care nurses experience many challenges in their practice environments. The innovative NEST coach role enabled access to just-in-time support and guidance through morally and ethically challenging situations. As evidenced by the number of consultations and the positive staff response, intensive and progressive care nurses have embraced and integrated the NEST coach role into their culture and practice.
Pediatric intensive and progressive care nurses experience many challenges in their practice environments. The innovative NEST coach role enabled access to just-in-time support and guidance through morally and ethically challenging situations. As evidenced by the number of consultations and the positive staff response, intensive and progressive care nurses have embraced and integrated the NEST coach role into their culture and practice.
With telemedicine technology, off-site expert clinicians can consult in real time with bedside nurses and providers. The success of telemedicine may depend on its acceptance by bedside nurses and providers.

To compare nurses' perceptions of telemedicine in 2 intensive care units (ICUs) at Emory University Hospital, an academic medical center, and to determine the relation between nurses' years of ICU experience and their perceptions of telemedicine in the hospital's ICUs (Emory e-ICU Center).

This study used a descriptive correlational design. link3 Nurses in the 2 units completed a demographic form and a questionnaire about their perceptions of the Emory e-ICU Center.

A total of 60 participants completed the study (30 nurses from each unit). Among the entire sample, the perception scores ranged from 2.4 to 5.0, with a mean score of 3.8 (SD, 0.6). Perception scores were significantly higher for nurses in the acute respiratory ICU than for those in the cardiovascular ICU; nurses in the acute respiratory ICU had spent less time working in an ICU. No statistically significant correlation was found between nurses' years of experience in an ICU and their perception scores. This correlation was also not significant within each unit. Nurses' experience with telemedicine in the ICU also did not correlate significantly with perception scores.

Despite differences in nurses' years of experience, the perceptions of the Emory e-ICU Center did not differ significantly among nurses.
Despite differences in nurses' years of experience, the perceptions of the Emory e-ICU Center did not differ significantly among nurses.
As the role of a health care system's influence on nurse burnout becomes better understood, an under-standing of the impact of a nurses' work environment on burnout and well-being is also imperative.

To identify the key elements of a healthy work environment associated with burnout, secondary trauma, and compassion satisfaction, as well as the effect of burnout and the work environment on nurse turnover.

A total of 779 nurses in 24 critical care units at 13 hospitals completed a survey measuring burnout and quality of the work environment. Actual unit-level data for nurse turnover during a 5-month period were queried and compared with the survey results.

Among nurses in the sample, 61% experience moderate burnout. In models controlling for key nurse characteristics including age, level of education, and professional recognition, 3 key elements of the work environment emerged as significant predictors of burnout staffing, meaningful recognition, and effective decision-making. The latter 2 elements also address the crisis of burnout in health care.
Website: https://www.selleckchem.com/products/vps34-in1.html