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ntal workload of cardiopulmonary resuscitation providers. There was no change in team leader workload.OBJECTIVES Children with developmental disabilities are at high risk for developing delirium when critically ill. However, existing pediatric delirium screening tools were designed for children with typical development. The objective of this study was to improve the specificity of the Cornell Assessment for Pediatric Delirium, to allow for accurate detection of delirium in developmentally delayed children admitted to the PICU. We hypothesized that the Cornell Assessment for Pediatric Delirium, when combined with fluctuation in level of awareness as measured by the Richmond Agitation-Sedation Scale, would be valid and reliable for the diagnosis of delirium in developmentally delayed children. DESIGN Prospective observational double-blind cohort study. SETTING Tertiary care academic PICU. LY2880070 cell line PATIENTS Children with moderate to severe developmental delay. INTERVENTIONS Each child was evaluated by the bedside nurse with the Cornell Assessment for Pediatric Delirium once every 12 hours and the Richmond Agitation-Sedatsessments were performed by two or more psychiatrists in a blinded fashion. There was perfect agreement (κ = 1), indicating reliability in psychiatric diagnosis of delirium in developmentally delayed children. CONCLUSION When used in conjunction with Richmond Agitation-Sedation Scale score fluctuation, the Cornell Assessment for Pediatric Delirium is a sensitive and specific tool for the detection of delirium in children with developmental delay. This allows for reliable delirium screening in this hard-to-assess population.OBJECTIVES Despite the ubiquitous role of pharmacotherapy in the care of critically ill children, descriptions of the extent of pharmacotherapy in critical illness are limited. Greater understanding of drug therapy can help identify clinically important associations and assist in the prioritization of efforts to address knowledge gaps. The objectives of this study were to describe the diversity, volume, and patterns of pharmacotherapy in critically ill children. DESIGN A retrospective cohort study was performed with patient admissions to the ICU between July 31, 2006, and July 31, 2015. SETTING The study took place at a single, free-standing, pediatric, quaternary center. PATIENTS Eligible patient admissions were admitted to the ICU for more than 6 hours and received one or more drug administration. There were a total 17,482 patient-admissions and after exclusion of 283 admissions (2%) with no documented enteral or parenteral drug administration, 17,199 eligible admissions were studied. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 17,199 eligible admissions were admitted to the ICU for 2,208,475 hours and received 515 different drugs. The 1,954,171 administrations were 894,709 (45%) enteral administrations, 998,490 (51%) IV injections and 60,972 (3%) infusions. Infusions were administered for 4,476,538 hours. Twelve-thousand two-hundred seventy-three patients (71%) were administered five or more different drugs on 80,943 of patient days (75%). The 10 most commonly administered drugs comprised of 834,441 administrations (43%). CONCLUSIONS Drug administration in the ICU is complex, involves many medications, and the potential for drug interaction and reaction is compounded by the volume and diversity of therapies routinely provided in ICU. Further evaluation of polytherapy could be used to improve outcomes and enhance the safety of pharmacotherapy in critically ill children.BACKGROUND In patients with hypoalbuminemia after craniotomy, total serum concentrations of valproic acid (VPA) may provide poor clinical insights, owing to saturated protein binding and increased unbound fractions. However, very few clinical laboratories routinely analyze free concentrations of the drug. The aim of this study was to develop a model to predict serum-free and cerebrospinal fluid (CSF) levels of VPA based on its total concentration and to investigate the model's applicability. METHODS Total serum and CSF concentrations of VPA in 79 patients were measured using a validated immunoassay between January and December 2015. The demographic, clinical, and laboratory information of patients were retrieved from medical records. A multiple linear regression analysis was adopted to determine the potential variations and establish the functional relationship between CSF concentration and significant clinical factors. RESULTS Based on the stepwise multiple linear regression analysis performed using the natural logarithm of the concentration (LN C) of VPA in the CSF as the dependent variable, serum concentrations of VPA (X1, β' = 0.844), serum albumin concentration (X2, β' = -0.393), and CSF protein concentration (X3, β' = 0.098) were identified as the three variables that significantly predicted the dependent variable; Ŷ=2.356+0.024X1-0.059X2+0.044X3, with a coefficient of determination (R) of 0.874. link2 As the CSF protein level is often unavailable, the model was redefined to include two variables-serum concentrations of VPA (X1, β' = 0.840) and serum albumin concentration (X2, β' = -0.359). Ŷ=1.706+0.024X1-0.039X2, R = 0.813. CONCLUSIONS Based on total VPA and serum albumin concentrations, we developed a model to predict serum-free and CSF levels of VPA. This model is useful for correcting dose adjustment in patients with hypoalbuminemia post craniotomy.BACKGROUND Women have worse stroke outcomes than men, and almost 17% of all stroke cases have symptom onset when admitted to the hospital for a separate condition. link3 OBJECTIVE The aim of this study was to investigate the distinctive factors that impact the activation of an in-hospital stroke code and outcomes in women who have a stroke while admitted to the hospital for a separate condition. METHODS A retrospective observational propensity score study guided by the model for nursing effectiveness was used. RESULTS In-hospital stroke code was activated in 46 of 149 or 30.9% of women and 15 of 149 or 10.1% of women received thrombolytic therapy. Activation of an in-hospital stroke code was significant (P less then .001) for women receiving thrombolytic therapy and significant to a home discharge status (P = .014). Age (P less then .001), ethnicity (P less then .001), common (P ≤ .001) and unique (P = .012) stroke symptoms, stroke risk factors (P less then .001), comorbid conditions (P less then .001), time last known well (P = .041), and diagnostic imaging (P less then .001) were all significantly related to activation of an in-hospital stroke code. CONCLUSIONS Activation of an in-hospital stroke is a key indicator for women to receive thrombolytic therapy and be discharged to home. Younger married women from non-Caucasian ethnic groups and women with stroke risk factors and comorbid conditions are at a greater risk for delayed stroke symptom detection and not having an in-hospital stroke code activated. Awareness of these factors that hinder early stroke detection in women is crucial to improving stroke treatment and outcomes in women.STUDY DESIGN Retrospective analysis using data from RCTs OBJECTIVE. This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis. SUMMARY OF BACKGROUND DATA Cervical disc prostheses were introduced to prevent ASD in the post-surgical follow-up. However, it is still a controversial issue. METHODS 253 Patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level. RESULTS Radiological ASD was present in 34% of patients at baseline and increased to 59% at two-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up. CONCLUSIONS Radiological ASD occurs in a similar manner in patients that were subjected to arthrodesis in cervical radiculopathy and in patients that received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent. LEVEL OF EVIDENCE 2.OBJECTIVE The aim of the study was to explore how the term patient safety is understood by healthcare professionals (nurses, educators, doctors, ward managers, senior managers, and health assistants), all of whom are responsible for promoting the patient safety agenda in the Bhutanese healthcare system. METHODS The study was conducted as a naturalistic inquiry using qualitative exploratory descriptive inquiry. A purposeful sample of 94 healthcare professionals and managers was recruited from three different hospitals, a training institute, and the Ministry of Health. Data were collected via in-depth individual interviews. All data were subsequently analyzed using thematic analysis strategies. RESULTS Data analysis revealed variation in the understanding of patient safety among healthcare professionals. Although most participants understood patient safety as fundamentally concerning "doing no harm" or "reducing the risk of harm or injuries" to patients, some understood patient safety as simply having sturdy infrastructure/buildings with sufficient space to manage public health emergencies such as earthquakes, floods, and epidemics. Some confused patient safety with quality of care and patient rights. CONCLUSIONS Inadequate understanding of the term patient safety has potential to hinder improvement of patient safety processes and practices in the Bhutanese healthcare system. To improve patient safety in Bhutan's healthcare system, patient safety training and education need to be provided to all categories of healthcare professionals.OBJECTIVES Many countries and organizations have promoted the disclosure of patient safety incidents (DPSI). However, reporting frequency and quality of DPSI fall short of patient and caregiver' expectations. In this study, we examined the attitudes toward DPSI of the general public representing the Korean population. METHODS Survey questions were developed based on a previous systematic review and qualitative research. Face-to-face interviews using paper-based questionnaires were conducted. We explored attitudes toward DPSI in various scenarios and opinions on methods to facilitate DPSI. RESULTS Almost all participants answered that it is necessary to disclose major errors (99.9%) and near misses (93.3%). A total of 96.6% (675/699) agreed that "DPSI will lead physicians to pay more attention to patient safety in the future," and 94.1% (658/699) agreed that "DPSI will make patients and their caregivers trust the physician more." Although 79.7% (558/700) agreed that "apology law will limit patients' ability to prove physicians' negligence," 95.
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