RESUMEN
OBJECTIVE: Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. METHODOLOGY/DESIGN/SETTING: Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. OUTCOME MEASURES: Change in practice and beliefs regarding delirium. RESULTS: McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction. Changes in "Delirium is largely preventable", were statistically significant (p=0.035). Haldol was the medication of choice for treating delirium, with an increase in use (p=0.062) post-intervention. The majority of participants believed a high percentage of patients experience delirium in a trauma intensive care. The two most frequent medical complications associated with delirium pre-questionnaire was over sedation 8 (22%) and falls 9 (24%) and in post-questionnaire, over sedation 12 (26%) and falls 13 (28%). CONCLUSIONS: An educational intervention emphasising the importance of screening for delirium, risk factors for delirium and approaches to decrease the incidence of delirium can improve identifying and correctly treating delirium in a critical care setting. An educational program had concrete results in respondents' knowledge about delirium.
Asunto(s)
Enfermedad Crítica/psicología , Delirio/diagnóstico , Enfermeras y Enfermeros/normas , Heridas y Lesiones/psicología , Adulto , Delirio/etiología , Educación Continua en Enfermería/métodos , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
AIMS: To evaluate an education intervention to decrease restraint use in patients in a Trauma Intensive Care Unit (TICU) and to evaluate nurses' perceptions regarding restraints. OBJECTIVES: To measure restraint use pre/post-intervention and to measure nurses' perceptions of restraint use. METHODS: Pre/post-intervention design to collate incidences of delirium and restraints pre/post-intervention. Data reporting nurses' views and preferences were collected pre-intervention. MEASURES: Patients were assessed by nursing on admission and every shift with the Confusion Assessment Method for TICU. Restraint use was measured in a 24-hour period. Nurses' perception of restraints was measured using Perceptions of Restraint Use Questionnaire (PRUQ). RESULTS: A statistically significant difference was demonstrated in restraint use before and after the educational intervention. Mean and standard deviation for restraints per 1000 patient days pre-intervention was 314.1 (35.4), post-intervention 237.8 (56.4) (p=0.008). Mean PRUQ overall, 3.57 (range 1-5) indicated that nurses had positive attitudes towards restraints in certain circumstances. The primary reasons for using restraints were: "protecting patients from falling out of bed", 37 (72.5%), and "protecting patients from falling out of chair", 34 (66.7%). CONCLUSION: This study demonstrates that a low risk educational intervention aimed at use of an alternative device use can reduce restraint use.
Asunto(s)
Educación Continua en Enfermería/métodos , Enfermeras y Enfermeros/normas , Restricción Física/estadística & datos numéricos , Adulto , Anciano , Arizona , Educación Continua en Enfermería/normas , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros/tendencias , Percepción , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Evaluate change in ventilator associated pneumonia (VAP) and nurse's attitudes, beliefs post implementation of an evidence based practice (EBP) oral hygiene protocol. METHODOLOGY/DESIGN/SETTING: Descriptive pre and post test design in two critical care units in a Level One Trauma Community Hospital. Oral hygiene protocol data was reanalysed to examine effects in medical surgical and trauma subgroups. OUTCOME MEASURES: Oral care practices, attitudes and beliefs among nurses, and VAP rates according to Centers for Disease Control and Prevention guidelines. RESULTS: Trauma rates increased from 6.4% to 10.0% (p=0.346), and medical/surgical rates decreased from 3.3% to 1.0% (p=0.042). Results revealed changes in nurses' beliefs regarding pre-admission colonisation (p=0.027) and having adequate training. Nurses' perception of facility support improved, by having suitable equipment and readily available supplies. Foam swabs with moisture agents at 4hours or less was 88.6% and toothbrush use at 12hours or less was 71%, with significant changes in frequency of oral care post intervention. CONCLUSIONS: Trauma patients present with unique characteristics which compromise oral care. Understanding risk and prognostic factors, mechanisms of transmission and systemic inflammatory response are important when implementing EBP protocols. Nurses' attitudes, beliefs are important, and staff adherence considered when initiating EBP changes.
Asunto(s)
Protocolos Clínicos , Conocimientos, Actitudes y Práctica en Salud , Higiene Bucal/enfermería , Neumonía Asociada al Ventilador/prevención & control , Heridas y Lesiones/enfermería , Adulto , Enfermería Basada en la Evidencia/educación , Femenino , Encuestas de Atención de la Salud , Humanos , Unidades de Cuidados Intensivos , Masculino , Personal de Enfermería en Hospital/educación , Cepillado Dental , Estados UnidosRESUMEN
OBJECTIVE: The purpose of this study was to characterize the relationship between whole brain atrophy rates and three levels of genetic risk for Alzheimer's disease in cognitively normal persons. The authors previously found accelerated whole brain atrophy rates in patients with probable Alzheimer's disease by computing changes in brain volume from sequential magnetic resonance images (MRIs). METHODS: The authors assessed 36 late-middle-aged persons from three genetic groups: those with two, one, and no copies of the apolipoprotein E (APOE) epsilon4 allele, a common Alzheimer's disease susceptibility gene. The participants had clinical ratings, neuropsychological tests, and volumetric T1-weighted MRIs during a baseline visit and again approximately 2 years later. Two different image-analysis techniques, brain boundary shift integration and iterative principal component analysis, were used to compute whole brain atrophy rates. RESULTS: While there were no baseline, follow-up, or between-visit differences in the clinical ratings or neuropsychological test scores among the three subject groups, whole brain atrophy rates were significantly greater in the epsilon4 homozygote group than in noncarriers and were significantly correlated with epsilon4 gene dose (i.e., the number of epsilon4 alleles in a person's APOE genotype). CONCLUSION: Since APOE epsilon4 gene dose is associated with an increased risk of Alzheimer's disease and a younger median age at dementia onset, this study suggests an association between the risk of Alzheimer's disease and accelerated brain atrophy rates before the onset of cognitive impairment.
Asunto(s)
Enfermedad de Alzheimer/genética , Enfermedad de Alzheimer/patología , Apolipoproteína E4/genética , Encéfalo/patología , Edad de Inicio , Anciano , Alelos , Enfermedad de Alzheimer/diagnóstico , Atrofia/patología , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genotipo , Heterocigoto , Homocigoto , Humanos , Procesamiento de Imagen Asistido por Computador , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Análisis de Componente Principal , Factores de Riesgo , Factores de TiempoRESUMEN
We recently demonstrated in subjects referred for the evaluation of cardiovascular disease that coronary atherosclerosis and coronary artery calcium (CAC) were reduced in Hispanics compared with non-Hispanic whites (NHWs). We now evaluate whether this ethnic disparity is present in a unselected healthy cohort of men. Despite the apparently worse risk factor profile, mean and median levels of CAC trended lower in Hispanic men, and the distribution of CAC scores differed from that of NHW (p <0.05), with fewer Hispanic subjects having CAC scores that are generally equated with extensive atherosclerotic burden (>400). These results demonstrate that healthy Hispanic men have reduced CAC compared with age-matched NHW men and this occurs despite evidence for a worse cardiovascular risk profile.