Browsing by keyword "Intensive Care"
Now showing items 1-5 of 5
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Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonizationOBJECTIVE: The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine. DESIGN: Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial. SETTING: Twenty-five US medical center intensive care units. PATIENTS: A total of 960 adult patients requiring central venous catheterization for up to 28 days. INTERVENTIONS: Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480). MEASUREMENTS AND MAIN RESULTS: The primary antimicrobial outcome was a dichotomous measure (/= 15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings. CONCLUSIONS: Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective alternative to catheters externally coated with chlorhexidine and silver sulfadiazine when used in critically ill patients.
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Family Experiences with ICU Bedside Rounds: A Qualitative Descriptive Study: A DissertationThe hospitalization of a family member in an intensive care unit can be a very stressful time for the family. Family bedside rounds is one way for the care team to inform family members, answer questions, and involve them in care decisions. Few studies have examined the experiences of family members with ICU bedside rounds. A qualitative descriptive study, undergirded by the Family Management Style Framework developed by Knafl and Deatrick (1990, 2003) and Knafl, Deatrick, and Havill (2012), was done at an academic medical center examining families who both participated and did not participate in the family bedside rounds. The majority of families who participated (80%) found the process helpful. One overarching theme emerged from the data of participating families: Making a Connection: Comfort and Confidence. Two major factors influenced how that connection was made: consistency and preparing families for the future. Three types of consistency were identified: consistency with information being shared, consistency about when rounds were being held, and consistency with being informed of delays. The second major contributing factor was preparing families for the future. When a connection was present, families felt comfortable with the situation. When any of the factors were missing, families described feelings of anger, frustration, and fear. Family members who did not participate described feelings of disappointment and frustration about not having participated. As healthcare providers, what we say to families matters. They need to be included in decision-making with honest, consistent, easy-to-understand information.
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Intensive care management of the patient with cystic fibrosisCystic fibrosis was previously thought to be a disease of childhood. With a better understanding of this condition along with improvements in therapy, patients with cystic fibrosis are now living well into adulthood. The aim of this article is to familiarize the intensive care unit physician with cystic fibrosis care, to discuss complications associated with cystic fibrosis specifically related to the intensive care unit, and to detail the current recommendations for the clinical management of the patient with cystic fibrosis. With advancing disease, the most severely affected organs are the lungs. Obstruction, infection, and inflammation contribute to the decline of pulmonary function, ultimately leading to death. Some patients may be eligible for lung transplantation, but choosing wisely will affect posttransplant survival. Because other organs are affected by the genetic defect and associated treatments, serious complications related to the liver, pancreas, intestines, and kidneys must be considered by the intensivist faced with a patient with cystic fibrosis. As practitioners, the fact that not all patients will survive and help our patients and families gracefully through the end-of-life process should be accepted.
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Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002BACKGROUND: Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE: We sought to compare the proportions of black and white men receiving aggressive therapy for newly diagnosed nonmetastatic prostate cancer between 1998 and 2002, accounting for the clustering of outcomes by facility. METHODS: We used the Massachusetts Cancer Registry of all cancer diagnosed in residents of Massachusetts. We used logistic regression, clustering by the facility where the tumor was diagnosed, to predict the probability that a patient would receive any aggressive therapy, and the specific therapeutic choices of radical prostatectomy, external-beam radiation therapy, and brachytherapy. Predictors included race, age, poverty, insurance status, marital status, year of diagnosis, and tumor grade. RESULTS: Black men were similarly likely to receive aggressive therapy compared with white men (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.62-1.01). However, there was a racial difference in the receipt of particular types of therapy: black men were significantly more likely to receive radiation therapy (OR 1.39, 95% CI 1.16-1.68) and less likely to receive radical prostatectomy (OR 0.53, 95% CI 0.38-0.74). CONCLUSIONS: Among men diagnosed with nonmetastatic prostate cancer in Massachusetts from 1998 to 2002, black men received aggressive therapy at rates approaching those of whites. However, they were more likely to receive radiation therapy and less likely to receive radical prostatectomy.
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Working as a team to improve patient care in the intensive care unitDoctors and nurses share the same goals for patient care. We are at our best when we function as a part of a multidisciplinary team, with individual team members contributing the perspectives and expertise afforded by their professions. Here, we share our perspectives on what a doctor is and what a nurse is, based on our respective experiences as a critical care physician and an acute care nurse practitioner.
