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Sample records for national sepsis practice

  1. Quality in practice: preventing and managing neonatal sepsis in Nicaragua.

    PubMed

    López, Sergio; Wong, Yudy; Urbina, Luis; Gómez, Ivonne; Escobar, Flavia; Tinoco, Bernarda; Parrales, Alba

    2013-10-01

    Incorrect and excessive diagnosis of newborn infections in Nicaragua caused overcrowding in the neonatal intensive care units and unnecessary hospitalization. A baseline study in nine hospitals found that none correctly utilized disinfectants, sterilization or hand hygiene and that diagnosis of neonatal sepsis was based primarily on clinical manifestations. In 2007, the Ministry of Health (MINSA), with Unites States Agency for the International Development technical assistance, began developing guidelines and implementing quality improvement in infection prevention and control to reduce neonatal infections. In a second intervention phase, the MINSA introduced an algorithm for correct identification of maternal risk factors and standardized laboratory tests for neonatal sepsis. Interventions included developing national guidelines on correct use of disinfectants and hand hygiene; training medical staff on the guidelines; revising the basic medical supply list to support appropriate antisepsis; defining a package of diagnostic tests for neonatal sepsis and systematically measuring compliance with the new procedures. The 18 hospitals achieved appropriate use of disinfectants in a 12-month period. In seven hospitals that introduced improvements in diagnosis and management of neonatal sepsis, application of the standardized laboratory package in suspected sepsis cases increased from 0% in April 2009 to 93% in July 2011, and the median incidence of neonatal sepsis was reduced by 67%. The organizational changes implemented for the diagnosis and verification of neonatal sepsis led to a reduction in the newborn sepsis admissions and expenditures for antibiotics, allowing resources to be redirected to treating other critically ill newborns.

  2. Sepsis

    MedlinePlus

    ... Sepsis syndrome; Systemic inflammatory response syndrome; SIRS; Septic shock ... In sepsis, blood pressure drops, resulting in shock . Major organs ... system may stop working properly because of poor blood flow. ...

  3. Sepsis

    PubMed Central

    Karnatovskaia, Lioudmila V.; Festic, Emir

    2012-01-01

    Sepsis represents a major challenge in medicine. It begins as a systemic response to infection that can affect virtually any organ system, including the central and peripheral nervous systems. Akin to management of stroke, early recognition and treatment of sepsis are just as crucial to a successful outcome. Sepsis can precipitate myasthenic crisis and lead to encephalopathy and critical illness neuropathy. Stroke and traumatic brain injury can predispose a patient to develop sepsis, whereas Guillain-Barré syndrome is similarly not uncommon following infection. This review article will first describe the essential principles of sepsis recognition, pathophysiology, and management and will then briefly cover the neurologic aspects associated with sepsis. Vigilant awareness of the clinical features of sepsis and timeliness of intervention can help clinicians prevent progression of this disease to a multisystem organ failure, which can be difficult to reverse even after the original source of infection is under control. PMID:23983879

  4. Implications of the new sepsis definition on research and practice.

    PubMed

    Peach, Brian C

    2017-04-01

    practice will be essential, to determine if the Sepsis 3 definition, its associated clinical criteria, and the qSOFA need further revision. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

    PubMed

    Dey, A C; Hossain, M I; Afroze, S; Dey, S K; Mannan, M A; Shahidullah, M

    2016-04-01

    It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly.

  6. Sepsis

    MedlinePlus

    ... breathing Abnormal heart pumping function Abdominal pain Septic shock To be diagnosed with septic shock, you must have the signs and symptoms of ... mild sepsis, but the mortality rate for septic shock is nearly 50 percent. Also, an episode of ...

  7. Early onset neonatal sepsis: diagnostic dilemmas and practical management.

    PubMed

    Bedford Russell, A R; Kumar, R

    2015-07-01

    Early onset neonatal sepsis is persistently associated with poor outcomes, and incites clinical practice based on the fear of missing a treatable infection in a timely fashion. Unnecessary exposure to antibiotics is also hazardous. Diagnostic dilemmas are discussed in this review, and suggestions offered for practical management while awaiting a more rapidly available 'gold standard' test; in an ideal world, this test would be 100% sensitive and 100% specific for the presence of organisms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

    PubMed

    Wang, Henry E; Jones, Allison R; Donnelly, John P

    2017-09-01

    The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. Analysis of data from the National Hospital Ambulatory Medical Care Survey. U.S. emergency department visits, 2009-2011. Adult (age, ≥ 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications: 1) original emergency department sepsis-serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90 mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis-serious infection plus presence of at least two "quick" Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ≤ 14, respiratory rate ≥ 22 breaths/min, or systolic blood pressure ≤ 100 mm Hg); and 3) revised emergency department sepsis-original or quick Sequential Organ Failure Assessment emergency department sepsis. None. We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009-2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows: 1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57-0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26-0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74-0.91). Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated

  9. Sepsis in general surgery: the 2005-2007 national surgical quality improvement program perspective.

    PubMed

    Moore, Laura J; Moore, Frederick A; Todd, S Rob; Jones, Stephen L; Turner, Krista L; Bass, Barbara L

    2010-07-01

    To document the incidence, mortality rate, and risk factors for sepsis and septic shock compared with pulmonary embolism and myocardial infarction in the general-surgery population. Retrospective review. American College of Surgeons National Surgical Quality Improvement Program institutions. General-surgery patients in the 2005-2007 National Surgical Quality Improvement Program data set. Incidence, mortality rate, and risk factors for sepsis and septic shock. Of 363 897 general-surgery patients, sepsis occurred in 8350 (2.3%), septic shock in 5977 (1.6%), pulmonary embolism in 1078 (0.3%), and myocardial infarction in 615 (0.2%). Thirty-day mortality rates for each of the groups were as follows: 5.4% for sepsis, 33.7% for septic shock, 9.1% for pulmonary embolism, and 32.0% for myocardial infarction. The septic-shock group had a greater percentage of patients older than 60 years (no sepsis, 40.2%; sepsis, 51.7%; and septic shock, 70.3%; P < .001). The need for emergency surgery resulted in more cases of sepsis (4.5%) and septic shock (4.9%) than did elective surgery (sepsis, 2.0%; septic shock, 1.2%) (P < .001). The presence of any comorbidity increased the risk of sepsis and septic shock 6-fold (odds ratio, 5.8; 95% confidence interval, 5.5-6.2) and increased the 30-day mortality rate 22-fold (odds ratio, 21.8; 95% confidence interval, 17.6-26.9). The incidences of sepsis and septic shock exceed those of pulmonary embolism and myocardial infarction. The risk factors for mortality include age older than 60 years, the need for emergency surgery, and the presence of any comorbidity. This study emphasizes the need for early recognition of patients at risk via aggressive screening and the rapid implementation of evidence-based guidelines.

  10. Is Drotrecogin alfa (activated) for adults with severe sepsis, cost-effective in routine clinical practice?

    PubMed Central

    2011-01-01

    Introduction Previous cost-effectiveness analyses (CEA) reported that Drotrecogin alfa (DrotAA) is cost-effective based on a Phase III clinical trial (PROWESS). There is little evidence on whether DrotAA is cost-effective in routine clinical practice. We assessed whether DrotAA is cost-effective in routine practice for adult patients with severe sepsis and multiple organ systems failing. Methods This CEA used data from a prospective cohort study that compared DrotAA versus no DrotAA (control) for severe sepsis patients with multiple organ systems failing admitted to critical care units in England, Wales, and Northern Ireland. The cohort study used case-mix and mortality data from a national audit, linked with a separate audit of DrotAA infusions. Re-admissions to critical care and corresponding mortality were recorded for four years. Patients receiving DrotAA (n = 1,076) were matched to controls (n = 1,650) with a propensity score (Pscore), and Genetic Matching (GenMatch). The CEA projected long-term survival to report lifetime incremental costs per quality-adjusted life year (QALY) overall, and for subgroups with two or three to five organ systems failing at baseline. Results The incremental costs per QALY for DrotAA were £30,000 overall, and £16,000 for the subgroups with three to five organ systems failing. For patients with two organ systems failing, DrotAA resulted in an average loss of one QALY at an incremental cost of £15,000. When the subgroup with two organ systems was restricted to patients receiving DrotAA within 24 hours, DrotAA led to a gain of 1.2 QALYs at a cost per QALY of £11,000. The results were robust to other assumptions including the approach taken to projecting long-term outcomes. Conclusions DrotAA is cost-effective in routine practice for severe sepsis patients with three to five organ systems failing. For patients with two organ systems failing, this study could not provide unequivocal evidence on the cost-effectiveness of Drot

  11. A national quality improvement initiative for reducing harm and death from sepsis in Wales.

    PubMed

    Hancock, Chris

    2015-04-01

    The Rapid Response to Acute Illness (RRAILS) Programme is a quality and service improvement initiative which is participated in by all Welsh healthcare organisations including the Welsh Ambulance Service Trust (WAST) and Velindre Cancer Centre. The aims of the programme were and are: Implementing the National Early Warning Score (NEWS) as standard in all clinical areas in all 18 acute hospitals. Quantifying the incidence of sepsis and acute deterioration in the non Critical Care setting. Improving reliability of systems for identification, escalation and treatment of sepsis. Demonstrably improving outcomes from sepsis and other causes of acute deterioration. Clinical teams participated in learning sets at which they were trained in service improvement and human factors principles and then supported to implement 'bundles' of best evidence whilst measuring both processes and outcomes. All organisations have implemented standardised tools and operating procedures including NEWS, sepsis screening tools, Patient Status at A Glance (PSAG) boards, sepsis response bags and an antibiotic formulary. All organisations have demonstrated improvements in the reliability of detection and escalation of acute deterioration whilst many have started to demonstrate local improvements in outcomes. The collaborative learning set is an effective method for improving quality of sepsis care throughout a single healthcare economy. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines.

    PubMed

    Darlow, Brian A; Voss, Lesley; Lennon, Diana R; Grimwood, Keith

    2016-02-01

    Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in New Zealand five years after the publication of national risk-based GBS prevention guidelines. Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48 h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life. There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per 1000 live births. Ten years after a similar survey and five years after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  13. Sepsis Fact Sheet

    MedlinePlus

    ... after the episode. 3 , 4 What is the economic cost of sepsis? Treatment for sepsis often involves ... Accessibility Disclaimers FOIA U.S. Department of Health and Human Services National Institutes of Health: NIH...Turning Discovery ...

  14. Practice and perception--a nationwide survey of therapy habits in sepsis.

    PubMed

    Brunkhorst, Frank M; Engel, Christoph; Ragaller, Max; Welte, Tobias; Rossaint, Rolf; Gerlach, Herwig; Mayer, Konstantin; John, Stefan; Stuber, Frank; Weiler, Norbert; Oppert, Michael; Moerer, Onnen; Bogatsch, Holger; Reinhart, Konrad; Loeffler, Markus; Hartog, Christiane

    2008-10-01

    To simultaneously determine perceived vs. practiced adherence to recommended interventions for the treatment of severe sepsis or septic shock. One-day cross-sectional survey. Representative sample of German intensive care units stratified by hospital size. Adult patients with severe sepsis or septic shock. None. Practice recommendations were selected by German Sepsis Competence Network (SepNet) investigators. External intensivists visited intensive care units randomly chosen and asked the responsible intensive care unit director how often these recommendations were used. Responses "always" and "frequently" were combined to depict perceived adherence. Thereafter patient files were audited. Three hundred sixty-six patients on 214 intensive care units fulfilled the criteria and received full support. One hundred fifty-two patients had acute lung injury or acute respiratory distress syndrome. Low-tidal volume ventilation < or = 6 mL/kg/predicted body weight was documented in 2.6% of these patients. A total of 17.1% patients had tidal volume between 6 and 8 mL/kg predicted body weight and 80.3% > 8 mL/kg predicted body weight. Mean tidal volume was 10.0 +/- 2.4 mL/kg predicted body weight. Perceived adherence to low-tidal volume ventilation was 79.9%. Euglycemia (4.4-6.1 mmol/L) was documented in 6.2% of 355 patients. A total of 33.8% of patients had blood glucose levels < or = 8.3 mmol/L and 66.2% were hyperglycemic (blood glucose > 8.3 mmol/L). Among 207 patients receiving insulin therapy, 1.9% were euglycemic, 20.8% had blood glucose levels < or = 8.3 mmol/L, and 1.0% were hypoglycemic. Overall, mean maximal glucose level was 10.0 +/- 3.6 mmol/L. Perceived adherence to strict glycemic control was 65.9%. Although perceived adherence to recommendations was higher in academic and larger hospitals, actual practice was not significantly influenced by hospital size or university affiliation. This representative survey shows that current therapy of severe sepsis in German

  15. The impact of evidence-based sepsis guidelines on emergency department clinical practice: a pre-post medical record audit.

    PubMed

    Romero, Bernadine; Fry, Margaret; Roche, Michael

    2017-01-10

    To explore the number of patients presenting with sepsis before and after guideline implementation; the impact of sepsis guidelines on triage assessment, emergency department management and time to antibiotics. Sepsis remains one of the leading causes of mortality and morbidity within hospitals. Globally, strategies have been implemented to reduce morbidity and mortality rates, which rely on the early recognition and management of sepsis. To improve patient outcomes, the New South Wales government in Australia introduced sepsis guidelines into emergency departments. However, the impact of the guidelines on clinical practice remains unclear. A 12-month pre-post retrospective randomised medical record audit of adult patients with a sepsis diagnosis. Data were extracted from the emergency department database and paper medical record. Data included patient demographic (age, gender), clinical information (time of arrival, triage code, seen by time, disposition, time to antibiotic, pathology, time to intravenous fluids) and patient assessment data (heart rate, respiratory rate, blood pressure, temperature, oxygen saturations, medication). This study demonstrated a statistically significant 230-minute reduction in time to antibiotics post implementation of the guidelines. The post group (n = 165) received more urgent triage categories (n = 81; 49·1%), a 758-minute reduction in mean time to second litre of intravenous fluids and an improvement in collection of lactate (n = 112, 67·9%), also statistically significant. The findings highlight the impact the guidelines can have on clinician decision-making and behaviour that support best practice and positive patient outcomes. The sepsis guidelines improved the early assessment, recognition and management of patients presenting with sepsis in one tertiary referral emergency department. The use of evidenced-based guidelines can impact clinical decision-making and behaviour, resulting in the translation and support of

  16. Severe sepsis in women with group B Streptococcus in pregnancy: an exploratory UK national case–control study

    PubMed Central

    Kalin, Asli; Acosta, Colleen; Kurinczuk, Jennifer J; Brocklehurst, Peter; Knight, Marian

    2015-01-01

    Objective To estimate the incidence of severe maternal sepsis due to group B Streptococcus (GBS) in the UK, and to investigate the associated outcomes for mother and infant. Design National case–control study. Setting All UK consultant-led maternity units. Participants 30 women with confirmed or suspected severe GBS sepsis, and 757 control women. Main outcome measures Disease incidence, additional maternal morbidity, critical care admission, length of stay, infant infection, mortality. Results The incidences of confirmed and presumed severe maternal GBS sepsis were 1.00 and 2.75 per 100 000 maternities, respectively, giving an overall incidence of 3.75 per 100 000. Compared with controls, severe GBS sepsis was associated with higher odds of additional maternal morbidity (OR 12.35, 95% CI 3.96 to 35.0), requiring level 2 (OR 39.3, 95% CI 16.0 to 99.3) or level 3 (OR 182, 95% CI 21.0 to 8701) care and longer hospital stay (median stay in cases and controls was 7 days (range 3–29 days) and 2 days (range 0–16 days), respectively, p<0.001). None of the women died. Severe maternal GBS sepsis was associated with higher odds of infant sepsis (OR 32.7, 95% CI 8.99 to 119.0); 79% of infants, however, did not develop sepsis. There were no associated stillbirths or neonatal deaths. Conclusions Severe maternal GBS sepsis is a rare occurrence in the UK. It is associated with adverse maternal and neonatal outcomes. PMID:26450426

  17. Emergency department management of early sepsis: a national survey of emergency medicine and intensive care consultants.

    PubMed

    Jiwaji, Zoeb; Brady, Shirin; McIntyre, Lauralyn A; Gray, Alasdair; Walsh, Timothy S

    2014-12-01

    Early goal-directed therapy (EGDT) is recommended for sepsis management in current guidelines, but the underpinning evidence is controversial. Clinician beliefs and the capacity to implement all recommended elements of EGDT in emergency departments (EDs) are uncertain. Our study aimed to explore self-reported management of early sepsis by Scottish emergency medicine (EM) and intensive care medicine (ICM) consultants, delineate important differences and determine the guideline recommendations rated most important and deliverable within the ED. A postal survey using a hypothetical patient with septic shock was sent to all EM and ICM consultants practising in Scotland. 67% (76/114) EM and 61% (96/157) ICM consultants responded. Normal saline was preferred by EM respondents ('always/often used': EM 86%, ICM 23%, p<0.0001), whereas ICM respondents preferred Hartmann's solution (EM 42%, ICM 72%, p=0.0164), gelofusin (EM 10%, ICM 63%, p<0.0001) and starch (EM 0%, ICM 24%, p<0.0001). More ICM respondents indicated they used central venous pressure and invasive arterial pressure monitoring in the ED, and initiated vasopressors (EM 57%, ICM 90%, p<0.0001). More ICM consultants used specific haemoglobin transfusion triggers (48% EM, 77% ICM, p=0.0002), but marked variation in haemoglobin triggers and targets was reported. Lactate was rated the most important single resuscitation parameter by both specialties; no ED and only two ICM consultants rated ScVO2 most important. Differences in early fluid and vasopressor management of sepsis exist between Scottish ICM and EM consultants. Transfusion practice is highly variable, suggesting clinical uncertainty. Lactate is considered more important than ScVO2 measurement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Practices related to late-onset sepsis in very low-birth weight preterm infants.

    PubMed

    Bentlin, Maria Regina; Rugolo, Ligia M S S; Ferrari, Ligia S L

    2015-01-01

    To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS. This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others. All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside. The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  19. Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice.

    PubMed

    Naik, Abhijit S; Dharnidharka, Vikas R; Schnitzler, Mark A; Brennan, Daniel C; Segev, Dorry L; Axelrod, David; Xiao, Huiling; Kucirka, Lauren; Chen, Jiajing; Lentine, Krista L

    2016-02-01

    We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000-2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60 702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, nonstandard criteria organs, sirolimus-based immunosuppression, and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95% CI 1.25-1.56) for UTI alone, 6- to 12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95% CI 30.35-38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17 691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40 000-$50 000 (SE $1054-1238) for pneumonia or sepsis alone, to $134 773 (SE $1876) for those with UTI, pneumonia, and sepsis. Clinical and economic impacts persisted in years 2-3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care. © 2015 Steunstichting ESOT.

  20. Clinical and Economic Consequences of First-Year Urinary Tract Infections, Sepsis and Pneumonia in Contemporary Kidney Transplantation Practice

    PubMed Central

    Naik, Abhijit S.; Dharnidharka, Vikas R.; Schnitzler, Mark A.; Brennan, Daniel C.; Segev, Dorry L.; Axelrod, David; Xiao, Huiling; Kucirka, Lauren; Chen, Jiajing; Lentine, Krista L.

    2015-01-01

    We examined United States Renal Data System registry records for Medicare-insured kidney transplant recipients in 2000–2011 to study the clinical and cost impacts of urinary tract infections (UTI), pneumonia, and sepsis in the first year post-transplant among a contemporary, national cohort. Infections were identified by billing diagnostic codes. Among 60,702 recipients, 45% experienced at least one study infection in the first year post-transplant, including UTI in 32%, pneumonia in 13%, and sepsis in 12%. Older recipient age, female sex, diabetic kidney failure, non-standard criteria organs, sirolimus-based immunosuppression and steroids at discharge were associated with increased risk of first-year infections. By time-varying, multivariate Cox regression, all study infections predicted increased first-year mortality, ranging from 41% (aHR 1.41, 95%CI 1.25–1.56) for UTI alone, 6-to-12-fold risk for pneumonia or sepsis alone, to 34-fold risk (aHR 34.38, 95%CI 30.35–38.95) for those with all three infections. Infections also significantly increased first-year costs, from $17,691 (standard error (SE) $591) marginal cost increase for UTI alone, to approximately $40,000–$50,000 (SE $1054–1238) for pneumonia or sepsis alone, to $134,773 (SE $1876) for those with UTI, pneumonia and sepsis. Clinical and economic impacts persisted in years 2–3 post-transplant. Early infections reflect important targets for management protocols to improve post-transplant outcomes and reduce costs of care. PMID:26563524

  1. Severe Maternal Sepsis in the UK, 2011–2012: A National Case-Control Study

    PubMed Central

    Acosta, Colleen D.; Kurinczuk, Jennifer J.; Lucas, D. Nuala; Tuffnell, Derek J.; Sellers, Susan; Knight, Marian

    2014-01-01

    Background In light of increasing rates and severity of sepsis worldwide, this study aimed to estimate the incidence of, and describe the causative organisms, sources of infection, and risk factors for, severe maternal sepsis in the UK. Methods and Findings A prospective case-control study included 365 confirmed cases of severe maternal sepsis and 757 controls from all UK obstetrician-led maternity units from June 1, 2011, to May 31, 2012. Incidence of severe sepsis was 4.7 (95% CI 4.2–5.2) per 10,000 maternities; 71 (19.5%) women developed septic shock; and five (1.4%) women died. Genital tract infection (31.0%) and the organism Escherichia coli (21.1%) were most common. Women had significantly increased adjusted odds ratios (aORs) of severe sepsis if they were black or other ethnic minority (aOR = 1.82; 95% CI 1.82–2.51), were primiparous (aOR = 1.60; 95% CI 1.17–2.20), had a pre-existing medical problem (aOR = 1.40; 95% CI 1.01–1.94), had febrile illness or were taking antibiotics in the 2 wk prior to presentation (aOR = 12.07; 95% CI 8.11–17.97), or had an operative vaginal delivery (aOR = 2.49; 95% CI 1.32–4.70), pre-labour cesarean (aOR = 3.83; 95% CI 2.24–6.56), or cesarean after labour onset (aOR = 8.06; 95% CI 4.65–13.97). Median time between delivery and sepsis was 3 d (interquartile range = 1–7 d). Multiple pregnancy (aOR = 5.75; 95% CI 1.54–21.45) and infection with group A streptococcus (aOR = 4.84; 2.17–10.78) were associated with progression to septic shock; for 16 (50%) women with a group A streptococcal infection there was <2 h—and for 24 (75%) women, <9 h—between the first sign of systemic inflammatory response syndrome and a diagnosis of severe sepsis. A limitation of this study was the proportion of women with sepsis without an identified organism or infection source (16.4%). Conclusions For each maternal sepsis death, approximately 50 women have life-threatening morbidity from

  2. Sepsis biomarkers: a review

    PubMed Central

    2010-01-01

    Introduction Biomarkers can be useful for identifying or ruling out sepsis, identifying patients who may benefit from specific therapies or assessing the response to therapy. Methods We used an electronic search of the PubMed database using the key words "sepsis" and "biomarker" to identify clinical and experimental studies which evaluated a biomarker in sepsis. Results The search retrieved 3370 references covering 178 different biomarkers. Conclusions Many biomarkers have been evaluated for use in sepsis. Most of the biomarkers had been tested clinically, primarily as prognostic markers in sepsis; relatively few have been used for diagnosis. None has sufficient specificity or sensitivity to be routinely employed in clinical practice. PCT and CRP have been most widely used, but even these have limited ability to distinguish sepsis from other inflammatory conditions or to predict outcome. PMID:20144219

  3. Neonatal sepsis at Muhimbili National Hospital, Dar es Salaam, Tanzania; aetiology, antimicrobial sensitivity pattern and clinical outcome.

    PubMed

    Mhada, Tumaini V; Fredrick, Francis; Matee, Mecky I; Massawe, Augustine

    2012-10-24

    Neonatal sepsis contributes significantly to morbidity and mortality among young infants. The aetiological agents as well as their susceptibility to antimicrobial agents are dynamic. This study determined aetiology, antimicrobial susceptibility and clinical outcome of neonatal sepsis at Muhimbili National Hospital. Three hundred and thirty neonates admitted at the Muhimbili National Hospital neonatal ward between October, 2009 and January, 2010 were recruited. Standardized questionnaires were used to obtain demographic and clinical information. Blood and pus samples were cultured on MacConkey, blood and chocolate agars and bacteria were identified based on characteristic morphology, gram stain appearance and standard commercially prepared biochemical tests. Antimicrobial sensitivity testing was performed for ampicillin, cloxacillin, gentamicin, amikacin, cefuroxime and ceftriaxone on Mueller Hinton agar using the Kirby Bauer diffusion method. Culture proven sepsis was noted in 24% (74/330) of the study participants. Isolated bacterial pathogens were predominantly Staphylococcus aureus, Klebsiella spp and Escherichia coli. Klebsiella spp 32.7% (17/52) was the predominant blood culture isolate in neonates aged below seven days while Staphylococcus aureus 54.5% (12/22) was commonest among those aged above seven days. Staphylococcus aureus was the predominant pus swabs isolate for both neonates aged 0-6 days 42.2% (98/232) and 7-28 days 52.3% (34/65). Resistance of blood culture isolates was high to ampicillin 81.1% (60/74) and cloxacillin 78.4% (58/74), moderate to ceftriaxone 14.9% (11/74) and cefuroxime 18.9% (14/74), and low to amikacin 1.3% (1/74). Isolates from swabs had high resistance to ampicillin 89.9% (267/297) and cloxacillin 85.2 (253/297), moderate resistance to ceftriaxone 38.0% (113/297) and cefuroxime 36.0% (107/297), and low resistance to amikacin 4.7% (14/297). Sepsis was higher in neonates with fever and hypothermia (p=0.02), skin pustules (p<0

  4. Sepsis: An update in management.

    PubMed

    Galen, Benjamin T; Sankey, Christopher

    2015-11-01

    Hospitalists are a critical link in providing evidence-based care for patients with sepsis across the disease spectrum, from early recognition to recovery. The past decade of sepsis research has led to significant findings that will change clinical practice for hospital medicine practitioners. Although the incidence of severe sepsis in the United States has continued to rise, in-hospital mortality has declined. Management of the spectrum of sepsis disorders is no longer restricted to the intensive care unit (ICU). This review article will provide an update in the management of sepsis for hospitalists based on recently published pivotal studies. The expanding evidence base in sepsis includes early goal-directed therapy/clinical endpoints/sepsis bundles, antibiotics and source control, volume resuscitation, ICU considerations (including the use of insulin and corticosteroids), mortality/complications, and the newly recognized condition of "sepsis survivorship".

  5. Risk factors and practices contributing to newborn sepsis in a rural district of Eastern Uganda, August 2013: a cross sectional study.

    PubMed

    John, Bua; David, Mukanga; Mathias, Lwanga; Elizabeth, Nabiwemba

    2015-08-09

    In Uganda, newborn deaths constituted over 38% of all infant deaths in 2010. Despite different mitigation interventions over years, the newborn mortality rate is high at 27/1,000 and newborn sepsis contributes to 31% of that mortality. Therefore, improved strategies that contribute to reduction of newborn sepsis need to be developed and implemented. Understanding the context relevant risk factors that determine and practices contributing to newborn sepsis will inform this process. A cross sectional study was conducted at Kidera Health Centre in Kidera Sub County, Buyende district between January and August 2013. A total of 174 mothers of sick newborns and 8 health workers were interviewed. Main outcome was newborn sepsis confirmed by blood culture. Independent variables included; mothers' demographics characteristics, maternal care history and newborn care practices. The odds ratios were used to measure associations and Chi square or Fisher's exact tests to test the associations. 95% confidence intervals and P values for the odds ratios were determined. Logistic regression was conducted to identify predictor factors for newborn sepsis. 21.8% (38/174) of newborns had laboratory confirmed sepsis. Staphylococcus aureus was the commonest aetiological agent. Mothers not screened and treated for infections during antenatal (OR = 3.37; 95% CI 1.23-9.22) plus inability of sick newborns to breast feed (OR = 3.9; 95% CI 1.54-9.75) were factors associated with increased likelihood of having laboratory confirmed sepsis. Women not receiving health education during antenatal about care seeking (OR 2.22; 95% CI 1.07-4.61) and newborn danger signs (OR 2.26; 95% CI 1.08-4.71) was associated with laboratory confirmed newborn sepsis. The supply of antibiotics and sundries was inadequate to sufficiently control sepsis within health facility. Lack of antenatal care or access to it at health facilities was likely to later result in more sick newborns with sepsis. Poor breastfeeding by

  6. Implementing sepsis bundles

    PubMed Central

    Jozwiak, Mathieu; Monnet, Xavier

    2016-01-01

    Sepsis bundles represent key elements of care regarding the diagnosis and treatment of patients with septic shock and allow ones to convert complex guidelines into meaningful changes in behavior. Sepsis bundles endorsed the early goal-directed therapy (EGDT) and their implementation resulted in an improved outcome of septic shock patients. They induced more consistent and timely application of evidence-based care and reduced practice variability. These benefits mainly depend on the compliance with sepsis bundles, highlighting the importance of dedicated performance improvement initiatives, such as multifaceted educational programs. Nevertheless, the interest of early goal directed therapy in septic shock patients compared to usual care has recently been questioned, leading to an update of sepsis bundles in 2015. These new sepsis bundles may also exhibit, as the previous bundles, some limits and pitfalls and the effects of their implementation still needs to be evaluated. PMID:27713890

  7. Neutrophil Dysfunction in Sepsis

    PubMed Central

    Zhang, Fang; Liu, An-Lei; Gao, Shuang; Ma, Shui; Guo, Shu-Bin

    2016-01-01

    Objective: Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. In this article, we reviewed the correlation between neutrophil dysfunction and sepsis. Data Sources: Articles published up to May 31, 2016, were selected from the PubMed databases, with the keywords of “neutrophil function”, “neutrophil dysfunction”, and “sepsis”. Study Selection: Articles were obtained and reviewed to analyze the neutrophil function in infection and neutrophil dysfunction in sepsis. Results: We emphasized the diagnosis of sepsis and its limitations. Pathophysiological mechanisms involve a generalized circulatory, immune, coagulopathic, and/or neuroendocrine response to infection. Many studies focused on neutrophil burst or cytokines. Complement activation, impairment of neutrophil migration, and endothelial lesions are involved in this progress. Alterations of cytokines, chemokines, and other mediators contribute to neutrophil dysfunction in sepsis. Conclusions: Sepsis represents a severe derangement of the immune response to infection, resulting in neutrophil dysfunction. Neutrophil dysfunction promotes sepsis and even leads to organ failure. Mechanism studies, clinical practice, and strategies to interrupt dysregulated neutrophil function in sepsis are desperately needed. PMID:27824008

  8. THE ENDOTHELIUM IN SEPSIS

    PubMed Central

    Ince, Can; Mayeux, Philip R.; Nguyen, Trung; Gomez, Hernando; Kellum, John A.; Ospina-Tascón, Gustavo A.; Hernandez, Glenn; Murray, Patrick; De Backer, Daniel

    2017-01-01

    Sepsis affects practically all aspects of endothelial cell (EC) function and is thought to be the key factor in the progression from sepsis to organ failure. Endothelial functions affected by sepsis include vasoregulation, barrier function, inflammation, and hemostasis. These are among other mechanisms often mediated by glycocalyx shedding, such as abnormal nitric oxide metabolism, up-regulation of reactive oxygen species generation due to down-regulation of endothelial-associated antioxidant defenses, transcellular communication, proteases, exposure of adhesion molecules, and activation of tissue factor. This review covers current insight in EC-associated hemostatic responses to sepsis and the EC response to inflammation. The endothelial cell lining is highly heterogeneous between different organ systems and consequently also in its response to sepsis. In this context, we discuss the response of the endothelial cell lining to sepsis in the kidney, liver, and lung. Finally, we discuss evidence as to whether the EC response to sepsis is adaptive or maladaptive. This study is a result of an Acute Dialysis Quality Initiative XIV Sepsis Workgroup meeting held in Bogota, Columbia, between October 12 and 15, 2014. PMID:26871664

  9. THE ENDOTHELIUM IN SEPSIS.

    PubMed

    Ince, Can; Mayeux, Philip R; Nguyen, Trung; Gomez, Hernando; Kellum, John A; Ospina-Tascón, Gustavo A; Hernandez, Glenn; Murray, Patrick; De Backer, Daniel

    2016-03-01

    Sepsis affects practically all aspects of endothelial cell (EC) function and is thought to be the key factor in the progression from sepsis to organ failure. Endothelial functions affected by sepsis include vasoregulation, barrier function, inflammation, and hemostasis. These are among other mechanisms often mediated by glycocalyx shedding, such as abnormal nitric oxide metabolism, up-regulation of reactive oxygen species generation due to down-regulation of endothelial-associated antioxidant defenses, transcellular communication, proteases, exposure of adhesion molecules, and activation of tissue factor. This review covers current insight in EC-associated hemostatic responses to sepsis and the EC response to inflammation. The endothelial cell lining is highly heterogeneous between different organ systems and consequently also in its response to sepsis. In this context, we discuss the response of the endothelial cell lining to sepsis in the kidney, liver, and lung. Finally, we discuss evidence as to whether the EC response to sepsis is adaptive or maladaptive. This study is a result of an Acute Dialysis Quality Initiative XIV Sepsis Workgroup meeting held in Bogota, Columbia, between October 12 and 15, 2014.

  10. Pediatric Sepsis.

    PubMed

    Prusakowski, Melanie K; Chen, Audrey P

    2017-02-01

    Pediatric sepsis is distinct from adult sepsis in its definitions, clinical presentations, and management. Recognition of pediatric sepsis is complicated by the various pediatric-specific comorbidities that contribute to its mortality and the age- and development-specific vital sign and clinical parameters that obscure its recognition. This article outlines the clinical presentation and management of sepsis in neonates, infants, and children, and highlights some key populations who require specialized care.

  11. Sepsis and septic shock

    PubMed Central

    Hotchkiss, Richard S.; Moldawer, Lyle L.; Opal, Steven M.; Reinhart, Konrad; Turnbull, Isaiah R.; Vincent, Jean-Louis

    2017-01-01

    For more than two decades, sepsis was defined as a microbial infection that produces fever (or hypothermia), tachycardia, tachypnoea and blood leukocyte changes. Sepsis is now increasingly being considered a dysregulated systemic inflammatory and immune response to microbial invasion that produces organ injury for which mortality rates are declining to 15–25%. Septic shock remains defined as sepsis with hyperlactataemia and concurrent hypotension requiring vasopressor therapy, with in-hospital mortality rates approaching 30–50%. With earlier recognition and more compliance to best practices, sepsis has become less of an immediate life-threatening disorder and more of a long-term chronic critical illness, often associated with prolonged inflammation, immune suppression, organ injury and lean tissue wasting. Furthermore, patients who survive sepsis have continuing risk of mortality after discharge, as well as long-term cognitive and functional deficits. Earlier recognition and improved implementation of best practices have reduced in-hospital mortality, but results from the use of immunomodulatory agents to date have been disappointing. Similarly, no biomarker can definitely diagnose sepsis or predict its clinical outcome. Because of its complexity, improvements in sepsis outcomes are likely to continue to be slow and incremental. PMID:28117397

  12. Epidemiological Study of Sepsis in China: Protocol of a Cross-sectional Survey

    PubMed Central

    Yang, Yi; Xie, Jian-Feng; Yu, Kai-Jiang; Yao, Chen; Li, Jian-Guo; Guan, Xiang-Dong; Yan, Jing; Ma, Xiao-Chun; Kang, Yan; Yang, Cong-Shan; Yao, Xiao-Qing; Shang, Hong-Cai; Qiu, Hai-Bo

    2016-01-01

    Background: Sepsis is the leading cause of death among critically ill patients. Herein, we conducted a national survey to provide data on epidemiology and treatment of sepsis in the clinical practice in China, which has no detailed epidemiological data available on sepsis. Methods: This was a prospective cross-sectional survey from December 1, 2015 to January 31, 2016 in all provinces/municipalities of the mainland of China. The primary outcome of this study was the incidence of sepsis, and the secondary outcome was its etiology in China. Patients with sepsis admitted to the Intensive Care Units were included in this study. The demographic, physiological, bacteriological, and therapeutic data of these patients were recorded. The incidence of sepsis was estimated using the data from the sixth census in China, reported by the Chinese National Health and Family Planning Commission and the National Bureau of Statistics as the standard population. The independent risk factors for increased mortality from sepsis were calculated. Conclusions: This study indicated the incidence and outcome of sepsis in China. It also showed the most common etiology of different sites and types of infection, which could guide empiric antibiotic therapy. Moreover, it provided information on the independent risk factors for increased mortality due to sepsis. The findings provide evidence to guide clinical management and may help improve the outcome in septic patients. Trial Registration: ClinicalTrials.gov, NCT02448472; https://clinicaltrials.gov/show/NCT02448472. PMID:27958229

  13. Homeopathic practice in Intensive Care Units: objective semiology, symptom selection and a series of sepsis cases.

    PubMed

    Teixeira, M Z; Leal, S M; Ceschin, V M F A

    2008-10-01

    Homeopathy has been used for more than two hundred years to treat chronic disease using various approaches in a wide range of diseases. However, for acute disease and critical illness, application has been limited by inadequate training of homeopathic physicians and the small number of pertinent clinical studies. In view of the difficulty of practising homeopathy in Intensive Care Units (ICU), a protocol was developed to facilitate description of objective homeopathic symptoms with a ranking of symptoms appropriate for these situations (Protocol for Objective Homeopathic Semiology). Examples of favorable results with individualized homeopathic treatments for a series of cases of Systemic Inflammatory Response Syndrome (sepsis) are described.

  14. [Prevalence of severe sepsis in intensive care units. A national multicentric study].

    PubMed

    Dougnac, Alberto L; Mercado, Marcelo F; Cornejo, Rodrigo R; Cariaga, Mario V; Hernández, Glenn P; Andresen, Max H; Bugedo, Guillermo T; Castillo, Luis F

    2007-05-01

    Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU). To study the prevalence of SS in Chilean ICUs. An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days. Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66%. Mean age of patients was 57.7+/-18 years and 59% were male, APACHE II score was 15+/-7.5 and SOFA score was 6+/-4. SS was the admission diagnosis of 94 of the 283 patients (33%) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients that presented SS after admission, had a respiratory focus. SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APACHE II and SOFA scores were independent predictors of mortality.

  15. Aquatic Trash Prevention National Great Practices Compendium

    EPA Pesticide Factsheets

    The National Great Practice Compendium highlights outstanding activities, technologies, and programs that prevent trash from entering the aquatic environment and/or that reduce the overall volume of trash that is generated.

  16. Management of neonatal sepsis at Muhimbili National Hospital in Dar es Salaam: diagnostic accuracy of C-reactive protein and newborn scale of sepsis and antimicrobial resistance pattern of etiological bacteria.

    PubMed

    Mkony, Martha Franklin; Mizinduko, Mucho Michael; Massawe, Augustine; Matee, Mecky

    2014-12-05

    We determined the accuracy of Rubarth's newborn scale of sepsis and C- reactive protein in diagnosing neonatal sepsis and assessed antimicrobial susceptibility pattern of etiological bacteria. This cross sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania between July 2012 and March 2013. Neonates suspected to have sepsis underwent physical examination using Rubarth's newborn scale of sepsis (RNSOS). Blood was taken for culture and antimicrobial sensitivity testing, full blood picture and C - reactive protein (CRP) performed 12 hours apart. The efficacy of RNSOS and serial CRP was assessed by calculating sensitivity, specificity, negative and positive predictive values, receiver operating characteristics (ROC) analysis as well as likelihood ratios (LHR) with blood culture result used as a gold standard. Out of 208 blood samples, 19.2% had a positive blood culture. Single CRP had sensitivity and specificity of 87.5% and 70.9% respectively, while RNSOS had sensitivity of 65% and specificity of 79.7%. Serial CRP had sensitivity of 69.0% and specificity of 92.9%. Combination of CRP and RNSOS increased sensitivity to 95.6% and specificity of 56.4%. Combination of two CRP and RNSOS decreased sensitivity to 89.1% but increased specificity to 74%. ROC for CRP was 0.86; and for RNSOS was 0.81. For CRP the LHR for positive test was 3 while for negative test was 0.18, while for RNSOS the corresponding values were 3.24 and for negative test was 0.43. Isolated bacteria were Klebsiella spp 14 (35%), Escherichia coli 12 (22.5%), Coagulase negative staphlococci 9 (30%), Staphylococcus aureus 4 (10%), and Pseudomonas spp 1 (2.5%). The overall resistance to the WHO recommended first line antibiotics was 100%, 92% and 42% for cloxacillin, ampicillin and gentamicin, respectively. For the second line drugs resistance was 45%, 40%, and 7% for ceftriaxone, vancomycin and amikacin respectively. Single CRP in combination with RNSOS can be used for rapid

  17. Neonatal sepsis.

    PubMed

    Stefanovic, Iva Mihatov

    2011-01-01

    Neonatal sepsis is the most common cause of neonatal deaths with high mortality despite treatment. Neonatal sepsis can be classified into two subtypes depending upon onset of symptoms. There are many factors that make neonates more susceptable to infection. Signs of sepsis in neonates are often non-specific and high degree of suspicion is needed for early diagnosis. Some laboratory parameters can be helpful for screening of neonates with neonatal sepsis, but none of it is specific and sensitive enough to be used singly. Diagnostic approach mostly focuses on history and review of non specific signs and symptoms. Antibiotic treatment is the mainstay of treatment and supportive care is equally important. The aim of this review is to give an overview of neonatal sepsis, including incidence, etiology, clinical picture, diagnostics and therapy.

  18. Training for general practice: a national survey.

    PubMed Central

    Crawley, H S; Levin, J B

    1990-01-01

    OBJECTIVES--(a) To compare current vocational training in general practice with that ascertained by a survey in 1980; (b) to compare the training of trainees in formal training schemes with that of trainees arranging their own hospital and general practice posts. DESIGN--National questionnaire survey of United Kingdom and armed services trainees who were in a training practice on 1 April 1989. Questionnaires were distributed by course organisers. SETTING--Research project set up after an ad hoc meeting of trainees at the 1988 national trainee conference. SUBJECTS--2132 Of the 2281 trainees (93%) known to be in a training practice on 1 April 1989. RESULTS--1657 Trainees returned the questionnaires, representing 73% of all trainees known to be in a training practice on 1 April 1989. Between 1980 and 1989 there were significant improvements in the trainee year, and there was also evidence of improvements in general practice study release courses. There was no evidence of improvement in other aspects of training. General practice trainees spent an average of three years in junior hospital posts, which provided very little opportunity for study related to general practice. Training received during tenure of hospital posts differed significantly between trainees in formal schemes and those arranging their own hospital posts. During the trainee year training was almost the same for those in formal schemes and those arranging their own posts. Regions varied significantly in virtually all aspects of general practice training. CONCLUSIONS--The trainee year could be improved further by enforcing the guidelines of the Joint Committee on Postgraduate Training for General Practice. The poor training in junior hospital posts reflected the low priority that training is generally given during tenure of these posts. A higher proportion of general practice trainees should be attached to vocational training schemes. More hospital trainees could attend general practice study release

  19. Neonatal sepsis

    PubMed Central

    Shah, Birju A; Padbury, James F

    2014-01-01

    Neonatal sepsis continues to be a common and significant health care burden, especially in very-low-birth-weight infants (VLBW <1500 g). Though intrapartum antibiotic prophylaxis has decreased the incidence of early-onset group B streptococcal infection dramatically, it still remains a major cause of neonatal sepsis. Moreover, some studies among VLBW preterm infants have shown an increase in early-onset sepsis caused by Escherichia coli. As the signs and symptoms of neonatal sepsis are nonspecific, early diagnosis and prompt treatment remains a challenge. There have been a myriad of studies on various diagnostic markers like hematological indices, acute phase reactants, C-reactive protein, procalcitonin, cytokines, and cell surface markers among others. Nonetheless, further research is needed to identify a biomarker with high diagnostic accuracy and validity. Some of the newer markers like inter α inhibitor proteins have shown promising results thereby potentially aiding in early detection of neonates with sepsis. In order to decrease the widespread, prolonged use of unnecessary antibiotics and improve the outcome of the infants with sepsis, reliable identification of sepsis at an earlier stage is paramount. PMID:24185532

  20. Clean birth and postnatal care practices to reduce neonatal deaths from sepsis and tetanus: a systematic review and Delphi estimation of mortality effect

    PubMed Central

    2011-01-01

    Background Annually over 520,000 newborns die from neonatal sepsis, and 60,000 more from tetanus. Estimates of the effect of clean birth and postnatal care practices are required for evidence-based program planning. Objective To review the evidence for clean birth and postnatal care practices and estimate the effect on neonatal mortality from sepsis and tetanus for the Lives Saved Tool (LiST). Methods We conducted a systematic review of multiple databases. Data were abstracted into standard tables and assessed by GRADE criteria. Where appropriate, meta-analyses were undertaken. For interventions with low quality evidence but a strong GRADE recommendation, a Delphi process was conducted. Results Low quality evidence supports a reduction in all-cause neonatal mortality (19% (95% c.i. 1–34%)), cord infection (30% (95% c.i. 20–39%)) and neonatal tetanus (49% (95% c.i. 35–62%)) with birth attendant handwashing. Very low quality evidence supports a reduction in neonatal tetanus mortality with a clean birth surface (93% (95% c.i. 77-100%)) and no relationship between a clean perineum and tetanus. Low quality evidence supports a reduction of neonatal tetanus with facility birth (68% (95% c.i. 47-88%). No relationship was found between birth place and cord infections or sepsis mortality. For postnatal clean practices, all-cause mortality is reduced with chlorhexidine cord applications in the first 24 hours of life (34% (95% c.i. 5–54%, moderate quality evidence) and antimicrobial cord applications (63% (95% c.i. 41–86%, low quality evidence). One study of postnatal maternal handwashing reported reductions in all-cause mortality (44% (95% c.i. 18–62%)) and cord infection ((24% (95% c.i. 5-40%)). Given the low quality of evidence, a Delphi expert opinion process was undertaken. Thirty experts reached consensus regarding reduction of neonatal sepsis deaths by clean birth practices at home (15% (IQR 10–20)) or in a facility (27% IQR 24–36)), and by clean

  1. Dental sepsis.

    PubMed

    Mueller, P O; Lowder, M Q

    1998-08-01

    Dental sepsis or periapical abscess formation constitutes a large percentage of dental conditions that afflict horses. Dental sepsis occurs when the pulp chamber of the tooth is exposed to the oral cavity or external environment, allowing bacterial localization with resulting infection. Although acute, primary, septic pulpitis in horses is rare, dental sepsis often results from colonization of the pulp chamber with pathogenic bacteria secondary to maleruption or impaction of teeth with secondary alveolar bone lysis, primary fractures of the tooth, mandible, or maxilla, periodontal disease, or infundibular necrosis. The sequela to pulpal infection are extensions into the periradicular tissues and mandibular or maxillary periapical abscess formation.

  2. Update on pediatric sepsis: a review.

    PubMed

    Kawasaki, Tatsuya

    2017-01-01

    Sepsis is one of the leading causes of mortality among children worldwide. Unfortunately, however, reliable evidence was insufficient in pediatric sepsis and many aspects in clinical practice actually depend on expert consensus and some evidence in adult sepsis. More recent findings have given us deep insights into pediatric sepsis since the publication of the Surviving Sepsis Campaign guidelines 2012. New knowledge was added regarding the hemodynamic management and the timely use of antimicrobials. Quality improvement initiatives of pediatric "sepsis bundles" were reported to be successful in clinical outcomes by several centers. Moreover, a recently published global epidemiologic study (the SPROUT study) did not only reveal the demographics, therapeutic interventions, and prognostic outcomes but also elucidated the inappropriateness of the current definition of pediatric sepsis. With these updated knowledge, the management of pediatric sepsis would be expected to make further progress. In addition, it is meaningful that the fundamental data on which future research should be based were established through the SPROUT study.

  3. Sepsis after elective ureteroscopy.

    PubMed

    Bloom, Jonathan; Fox, Cristina; Fullerton, Sean; Matthews, Gerald; Phillips, John

    2017-10-01

    We sought to determine our rate of postoperative sepsis after ureteroscopy as well as identifying associative factors, common antibiotic practices along with culture data. Records of all patients who underwent elective ureteroscopy from 2010 to 2015 at an urban tertiary care facility were retrospectively reviewed. Factors thought to be associated with infection were collected, along with comorbidities depicted as Charlson Age-Adjusted Comorbidity Index (CAACI) and American Society of Anesthesia (ASA) score. Each patient's course was reviewed to determine if they were treated for postoperative sepsis as defined by standardized criteria. A total of 345 patients underwent elective ureteroscopy with 15 (4.3%) being treated for sepsis postoperatively. This resulted in an additional 5.33 ± 3.84 days of hospitalization per patient. The sepsis group grew three gram positive organisms and five multi-drug resistant (MDR) gram negatives while 7/15 (46.7%) had negative cultures. The most common preoperative antibiotics used in the sepsis group were cefazolin (60.0%), gentamicin (48.5%) and ciprofloxacin (20.0%). Univariate analysis showed prior endoscopic procedures, recent treatment for urinary tract infections (UTI), multiple comorbidities and longer operative times associated with sepsis. However, significant variables after multivariate analysis were treatment for UTI within the last month, (OR) 7.19 (2.25-22.99), p = 0.001. Patients with multiple comorbidities, prior endoscopic procedures, longer operative times and especially those recently treated for a urinary infection should be carefully monitored after ureteroscopy for signs of sepsis. Perioperative antibiotics in these patients should be selected to cover both MDR organisms and gram positives.

  4. [The definition of sepsis. 25-year experience of concept development].

    PubMed

    Sazhin, V P; Karsanov, A M; Maskin, S S; Remizov, O V

    2017-01-01

    The review, presented in chronological order the stages of formation of the modern definition of sepsis syndrome, since the recommendations of the conciliation conference ACCP/SCCM (1991), the experience of the practical use of which has been extensively critically assessed in future studies. As a result, it formed a strong opinion that the global challenge of early diagnosis of sepsis, under the previously proposed definitive categories have not been solved, moreover, in the scientific community formed a firm belief in the need to make fundamental changes in the definition of the term 'sepsis'. As a result, in 2016 the scientific community were presented the recommendations of the working group 'Sepsis-3', in which sepsis is defined as life-threatening organ dysfunction due to dysregulated response to infection, and fundamentally distinguish them from the former, is a laconic definitions and availability of diagnostic criteria. National expert community to analyze, discuss and define the field of clinical testing 'Sepsis-3' in the Russian Federation.

  5. Biomarkers for Sepsis

    PubMed Central

    Henriquez-Camacho, Cesar; Losa, Juan

    2014-01-01

    Bloodstream infections are a major concern because of high levels of antibiotic consumption and of the increasing prevalence of antimicrobial resistance. Bacteraemia is identified in a small percentage of patients with signs and symptoms of sepsis. Biomarkers are widely used in clinical practice and they are useful for monitoring the infectious process. Procalcitonin (PCT) and C-reactive protein (CRP) have been most widely used, but even these have limited abilities to distinguish sepsis from other inflammatory conditions or to predict outcome. PCT has been used to guide empirical antibacterial therapy in patients with respiratory infections and help to determine if antibacterial therapy can be stopped. New biomarkers such as those in this review will discuss the major types of biomarkers of bloodstream infections/sepsis, including soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), soluble urokinase-type plasminogen receptor (suPAR), proadrenomedullin (ProADM), and presepsin. PMID:24800240

  6. Biomarkers for sepsis.

    PubMed

    Henriquez-Camacho, Cesar; Losa, Juan

    2014-01-01

    Bloodstream infections are a major concern because of high levels of antibiotic consumption and of the increasing prevalence of antimicrobial resistance. Bacteraemia is identified in a small percentage of patients with signs and symptoms of sepsis. Biomarkers are widely used in clinical practice and they are useful for monitoring the infectious process. Procalcitonin (PCT) and C-reactive protein (CRP) have been most widely used, but even these have limited abilities to distinguish sepsis from other inflammatory conditions or to predict outcome. PCT has been used to guide empirical antibacterial therapy in patients with respiratory infections and help to determine if antibacterial therapy can be stopped. New biomarkers such as those in this review will discuss the major types of biomarkers of bloodstream infections/sepsis, including soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), soluble urokinase-type plasminogen receptor (suPAR), proadrenomedullin (ProADM), and presepsin.

  7. Driving sepsis mortality down: emergency department and critical care partnerships.

    PubMed

    Powell, Kristine K; Fowler, Rita J

    2014-12-01

    This article describes the Baylor Health Care System (BHCS) approach to decreasing sepsis-related mortality within a large complex adaptive health care system. BHCS implemented sepsis care improvement initiatives based on the Surviving Sepsis Campaign early goal directed therapy guidelines. By adhering to rigorous process improvement and evidence-based practice principles, BHCS has demonstrated improvements in sepsis care processes and a significant reduction in sepsis mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Neonatal sepsis

    MedlinePlus

    ... better the outcome. Possible Complications Complications may include: Disability Death When to Contact a Medical Professional Seek medical help right away for an infant that shows symptoms of neonatal sepsis. Prevention Pregnant women may need preventive antibiotics if they have: Chorioamnionitis ...

  9. Improving multidisciplinary severe sepsis management using the Sepsis Six .

    PubMed

    Bhat, Amar; Asghar, Maryam; Raulia, Gagandeep; Mandal, Amit Keiran John

    2016-12-01

    Each year in the UK, it is estimated that more than 100,000 people are admitted to hospital with sepsis and around 37,000 people will die as a result of the condition. We present an audit, re-audit and the implications these have had on the management of severe sepsis using the Sepsis Six, ultimately through actively promoting teamwork to initiate the protocol. This led to a significant improvement in management, decreasing admissions to the intensive care unit (ITU), length of stay in hospital and the number of patient deaths.The initial audit and re-audit were done over 2-month periods. All clerking notes of patients with a medical consultant diagnosis of 'sepsis' on post-take ward round were analysed and further screened for presence of severe sepsis according to national guidelines.There was significant improvement from only 1% of patients being appropriately managed (according to the existing guidelines) to 67% of eligible subjects adhering to the protocol (p<0.0001). Initially, 19% were admitted to the ITU (6% died), improving to 7% on re-audit (with no deaths). Length of hospital stay reduced from 10 to 7 days (p<0.0001).There was a complete change in the management of severe sepsis with trust-wide updated protocols, resulting in a decrease in hospital morbidity and mortality. © Royal College of Physicians 2016. All rights reserved.

  10. National Board Certification and Developmentally Appropriate Practices: Perceptions of Impact

    ERIC Educational Resources Information Center

    McKenzie, Ellen Nancy

    2013-01-01

    The study investigated a relationship between National Board certification and perceived use of developmentally appropriate practices (DAP). A self-developed survey, the Early-childhood Teacher Inventory of Practices, was e-mailed to participants. Participants included 246 non-National Board-certified (non-NBCT) and 135 National Board-certified…

  11. Sepsis-related hypertensive response: friend or foe?

    PubMed Central

    Saleh, Mohamed

    2014-01-01

    In daily practice acute arterial hypertension may occur during acute sepsis. No management guidelines concerning this issue figured in the latest sepsis campaign guidelines. Arterial hypertension occurring during sepsis could be an overlooked condition despite its potential haemodynamic harmful consequences. In this paper, a clinical study of acute hypertensive response related to sepsis is detailed. It shows that arterial hypertension, renal salt wasting and glomerular hyperfiltration can occur simultaneously during sepsis. Mechanisms and management options of sepsis-related arterial hypertensive response are also discussed. PMID:24855080

  12. National agenda for advanced practice nursing: the practice doctorate.

    PubMed

    Clinton, Patricia; Sperhac, Arlene M

    2006-01-01

    The purpose of this article was to provide the background and rationale for the practice doctorate in nursing. The American Association of Colleges of Nursing's Position Statement on the Practice Doctorate in Nursing, approved in October 2004, will be discussed. Outlined are some of the changes that will be needed in education, regulation, and advanced practice. Common questions and concerns that advanced practice nurses have, including titling, salary, and transitioning to the doctor of nursing practice degree, will be addressed.

  13. Comparison of trends in sepsis incidence and coding using administrative claims versus objective clinical data.

    PubMed

    Rhee, Chanu; Murphy, Michael V; Li, Lingling; Platt, Richard; Klompas, Michael

    2015-01-01

    National reports of a dramatic rise in sepsis incidence are largely based on analyses of administrative databases. It is unclear if these estimates are biased by changes in coding practices over time. We calculated linear trends in the annual incidence of septicemia, sepsis, and severe sepsis at 2 academic hospitals from 2003 to 2012 using 5 different claims methods and compared case identification rates to selected objective clinical markers, including positive blood cultures, vasopressors, and/or lactic acid levels. The annual incidence of hospitalizations with sepsis claims increased over the decade, ranging from a 54% increase for the method combining septicemia, bacteremia, and fungemia codes (P < .001 for linear trend) to a 706% increase for explicit severe sepsis/septic shock codes (P = .001). In contrast, the incidence of hospitalizations with positive blood cultures decreased by 17% (P = .006), and hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis remained stable (P = .098). The sensitivity of sepsis claims for capturing hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis increased (P < .001 for all methods), whereas the proportion of septicemia hospitalizations with positive blood cultures decreased from 50% to 30% (P < .001). The incidence of hospitalizations with sepsis codes rose dramatically while hospitalizations with corresponding objective clinical markers remained stable or decreased. Coding for sepsis has become more inclusive, and septicemia diagnoses are increasingly being applied to patients without positive blood cultures. These changes likely explain some of the apparent rise in sepsis incidence and underscore the need for more reliable surveillance methods. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  14. Comparison of Trends in Sepsis Incidence and Coding Using Administrative Claims Versus Objective Clinical Data

    PubMed Central

    Rhee, Chanu; Murphy, Michael V.; Li, Lingling; Platt, Richard; Klompas, Michael

    2015-01-01

    Background. National reports of a dramatic rise in sepsis incidence are largely based on analyses of administrative databases. It is unclear if these estimates are biased by changes in coding practices over time. Methods. We calculated linear trends in the annual incidence of septicemia, sepsis, and severe sepsis at 2 academic hospitals from 2003 to 2012 using 5 different claims methods and compared case identification rates to selected objective clinical markers, including positive blood cultures, vasopressors, and/or lactic acid levels. Results. The annual incidence of hospitalizations with sepsis claims increased over the decade, ranging from a 54% increase for the method combining septicemia, bacteremia, and fungemia codes (P < .001 for linear trend) to a 706% increase for explicit severe sepsis/septic shock codes (P = .001). In contrast, the incidence of hospitalizations with positive blood cultures decreased by 17% (P = .006), and hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis remained stable (P = .098). The sensitivity of sepsis claims for capturing hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis increased (P < .001 for all methods), whereas the proportion of septicemia hospitalizations with positive blood cultures decreased from 50% to 30% (P < .001). Conclusions. The incidence of hospitalizations with sepsis codes rose dramatically while hospitalizations with corresponding objective clinical markers remained stable or decreased. Coding for sepsis has become more inclusive, and septicemia diagnoses are increasingly being applied to patients without positive blood cultures. These changes likely explain some of the apparent rise in sepsis incidence and underscore the need for more reliable surveillance methods. PMID:25258352

  15. National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study.

    PubMed

    Keep, J W; Messmer, A S; Sladden, R; Burrell, N; Pinate, R; Tunnicliff, M; Glucksman, E

    2016-01-01

    Severe sepsis and septic shock (SS) are time-critical medical emergencies that affect millions of people in the world. Earlier administration of antibiotics has been shown to reduce mortality from SS; however, the initiation of early resuscitation requires recognition that a patient may have sepsis. Early warning scores (EWS) are broadly used to detect patient deterioration, but to date have not been evaluated to detect patients at risk for SS. The purpose of our study was to look at the relationship between the initial national EWS (NEWS) in the emergency department (ED) and the diagnosis of SS. We performed a retrospective, single-centre, observational study in the ED of an urban university hospital with an annual attendance of 140,000 patients. We aimed to include 500 consecutive non-trauma adult patients presenting to the ED with Manchester Triage System (MTS) category 1-3. The final diagnosis was taken from either the ED medical records or the hospital discharge summary. For all NEWS, the sensitivity and specificity to detect patients with SS was calculated. A total of 500 patients were included, 27 patients (5.4%) met the criteria for SS. The area under the curve (AUC) for NEWS to identify patient at risk for SS is 0.89 (95% CI 0.84 to 0.94). A NEWS of 3 or more at ED triage has a sensitivity of 92.6% (95% CI 74.2% to 98.7%) and a specificity of 77% (95% CI 72.8% to 80.6%) to detect patients at risk for SS at ED triage. A NEWS of 3 or more at ED triage may be the trigger to systematically screen the patient for SS, which may ultimately lead to early recognition and treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Academic practice partnerships: a national dialogue.

    PubMed

    Beal, Judy A; Alt-White, Anna; Erickson, Judith; Everett, Linda Q; Fleshner, Irene; Karshmer, Judith; Swider, Susan; Gale, Sharon

    2012-01-01

    Academic-practice partnerships are an important mechanism to strengthen nursing practice and help nurses become well positioned to lead change and advance health. Through implementing such partnerships, both academic institutions and practice settings will formally address the recommendations of the Institute of Medicine Future of Nursing Committee. Effective partnerships will create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs. This paper details the work of the American Association of Colleges of Nursing-American Organization of Nurse Executives Task Force on Academic-Practice Partnerships that has identified hallmarks of successful partnership and produced tools and shared exemplars to assist nursing leaders in developing and sustaining partnerships for the future.

  17. Development and implementation of sepsis alert systems

    PubMed Central

    Harrison, Andrew M.; Gajic, Ognjen; Pickering, Brian W.; Herasevich, Vitaly

    2016-01-01

    Synopsis/Summary Development and implementation of sepsis alert systems is challenging, particularly outside the monitored intensive care unit (ICU) setting. Important barriers to wider use of sepsis alerts include evolving clinical definitions of sepsis, information overload & alert fatigue, due to suboptimal alert performance. Outside the ICU, additional barriers include differences in health care delivery models, charting behaviors, and availability of electronic data. Currently available evidence does not support routine use of sepsis alert systems in clinical practice. However, continuous improvement in both the afferent (data availability and accuracy of detection algorithms) and efferent (evidence-based decision support and smoother integration into clinical workflow) limbs of sepsis alert systems will help translate theoretical advantages into measurable patient benefit. PMID:27229639

  18. [New Sepsis-3 definition : Do we have to treat sepsis before we can diagnose it from now on?

    PubMed

    Schmoch, T; Bernhard, M; Uhle, F; Gründling, M; Brenner, T; Weigand, M A

    2017-05-11

    The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) have been available since the beginning of 2016. SEPSIS-3 completely replaces the old SIRS criteria in the definition of sepsis and defines sepsis from now on as "life-threatening organ dysfunction caused by a dysregulated host response to infection". However, it seems questionable whether in clinical practice the new definition is really superior to the old one. The most important question is the following: Is it helpful to have a definition that first recognizes a patient once organ dysfunction has occurred and the patient already needs intensive care?

  19. National Foreign Language Planning: Practices and Prospects.

    ERIC Educational Resources Information Center

    Sajavaara, Kari, Ed.; And Others

    A selection of essays on foreign language planning at the national level contains articles on the language planning process, language choice, teacher education, testing and assessment, and transnational planning. Essays include the following: "Foreign Language Teaching Policy: Some Planning Issues" (Theo J. M. van Els); "Foreign…

  20. Practice educators in the United Kingdom: A national job description.

    PubMed

    Rowe, John

    2008-11-01

    Much is known about the purpose of practice educators in the United Kingdom, but how their role is implemented is subject to conflicting expectations, partly created by the structure in which they work. Joint appointments between universities and practice are an opportunity for both organisations to collaborate in a partnership to enhance practice learning and fulfill one of the main aims of the practice educator role: to narrow the theory-practice gap. However tensions exist. This paper advocates a national (UK) job description for practice educators to reduce some of the tensions and conflict between the expectations of collaborating partners in practice learning. This would enable practice educators to concentrate on their obligations while employers concentrate on enabling practice educators to fulfill their obligations by upholding their rights to proper preparation, support and career structure.

  1. Where Sepsis and Antimicrobial Resistance Countermeasures Converge

    PubMed Central

    Inglis, Timothy J. J.; Urosevic, Nadia

    2017-01-01

    The United Nations General Assembly debate on antimicrobial resistance (AMR) recognizes the global significance of AMR. Much work needs to be done on technology capability and capacity to convert the strategic intent of the debate into operational plans and tangible outcomes. Enhancement of the biomedical science–clinician interface requires better exploitation of systems biology tools for in-laboratory and point of care methods that detect sepsis and characterize AMR. These need to link sepsis and AMR data with responsive, real-time surveillance. We propose an AMR sepsis register, similar in concept to a cancer registry, to aid coordination of AMR countermeasures. PMID:28220145

  2. [Early goal directed therapy in severe sepsis].

    PubMed

    Janssens, U

    2014-11-01

    The treatment of patients with severe sepsis and septic shock continues to evolve. Recent studies have enunciated the benefit of early goal-directed therapy (EGDT) during the first 6 h after recognition of the condition. With EGDT a reduction in mortality of over 16% was shown over standard care. Thereafter the components of the EGDT were consequently implemented in the international Surviving Sepsis Campaign as well as the German sepsis guidelines. Nevertheless the medical community's enthusiasm for EGDT has remained indecisive. There remains a profound skepticism about treatment targets such as central venous pressure or mean arterial pressure as well as central venous oxygen saturation. Moreover multiple barriers such as critical shortage of nursing staff, problems in obtaining central venous pressure monitoring or lack of agreement with the EGDT resuscitation protocol may lead to non-adherence to EGDT early in the course of sepsis. In a recent multicenter trial, protocol-based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes. The Severe Sepsis 3-Hour Resuscitation Bundle and the 6-Hour Septic Shock Bundle represent a distillation of the concepts and recommendations found in the practice guidelines published by the Surviving Sepsis Campaign. The bundles are designed to allow teams to follow the timing, sequence, and goals of the individual elements of care. Early recognition, early mobilization of resources, and multidisciplinary collaboration are imperative to enhance the prognosis of patients with sepsis.

  3. [Sepsis - how to recognize and what to focus on - back to basics in the light of the new definition].

    PubMed

    Horák, Jan; Harazim, Martin; Karvunidis, Thomas; Raděj, Jaroslav; Novák, Ivan; Matějovič, Martin

    Sepsis is the primary cause of death from infection. However, its early recognition remains a fundamental challenge in clinical practice. In February 2016, a newly revised sepsis definition has been published (SEPSIS-3). Sepsis has been redefined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In this article, we introduce the updated definition of sepsis, discuss its pros and cons and suggest practical implications. The emphasis is put on basic and comprehensive clinical assessment. definition - early recognition of sepsis - infection - sepsis - septic shock.

  4. AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

    PubMed Central

    Smischney, Nathan J.; Zhang, Haibo; Van Poucke, Sven; Tsirigotis, Panagiotis; Rello, Jordi; Honore, Patrick M.; Sen Kuan, Win; Ray, Juliet June; Zhou, Jiancang; Shang, You; Yu, Yuetian; Jung, Christian; Robba, Chiara; Taccone, Fabio Silvio; Caironi, Pietro; Grimaldi, David; Hofer, Stefan; Dimopoulos, George; Leone, Marc; Hong, Sang-Bum; Bahloul, Mabrouk; Argaud, Laurent; Kim, Won Young; Spapen, Herbert D.; Rocco, Jose Rodolfo

    2016-01-01

    Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for clinical use of different diagnostic tools rely on the Grades of Recommendation Assessment, Development and Evaluation (GRADE) framework. Because most of the studies were observational and did not allow a reliable assessment of these tools, a two-step inference approach was employed. Future trials need to confirm or refute a particular index test and should directly explore relevant patient outcome parameters. PMID:27747021

  5. Changing Definitions of Sepsis

    PubMed Central

    Gül, Fethi; Arslantaş, Mustafa Kemal; Cinel, İsmail; Kumar, Anand

    2017-01-01

    Sepsis is one of the main causes of morbidity and mortality in critically ill patients despite the use of modern antibiotics and resuscitation therapies. Outcomes in sepsis have improved overall, probably because of an enhanced focus on early diagnosis and other improvements in supportive care, but mortality rates still remain unacceptably high. The diagnosis and definition of sepsis is a critical problem due to the heterogeneity of this disease process. Although it is apparent that much more needs to be done to advance our understanding, sepsis and related terms remain difficult to define. A 1991 consensus conference developed initial definitions that systemic inflammatory response syndrome (SIRS) to infection would be called sepsis. Definitions of sepsis and septic shock were revised in 2001 to incorporate the threshold values for organ damage. In early 2016, the new definitions of sepsis and septic shock have changed dramatically. Sepsis is now defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The consensus document describes organ dysfunction as an acute increase in total Sequential Organ Failure Assessment (SOFA) score two points consequently to the infection. A significant change in the new definitions is the elimination of any mention of SIRS. The Sepsis-3 Task Force also introduced a new bedside index, called the qSOFA, to identify outside of critical care units patients with suspected infection who are likely to develop sepsis. Recently updated the consensus definitions improved specificity compared with the previous descriptions. PMID:28752002

  6. Introduction to Pediatric Sepsis.

    PubMed

    Wheeler, Derek S

    2011-10-07

    Sepsis is a significant health problem in both critically ill children and adults. While the mortality rate from sepsis is much lower in children, sepsis is directly responsible for over 4,000 childhood deaths per year in the United States alone. At face value, this number suggests that more children die per year in the United States from sepsis as the primary cause than from cancer. Unfortunately, there are few studies on the epidemiology, pathophysiology, and management of sepsis in children. Moreover, extrapolation of adult data to critically ill children is probably not appropriate due to several key developmental differences in the host response to infection and response to therapy. Therefore, additional studies targeting sepsis in the pediatric population are urgently required.

  7. Sandia National Laboratories ASCI Applications Software Quality Engineering Practices

    SciTech Connect

    ZEPPER, JOHN D.; ARAGON, KATHRYN MARY; ELLIS, MOLLY A.; BYLE, KATHLEEN A.; EATON, DONNA SUE

    2003-04-01

    This document provides a guide to the deployment of the software verification activities, software engineering practices, and project management principles that guide the development of Accelerated Strategic Computing Initiative (ASCI) applications software at Sandia National Laboratories (Sandia). The goal of this document is to identify practices and activities that will foster the development of reliable and trusted products produced by the ASCI Applications program. Document contents include an explanation of the structure and purpose of the ASCI Quality Management Council, an overview of the software development lifecycle, an outline of the practices and activities that should be followed, and an assessment tool.

  8. Who's using treatment manuals? A national survey of practicing therapists.

    PubMed

    Becker, Emily M; Smith, Ashley M; Jensen-Doss, Amanda

    2013-10-01

    Treatment manuals are currently the most common way treatments are disseminated to practicing clinicians, although little is known about the rates with which practicing therapists incorporate these manuals into their practice. In light of a widely acknowledged research-practice gap, understanding how often therapists are using manuals is important for shaping future dissemination efforts. This study collected data on rates of manual use among a national sample of mental health clinicians representative of those likely to be targeted in dissemination efforts (N = 756), as well as predictors of use. Results indicated that few clinicians (< 10%) routinely incorporated manuals into their practice, although most employed them to some degree. Predictors of manual use included greater openness to new treatments, younger age, and a cognitive-behavioral treatment orientation (ps < .05). Implications for future dissemination efforts are discussed.

  9. Assessment and Verification of National Vocational Qualifications: Policy and Practice.

    ERIC Educational Resources Information Center

    Konrad, John

    2000-01-01

    To overcome problems of assessment and verification of National Vocational Qualifications, the system should move from narrow quality control to total quality management. Situated learning in communities of practice, including assessors and assessees, should be developed. This requires radically different quality criteria and professional…

  10. National Best Practices Manual for Building High Performance Schools

    ERIC Educational Resources Information Center

    US Department of Energy, 2007

    2007-01-01

    The U.S. Department of Energy's Rebuild America EnergySmart Schools program provides school boards, administrators, and design staff with guidance to help make informed decisions about energy and environmental issues important to school systems and communities. "The National Best Practices Manual for Building High Performance Schools" is a part of…

  11. National Education Practice File. Final Report. Evaluation Report.

    ERIC Educational Resources Information Center

    Clay, Katherine; Davis, James E.

    The purpose of the National Education Practice File (NEPF) was to find out from educational practitioners what types of materials would be of value to them; to locate the types of information identified; and to make this information available to them through the development of a computerized file of practitioner-oriented materials. The 2-year,…

  12. Identifying Exemplary School Counseling Practices in Nationally Recognized High Schools

    ERIC Educational Resources Information Center

    Militello, Matthew; Carey, John; Dimmitt, Carey; Lee, Vivian; Schweid, Jason

    2009-01-01

    The National Center for School Counseling Outcome Research (CSCOR) at the University of Massachusetts-Amherst studied exemplary practices of 18 high schools that received recognition for college preparation and placement in 2004 and 2005. Through interviews with key personnel at each of the high schools, the researchers generated a set of ten…

  13. Methods for reducing sepsis mortality in emergency departments and inpatient units.

    PubMed

    Doerfler, Martin E; D'Angelo, John; Jacobsen, Diane; Jarrett, Mark P; Kabcenell, Andrea I; Masick, Kevin D; Parmentier, Darlene; Nelson, Karen L; Stier, Lori

    2015-05-01

    As part of a zero-tolerance approach to preventable deaths, North Shore-LIJ Health System (North Shore-LIJ) leadership prioritized a major patient safety initiative to reduce sepsis mortality in 2009 across 10 acute care hospitals (an 11th joined later). At baseline (2008), approximately 3,500 patients were discharged with a diagnosis of sepsis, which ranked as the top All Patient Refined Diagnosis-Related Group by number of deaths (N = 883). Initially, the focus was sepsis recognition and treatment in the emergency departments (EDs). North Shore-LIJ, the 14th largest health care system in the United States, cares for individuals at every stage of life at 19 acute care and specialty hospitals and more than 400 outpatient physician practice sites throughout New York City and the greater New York metropolitan area. The health system launched a strategic partnership with the Institute for Healthcare Improvement (IHI) in August 2011 to accelerate the pace of sepsis improvement. Throughout the course of the initiative, North Shore-LIJ collaborated with many local, state, national, and international organizations to test innovative ideas, share evidence-based best practices, and, more recently, to raise public awareness. North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008-2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals. Improvements were achieved by engaging leadership; fostering interprofessional collaboration, collaborating with other leading health care organizations; and developing meaningful, real-time metrics for all levels of staff.

  14. Identifying advanced practice: A national survey of a nursing workforce.

    PubMed

    Gardner, Glenn; Duffield, Christine; Doubrovsky, Anna; Adams, Margaret

    2016-03-01

    The size and flexibility of the nursing workforce has positioned nursing as central to the goals of health service improvement. Nursing's response to meeting these goals has resulted in proliferation of advanced practice nursing with a confusing array of practice profiles, titles and roles. Whilst numerous models and definitions of advanced practice nursing have been developed there is scant published research of significant scope that supports these models. Consequently there is an ongoing call in the literature for clarity and stability in nomenclature, and confusion in the health industry on how to optimise the utility of advanced practice nursing. To identify and delineate advanced practice from other levels of nursing practice through examination of a national nursing workforce. A cross-sectional electronic survey of nurses using the validated Advanced Practice Role Delineation tool based on the Strong Model of Advanced Practice. Study participants were registered nurses employed in a clinical service environment across all states and territories of Australia. A sample of 5662 registered nurses participated in the study. Domain means for each participant were calculated then means for nursing position titles were calculated. Position titles were grouped by delineation and were compared with one-way analysis of variance on domain means. The alpha for all tests was set at 0.05. Significant effects were examined with Scheffe post hoc comparisons to control for Type 1 error. The survey tool was able to identify position titles where nurses were practicing at an advanced level and to delineate this cohort from other levels of nursing practice, including nurse practitioner. The results show that nurses who practice at an advanced level are characterised by high mean scores across all Domains of the Strong Model of Advanced Practice. The mean scores of advanced practice nurses were significantly different from nurse practitioners in the Direct Care Domain and

  15. Particularities regarding the etiology of sepsis in forensic services.

    PubMed

    Dermengiu, Dan; Curca, George Cristian; Ceausu, Mihai; Hostiuc, Sorin

    2013-09-01

    If in clinical practice definitive diagnostic criteria had been established, after death sepsis is often difficult to diagnose, especially if a site of origin is not found or if no clinical data are available. This article will analyze the etiology of sepsis in a medical-legal service with emphasis on the differences in diagnosing it in clinical and forensic environments. A total of 78 cases of sepsis cases diagnosed or confirmed at the autopsy were selected. The etiological agent was determined either during the hospitalization or by postmortem bacteriology. A high prevalence of Gram-negative sepsis was found, especially multidrug-resistant micro-organisms. Most frequent etiological agents were Acinetobacter baumannii, Escherichia coli, Enterobacter, Enterococcus, Pseudomonas, and Klebsiella. Polymicrobial sepsis is much more frequent than in nonforensic cases. In legal medicine, the prevalence of Gram-negative sepsis is much higher than in nonforensic autopsies, and the point of origin is shifted toward the skin and the gastrointestinal system.

  16. Rapid diagnosis of sepsis

    PubMed Central

    Bloos, Frank; Reinhart, Konrad

    2014-01-01

    Fast and appropriate therapy is the cornerstone in the therapy of sepsis. However, the discrimination of sepsis from non-infectious causes of inflammation may be difficult. Biomarkers have been suggested to aid physicians in this decision. There is currently no biochemical technique available which alone allows a rapid and reliable discrimination between sepsis and non-infectious inflammation. Procalcitonin (PCT) is currently the most investigated biomarker for this purpose. C-reactive protein and interleukin 6 perform inferior to PCT in most studies and their value in diagnosing sepsis is not defined. All biomarkers including PCT are also released after various non-infectious inflammatory impacts. This shortcoming needs to be taken into account when biomarkers are used to aid the physician in the diagnosis of sepsis. Polymerase chain reaction (PCR) based pathogen detection may improve time to adequate therapy but cannot rule out the presence of infection when negative. PMID:24335467

  17. Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality.

    PubMed

    Wiens, Matthew O; Kumbakumba, Elias; Kissoon, Niranjan; Ansermino, J Mark; Ndamira, Andrew; Larson, Charles P

    2012-01-01

    Sepsis represents the progressive underlying inflammatory pathway secondary to any infectious illness, and ultimately is responsible for most infectious disease-related deaths. Addressing issues related to sepsis has been recognized as an important step towards reducing morbidity and mortality in developing countries, where the majority of the 7.5 million annual deaths in children under 5 years of age are considered to be secondary to sepsis. However, despite its prevalence, sepsis is largely neglected. Application of sepsis definitions created for use in resource-rich countries are neither practical nor feasible in most developing country settings, and alternative definitions designed for use in these settings need to be established. It has also been recognized that the inflammatory state created by sepsis increases the risk of post-discharge morbidity and mortality in developed countries, but exploration of this issue in developing countries is lacking. Research is urgently required to characterize better this potentially important issue.

  18. Sandia National Laboratories ASCI Applications Software Quality Engineering Practices

    SciTech Connect

    ZEPPER, JOHN D.; ARAGON, KATHRYN MARY; ELLIS, MOLLY A.; BYLE, KATHLEEN A.; EATON, DONNA SUE

    2002-01-01

    This document provides a guide to the deployment of the software verification activities, software engineering practices, and project management principles that guide the development of Accelerated Strategic Computing Initiative (ASCI) applications software at Sandia National Laboratories (Sandia). The goal of this document is to identify practices and activities that will foster the development of reliable and trusted products produced by the ASCI Applications program. Document contents include an explanation of the structure and purpose of the ASCI Quality Management Council, an overview of the software development lifecycle, an outline of the practices and activities that should be followed, and an assessment tool. These sections map practices and activities at Sandia to the ASCI Software Quality Engineering: Goals, Principles, and Guidelines, a Department of Energy document.

  19. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis.

    PubMed

    Griffin, M P; Moorman, J R

    2001-01-01

    Abrupt clinical deterioration because of sepsis is a major cause of morbidity and mortality in neonates, and earlier diagnosis should improve therapy of this potentially catastrophic illness. In practice, clinical signs and laboratory data have not been perceived as sensitive or specific for early stages of sepsis. Because heart rate characteristics (HRC) are abnormal during fetal distress and neonatal illness, we hypothesized that abnormal HRC might precede the clinical diagnosis of neonatal sepsis, adding independent information to standard clinical parameters. In the neonatal intensive care unit at the University of Virginia, we prospectively studied infants admitted from August 1995 to April 1999 who were at risk for developing sepsis. Infants in the sepsis (culture-positive) and sepsis-like illness (culture-negative) groups had an abrupt clinical deterioration that raised clinical suspicion of infection and prompted physicians to obtain blood cultures and start antibiotic therapy. Infants without sepsis raised no clinical suspicion of illness and had no cultures obtained. We measured novel characteristics-moments and percentiles-of normalized heart rate (HR) time series for 5 days before and 3 days after sepsis, sepsis-like illness, or a random time in controls. We also calculated the Score for Neonatal Acute Physiology (SNAP) and the Neonatal Therapeutic Intervention Scoring System (NTISS) as clinical scores of the severity of illness. There were 46 episodes of culture-positive sepsis in 40 patients and 27 episodes of culture-negative sepsis-like illness in 23 patients. We analyzed 29 control periods in 26 patients. Infants with sepsis and sepsis-like illness had lower birth weights and gestational ages and higher SNAP and NTISS scores than did infants without sepsis. The most important new finding was that the infants in the sepsis and sepsis-like illness groups had increasingly abnormal HRC for up to 24 hours preceding their abrupt clinical deterioration

  20. Sepsis and Acute Kidney Injury.

    PubMed

    Bilgili, Beliz; Haliloğlu, Murat; Cinel, İsmail

    2014-12-01

    Acute kindney injury (AKI) is a clinical syndrome which is generally defined as an abrupt decline in glomerular filtration rate, causing accumulation of nitrogenous products and rapid development of fluid, electrolyte and acid base disorders. In intensive care unit sepsis and septic shock are leading causes of AKI. Sepsis-induced AKI literally acts as a biologic indicator of clinical deterioration. AKI triggers variety of immune, inflammatory, metabolic and humoral patways; ultimately leading distant organ dysfunction and increases morbidity and mortality. Serial mesurements of creatinine and urine volume do not make it possible to diagnose AKI at early stages. Serum creatinine influenced by age, weight, hydration status and become apparent only when the kidneys have lost 50% of their function. For that reason we need new markers, and many biomarkers in the diagnosis of early AKI activity is assessed. Historically "Risk-Injury-Failure-Loss-Endstage" (RIFLE), "Acute Kidney Injury Netwok" (AKIN) and "The Kidney Disease/ Improving Global Outcomes" (KDIGO) classification systems are used for diagnosing easily in clinical practice and research and grading disease. Classifications including diagnostic criteria are formed for the identification of AKI. Neutrophil gelatinase associated lipocalin (NGAL), cystatin-C (Cys-C), kidney injury molecule-1 (KIM-1) and also "cell cycle arrest" molecules has been concerned for clinical use. In this review the pathophysiology of AKI, with the relationship of sepsis and the importance of early diagnosis of AKI is evaluated.

  1. Sepsis and Acute Kidney Injury

    PubMed Central

    Bilgili, Beliz; Haliloğlu, Murat; Cinel, İsmail

    2014-01-01

    Acute kindney injury (AKI) is a clinical syndrome which is generally defined as an abrupt decline in glomerular filtration rate, causing accumulation of nitrogenous products and rapid development of fluid, electrolyte and acid base disorders. In intensive care unit sepsis and septic shock are leading causes of AKI. Sepsis-induced AKI literally acts as a biologic indicator of clinical deterioration. AKI triggers variety of immune, inflammatory, metabolic and humoral patways; ultimately leading distant organ dysfunction and increases morbidity and mortality. Serial mesurements of creatinine and urine volume do not make it possible to diagnose AKI at early stages. Serum creatinine influenced by age, weight, hydration status and become apparent only when the kidneys have lost 50% of their function. For that reason we need new markers, and many biomarkers in the diagnosis of early AKI activity is assessed. Historically “Risk-Injury-Failure-Loss-Endstage” (RIFLE), “Acute Kidney Injury Netwok” (AKIN) and “The Kidney Disease/ Improving Global Outcomes” (KDIGO) classification systems are used for diagnosing easily in clinical practice and research and grading disease. Classifications including diagnostic criteria are formed for the identification of AKI. Neutrophil gelatinase associated lipocalin (NGAL), cystatin-C (Cys-C), kidney injury molecule-1 (KIM-1) and also “cell cycle arrest” molecules has been concerned for clinical use. In this review the pathophysiology of AKI, with the relationship of sepsis and the importance of early diagnosis of AKI is evaluated. PMID:27366441

  2. CHEER National Study of Chronic Rhinosinusitis Practice Patterns.

    PubMed

    Chapurin, Nikita; Pynnonen, Melissa A; Roberts, Rhonda; Schulz, Kristine; Shin, Jennifer J; Witsell, David L; Parham, Kourosh; Langman, Alan; Carpenter, David; Vambutas, Andrea; Nguyen-Huynh, Anh; Wolfley, Anne; Lee, Walter T

    2017-02-01

    Objectives (1) Describe national patterns of chronic rhinosinusitis (CRS) care across academic and community practices. (2) Determine the prevalence of comorbid disorders in CRS patients, including nasal polyposis, allergic rhinitis, asthma, and cystic fibrosis. (3) Identify demographic, clinical, and practice type factors associated with endoscopic sinus surgery (ESS). Study Design Multisite cross-sectional study. Setting Otolaryngology's national research network CHEER (Creating Healthcare Excellence through Education and Research). Subjects and Methods A total of 17,828 adult patients with CRS were identified, of which 10,434 were seen at community practices (59%, n = 8 sites) and 7394 at academic practices (41%, n = 10 sites). Multivariate logistic regression was used to evaluate the association between demographic, practice type, and clinical factors and the odds of a patient undergoing ESS. Results The average age was 50.4 years; 59.5% of patients were female; and 88.3% were Caucasian. The prevalence of comorbid diseases was as follows: allergic rhinitis (35.1%), nasal polyposis (13.3%), asthma (4.4%), and cystic fibrosis (0.2%). In addition, 24.8% of patients at academic centers underwent ESS, as compared with 12.3% at community sites. In multivariate analyses, nasal polyposis (odds ratio [OR], 4.28), cystic fibrosis (OR, 2.42), and academic site type (OR, 1.86) were associated with ESS ( P < .001), while adjusting for other factors. Conclusions We describe practice patterns of CRS care, as well as demographic and clinical factors associated with ESS. This is the first study of practice patterns in CRS utilizing the CHEER network and may be used to guide future research.

  3. Current clinical practices in Aphasia Therapy in Finland: challenges in moving towards national best practice.

    PubMed

    Klippi, A; Sellman, J; Heikkinen, P; Laine, M

    2012-01-01

    The objective of this article is to discover and document the state of clinical practices for aphasia therapy in Finland and to gather information for developing national best practice. Two surveys were administered in Finland that explored current clinical practices in aphasia rehabilitation and the resources available to speech and language therapists (SLTs). We integrated and compared the results of these surveys. The results are based on the responses of the 88 (45 + 43) returned questionnaires from SLTs. Four principle themes were identified: planning the aphasia therapy, measures and assessment methods, current therapy service provision, and development suggestions and barriers to change. The results of this study showed considerable consistency in clinical practices among the respondents to the surveys. However, we noticed that there are some discrepancies between the recent research findings and present clinical practices. The findings from this study indicate that there are many challenges in clinical decision-making at the moment in Finland. The article helps clinicians to evaluate the practices they use and to execute justified modifications in order to implement more effective models of practice. It is evident that national best practice guidelines for aphasia therapy would support SLTs in clinical decision-making. Copyright © 2012 S. Karger AG, Basel.

  4. [Nursing practice within the French national gendarmerie intervention group].

    PubMed

    Fressancourt, Yves; Quémeneur, Éric; Bertho, Kilian; Dubourg, Olivier

    2016-11-01

    Intervening in the event of a major crisis in France and abroad, the national gendarmerie intervention group carries out complex and specific operations in varied conditions and environments. Due to the multiplicity and dangerousness of the missions, adapted and integrated medical support is essential. In this context, nurses provide operational medical assistance as close as possible to the intervention. This nursing practice in an exceptional environment requires specific knowledge and intensive training.

  5. Sepsis pathophysiology and anesthetic consideration.

    PubMed

    Yuki, Koichi; Murakami, Naoka

    2015-01-01

    Sepsis remains to be a significant health care issue associated with high mortality and healthcare cost, despite the extensive effort to better understand the pathophysiology of the sepsis. Recently updated clinical guideline for severe sepsis and septic shock, "Surviving Sepsis Campaign 2012", emphasizes the importance of early goal-directed therapy, which can be implemented in intraoperative management of sepsis patients. Herein, we review the updates of current guideline and discuss its application to anesthesic management. Furthermore, we review the recent advance in knowledge of sepsis pathophysiology, focusing on immune modulation, which may lead to new clinical therapeutic approach to sepsis.

  6. Sepsis Pathophysiology and Anesthetic Consideration

    PubMed Central

    Yuki, Koichi; Murakami, Naoka

    2015-01-01

    Sepsis remains to be a significant health care issue associated with high mortality and healthcare cost, despite the extensive effort to better understand the pathophysiology of the sepsis. Recently updated clinical guideline for severe sepsis and septic shock, “Surviving Sepsis Campaign 2012”, emphasizes the importance of early goal-directed therapy, which can be implemented in intraoperative management of sepsis patients. Herein, we review the updates of current guideline and discuss its application to anesthesic management. Furthermore, we review the recent advance in knowledge of sepsis pathophysiology, focusing on immune modulation, which may lead to new clinical therapeutic approach to sepsis. PMID:25567335

  7. Biomarkers of sepsis.

    PubMed

    Faix, James D

    2013-01-01

    Sepsis is an unusual systemic reaction to what is sometimes an otherwise ordinary infection, and it probably represents a pattern of response by the immune system to injury. A hyper-inflammatory response is followed by an immunosuppressive phase during which multiple organ dysfunction is present and the patient is susceptible to nosocomial infection. Biomarkers to diagnose sepsis may allow early intervention which, although primarily supportive, can reduce the risk of death. Although lactate is currently the most commonly used biomarker to identify sepsis, other biomarkers may help to enhance lactate's effectiveness; these include markers of the hyper-inflammatory phase of sepsis, such as pro-inflammatory cytokines and chemokines; proteins such as C-reactive protein and procalcitonin which are synthesized in response to infection and inflammation; and markers of neutrophil and monocyte activation. Recently, markers of the immunosuppressive phase of sepsis, such as anti-inflammatory cytokines, and alterations of the cell surface markers of monocytes and lymphocytes have been examined. Combinations of pro- and anti-inflammatory biomarkers in a multi-marker panel may help identify patients who are developing severe sepsis before organ dysfunction has advanced too far. Combined with innovative approaches to treatment that target the immunosuppressive phase, these biomarkers may help to reduce the mortality rate associated with severe sepsis which, despite advances in supportive measures, remains high.

  8. Biomarkers of sepsis

    PubMed Central

    2013-01-01

    Sepsis is an unusual systemic reaction to what is sometimes an otherwise ordinary infection, and it probably represents a pattern of response by the immune system to injury. A hyper-inflammatory response is followed by an immunosuppressive phase during which multiple organ dysfunction is present and the patient is susceptible to nosocomial infection. Biomarkers to diagnose sepsis may allow early intervention which, although primarily supportive, can reduce the risk of death. Although lactate is currently the most commonly used biomarker to identify sepsis, other biomarkers may help to enhance lactate’s effectiveness; these include markers of the hyper-inflammatory phase of sepsis, such as pro-inflammatory cytokines and chemokines; proteins such as C-reactive protein and procalcitonin which are synthesized in response to infection and inflammation; and markers of neutrophil and monocyte activation. Recently, markers of the immunosuppressive phase of sepsis, such as anti-inflammatory cytokines, and alterations of the cell surface markers of monocytes and lymphocytes have been examined. Combinations of pro- and anti-inflammatory biomarkers in a multi-marker panel may help identify patients who are developing severe sepsis before organ dysfunction has advanced too far. Combined with innovative approaches to treatment that target the immunosuppressive phase, these biomarkers may help to reduce the mortality rate associated with severe sepsis which, despite advances in supportive measures, remains high. PMID:23480440

  9. Pharmacological management of sepsis

    SciTech Connect

    Fletcher, J.R.

    1985-01-01

    Systemic sepsis continues to be the most-difficult management problem in caring for the combat casualty. The complications of sepsis pervade all areas of injury to soldiers in the field, whether it is mechanical (missiles), thermal (burns), chemical, biological, or radiation injury. With the advent of tactical nuclear weapons, the problem of sepsis will be much higher in future wars than has previously been experienced through the world. The purpose of this chapter is a) to review the data suggesting pharmacological agents that may benefit the septic patient, and b) to emphasize the adjunctive therapies that should be explored in clinical trials. The pharmacological management of sepsis remains controversial. Most of the drugs utilized clinically treat the symptoms of the disease and are not necessarily directed at fundamental mechanisms that are known to be present in sepsis. A broad data base is emerging, indicating that NSAID should be used in human clinical trials. Prostaglandins are sensitive indicators of cellular injury and may be mediators for a number of vasoactive chemicals. Opiate antagonists and calcium channel blockers require more in-depth data; however, recent studies generate excitement for their potential use in the critically ill patient. Pharmacological effects of antibiotics, in concert with other drugs, suggest an entirely new approach to pharmacological treatment in sepsis. There is no doubt that new treatment modalities or adjunctive therapies must be utilized to alter the poor prognosis of severe sepsis that we have observed in the past 4 decades.

  10. A National Survey of Physician Practices Regarding Influenza Vaccine

    PubMed Central

    Davis, Matthew M; McMahon, Shawn R; Santoli, Jeanne M; Schwartz, Benjamin; Clark, Sarah J

    2002-01-01

    OBJECTIVE To characterize U.S. physicians' practices regarding influenza vaccine, particularly regarding the capacity to identify high-risk patients, the use of reminder systems, and the typical period of administration of vaccine. DESIGN Cross-sectional mail survey administered in October and November 2000. PARTICIPANTS National random sample of internists and family physicians (N = 1,606). RESULTS Response rate was 60%. Family physicians are significantly more likely than internists to administer influenza vaccine in their practices (82% vs 76%; P < .05). Eighty percent of physicians typically administer influenza vaccine for 3 to 5 months, but only 27% continue administering vaccine after the typical national peak of influenza activity. Only one half of physicians said their practices are able to generate lists of patients with chronic illnesses at high risk for complications of influenza, and only one quarter had used mail or telephone reminder systems to contact high-risk patients. Physicians working in a physician network (including managed care organizations) are more than twice as likely to use reminders as physicians in other practice settings (odds ratio, 2.04; 95% confidence interval, 1.17 to 3.55). CONCLUSIONS Over three quarters of U.S. internists and family physicians routinely administer influenza vaccine, but few continue immunization efforts past the typical national peak of influenza activity. Many physicians may be limited by their practice data systems' capacity to identify high-risk patients. Despite the known effectiveness and cost-effectiveness of reminder systems, few physicians use reminders for influenza vaccination efforts. These findings raise concerns about meeting domestic influenza vaccination goals—especially for individuals with chronic illness and during periods of delayed vaccine availability—and the possibility of increased morbidity and mortality attributable to influenza as a result. PMID:12220362

  11. National Board Certification and Developmentally Appropriate Practices: Perceptions of Impact

    PubMed Central

    McKenzie, Ellen Nancy

    2013-01-01

    The study investigated a relationship between National Board certification and perceived use of developmentally appropriate practices (DAP). A self-developed survey, the Early-childhood Teacher Inventory of Practices, was e-mailed to participants. Participants included 246 non-National Board-certified (non-NBCT) and 135 National Board-certified (NBCT) early childhood teachers. Descriptives were reported for age, years of teaching experience, grade level currently teaching, ethnicity, degree type, certification type, and degree level. Inferential statistics were used to understand the differences between perceived use of DAP. NBCTs scored significantly higher than non-NBCTs in three of the four target areas and on the total of the scale. Pearson product-moment corelations were used to determine a relationship between years of experience or level of education and NBCTs’ perceived use of DAP. Years of experience were significantly related, but level of education was not. The findings indicate that NBCT teachers perceive they incorporate more developmentally appropriate practices into their teaching than do non-NBCT teachers. PMID:23626399

  12. Sepsis in Children: Global Implications of the World Health Assembly Resolution on Sepsis.

    PubMed

    Kissoon, Niranjan; Reinhart, Konrad; Daniels, Ron; Machado, Machado Flavia R; Schachter, Raymond D; Finfer, Simon

    2017-09-13

    Sepsis, worldwide the leading cause of death in children, has now been recognized as the global health emergency it is. On May 26, 2017, the World Health Assembly, the decision-making body of the World Health Organization, adopted a resolution proposed by the Global Sepsis Alliance to improve the prevention, diagnosis, and management of sepsis. To discuss the implications of this resolution for children worldwide. The resolution highlights sepsis as a global threat and urges the 194 United Nations member states to take specific actions and implement appropriate measures to reduce its human and health economic burden. The resolution is a major step toward achieving the targets outlined by the Sustainable Developmental Goals for decreasing mortality in infants and children, but implementing it will require a concerted global effort.

  13. Mentoring for nurses in general practice: national issues and challenges.

    PubMed

    Heartfield, Marie; Gibson, Terri

    2005-04-01

    This paper reports the findings of a research project designed to identify national issues impacting on the development of a mentoring framework for nurses in general practice in Australia. The project comprised the first phase of a three-phase study commissioned by the Australian Government Department of Health and Ageing to develop a contemporary, flexible and sustainable mentoring framework that enhances the capacity of nurses to contribute to general practice outcomes. Key stakeholders and influential informants from around Australia were brought together via a national teleconference to identify issues surrounding the development of such a framework. Outcomes focussed on major themes concerning choice, relationships, structures and resources. Here, we consider the issues and challenges identified in light of some contemporary case studies from outside the field of nursing in the hope of sparking new ideas and strategies. A case study from an Australian practice nurse is included. No research has been conducted on mentoring for nurses in general practice in Australia to date, highlighting an urgent need for new models and their evaluation.

  14. Defining Sepsis Mortality Clusters in the United States.

    PubMed

    Moore, Justin Xavier; Donnelly, John P; Griffin, Russell; Howard, George; Safford, Monika M; Wang, Henry E

    2016-07-01

    In the United States, sepsis is a major public health problem accounting for over 200,000 annual deaths. The aims of this study were to identify U.S. counties with high sepsis mortality and to assess the community characteristics associated with increased sepsis mortality. We performed a descriptive analysis of 2003 through 2012 Compressed Mortality File data. We defined sepsis deaths as deaths associated with an infection, classified according to the International Classification of Diseases, 10th Version. Three thousand one hundred and eight counties in the contiguous U.S. counties, excluding Hawaii and Alaska. Using geospatial autocorrelation methods, we defined county-level sepsis mortality as strongly clustered, moderately clustered, and nonclustered. We approximated the mean crude, age-adjusted, and community-adjusted sepsis mortality rates nationally and for clustering groups. We contrasted demographic and community characteristics between clustering groups. We performed logistic regression for the association between strongly clustered counties and community characteristics. Among 3,108 U.S. counties, the age-adjusted sepsis mortality rate was 59.6 deaths per 100,000 persons (95% CI, 58.9-60.4). Sepsis mortality was higher in the Southern U.S. and clustered in three major regions: Mississippi Valley, Middle Georgia, and Central Appalachia. Among 161 (5.2%) strongly clustered counties, age-adjusted sepsis mortality was 93.1 deaths per 100,000 persons (95% CI, 90.5-95.7). Strongly clustered sepsis counties were more likely to be located in the south (92.6%; p < 0.001), exhibit lower education, higher impoverished population, without medical insurance, higher medically uninsured rates, and had higher unemployment rates (p < 0.001). Sepsis mortality is higher in the Southern United States, with three regional clusters: "Mississippi Valley," "Middle Georgia," and "Central Appalachia": Regions of high sepsis mortality are characterized by lower education, income

  15. Abortion and neonaticide: ethics, practice, and policy in four nations.

    PubMed

    Gross, Michael L

    2002-06-01

    Abortion, particularly later-term abortion, and neonaticide, selective non-treatment of newborns, are feasible management strategies for fetuses or newborns diagnosed with severe abnormalities. However, policy varies considerably among developed nations. This article examines abortion and neonatal policy in four nations: Israel, the US, the UK and Denmark. In Israel, late-term abortion is permitted while non-treatment of newborns is prohibited. In the US, on the other hand, later-term abortion is severely restricted, while treatment to newborns may be withdrawn. Policy in the UK and Denmark bridges some of these gaps with liberal abortion and neonatal policy. Disparate policy within and between nations creates practical and ethical difficulties. Practice diverges from policy as many practitioners find it difficult to adhere to official policy. Ethically, it is difficult to entirely justify perinatal policy in these nations. In each nation, there are elements of ethically sound policy, while other aspects cannot be defended. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. These include 1) a grant of full moral and legal status to the newborn but only partial moral and legal status to the late-term fetus 2) a general prohibition against feticide unless to save the life of the mother or prevent the birth of a fetus facing certain death or severe pain or suffering and 3) a general endorsement of neonaticide subject to a parent's assessment of the newborn's interest broadly defined to consider physical harm as well as social, psychological and or financial harm to related third parties. Policies in each of the nations surveyed diverging from these norms should be the subject of public discourse and, where possible

  16. The Microcirculation in Sepsis

    PubMed Central

    Tyagi, Asha; Sethi, Ashok Kumar; Girotra, Gautam; Mohta, Medha

    2009-01-01

    Summary Sepsis is a leading cause of mortality in critically ill patients. The pathophysiology of sepsis involves a highly complex and integrated response, including the activation of various cell types, inflammatory mediators, and the haemostatic system. Recent evidence suggests an emerging role of the microcirculation in sepsis, necessitating a shift in our locus away Irom the macrohaemodynamics to ill icrohaemodynanmics in a septic patient. This review article provides a brief overview of the microcirculation, its assessment techniques, and specific therapies to resuscitate the microhaemodynamics. PMID:20640135

  17. Neutrophil paralysis in sepsis.

    PubMed

    Alves-Filho, José C; Spiller, Fernando; Cunha, Fernando Q

    2010-09-01

    Sepsis develops when the initial host response is unable to contain the primary infection, resulting in widespread inflammation and multiple organ dysfunction. The impairment of neutrophil migration into the infection site, also termed neutrophil paralysis, is a critical hallmark of sepsis, which is directly related to the severity of the disease. Although the precise mechanism of this phenomenon is not fully understood, there has been much advancement in the understanding of this field. In this review, we highlight the recent insights into the molecular mechanisms of neutrophil paralysis during sepsis.

  18. Prehospital Sepsis Care.

    PubMed

    Jones, Jerrilyn; Lawner, Benjamin J

    2017-02-01

    Prehospital care providers are tasked with the delivery of time-sensitive care, and emergency medical services (EMS) systems must match patients to appropriate clinical resources. Modern systems are uniquely positioned to recognize and treat patients with sepsis. Interventions such as administration of intravenous fluid and transporting patients to the appropriate level of definitive care are linked to improved patient outcomes. As EMS systems refine their protocols for the recognition and stabilization of patients with suspected or presumed sepsis, EMS providers need to be educated about the spectrum of sepsis-related presentations and treatment strategies need to be standardized.

  19. A national survey of practical airway training in UK anaesthetic departments. Time for a national policy?

    PubMed

    Lindkaer Jensen, N H; Cook, T M; Kelly, F E

    2016-11-01

    The Fourth National Audit Project (NAP4) recommended airway training for trainee and trained anaesthetists. As the skills required for management of airway emergencies differ from routine skills and these events are rare, practical training is likely to require training workshops. In 2013, we surveyed all UK National Health Service hospitals to examine the current practices regarding airway training workshops. We received responses from 206 hospitals (62%) covering all regions. Regarding airway workshops, 16% provide none and 51% only for trainees. Of those providing workshops, more than half are run less than annually. Workshop content varies widely, with several Difficult Airway Society (DAS) guideline techniques not taught or only infrequently. Reported barriers to training include lack of time and departmental or individual interest. Workshop-based airway training is variable in provision, frequency and content, and is often not prioritised by departments or individual trainers. It could be useful if guidance on workshop organisation, frequency and content was considered nationally.

  20. Sepsis Questions and Answers

    MedlinePlus

    ... associated with infections of the lungs (e.g., pneumonia), urinary tract (e.g., kidney), skin, and gut. Staphylococcus aureus ( staph ), Escherichia coli ( E. coli ), and some types of Streptococcus (strep) are common germs that can cause sepsis. ...

  1. The Pathogenesis of Sepsis

    PubMed Central

    Stearns-Kurosawa, Deborah J.; Osuchowski, Marcin F.; Valentine, Catherine; Kurosawa, Shinichiro; Remick, Daniel G.

    2013-01-01

    Sepsis is a serious clinical condition that represents a patient’s response to a severe infection and has a very high mortality rate. Normal immune and physiologic responses eradicate pathogens, and the pathophysiology of sepsis is due to the inappropriate regulation of these normal reactions. In an ideal scenario, the first pathogen contact with the inflammatory system should eliminate the microbe and quickly return the host to homeostasis. The septic response may accelerate due to continued activation of neutrophils and macrophages/monocytes. Upregulation of lymphocyte costimulatory molecules and rapid lymphocyte apoptosis, delayed apoptosis of neutrophils, and enhanced necrosis of cells/tissues also contribute to the pathogenesis of sepsis. The coagulation system is closely tied to the inflammatory response, with cross talk between the two systems driving the dysregulated response. Biomarkers may be used to help diagnose patients with sepsis, and they may also help to identify patients who would benefit from immunomodulatory therapies. PMID:20887193

  2. Vitamin D and sepsis

    PubMed Central

    Kempker, Jordan A.; Han, Jenny E.; Tangpricha, Vin; Ziegler, Thomas R.; Martin, Greg S.

    2012-01-01

    Vitamin D insufficiency and sepsis are both highly prevalent worldwide problems and this article reviews the emerging science that is defining the intersections of these conditions. The importance of vitamin D’s role in skeletal health has long been understood but recent evidence is beginning to highlight its role in the functioning of other physiologic systems of the body. Basic science data reveal its integral role in local immune responses to pathogens and the systemic inflammatory pathways of sepsis. Furthermore, clinical scientists have found associations with respiratory infections, critical illness and sepsis but the causal relationship and its clinical impact have yet to be clearly defined. The article ends with speculations on the connections between racial disparities and seasonal differences in sepsis and vitamin D insufficiency. PMID:22928065

  3. Neurologic complications of sepsis.

    PubMed

    Schmutzhard, E; Pfausler, B

    2017-01-01

    Over the past decades, the incidence of sepsis and resultant neurologic sequelae has increased, both in industrialized and low- or middle-income countries, by approximately 5% per year. Up to 300 patients per 100 000 population per year are reported to suffer from sepsis, severe sepsis, and septic shock. Mortality is up to 30%, depending on the precision of diagnostic criteria. The increasing incidence of sepsis is partially explained by demographic changes in society, with aging, increasing numbers of immunocompromised patients, dissemination of multiresistant pathogens, and greater availability of supportive medical care in both industrialized and middle-income countries. This results in more septic patients being admitted to intensive care units. Septic encephalopathy is a manifestation especially of severe sepsis and septic shock where the neurologist plays a crucial role in diagnosis and management. It is well known that timely treatment of sepsis improves outcome and that septic encephalopathy may precede other signs and symptoms. Particularly in the elderly and immunocompromised patient, the brain may be the first organ to show signs of failure. The neurologist diagnosing early septic encephalopathy may therefore contribute to the optimal management of septic patients. The brain is not only an organ failing in sepsis (a "sepsis victim" - as with other organs), but it also overwhelmingly influences all inflammatory processes on a variety of pathophysiologic levels, thus contributing to the initiation and propagation of septic processes. Therefore, the best possible pathophysiologic understanding of septic encephalopathy is essential for its management, and the earliest possible therapy is crucial to prevent the evolution of septic encephalopathy, brain failure, and poor prognosis.

  4. Sepsis and maternal mortality.

    PubMed

    Acosta, Colleen D; Knight, Marian

    2013-04-01

    Despite global progress towards reducing maternal mortality, sepsis remains a leading cause of preventable maternal death. This review focuses on current measurement challenges, trends, causes and efforts to curb maternal death from sepsis in high and low-income countries. Under-reporting using routine registration data, compounded by misclassification and unreported deaths, results in significant underestimation of the burden of maternal death from sepsis. In the UK and the Netherlands the recent increase in maternal death from sepsis is mainly attributed to an increase in invasive group A streptococcal infections. Susceptibility to infection may be complicated by modulation of maternal immune response and increasing rates of risk factors such as caesarean section and obesity. Failure to recognize severity of infection is a major universal risk factor. Standardized Surviving Sepsis Campaign (SSC) recommendations for management of severe maternal sepsis are continuing to be implemented worldwide; however, outcomes differ according to models of intensive care resourcing and use. The need for robust data with subsequent analyses is apparent. This will significantly increase our understanding of risk factors and their causal pathways, which are critical to informing effective treatment strategies in consideration of resource availability.

  5. Variations in tobacco control in National Dental PBRN practices: the role of patient and practice factors.

    PubMed

    Ray, Midge N; Allison, Jeroan J; Coley, Heather L; Williams, Jessica H; Kohler, Connie; Gilbert, Gregg H; Richman, Joshua S; Kiefe, Catarina I; Sadasivam, Rajani S; Houston, Thomas K

    2013-01-01

    We engaged dental practices enrolled in The National Dental Practice-Based Research Network to quantify tobacco screening (ASK) and advising (ADVISE); and to identify patient and practice -characteristics associated with tobacco control. Dental practices (N = 190) distributed patient surveys that measured ASK and ADVISE. Twenty-nine percent of patients were ASKED about tobacco use during visit, 20% were identified as tobacco users, and 41% reported being ADVISED. Accounting for clustering of patients within practices, younger age and male gender were positively associated with ASK and ADVISE. Adjusting for patient age and gender, a higher proportion of non-whites in the practice, preventive services and proportion on public assistance were positively associated with ASK. Proportion of tobacco users in the practice and offering other preventive services were more strongly associated with ASK and ADVISE than other practice characteristics. Understanding variations in performance is an important step toward designing strategies for improving tobacco control in dentistry. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

  6. Fluid Resuscitation in Sepsis: Reexamining the Paradigm

    PubMed Central

    Tirupakuzhi Vijayaraghavan, Bharath Kumar; Cove, Matthew Edward

    2014-01-01

    Sepsis results in widespread inflammatory responses altering homeostasis. Associated circulatory abnormalities (peripheral vasodilation, intravascular volume depletion, increased cellular metabolism, and myocardial depression) lead to an imbalance between oxygen delivery and demand, triggering end organ injury and failure. Fluid resuscitation is a key part of treatment, but there is little agreement on choice, amount, and end points for fluid resuscitation. Over the past few years, the safety of some fluid preparations has been questioned. Our paper highlights current concerns, reviews the science behind current practices, and aims to clarify some of the controversies surrounding fluid resuscitation in sepsis. PMID:25180196

  7. Salary administration practices, Sandia National Laboratories, Albuquerque, New Mexico

    SciTech Connect

    Not Available

    1989-03-20

    This report concerns the Department of Energy's (Department) oversight of Sandia National Laboratories' (Sandia) salary administration practices for employees not covered by union agreements. Sandia is a management and operating (MandO) contractor responsible for research and development (RandD) relating to nuclear weapons and energy. Sandia's 1987 payroll was $319 million, $42 million for bargaining and $277 million for non-bargaining unit employees. For the period covered by the audit, Department policy required Headquarters monitoring and approval of the reasonableness of MandO contractor salary administration practices in cases where the annual non-bargaining payroll exceeded $75 million. The purpose of this audit was to determine whether Department oversight of Sandia employee compensation assured that contractor pay rates were consistent with Department policy.

  8. Neutropenic sepsis: prevention, identification and treatment.

    PubMed

    Warnock, Clare

    2016-04-27

    Chemotherapy-induced neutropenia may result in significant physical, social and emotional consequences for patients receiving anticancer therapy. Chemotherapy-induced neutropenia also leads to delays in treatment and reductions in dose intensity. In some cases neutropenia may be prevented by the use of granulocyte-colony stimulating factor, but it remains one of the most common side effects of chemotherapy. Patients who are neutropenic have a reduced ability to fight infection and are at increased risk of developing neutropenic sepsis. Nurses need to be able to recognise the signs and symptoms of neutropenic sepsis to ensure early diagnosis and treatment. There are evidence-based pathways for the treatment of patients with neutropenic sepsis and nurses have the potential to develop services and initiatives to support best practice for this group of patients.

  9. Blood purification therapy for sepsis.

    PubMed

    Sakata, Hiromi; Yonekawa, Motoki; Kawamura, Akio

    2006-12-01

    Accumulating evidences of underlining pathogenesis of sepsis have contributed to the therapeutic strategy for sepsis. Not only endotoxin and cytokine, but also signal transduction through Toll-like receptors could be a strategic target for the management of sepsis. Blood purification therapy including polymyxin B-immobilized hemoperfusion cartridge and continuous hemodiafiltration has shown the beneficial effect on patients with sepsis in Japan. Although they were initially designed to remove endotoxin and cytokines respectively, they might eliminate unexpected mediators responsible for sepsis. Further elucidation of mechanism and randomized controlled studies are needed to establish the role of blood purification therapy in sepsis.

  10. [Severe sepsis and septic shock].

    PubMed

    Tønnesen, Else; Larsen, Kim

    2014-07-07

    Sepsis, severe sepsis and septic shock are syndromes. The incidence of sepsis is as high as 35% and with mortality rates in the intensive care unit from 27% to 54% in sepsis and septic shock, respectively. Many new treatments have been tested but only few have been implemented in clinical practise. The treatment of severe sepsis and septic shock is based on the Surviving Sepsis Campaign guidelines developed by an international expert panel. Early diagnosis, optimization of haemodynamics, rapid identification of focus and adequate antibiotic treatment are the most important strategies.

  11. Improving the care of sepsis: Between system redesign and professional responsibility: A roundtable discussion in the world sepsis day, September 25, 2013, Riyadh, Saudi Arabia.

    PubMed

    Arabi, Yaseen; Alamry, Ahmed; Levy, Mitchell M; Taher, Saadi; Marini, Abdellatif M

    2014-07-01

    This paper summarizes the roundtable discussion in September 25, 2013, Riyadh, Saudi Arabia as part of the World Sepsis Day held in King Abdulaziz Medical City, Riyadh. The objectives of the roundtable discussion were to (1) review the chasm between the current management of sepsis and best practice, (2) discuss system redesign and role of the microsystem in sepsis management, (3) emphasize the multidisciplinary nature of the care of sepsis and that improvement of the care of sepsis is the responsibility of all, (4) discuss the bundle concept in sepsis management, and (5) reflect on the individual responsibility of the health care team toward sepsis with a focus on accountability and the moral agent.

  12. Using the integrated nurse leadership program to reduce sepsis mortality.

    PubMed

    Kliger, Julie; Singer, Sara J; Hoffman, Frank H

    2015-06-01

    The Integrated Nurse Leadership Program (INLP) is a collaborative improvement model focused on developing practical leadership skills of nurses and other frontline clinicians to lead quality improvement efforts. Sepsis is a major challenge to treat because it arises unpredictably and can progress rapidly. Nine San Francisco Bay Area hospitals participated in a 22-month INLP Sepsis Mortality Reduction Project to improve sepsis detection and management. The INLP focused on developing leadership and process improvement skills of nurses and other frontline clinicians. Teams of trained clinicians then implemented three strategies to improve early identification and timely treatment of sepsis: (1) sepsis screening of all patients, with diagnostic testing according to protocol; (2) timely treatment on the basis of key elements of Early Goal-Directed Therapy (EGDT); and (3) ongoing data review. Each hospital agreed to pursue the goal of reducing sepsis mortality by 15% by the end of the project. In the data collection period (baseline, July-December 2008 and project completion, January-June 2011), team members showed strong improvement in perceived leadership skills, team effectiveness, and ability to improve care quality. During this period, sepsis mortality for eight of the participating hospitals (Hospital 9 joined the project six months after it began) decreased by 43.7%-from 28% in the baseline period to 16% at project completion. Sepsis mortality rates trended downward for all hospitals, significantly decreasing (p<.05 at one hospital, p<.01 for four hospitals). In addition to improvement in safety culture and management of septic patients, hospitals participating in the INLP Sepsis Mortality Reduction Project achieved reductions in sepsis mortality during the study period and sustained reductions for more than one year later. The INLP model can be readily applied beyond sepsis management and mortality to other quality problems.

  13. Understanding of sepsis among emergency medical services: a survey study.

    PubMed

    Seymour, Christopher W; Carlbom, David; Engelberg, Ruth A; Larsen, Jonathan; Bulger, Eileen M; Copass, Michael K; Rea, Thomas D

    2012-06-01

    Emergency medical services (EMS) personnel commonly encounter sepsis, yet little is known about their understanding of sepsis. To determine the awareness, knowledge, current practice, and attitudes about sepsis among EMS personnel. We performed an anonymous, multi-agency, online survey of emergency medical technicians (EMTs), firefighter-emergency medical technicians (FF-EMTs), and paramedics in a metropolitan, 2-tier EMS system. We compared responses according to the level of EMS training and used multivariable logistic regression to determine the odds of correctly identifying the definition of sepsis, independent of demographic and professional factors. Overall response rate of study participants was 57% (786/1390), and was greatest among EMTs (79%; 276/350). A total of 761 respondents (97%) had heard of the term "sepsis." EMTs and FF-EMTs were at significantly reduced odds of correctly defining sepsis compared to paramedics, independent of age, sex, and years of experience (EMTs: odds ratio 0.44, 95% confidence interval 0.3-0.8; FF-EMTs: odds ratio 0.32, 95% confidence interval 0.2-0.6. Overall, knowledge of the clinical signs and symptoms and recommended treatments for sepsis was typically>75%, though better among paramedics than EMTs or FF-EMTs (p<0.01). The majority of respondents believed sepsis is not recognized by EMS "some" or "a lot" of the time (76%, 596/786). EMS personnel demonstrated an overall sound awareness of sepsis. Knowledge of sepsis was less among FF-EMTs and EMTs compared to paramedics. These results suggest that paramedics could be integrated into strategies of early identification and treatment of sepsis, and EMTs may benefit from focused education and training. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Determinants of parental discipline practices: a national sample from primary care practices.

    PubMed

    Barkin, Shari; Scheindlin, Benjamin; Ip, Edward H; Richardson, Irma; Finch, Stacia

    2007-01-01

    National guidelines urge pediatricians to address discipline as part of anticipatory guidance, yet pediatricians know little about what leads parents to use different discipline approaches. Parents seen in Pediatric Research in Office Settings practices participated in an office-based survey before the well-child visit for children 2 to 11 years old (N = 2134). Parents reported using the following discipline approaches frequently: time-outs (42%), removal of privileges (41%), sent to bedroom (27%), yelling (13%), and spanking (9%). A third of parents believe their discipline approach to be ineffective. This directs the pediatric provider to help families develop effective discipline practices tailored to their context.

  15. Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis.

    PubMed

    Thomas, Benjamin S; Jafarzadeh, S Reza; Warren, David K; McCormick, Sandra; Fraser, Victoria J; Marschall, Jonas

    2015-11-24

    Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. We performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Louis, Missouri. Temporal-trend and annual percent change were estimated using regression models with autoregressive integrated moving average errors. We analyzed 62,261 inpatient admissions during the 5-year study period. 'Any SIRS' (i.e., SIRS on a single calendar day during the hospitalization) and 'multi-day SIRS' (i.e., SIRS on 3 or more calendar days), which both use patient-level data, and medical coding for sepsis (i.e., ICD-9-CM discharge diagnosis codes 995.91, 995.92, or 785.52) were present in 35.3 %, 17.3 %, and 3.3 % of admissions, respectively. The incidence of admissions coded for sepsis increased 9.7 % (95 % CI: 6.1, 13.4) per year, while the patient data-defined events of 'any SIRS' decreased by 1.8 % (95 % CI: -3.2, -0.5) and 'multi-day SIRS' did not change significantly over the study period. Clinically-defined sepsis (defined as SIRS plus bacteremia) and severe sepsis (defined as SIRS plus hypotension and bacteremia) decreased at statistically significant rates of 5.7 % (95 % CI: -9.0, -2.4) and 8.6 % (95 % CI: -4.4, -12.6) annually. All-cause mortality, SIRS mortality, and SIRS and clinically-defined sepsis case fatality did not change significantly during the study period. Sepsis mortality, based on ICD-9-CM codes, however, increased by 8.8 % (95 % CI: 1.9, 16.2) annually. The incidence of sepsis, defined by ICD-9-CM codes, and sepsis mortality increased steadily without a concomitant increase in SIRS or clinically-defined sepsis. Our results highlight the need to develop

  16. Nutrition practices of nurseries in England. Comparison with national guidelines.

    PubMed

    Neelon, Sara E Benjamin; Burgoine, Thomas; Hesketh, Kathryn R; Monsivais, Pablo

    2015-02-01

    Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p = 0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p = 0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Inadequate exercise as a risk factor for sepsis mortality.

    PubMed

    Williams, Paul T

    2013-01-01

    Test whether inadequate exercise is related to sepsis mortality. Mortality surveillance of an epidemiological cohort of 155,484 National Walkers' and Runners' Health Study participants residing in the United States. Deaths were monitored for an average of 11.6-years using the National Death index through December 31, 2008. Cox proportional hazard analyses were used to compare sepsis mortality (ICD-10 A40-41) to inadequate exercise (<1.07 METh/d run or walked) as measured on their baseline questionnaires. Deaths occurring within one year of the baseline survey were excluded. Sepsis was the underlying cause in 54 deaths (sepsis(underlying)) and a contributing cause in 184 deaths (sepsis(contributing)), or 238 total sepsis-related deaths (sepsis(total)). Inadequate exercise was associated with 2.24-fold increased risk for sepsis(underlying) (95%CI: 1.21 to 4.07-fold, P = 0.01), 2.11-fold increased risk for sepsis(contributing) (95%CI: 1.51- to 2.92-fold, P<10(-4)), and 2.13-fold increased risk for sepsis(total) (95%CI: 1.59- to 2.84-fold, P<10(-6)) when adjusted for age, sex, race, and cohort. The risk increase did not differ significantly between runners and walkers, by sex, or by age. Sepsis(total) risk was greater in diabetics (P = 10(-5)), cancer survivors (P = 0.0001), and heart attack survivors (P = 0.003) and increased with waist circumference (P = 0.0004). The sepsis(total) risk associated with inadequate exercise persisted when further adjusted for diabetes, prior cancer, prior heart attack and waist circumference, and when excluding deaths with cancer, or cardiovascular, respiratory, or genitourinary disease as the underlying cause. Inadequate exercise also increased sepsis(total) risk in 2163 baseline diabetics (4.78-fold, 95%CI: 2.1- to 13.8-fold, P = 0.0001) when adjusted, which was significantly greater (P = 0.03) than the adjusted risk increase in non-diabetics (1.80-fold, 95%CI: 1.30- to 2.46-fold, P = 0

  18. Sepsis-associated encephalopathy.

    PubMed

    Cotena, Simona; Piazza, Ornella

    2012-01-01

    Sepsis-associated encephalopathy (SAE) is defined as a diffuse or multifocal cerebral dysfunction induced by the systemic response to the infection without clinical or laboratory evidence of direct brain infection. Its pathogenesis is multifactorial. SAE generally occurs early during severe sepsis and precedes multiple-organ failure. The most common clinical feature of SAE is the consciousness alteration which ranges from mildly reduced awareness to unresponsiveness and coma. Diagnosis of SAE is primarily clinical and depends on the exclusion of other possible causes of brain deterioration. Electroencephalography (EEG) is almost sensitive, but it is not specific for SAE. Computed Tomography (CT) head scan generally is negative in case of SAE, while Magnetic Resonance Imaging (MRI) can show brain abnormalities in case of SAE, but they are not specific for this condition. Somatosensitive Evoked Potentials (SEPs) are sensitive markers of developing cerebral dysfunction in sepsis. Cerebrospinal fluid (CBF) analysis is generally normal, a part an inconstant elevation of proteins concentration. S100B and NSE have been proposed like biomarkers for diagnosis of SAE, but the existing data are controversial. SAE is reversible even if survivors of severe sepsis have often long lasting or irreversible cognitive and behavioral sequel; however the presence of SAE can have a negative influence on survival. A specific therapy of SAE does not exist and the outcome depends on a prompt and appropriate treatment of sepsis as whole.

  19. Mitochondrial Function in Sepsis

    PubMed Central

    Arulkumaran, Nishkantha; Deutschman, Clifford S.; Pinsky, Michael R.; Zuckerbraun, Brian; Schumacker, Paul T.; Gomez, Hernando; Gomez, Alonso; Murray, Patrick; Kellum, John A.

    2015-01-01

    Mitochondria are an essential part of the cellular infrastructure, being the primary site for high energy adenosine triphosphate (ATP) production through oxidative phosphorylation. Clearly, in severe systemic inflammatory states, like sepsis, cellular metabolism is usually altered and end organ dysfunction not only common but predictive of long term morbidity and mortality. Clearly, interest is mitochondrial function both as a target for intracellular injury and response to extrinsic stress have been a major focus of basic science and clinical research into the pathophysiology of acute illness. However, mitochondria have multiple metabolic and signaling functions that may be central in both the expression of sepsis and its ultimate outcome. In this review, the authors address five primary questions centered on the role of mitochondria in sepsis. This review should be used as both a summary source in placing mitochondrial physiology within the context of acute illness and as a focal point for addressing new research into diagnostic and treatment opportunities these insights provide. PMID:26871665

  20. Children's surgery: a national survey of consultant clinical practice

    PubMed Central

    Mason, David G; Shotton, Hannah; Wilkinson, Kathleen A; Gough, Michael J; Alleway, Robert; Freeth, Heather; Mason, Marisa

    2012-01-01

    Objectives To survey clinical practice and opinions of consultant surgeons and anaesthetists caring for children to inform the needs for training, commissioning and management of children's surgery in the UK. Design The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) hosted an online survey to gather data on current clinical practice of UK consultant surgeons and anaesthetists caring for children. Setting The questionnaire was circulated to all hospitals and to Anaesthetic and Surgical Royal Colleges, and relevant specialist societies covering the UK and the Channel Islands and was mainly completed by consultants in District General Hospitals. Participants 555 surgeons and 1561 anaesthetists completed the questionnaire. Results 32.6% of surgeons and 43.5% of anaesthetists considered that there were deficiencies in their hospital's facilities that potentially compromised delivery of a safe children's surgical service. Almost 10% of all consultants considered that their postgraduate training was insufficient for current paediatric practice and 20% felt that recent Continued Professional Development failed to maintain paediatric expertise. 45.4% of surgeons and 39.2% of anaesthetists considered that the current specialty curriculum should have a larger paediatric component. Consultants in non-specialist paediatric centres were prepared to care for younger children admitted for surgery as emergencies than those admitted electively. Many of the surgeons and anaesthetists had <4 h/week in paediatric practice. Only 55.3% of surgeons and 42.8% of anaesthetists participated in any form of regular multidisciplinary review of children undergoing surgery. Conclusions There are significant obstacles to consultant surgeons and anaesthetists providing a competent surgical service for children. Postgraduate curricula must meet the needs of trainees who will be expected to include children in their caseload as consultants. Trusts must ensure appropriate

  1. Quality improvement in pediatric sepsis.

    PubMed

    Melendez, Elliot; Bachur, Richard

    2015-06-01

    Although there is abundant literature detailing the impact of quality improvement in adult sepsis, the pediatric literature is lacking. Despite consensus definitions for sepsis, which patients along the sepsis spectrum should receive aggressive management and the exact onset of sepsis ('time zero') are not clearly established. In the adult emergency department (ED), sepsis onset is defined as the time of entry into the ED; however, this definition cannot be applied to hospitalized patients or patients who evolve during their ED course. Since the time of sepsis onset will dictate the timeliness of subsequent process measures, the variable definitions in the literature make it difficult to generalize findings among prior studies. Despite the variation in defining time zero, aggressive fluid administration, timely antibiotics, and compliance with sepsis bundles have been shown to improve mortality and to reduce hospital and intensive care length of stay. In addition, early identification tools show promise in beginning to define sepsis onset and retrospective search tools may allow improved case finding of those children of concern for sepsis. Quality improvement in pediatric sepsis is evolving. As we continue to define quality measures, we must standardize the definition of sepsis onset. This definition should be applicable to any treatment venue to ensure measures can be evaluated across all settings. In addition, we must delineate which patients along the sepsis spectrum should be candidates for timely interventions and standardize other outcome measures beyond mortality.

  2. Essentials of sepsis management.

    PubMed

    Green, John M

    2015-04-01

    Despite remarkable advances in the knowledge of infection and human response to it, sepsis continues to be one of the most common challenges surgeons and critical care providers face. Surgeons confront the problem of infection every day, in treating established infections or reacting to a consequence of surgical intervention. Infections after surgery continue to be a problem despite massive efforts to prevent them. Patients rely on the surgeon's ability to recognize infection and treat it. Also, preventing nosocomial infection and antibiotic resistance is a primary responsibility. This article describes diagnostic and therapeutic measures for sepsis in the perioperative surgical patient.

  3. Sepsis-induced brain dysfunction.

    PubMed

    Adam, Nicolas; Kandelman, Stanislas; Mantz, Jean; Chrétien, Fabrice; Sharshar, Tarek

    2013-02-01

    Systemic infection is often revealed by or associated with brain dysfunction, which is characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. Its pathophysiology involves an ischemic process, secondary to impairment of cerebral perfusion and its determinants and a neuroinflammatory process that includes endothelial activation, alteration of the blood-brain barrier and passage of neurotoxic mediators. Microcirculatory dysfunction is common to these two processes. This brain dysfunction is associated with increased mortality, morbidity and long-term cognitive disability. Its diagnosis relies essentially on neurological examination that can lead to specific investigations, including electrophysiological testing or neuroimaging. In practice, cerebrospinal fluid analysis is indisputably required when meningitis is suspected. Hepatic, uremic or respiratory encephalopathy, metabolic disturbances, drug overdose, sedative or opioid withdrawal, alcohol withdrawal delirium or Wernicke's encephalopathy are the main differential diagnoses. Currently, treatment consists mainly of controlling sepsis. The effects of insulin therapy and steroids need to be assessed. Various drugs acting on sepsis-induced blood-brain barrier dysfunction, brain oxidative stress and inflammation have been tested in septic animals but not yet in patients.

  4. Japanese Practicing Physicians' Relationships with Pharmaceutical Representatives: A National Survey

    PubMed Central

    Saito, Sayaka; Mukohara, Kei; Bito, Seiji

    2010-01-01

    Background Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. Methods and Findings From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%), received drug samples (85%) and stationery (96%), and participated in industry-sponsored continuing medical education (CME) events at the workplace (80%) and outside the workplace (93%). Half accepted meals outside the workplace (49%) and financial subsidies to attend CME events (49%). Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to prescribe brand

  5. Japanese practicing physicians' relationships with pharmaceutical representatives: a national survey.

    PubMed

    Saito, Sayaka; Mukohara, Kei; Bito, Seiji

    2010-08-13

    Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs) have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%), received drug samples (85%) and stationery (96%), and participated in industry-sponsored continuing medical education (CME) events at the workplace (80%) and outside the workplace (93%). Half accepted meals outside the workplace (49%) and financial subsidies to attend CME events (49%). Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to prescribe brand-name medications. Involvement in

  6. Community-, Healthcare- and Hospital-Acquired Severe Sepsis Hospitalizations in the University HealthSystem Consortium

    PubMed Central

    Page, David B.; Donnelly, John P.; Wang, Henry E.

    2015-01-01

    Objectives Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. Setting United States Interventions None Measurements & Main Results Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital-acquired [19.2%] vs healthcare-associated [12.8%] vs community-acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community-acquired [6 d]), median length of ICU stay (hospital-acquired [8 d] vs healthcare-associated [3 d] vs community-acquired [3 d]), and median hospital costs (hospital-acquired [$38,369] vs healthcare-associated [$8,796] vs community-acquired [$7,024]). Conclusions In this series, severe sepsis hospitalizations included CA-SS (62.8%), HCA-SS (25.9%) and HA-SS (11.3%) cases. HA-SS was associated with both higher mortality and resource utilization than CA-SS and HCA-SS. PMID:26110490

  7. Revisiting caspases in sepsis

    PubMed Central

    Aziz, M; Jacob, A; Wang, P

    2014-01-01

    Sepsis is a life-threatening illness that occurs due to an abnormal host immune network which extends through the initial widespread and overwhelming inflammation, and culminates at the late stage of immunosupression. Recently, interest has been shifted toward therapies aimed at reversing the accompanying periods of immune suppression. Studies in experimental animals and critically ill patients have demonstrated that increased apoptosis of lymphoid organs and some parenchymal tissues contributes to this immune suppression, anergy and organ dysfunction. Immediate to the discoveries of the intracellular proteases, caspases for the induction of apoptosis and inflammation, and their striking roles in sepsis have been focused elaborately in a number of original and review articles. Here we revisited the different aspects of caspases in terms of apoptosis, pyroptosis, necroptosis and inflammation and focused their links in sepsis by reviewing several recent findings. In addition, we have documented striking perspectives which not only rewrite the pathophysiology, but also modernize our understanding for developing novel therapeutics against sepsis. PMID:25412304

  8. Sepsis Associated Encephalopathy.

    PubMed

    Chaudhry, Neera; Duggal, Ashish Kumar

    2014-01-01

    Sepsis associated encephalopathy (SAE) is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis.

  9. Emerging drugs in sepsis.

    PubMed

    Leone, Marc; Textoris, Julien; Michel, Fabrice; Wiramus, Sandrine; Martin, Claude

    2010-03-01

    Sepsis remains a major cause of death in intensive care units. Despite an intense research, a new drug that is effective in reducing mortality in sepsis is still awaited. The literature was analyzed with Pubmed() during the 2008 - 2009 period. If required, seminal articles published before 2008 were cited. Clinical trials focusing on 'sepsis' were first assessed. Next, relevant experimental data in this field were reported. The goal of the review is to determine the role for new licensed antibiotics, to give an insight into the conflict on adjuvant therapies and to disclose new experimental concepts. New licensed antibiotics will offer the opportunity to refine the treatment choices. Direct hemoperfusion using polymyxin B-immobilized fiber column may be an option in sepsis due to Gram-negative bacilli. Among non-antibiotic drugs, new ongoing studies will clarify the role of drotrecogin alfa (activated) and low dose hydrocortisone. The modulation of monocytic human leukocyte antigen-DR seems the most prominent treatment. The use of cardiovascular drugs requires well-conducted clinical trials. The regulation of high mobility group box 1, adenosine blockade or correction of the impaired energy production is still at the experimental level.

  10. Defining Neonatal Sepsis

    PubMed Central

    Wynn, James L.

    2016-01-01

    Purpose of the review Although infection rates have modestly decreased in the neonatal intensive care unit (NICU) as a result of ongoing quality improvement measures, neonatal sepsis remains a frequent and devastating problem among hospitalized preterm neonates. Despite multiple attempts to address this unmet need, there have been minimal advances in clinical management, outcomes, and accuracy of diagnostic testing options over the last three decades. One strong contributor to a lack of medical progress is a variable case definition of disease. The inability to agree on a precise definition greatly reduces the likelihood of aligning findings from epidemiologists, clinicians, and researchers, which, in turn, severely hinders progress towards improving outcomes. Recent findings Pediatric consensus definitions for sepsis are not accurate in term infants and are not appropriate for preterm infants. In contrast to the defined multi-stage criteria for other devastating diseases encountered in the NICU (e.g., bronchopulmonary dysplasia), there is significant variability in the criteria used by investigators to substantiate the diagnosis of neonatal sepsis. Summary The lack of an accepted consensus definition for neonatal sepsis impedes our efforts towards improved diagnostic and prognostic options as well as accurate outcomes information for this vulnerable population. PMID:26766602

  11. Sepsis Associated Encephalopathy

    PubMed Central

    Chaudhry, Neera; Duggal, Ashish Kumar

    2014-01-01

    Sepsis associated encephalopathy (SAE) is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis. PMID:26556425

  12. Sepsis and cytokines: current status.

    PubMed

    Blackwell, T S; Christman, J W

    1996-07-01

    Sepsis is a constellation of clinical signs and symptoms resulting from excessive systemic host inflammatory response to infection. This inflammatory response is largely mediated by cytokines, which are released into the systemic circulation. Plasma concentrations of specific cytokines, TNF alpha, IL-1 beta, IL-6 and IL-8 are frequently elevated in human sepsis and cytokine concentrations correlate with severity and outcome of sepsis. In addition to pro-inflammatory cytokines, soluble cytokine receptors, cytokine receptor antagonists and counter-inflammatory cytokines are also produced in large quantities in patients with sepsis; however, the specific role of these molecules in sepsis remains undefined. A complex interaction of cytokines and cytokine-neutralizing molecules probably determines the clinical presentation and course of sepsis. Intervening in this sequence of events to modify the host inflammatory responses may prove to be a beneficial treatment strategy for sepsis, but currently tested anticytokine therapies have been largely unsuccessful.

  13. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation.

    PubMed

    Bonet, Mercedes; Nogueira Pileggi, Vicky; Rijken, Marcus J; Coomarasamy, Arri; Lissauer, David; Souza, João Paulo; Gülmezoglu, Ahmet Metin

    2017-05-30

    There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego. Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition "Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period". Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of

  14. 75 FR 51830 - National Cancer Institute's Best Practices for Biospecimen Resources

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-23

    ... Cancer Institute's Best Practices for Biospecimen Resources AGENCY: National Institutes of Health (NIH... commitment to maintaining current and scientifically accurate best practices, the National Cancer Institute (NCI) is seeking public comment on a revised version of the NCI Best Practices for...

  15. Integrating Communication Best Practices in the Third National Climate Assessment

    NASA Astrophysics Data System (ADS)

    Hassol, S. J.

    2014-12-01

    Modern climate science assessments now have a history of nearly a quarter-century. This experience, together with important advances in relevant social sciences, has greatly improved our ability to communicate climate science effectively. As a result, the Third National Climate Assessment (NCA) was designed to be truly accessible and useful to all its intended audiences, while still being comprehensive and scientifically accurate. At a time when meeting the challenge of climate change is increasingly recognized as an urgent national and global priority, the NCA is proving to be valuable to decision-makers, the media, and the public. In producing this latest NCA, a communication perspective was an important part of the process from the beginning, rather than an afterthought as has often been the case with scientific reports. Lessons learned from past projects and science communications research fed into developing the communication strategy for the Third NCA. A team of editors and graphic designers worked closely with the authors on language, graphics, and photographs throughout the development of the report, Highlights document, and other products. A web design team helped bring the report to life online. There were also innovations in outreach, including a network of organizations intended to extend the reach of the assessment by engaging stakeholders throughout the process. Professional slide set development and media training were part of the preparation for the report's release. The launch of the NCA in May 2014 saw widespread and ongoing media coverage, continued references to the NCA by decision-makers, and praise from many quarters for its excellence in making complex science clear and accessible. This NCA is a professionally crafted report that exemplifies best practices in 21st century communications.

  16. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

    PubMed

    Rhodes, Andrew; Evans, Laura E; Alhazzani, Waleed; Levy, Mitchell M; Antonelli, Massimo; Ferrer, Ricard; Kumar, Anand; Sevransky, Jonathan E; Sprung, Charles L; Nunnally, Mark E; Rochwerg, Bram; Rubenfeld, Gordon D; Angus, Derek C; Annane, Djillali; Beale, Richard J; Bellinghan, Geoffrey J; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig; De Backer, Daniel P; French, Craig J; Fujishima, Seitaro; Gerlach, Herwig; Hidalgo, Jorge Luis; Hollenberg, Steven M; Jones, Alan E; Karnad, Dilip R; Kleinpell, Ruth M; Koh, Younsuk; Lisboa, Thiago Costa; Machado, Flavia R; Marini, John J; Marshall, John C; Mazuski, John E; McIntyre, Lauralyn A; McLean, Anthony S; Mehta, Sangeeta; Moreno, Rui P; Myburgh, John; Navalesi, Paolo; Nishida, Osamu; Osborn, Tiffany M; Perner, Anders; Plunkett, Colleen M; Ranieri, Marco; Schorr, Christa A; Seckel, Maureen A; Seymour, Christopher W; Shieh, Lisa; Shukri, Khalid A; Simpson, Steven Q; Singer, Mervyn; Thompson, B Taylor; Townsend, Sean R; Van der Poll, Thomas; Vincent, Jean-Louis; Wiersinga, W Joost; Zimmerman, Janice L; Dellinger, R Phillip

    2017-03-01

    To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable. The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. Substantial agreement exists among a large cohort of international experts regarding many strong recommendations for the best care of patients with sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for these critically ill patients with high mortality.

  17. Postoperative sepsis prediction in patients undergoing major cancer surgery.

    PubMed

    Sood, Akshay; Abdollah, Firas; Sammon, Jesse D; Arora, Nivedita; Weeks, Matthew; Peabody, James O; Menon, Mani; Trinh, Quoc-Dien

    2017-03-01

    Cancer patients are at increased risk for postoperative sepsis. However, studies addressing the issue are lacking. We sought to identify preoperative and intraoperative predictors of 30-d sepsis after major cancer surgery (MCS) and derive a postoperative sepsis risk stratification tool. Patients undergoing one of nine MCSs (gastrointestinal, urological, gynecologic, or pulmonary) were identified within the American College of Surgeons National Surgical Quality Improvement Program (2005-2011, n = 69,169). Multivariable adjusted analyses (MVA) were performed to identify the predictors of postoperative sepsis. A composite sepsis risk score (CSRS) was constructed using the regression coefficients of predictors significant on MVA. The score was stratified into low, intermediate, and high risk, and its predictive accuracy for sepsis, septic shock, and mortality was assessed using the area under the curve analysis. Overall, 4.3% (n = 2954) of patients developed postoperative sepsis. In MVA, Black race (odds ratio [OR] = 1.30, P = 0.002), preoperative hematocrit <30 (OR = 1.40, P = 0.022), cardiopulmonary and cerebrovascular comorbidities (P < 0.010), American Society of Anesthesiologists score >3 (P < 0.05), operative time (OR = 1.002, P < 0.001), surgical approach (OR = 1.81, P < 0.001), and procedure type (P < 0.001) were significant predictors of postoperative sepsis. CSRS demonstrated favorable accuracy in predicting postoperative sepsis, septic shock, and mortality (area under the curve 0.72, 0.75, and 0.74, respectively). Furthermore, CSRS risk stratification demonstrated high concordance with sepsis rates, 1.3% in low-risk patients versus 9.7% in high-risk patients. Similarly, 30-d mortality rate varied from 0.5% to 5.5% (10-fold difference) in low-risk patients versus high-risk patients. Our study identifies the major risk factors for 30-d sepsis after MCS. These risk factors have been converted into a simple, accurate bedside sepsis risk

  18. Sepsis-induced Cardiomyopathy

    PubMed Central

    Romero-Bermejo, Francisco J; Ruiz-Bailen, Manuel; Gil-Cebrian, Julián; Huertos-Ranchal, María J

    2011-01-01

    Myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70%. During the sepsis-induced myocardial dysfunction, both ventricles can dilate and diminish its ejection fraction, having less response to fluid resuscitation and catecholamines, but typically is assumed to be reversible within 7-10 days. In the last 30 years, It´s being subject of substantial research; however no explanation of its etiopathogenesis or effective treatment have been proved yet. The aim of this manuscript is to review on the most relevant aspects of the sepsis-induced myocardial dysfunction, discuss its clinical presentation, pathophysiology, etiopathogenesis, diagnostic tools and therapeutic strategies proposed in recent years. PMID:22758615

  19. [Adsorption therapy in sepsis].

    PubMed

    Hasper, D; Schefold, J C; Jörres, A

    2015-05-01

    The activation of multiple pro- and anti-inflammatory mediators is a key feature in the pathophysiology of sepsis. Many of these mediators may directly contribute to organ dysfunction and determine disease severity. So far our ability to modulate these upregulated mediator pathways is very limited. Therefore the adsorption of such mediators via an extracorporeal circuit may be a beneficial intervention during sepsis. Recent technical innovations have made this intervention feasible. Both systems for exclusive mediator adsorption and for adsorption beside a conventional renal replacement therapy are now available. Some of the membranes can adsorb a broad range of mediators by rather unspecific binding, whereas others specifically adsorb endotoxin or mediators. Whilst biochemical efficacy could be demonstrated by some of the systems, controlled and randomized studies demonstrating improved clinical endpoints are still lacking. Therefore the use of such therapies outside clinical studies cannot yet be recommended.

  20. Defining and Diagnosing Sepsis.

    PubMed

    Scott, Michael C

    2017-02-01

    Sepsis is a heterogeneous clinical syndrome that encompasses infections of many different types and severity. Not surprisingly, it has confounded most attempts to apply a single definition, which has also limited the ability to develop a set of reliable diagnostic criteria. It is perhaps best defined as the different clinical syndromes produced by an immune response to infection that causes harm to the body beyond that of the local effects of the infection.

  1. Development of an e-learning package for sepsis care.

    PubMed

    Davis, Anna; Henderson, James; Langmack, Gill

    Severe sepsis is a major cause of morbidity and mortality in the UK. This article describes the collaborative development and implementation of an interactive online learning package to understand the key role nurses have in recognising and then starting to apply the Sepsis Six care bundle in clinical practice. The e-learning package, developed in a UK teaching hospital, uses a case study approach to address the knowledge that is required to be able to recognise sepsis, to understand the processes that occur and the ongoing care and treatment required. The package is relevant to final-year student nurses, newly registered nurses in preceptorship and other health professionals involved in assessing and treating patients who may be developing sepsis.

  2. Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

    PubMed Central

    Ellis, Gemma; Morgan, Paul; Kopczynska, Maja; Dhadda, Amrit; Mann, Charlotte; Donoghue, Danielle; Rollason, Sarah; Brownlow, Emma; Hill, Francesca; Carr, Grace; Turley, Hannah; Hassall, James; Lloyd, James; Davies, Llywela; Atkinson, Michael; Jones, Molly; Jones, Nerys; Martin, Rhodri; Ibrahim, Yousef; Hall, Judith E.

    2016-01-01

    Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3–4 for non-sepsis and 4 IQR 3–6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36–85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality. PMID:27907062

  3. Sepsis in vulnerable populations.

    PubMed

    Bhagwanjee, Satish; Ugarte, Sebastian

    2014-09-01

    Despite the acquisition of a large body of evidence, there are many unanswered questions about sepsis. The definition of this disease is plagued by the lack of a simple pathophysiological description linking cause to effect and the activation of host immune responses that hinders disease progression at the same time producing multiorgan dysfunction. A plethora of inconsistent clinical features has served to obfuscate rather than illuminate. The Surviving Sepsis Guidelines (SSG) are a major advance because it comprehensively interrogates all aspects of care for the critically ill. For vulnerable populations living in low- and middle-income countries, this guideline is ineffectual because of the lack of region-specific data, differences in etiology of sepsis and burden of disease, limited human capacity and infrastructure, as well as socioeconomic realities. Appropriate care must be guided by common sense guidelines that are sensitive to local realities and adapted as relevant data are acquired. Copyright © 2014 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  4. Clinical trials in neonatal sepsis.

    PubMed

    Oeser, Clarissa; Lutsar, Irja; Metsvaht, Tuuli; Turner, Mark A; Heath, Paul T; Sharland, Mike

    2013-12-01

    Antibiotic licensing studies remain a problem in neonates. The classical adult clinical syndrome-based licensing studies do not apply to neonates, where sepsis is the most common infection. The main obstacle to conducting neonatal antibiotic trials is a lack of consensus on the definition of neonatal sepsis itself and the selection of appropriate endpoints. This article describes the difficulties of the clinical and laboratory definitions of neonatal sepsis and reviews the varying designs of previous neonatal sepsis trials. The optimal design of future trials of new antibiotics will need to be based on pharmacokinetic/pharmacodynamic parameters, combined with adequately powered clinical studies to determine safety and efficacy.

  5. Practices in Early Intervention for Children with Autism: A Comparison with the National Research Council Recommended Practices

    ERIC Educational Resources Information Center

    Downs, Robyn Conley; Downs, Andrew

    2010-01-01

    The National Research Council (2001) report was reviewed to identify and document recommended practices for programs serving young children with autism spectrum disorder. Twenty seven surveys inquiring about program practices were sent to educational service districts, school districts, and neurodevelopmental centers in Oregon and Washington that…

  6. National cultures, performance appraisal practices, and organizational absenteeism and turnover: a study across 21 countries.

    PubMed

    Peretz, Hilla; Fried, Yitzhak

    2012-03-01

    Performance appraisal (PA) is a key human resource activity in organizations. However, in this global economy, we know little about how societal cultures affect PA practices. In this study, we address this gap by focusing on 2 complementary issues: (a) the influence of societal (national) cultural practices on PA practices adopted by organizations and (b) the contribution of the level of congruence between societal cultural practices and the characteristics of organizational PA practices to absenteeism and turnover. The results, based on a large data set across multiple countries and over 2 time periods, support the hypothesized effects of societal (national) cultural practices on particular PA practices and the interactive effects of societal cultural practices and PA practices on absenteeism and turnover. We discuss theoretical and practical implications of our findings.

  7. 78 FR 65342 - National Advisory Council on Nurse Education and Practice; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-31

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... Council on Nurse Education and Practice (NACNEP). Dates and Times: November 7, 2013, 9:00 a.m.-5:00 p.m... Jeanne Brown, Staff Assistant, National Advisory Council on Nurse Education and Practice,...

  8. 78 FR 22890 - National Advisory Council on Nurse Education and Practice; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-17

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... Council on Nurse Education and Practice (NACNEP) Dates and Times: April 24 and 25, 2013, 9:00 a.m.-5:00 p... contact Jeanne Brown, Staff Assistant, National Advisory Council on Nurse Education and Practice,...

  9. Identification of sepsis subtypes in critically ill adults using gene expression profiling.

    PubMed

    Maslove, David M; Tang, Benjamin M; McLean, Anthony S

    2012-10-04

    Sepsis is a syndromic illness that has traditionally been defined by a set of broad, highly sensitive clinical parameters. As a result, numerous distinct pathophysiologic states may meet diagnostic criteria for sepsis, leading to syndrome heterogeneity. The existence of biologically distinct sepsis subtypes may in part explain the lack of actionable evidence from clinical trials of sepsis therapies. We used microarray-based gene expression data from adult patients with sepsis in order to identify molecularly distinct sepsis subtypes. We used partitioning around medoids (PAM) and hierarchical clustering of gene expression profiles from neutrophils taken from a cohort of septic patients in order to identify distinct subtypes. Using the medoids learned from this cohort, we then clustered a second independent cohort of septic patients, and used the resulting class labels to evaluate differences in clinical parameters, as well as the expression of relevant pharmacogenes. We identified two sepsis subtypes based on gene expression patterns. Subtype 1 was characterized by increased expression of genes involved in inflammatory and Toll receptor mediated signaling pathways, as well as a higher prevalence of severe sepsis. There were differences between subtypes in the expression of pharmacogenes related to hydrocortisone, vasopressin, norepinephrine, and drotrecogin alpha. Sepsis subtypes can be identified based on different gene expression patterns. These patterns may generate hypotheses about the underlying pathophysiology of sepsis and suggest new ways of classifying septic patients both in clinical practice, and in the design of clinical trials.

  10. Sepsis management: An evidence-based approach.

    PubMed

    Baig, Muhammad Akbar; Shahzad, Hira; Jamil, Bushra; Hussain, Erfan

    2016-03-01

    The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients.

  11. Assessing the National School Social Work Practice Model: Findings from the Second National School Social Work Survey.

    PubMed

    Kelly, Michael S; Frey, Andy; Thompson, Aaron; Klemp, Heather; Alvarez, Michelle; Berzin, Stephanie Cosner

    2016-01-01

    The Second National School Social Work Survey in 2014 aimed to update knowledge of school social work practice by examining how practitioner characteristics, practice context, and practice choices have evolved since the last national survey in 2008. This second survey was also developed to assess how the new national school social work practice model created by the School Social Work Association of America aligns with early 21st century school social work practice realities. The second survey was conducted from February through April 2014 (3,769 total responses were collected) and represents the largest sample of American school social workers surveyed in two decades. Data from the Second National School Social Work Survey showed a field that still has not fully responded to calls to implement evidence-informed and data-driven practices. This article notes the need to better integrate pre- and postservice training in data-driven practices and provides recommendations for ways to overcome barriers that school social workers report facing.

  12. 75 FR 75689 - National Advisory Council on Nurse Education and Practice; Notice for Request for Nominations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-06

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... Administration (HRSA) is requesting nominations to fill eight vacancies on the National Advisory Council on Nurse... contact, Lakisha Smith, Executive Secretary, National Advisory Council on Nurse Education and Practice,...

  13. Coagulation and sepsis.

    PubMed

    Levi, Marcel; van der Poll, Tom

    2017-01-01

    Severe sepsis is almost invariably associated with systemic activation of coagulation. There is ample evidence that demonstrates a wide-ranging cross-talk between hemostasis and inflammation, which is probably implicated in the pathogenesis of organ dysfunction in patients with sepsis. Inflammation not only leads to initiation and propagation of coagulation activity, but coagulation also markedly influences inflammation. Molecular mechanisms that play a role in inflammation-induced effects on coagulation have been recognized in much detail. Pro-inflammatory cells and cyto- and chemokines can activate the coagulation system and downregulate crucial physiological anticoagulant mechanisms. Initiation of coagulation activation and consequent thrombin generation is caused by expression of tissue factor on activated monocytes and endothelial cells and is ineffectually offset by tissue factor pathway inhibitor. At the same time, endothelial-associated anticoagulant pathways, in particular the protein C system, is impaired by pro-inflammatory cytokines. Also, fibrin removal is severely obstructed by inactivation of the endogenous fibrinolytic system, mainly as a result of upregulation of its principal inhibitor, plasminogen activator inhibitor type 1 (PAI-1). Increased fibrin generation and impaired break down lead to deposition of (micro)vascular clots, which may contribute to tissue ischemia and ensuing organ dysfunction. The foundation of the management of coagulation in sepsis is the explicit and thorough treatment of the underlying disorder by antibiotic treatment and source control measures. Adjunctive strategies focused at the impairment of coagulation, including anticoagulants and restoration of physiological anticoagulant mechanisms, may supposedly be indicated and have been found advantageous in experimental and initial clinical trials.

  14. Assessing available information on the burden of sepsis: global estimates of incidence, prevalence and mortality

    PubMed Central

    Jawad, Issrah; Lukšić, Ivana; Rafnsson, Snorri Bjorn

    2012-01-01

    Objective Sepsis is a complex and hard-to-define condition with many different interactions with other disorders. Presently, there are no estimates of the burden of sepsis and septicaemia at the global level and it was not included in the initial Global Burden of Disease study. Non-maternal sepsis has only recently received attention as a substantial global public health problem. The aim of this study was to assess available data on the burden of non-maternal sepsis, severe sepsis and septic shock in the community and to identify key gaps in information needed to estimate the global burden of sepsis. Methods Literature review of English language-based studies reporting on the incidence, prevalence, mortality or case-fatality of sepsis, severe sepsis and septic shock. The available literature was searched using the MEDLINE database of citations and abstracts of biomedical research articles published between 1980 and 2008. Findings 8 studies reported incidence of sepsis, severe sepsis or septic shock at the national level (4 from the USA and 1 from Brazil, the UK, Norway and Australia). No studies on the incidence, prevalence, mortality or case-fatality from sepsis in developing countries were found. The population sepsis incidence ranged from 22 to 240/100 000 (most plausible estimates ranged from 149 to 240/100 000); of severe sepsis from 13 to 300/100 000 (most of the estimates were between 56 and 91/100 000); and of septic shock 11/100 000. Case-fatality rate depends on the setting and severity of disease. It can reach up to 30% for sepsis, 50% for severe sepsis and 80% for septic shock. While the data were compiled using strict inclusion and exclusion criteria, a degree of uncertainty still exists regarding the reported estimates. Conclusion The few national-level reports available allow only a very crude estimation of the incidence of sepsis in developed countries while there is apparent lack of data from developing countries. A clear and universal

  15. Sleep apnoea patients have higher mortality when confronting sepsis.

    PubMed

    Huang, Chien-Yu; Chen, Yung-Tai; Wu, Li-An; Liu, Chia-Jen; Chang, Shi-Chuan; Perng, Diahn-Warng; Chen, Yuh-Min; Chen, Tzeng-Ji; Lee, Yu-Chin; Chou, Kun-Ta

    2014-01-01

    Sleep is essential for the maintenance of an intact immune function. Patients with sleep apnoea experience frequent sleep interruption due to apnoea-related arousals, possibly adversely impacting their immunity and affecting their outcomes when confronting sepsis. This case-control study aimed to compare the outcomes of sepsis patients with and without sleep apnoea. From 2000 to 2009, 168 sleep apnoea patients who were first admitted for sepsis were identified from the Taiwan National Health Insurance Research Database. Also, 672 sepsis patients without sleep apnoea, who were matched by age, gender and Charlson's comorbidity index scores, served as controls. Hospital outcomes of the two groups were compared. Binary logistic regression was employed for multivariate analysis. The mortality rates of sepsis patients with and without sleep apnoea were 60.1% and 47.9%, respectively (P = 0. 005). After multivariate adjustment, sleep apnoea (OR: 1.805, 95% CI: 1.227-2.656, P = 0.003), presence of shock (OR: 3.600, 95% CI: 2.144-6.046, P < 0.001) and number of organs with dysfunction (OR: 1.591, 95% CI: 1.087-2.329, P = 0.017) were found to be independently associated with mortality. Sleep apnoea patients who needed continuous positive airway pressure treatment had an even higher risk of mortality. Sepsis patients with sleep apnoea may have poorer hospital outcomes than those without sleep apnoea. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

  16. The role of the liver in sepsis.

    PubMed

    Yan, Jun; Li, Song; Li, Shulin

    2014-01-01

    Despite the progress made in the clinical management of sepsis, sepsis morbidity and mortality rates remain high. The inflammatory pathogenesis and organ injury leading to death from sepsis are not fully understood for vital organs, especially the liver. Only recently has the role of the liver in sepsis begun to be revealed. Pre-existing liver dysfunction is a risk factor for the progression of infection to sepsis. Liver dysfunction after sepsis is an independent risk factor for multiple organ dysfunction and sepsis-induced death. The liver works as a lymphoid organ in response to sepsis. Acting as a double-edged sword in sepsis, the liver-mediated immune response is responsible for clearing bacteria and toxins but also causes inflammation, immunosuppression, and organ damage. Attenuating liver injury and restoring liver function lowers morbidity and mortality rates in patients with sepsis. This review summarizes the central role of liver in the host immune response to sepsis and in clinical outcomes.

  17. Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes--United States, 1999-2014.

    PubMed

    Epstein, Lauren; Dantes, Ray; Magill, Shelley; Fiore, Anthony

    2016-04-08

    Sepsis is a clinical syndrome caused by a dysregulated host response to infection (1). Because there is no confirmatory diagnostic test, the diagnosis of sepsis is based on evidence of infection and clinical judgement. Both death certificates and health services utilization data (administrative claims) have been used to assess sepsis incidence and mortality, but estimates vary depending on the surveillance definition and data source. To highlight the challenges and variability associated with estimating sepsis mortality, CDC compared national estimates of sepsis-related mortality based on death certificates using the CDC WONDER database with published sepsis mortality estimates generated using administrative claims data from hospital discharges reported in the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (2). During 2004-2009, using data rounded to thousands, the annual range of published sepsis-related mortality estimates based on administrative claims data was 15% to 140% higher (range = 168,000-381,000) than annual estimates generated using death certificate data (multiple causes) (range = 146,000-159,000). Differences in sepsis-related mortality reported using death certificates and administrative claims data might be explained by limitations inherent in each data source. These findings underscore the need for a reliable sepsis surveillance definition based on objective clinical data to more accurately track national sepsis trends and enable objective assessment of the impact of efforts to increase sepsis awareness and prevention.

  18. National Center on Accessibility: Putting Research into Practice.

    ERIC Educational Resources Information Center

    Bowerman, Jennifer; Robb, Gary

    2001-01-01

    A collaborative program of Indiana University and the National Park Service, the National Center on Accessibility provides research, training, and technical assistance to link the needs and preferences of people with disabilities to practitioners designing facilities and planning programs in parks and recreation. Research and recommendations…

  19. National Center on Accessibility: Putting Research into Practice.

    ERIC Educational Resources Information Center

    Bowerman, Jennifer; Robb, Gary

    2001-01-01

    A collaborative program of Indiana University and the National Park Service, the National Center on Accessibility provides research, training, and technical assistance to link the needs and preferences of people with disabilities to practitioners designing facilities and planning programs in parks and recreation. Research and recommendations…

  20. Sepsis and septic shock.

    PubMed

    Maloney, Patrick J

    2013-08-01

    Early recognition of sepsis and septic shock in children relies on obtaining an attentive clinical history, accurate vital signs, and a physical examination focused on mental status, work of breathing, and circulatory status. Laboratory tests may support the diagnosis but are not reliable in isolation. The goal of septic shock management is reversal of tissue hypoperfusion. The therapeutic end point is shock reversal. Mortality is significantly better among children when managed appropriately. Every physician who cares for children must strive to have a high level of suspicion and keen clinical acumen for recognizing the rare but potentially seriously ill child.

  1. Sepsis in Special Populations.

    PubMed

    Borloz, Matthew P; Hamden, Khalief E

    2017-02-01

    Sepsis is recognized by the presence of physiologic and laboratory changes that reflect the inflammatory response to infection on cellular and systemic levels. Comorbid conditions, such as cirrhosis, end-stage renal disease, and obesity, alter patients' susceptibility to infection and their response to it once present. Baseline changes in vital signs and chronic medications often mask clues to the severity of illness. The physiologic, hematologic, and biochemical adjustments that accompany pregnancy and the puerperium introduce similar challenges. Emergency providers must remain vigilant for subtle alterations in the expected baseline for these conditions to arrive at appropriate management decisions.

  2. National Cultures, Performance Appraisal Practices, and Organizational Absenteeism and Turnover: A Study across 21 Countries

    ERIC Educational Resources Information Center

    Peretz, Hilla; Fried, Yitzhak

    2012-01-01

    Performance appraisal (PA) is a key human resource activity in organizations. However, in this global economy, we know little about how societal cultures affect PA practices. In this study, we address this gap by focusing on 2 complementary issues: (a) the influence of societal (national) cultural practices on PA practices adopted by organizations…

  3. National Cultures, Performance Appraisal Practices, and Organizational Absenteeism and Turnover: A Study across 21 Countries

    ERIC Educational Resources Information Center

    Peretz, Hilla; Fried, Yitzhak

    2012-01-01

    Performance appraisal (PA) is a key human resource activity in organizations. However, in this global economy, we know little about how societal cultures affect PA practices. In this study, we address this gap by focusing on 2 complementary issues: (a) the influence of societal (national) cultural practices on PA practices adopted by organizations…

  4. Immunotherapy of Sepsis: Blind Alley or Call for Personalized Assessment?

    PubMed

    Prucha, Miroslav; Zazula, Roman; Russwurm, Stefan

    2017-02-01

    Sepsis is the most frequent cause of death in noncoronary intensive care units. In the past 10 years, progress has been made in the early identification of septic patients and their treatment. These improvements in support and therapy mean that mortality is gradually decreasing, however, the rate of death from sepsis remains unacceptably high. Immunotherapy is not currently part of the routine treatment of sepsis. Despite experimental successes, the administration of agents to block the effect of sepsis mediators failed to show evidence for improved outcome in a multitude of clinical trials. The following survey summarizes the current knowledge and results of clinical trials on the immunotherapy of sepsis and describes the limitations of our knowledge of the pathogenesis of sepsis. Administration of immunomodulatory drugs should be linked to the current immune status assessed by both clinical and molecular patterns. Thus, a careful daily review of the patient's immune status needs to be introduced into routine clinical practice giving the opportunity for effective and tailored use of immunomodulatory therapy.

  5. Management of sepsis: a 47-year-old woman with an indwelling intravenous catheter and sepsis.

    PubMed

    Angus, Derek C

    2011-04-13

    Severe sepsis is the term used to describe the host response to infection when complicated by acute organ dysfunction. Severe sepsis occurs in more than 750,000 individuals in the United States each year, with a hospital mortality of about 30%. Although the classic presentation is of florid shock with frank hypotension, fever, and elevated white blood cell count, many patients can present with cryptogenic shock (shock without hypotension) with more subtle signs of vital organ compromise. Using the case of Ms C, a 47-year-old woman with short gut syndrome and an indwelling intravenous catheter who developed an episode of severe sepsis secondary to a central line infection, treatment of sepsis is discussed. Management consists of prompt intervention with broad-spectrum antibiotics and fluid resuscitation, even in the absence of hypotension, and institution of a variety of strategies in the emergency setting to prevent development or worsening of vital organ dysfunction. Although advances in understanding the host immune response have fueled considerable interest in immunomodulatory therapy, the role of such agents in clinical practice remains limited and controversial.

  6. [Bacterial sepsis : Diagnostics and calculated antibiotic therapy].

    PubMed

    Richter, D C; Heininger, A; Brenner, T; Hochreiter, M; Bernhard, M; Briegel, J; Dubler, S; Grabein, B; Hecker, A; Krüger, W A; Mayer, K; Pletz, M W; Störzinger, D; Pinder, N; Hoppe-Tichy, T; Weiterer, S; Zimmermann, S; Brinkmann, A; Weigand, M A; Lichtenstern, Christoph

    2017-10-04

    routine sepsis diagnostics due to the limited number of studies, high costs and limited availability. In complicated septic courses with multiple anti-infective treatment or recurrent sepsis, PCR-based procedures can be used in addition to therapy monitoring and diagnostics. Novel antibiotics represent potent alternatives in the treatment of MDR infections. Due to the often defined spectrum of pathogens and the practically absent resistance, they are suitable for targeted treatment of severe MDR infections (therapy escalation).

  7. The evolutionary logic of sepsis.

    PubMed

    Rózsa, Lajos; Apari, Péter; Sulyok, Mihály; Tappe, Dennis; Bodó, Imre; Hardi, Richárd; Müller, Viktor

    2017-09-09

    The recently proposed Microbiome Mutiny Hypothesis posits that members of the human microbiome obtain information about the host individuals' health status and, when host survival is compromised, switch to an intensive exploitation strategy to maximize residual transmission. In animals and humans, sepsis is an acute systemic reaction to microbes invading the normally sterile body compartments. When induced by formerly mutualistic or neutral microbes, possibly in response to declining host health, sepsis appears to fit the 'microbiome mutiny' scenario except for its apparent failure to enhance transmission of the causative organisms. We propose that the ability of certain species of the microbiome to induce sepsis is not a fortuitous side effect of within-host replication, but rather it might, in some cases, be the result of their adaptive evolution. Whenever host health declines, inducing sepsis can be adaptive for those members of the healthy human microbiome that are capable of colonizing the future cadaver and spread by cadaver-borne transmission. We hypothesize that such microbes might exhibit switches along the 'mutualist - lethal pathogen - decomposer - mutualist again' scenario, implicating a previously unsuspected, surprising level of phenotypic plasticity. This hypothesis predicts that those species of the healthy microbiome that are recurring causative agents of sepsis can participate in the decomposition of cadavers, and can be transmitted as soil-borne or water-borne infections. Furthermore, in individual sepsis cases, the same microbial clones that dominate the systemic infection that precipitates sepsis, should also be present in high concentration during decomposition following death: this prediction is testable by molecular fingerprinting in experimentally induced animal models. Sepsis is a leading cause of human death worldwide. If further research confirms that some cases of sepsis indeed involve the 'mutiny' (facultative phenotypic switching) of

  8. Practice-Based Evidence to Evidence-Based Practice: Building the National Radiation Oncology Registry

    PubMed Central

    Efstathiou, Jason A.; Nassif, Deborah S.; McNutt, Todd R.; Bogardus, C. Bob; Bosch, Walter; Carlin, Jeffrey; Chen, Ronald C.; Chou, Henry; Eggert, Dave; Fraass, Benedick A.; Goldwein, Joel; Hoffman, Karen E.; Hotz, Ken; Hunt, Margie; Kessler, Marc; Lawton, Colleen A.F.; Mayo, Charles; Michalski, Jeff M.; Mutic, Sasa; Potters, Louis; Rose, Christopher M.; Sandler, Howard M.; Sharp, Gregory; Tomé, Wolfgang; Tran, Phuoc T.; Wall, Terry; Zietman, Anthony L.; Gabriel, Peter E.; Bekelman, Justin E.

    2013-01-01

    The National Radiation Oncology Registry (NROR), sponsored by the Radiation Oncology Institute and the American Society for Radiation Oncology, is designed to collect standardized information on cancer care delivery among patients treated with radiotherapy in the United States and will focus on patients with prostate cancer. Stakeholders were engaged through a forum that emphasized the need for patient-centered outcomes, minimal data burden, and maximal connectivity to existing registries and databases. An electronic infrastructure is under development to provide connectivity across radiation oncology and hospital information systems. The NROR Gateway features automatic abstraction as well as aggregation of treatment and outcome data. The prostate cancer data dictionary provides standardized elements in four domains: facility, physician, patient, and treatment. The pilot phase will consist of clinical centers chosen to provide a representative mix of radiation treatment modalities, facility types, population-based settings, and regional locations. The initial set of radiation practice metrics includes physician board certification and maintenance, ordering of staging scans, active surveillance discussion, dose prescriptions for low-risk/high-risk disease, radiation fields for low-risk/high-risk disease, image-guided radiation therapy use, androgen deprivation therapy use, post-brachytherapy implant computed tomography dosimetry, collection of toxicity assessments, and longitudinal patient follow-up. The NROR pilot study will provide the framework for expansion to a nationwide electronic registry for radiation oncology. PMID:23942508

  9. Gender differences in sepsis

    PubMed Central

    Angele, Martin K; Pratschke, Sebastian; Hubbard, William J; Chaudry, Irshad H

    2014-01-01

    During sepsis, a complex network of cytokine, immune, and endothelial cell interactions occur and disturbances in the microcirculation cause organ dysfunction or even failure leading to high mortality in those patients. In this respect, numerous experimental and clinical studies indicate sex-specific differences in infectious diseases and sepsis. Female gender has been demonstrated to be protective under such conditions, whereas male gender may be deleterious due to a diminished cell-mediated immune response and cardiovascular functions. Male sex hormones, i.e., androgens, have been shown to be suppressive on cell-mediated immune responses. In contrast, female sex hormones exhibit protective effects which may contribute to the natural advantages of females under septic conditions. Thus, the hormonal status has to be considered when treating septic patients. Therefore, potential therapies could be derived from this knowledge. In this respect, administration of female sex hormones (estrogens and their precursors) may exert beneficial effects. Alternatively, blockade of male sex hormone receptors could result in maintained immune responses under adverse circulatory conditions. Finally, administration of agents that influence enzymes synthesizing female sex hormones which attenuate the levels of pro-inflammatory agents might exert salutary effects in septic patients. Prospective patient studies are required for transferring those important experimental findings into the clinical arena. PMID:24193307

  10. Cytopathic hypoxia in sepsis.

    PubMed

    Fink, M

    1997-01-01

    Diminished availability of oxygen at the cellular level might account for organ dysfunction in sepsis. Although the classical forms of tissue hypoxia due to hypoxemia, anemia, or inadequate perfusion all might be important under some conditions, it seems increasingly likely that a fourth mechanism, namely cytopathic hypoxia, might play a role as well. The term cytopathic hypoxia is used to denote diminished production of adenosine triphosphate (ATP) despite normal (or even supranormal) PO2 values in the vicinity of mitochondria within cells. At least in theory, cytopathic hypoxia could be a consequence of several different (but mutually compatible) pathogenic mechanisms, including diminished delivery of a key substrate (e.g., pyruvate) into the mitochondrial tricarboxylic acid (TCA) cycle, inhibition of key mitochondrial enzymes involved in either the TCA cycle or the electron transport chain, activation of the enzyme, poly-(ADP)-ribosylpolymerase (PARP), or collapse of the protonic gradient across the inner mitochondrial membrane leading to uncoupling of oxidation (of NADH and FADH) from phosphorylation of ADP to form ATP. Tantalizing, but limited, data support the view that cytopathic hypoxia occurs in both animals and patients with sepsis or endotoxemia.

  11. National Best Practices Manual for Building High Performance Schools

    SciTech Connect

    2007-10-01

    The Best Practices Manual was written as a part of the promotional effort for EnergySmart Schools, provided by the US Department of Energy, to educate school districts around the country about energy efficiency and renewable energy.

  12. The Changing Epidemiology and Definitions of Sepsis

    PubMed Central

    Kempker, Jordan A.; Martin, Greg S.

    2016-01-01

    Synopsis This review begins with a description of the trends in the incidence of and mortality from sepsis in the United States and globally. Then we discuss the known factors associated with increased risk for the development of sepsis. Finally, we discuss the limitations of the current clinical definition of sepsis and the clinical correlations of the current epidemiology of sepsis. PMID:27229635

  13. Neonatal sepsis: progress towards improved outcomes.

    PubMed

    Shane, Andi L; Stoll, Barbara J

    2014-01-01

    Neonates are predisposed to infections during the perinatal period due to multiple exposures and a relatively compromised immune system. The burden of disease attributed to neonatal infections varies by geographic region and maternal and neonatal risk factors. Worldwide, it is estimated that more than 1.4 million neonatal deaths annually are the consequence of invasive infections. Risk factors for early-onset neonatal sepsis (EOS) include prematurity, immunologic immaturity, maternal Group B streptococcal colonization, prolonged rupture of membranes, and maternal intra-amniotic infection. Intrapartum antimicrobial prophylaxis administered to GBS-colonized women has reduced the burden of disease associated with early onset GBS invasive infections. Active surveillance has identified Gram-negative pathogens as an emerging etiology of early-onset invasive infections. Late-onset neonatal sepsis (LOS) attributable to Gram-positive organisms, including coagulase negative Staphylococci and Staphylococcus aureus, is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of late-onset sepsis, especially among infants who receive broad spectrum antimicrobial agents. Prophylactic fluconazole administration to very low birthweight (VLBW) neonates during the first 6 weeks of life reduces invasive candidiasis in neonatal intensive care units with high rates of fungal infection. Prevention of healthcare associated infections through antimicrobial stewardship, limited steroid use, early enteral feeding, limited use of invasive devices and standardization of catheter care practices, and meticulous hand hygiene are important and cost-effective strategies for reducing the burden of late-onset neonatal sepsis. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  14. Towards best practice in national health workforce planning.

    PubMed

    McCarty, Maureen V; Fenech, Bethany J

    2013-09-02

    Health Workforce Australia (HWA) was established by the Council of Australian Governments through its 2008 National Partnership Agreement on Hospital and Health Workforce Reform, as the national agency to progress health workforce reform and address the challenges of providing a skilled, innovative and flexible health workforce in Australia. The Australian Health Ministers' Conference commissioned HWA to undertake a workforce planning exercise for doctors, nurses and midwives over a planning horizon to 2025. Health Workforce 2025 (HW 2025) was conducted in two phases: developing projections for the size and type of the health workforce (doctors, nurses and midwives) needed to meet future service requirements from 2012 to 2025; and modelling the training pipeline necessary to meet the size and type of this health workforce. HWA has used a number of key principles in developing HW 2025 to ensure the projections are robust and able to be applied nationally. HW 2025 is not a one-off project. Projections will be updated as new data become available, and methodology and assumptions underpinning the projections will be periodically reviewed. To also ensure the continued improvement of national health workforce planning, HWA is pursuing other areas for improvement, including better national data collections and improved estimation methodology for demand. Results of HW 2025 were presented to the Australian Health Ministers (through the Standing Council on Health) in April 2012.

  15. Association Among Blood Transfusion, Sepsis, and Decreased Long-term Survival After Colon Cancer Resection.

    PubMed

    Aquina, Christopher T; Blumberg, Neil; Becerra, Adan Z; Boscoe, Francis P; Schymura, Maria J; Noyes, Katia; Monson, John R T; Fleming, Fergal J

    2017-08-01

    , independent of sepsis, after colon cancer resection. However, receiving a transfusion and developing sepsis has an additive effect and is associated with even worse survival. Restrictive perioperative transfusion practices are a possible strategy to reduce sepsis rates and improve survival after colon cancer surgery.

  16. Renal blood flow in sepsis

    PubMed Central

    Langenberg, Christoph; Bellomo, Rinaldo; May, Clive; Wan, Li; Egi, Moritoki; Morgera, Stanislao

    2005-01-01

    Introduction To assess changes in renal blood flow (RBF) in human and experimental sepsis, and to identify determinants of RBF. Method Using specific search terms we systematically interrogated two electronic reference libraries to identify experimental and human studies of sepsis and septic acute renal failure in which RBF was measured. In the retrieved studies, we assessed the influence of various factors on RBF during sepsis using statistical methods. Results We found no human studies in which RBF was measured with suitably accurate direct methods. Where it was measured in humans with sepsis, however, RBF was increased compared with normal. Of the 159 animal studies identified, 99 reported decreased RBF and 60 reported unchanged or increased RBF. The size of animal, technique of measurement, duration of measurement, method of induction of sepsis, and fluid administration had no effect on RBF. In contrast, on univariate analysis, state of consciousness of animals (P = 0.005), recovery after surgery (P < 0.001), haemodynamic pattern (hypodynamic or hyperdynamic state; P < 0.001) and cardiac output (P < 0.001) influenced RBF. However, multivariate analysis showed that only cardiac output remained an independent determinant of RBF (P < 0.001). Conclusion The impact of sepsis on RBF in humans is unknown. In experimental sepsis, RBF was reported to be decreased in two-thirds of studies (62 %) and unchanged or increased in one-third (38%). On univariate analysis, several factors not directly related to sepsis appear to influence RBF. However, multivariate analysis suggests that cardiac output has a dominant effect on RBF during sepsis, such that, in the presence of a decreased cardiac output, RBF is typically decreased, whereas in the presence of a preserved or increased cardiac output RBF is typically maintained or increased. PMID:16137349

  17. National Best Practices Manual for Building High Performance Schools (Revised)

    SciTech Connect

    Not Available

    2007-10-01

    The Best Practices Manual was written as a part of the promotional effort for EnergySmart Schools, provided by the US Department of Energy, to educate school districts around the country about energy efficiency and renewable energy. Written specifically for architects and engineers, The Best Practices Manual is designed to help those who are responsible for designing or retrofitting schools, as well as their project managers. This manual will help design staff make informed decisions about energy and environmental issues important to the school systems and communities.

  18. Neonatal Sepsis and Neutrophil Insufficiencies

    PubMed Central

    Melvan, John Nicholas; Bagby, Gregory J.; Welsh, David A.; Nelson, Steve; Zhang, Ping

    2011-01-01

    Sepsis has continuously been a leading cause of neonatal morbidity and mortality despite current advances in chemotherapy and patient intensive care facilities. Neonates are at high risk for developing bacterial infections due to quantitative and qualitative insufficiencies of innate immunity, particularly granulocyte lineage development and response to infection. Although antibiotics remain the mainstay of treatment, adjuvant therapies enhancing immune function have shown promise in treating sepsis in neonates. This chapter reviews current strategies for the clinical management of neonatal sepsis and analyzes mechanisms underlying insufficiencies of neutrophil defense in neonates with emphasis on new directions for adjuvant therapy development. PMID:20521927

  19. Fluid Resuscitation in Severe Sepsis.

    PubMed

    Loflin, Rob; Winters, Michael E

    2017-02-01

    Since its original description in 1832, fluid resuscitation has become the cornerstone of early and aggressive treatment of severe sepsis and septic shock. However, questions remain about optimal fluid composition, dose, and rate of administration for critically ill patients. This article reviews pertinent physiology of the circulatory system, pathogenesis of septic shock, and phases of sepsis resuscitation, and then focuses on the type, rate, and amount of fluid administration for severe sepsis and septic shock, so providers can choose the right fluid, for the right patient, at the right time.

  20. Multicultural Career Counseling: A National Survey of Competencies and Practices

    ERIC Educational Resources Information Center

    Vespia, Kristin M.; Fitzpatrick, Mary E.; Fouad, Nadya A.; Kantamneni, Neeta; Chen, Yung-Lung

    2010-01-01

    Career counselors' multicultural competence has not been widely investigated. In this study, a national sample of 230 career counselors completed an online survey that included measures of career counseling self-efficacy and multicultural counseling competence. Beyond these self-report instruments, counselors responded to open-ended items that…

  1. A National Survey of Revising Practices in the Primary Classroom

    ERIC Educational Resources Information Center

    Saddler, Bruce; Saddler, Kristie; Befoorhooz, Bita; Cuccio-Slichko, Julie

    2014-01-01

    A random national sampling of primary grade teachers in the United States were surveyed to determine how they teach revising to writers in the elementary grades. Our findings suggest that in our sample of teachers, little time is dedicated in the school day to writing and especially revising. The teachers believed that more time spent revising did…

  2. Developing Inclusive Practice in Scotland: The National Framework for Inclusion

    ERIC Educational Resources Information Center

    Barrett, Louise; Beaton, Mhairi; Head, George; McAuliffe, Lisa; Moscardini, Lio; Spratt, Jennifer; Sutherland, Margaret

    2015-01-01

    This paper reports on the collaborative development of a "National Framework for Inclusion" under the auspices of the Scottish Teacher Education Committee by a working party representing each of the Scottish Universities providing initial teacher education. Recent research, international legislation and Scottish education policy have…

  3. Adult Education and National Development: Concepts and Practices in India.

    ERIC Educational Resources Information Center

    Ministry of Education and Social Welfare, New Delhi (India).

    The importance of eradicating adult illiteracy in developing countries as a part of promoting community participation in democracy and in accelerating the rate of national development is treated in the study of adult education in India. Attempts have been made to: link adult education to major developmental and productive activities through…

  4. A National Survey of Revising Practices in the Primary Classroom

    ERIC Educational Resources Information Center

    Saddler, Bruce; Saddler, Kristie; Befoorhooz, Bita; Cuccio-Slichko, Julie

    2014-01-01

    A random national sampling of primary grade teachers in the United States were surveyed to determine how they teach revising to writers in the elementary grades. Our findings suggest that in our sample of teachers, little time is dedicated in the school day to writing and especially revising. The teachers believed that more time spent revising did…

  5. Developing Inclusive Practice in Scotland: The National Framework for Inclusion

    ERIC Educational Resources Information Center

    Barrett, Louise; Beaton, Mhairi; Head, George; McAuliffe, Lisa; Moscardini, Lio; Spratt, Jennifer; Sutherland, Margaret

    2015-01-01

    This paper reports on the collaborative development of a "National Framework for Inclusion" under the auspices of the Scottish Teacher Education Committee by a working party representing each of the Scottish Universities providing initial teacher education. Recent research, international legislation and Scottish education policy have…

  6. Copernicus - Practice of Daily Life in a National Mapping Agency?

    NASA Astrophysics Data System (ADS)

    Wiatr, T.; Suresh, G.; Gehrke, R.; Hovenbitzer, M.

    2016-06-01

    Copernicus is an European system created for Earth observation and monitoring. It consists of a set of Earth observation satellites and in-situ sensors that provide geo-information that are used, through a set of Copernicus services, for applications related to the environment and global security. The main services of the Copernicus programme address six thematic areas: land, marine, atmosphere, climate change, emergency management and security. In Germany, there is a national service team of Copernicus service coordinators, who are responsible for the national development of the Copernicus services and for providing user-specific information about the Copernicus processes. These coordinators represent the contact points for all the programmes and services concerning their respective Copernicus theme. To publish information about Copernicus, national conferences and workshops are organised. Many people are involved in planning the continuous process of bringing the information to public authorities, research institutes and commercial companies. The Federal Agency for Cartography and Geodesy (Bundesamt für Kartographie und Geodäsie, BKG) is one such organisation, and is mainly responsible for the national land monitoring service of Copernicus. To make use of the freely available data from the Copernicus programme, the Federal Agency for Cartography and Geodesy is currently developing new applications and projects in the field of remote sensing and land monitoring. These projects can be used by other public authorities as examples on how to use the Copernicus data and services for their individual demands and requirements. Copernicus data and services are currently not very commonly used in the daily routine of the national mapping agencies, but they will soon be.

  7. 78 FR 39738 - National Advisory Council on Nurse Education and Practice; Notice for Request for Nominations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-02

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education and Practice; Notice for Request for Nominations SUMMARY: The Health Resources and Services... of Health Professions (BHPr), Health Resources and Administration (HRSA), Parklawn Building, Room...

  8. Undergraduate Psychological Writing: A Best Practices Guide and National Survey

    ERIC Educational Resources Information Center

    Ishak, Shaziela; Salter, Nicholas P.

    2017-01-01

    There is no comprehensive guide for teaching psychological writing, and little is known about how often instructors teach the topic. We present a best practices guide for teaching psychological writing beyond just American Psychological Association style, discuss psychology-specific writing assignments, and examine psychological writing…

  9. Undergraduate Psychological Writing: A Best Practices Guide and National Survey

    ERIC Educational Resources Information Center

    Ishak, Shaziela; Salter, Nicholas P.

    2017-01-01

    There is no comprehensive guide for teaching psychological writing, and little is known about how often instructors teach the topic. We present a best practices guide for teaching psychological writing beyond just American Psychological Association style, discuss psychology-specific writing assignments, and examine psychological writing…

  10. Nanosafety practices: results from a national survey at research facilities

    NASA Astrophysics Data System (ADS)

    Díaz-Soler, Beatriz María; López-Alonso, Mónica; Martínez-Aires, María Dolores

    2017-05-01

    The exposure to engineered nanomaterials (ENMs) is a new emerging risk at work due to an increase in the number of workers potentially exposed to them and the current lack of data on their health and safety risks. This paper reports the findings of a survey designed to study the safety practices employed by workers in Spanish research facilities performing tasks involving the use of ENMs at research level. A questionnaire pretested and validated by an expert panel was sent by e-mail to the target audience. The 425 surveys completed show that most of the respondents handled up to 5 different ENMs, in suspension, in small amounts during short periods of exposure. The implementation of common hygienic practices, such as the use of protection for hands and the implementation of fume hoods, is widely indicated. The selection of the preventive and protective measures does not depend on the characteristics of ENMs handled. Also, the risks posed by ENMs are widely ignored. Besides the performance of risk assessment, hygienic monitoring and the conducting of a specific health surveillance are practically non-existent although some accidents relating to ENMs were identified. In conclusion, workers' exposure to ENMs seems to be low. Even though the best practices and preventive and protective measures reported were employed, most of the respondents could not be correctly protected. Moreover, workers do not associate the measures implemented with the nanorisks. Finally, there is a lack of proactive action underway to protect the workers, and concerns about safety are weakly evidenced.

  11. Academic Advising Assessment Practices: Results of a National Study

    ERIC Educational Resources Information Center

    Powers, Keith L.; Carlstrom, Aaron H.

    2014-01-01

    Best practices of academic advising assessment involve identification of student learning outcomes, the development and use of multiple measures of student learning, and sound professional judgment to understand the information gathered and to improve student learning. However, the assessment results often come from minimal, narrow, and…

  12. Selection Practices of Group Leaders: A National Survey.

    ERIC Educational Resources Information Center

    Riva, Maria T.; Lippert, Laurel; Tackett, M. Jan

    2000-01-01

    Study surveys the selection practices of group leaders. Explores methods of selection, variables used to make selection decisions, and the types of selection errors that leaders have experienced. Results suggest that group leaders use clinical judgment to make selection decisions and endorse using some specific variables in selection. (Contains 22…

  13. The Significance of Constructivist Classroom Practice in National Curricular Design

    ERIC Educational Resources Information Center

    Booyse, Celia; Chetty, Rajendra

    2016-01-01

    Evidence of the value of constructivist theory in the classroom is especially important for educational practice in areas of poverty and social challenge. Research was undertaken in 2010 into the application of constructivist theory on instructional design. The findings of this research are particularly relevant to the current curricular crisis in…

  14. Selection Practices of Group Leaders: A National Survey.

    ERIC Educational Resources Information Center

    Riva, Maria T.; Lippert, Laurel; Tackett, M. Jan

    2000-01-01

    Study surveys the selection practices of group leaders. Explores methods of selection, variables used to make selection decisions, and the types of selection errors that leaders have experienced. Results suggest that group leaders use clinical judgment to make selection decisions and endorse using some specific variables in selection. (Contains 22…

  15. Thyroid hormone disorders and sepsis.

    PubMed

    Luo, Bin; Yu, Zhui; Li, Yinping

    2017-01-01

    Sepsis is a systemic inflammatory response syndrome with high mortality, which results from severe infection and can lead to secondary organ dysfunction. It is one of the most common cause of death in intensive care unit. Clinical reports have shown that sepsis was often accompanied by thyroid dysfunction, which is called "low triiodothyronine (T3)" syndrome and characterized by decreased blood total T3 and free T3, and by normal or decreased thyroxine (T4) and thyroid stimulating hormone (TSH). This syndrome may greatly affect the prognosis of patients with sepsis. The main purpose of this review is to illustrate the role of thyroid hormone disorder in the development and prognosis of sepsis.

  16. First-trimester medical abortion practices in Canada: National survey.

    PubMed

    Guilbert, Edith R; Hayden, Althea S; Jones, Heidi E; White, Katharine O'Connell; Steven Lichtenberg, E; Paul, Maureen; Norman, Wendy V

    2016-04-01

    To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Canada. A total of 94 abortion facilities were identified. Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ(2) and t tests. A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed. Copyright© the College of Family Physicians of Canada.

  17. Strategies for prevention of nosocomial sepsis in the neonatal intensive care unit.

    PubMed

    Saiman, Lisa

    2006-04-01

    Infants hospitalized in the neonatal intensive care unit, particularly preterm infants, have very high rates of nosocomial sepsis (also referred to as late onset sepsis or healthcare-associated sepsis). Today's preventive strategies for nosocomial sepsis focus on augmenting the immunologic and functional immaturities of premature infants and ameliorating the risks of extrinsic factors by the use of prophylactic antibiotics and best clinical practices. Topical emollients improved neonatal skin condition, but were associated with an increased risk of nosocomial bacterial sepsis and coagulase negative staphylococcal infections, and thus should not be used in extremely-low-birth-weight infants. Single-center studies have shown that probiotics containing anaerobic bacteria may reduce the rate of necrotizing enterocolitis, the severity of necrotizing enterocolitis, and/or bacterial sepsis. Single-center studies have shown that prophylactic fluconazole reduces the rates of invasive candidiasis and/or colonization of extremely-low-birth-weight infants. Quality improvement projects to improve adherence to appropriate hand hygiene and best practices for central venous catheter insertion and maintenance can reduce rates of nosocomial sepsis. The safety and efficacy of probiotics and prophylactic fluconazole require large multicenter trials. Quality improvement initiatives, however, can be performed now and can reduce the rates of nosocomial sepsis in the neonatal intensive care unit.

  18. Changing Classroom Practice at Key Stage 2: The Impact of New Labour's National Strategies

    ERIC Educational Resources Information Center

    Webb, Rosemary; Vulliamy, Graham

    2007-01-01

    The article examines the impact of New Labour policies--particularly the National Literacy and Numeracy Strategies and the subsequent Primary National Strategy--on classroom practice at Key Stage 2 in England. Evidence is drawn from fieldwork conducted in 2003-2005 from a sample of 50 schools, replicating a study conducted a decade previously in…

  19. Providing Assistance to the Victims of Adolescent Dating Violence: A National Assessment of School Nurses' Practices

    ERIC Educational Resources Information Center

    Khubchandani, Jagdish; Telljohann, Susan K.; Price, James H.; Dake, Joseph A.; Hendershot, Candace

    2013-01-01

    Background: This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV). Methods: The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N?=?750). A valid and reliable survey…

  20. Employing National Board Certification Practices with All Teachers: The Potential of Cognitive Coaching and Mentoring

    ERIC Educational Resources Information Center

    Diaz, Kirsten Anne

    2013-01-01

    National Board Certification is an esteemed certification and professional learning and reflective opportunity for teachers. Cognitive coaching is also a method of support many teachers receive over the course of their National Board Certification journey. The certification process involves reflective practices and opportunities for teachers to…

  1. Employing National Board Certification Practices with All Teachers: The Potential of Cognitive Coaching and Mentoring

    ERIC Educational Resources Information Center

    Diaz, Kirsten Anne

    2013-01-01

    National Board Certification is an esteemed certification and professional learning and reflective opportunity for teachers. Cognitive coaching is also a method of support many teachers receive over the course of their National Board Certification journey. The certification process involves reflective practices and opportunities for teachers to…

  2. Organizations in America: Analyzing Their Structures and Human Resource Practices Based on the National Organizations Study.

    ERIC Educational Resources Information Center

    Kalleberg, Arne L.; Knoke, David; Marsden, Peter V.; Spaeth, Joe L.

    In 1991 the National Organizations Study (NOS) surveyed a number of U.S. businesses about their structure, context, and personnel practices to produce a database for answering questions about social behavior in work organizations. This book presents the results of that survey. The study aimed to create a national database on organizations--based…

  3. Providing Assistance to the Victims of Adolescent Dating Violence: A National Assessment of School Nurses' Practices

    ERIC Educational Resources Information Center

    Khubchandani, Jagdish; Telljohann, Susan K.; Price, James H.; Dake, Joseph A.; Hendershot, Candace

    2013-01-01

    Background: This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV). Methods: The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N?=?750). A valid and reliable survey…

  4. Impact of sepsis on CD4 T cell immunity

    PubMed Central

    Cabrera-Perez, Javier; Condotta, Stephanie A.; Badovinac, Vladimir P.; Griffith, Thomas S.

    2014-01-01

    Sepsis remains the primary cause of death from infection in hospital patients, despite improvements in antibiotics and intensive-care practices. Patients who survive severe sepsis can display suppressed immune function, often manifested as an increased susceptibility to (and mortality from) nosocomial infections. Not only is there a significant reduction in the number of various immune cell populations during sepsis, but there is also decreased function in the remaining lymphocytes. Within the immune system, CD4 T cells are important players in the proper development of numerous cellular and humoral immune responses. Despite sufficient clinical evidence of CD4 T cell loss in septic patients of all ages, the impact of sepsis on CD4 T cell responses is not well understood. Recent findings suggest that CD4 T cell impairment is a multipronged problem that results from initial sepsis-induced cell loss. However, the subsequent lymphopenia-induced numerical recovery of the CD4 T cell compartment leads to intrinsic alterations in phenotype and effector function, reduced repertoire diversity, changes in the composition of naive antigen-specific CD4 T cell pools, and changes in the representation of different CD4 T cell subpopulations (e.g., increases in Treg frequency). This review focuses on sepsis-induced alterations within the CD4 T cell compartment that influence the ability of the immune system to control secondary heterologous infections. The understanding of how sepsis affects CD4 T cells through their numerical loss and recovery, as well as function, is important in the development of future treatments designed to restore CD4 T cells to their presepsis state. PMID:24791959

  5. Sepsis: a review of therapeutics and considerations for anesthesiologists.

    PubMed

    Dhillon, Anahat; Nguyen, Jen; Kistler, Erik

    2012-11-01

    Sepsis and septic shock remain a major cause of morbidity and mortality. The complexity of the disease pathophysiology has resulted in a rich area of research on etiology and therapeutics. Anesthesiologists will often encounter the syndrome in their routine practice. This review summarizes some of the basic concepts of therapeutics and some novel therapeutics that are pertinent to anesthesia.

  6. Assessment for Learning Practices and Competency among Malaysian University Lecturers: A National Study

    ERIC Educational Resources Information Center

    Ahmad, Tunku Badariah Tunku; Zubairi, Ainol Madziah; Ibrahim, Mohd Burhan; Othman, Joharry; Rahman, Nik Suryani Abd; Rahman, Zainurin Abd; Nordin, Mohamad Sahari; Nor, Zainab Mohd

    2014-01-01

    This paper reports the findings of a national study involving 534 lecturers from 33 higher learning institutions in Malaysia to find out their self-reported practices and perceived competencies in assessment for learning. Data were collected using a 24-item assessment practice inventory drawn from five of the six standards stipulated in an…

  7. 78 FR 2275 - National Advisory Council on Nurse Education and Practice; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-10

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... on Nurse Education and Practice (NACNEP). Dates and Times: January 31, 2013, 9:30 a.m.-12:30 p.m... Nurse Education and Practice, Parklawn Building, Room 9-61, 5600 Fishers Lane, Rockville, Maryland...

  8. 76 FR 14033 - National Advisory Council on Nurse Education and Practice; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-15

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... Council on Nurse Education and Practice (NACNEP). Dates and Times: April 11, 2011, 8:30 a.m.-4 p.m. April.... Purpose: The purpose of this meeting is to address diversity in nurse education and practice....

  9. 75 FR 64318 - National Advisory Council on Nurse Education and Practice; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-19

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... Council on Nurse Education and Practice (NACNEP). Dates and Times: November 17, 2010, 1 p.m.-5 p.m...: The purpose of this meeting is to address diversity in nurse education and practice. The objectives...

  10. Assessment and Intervention Practices for Attention Deficit Hyperactivity Disorder (ADHD): A National Survey of School Psychologists

    ERIC Educational Resources Information Center

    Borick, Timothy J.

    2011-01-01

    This study examined school psychologists' assessment and intervention practices regarding ADHD. Five hundred school psychologists who practiced in a school setting and were regular members of the National Association of School Psychologists were randomly selected to complete and return a questionnaire titled Assessment and Intervention Practices…

  11. Severe sepsis in older adults.

    PubMed

    Umberger, Reba; Callen, Bonnie; Brown, Mary Lynn

    2015-01-01

    Severe sepsis may be underrecognized in older adults. Therefore, the purpose of this article is to review special considerations related to early detection of severe sepsis in older adults. Normal organ changes attributed to aging may delay early detection of sepsis at the time when interventions have the greatest potential to improve patient outcomes. Systems are reviewed for changes. For example, the cardiovascular system may have a limited or absent compensatory response to inflammation after an infectious insult, and the febrile response and recruitment of white blood cells may be blunted because of immunosenescence in aging. Three of the 4 hallmark responses (temperature, heart rate, and white blood cell count) to systemic inflammation may be diminished in older adults as compared with younger adults. It is important to consider that older adults may not always manifest the typical systemic inflammatory response syndrome. Atypical signs such as confusion, decreased appetite, and unsteady gait may occur before sepsis related organ failure. Systemic inflammatory response syndrome criteria and a comparison of organ failure criteria were reviewed. Mortality rates in sepsis and severe sepsis remain high and are often complicated by multiple organ failures. As the numbers of older adults increase, early identification and prompt treatment is crucial in improving patient outcomes.

  12. Neonatal Sepsis and Inflammatory Mediators

    PubMed Central

    Reis Machado, Juliana; Soave, Danilo Figueiredo; da Silva, Marcos Vinícius; de Menezes, Liliana Borges; Etchebehere, Renata Margarida; Monteiro, Maria Luiza Gonçalves dos Reis; Antônia dos Reis, Marlene; Corrêa, Rosana Rosa Miranda; Celes, Mara Rúbia Nunes

    2014-01-01

    Neonatal sepsis is a major cause of morbidity and mortality and its signs and symptoms are nonspecific, which makes the diagnosis difficult. The routinely used laboratory tests are not effective methods of analysis, as they are extremely nonspecific and often cause inappropriate use of antibiotics. Sepsis is the result of an infection associated with a systemic inflammatory response with production and release of a wide range of inflammatory mediators. Cytokines are potent inflammatory mediators and their serum levels are increased during infections, so changes from other inflammatory effector molecules may occur. Although proinflammatory and anti-inflammatory cytokines have been identified as probable markers of neonatal infection, in order to characterize the inflammatory response during sepsis, it is necessary to analyze a panel of cytokines and not only the measurement of individual cytokines. Measurements of inflammatory mediators bring new options for diagnosing and following up neonatal sepsis, thus enabling early treatment and, as a result, increased neonatal survival. By taking into account the magnitude of neonatal sepsis, the aim of this review is to address the role of cytokines in the pathogenesis of neonatal sepsis and its value as a diagnostic criterion. PMID:25614712

  13. Understanding brain dysfunction in sepsis

    PubMed Central

    2013-01-01

    Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood–brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke’s encephalopathy. Modulation of microglial activation, prevention of blood–brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors. PMID:23718252

  14. Photovoltaic power systems and the National Electrical Code: Suggested practices

    SciTech Connect

    Wiles, J.

    1996-12-01

    This guide provides information on how the National Electrical Code (NEC) applies to photovoltaic systems. The guide is not intended to supplant or replace the NEC; it paraphrases the NEC where it pertains to photovoltaic systems and should be used with the full text of the NEC. Users of this guide should be thoroughly familiar with the NEC and know the engineering principles and hazards associated with electrical and photovoltaic power systems. The information in this guide is the best available at the time of publication and is believed to be technically accurate; it will be updated frequently. Application of this information and results obtained are the responsibility of the user.

  15. The use of common continuous monitoring parameters: a quality indicator for critically ill patients with sepsis.

    PubMed

    Giuliano, Karen K; Kleinpell, Ruth

    2005-01-01

    Sepsis is a common source of morbidity and mortality among critically ill patients, and targeting measures to promote early recognition and treatment of sepsis is at the forefront of many critical care initiatives. Starting formally in 1992, with the publication of the definitions of sepsis, continuous monitoring of several common physiologic parameters, including electrocardiogram, blood pressure, and oxygen saturation, have been advocated as important in the early identification and treatment of patients with sepsis. The descriptive study detailed in this article was conducted to assess the perceptions and clinical continuous physiologic monitoring practices of experienced critical care clinicians with regard to their use of common physiologic monitoring parameters in the care of patients with sepsis. A convenience sample of 100 physicians and 517 nurses completed a 20-item survey assessing perceptions and clinical monitoring practices related to the care of patients with sepsis. Results indicated that the basic parameters of electrocardiogram, invasive blood pressure, pulmonary arterial catheter monitoring, and oxygen saturation all have value in the recognition and treatment of patients with sepsis. The majority of clinicians used these parameters routinely and felt they were necessary for patient care. These results indicate that clinical practice is in concordance with current practice recommendations.

  16. Sepsis in Pediatric Cardiac Intensive Care

    PubMed Central

    Wheeler, Derek S.; Wong, Hector R.

    2016-01-01

    Objectives In this review we will discuss risk factors for developing sepsis; the role of biomarkers in establishing an early diagnosis, monitoring therapeutic efficacy, stratification, and for the identification of sepsis endotypes; and the pathophysiology and management of severe sepsis and septic shock, with an emphasis on the impact of sepsis on cardiovascular function. Data Source MEDLINE, PubMed Conclusion There is a lot of excitement in the field of sepsis research today. Scientific advances in the diagnosis and clinical staging of sepsis, as well as a personalized approach to the treatment of sepsis, offer tremendous promise for the future. However, at the same time, it is also evident that sepsis mortality has not improved enough, even with progress in our understanding of the molecular pathophysiology of sepsis. PMID:27490609

  17. Continuing education: a national imperative for school nursing practice.

    PubMed

    Vought-O'Sullivan, Victoria; Meehan, Nancy K; Havice, Pamela A; Pruitt, Rosanne H

    2006-02-01

    Competency-based continuing education is critical to the professional development of school nurses to ensure the application of timely, age-appropriate clinical knowledge and leadership skills in the school setting. School nurses are responsible for a large number of students with a variety of complex and diverse health care needs. Benner's theory of novice to expert provides a framework for the development of roles and competencies in the practice of school nursing. This manuscript synthesizes research reviewed in 15 articles. Common themes found in the articles include the importance of continuing education and identified barriers to attainment. In response, methods to access continuing education and financial resources are presented.

  18. Antibiotic use in neonatal sepsis.

    PubMed

    Yurdakök, M

    1998-01-01

    Neonatal sepsis is a life-threatening emergency and any delay in treatment may cause death. Initial signs of neonatal sepsis are slight and nonspecific. Therefore, in suspected sepsis, two or three days empirical antibiotic therapy should begin immediately after cultures have been obtained without awaiting the results. Antibiotics should be reevaluated when the results of the cultures and susceptibility tests are available. If the cultures are negative and the clinical findings are well, antibiotics should be stopped. Because of the nonspecific nature of neonatal sepsis, especially in small preterm infants, physicians continue antibiotics once started. If a baby has pneumonia or what appears to be sepsis, antibiotics should not be stopped, although cultures are negative. The duration of therapy depends on the initial response to the appropriate antibiotics but should be 10 to 14 days in most infants with sepsis and minimal or absent focal infection. In infants who developed sepsis during the first week of life, empirical therapy must cover group B streptococci, Enterobacteriaceae (especially E. coli) and Listeria monocytogenes. Penicillin or ampicillin plus an aminoglycoside is usually effective against all these organisms. Initial empirical antibiotic therapy for infants who developed sepsis beyond the first days of life must cover the organisms associated with early-onset sepsis as well as hospital-acquired pathogens such as staphylococci, enterococci and Pseudomonas aeruginosa. Penicillin or ampicillin and an aminoglycoside combination may also be used in the initial therapy of late-onset sepsis as in cases with early-onset sepsis. In nosocomial infections, netilmicin or amikacin should be preferred. In cases showing increased risk of staphylococcal infection (e.g. presence of vascular catheter) or Pseudomonas infection (e.g. presence of typical skin lesions), antistaphylococcal or anti-Pseudomonas agents may be preferred in the initial empirical therapy. In

  19. American Society of Clinical Oncology National Census of Oncology Practices: preliminary report.

    PubMed

    Forte, Gaetano J; Hanley, Amy; Hagerty, Karen; Kurup, Anupama; Neuss, Michael N; Mulvey, Therese M

    2013-01-01

    In response to reports of increasing financial and administrative burdens on oncology practices and a lack of systematic information related to these issues, American Society of Clinical Oncology (ASCO) leadership started an effort to collect key practice-level data from all oncology practices in the United States. The result of the effort is the ASCO National Census of Oncology Practices (Census) launched in June 2012. The initial Census work involved compiling an inventory of oncology practices from existing lists of oncology physicians in the United States. A comprehensive, online data collection instrument was developed, which covered a number of areas, including practice characteristics (staffing configuration, organizational structure, patient mix and volume, types of services offered); organizational, staffing, and service changes over the past 12 months; and an assessment of the likelihood that the practice would experience organizational, staffing, and service changes in the next 12 months. More than 600 practices participated in the Census by providing information. In this article, we present preliminary highlights from the data gathered to date. We found that practice size was related to having experienced practice mergers, hiring additional staff, and increasing staff pay in the past 12 months, that geographic location was related to having experienced hiring additional staff, and that practices in metropolitan areas were more likely to have experienced practice mergers in the past 12 months than those in nonmetropolitan areas. We also found that practice size and geographic location were related to higher likelihoods of anticipating practice mergers, sales, and purchases in the future.

  20. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study.

    PubMed

    Machado, Flavia R; Cavalcanti, Alexandre Biasi; Bozza, Fernando Augusto; Ferreira, Elaine M; Angotti Carrara, Fernanda Sousa; Sousa, Juliana Lubarino; Caixeta, Noemi; Salomao, Reinaldo; Angus, Derek C; Pontes Azevedo, Luciano Cesar

    2017-08-17

    The sepsis burden on acute care services in middle-income countries is a cause for concern. We estimated incidence, prevalence, and mortality of sepsis in adult Brazilian intensive care units (ICUs) and association of ICU organisational factors with outcome. We did a 1-day point prevalence study with follow-up of patients in ICU with sepsis in a nationally representative pseudo-random sample. We produced a sampling frame initially stratified by geographical region. Each stratum was then stratified by hospitals' main source of income (serving general public vs privately insured individuals) and ICU size (ten or fewer beds vs more than ten beds), finally generating 40 strata. In each stratum we selected a random sample of ICUs so as to enrol the total required beds in 1690 Brazilian adult ICUs. We followed up patients until hospital discharge censored at 60 days, estimated incidence from prevalence and length of stay, and generated national estimates. We assessed mortality prognostic factors using random-effects logistic regression models. On Feb 27, 2014, 227 (72%) of 317 ICUs that were randomly selected provided data on 2632 patients, of whom 794 had sepsis (30·2 septic patients per 100 ICU beds, 95% CI 28·4-31·9). The ICU sepsis incidence was 36·3 per 1000 patient-days (95% CI 29·8-44·0) and mortality was observed in 439 (55·7%) of 788 patients (95% CI 52·2-59·2). Low availability of resources (odds ratio [OR] 1·67, 95% CI 1·02-2·75, p=0·045) and adequacy of treatment (OR 0·56, 0·37-0·84, p=0·006) were independently associated with mortality. The projected incidence rate is 290 per 100 000 population (95% CI 237·9-351·2) of adult cases of ICU-treated sepsis per year, which yields about 420 000 cases annually, of whom 230 000 die in hospital. The incidence, prevalence, and mortality of ICU-treated sepsis is high in Brazil. Outcome varies considerably, and is associated with access to adequate resources and treatment. Our results show the

  1. Validation of c-reactive protein in the early diagnosis of neonatal sepsis in a tertiary care hospital in Kenya.

    PubMed

    Kumar, R; Musoke, R; Macharia, W M; Revathi, G

    2010-06-01

    To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. Cross-sectional study. Newborn Unit, Kenyatta National Hospital. All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a specificity of 85.3%, positive predictive value of 80.6%, and a negative predictive value of 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive value of 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy in proven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysis showed a lower positive predictive value (61.5%) for early onset sepsis compared to 93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the 29 with proven/probable infection had a ten-fold increase in CRP levels, but levels were noted to be low or reducing in seven (24.1%) babies showing signs of improvement clinically. Using a receiver operator characteristic curve, the optimal cut-off point for CRP was found to be 5 mg/dl. Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity, specificity and predictive values, at the standard cut-off of 5. CRP is a better screening test for late-onset than early-onset neonatal sepsis. The standard recommended CRP cut -off point of 5 is appropriate for local use.

  2. Molecular microbiological methods in the diagnosis of neonatal sepsis

    PubMed Central

    Venkatesh, Mohan; Flores, Angela; Luna, Ruth Ann; Versalovic, James

    2010-01-01

    Neonatal sepsis is a major cause of neonatal mortality and morbidity. The current gold standard for diagnosis of sepsis, namely blood culture, suffers from low sensitivity and a reporting delay of approximately 48–72 h. Rapid detection of sepsis and institution of antimicrobial therapy may improve patient outcomes. Rapid and sensitive tests that can inform clinicians regarding the institution or optimization of antimicrobial therapy are urgently needed. The ideal diagnostic test should have adequate specificity and negative predictive value to reliably exclude sepsis and avoid unnecessary antibiotic therapy. We comprehensively searched for neonatal studies that evaluated molecular methods for diagnosis of sepsis. We identified 19 studies that were assessed with respect to assay methodology and diagnostic characteristics. In addition, we also reviewed newer molecular microbiological assays of relevance that have not been fully evaluated in neonates. Molecular methods offer distinct advantages over blood cultures, including increased sensitivity and rapid diagnosis. However, diagnostic accuracy and cost–effectiveness should be established before implementation in clinical practice. PMID:20818947

  3. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

    PubMed Central

    Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

    2017-01-01

    Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. Participants The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. Outcome measures An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. Results 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. Conclusions The process established a new network of opinion leaders and researchers for further

  4. Sepsis-associated encephalopathy.

    PubMed

    Gofton, Teneille E; Young, G Bryan

    2012-10-01

    Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction that occurs secondary to infection in the body without overt CNS infection. SAE is frequently encountered in critically ill patients in intensive care units, and in up to 70% of patients with severe systemic infection. The severity of SAE can range from mild delirium to deep coma. Seizures and myoclonus are infrequent and cranial nerves are almost always spared, but most severe cases have an associated critical illness neuromyopathy. Development of SAE probably involves a number of mechanisms that are not mutually exclusive and vary from patient to patient. Substantial neurological and psychological morbidities often occur in survivors. Mortality is almost always due to multiorgan failure rather than neurological complications, and is almost 70% in patients with severe SAE. Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE. Recent evidence for SAE pathophysiology is outlined and a diagnostic approach to patients with this syndrome is presented. Lastly, prognosis and management of SAE is discussed.

  5. Antimicrobial Peptides in Human Sepsis

    PubMed Central

    Martin, Lukas; van Meegern, Anne; Doemming, Sabine; Schuerholz, Tobias

    2015-01-01

    Nearly 100 years ago, antimicrobial peptides (AMPs) were identified as an important part of innate immunity. They exist in species from bacteria to mammals and can be isolated in body fluids and on surfaces constitutively or induced by inflammation. Defensins have anti-bacterial effects against Gram-positive and Gram-negative bacteria as well as anti-viral and anti-yeast effects. Human neutrophil peptides (HNP) 1–3 and human beta-defensins (HBDs) 1–3 are some of the most important defensins in humans. Recent studies have demonstrated higher levels of HNP 1–3 and HBD-2 in sepsis. The bactericidal/permeability-increasing protein (BPI) attenuates local inflammatory response and decreases systemic toxicity of endotoxins. Moreover, BPI might reflect the severity of organ dysfunction in sepsis. Elevated plasma lactoferrin is detected in patients with organ failure. HNP 1–3, lactoferrin, BPI, and heparin-binding protein are increased in sepsis. Human lactoferrin peptide 1–11 (hLF 1–11) possesses antimicrobial activity and modulates inflammation. The recombinant form of lactoferrin [talactoferrin alpha (TLF)] has been shown to decrease mortality in critically ill patients. A phase II/III study with TLF in sepsis did not confirm this result. The growing number of multiresistant bacteria is an ongoing problem in sepsis therapy. Furthermore, antibiotics are known to promote the liberation of pro-inflammatory cell components and thus augment the severity of sepsis. Compared to antibiotics, AMPs kill bacteria but also neutralize pathogenic factors such as lipopolysaccharide. The obstacle to applying naturally occurring AMPs is their high nephro- and neurotoxicity. Therefore, the challenge is to develop peptides to treat septic patients effectively without causing harm. This overview focuses on natural and synthetic AMPs in human and experimental sepsis and their potential to provide significant improvements in the treatment of critically ill with severe infections

  6. The National Practice Benchmark for Oncology: 2015 Report for 2014 Data

    PubMed Central

    Balch, Carla; Ogle, John D.

    2016-01-01

    The National Practice Benchmark (NPB) is a unique tool used to measure oncology practices against others across the country in a meaningful way despite variations in practice demographics, size, and setting. In today’s challenging economic environment, each practice positions service offerings and competitive advantages to attract patients. Although the data in the NPB report are primarily reported by community oncology practices, the business structure and arrangements with regional health care systems are also reflected in the benchmark report. The ability to produce detailed metrics is an accomplishment of excellence in business and clinical management. With these metrics, a practice should be able to measure and analyze its current business practices and make appropriate changes, if necessary. In this report, we build on the foundation initially established by Oncology Metrics (acquired by Flatiron Health in 2014) over years of data collection and refine definitions to deliver the NPB, which is uniquely meaningful in the oncology market. PMID:27006357

  7. Administrative, counseling and medical practices in National Abortion Federation facilities.

    PubMed

    Landy, U; Lewit, S

    1982-01-01

    A survey of members of the National Abortion Federation (NAF), most of them non-hospital facilities, responsible for performing almost half of the abortions in the United States, was carried out by the NAF in 1981. Among the principal findings were the following: Fifty-three percent of the NAF facilities are freestanding clinics operated for profit. Fifty-one percent are open more than 50 hours per week, and 77 percent are open six days a week; 86 percent are open on Saturdays. Seventy-five percent of the physicians performing abortions in these facilities are gynecologists. Counseling provided by specially trained abortion counselors is a unique contribution of abortion facilities to health-care delivery. Virtually all facilities employ counselors who are neither doctors nor nurses. Most NAF facilities have more counselors than nurses and more nurses than doctors. Counseling in virtually all facilities includes providing written as well as verbal information about the nature of the procedure and its medical risks; such information is given to the patient so that she can give informed consent for the abortion. Almost all facilities include information about contraception and about the options available to a woman with a problem pregnancy. Most offer counseling to the male, as well as the female partner, on the patient's request. Twenty-eight percent of facilities generally provide both individual and group counseling. Where only one type of counseling is provided, it is usually individual counseling.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Recovery practice in community mental health teams: national survey.

    PubMed

    Leamy, M; Clarke, E; Le Boutillier, C; Bird, V; Choudhury, R; MacPherson, R; Pesola, F; Sabas, K; Williams, J; Williams, P; Slade, M

    2016-10-01

    There is consensus about the importance of 'recovery' in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31-0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery. © The Royal College of Psychiatrists 2016.

  9. Electroconvulsive Therapy Practice in Spain: A National Survey.

    PubMed

    Vera, Ignacio; Sanz-Fuentenebro, Javier; Urretavizcaya, Mikel; Verdura, Ernesto; Soria, Virginia; Martínez-Amorós, Erika; Bernardo, Miquel

    2016-03-01

    The use of electroconvulsive therapy (ECT) in Spain has not been systematically evaluated since 2000 to 2001. The aim of this study is to assess the current use of ECT in Spain. A cross-sectional survey was conducted covering every psychiatric unit in Spain as of December 31, 2012. About 93.2% of the centers answered the questionnaire. About 54.9% of the psychiatric units applied ECT at a rate of 0.66 patients per 10,000 inhabitants. Wide variations existed among the different autonomous communities and provinces. Written informed consent was obtained in all the facilities. About 38.2% of ECT-treated patients were 65 years or older. About 55.7% were women. Depressive episodes were the main indication for ECT (80.2%). All the facilities applied modified ECT. No sine wave current devices are currently used in Spain. Bifrontotemporal ECT was elective in 85% of the hospitals, bifrontal in 13.3%, and unilateral in 1.8%. Stimulus titration methods were elective in 8.6% of the centers. The decision to end ECT relied on the psychiatrist's clinical impression in 89.4% of the centers and on rating scales in 10.6%. The ECT training was mandatory in 56.5% of the centers. The ECT practice has significantly improved in Spain in recent years. Overall, Spanish facilities seem to comply with established clinical guidelines; however, specific concerns were identified, meaning there is still further scope for improvement.

  10. National Practice in Antibiotic Prophylaxis in Breast Cancer Surgery

    PubMed Central

    Eroglu, Aydan; Karasoy, Durdu; Kurt, Halil; Baskan, Semih

    2014-01-01

    Background Although breast cancer surgery is regarded as a “clean” surgery, surgical site infection (SSI) rates are higher than expected. There is no consensus regarding the use of antibiotic prophylaxis in elective breast surgery. The nationwide survey was conducted to determine the trend of antibiotic prophylaxis in breast cancer among Turkish surgeons. Methods The survey was sent to surgeons who are member of Turkish Surgical Association (TSA) via e-mail from TSA web address. A 15 item web-based survey consisted of surgeon demographics and the use of prophylactic antibiotic in patients with risk factors related to SSI. Results The number of completed questionnaires was 245. The most common antibiotic used was first generation of cephalosporins. A majority of respondents indicated that prophylaxis was preferred in patients with high risk of SSI including preoperative chemotherapy or radiotherapy, older age, diabetes mellitus, immunodeficiency, immediate reconstruction (P < 0.05). However, the use of drain did not significantly influence antibiotic prophylaxis (P = 0.091). Conclusions The use of prophylactic antibiotic was strongly dependent on the presence of some risk factors; however, the variation in current practice regarding antibiotic prophylaxis demonstrated a lack of its effect on preventing SSI after breast cancer surgery. PMID:24400029

  11. A "three delays" model for severe sepsis in resource-limited countries.

    PubMed

    Papali, Alfred; McCurdy, Michael T; Calvello, Emilie J B

    2015-08-01

    The developing world carries the greatest burden of sepsis-related mortality, but success in managing severe sepsis in resource-limited countries (RLCs) remains challenging. A "three delays" model has been developed to describe factors influencing perinatal mortality in developing nations. This model has been validated across different World Health Organization regions and has provided the framework for policymakers to plan targeted interventions. Here, we propose a three delays model for severe sepsis in RLCs. A literature review was performed using the PubMed, Google Scholar, and Ovid databases. Additional sources were found after review of the reference lists from retrieved articles. We propose a three delays model for severe sepsis in adults in RLCs. The model highlights limitations in the 3 basic pillars of sepsis management: (1) sepsis recognition and diagnosis at the time of triage, (2) initial focused resuscitation, and (3) postresuscitation clinical monitoring and reassessment. Characterizing the major barriers to effective treatment of severe sepsis in RLCs frames the problem in a language common to global health circles, which may stimulate further research, streamline treatment, and reduce sepsis-related mortality in the developing world. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Recovery practice in community mental health teams: national survey

    PubMed Central

    Leamy, M.; Clarke, E.; Le Boutillier, C.; Bird, V.; Choudhury, R.; MacPherson, R.; Pesola, F.; Sabas, K.; Williams, J.; Williams, P.; Slade, M.

    2016-01-01

    Background There is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. Aims To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. Method In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). Results Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31–0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. Conclusions Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery. PMID:27340113

  13. National survey of pediatric anesthesia practice in Thailand.

    PubMed

    Suraseranivongse, Suwannee; Attachoo, Anchalee; Leelanukrom, Ruenreong; Chareonsawan, Usa; Horatanaruang, Duenpen

    2011-04-01

    To assess current pediatric anesthesia practice for further education from Royal College of Anesthesiologists of Thailand. A questionnaire was sent to 500 anesthetists in public hospitals in January 2010 to investigate preoperative data, intraoperative data, postoperative pain management, ambulatory anesthesia, and pediatric anesthesia training requirement. Response rate was 30.6%. Preoperative fasting and infective endocarditis (IE) prophylaxis were appropriate except that half the anesthesiologists preferred giving antibiotics in non-cyanotic heart diseases and ordering complete blood count as a routine investigation in healthy patients undergoing minor surgery. Premedication was preferred in children and adolescents. Parental presence during induction was most often selected in children (74.5%). Modified Ayre T-piece was the most popular breathing circuit used during induction while circle circuit was more likely used during maintenance period. Manual ventilation was preferred in neonates. Scavenging system was rarely used Intraoperative fluid was given based on Holliday & Segar Law (> 90%). Isotonic fluid without glucose was preferred for replacement of third space loss and hypotonic fluid with glucose was preferred for maintenance fluid. Transfusion trigger was inversely correlated with age. Postoperative pain scales were more often used in children and adolescents. Fentanyl was more popular in younger age group. Intermittent intravenous administration was the most preferred route. Age group of infants and older were predominantly accepted to be anaesthetized on an ambulatory basis. Pediatric advanced life support was seldom performed. Intermittent training was more popular than certified fellowship training. Routine investigation in healthy patients, IE prophylaxis in non-cyanotic patients, intraoperative fluid replacement, and pediatric advanced life support and postoperative pain management were the issues recommended for further education.

  14. National health insurance in America--can we practice with it? Can we continue to practice without it?

    PubMed Central

    Grumbach, K

    1989-01-01

    Health insurance in the United States is failing patients and physicians alike. In this country 37 million uninsured face economic barriers to care, and the health of many suffers as a result. The "corporatization" of medical care threatens professional values with an unprecedented administrative and commercial intrusion into the daily practice of medicine. Competitive strategies have also failed their most ostensible goal--cost control. In contrast, Canada offers a model of a national health insurance plan that provides universal and comprehensive coverage, succeeds at restraining health care inflation, and does little to abrogate the clinical autonomy of physicians in private practice. I propose that American physicians relent in their historical opposition to national health insurance and participate in the development of a universal, public insurance plan responsive to the needs of both patients and physicians. Images PMID:2672604

  15. [An Archive for Science, State and Nation : Climatological Data Practices in Switzerland, 1860-1914].

    PubMed

    Hupfer, Franziska

    2017-09-27

    In the second half of the nineteenth century, most European countries began to finance weather observation networks. As a result, climatological data practices changed fundamentally. Using the example of Switzerland, this paper examines the political, institutional and methodological dimensions of national data archives. The institutionalization of data collection within the national framework meant, on the one hand, that more observations were systematically made and published. On the other hand, it also meant that the monitoring was connected to state boundaries. However, based on their universalistic conception of science, this did not preclude national institutions from striving for international data standardization. The national framework also shaped the process of transforming weather observations into statistical data. This information formed the basis for national climatographies and thus had a nation-building effect. According to the Swiss Meteorological Institute, climate data were practically useful and had great potential for research work. However, the epistemic status of data collection was uncertain, since physical approaches to climatology had gained in importance. The anticipation of scientific and practical potential benefits played a central role for the continuation of data production. The Swiss case study presented here illustrates that climatology was transformed by the process of nation-building, affecting its institutional structure, spatial references, and epistemology.

  16. Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey

    PubMed Central

    Wanbon, Richard; Lyder, Catherine; Villeneuve, Eric; Shalansky, Stephen; Manuel, Leslie; Harding, Melanie

    2015-01-01

    Background: As of 2015, Accreditation Canada’s Qmentum program expects emergency departments (EDs) to initiate medication reconciliation for 2 groups of patients: (1) those with a decision to admit and (2) those without a decision to admit who meet the criteria of a risk-based, health care organization–defined selection process. Pharmacist-led best possible medication histories (BPMHs) obtained in the ED are considered more complete and accurate than BPMHs obtained by other ED providers, with pharmacy technicians obtaining BPMHs as effectively as do pharmacists. A current assessment of the role of pharmacy in BPMH processes in Canadian EDs is lacking. Objectives: To identify and describe BPMH and medication reconciliation practices in Canadian EDs, including those performed by members of the ED pharmacy team. Methods: All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least a 0.5 full-time equivalent position). Different electronic surveys were then distributed to ED pharmacy team members (where available) and ED managers (all hospitals). Results: Survey responses were obtained from 60 (63%) of 95 ED pharmacy teams and 128 (53%) of 243 ED managers. Only 38 (30%) of the 128 ED managers believed that their current BPMH processes were adequate to obtain a BPMH for all admissions. Fifty-nine (98%) of the ED pharmacy personnel reported obtaining BPMHs (most commonly 6–10 per day), with priority given to admitted patients. Only 14 (23%) of the 60 ED pharmacy teams reported that their EDs had adequate staffing to comply with Accreditation Canada’s requirements for obtaining BPMHs. This result is supported by the 104 (81%) out of 128 ED managers who reported that additional ED staffing would be needed to comply with the requirements. Numerous ED managers identified the need to expand ED pharmacy services and improve information technology support. Conclusions

  17. Substituted judgment in principle and practice: a national physician survey.

    PubMed

    Combs, Michael P; Rasinski, Kenneth A; Yoon, John D; Curlin, Farr A

    2013-07-01

    To describe the extent to which US physicians endorse substituted judgments in principle or accommodate them in practice. We surveyed a stratified, random sample of 2016 physicians by mail from June 25, 2010, to September 3, 2010. Primary outcome measures were agreement with 2 in-principle statements about substituted judgment and, after an experimental vignette that varied the basis used by a patient's surrogate to refuse life-saving treatment, responses indicating how appropriate it would be to overrule the surrogate's decision. Our response rate was 62% (1156 of 1875 respondents). When there is a conflict between what a surrogate believes a patient would have wanted (substituted judgment) and what the surrogate believes is in the patient's best interest, 4 of 5 physicians (78%) agreed that the surrogate should base their decision on substituted judgment. Yet we also found that 2 of 5 physicians (40%) agree that surrogates should make decisions they believe are in the patient's best interest, even if those seem to contradict the patient's prior wishes. In the experimental vignette, physicians were much more likely to oppose overruling a surrogate's refusal of life-sustaining medical treatment when that refusal was made on the basis of substituted judgment compared with when the refusal was made on the basis of the patient's best interest (50% vs 20%; odds ratio, 4.2; 95% CI, 2.7-6.3). Responses to the in-principle items about substituted judgment were not consistently associated with responses to the experimental vignette. US physicians largely agree, in principle, that surrogates should prioritize what the patient would have wanted over what they believe is in the patient's best interest, although many physicians are ambivalent in cases in which the 2 norms conflict. Even physicians who reject the principle of substituted judgment tend to treat substituted judgment as the preferred norm for surrogate decision making when responding to a clinical vignette

  18. Medication Reconciliation Practices in Canadian Emergency Departments: A National Survey.

    PubMed

    Wanbon, Richard; Lyder, Catherine; Villeneuve, Eric; Shalansky, Stephen; Manuel, Leslie; Harding, Melanie

    2015-01-01

    As of 2015, Accreditation Canada's Qmentum program expects emergency departments (EDs) to initiate medication reconciliation for 2 groups of patients: (1) those with a decision to admit and (2) those without a decision to admit who meet the criteria of a risk-based, health care organization-defined selection process. Pharmacist-led best possible medication histories (BPMHs) obtained in the ED are considered more complete and accurate than BPMHs obtained by other ED providers, with pharmacy technicians obtaining BPMHs as effectively as do pharmacists. A current assessment of the role of pharmacy in BPMH processes in Canadian EDs is lacking. To identify and describe BPMH and medication reconciliation practices in Canadian EDs, including those performed by members of the ED pharmacy team. All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least a 0.5 full-time equivalent position). Different electronic surveys were then distributed to ED pharmacy team members (where available) and ED managers (all hospitals). Survey responses were obtained from 60 (63%) of 95 ED pharmacy teams and 128 (53%) of 243 ED managers. Only 38 (30%) of the 128 ED managers believed that their current BPMH processes were adequate to obtain a BPMH for all admissions. Fifty-nine (98%) of the ED pharmacy personnel reported obtaining BPMHs (most commonly 6-10 per day), with priority given to admitted patients. Only 14 (23%) of the 60 ED pharmacy teams reported that their EDs had adequate staffing to comply with Accreditation Canada's requirements for obtaining BPMHs. This result is supported by the 104 (81%) out of 128 ED managers who reported that additional ED staffing would be needed to comply with the requirements. Numerous ED managers identified the need to expand ED pharmacy services and improve information technology support. BPMH processes in Canadian EDs were variable and inadequately

  19. Clinical transfusion practice update: haemovigilance, complications, patient blood management and national standards.

    PubMed

    Engelbrecht, Sunelle; Wood, Erica M; Cole-Sinclair, Merrole F

    2013-09-16

    Blood transfusion is not without risk. Although the risks of HIV and hepatitis transmission have diminished, haemovigilance programs highlight that other significant transfusion hazards remain. Sepsis from bacterial contamination is the most common residual infectious hazard in developed countries, and events due to clerical error are problematic. Unnecessary transfusions should be avoided. New national guidelines on patient blood management (PBM) emphasise holistic approaches, including strategies to reduce transfusion requirements. Perioperative PBM should incorporate preoperative haemoglobin and medication optimisation, intraoperative blood conservation, and consideration of restrictive postoperative transfusion and cell-salvage techniques. When massive transfusion is required, hospitals should implement massive transfusion protocols. These protocols reduce mortality, improve communication and facilitate adequate provision of blood products. They should include multidisciplinary team involvement and guidelines for use of blood components and adjunctive agents. Although fresh frozen plasma to red blood cell and platelet to red blood cell ratios of ≥ 1 : 2 appear to reduce mortality in trauma patients who receive massive transfusion, there is insufficient evidence to recommend specific ratios. Systematic reviews have found no significant benefit of recombinant activated factor VII in critical bleeding, and an increase in thromboembolic events; specialist haematology advice is therefore recommended when considering use of this agent. The National Safety and Quality Health Service Standards address use of blood and blood products, and provide important transfusion principles for adoption by all clinicians. Storage of red cells in additive solution results in changes, known as the "storage lesion", and studies to determine the clinical effect of the age of blood at transfusion are ongoing.

  20. Established and novel biomarkers of sepsis.

    PubMed

    Faix, James D

    2011-04-01

    The increased incidence of sepsis, a systemic response to infection that occurs in some patients, has stimulated interest in identifying infected patients who are at risk and intervening early. When this condition progresses to severe sepsis (characterized by organ dysfunction), mortality is high. Hospitals that have implemented recommendations of the Surviving Sepsis Campaign have seen a reduction in mortality rate for hospital-acquired severe sepsis. They may reduce this further by focusing on new approaches to diagnosing sepsis, especially at an early stage. Sepsis is a complicated syndrome with many physiological derangements and many emerging laboratory markers of sepsis have been proposed as adjuncts to clinical evaluation. The list includes cytokines, acute phase proteins, neutrophil activation markers, markers of abnormal coagulation and, recently, markers of suppression of both the innate and adaptive immune response. The perfect biomarker would accurately identify patients at risk of developing severe sepsis and then guide targeted therapy.

  1. Sepsis care: getting it right every time.

    PubMed

    2016-10-06

    In the UK, there are an estimated 150,000 cases of sepsis per year, resulting in 44,000 deaths. This equates to more deaths than from bowel, breast and prostate cancer combined according to the Sepsis Trust.

  2. Current epidemiology of sepsis in mainland China

    PubMed Central

    Liao, Xuelian; Du, Bin; Lu, Meizhu; Wu, Minming

    2016-01-01

    The disease burden of sepsis is a global issue. Most of the large-scale epidemiological investigations on sepsis have been carried out in developed countries. The population of 1.3 billion in mainland China accounts for approximately 1/5th of the whole world population. Thus, the knowledge of the incidence and mortality of sepsis in mainland China is vital before employing measures for its improvement. However, most of the epidemiological data of sepsis in mainland China was obtained from ICU settings, and thus lacks the population-based incidence and mortality of sepsis. In the present review, we summarized the limited literature encompassing the incidence, mortality, long-term outcome, and pathogens of sepsis in mainland China. Therefore, it might provide some valuable information regarding the sepsis disease burden and current issues in the management of sepsis in mainland China. PMID:27713882

  3. Trends and disparities in sepsis hospitalisations in Victoria, Australia.

    PubMed

    Ore, Timothy

    2015-12-14

    clinical practice. Greater understanding of the epidemiology of sepsis could improve care quality and outcomes.What is known about the topic? Sepsis is associated with high mortality rates and severe sepsis is the most common cause of death in intensive care units (ICU). The last published study of sepsis in Victoria (in 2005) showed a gradual rise in rates; since then, there is little information as to whether there has been any significant improvement in treatment outcomes.What does this paper add? This paper provides new information by analysing trends and variations in sepsis hospitalisations in Victoria by several demographic groups from 2004-05 to 2013-14.What are the implications for practitioners? Patients with severe sepsis consume approximately half the ICU resources. Reliable and recent data on the growth of this disease are important for prevention, allocation of resources and to track the effectiveness of care. A key area for intervention is promoting greater adherence to clinical guidelines.

  4. [Understanding the pathogenetic mechanisms of SIRS and sepsis and development of innovative therapies of sepsis].

    PubMed

    Aikawa, Naoki; Fujishima, Seitaro

    2004-12-01

    The concept of systemic inflammatory response syndrome (SIRS) was introduced in 1992 to define and objectively diagnose sepsis. Over the last decade, the definition of sepsis has been used for inclusion criteria of multicenter trials to develop innovative therapies of sepsis. With the recent understanding of the pathogenetic mechanisms of sepsis, many drugs have been tested, but only two drugs (activated protein C and neutrophil-elastase inhibitor) have been approved for clinical use in sepsis or SIRS. Further understanding of basic pathophysiology of SIRS and sepsis holds promise to develop a new therapeutic strategy to improve survival of patients with SIRS and sepsis.

  5. Severe sepsis in intensive care units in Poland--a point prevalence study in 2012 and 2013.

    PubMed

    Kübler, Andrzej; Adamik, Barbara; Ciszewicz-Adamiczka, Beata; Ostrowska, Elżbieta

    2015-01-01

    Severe sepsis is associated with a high mortality rate, but the detailed epidemiology of sepsis is not well known in Polish hospitals. The aim of the study was to determine the prevalence and incidence of severe sepsis in Polish intensive care units (ICUs). Two one-day, point-prevalence studies were performed on March 8th, 2012 and March 13th, 2013. An online questionnaire was sent to 320 accredited ICUs. Demographic data regarding hospitals, ICUs, number of patients with severe sepsis and septic shock, and number of patients mechanically ventilated with a central catheter or a urinary catheter were collected. The one-day prevalence of severe sepsis in ICUs was calculated, and the annual incidence of severe sepsis in Poland was estimated from the prevalence rate and the mean length of stay in ICUs. 1398 patients participated in the study in 2012, which accounted for 50% of all ICU beds registered by the National Health Care (NHC) system; 860 patients participated in 2013 (30% of all ICU beds). The daily prevalence of severe sepsis in ICUs was 26% in 2012 and 22% in 2013. Based on the data provided by the NHC system, the number of severe sepsis patients treated in accredited ICUs in Poland amounted to 24,905 patients per year, and the incidence of severe sepsis was 65/100,000 cases per year. Severe sepsis was observed in one-fourth of patients treated in ICUs in Poland. However, the actual number of severe sepsis patients is at least 2 times higher because many patients with severe sepsis were treated outside accredited ICUs. Severe sepsis constitutes a major health problem in Poland.

  6. Association of fungal sepsis and galactosemia.

    PubMed

    Verma, Sanjay; Bharti, Bhavneet; Inusha, P

    2010-06-01

    Galactosemia is one of the rare inborn errors of metabolism, which if detected early can be treated effectively. Galactosemic infants have a significant increased risk of developing sepsis. E. coli sepsis is a known entity, and also an important cause of early mortality in these children. But fungal sepsis in these patients is rarely reported. Here is a case of 45 day-old child who presented with fungal sepsis, which on investigation turned out to be galactosemia.

  7. Preventing intensive care admissions for sepsis in tropical Africa (PICASTA): an extension of the international pediatric global sepsis initiative: an African perspective.

    PubMed

    Pollach, Gregor; Namboya, Felix

    2013-07-01

    The Global Sepsis Initiative recommends prevention of sepsis through immunizations, vitamins, breast feeding, and other important interventions. In our study, we consider a second set of proposals for preventing intensive care admissions for sepsis in tropical Africa, which have been specifically designed to further prevent ICU admissions for sepsis in the group A nation hospital setting. To reduce admissions with severe sepsis in an ICU of a group A nation through the identification of challenges leading to preventable, foreseeable, or nosocomial sepsis specific to our setting. Malawi is one of the poorest countries in the world. Lacking the ability to comply with standard sepsis treatment, we conducted over 4 years several studies, audits, and surveys to identify challenges leading to preventable pediatric sepsis in our setting. We developed a method to identify malnourished children through a "gatekeeper" in the theaters without any equipment, tried to implement the World Health Organization's Safe Surgery Campaign checklist, evaluated our educational courses for the districts to improve the quality of referrals, looked into the extreme fasting times discovered in our hospital, trained different cadres in the districts to deal with peripartal and posttraumatic sepsis, and identified the needs in human resources to deal with pediatric sepsis in our setting. Six foci were identified as promising to work on in future. Focus 1: Preventing elective operations and procedures in malnourished children in the hospital and in the district: 134 of 145 nurses (92.4%) and even 25 of 31 African laymen (80.6%) were able to identify malnourished children with their own fingers. Focus 2: Preventing sepsis-related problems in emergencies through the implementation of the Safe Surgery Campaign checklist: only 100 of 689 forms (14.5%) were filled in due to challenges in ownership, communication responsibility, and time constraints. Focus 3: Preventing sepsis through the reduction

  8. Sustaining practice change one year after completion of the national depression management leadership initiative.

    PubMed

    Chung, Henry; Duffy, Farifteh Firoozmand; Katzelnick, David J; Williams, Mark D; Trivedi, Madhukar H; Rae, Donald S; Regier, Darrel A

    2013-07-01

    This report describes the sustainability of quality improvement interventions for depression care in psychiatric practice one year after the completion of the National Depression Management Leadership Initiative (NDMLI) in 2006. The main intervention involved continued use of the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) for routine care of patients with depressive disorders. One year after project completion, lead psychiatrists from the 17 participating practices were surveyed about the sustainability of key practice interventions and dissemination of the interventions. All 14 practices that provided baseline and follow-up data reported sustained use of the PHQ-9 for screening, diagnosis, or monitoring purposes. Moreover, practices reported dissemination of this approach to clinicians within and outside their practices. Psychiatrists reported sustainability and dissemination of PHQ-9 use one year after the conclusion of the NDMLI. The model has potential as a depression care improvement strategy and is worthy of additional study.

  9. The inflammatory response in sepsis.

    PubMed

    Bosmann, Markus; Ward, Peter A

    2013-03-01

    The pathophysiology of sepsis and its accompanying systemic inflammatory response syndrome (SIRS) and the events that lead to multiorgan failure and death are poorly understood. It is known that, in septic humans and rodents, the development of SIRS is associated with a loss of the redox balance, but SIRS can also develop in noninfectious states. In addition, a hyperinflammatory state develops, together with impaired innate immune functions of phagocytes, immunosuppression, and complement activation, collectively leading to septic shock and lethality. Here, we discuss recent insights into the signaling pathways in immune and phagocytic cells that underlie sepsis and SIRS and consider how these might be targeted for therapeutic interventions to reverse or attenuate pathways that lead to lethality during sepsis.

  10. The Inflammatory Response in Sepsis

    PubMed Central

    Bosmann, Markus; Ward, Peter A.

    2012-01-01

    The pathophysiology of sepsis and its accompanying systemic inflammatory response syndrome (SIRS) and the events that lead to multiorgan failure and death are poorly understood. It is known that, in septic humans and rodents, the development of SIRS is associated with a loss of the redox balance, but SIRS can also develop in non-infectious states. In addition, a hyperinflammatory state develops, together with impaired innate immune functions of phagocytes, immunosuppression, and complement activation, collectively leading to septic shock and lethality. Here we discuss recent insights into the signaling pathways in immune and phagocytic cells that underlie sepsis and SIRS and consider how these might be targeted for therapeutic interventions to reverse or attenuate pathways that lead to lethality during sepsis. PMID:23036432

  11. Transfusion-associated bacterial sepsis.

    PubMed Central

    Wagner, S J; Friedman, L I; Dodd, R Y

    1994-01-01

    The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed. PMID:7923050

  12. Serum procalcitonin as an early marker of neonatal sepsis.

    PubMed

    Ballot, Daynia E; Perovic, Olga; Galpin, Jacky; Cooper, Peter A

    2004-10-01

    It has recently been suggested that procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. This study was to evaluate the role of PCT as a single early marker of neonatal sepsis. Neonatal Unit, Johannesburg Hospital, and Microbiology Laboratory, National Health Laboratory Service (NHLS), South Africa. Neonates undergoing evaluation for sepsis between April and August 2002 were eligible for inclusion. Patients were categorised into 'no infection', 'possible infection' and 'definite infection' on the basis of C-reactive protein (CRP), white cell count (WCC), platelet count and blood culture results. PCT was correlated with infection categories. One hundred and eighty-three neonates were enrolled. One hundred and eighteen had no infection, 52 possible infection and 13 definite infection. PCT differed significantly among infection categories (p < 0.0001) and correlated significantly with CRP at presentation (correlation coefficient 0.404, p < 0.001) and CRP at 24 hours (correlation coefficient 0.343, p < 0.001). PCT predicted 89.5% of definite infection. Receiver operating characteristic (ROC) analysis for PCT to predict definite infection showed odds ratio (OR) 1.145 (95% confidence interval (CI): 1.05-1.25) with an area under the curve of 0.778. PCT had a negative predictive value of 0.95 (95% CI: 0.915-0.988) for definite infection. Although PCT was significantly related to the category of infection, it is not sufficiently reliable to be the sole marker of neonatal sepsis. PCT would be useful as part of a full sepsis evaluation, but is relatively expensive. A negative PCT on presentation may rule out sepsis, but this needs to be evaluated further.

  13. Sepsis associated encephalopathy (SAE): a review.

    PubMed

    Green, Rebecca; Scott, L Keith; Minagar, Alireza; Conrad, Steven

    2004-05-01

    Sepsis associated encephalopathy (SAE) is a poorly understood condition that is associated with severe sepsis and appears to have a negative influence on survival. The incidence of encephalopathy secondary to sepsis is unknown. Amino acid derangements, blood-brain barrier disruption, abnormal neurotransmitters, and direct CNS effect are possible causes of septic encephalopathy. Research has not defined the pathogenesis of SAE.

  14. Best practices: A national mental health learning collaborative on supported employment.

    PubMed

    Becker, Deborah R; Drake, Robert E; Bond, Gary R; Nawaz, Saira; Haslett, William R; Martinez, Rick A

    2011-07-01

    This column describes a best practice for dissemination and implementation used by the Johnson & Johnson-Dartmouth Program: a national learning collaborative among community mental health programs on supported employment. In this two-tiered learning collaborative, researchers meet regularly with mental health and vocational rehabilitation leaders in 12 states and the District of Columbia, and state leaders oversee more than 130 individual programs in their respective states. Participants share educational programs, implementation and intervention strategies, practice experiences, outcome data, and research projects. The national learning collaborative facilitates implementation, dissemination, standardization, and sustainability of supported employment.

  15. Purpose, structure, and function of the United States National Dental Practice-Based Research Network.

    PubMed

    Gilbert, Gregg H; Williams, O Dale; Korelitz, James J; Fellows, Jeffrey L; Gordan, Valeria V; Makhija, Sonia K; Meyerowitz, Cyril; Oates, Thomas W; Rindal, D Brad; Benjamin, Paul L; Foy, Patrick J

    2013-11-01

    Following a successful 2005-2012 phase with three regional practice-based research networks (PBRNs), a single, unified national network called "The National Dental PBRN" was created in 2012 in the United States to improve oral health by conducting practice-based research and serving dental professionals through education and collegiality. Central administration is based in Alabama. Regional centres are based in Alabama, Florida, Minnesota, Oregon, New York and Texas, with a Coordinating Centre in Maryland. Ideas for studies are prioritized by the Executive Committee, comprised mostly of full-time clinicians. To date, 2763 persons have enrolled, from all six network regions; enrollment continues to expand. They represent a broad range of practitioners, practice types, and patient populations. Practitioners are actively improving every step of the research process, from idea generation, to study development, field testing, data collection, and presentation and publication. Practitioners from diverse settings are partnering with fellow practitioners and academics to improve clinical practice and meet the needs of clinicians and their patients. This "nation's network" aims to serve as a precious national resource to improve the scientific basis for clinical decision-making and foster movement of the latest evidence into routine practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals' Practices in France.

    PubMed

    Bertille, Nathalie; Pons, Gerard; Khoshnood, Babak; Fournier-Charrière, Elisabeth; Chalumeau, Martin

    2015-01-01

    Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs' practices are limited. We studied HPs' practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs' observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education.

  17. Defining inappropriate practices in prescribing for elderly people: a national consensus panel

    PubMed Central

    McLeod, P J; Huang, A R; Tamblyn, R M; Gayton, D C

    1997-01-01

    OBJECTIVE: To develop a consensus-based list of inappropriate practices in prescribing for elderly people. DESIGN: Mail survey of a 32-member national panel. SETTING: Academic medical centres across Canada. PARTICIPANTS: Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. OUTCOME MEASURES: Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy. RESULTS: The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies. CONCLUSION: The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study. PMID:9033421

  18. Defining inappropriate practices in prescribing for elderly people: a national consensus panel.

    PubMed

    McLeod, P J; Huang, A R; Tamblyn, R M; Gayton, D C

    1997-02-01

    To develop a consensus-based list of inappropriate practices in prescribing for elderly people. Mail survey of a 32-member national panel. Academic medical centres across Canada. Thirty-two specialists selected arbitrarily, including 7 clinical pharmacologists, 9 geriatricians, 8 family practitioners and 8 pharmacists. Consensus that the practice would introduce a substantial and significant increase in the risk of serious adverse effect and is common enough that its curtailment would decrease morbidity among elderly people, ranking of clinical importance of the risk, and availability of equally or more effective and less risky alternative therapy. The 32-member national panel developed a list of 71 practices in prescribing for elderly people and rated the clinical significance of each on a scale of 1 (not significant) to 4 (highly significant). The practices in prescribing identified fell into 3 categories: drugs generally contraindicated for elderly people, drug-disease interactions and drug-drug interactions. The mean significance rating was greater than 3 for 39 practices. For each practice, alternative therapies were recommended. There was surprising congruence among the specialists on the significance rating and the suggested alternative therapies. The authors have developed a valid, relevant list of inappropriate practices in prescribing for elderly people, to be used in a practice-based intervention study.

  19. Galactosemia presenting as recurrent sepsis.

    PubMed

    Rathi, Narendra; Rathi, Akanksha

    2011-12-01

    Galactosemia is a treatable metabolic disorder caused by the deficiency of enzyme galactose-1-phosphate uridyl transferase (GALT) and inherited as an autosomal recessive trait. A case of neonate manifesting with recurrent Escherichia coli sepsis is presented here which turned out to be a classic galactosemia. No other common presenting features were observed in this infant except cataract on slit lamp examination. To the best of our knowledge, there is no case of galactosemia reported in literature which presented with recurrent neonatal sepsis without hepatomegaly, hyperbilirubinemia, bleeding disorder, vomiting, diarrhea, failure to thrive, hypoglycemia, coagulopathy, hemolysis or renal tubular acidosis.

  20. Vasopressors and Inotropes in Sepsis.

    PubMed

    Stratton, Leeanne; Berlin, David A; Arbo, John E

    2017-02-01

    Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result.

  1. Septris: A Novel, Mobile, Online, Simulation Game That Improves Sepsis Recognition and Management

    PubMed Central

    Daines, William; Tsui, Jamie; Strehlow, Matthew; Maggio, Paul; Shieh, Lisa

    2015-01-01

    Problem Annually affecting over 18 million people worldwide, sepsis is common, deadly, and costly. Despite significant effort by the Surviving Sepsis Campaign and other initiatives, sepsis remains underrecognized and undertreated. Approach Research indicates that educating providers may improve sepsis diagnosis and treatment; thus, the Stanford School of Medicine has developed a mobile-accessible, case-based, online game entitled Septris (http://med.stanford.edu/septris/). Septris, launched online worldwide in December 2011, takes an innovative approach to teaching early sepsis identification and evidence-based management. The free gaming platform leverages the massive expansion over the past decade of smartphones and the popularity of noneducational gaming. The authors sought to assess the game’s dissemination and its impact on learners’ sepsis-related knowledge, skills, and attitudes. In 2012, the authors trained Stanford pregraduate (clerkship) and postgraduate (resident) medical learners (n = 156) in sepsis diagnosis and evidence-based practices via 20 minutes of self-directed game play with Septris. The authors administered pre- and posttests. Outcomes By October 2014, Septris garnered over 61,000 visits worldwide. After playing Septris, both pre- and postgraduate groups improved their knowledge on written testing in recognizing and managing sepsis (P < .001). Retrospective self-reporting on their ability to identify and manage sepsis also improved (P < .001). Over 85% of learners reported that they would or would maybe recommend Septris. Next Steps Future evaluation of Septris should assess its effectiveness among different providers, resource settings, and cultures; generate information about how different learners make clinical decisions; and evaluate the correlation of game scores with sepsis knowledge. PMID:25517703

  2. Biosafety Practices and Emergency Response at the Idaho National Laboratory and Los Alamos National Laboratory

    SciTech Connect

    Frank F. Roberto; Dina M. Matz

    2008-03-01

    Strict federal regulations govern the possession, use, and transfer of pathogens and toxins with potential to cause harm to the public, either through accidental or deliberate means. Laboratories registered through either the Centers for Disease Control and Prevention (CDC), the U.S. Dept. of Agriculture (USDA), or both, must prepare biosafety, security, and incident response plans, conduct drills or exercises on an annual basis, and update plans accordingly. At the Idaho National Laboratory (INL), biosafety, laboratory, and emergency management staff have been working together for 2 years to satisfy federal and DOE/NNSA requirements. This has been done through the establishment of plans, training, tabletop and walk-through exercises and drills, and coordination with local and regional emergency response personnel. Responding to the release of infectious agents or toxins is challenging, but through familiarization with the nature of the hazardous biological substances or organisms, and integration with laboratory-wide emergency response procedures, credible scenarios are being used to evaluate our ability to protect workers, the public, and the environment from agents we must work with to provide for national biodefense.

  3. Sepsis and Septic Shock: Lingering Questions.

    PubMed

    Dumont, Tiffany; Francis-Frank, Lyndave; Chong, Josebelo; Balaan, Marvin R

    2016-01-01

    Sepsis and septic shock are major health conditions in the United States, with a high incidence and mortality. The Surviving Sepsis Campaign, which was formed in 2002, formulates guidelines for the management of severe sepsis and septic shock and has actually demonstrated a reduction in mortality with institution of "sepsis bundles." Despite this, some elements of the guidelines have been questioned, and recent data suggest that strict compliance with bundles and protocols may not be necessary. Still, prompt recognition and treatment of sepsis and septic shock remain of utmost importance.

  4. [Molecular biology and immunopathogenetic mechanisms of sepsis].

    PubMed

    Průcha, M

    2009-01-01

    Sepsis, the systemic inflammatory response to infection, causes high mortality in patients in non-coronary units of intensive care. The most important characteristic of sepsis is the interaction between two subjects, the macro and the microorganism, associated with the dysfunction of innate and adaptive immunity. Sepsis is understood more as a dynamic syndrome characterized by many phenomenona which are often antagonistic. The inflammation, characterizing sepsis, does not act as a primary physiological compensatory mechanism and rather oscillates between the phase of hyperinflammatory response and anergy or immunoparalysis. The elucidation of the pathogenesis of sepsis is linked to the understanding of immunopathogenetic mechanisms, which characterize the interaction between the macro and microorganisms.

  5. The national occupational therapy practice analysis: findings and implications for competence.

    PubMed

    Dunn, W; Cada, E

    1998-10-01

    This article reports some of the findings from a national study of occupational therapy practice conducted by the National Board for Certification in Occupational Therapy (NBCOT) as part of its fiduciary responsibility to ensure that its entry-level certification examination is formulated on the basis of current practice. The NBCOT developed a survey with input from approximately 200 occupational therapy leaders and then used it to solicit information about current practice from 4,000 occupational therapists and 3,000 occupational therapy assistants. The sample included geographical location, experience level, and practice area distributions. Approximately 50% of the sample responded to the survey. Data indicate similarities and differences in occupational therapist and occupational therapy assistant practice (e.g., occupational therapists spend more time conducting evaluations, planning interventions, and supervising, whereas occupational therapy assistants spend more time providing interventions), an increased emphasis on population-based services (e.g., serving a business or industry rather than an individual worker), and an emphasis on occupation as a core knowledge base for practice. From a continuing competency perspective, the data can be useful to the profession; we can plan continuing education to address topics that practitioners have indicated are critical to their practice. The findings will be useful for revising the entry-level certification examination and may guide thinking about the parameters of continuing competence because the responses represent a cross-section of the profession.

  6. A National Study of Student Selection Practices in the Allied Health Professions.

    ERIC Educational Resources Information Center

    Dietrich, Marie C.; Crowley, Judeth A.

    1982-01-01

    Reports the outcomes of a 1978 national survey of candidate selection practices in 4 baccalaureate level and 7 associate degree level allied health disciplines. Found that few programs conducted evaluation of their admissions activities and that physical therapy and dental hygiene programs were the most structured in student selection. (JOW)

  7. Associations among School Characteristics and Foodservice Practices in a Nationally Representative Sample of United States Schools

    ERIC Educational Resources Information Center

    Thomson, Jessica L.; Tussing-Humphreys, Lisa M.; Martin, Corby K.; LeBlanc, Monique M.; Onufrak, Stephen J.

    2012-01-01

    Objective: Determine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices. Design: Secondary analysis of cross-sectional data. Setting: Nationally representative sample of public and private elementary, middle, and high schools. Participants: Data from the 2006 School Health Policies…

  8. Best Practices of National Blue Ribbon Schools: A Collection from Distinguished Catholic Schools

    ERIC Educational Resources Information Center

    Jones, Annette; Gallagher, Gabrielle

    2017-01-01

    Of the 50 private schools recognized each year as National Blue Ribbon Schools, 75 percent of them are Catholic schools. These are the stories of many of the award-winning schools and the best practices that define them. Learn marketing strategies that can highlight a school's academic success as well as its strong faith formation and make it a…

  9. Literacy for the Twenty-First Century: Research, Policy, Practices, and the National Adult Literacy Survey.

    ERIC Educational Resources Information Center

    Smith, M. Cecil, Ed.

    This book focuses on results from secondary analyses of the National Adult Literacy Survey (NALS) and implications of these analyses for policy, practice, and further research on adult literacy. Part I contains an introduction and three additional chapters that provide a substantive summary of the NALS and its purposes: "Introduction: Adult…

  10. Evidence-Based Reading Instruction: Putting the National Reading Panel Report into Practice.

    ERIC Educational Resources Information Center

    International Reading Association, Newark, DE.

    This collection of articles from "The Reading Teacher" provides examples of the instructional practices which improve reading achievement, according to Reading First legislation. Each section offers a summary and discussion of the National Reading Panel Report findings, and presents several articles from "The Reading Teacher"…

  11. Teaching and Assessment Practices at the National University of Lesotho: Some Critical Comments

    ERIC Educational Resources Information Center

    Tlali, Tebello; Jacobs, Lynette

    2015-01-01

    This paper explores the teaching and assessment practices of some lecturers at the National University of Lesotho in view of the negative perception that was created in the press and also suggested in limited research findings about quality-related issues. We adopted a qualitative approach and drew from Constructivism's theoretical lens to…

  12. Authentic Assessment as "Best Practice" for Early Childhood Intervention: National Consumer Social Validity Research

    ERIC Educational Resources Information Center

    Bagnato, Stephen J.; Goins, Deborah D.; Pretti-Frontczak, Kristie; Neisworth, John T.

    2014-01-01

    The early childhood professionals recognize the limitations of conventional testing with young children. This recognition has given rise to Authentic Assessment, now recognized officially as best practice by the major professional organizations. However, no national studies have been conducted to document the comparative qualities of either…

  13. National Association of Diversity Officers in Higher Education Standards of Professional Practice for Chief Diversity Officers

    ERIC Educational Resources Information Center

    Worthington, Roger L.; Stanley, Christine A.; Lewis, William T., Sr.

    2014-01-01

    The National Association of Diversity Officers in Higher Education (NADOHE) have developed and approved Standards of Professional Practice for Chief Diversity Officers (CDOs). The standards established in this document are a formative advancement toward the increased professionalization of the CDO in institutions of higher education. These…

  14. An Exploration of Program Director Leadership Practices in Nationally Accredited Paramedic Education Programs

    ERIC Educational Resources Information Center

    Kokx, Gordon A.

    2016-01-01

    The number of paramedic education programs participating in the national accreditation process has nearly tripled in the past several years. Although accreditation standards describe program director roles and responsibilities, nothing has been formally studied regarding their leadership practices. The purpose of this study was to explore…

  15. An Exploration of Program Director Leadership Practices in Nationally Accredited Paramedic Education Programs

    ERIC Educational Resources Information Center

    Kokx, Gordon A.

    2016-01-01

    The number of paramedic education programs participating in the national accreditation process has nearly tripled in the past several years. Although accreditation standards describe program director roles and responsibilities, nothing has been formally studied regarding their leadership practices. The purpose of this study was to explore…

  16. Bringing Theory into Practice: A Study of Effective Leadership at Lawrence Livermore National Laboratory

    ERIC Educational Resources Information Center

    Khoury, Anne

    2006-01-01

    Leadership development, a component of HRD, is becoming an area of increasingly important practice for all organizations. When companies such as Lawrence Livermore National Laboratory rely on knowledge workers for success, leadership becomes even more important. This research paper tests the hypothesis that leadership credibility and the courage…

  17. The Swedish National Diabetes Register in clinical practice and evaluation in primary health care.

    PubMed

    Hallgren Elfgren, Ing-Marie; Grodzinsky, Ewa; Törnvall, Eva

    2016-11-01

    Aim The purpose of this project is to describe the use of the Swedish National Diabetes Register (NDR) in clinical practice in a Swedish county and to specifically monitor the diabetes care routines at two separate primary health-care centres (PHCC) with a special focus on older patients.

  18. 76 FR 3853 - National Science Foundation Rules of Practice and Statutory Conflict-of-Interest Exemptions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-21

    ... 45 CFR Part 680 RIN 3145-AA51 National Science Foundation Rules of Practice and Statutory Conflict-of... Foundation (NSF) is amending its regulations to remove the provisions concerning statutory conflict-of... 45 CFR Part 680 Conflict of interests. Accordingly, 45 CFR part 680 is amended as follows: PART 680...

  19. Exploring the Complex Interplay of National Learning and Teaching Policy and Academic Development Practice

    ERIC Educational Resources Information Center

    Smith, Karen

    2016-01-01

    Academic developers are important interpreters of policy, yet little research has focussed on the interplay of policy and academic development practice. Using methods from critical discourse analysis, this article analyses a national learning and teaching policy, charts its development, and explores its interpretation by the academic development…

  20. 75 FR 12554 - National Advisory Council on Nurse Education and Practice; Notice of Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... HUMAN SERVICES Health Resources and Services Administration National Advisory Council on Nurse Education... Council on Nurse Education and Practice (NACNEP). Dates and Times: April 22, 2010, 8:30 a.m.-4:30 p.m... meeting are to: (1) Delineate the variety of roles nurses play in primary care including health...

  1. A National Study of Kindergarten Transition Practices for Children with Disabilities

    ERIC Educational Resources Information Center

    Daley, Tamara C.; Munk, Tom; Carlson, Elaine

    2011-01-01

    This study used data drawn from a large, national sample to describe transition practices provided to 1989 children with disabilities as they entered their kindergarten year, obtained through a survey administered to kindergarten teachers. Using path modeling, we examined the child and family, school, and district factors that predict which…

  2. A National Survey of Bibliotherapy Preparation and Practices of Professional Counselors

    ERIC Educational Resources Information Center

    Pehrsson, Dale-Elizabeth; McMillen, Paula S.

    2010-01-01

    A national survey of "Bibliotherapy Practices in Counseling" was conducted in 2008. This project was partially supported by an Association of Creativity in Counseling Research Award. Little research exists regarding preparation of professional counselors and their specific use of bibliotherapy interventions. Invitations and survey requests were…

  3. Drama: Same Difference--Diversity and Mutuality of Process and Practice--National Drama Conference 2011

    ERIC Educational Resources Information Center

    Gyokery, Lisa; Lam, Van Va; Hida, Norifumi; Kim, Su-yuon; Efthymiou, Antri; Frost, Wendy; Lewis, Janine; Broekman, Kirsten

    2012-01-01

    This article presents reviews of different conferences that focus on drama education. It first presents six perspectives on " Drama: same difference: diversity and mutuality of process and practice--National Drama Conference 2011," held in Swansea University, UK, 11-14 April 2011. Then it presents reviews of "2011 African Theatre…

  4. Marriage and Family Therapists and Psychotropic Medications: Practice Patterns from a National Study

    ERIC Educational Resources Information Center

    Hernandez, Barbara Couden; Doherty, William J.

    2005-01-01

    A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n = 283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n = 375) rated their improvement and…

  5. Evidence-Based Reading Instruction: Putting the National Reading Panel Report into Practice.

    ERIC Educational Resources Information Center

    International Reading Association, Newark, DE.

    This collection of articles from "The Reading Teacher" provides examples of the instructional practices which improve reading achievement, according to Reading First legislation. Each section offers a summary and discussion of the National Reading Panel Report findings, and presents several articles from "The Reading Teacher"…

  6. Strategies for Improving Fidelity in the National Evidence-Based Practices Project

    ERIC Educational Resources Information Center

    Bond, Gary R.; Drake, Robert E.; McHugo, Gregory J.; Rapp, Charles A.; Whitley, Rob

    2009-01-01

    Background: The National Evidence-Based Practices (EBPs) Project developed and tested a model for facilitating the implementation of five psychosocial EBPs for adults with severe mental illness in the United States. Methods: The implementation model was tested in 53 sites in 8 states. In each site, one of the five EBPs was adopted for…

  7. A National Study of Kindergarten Transition Practices for Children with Disabilities

    ERIC Educational Resources Information Center

    Daley, Tamara C.; Munk, Tom; Carlson, Elaine

    2011-01-01

    This study used data drawn from a large, national sample to describe transition practices provided to 1989 children with disabilities as they entered their kindergarten year, obtained through a survey administered to kindergarten teachers. Using path modeling, we examined the child and family, school, and district factors that predict which…

  8. A National Survey of Bibliotherapy Preparation and Practices of Professional Counselors

    ERIC Educational Resources Information Center

    Pehrsson, Dale-Elizabeth; McMillen, Paula S.

    2010-01-01

    A national survey of "Bibliotherapy Practices in Counseling" was conducted in 2008. This project was partially supported by an Association of Creativity in Counseling Research Award. Little research exists regarding preparation of professional counselors and their specific use of bibliotherapy interventions. Invitations and survey requests were…

  9. Associations among School Characteristics and Foodservice Practices in a Nationally Representative Sample of United States Schools

    ERIC Educational Resources Information Center

    Thomson, Jessica L.; Tussing-Humphreys, Lisa M.; Martin, Corby K.; LeBlanc, Monique M.; Onufrak, Stephen J.

    2012-01-01

    Objective: Determine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices. Design: Secondary analysis of cross-sectional data. Setting: Nationally representative sample of public and private elementary, middle, and high schools. Participants: Data from the 2006 School Health Policies…

  10. Literacy for the Twenty-First Century: Research, Policy, Practices, and the National Adult Literacy Survey.

    ERIC Educational Resources Information Center

    Smith, M. Cecil, Ed.

    This book focuses on results from secondary analyses of the National Adult Literacy Survey (NALS) and implications of these analyses for policy, practice, and further research on adult literacy. Part I contains an introduction and three additional chapters that provide a substantive summary of the NALS and its purposes: "Introduction: Adult…

  11. Exploring the Practical Adequacy of the Normative Framework Guiding South Africa's National Curriculum Statement

    ERIC Educational Resources Information Center

    Lotz-Sisikta, Heila; Schudel, Ingrid

    2007-01-01

    This article examines the practical adequacy of the recent defining of a normative framework for the South African National Curriculum Statement that focuses on the relationship between human rights, social justice and a healthy environment. This politically framed and socially critical normative framework has developed in response to…

  12. National Culture in Practice: Its Impact on Knowledge Sharing in Global Virtual Collaboration

    ERIC Educational Resources Information Center

    Wei, Kangning

    2009-01-01

    Issues concerning global virtual collaboration have received considerable attention in both the academic and practical world; however, little research has been conducted on knowledge-sharing activities in global virtual collaboration, which is a key process to achieve collaboration effectiveness. Due to national culture having been seen as one of…

  13. Exploring the Complex Interplay of National Learning and Teaching Policy and Academic Development Practice

    ERIC Educational Resources Information Center

    Smith, Karen

    2016-01-01

    Academic developers are important interpreters of policy, yet little research has focussed on the interplay of policy and academic development practice. Using methods from critical discourse analysis, this article analyses a national learning and teaching policy, charts its development, and explores its interpretation by the academic development…

  14. Knowledge and practices regarding iodine supplementation: A national survey of healthcare providers.

    PubMed

    Guess, Kimberly; Malek, Lenka; Anderson, Amanda; Makrides, Maria; Zhou, Shao J

    2017-02-01

    Little is known of healthcare providers' awareness and implementation of the National Health and Medical Research Council's recommendation regarding iodine supplementation during pre-conception, pregnancy and lactation. To assess knowledge and practices of Australian healthcare providers in relation to the National Health and Medical Research Council's iodine supplement recommendation. Obstetricians, gynaecologists, general practitioners, dietitians and midwives were recruited through their relevant professional bodies to participate in an online survey. The survey was completed by 396 healthcare providers Australia-wide. While 71% of healthcare providers' were aware of the National Health and Medical Research Council's recommendation for iodine supplementation, fewer were aware of the recommended dose (38%) or duration (44%). Seventy-three percent of healthcare providers recommended iodine supplements in pregnancy, 56% when planning pregnancy and 52% during lactation. The main reasons for not recommending iodine supplements included belief there was no need for iodine supplements due to mandatory iodine fortification of food (28%) and unawareness of the recommendation (25%). Awareness of the recommendation was positively associated with recommending iodine supplements while length of practice, time spent per consultation, age or area of practice were not associated with recommending iodine supplements. There is a need to improve healthcare providers' knowledge of and adherence to the National Health and Medical Research Council's iodine supplement recommendation. Strategies within antenatal and postnatal services, as well as public health initiatives, are required to improve the knowledge and practices of healthcare providers. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. The National Board as Professional Development: Technical, Practical, and Emancipatory Dimensions

    ERIC Educational Resources Information Center

    Rennert-Ariev, Peter

    2006-01-01

    This study investigates what teachers learn from a graduate-level course that prepares them to pursue an advanced form of professional teaching certification based on the National Board for Professional Teaching Standards (NBPTS). The study draws from Habermas's (1972, 1974) three knowledge constitutive interests--the technical, the practical, and…

  16. Teaching Excellence and Innovative Practices: A Case Study of National Awardee Teachers of India

    ERIC Educational Resources Information Center

    Sengupta, Aparajita; Tyagi, Harish Kumar

    2016-01-01

    Aim: The study intended to identify the contributions of the National awardee teachers to the teaching learning process through their teaching excellence and innovative practices which can act as exemplary model for the entire teaching community. Method: Attempts has been made to carry out a qualitative study where two selected cases are based on…

  17. The Coagulopathy of Acute Sepsis

    PubMed Central

    Simmons, Jeff; Pittet, Jean-Francois

    2015-01-01

    Purpose of Review Sepsis, defined by the presence of infection and host inflammation, is a lethal clinical syndrome with an increasing mortality rate worldwide. In severe disease, the coagulation system becomes diffusely activated, with consumption of multiple clotting factors resulting in Disseminated Intravascular Coagulation (DIC). When present, DIC portends a higher mortality rate. Understanding the mechanisms that tie inflammation and diffuse thrombosis will allow therapeutic interventions to be developed. The Coagulopathy of Acute Sepsis is a dynamic process that is time and disease burden specific. Whole blood testing of coagulation may provide more clinically useful information than classical tests. Natural anticoagulants that regulate thrombosis are down regulated in sepsis. Patients may benefit from modulation of the coagulation system when systemic inflammation and hypercoagulopathy exist. Proper timing of anticoagulant therapy may ultimately lead to decreased incidence of multisystem organ dysfunction (MODS). Recent Findings The pathogenesis of coagulopathy in sepsis is driven by an up-regulation of procoagulant mechanisms and simultaneous down-regulation of natural anticoagulants. Inflammation caused by the invading organism is a natural host defense than cannot be eliminated during treatment. Successful strategies to prevent MODS center on stratifying patients at high risk for DIC and restoring the balance of inflammation and coagulation. Summary The prevention of DIC in septic patients is a key therapeutic target in preventing death from multisystem organ failure. Stratifying patients for therapy using thromboelastometry, specific markers for DIC, and composite scoring systems is an area of growing research. PMID:25590467

  18. Which Biomarkers Reveal Neonatal Sepsis?

    PubMed Central

    Wang, Kun; Bhandari, Vineet; Chepustanova, Sofya; Huber, Greg; O′Hara, Stephen; O′Hern, Corey S.; Shattuck, Mark D.; Kirby, Michael

    2013-01-01

    We address the identification of optimal biomarkers for the rapid diagnosis of neonatal sepsis. We employ both canonical correlation analysis (CCA) and sparse support vector machine (SSVM) classifiers to select the best subset of biomarkers from a large hematological data set collected from infants with suspected sepsis from Yale-New Haven Hospital's Neonatal Intensive Care Unit (NICU). CCA is used to select sets of biomarkers of increasing size that are most highly correlated with infection. The effectiveness of these biomarkers is then validated by constructing a sparse support vector machine diagnostic classifier. We find that the following set of five biomarkers capture the essential diagnostic information (in order of importance): Bands, Platelets, neutrophil CD64, White Blood Cells, and Segs. Further, the diagnostic performance of the optimal set of biomarkers is significantly higher than that of isolated individual biomarkers. These results suggest an enhanced sepsis scoring system for neonatal sepsis that includes these five biomarkers. We demonstrate the robustness of our analysis by comparing CCA with the Forward Selection method and SSVM with LASSO Logistic Regression. PMID:24367543

  19. The role of the liver in sepsis

    PubMed Central

    Yan, Jun; Li, Song; Li, Shulin

    2014-01-01

    Despite the progress made in the clinical management of sepsis, sepsis morbidity and mortality rates remain high. The inflammatory pathogenesis and organ injury leading to death from sepsis are not fully understood for vital organs, especially the liver. Only recently has the role of the liver in sepsis begun to be revealed. Pre-existing liver dysfunction is a risk factor for the progression of infection to sepsis. Liver dysfunction after sepsis is an independent risk factor for multiple organ dysfunction and sepsis-induced death. The liver works as a lymphoid organ in response to sepsis. Acting as a double-edged sword in sepsis, the liver-mediated immune response is responsible for clearing bacteria and toxins but also causes inflammation, immunosuppression, and organ damage. Attenuating liver injury and restoring liver function lowers morbidity and mortality rates in patients with sepsis. This review summarizes the central role of liver in the host immune response to sepsis and in clinical outcomes. PMID:24611785

  20. Current Transition Practices in Pediatric IBD: Findings from a National Survey of Pediatric Providers.

    PubMed

    Gray, Wendy N; Maddux, Michele H

    2016-02-01

    Although practice guidelines have been published for transition to adult care among general chronic illness populations and specific to pediatric inflammatory bowel disease (IBD), little is known about current transition practices in IBD care. This study presents data characterizing current transition practices as reported by a national sample of pediatric providers in the United States. One hundred forty-one pediatric providers completed an online survey designed to assess current transition practices, barriers and challenges to developing and maintaining transition programming, and desired resources to improve transition services. Practices varied greatly in terms of when providers begin discussing transition and transfer, age at transfer to adult care, and patient supports provided to facilitate transition. Multiple disciplines were often involved in transition programming and 75.9% reported using objective assessment of patient transition readiness. Knowledge and application of published transition practice guidelines was limited, and few respondents reported having a written transition policy at their institution (14.2%). 99.3% of respondents reported barriers to their transition programming efforts. Additional time and instrumental supports were the most common desired resources to support transition efforts. Variability in IBD transition programming, practices, and policies reflect the emerging nature of clinical practice in this area. Understanding the current state of transition programming can inform future programming. Efforts to identify evidence-based practices in transition to adult care are needed.

  1. The structure of nursing: a national examination of titles and practice profiles.

    PubMed

    Gardner, G; Duffield, C; Doubrovsky, A; Bui, U T; Adams, M

    2017-06-01

    To identify the practice patterns of the Australian registered nurse workforce according to position title and to map these disparate titles across all jurisdictions of the country. Effective nursing workforce planning can contribute to improved patient care and increased effectiveness and efficiency of healthcare systems. The prevailing approach to nursing workforce planning focuses on number of nursing staff needed in relation to the number of patients. The level of expertise and skill mix of registered nurses as a variable in workforce planning is rarely considered. A national cross-sectional electronic survey of registered nurses in Australia was conducted using the validated Advanced Practice Role Delineation tool developed from the Strong Model of Advanced Practice. The study involved a sample of 5599 registered nurses. Sixty-six nursing position titles nationally were mapped using cluster analysis technique and gave rise to seven clusters of equivalent Australian jurisdictional nursing position titles and practice profiles. Effective workforce policy and planning is reliant upon access to reliable evidence. This research is an international first in that it has provided comprehensive knowledge of the clinical level and practice profiles of a national nursing workforce. Effective, patient-centred workforce planning must consider both the numerical and expertise mix of a nursing workforce. This research provides Australian health service and policy planners with evidence-base knowledge of the nursing workforce. Internationally, this research establishes a platform from which to develop validated tools and established processes to support replication of this research. © 2017 International Council of Nurses.

  2. Purpose, structure, and function of the United States National Dental Practice-Based Research Network

    PubMed Central

    Gilbert, Gregg H.; Williams, O. Dale; Korelitz, James J.; Fellows, Jeffrey L.; Gordan, Valeria V.; Makhija, Sonia K.; Meyerowitz, Cyril; Oates, Thomas W.; Rindal, D. Brad; Benjamin, Paul L.; Foy, Patrick J.

    2013-01-01

    Objective Following a successful2005–2012 phase with three regional practice-based research networks (PBRNs), a single, unified national network called “The National Dental PBRN” was created in 2012 in the United States to improve oral health by conducting practice-based research and serving dental professionals through education and collegiality. Methods Central administration is based in Alabama. Regional centres are based in Alabama, Florida, Minnesota, Oregon, New York and Texas, with a Coordinating Centre in Maryland. Ideas for studies are prioritized by the Executive Committee, comprised mostly of full-time clinicians. Results To date, 2736 persons have enrolled, from all six network regions; enrollment continues to expand. They represent a broad range of practitioners, practice types, and patient populations. Practitioners are actively improving every step of the research process, from idea generation, to study development, field testing, data collection, and presentation and publication. Conclusions Practitioners from diverse settings are partnering with fellow practitioners and academics to improve clinical practice and meet the needs of clinicians and their patients. Clinical significance This “nation’s network” aims to serve as a precious national resource to improve the scientific basis for clinical decision-making and foster movement of the latest evidence into routine practice. PMID:23597500

  3. Antihypertensive agents acting on the renin-angiotensin system and the risk of sepsis.

    PubMed

    Dial, Sandra; Nessim, Sharon J; Kezouh, Abbas; Benisty, Jacques; Suissa, Samy

    2014-11-01

    In response to safety concerns from two large randomized controlled trials, we investigated whether the use of telmisartan, an angiotensin receptor blocker (ARB), ARBs as a class and angiotensin-converting enzyme inhibitors (ACEIs) increase the risk of sepsis, sepsis-associated mortality and renal failure in hypertensive patients. We performed a nested case-control study from a retrospective cohort of adults with hypertension from the UK General Practice Research Database diagnosed between 1 January 2000 and 30 June 2009. All subjects hospitalized with sepsis during follow-up were matched for age, sex, practice and duration of follow-up with 10 control subjects. Exposure was defined as current use of antihypertensive drugs. From the cohort of 550 436 hypertensive patients, 1965 were hospitalized with sepsis during follow-up (rate 6.9 per 10 000 per year), of whom 824 died and 346 developed acute renal failure within 30 days. Compared with use of β-blockers, calcium-channel blockers or diuretics, use of ARBs, including telmisartan, was not associated with an elevated risk of sepsis (relative risk 1.09; 95% confidence interval 0.83-1.43); but use ACEIs was (relative risk 1.65; 95% confidence interval 1.42-1.93). Users of ARBs, β-blockers, calcium-channel blockers or diuretics, but not users of ACEIs, had lower rates of hospitalization for sepsis compared with untreated hypertensive patients. Findings were similar for sepsis-related 30 day mortality and renal failure. Hypertensive patients treated with ARBs, including telmisartan, do not appear to be at increased risk of sepsis or sepsis-related 30 day mortality or renal failure. On the contrary, users of ACEIs may have an increased risk. © 2014 The British Pharmacological Society.

  4. Antihypertensive agents acting on the renin–angiotensin system and the risk of sepsis

    PubMed Central

    Dial, Sandra; Nessim, Sharon J; Kezouh, Abbas; Benisty, Jacques; Suissa, Samy

    2014-01-01

    Aims In response to safety concerns from two large randomized controlled trials, we investigated whether the use of telmisartan, an angiotensin receptor blocker (ARB), ARBs as a class and angiotensin-converting enzyme inhibitors (ACEIs) increase the risk of sepsis, sepsis-associated mortality and renal failure in hypertensive patients. Methods We performed a nested case–control study from a retrospective cohort of adults with hypertension from the UK General Practice Research Database diagnosed between 1 January 2000 and 30 June 2009. All subjects hospitalized with sepsis during follow-up were matched for age, sex, practice and duration of follow-up with 10 control subjects. Exposure was defined as current use of antihypertensive drugs. Results From the cohort of 550 436 hypertensive patients, 1965 were hospitalized with sepsis during follow-up (rate 6.9 per 10 000 per year), of whom 824 died and 346 developed acute renal failure within 30 days. Compared with use of β-blockers, calcium-channel blockers or diuretics, use of ARBs, including telmisartan, was not associated with an elevated risk of sepsis (relative risk 1.09; 95% confidence interval 0.83–1.43); but use ACEIs was (relative risk 1.65; 95% confidence interval 1.42–1.93). Users of ARBs, β-blockers, calcium-channel blockers or diuretics, but not users of ACEIs, had lower rates of hospitalization for sepsis compared with untreated hypertensive patients. Findings were similar for sepsis-related 30 day mortality and renal failure. Conclusions Hypertensive patients treated with ARBs, including telmisartan, do not appear to be at increased risk of sepsis or sepsis-related 30 day mortality or renal failure. On the contrary, users of ACEIs may have an increased risk. PMID:24803383

  5. Predictors of health practices within age-sex groups: National Survey of Personal Health Practices and Consequences, 1979.

    PubMed Central

    Rakowski, W

    1988-01-01

    Health promotion-disease prevention programs share with health behavior research the common objective of identifying population subgroups toward whom services can be targeted. For this report, six age-sex groups were examined to determine similarities and differences in the predictors of eight health practice indices. Data were from the 1979 National Survey of Personal Health Practices and Consequences. Results showed very little similarity of predictors across the three age cohorts (20-34, 35-49, 50-64), between men and women, and among the six age-sex groups. No predictor achieved significance consistently for several health practices in any of the six groups, although years of education made the best showing. The lack of overlap among predictors helps to explain why health promotion messages and recruitment strategies may not appeal to as diverse an audience as initially intended. Possible explanations for the absence of similar predictors include differences in the nature of the various practices themselves, absence of data on intentions behind a person's behavior, and the "over-determined" character of an individual person's behavior. PMID:3136496

  6. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1: The Early Management Bundle for Severe Sepsis/Septic Shock.

    PubMed

    Faust, Jeremy S; Weingart, Scott D

    2017-02-01

    SEP-1, the new national quality measure on sepsis, resulted from an undertaking to standardize care for severe sepsis and septic shock regardless of the size of the emergency department where the patient is being treated. SEP-1 does not necessarily follow the best current evidence available. Nevertheless, a thorough understanding of SEP-1 is crucial because all hospitals and emergency providers will be accountable for meeting the requirements of this measure. SEP-1 is the first national quality measure on early management of sepsis care. This article provides a review of SEP-1 and all its potential implications on sepsis care in the United States.

  7. [Dilemmas of the pharmacist, 7th edition of Hungarian National Formulary in practice].

    PubMed

    Pál, Szilárd

    2005-01-01

    Most important event of year 2004 of the history of Hungarian pharmacy was the release of the 7th edition of the National Formulary. The general part of the new formulary expanded, remarks on the preparations are more detailed and dispensing technologies are more elaborated. Knowledge base on pharmaceutical substances and incompatibility is inserted as novelty. Following the principles of modern pharmacy practice the new National Formulary excludes pills, though it is still accepted as an alternative dosage form. Usage of tablets, hard gelatine capsules and medication stick as a new dosage forms are introduced. The aim of my study was to prepare and examine some new compositions of the new edition of the National Formulary to help the pharmacist's work. Results confirmed the novel solutions of the new National Formulary.

  8. Sepsis, parenteral vaccination and skin disinfection.

    PubMed

    Cook, Ian F

    2016-10-02

    ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like 'clean' surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost.

  9. Sepsis, parenteral vaccination and skin disinfection

    PubMed Central

    Cook, Ian F.

    2016-01-01

    ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like ‘clean’ surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost. PMID:27295449

  10. Severe sepsis in hematopoietic stem cell transplant recipients*.

    PubMed

    Kumar, Gagan; Ahmad, Shahryar; Taneja, Amit; Patel, Jayshil; Guddati, Achuta Kumar; Nanchal, Rahul

    2015-02-01

    Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic stem cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. Retrospective analysis of an administrative database. Twenty percent of community hospitals in United States, excluding federal hospitals. Patients with severe sepsis. None. We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ system failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify hematopoietic stem cell transplant recipients. We compared outcomes of hematopoietic stem cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-hematopoietic stem cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in hematopoietic stem cell transplant recipients. A total of 21,898 hematopoietic stem cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in hematopoietic stem cell transplant recipients was five times higher when compared with the non-hematopoietic stem cell transplant cohort. The unadjusted mortality was 32.9% in non-hematopoietic stem cell transplant cohort, which was similar to autologous hematopoietic stem cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft

  11. [Experience of the Mexican National Health System in the development of clinical practice guidelines].

    PubMed

    Sosa-García, Jesús Ojino; Nieves-Hernández, Pedro; Puentes-Rosas, Esteban; Pineda-Pérez, Dayana; Viniegra-Osorio, Arturo; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Barragán-Padilla, Sergio Baltazar; Díaz-González, Ruth; Chávez-Valdez, Lizbeth; Ramírez-López, Juan Carlos

    2016-01-01

    Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  12. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Clinical Practice: Quality Requirements*

    PubMed Central

    Sturgeon, Catharine M.; Hoffman, Barry R.; Chan, Daniel W.; Ch’ng, Soo-Ling; Hammond, Elizabeth; Hayes, Daniel F.; Liotta, Lance A.; Petricoin, Emmanuel F.; Schmitt, Manfred; Semmes, O. John; Söletormos, Györg; van der Merwe, Elena; Diamandis, Eleftherios P.

    2017-01-01

    BACKGROUND This report presents updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines summarizing quality requirements for the use of tumor markers. METHODS One subcommittee developed guidelines for analytical quality relevant to serum and tissue-based tumor markers in current clinical practice. Two other subcommittees formulated recommendations particularly relevant to the developing technologies of microarrays and mass spectrometry. RESULTS Prerequisites for optimal use of tumor markers in routine practice include formulation of the correct clinical questions to ensure selection of the appropriate test, adherence to good clinical and laboratory practices (e.g., minimization of the risk of incorrect patient and/or specimen identification, tube type, or timing), use of internationally standardized and well-characterized methods, careful adherence to manufacturer instructions, and proactive and timely reactions to information derived from both internal QC and proficiency-testing specimens. Highly desirable procedures include those designed to minimize the risk of the reporting of erroneous results attributable to interferences such as heterophilic antibodies or hook effects, to facilitate the provision of informative clinical reports (e.g., cumulative and/or graphical reports, appropriately derived reference intervals, and interpretative comments), and when possible to integrate these reports with other patient information through electronic health records. Also mandatory is extensive validation encompassing all stages of analysis before introduction of new technologies such as microarrays and mass spectrometry. Provision of high-quality tumor marker services is facilitated by dialogue involving researchers, diagnostic companies, clinical and laboratory users, and regulatory agencies. CONCLUSIONS Implementation of these recommendations, adapted to local practice, should encourage optimization of the clinical use of tumor markers

  13. Diagnosing sepsis - The role of laboratory medicine.

    PubMed

    Fan, Shu-Ling; Miller, Nancy S; Lee, John; Remick, Daniel G

    2016-09-01

    Sepsis is the host response to microbial pathogens resulting in significant morbidity and mortality. An accurate and timely diagnosis of sepsis allows prompt and appropriate treatment. This review discusses laboratory testing for sepsis because differentiating systemic inflammation from infection is challenging. Procalcitonin (PCT) is currently an FDA approved test to aid in the diagnosis of sepsis but with questionable efficacy. However, studies support the use of PCT for antibiotic de-escalation. Serial lactate measurements have been recommended for monitoring treatment efficacy as part of sepsis bundles. The 2016 sepsis consensus definitions include lactate concentrations >2mmol/L (>18mg/dL) as part of the definition of septic shock. Also included in the 2016 definitions are measuring bilirubin and creatinine to determine progression of organ failure indicating worse prognosis. Hematologic parameters, including a simple white blood cell count and differential, are frequently part of the initial sepsis diagnostic protocols. Several new biomarkers have been proposed to diagnose sepsis or to predict mortality, but they currently lack sufficient sensitivity and specificity to be considered as stand-alone testing. If sepsis is suspected, new technologies and microbiologic assays allow rapid and specific identification of pathogens. In 2016 there is no single laboratory test that accurately diagnoses sepsis. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. What is next in sepsis: current trials in sepsis.

    PubMed

    Artigas, Antonio; Niederman, Michael S; Torres, Antoni; Carlet, Jean

    2012-08-01

    International experts reviewed and updated the most recent and relevant scientific advances on severe sepsis during the 17th International Symposium on Infections in the Critically Ill Patients in Barcelona (Spain) in February 2012. All new pharmacological therapeutic strategies have failed to demonstrate a survival benefit. Despite the large variability among countries and hospitals, the improvement of standard care according to the Surviving Sepsis campaign recommendations reduced the 28-day mortality to 24%. These results may have implications for future clinical trials in which much larger samples sizes of patients at high risk of death will be necessary. The identification of novel proinflammatory endogeneous signals and pathways may lead to the discovery of new drugs to reduce inflammatory reactions and end-organ dysfunction in critically ill patients with sepsis. Extracorporeal blood purification stem or progenitor cells have received increasing interest for the treatment of inflammation and organ injury. A better understanding of how these therapies work is essential and its benefit should be confirmed in future prospective randomized studies.

  15. Music therapy services in pediatric oncology: a national clinical practice review.

    PubMed

    Tucquet, Belinda; Leung, Maggie

    2014-01-01

    This article presents the results of a national clinical practice review conducted in Australia of music therapy services in pediatric oncology hospitals. Literature specifically related to music therapy and symptom management in pediatric oncology is reviewed. The results from a national benchmarking survey distributed to all music therapists working with children with cancer in Australian pediatric hospitals are discussed. Patient and family feedback provided from a quality improvement activity conducted at a major pediatric tertiary hospital is summarized, and considerations for future growth as a profession and further research is proposed. © 2014 by Association of Pediatric Hematology/Oncology Nurses.

  16. Donation after circulatory death: a national survey of current practice in England in 2012.

    PubMed

    Patel, Sameer; Martin, Jonathan R; Marino, Philip S

    2014-10-01

    In recent years, England has seen renewed interest in donation after circulatory death. Many national and local initiatives have been implemented to encourage and support donation after circulatory death. To assess whether practice is in line with published guidance, we conducted a national survey with regard to current donation after circulatory death practices, local guidelines, and views on the need to further develop a national standardized protocol for donation after circulatory death. Online survey. Lead physicians for intensive care or organ donation for every acute National Health Service trust in England delivering adult care between April and June 2012. Physicians were e-mailed a link to a structured online questionnaire regarding their experience and practice of donation after circulatory death, including local protocols, use of organ optimization, and the need for a national protocol. We received replies from 119 of 156 eligible trusts (76.3%) in England. Of these, 112 trusts (94%) have performed donation after circulatory death. Ninety-three trusts (78.1%) have a local donation after circulatory death protocol, and 89 trusts (74.7%) felt there should be a national donation after circulatory death protocol. All responding transplant centers had performed donation after circulatory death, 14 of 17 (82.3%) had a donation after circulatory death protocol with 14 of 17 respondents (82.3%) supporting a national protocol. Regarding organ optimization, 92 institutions (77.3%) used vasoactive drugs to achieve a target mean arterial blood pressure with 82 centers (68.9%) employing positive end-expiratory pressure and FIO2 to optimize oxygenation. Eight centers (6.7%) used heparin premortem compared with two of 17 transplant centers (11.8%). Two centers have used phentolamine to facilitate organ retrieval, with another five centers (4.2%) cannulating vessels premortem. Our survey revealed varying approaches and views toward donation after circulatory death across

  17. The National Practice Benchmark for oncology, 2014 report on 2013 data.

    PubMed

    Towle, Elaine L; Barr, Thomas R; Senese, James L

    2014-11-01

    The National Practice Benchmark (NPB) is a unique tool to measure oncology practices against others across the country in a way that allows meaningful comparisons despite differences in practice size or setting. In today's economic environment every oncology practice, regardless of business structure or affiliation, should be able to produce, monitor, and benchmark basic metrics to meet current business pressures for increased efficiency and efficacy of care. Although we recognize that the NPB survey results do not capture the experience of all oncology practices, practices that can and do participate demonstrate exceptional managerial capability, and this year those practices are recognized for their participation. In this report, we continue to emphasize the methodology introduced last year in which we reported medical revenue net of the cost of the drugs as net medical revenue for the hematology/oncology product line. The effect of this is to capture only the gross margin attributable to drugs as revenue. New this year, we introduce six measures of clinical data density and expand the radiation oncology benchmarks. Copyright © 2014 by American Society of Clinical Oncology.

  18. China's growing contribution to sepsis research from 1984 to 2014: A bibliometric study.

    PubMed

    Zhang, Kai; Zhao, Jialian; Chu, Lihua; Jin, Yue; Cheng, Baoli; Xie, Guohao; Wang, Yan; Fang, Xiangming

    2017-06-01

    The aim of this study was to analyze the global trends of sepsis research and investigate China's contribution by comparing the quantity and quality of sepsis-related publications. Sepsis-related publications were main retrieved from the Web of Science online database by using the keywords "sepsis" or "septic shock." Bibliometric indicators, including the number of publications, total citation frequency, citation frequency per paper, h-index, research type, orientation, organization, author, journal, and funding support were analyzed. From 1984 to 2014, a total of 70,564 papers regarding sepsis research were published worldwide. 3.60% of which were contributed by authors from Chinese institutions. Although this contribution was less than the Unites States, Germany, England, France or Japan, a notable trend of increase in a number of scientific publications (r  =  0.57, P < .001), with an average annual growth rate of 20.78%, was observed. The quality of the publications was relatively low in China. Basic research was a clear dominant representation, accounting for 50.46% of China's sepsis research. The research centers in China were mainly located in Beijing (5 centers), Shanghai (4 centers), and Hong Kong (3 centers). The National Natural Science Foundation of China supported the most Chinese sepsis researches. Global sepsis research developed swiftly during the 1984 to 2014 period. The USA was in the forefront of sepsis research. Although the data indicated that China had a large increasing rate of publications, there was a considerable gap in the quality of articles between China and other developed countries.

  19. Making the journey safe: recognising and responding to severe sepsis in accident and emergency

    PubMed Central

    Pinnington, Sarah; Atterton, Brigid; Ingleby, Sarah

    2016-01-01

    Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality. The project intended to make the pathway for those presenting with sepsis safe and consistent, where sepsis is recognised and treated in a timely manner according to best practice. The aim of the project was to understand the what the barriers where to providing safe effective care for the patient presenting with severe sepsis in A&E. Using the Safer Clinical Systems (SCS) tools developed byte Health Foundation and Warwick University, the project team identified the hazards and associated risks in the septic patient pathway. The level of analysis employed enabled the project team to identify the major risks, themes, and factors of influence within this pathway. The analysis identified twenty nine possible interventions, of which six were chosen following option appraisal. Further interventions were recommended to the accident and emergency as part of a business case and further changes in process. Audits identified all severely septic patients presenting to A&E in October 2014 (n=67) and post intervention in September 2015 (n=93). Compared analysis demonstrated an increase in compliance with the implementation of the sepsis six care bundle from 7% to 41%, a reduction in LoS by 1.9 days and a decrease in 30 day mortality by 50%. Additional audit reviewed the management of 10 septic patients per week for the duration of the project to assess the real time impact of the selected interventions. PMID:27752314

  20. Population burden of long-term survivorship after severe sepsis in older Americans.

    PubMed

    Iwashyna, Theodore J; Cooke, Colin R; Wunsch, Hannah; Kahn, Jeremy M

    2012-06-01

    To ascertain the absolute number of Medicare beneficiaries surviving at least 3 years after severe sepsis and to estimate their burden of cognitive dysfunction and disability. Retrospective cohort analysis of Medicare data. All short-stay inpatient hospitals in the United States, 1996 to 2008. Individuals aged 65 and older. Severe sepsis was detected using a standard administrative definition. Case-fatality, prevalence, and incidence rates were calculated. Six hundred thirty-seven thousand eight hundred sixty-seven Medicare beneficiaries were alive at the end of 2008 who had survived severe sepsis 3 or more years earlier. An estimated 476,862 (95% confidence interval (CI) = 455,026-498,698) had functional disability, with 106,311 (95% CI = 79,692-133,930) survivors having moderate to severe cognitive impairment. The annual number of new 3-year survivors after severe sepsis rose 119% during 1998 to 2008. The increase in survivorship resulted from more new diagnoses of severe sepsis rather than a change in case-fatality rates; severe sepsis rates rose from 13.0 per 1,000 Medicare beneficiary-years to 25.8 (P < .001), whereas 3-year case fatality rates changed much less, from 73.5% to 71.3% (P < .001) for the same cohort. Increasing rates of organ dysfunction in hospitalized individuals drove the increase in severe sepsis incidence, with an additional small contribution from population aging. Sepsis survivorship, which has substantial long-term morbidity, is a common and rapidly growing public health problem for older Americans. There has been little change in long-term case-fatality, despite changes in practice. Clinicians should anticipate more-frequent sequelae of severe sepsis in their patient populations. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  1. End Points of Sepsis Resuscitation.

    PubMed

    Greenwood, John C; Orloski, Clinton J

    2017-02-01

    Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient's overall response to therapy. This review will discuss the role and limitations of central venous pressure (CVP), mean arterial pressure (MAP), and cardiac output/index as macrocirculatory resuscitation targets along with lactate, central venous oxygen saturation (ScvO2), central venous-arterial CO2 gradient, urine output, and capillary refill time as microcirculatory resuscitation endpoints in patients with sepsis.

  2. The heart in sepsis: from basic mechanisms to clinical management.

    PubMed

    Rudiger, Alain; Singer, Mervyn

    2013-03-01

    Septic shock is characterized by circulatory compromise, microcirculatory alterations and mitochondrial damage, which all reduce cellular energy production. In order to reduce the risk of major cell death and a diminished likelihood of recovery, adaptive changes appear to be activated. As a result, cells and organs may survive in a non-functioning hibernation-like condition. Sepsis-induced cardiac dysfunction may represent an example of such functional shutdown. Sepsis-induced myocardial dysfunction is common, corresponds to the severity of sepsis, and is reversible in survivors. Its mechanisms include the attenuation of the adrenergic response at the cardiomyocyte level, alterations of intracellular calcium trafficking and blunted calcium sensitivity of contractile proteins. All these changes are mediated by cytokines. Treatment includes preload optimization with sufficient fluids. However, excessive volume loading is harmful. The first line vasopressor recommended at present is norepinephrine, while vasopressin can be started as a salvage therapy for those not responding to catecholamines. During early sepsis, cardiac output can be increased by dobutamine. While early administration of catecholamines might be necessary to restore adequate organ perfusion, prolonged administration might be harmful. Novel therapies for sepsis-induced cardiac dysfunction are discussed in this article. Cardiac inotropy can be increased by levosimendan, istaroxime or omecamtiv mecarbil without greatly increasing cellular oxygen demands. Heart rate reduction with ivabradine reduces myocardial oxygen expenditure and ameliorates diastolic filling. Beta-blockers additionally reduce local and systemic inflammation. Advances may also come from metabolic interventions such as pyruvate, succinate or high dose insulin substitutions. All these potentially advantageous concepts require rigorous testing before implementation in routine clinical practice.

  3. Benchmarking the incidence and mortality of severe sepsis in the United States.

    PubMed

    Gaieski, David F; Edwards, J Matthew; Kallan, Michael J; Carr, Brendan G

    2013-05-01

    In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates. We seek to describe the variations in incidence and mortality of severe sepsis in the United States using four methods of database abstraction. We hypothesized that different methodologies of capturing cases of severe sepsis would result in disparate estimates of incidence and mortality. Using a nationally representative sample, four previously published methods (Angus et al, Martin et al, Dombrovskiy et al, and Wang et al) were used to gather cases of severe sepsis over a 6-year period (2004-2009). In addition, the use of new International Statistical Classification of Diseases, 9th Edition (ICD-9), sepsis codes was compared with previous methods. Annual national incidence and in-hospital mortality of severe sepsis. The average annual incidence varied by as much as 3.5-fold depending on method used and ranged from 894,013 (300/100,000 population) to 3,110,630 (1,031/100,000) using the methods of Dombrovskiy et al and Wang et al, respectively. Average annual increase in the incidence of severe sepsis was similar (13.0% to 13.3%) across all methods. In-hospital mortality ranged from 14.7% to 29.9% using abstraction methods of Wang et al and Dombrovskiy et al. Using all methods, there was a decrease in in-hospital mortality across the 6-year period (35.2% to 25.6% [Dombrovskiy et al] and 17.8% to 12.1% [Wang et al]). Use of ICD-9 sepsis codes more than doubled over the 6-year period (158,722 - 489,632 [995.92 severe sepsis], 131,719 - 303,615 [785.52 septic shock]). There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical

  4. Racial Disparities in Sepsis-Related In-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004-2013.

    PubMed

    Jones, Jenna M; Fingar, Kathryn R; Miller, Melissa A; Coffey, Rosanna; Barrett, Marguerite; Flottemesch, Thomas; Heslin, Kevin C; Gray, Darryl T; Moy, Ernest

    2017-09-12

    As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths. Retrospective, repeated cross-sectional study. Acute care hospitals in the Healthcare Cost and Utilization Project State Inpatient Databases for 18 states with consistent race/ethnicity reporting. Patients diagnosed with septicemia, sepsis, organ dysfunction plus infection, severe sepsis, or septic shock. In-hospital sepsis mortality rates adjusted for patient and hospital factors by race/ethnicity were calculated. From 2004 to 2013, sepsis hospitalizations for all racial/ethnic groups increased, and mortality rates decreased by 5-7% annually. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white (92.0 per 1,000 sepsis hospitalizations), black (94.0), and Hispanic (93.5) patients but remained elevated for Asian/Pacific Islander (106.4) and "other" (104.7; p < 0.001) racial/ethnic patients. Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations.

  5. Early sepsis does not increase the risk of late sepsis in very low birth weight neonates.

    PubMed

    Wynn, James L; Hansen, Nellie I; Das, Abhik; Cotten, C Michael; Goldberg, Ronald N; Sánchez, Pablo J; Bell, Edward F; Van Meurs, Krisa P; Carlo, Waldemar A; Laptook, Abbot R; Higgins, Rosemary D; Benjamin, Daniel K; Stoll, Barbara J

    2013-05-01

    To examine whether preterm very low birth weight (VLBW) infants have an increased risk of late-onset sepsis (LOS) following early-onset sepsis (EOS). Retrospective analysis of VLBW infants (401-1500 g) born September 1998 through December 2009 who survived >72 hours and were cared for within the National Institute of Child Health and Human Development Neonatal Research Network. Sepsis was defined by growth of bacteria or fungi in a blood culture obtained ≤ 72 hours of birth (EOS) or >72 hours (LOS) and antimicrobial therapy for ≥ 5 days or death <5 days while receiving therapy. Regression models were used to assess risk of death or LOS by 120 days and LOS by 120 days among survivors to discharge or 120 days, adjusting for gestational age and other covariates. Of 34,396 infants studied, 504 (1.5%) had EOS. After adjustment, risk of death or LOS by 120 days did not differ overall for infants with EOS compared with those without EOS [risk ratio (RR): 0.99 (0.89-1.09)] but was reduced in infants born at <25 weeks gestation [RR: 0.87 (0.76-0.99), P = .048]. Among survivors, no difference in LOS risk was found overall for infants with versus without EOS [RR: 0.88 (0.75-1.02)], but LOS risk was reduced in infants with birth weight 401-750 g who had EOS [RR: 0.80 (0.64-0.99), P = .047]. Risk of LOS after EOS was not increased in VLBW infants. Surprisingly, risk of LOS following EOS appeared to be reduced in the smallest, most premature infants, underscoring the need for age-specific analyses of immune function. Copyright © 2013 Mosby, Inc. All rights reserved.

  6. Algorithm linking patients and general practices in Denmark using the Danish National Health Service Register

    PubMed Central

    Kjaersgaard, Maiken Ina Siegismund; Vedsted, Peter; Parner, Erik Thorlund; Bech, Bodil Hammer; Vestergaard, Mogens; Flarup, Kaare Rud; Fenger-Grøn, Morten

    2016-01-01

    Background The patient list system in Denmark assigns virtually all residents to a general practice. Nevertheless, historical information on this link between patient and general practice is not readily available for research purposes. Objectives To develop, implement, and evaluate the performance of an algorithm linking individual patients to their general practice by using information from the Danish National Health Service Register and the Danish Civil Registration System. Materials and methods The National Health Service Register contains information on all services provided by general practitioners from 1990 and onward. On the basis of these data and information on migration history and death obtained from the Civil Registration System, we developed an algorithm that allocated patients to a general practice on a monthly basis. We evaluated the performance of the algorithm between 2002 and 2007. During this time period, we had access to information on the link between patients and general practices. Agreement was assessed by the proportion of months for which the algorithm allocated patients to the correct general practice. We also assessed the proportion of all patients in the patient list system for which the algorithm was able to suggest an allocation. Results The overall agreement between algorithm and patient lists was 98.6%. We found slightly higher agreement for women (98.8%) than for men (98.4%) and lower agreement in the age group 18–34 years (97.1%) compared to all other age groups (≥98.6%). The algorithm had assigned 83% of all patients in the patient list system after 1 year of follow-up, 91% after 2 years of follow-up, and peaked at 94% during the fourth year. Conclusion We developed an algorithm that enables valid and nearly complete linkage between patients and general practices. The algorithm performs better in subgroups of patients with high health care needs. The algorithm constitutes a valuable tool for primary health care research. PMID

  7. Algorithm linking patients and general practices in Denmark using the Danish National Health Service Register.

    PubMed

    Kjaersgaard, Maiken Ina Siegismund; Vedsted, Peter; Parner, Erik Thorlund; Bech, Bodil Hammer; Vestergaard, Mogens; Flarup, Kaare Rud; Fenger-Grøn, Morten

    2016-01-01

    The patient list system in Denmark assigns virtually all residents to a general practice. Nevertheless, historical information on this link between patient and general practice is not readily available for research purposes. To develop, implement, and evaluate the performance of an algorithm linking individual patients to their general practice by using information from the Danish National Health Service Register and the Danish Civil Registration System. The National Health Service Register contains information on all services provided by general practitioners from 1990 and onward. On the basis of these data and information on migration history and death obtained from the Civil Registration System, we developed an algorithm that allocated patients to a general practice on a monthly basis. We evaluated the performance of the algorithm between 2002 and 2007. During this time period, we had access to information on the link between patients and general practices. Agreement was assessed by the proportion of months for which the algorithm allocated patients to the correct general practice. We also assessed the proportion of all patients in the patient list system for which the algorithm was able to suggest an allocation. The overall agreement between algorithm and patient lists was 98.6%. We found slightly higher agreement for women (98.8%) than for men (98.4%) and lower agreement in the age group 18-34 years (97.1%) compared to all other age groups (≥98.6%). The algorithm had assigned 83% of all patients in the patient list system after 1 year of follow-up, 91% after 2 years of follow-up, and peaked at 94% during the fourth year. We developed an algorithm that enables valid and nearly complete linkage between patients and general practices. The algorithm performs better in subgroups of patients with high health care needs. The algorithm constitutes a valuable tool for primary health care research.

  8. Evaluation of dietary practices of National Collegiate Athletic Association Division I football players.

    PubMed

    Cole, Constance R; Salvaterra, George F; Davis, Joseph E; Borja, Marianne E; Powell, Loreen M; Dubbs, Elizabeth C; Bordi, Peter L

    2005-08-01

    The objective of this study is to evaluate the dietary practices of 28 football athletes on a National Collegiate Athletic Association (NCAA) Division I team using 3-day diet records. Student athletes completed 3-day diet records at 2 individual points of time, when no training table was available. Diet records were evaluated and were compared with the Third National Health and Nutrition Survey (NHANES III) data for the same ages and gender group. No differences in dietary practices of collegiate football athletes were observed when compared with data for the same ages and gender group culled from NHANES III. Inadequacies in energy intake for activity level were significant (p < 0.05). Influences of fad dieting trends were noted when the diets were mapped onto the United States Department of Agriculture (USDA) food guide pyramid. Changes in diet would be necessary to sustain the activity level of these athletes.

  9. Rational development of guidelines for management of neonatal sepsis in developing countries

    PubMed Central

    Seale, Anna C; Obiero, Christina W; Berkley, James A

    2015-01-01

    Purpose of review This review discusses the rational development of guidelines for the management of neonatal sepsis in developing countries. Recent findings Diagnosis of neonatal sepsis with high specificity remains challenging in developing countries. Aetiology data, particularly from rural, community based studies are very limited, but molecular tests to improve diagnostics are being tested in a community-based study in South Asia. Antibiotic susceptibility data are limited, but suggest reducing susceptibility to first and second line antibiotics in both hospital and community acquired neonatal sepsis. Results of clinical trials in South Asia and sub-Saharan Africa assessing feasibility of simplified antibiotic regimens are awaited. Summary Effective management of neonatal sepsis in developing countries is essential to reduce neonatal mortality and morbidity. Simplified antibiotic regimens are currently being examined in clinical trials, but reduced antimicrobial susceptibility threatens current empiric treatment strategies. Improved clinical and microbiological surveillance is essential, to inform current practice, treatment guidelines, and monitor implementation of policy changes. PMID:25887615

  10. Autoregressive hidden Markov models for the early detection of neonatal sepsis.

    PubMed

    Stanculescu, Ioan; Williams, Christopher K I; Freer, Yvonne

    2014-09-01

    Late onset neonatal sepsis is one of the major clinical concerns when premature babies receive intensive care. Current practice relies on slow laboratory testing of blood cultures for diagnosis. A valuable research question is whether sepsis can be reliably detected before the blood sample is taken. This paper investigates the extent to which physiological events observed in the patient's monitoring traces could be used for the early detection of neonatal sepsis. We model the distribution of these events with an autoregressive hidden Markov model (AR-HMM). Both learning and inference carefully use domain knowledge to extract the baby's true physiology from the monitoring data. Our model can produce real-time predictions about the onset of the infection and also handles missing data. We evaluate the effectiveness of the AR-HMM for sepsis detection on a dataset collected from the Neonatal Intensive Care Unit at the Royal Infirmary of Edinburgh.

  11. Rational development of guidelines for management of neonatal sepsis in developing countries.

    PubMed

    Seale, Anna C; Obiero, Christina W; Berkley, James A

    2015-06-01

    This review discusses the rational development of guidelines for the management of neonatal sepsis in developing countries. Diagnosis of neonatal sepsis with high specificity remains challenging in developing countries. Aetiology data, particularly from rural, community-based studies, are very limited, but molecular tests to improve diagnostics are being tested in a community-based study in South Asia. Antibiotic susceptibility data are limited, but suggest reducing susceptibility to first-and second-line antibiotics in both hospital and community-acquired neonatal sepsis. Results of clinical trials in South Asia and sub-Saharan Africa assessing feasibility of simplified antibiotic regimens are awaited. Effective management of neonatal sepsis in developing countries is essential to reduce neonatal mortality and morbidity. Simplified antibiotic regimens are currently being examined in clinical trials, but reduced antimicrobial susceptibility threatens current empiric treatment strategies. Improved clinical and microbiological surveillance is essential, to inform current practice, treatment guidelines, and monitor implementation of policy changes.

  12. Biosensor of endotoxin and sepsis

    NASA Astrophysics Data System (ADS)

    Shao, Yang; Wang, Xiang; Wu, Xi; Gao, Wei; He, Qing-hua; Cai, Shaoxi

    2001-09-01

    To investigate the relation between biosensor of endotoxin and endotoxin of plasma in sepsis. Method: biosensor of endotoxin was designed with technology of quartz crystal microbalance bioaffinity sensor ligand of endotoxin were immobilized by protein A conjugate. When a sample soliton of plasma containing endotoxin 0.01, 0.03, 0.06, 0.1, 0.5, 1.0Eu, treated with perchloric acid and injected into slot of quartz crystal surface respectively, the ligand was released from the surface of quartz crystal to form a more stable complex with endotoxin in solution. The endotoxin concentration corresponded to the weight change on the crystal surface, and caused change of frequency that occurred when desorbed. The result was biosensor of endotoxin might detect endotoxin of plasma in sepsis, measurements range between 0.05Eu and 0.5Eu in the stop flow mode, measurement range between 0.1Eu and 1Eu in the flow mode. The sensor of endotoxin could detect the endotoxin of plasm rapidly, and use for detection sepsis in clinically.

  13. Early-Onset Neonatal Sepsis

    PubMed Central

    Simonsen, Kari A.; Anderson-Berry, Ann L.; Delair, Shirley F.

    2014-01-01

    SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS. PMID:24396135

  14. Framework for a National Testing and Evaluation Program Based Upon the National Stormwater Testing and Evaluation for Products and Practices (STEPP) Initiative (WERF Report INFR2R14)

    EPA Science Inventory

    Abstract:The National STEPP Program seeks to improve water quality by accelerating the effective implementation and adoption of innovative stormwater management technologies. Itwill attempt to accomplish this by establishing practices through highly reliable, and cost-effective S...

  15. Framework for a National Testing and Evaluation Program Based Upon the National Stormwater Testing and Evaluation for Products and Practices (STEPP) Initiative (WERF Report INFR2R14)

    EPA Science Inventory

    Abstract:The National STEPP Program seeks to improve water quality by accelerating the effective implementation and adoption of innovative stormwater management technologies. Itwill attempt to accomplish this by establishing practices through highly reliable, and cost-effective S...

  16. [Sepsis: a new look at the problem].

    PubMed

    Beloborodova, N V

    2013-01-01

    The recent proceedings of congresses and forums on sepsis were used to write this review. The available definitions of sepsis and ideas on its etiology and pathogenesis are critically analyzed. There is information on new concepts of sepsis and data on a search for new targets, diagnostic and therapeutic approaches, and biomarkers. It is hypothesized that there is a mechanism of action of bacteria on mitochondrial dysfunction and human hormonal regulation with low-molecular weight exometabolites, namely aromatic microbial metabolites.

  17. Prevalence of Mindfulness Practices in the US Workforce: National Health Interview Survey

    PubMed Central

    Kachan, Diana; Olano, Henry; Tannenbaum, Stacey L.; Annane, Debra W.; Mehta, Ashwin; Arheart, Kristopher L.; Fleming, Lora E.; McClure, Laura A.; Lee, David J.

    2017-01-01

    Introduction Mindfulness-based practices can improve workers’ health and reduce employers’ costs by ameliorating the negative effect of stress on workers’ health. We examined the prevalence of engagement in 4 mindfulness-based practices in the US workforce. Methods We used 2002, 2007, and 2012 National Health Interview Survey (NHIS) data for adults (aged ≥18 y, n = 85,004) to examine 12-month engagement in meditation, yoga, tai chi, and qigong among different groups of workers. Results Reported yoga practice prevalence nearly doubled from 6.0% in 2002 to 11.0% in 2012 (P < .001); meditation rates increased from 8.0% in 2002 to 9.9% in 2007 (P < .001). In multivariable models, mindfulness practice was significantly lower among farm workers (odds ratio [OR] = 0.42; 95% confidence interval [CI], 0.21–0.83]) and blue-collar workers (OR = 0.63; 95% CI, 0.54–0.74) than among white-collar workers. Conclusion Worker groups with low rates of engagement in mindfulness practices could most benefit from workplace mindfulness interventions. Improving institutional factors limiting access to mindfulness-based wellness programs and addressing existing beliefs about mindfulness practices among underrepresented worker groups could help eliminate barriers to these programs. PMID:28055821

  18. Prevalence of Mindfulness Practices in the US Workforce: National Health Interview Survey.

    PubMed

    Kachan, Diana; Olano, Henry; Tannenbaum, Stacey L; Annane, Debra W; Mehta, Ashwin; Arheart, Kristopher L; Fleming, Lora E; Yang, Xuan; McClure, Laura A; Lee, David J

    2017-01-05

    Mindfulness-based practices can improve workers' health and reduce employers' costs by ameliorating the negative effect of stress on workers' health. We examined the prevalence of engagement in 4 mindfulness-based practices in the US workforce. We used 2002, 2007, and 2012 National Health Interview Survey (NHIS) data for adults (aged ≥18 y, n = 85,004) to examine 12-month engagement in meditation, yoga, tai chi, and qigong among different groups of workers. Reported yoga practice prevalence nearly doubled from 6.0% in 2002 to 11.0% in 2012 (P < .001); meditation rates increased from 8.0% in 2002 to 9.9% in 2007 (P < .001). In multivariable models, mindfulness practice was significantly lower among farm workers (odds ratio [OR] = 0.42; 95% confidence interval [CI], 0.21-0.83]) and blue-collar workers (OR = 0.63; 95% CI, 0.54-0.74) than among white-collar workers. Worker groups with low rates of engagement in mindfulness practices could most benefit from workplace mindfulness interventions. Improving institutional factors limiting access to mindfulness-based wellness programs and addressing existing beliefs about mindfulness practices among underrepresented worker groups could help eliminate barriers to these programs.

  19. National nursing workforce survey of nursing attitudes, knowledge and practice in genomics

    PubMed Central

    Calzone, Kathleen A; Jenkins, Jean; Culp, Stacey; Bonham, Vence L; Badzek, Laurie

    2013-01-01

    Aim Genomics has the potential to improve personalized healthcare. Nurses are vital to the utilization of genomics in practice. This study assessed nursing attitudes, receptivity, confidence, competency, knowledge and practice in genomics to inform education efforts. Materials & methods Cross-sectional study of registered nurses who completed an online Genetic/Genomic Nursing Practice Survey posted on a national nursing organization website. Results A total of 619 registered nurses participated. The largest proportion of education level were nurses with a baccalaureate degree (39%). Most (67.5%) considered genomics very important to nursing practice. However, 57% reported their genomic knowledge base to be poor or fair. The mean total knowledge score correct response rate was 75%. Yet 60% incorrectly answered that diabetes and heart disease are caused by a single gene variant. Most (64%) had never heard of the Essential Nursing Competencies and Curricula Guidelines in Genomics. Higher academic education or post licensure genetic education increased family history collection in practice. Conclusion Most nurses are inadequately prepared to translate genomic information into personalized healthcare. Targeted genomic education is needed to assure optimal workforce preparation for genomics practice integration. PMID:24363765

  20. Antimicrobial Stewardship in the Management of Sepsis.

    PubMed

    Pulia, Michael S; Redwood, Robert; Sharp, Brian

    2017-02-01

    Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department.

  1. Mechanical Ventilation in Sepsis: A Reappraisal.

    PubMed

    Zampieri, Fernando G; Mazza, Bruno

    2017-01-01

    Sepsis is the main cause of close to 70% of all cases of acute respiratory distress syndromes (ARDS). In addition, sepsis increases susceptibility to ventilator-induced lung injury. Therefore, the development of a ventilatory strategy that can achieve adequate oxygenation without injuring the lungs is highly sought after for patients with acute infection and represents an important therapeutic window to improve patient care. Suboptimal ventilatory settings cannot only harm the lung, but may also contribute to the cascade of organ failure in sepsis due to organ crosstalk.Despite the prominent role of sepsis as a cause for lung injury, most of the studies that addressed mechanical ventilation strategies in ARDS did not specifically assess sepsis-related ARDS patients. Consequently, most of the recommendations regarding mechanical ventilation in sepsis patients are derived from ARDS trials that included multiple clinical diagnoses. While there have been important improvements in general ventilatory management that should apply to all critically ill patients, sepsis-related lung injury might still have particularities that could influence bedside management.After revisiting the interplay between sepsis and ventilation-induced lung injury, this review will reappraise the evidence for the major components of the lung protective ventilation strategy, emphasizing the particularities of sepsis-related acute lung injury.

  2. The Effect of Sepsis on the Erythrocyte.

    PubMed

    Bateman, Ryon M; Sharpe, Michael D; Singer, Mervyn; Ellis, Christopher G

    2017-09-08

    Sepsis induces a wide range of effects on the red blood cell (RBC). Some of the effects including altered metabolism and decreased 2,3-bisphosphoglycerate are preventable with appropriate treatment, whereas others, including decreased erythrocyte deformability and redistribution of membrane phospholipids, appear to be permanent, and factors in RBC clearance. Here, we review the effects of sepsis on the erythrocyte, including changes in RBC volume, metabolism and hemoglobin's affinity for oxygen, morphology, RBC deformability (an early indicator of sepsis), antioxidant status, intracellular Ca(2+) homeostasis, membrane proteins, membrane phospholipid redistribution, clearance and RBC O₂-dependent adenosine triphosphate efflux (an RBC hypoxia signaling mechanism involved in microvascular autoregulation). We also consider the causes of these effects by host mediated oxidant stress and bacterial virulence factors. Additionally, we consider the altered erythrocyte microenvironment due to sepsis induced microvascular dysregulation and speculate on the possible effects of RBC autoxidation. In future, a better understanding of the mechanisms involved in sepsis induced erythrocyte pathophysiology and clearance may guide improved sepsis treatments. Evidence that small molecule antioxidants protect the erythrocyte from loss of deformability, and more importantly improve septic patient outcome suggest further research in this area is warranted. While not generally considered a critical factor in sepsis, erythrocytes (and especially a smaller subpopulation) appear to be highly susceptible to sepsis induced injury, provide an early warning signal of sepsis and are a factor in the microvascular dysfunction that has been associated with organ dysfunction.

  3. Ready for Prime Time? Biomarkers in Sepsis.

    PubMed

    Long, Brit; Koyfman, Alex

    2017-02-01

    Sepsis is a common condition managed in the emergency department. Current diagnosis relies on physiologic criteria and suspicion of a source of infection using history, physical examination, laboratory studies, and imaging studies. The infection triggers a host response with the aim to destroy the pathogen, and this response can be measured. A reliable biomarker for sepsis should assist with earlier diagnosis, improve risk stratification, or improve clinical decision making. Current biomarkers for sepsis include lactate, troponin, and procalcitonin. This article discusses the use of lactate, procalcitonin, troponin, and novel biomarkers for use in sepsis.

  4. [Severe infections : causes and management of sepsis].

    PubMed

    Salzberger, B; Hanses, F; Birkenfeld, G; Langgartner, J

    2013-08-01

    The sepsis syndrome has only recently been defined as a clinical syndrome but despite its unspecific definition it has evolved rapidly into an important concept. Although specific therapeutic interventions targeting the inflammatory pathway have not yet been effective in treating sepsis, a better understanding of mechanisms leading to organ dysfunction has led to better management of patients with sepsis. Clinical signs of systemic inflammatory response syndrome (SIRS) or sepsis are hallmarks for the definition of severe infections. Current guidelines are presented for the management of a number of severe infectious syndromes.

  5. Caring for the underserved: current practice of alumni of the National Health Service Corps.

    PubMed

    Porterfield, Deborah S; Konrad, Thomas R; Porter, Carol Q; Leysieffer, Kirsten; Martinez, Rose M; Niska, Richard; Wells, Barbara; Potter, Frank

    2003-05-01

    The objective of this study was to examine the number and characteristics of National Health Service Corps (NHSC) alumni who currently practice with an underserved population. The study design was a cross-sectional survey mailed in 1998 to a sample of 2,160 alumni. The response rate was 58.9 percent; overall, 52.5 percent of respondents reported currently working with the underserved. In bivariate analyses, retention in practice with the underserved was associated with several clinician and service experience variables. In a logistic regression model, higher initial desire to work with the underserved, older age, job satisfaction, and higher salary were associated with current service. The authors conclude that more than half of the NHSC alumni responding to the survey reported working with an underserved population in 1998. Associations between clinician and service experience characteristics and retention in practice with the underserved can inform policy and research to improve retention.

  6. Female Genital Cutting: A Persisting Practice

    PubMed Central

    Nour, Nawal M

    2008-01-01

    More than 130 million women worldwide have undergone female genital cutting (FGC). FGC occurs in parts of Africa and Asia, in societies with various cultures and religions. Reasons for the continuing practice of FGC include rite of passage, preserving chastity, ensuring marriageability, religion, hygiene, improving fertility, and enhancing sexual pleasure for men. The World Health Organization has classified FGC into 4 types depending on the extent of tissue removed. Immediate complications include hemorrhage, infection, sepsis, and death. Long-term complications include pain, scarring, urinary issues, and poor obstetric and neonatal outcomes. Efforts are being made nationally and internationally to eradicate this practice. PMID:19015765

  7. National programmes for validating physician competence and fitness for practice: a scoping review

    PubMed Central

    Horsley, Tanya; Lockyer, Jocelyn; Cogo, Elise; Zeiter, Jeanie; Bursey, Ford; Campbell, Craig

    2016-01-01

    Objective To explore and categorise the state of existing literature for national programmes designed to affirm or establish the continuing competence of physicians. Design Scoping review. Data sources MEDLINE, ERIC, Sociological Abstracts, web/grey literature (2000–2014). Selection Included when a record described a (1) national-level physician validation system, (2) recognised as a system for affirming competence and (3) reported relevant data. Data extraction Using bibliographic software, title and abstracts were reviewed using an assessment matrix to ensure duplicate, paired screening. Dyads included both a methodologist and content expert on each assessment, reflective of evidence-informed best practices to decrease errors. Results 45 reports were included. Publication dates ranged from 2002 to 2014 with the majority of publications occurring in the previous six years (n=35). Country of origin—defined as that of the primary author—included the USA (N=32), the UK (N=8), Canada (N=3), Kuwait (N=1) and Australia (N=1). Three broad themes emerged from this heterogeneous data set: contemporary national programmes, contextual factors and terminological consistency. Four national physician validation systems emerged from the data: the American Board of Medical Specialties Maintenance of Certification Program, the Federation of State Medical Boards Maintenance of Licensure Program, the Canadian Revalidation Program and the UK Revalidation Program. Three contextual factors emerged as stimuli for the implementation of national validation systems: medical regulation, quality of care and professional competence. Finally, great variation among the definitions of key terms was identified. Conclusions There is an emerging literature focusing on national physician validation systems. Four major systems have been implemented in recent years and it is anticipated that more will follow. Much of this work is descriptive, and gaps exist for the extent to which systems build

  8. Community-onset sepsis and its public health burden: a systematic review.

    PubMed

    Tsertsvadze, Alexander; Royle, Pam; Seedat, Farah; Cooper, Jennifer; Crosby, Rebecca; McCarthy, Noel

    2016-05-18

    body mass index as risk factors was inconclusive. The lack of a valid standard approach for defining sepsis makes it difficult to determine the true incidence of COS. Differences in case ascertainment contribute to the variation in incidence of COS. The evidence on COS is limited in terms of the number and quality of studies. This review highlights the urgent need for an accurate and standard method for identifying sepsis. Future studies need to improve the methodological shortcomings of previous research in terms of case definition, identification, and surveillance practice. PROSPERO CRD42015023484.

  9. The National Association of School Psychologists' Self-Assessment Tool for School Psychologists: Factor Structure and Relationship to the National Association of School Psychologists' Practice Model

    ERIC Educational Resources Information Center

    Eklund, Katie; Rossen, Eric; Charvat, Jeff; Meyer, Lauren; Tanner, Nick

    2016-01-01

    The National Association of School Psychologists' Model for Comprehensive and Integrated School Psychological Services (2010a), often referred to as the National Association of School Psychologists' Practice Model, describes the comprehensive range of professional skills and competencies available from school psychologists across 10 domains. The…

  10. The National Association of School Psychologists' Self-Assessment Tool for School Psychologists: Factor Structure and Relationship to the National Association of School Psychologists' Practice Model

    ERIC Educational Resources Information Center

    Eklund, Katie; Rossen, Eric; Charvat, Jeff; Meyer, Lauren; Tanner, Nick

    2016-01-01

    The National Association of School Psychologists' Model for Comprehensive and Integrated School Psychological Services (2010a), often referred to as the National Association of School Psychologists' Practice Model, describes the comprehensive range of professional skills and competencies available from school psychologists across 10 domains. The…

  11. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

    PubMed

    Dellinger, R Phillip; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven A; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO2/FIO2 ratio of ≤ 100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 hrs) for patients with early ARDS and a Pao2/Fio2 < 150 mm Hg (2C); a protocolized approach to blood glucose management commencing insulin dosing when two consecutive blood glucose levels are > 180 mg/dL, targeting an upper blood glucose ≤ 180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 hrs after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 hrs of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal

  12. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.

    PubMed

    Dellinger, R P; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

    2013-02-01

    positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) <150 mm Hg (2C); a protocolized approach to blood glucose management commencing insulin dosing when two consecutive blood glucose levels are >180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of

  13. A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis.

    PubMed

    Hunter, Christopher L; Silvestri, Salvatore; Ralls, George; Stone, Amanda; Walker, Ayanna; Papa, Linda

    2016-05-01

    To determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2). We conducted a prospective cohort study among sepsis alerts activated by emergency medical services during a 12 month period after the initiation of a new sepsis screening protocol utilizing ≥2 SIRS criteria and ETCO2 levels of ≤25 mmHg in patients with suspected infection. The outcomes of those that met all criteria of the protocol were compared to those that did not. The main outcome was the diagnosis of sepsis and severe sepsis. Secondary outcomes included mortality and in-hospital lactate levels. Of 330 sepsis alerts activated, 183 met all protocol criteria and 147 did not. Sepsis alerts that followed the protocol were more frequently diagnosed with sepsis (78% vs 43%, P < .001) and severe sepsis (47% vs 7%, P < .001), and had a higher mortality (11% vs 5%, P = .036). Low ETCO2 levels were the strongest predictor of sepsis (area under the ROC curve (AUC) of 0.99, 95% CI 0.99-1.00; P < .001), severe sepsis (AUC 0.80, 95% CI 0.73-0.86; P < .001), and mortality (AUC 0.70, 95% CI 0.57-0.83; P = .005) among all prehospital variables. Sepsis alerts that followed the protocol had a sensitivity of 90% (95% CI 81-95%), a specificity of 58% (95% CI 52-65%), and a negative predictive value of 93% (95% CI 87-97%) for severe sepsis. There were significant associations between prehospital ETCO2 and serum bicarbonate levels (r = 0.415, P < .001), anion gap (r = -0.322, P < .001), and lactate (r = -0.394, P < .001). A prehospital screening protocol utilizing SIRS criteria and ETCO2 predicts sepsis and severe sepsis, which could potentially decrease time to therapeutic intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Monocyte Profiles in Critically Ill Patients With Pseudomonas Aeruginosa Sepsis

    ClinicalTrials.gov

    2017-02-02

    Pseudomonas Infections; Pseudomonas Septicemia; Pseudomonas; Pneumonia; Pseudomonal Bacteraemia; Pseudomonas Urinary Tract Infection; Pseudomonas Gastrointestinal Tract Infection; Sepsis; Sepsis, Severe; Critically Ill

  15. The current practice trends in pediatric bone-anchored hearing aids in Canada: a national clinical and surgical practice survey

    PubMed Central

    2013-01-01

    Background Since the introduction of bone-anchored hearing aids (BAHAs) in the 1980s, the practices of surgeons who implant these hearing aids have become varied; different indications and surgical techniques are utilized depending on the surgeon and institution. The objective of the current study is to describe the clinical and surgical practices of otolaryngologists in Canada who perform pediatric BAHA operations. Methods A detailed practice questionnaire was devised and sent to all members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Those who performed pediatric BAHA surgeries were asked to participate. Results Twelve responses were received (response rate of 80%). All of the respondents identified congenital aural atresia to be an indication for pediatric BAHAs. Other indications were chronic otitis externa or media with hearing loss (92%), allergic reactions to conventional hearing aids (75%), congenital fixation or anomaly of ossicular chain (67%), and unilateral deafness (25%). Minor complications, such as skin reactions, were reported in 25% of cases, while major complications were very rare. There was great variability with regards to surgical techinque and post-operative management. The extent of financial support for the BAHA hardware and device also varied between provinces, and even within the same province. Conclusion There is a lack of general consensus regarding pediatric BAHA surgeries in Canada. With such a small community of otolaryngologists performing this procedure, we are hopeful that this survey can serve as an impetus for a national collaboration to establish a set of general management principles and inspire multi-site research ventures. PMID:23815797

  16. Neonatal sepsis-- a global problem: an overview.

    PubMed

    Afroza, S

    2006-01-01

    Neonatal sepsis is one of the major health problems throughout the world. Every year an estimated 30 million newborns acquire infection and 1-2 million of these die. The present review provides updates regarding neonatal sepsis to help paediatricians to protect the newborn from this deadly problem. The onset of sepsis within first 48 hours of life (early onset sepsis) is frequently associated with pre and perinatal predisposing factors while onset after 48-72 hours of life (late onset sepsis) frequently reflects infection acquired nosocomially. Some literatures say that early onset disease presents in the first 5-7 days of life. Klebsiella pneumoniae is the leading pathogen causing neonatal sepsis in Bangladesh and neighbouring countries. Among many risk factors the single most important neonatal risk factor is low birth weight. Other main risk factors are invassive procedures in the postnatal period and inadequate hand washing before and after handling babies. Sepsis score is a useful method for early and rapid diagnosis of neonatal sepsis which was developed by Tollner U in 1982. Antibiotics should be given to most of the neonates suspected of infection. Ampicillin and gentamicin are the first drug of choice. In Bangladesh context sepsis score may be used as a good parameter for the early and rapid diagnosis of sepsis and that will guide the treatment plan. Clean and safe delivery, early and exclusive breastfeeding, strict postnatal cleanliness following adequate handwashing and aseptic technique during invasive procedure might reduce the incidence of neonatal sepsis. Prompt use of antibiotic according to standard policy is warranted to save the newborn lives from septicaemia.

  17. Inadequate prenatal care use and breastfeeding practices in Canada: a national survey of women.

    PubMed

    Costanian, Christy; Macpherson, Alison K; Tamim, Hala

    2016-05-05

    Previous studies have demonstrated that prenatal care (PNC) has an effect on women's breastfeeding practices. This study aims to examine the influence of adequacy of PNC initiation and services use on breastfeeding practices in Canada. Data for this secondary analysis was drawn from the Maternity Experiences Survey (MES), a cross sectional, nationally representative study that investigated the peri-and post-natal experiences of mothers, aged 15 and above, with singleton live births between 2005 and 2006 in the Canadian provinces and territories. Adequacy of PNC initiation and services use were measured by the Adequacy of Prenatal Care Utilization Index. The main outcomes were mother's intent to breastfeed, initiate breastfeeding, exclusively breastfeed, and terminate breastfeeding at 6 months. Multivariate logistic regression analysis assessed the adequacy of PNC initiation and service use on breastfeeding practices, while adjusting for socioeconomic, demographic, maternal, pregnancy and delivery related variables. Bootstrapping was performed to account for the complex sampling design. Around 75.0% of women intended to only breastfeed their child, with 90.0% initiating breastfeeding, while 6 month termination and exclusive breastfeeding rates were at 52.0% and 14.3%, respectively. Regression analysis showed no association between adequate PNC initiation or services use, and any breastfeeding practice. Mothers with either a family doctor or a midwife as PNC provider were significantly more likely to have better breastfeeding practices compared to an obstetrician. In Canada, provider type impacts a mother's breastfeeding decision and behavior rather than quantity and timing of PNC.

  18. Sexual practices at last heterosexual encounter and occurrence of orgasm in a national survey.

    PubMed

    Richters, Juliet; Visser, Richard de; Rissel, Chris; Smith, Anthony

    2006-08-01

    In order to examine factors associated with orgasm in heterosexual encounters, we analyzed data from the Australian Study of Health and Relationships, a national telephone survey of sexual behavior and attitudes and sexual health knowledge carried out in 2001-2002 with a representative sample of 19,307 Australians aged 16 to 59. Respondents were asked whether at their last sexual encounter they gave or received manual stimulation and oral sex, had vaginal intercourse or anal intercourse, and whether they had an orgasm. Vaginal intercourse was the dominant practice: 95% of encounters included it. Of the 64 possible combinations of these practices, 13 account for 93% of encounters: vaginal intercourse alone (12%), vaginal + manual stimulation of the man's and/or woman's genitals (49%), and vaginal intercourse + manual + oral (32%). Encounters may also have included other practices. Men had an orgasm in 95% of encounters and women in 69%. Generally, the more practices engaged in, the higher a woman's chance of having an orgasm. Women were more likely to reach orgasm in encounters including cunnilingus. This is the first large-scale empirical study worldwide to link specific practices with orgasm. Demographic and sexual history variables were comparatively weakly associated with orgasm.

  19. Confirming the validity of Part II of the National Board Dental Examinations: a practice analysis.

    PubMed

    Kramer, Gene A; Neumann, Laura M

    2003-12-01

    Successful completion of Part II of the National Board Dental Examinations is a part of the licensure process for dentists. Good testing practice requires that the content of a high stakes examination like Part II be based on a strong relationship between the content and the judgments of practicing dentists on what is important to their practice of dentistry. In an effort to demonstrate this relationship for Part II, the Joint Commission conducted a practice analysis, which involved a two-dimensional model. The sixty-three Competencies of the New Dentist, developed and promulgated by the American Dental Education Association, were used for one dimension, and the current content specifications were used for the other. A survey of 520 practicing dentists was conducted to determine the importance of each of the competencies for patient care. These dentists were recent graduates of accredited programs and passed Part II three to five years prior to the conduct of the practice analysis. The survey directed the respondents to rate the importance of the competencies on a scale from 1 to 5. Of the 520 in the sample, 244 dentists responded. The reliability index was above 0.90. The importance rating for each competency was translated into the associated number of items. The number of items devoted to each competency was allocated to the current content elements that are related to the knowledge and problem-solving skills that support each competency. The findings specified revisions in the relative number of items dedicated to the various elements in the specifications. These findings indicate that the items on the examination under the current distribution adequately reflected practice. In general, there were relatively small changes in the content specifications. The total number of changes in items was forty-eight, which represents changes in slightly less than 10 percent of the overall number of items.

  20. Hospital cardiac arrest resuscitation practice in the US: a nationally representative survey

    PubMed Central

    Edelson, Dana P.; Yuen, Trevor C; Mancini, Mary E; Davis, Daniel P; Hunt, Elizabeth A; Miller, Joseph A; Abella, Benjamin S

    2014-01-01

    Background In-hospital cardiac arrest (IHCA) outcomes vary widely between hospitals, even after adjusting for patient characteristics, suggesting variations in practice as a potential etiology. However, little is known about the standards of IHCA resuscitation practice among US hospitals. Objective To describe current US hospital practices with regard to resuscitation care. Design A nationally representative mail survey. Setting A random sample of 1,000 hospitals from the American Hospital Association database, stratified into nine categories by hospital volume tertile and teaching status (major teaching, minor teaching and non-teaching). Subjects Surveys were addressed to each hospital's CPR Committee Chair or Chief Medical/Quality Officer. Measurements A 27-item questionnaire. Results Responses were received from 439 hospitals with a similar distribution of admission volume and teaching status as the sample population (p=0.50). Of the 270 (66%) hospitals with a CPR committee, 23 (10%) were chaired by a Hospitalist. High frequency practices included having a Rapid Response Team (91%) and standardizing defibrillators (88%). Low frequency practices included therapeutic hypothermia and use of CPR assist technology. Other practices such as debriefing (34%) and simulation training (62%) were more variable and correlated with the presence of a CPR Committee and/or dedicated personnel for resuscitation quality improvement. The majority of hospitals (79%) reported at least one barrier to quality improvement, of which the lack of a resuscitation champion and inadequate training were the most common. Conclusions There is wide variability between hospitals and within practices for resuscitation care in the US with opportunities for improvement. PMID:24550202

  1. The Canadian National Dairy Study 2015-Adoption of milking practices in Canadian dairy herds.

    PubMed

    Belage, E; Dufour, S; Bauman, C; Jones-Bitton, A; Kelton, D F

    2017-03-16

    Several studies have investigated which management practices have the greatest effect on udder health, but little information is available on how broadly the recommended milking practices are adopted across Canada. The National Dairy Study 2015 was designed to gather dairy cattle health and management data on dairy farms across Canada. The objectives of the present study were to describe the current proportions of adoption of milking practices on Canadian dairy farms, and identify factors associated with their use on farms. A bilingual questionnaire measuring use of various practices, including an udder health-specific section, was developed and sent to all Canadian dairy farms. The questions in the udder health section of the questionnaire were adapted from a bilingual questionnaire previously validated and containing questions regarding general milking hygiene and routine, and on-farm mastitis management. Chi-squared tests were used to investigate simple associations between adoption of practices and various explanatory variables including region, milking system, herd size, and bulk tank somatic cell count. In total, 1,373 dairy producers completed the survey. The regional distribution of the participants was representative of the Canadian dairy farm population, and milk quality was, on average, similar to nonparticipants. Overall, Canadian dairy producers followed the recommendations for milking procedures, but some were more extensively used than others. Fore-stripping, cleaning teats, wiping teats dry, using single-cow towels, and use of postmilking teat disinfectant were widely adopted. Use of gloves and glove hygiene, use of a premilking teat disinfectant, and use of automatic takeoffs were not as extensively implemented. Adoption percentages for several practices, including use of gloves, use of a premilking teat disinfectant, teat drying methods, and use of automatic takeoffs were significantly associated with milking system, herd size, and region. It

  2. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey.

    PubMed

    Ye, Zhiqiu; Mukamel, Dana B; Huang, Susan S; Li, Yue; Temkin-Greener, Helena

    2015-07-01

    OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.

  3. Novel strategies for the treatment of sepsis.

    PubMed

    Riedemann, Niels C; Guo, Ren-Feng; Ward, Peter A

    2003-05-01

    The history of therapeutic interventions in clinical trials for sepsis has been referred to as the "graveyard for pharmaceutical companies." That is now set to change, as research provides hope for new approaches that will be therapeutically effective in humans with sepsis.

  4. The Changing Epidemiology and Definitions of Sepsis.

    PubMed

    Kempker, Jordan A; Martin, Greg S

    2016-06-01

    This article describes the trends in the incidence of and mortality from sepsis in the United States and globally. The article then discusses the known factors associated with increased risk for developing sepsis and the limitations of the current clinical definition and the clinical correlations of the current epidemiology. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Pelvic sepsis after stapled hemorrhoidopexy

    PubMed Central

    van Wensen, Remco JA; van Leuken, Maarten H; Bosscha, Koop

    2008-01-01

    Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons. PMID:18855996

  6. Burn sepsis and burn toxin

    PubMed Central

    Allgöwer, Martin; Städtler, Karl; Schoenenberger, Guido A

    1974-01-01

    The salient steps of a 20-year programme of research into the nature of burn disease are described. By burn disease we mean the late mortality and morbidity following burns. We have isolated a burn toxin which is derived from a thermal polymerization of cell membrane lipoproteins within the dermis and have studied its influence on the effects of sepsis. We have also used it in the development of active and passive immunization therapy of severe burns. ImagesFig. 2Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:4429330

  7. Exome Sequencing Reveals Primary Immunodeficiencies in Children with Community-Acquired Pseudomonas aeruginosa Sepsis

    PubMed Central

    Asgari, Samira; McLaren, Paul J.; Peake, Jane; Wong, Melanie; Wong, Richard; Bartha, Istvan; Francis, Joshua R.; Abarca, Katia; Gelderman, Kyra A.; Agyeman, Philipp; Aebi, Christoph; Berger, Christoph; Fellay, Jacques; Schlapbach, Luregn J.; Posfay-Barbe, Klara

    2016-01-01

    One out of three pediatric sepsis deaths in high income countries occur in previously healthy children. Primary immunodeficiencies (PIDs) have been postulated to underlie fulminant sepsis, but this concept remains to be confirmed in clinical practice. Pseudomonas aeruginosa (P. aeruginosa) is a common bacterium mostly associated with health care-related infections in immunocompromised individuals. However, in rare cases, it can cause sepsis in previously healthy children. We used exome sequencing and bioinformatic analysis to systematically search for genetic factors underpinning severe P. aeruginosa infection in the pediatric population. We collected blood samples from 11 previously healthy children, with no family history of immunodeficiency, who presented with severe sepsis due to community-acquired P. aeruginosa bacteremia. Genomic DNA was extracted from blood or tissue samples obtained intravitam or postmortem. We obtained high-coverage exome sequencing data and searched for rare loss-of-function variants. After rigorous filtrations, 12 potentially causal variants were identified. Two out of eight (25%) fatal cases were found to carry novel pathogenic variants in PID genes, including BTK and DNMT3B. This study demonstrates that exome sequencing allows to identify rare, deleterious human genetic variants responsible for fulminant sepsis in apparently healthy children. Diagnosing PIDs in such patients is of high relevance to survivors and affected families. We propose that unusually severe and fatal sepsis cases in previously healthy children should be considered for exome/genome sequencing to search for underlying PIDs. PMID:27703454

  8. Exome Sequencing Reveals Primary Immunodeficiencies in Children with Community-Acquired Pseudomonas aeruginosa Sepsis.

    PubMed

    Asgari, Samira; McLaren, Paul J; Peake, Jane; Wong, Melanie; Wong, Richard; Bartha, Istvan; Francis, Joshua R; Abarca, Katia; Gelderman, Kyra A; Agyeman, Philipp; Aebi, Christoph; Berger, Christoph; Fellay, Jacques; Schlapbach, Luregn J

    2016-01-01

    One out of three pediatric sepsis deaths in high income countries occur in previously healthy children. Primary immunodeficiencies (PIDs) have been postulated to underlie fulminant sepsis, but this concept remains to be confirmed in clinical practice. Pseudomonas aeruginosa (P. aeruginosa) is a common bacterium mostly associated with health care-related infections in immunocompromised individuals. However, in rare cases, it can cause sepsis in previously healthy children. We used exome sequencing and bioinformatic analysis to systematically search for genetic factors underpinning severe P. aeruginosa infection in the pediatric population. We collected blood samples from 11 previously healthy children, with no family history of immunodeficiency, who presented with severe sepsis due to community-acquired P. aeruginosa bacteremia. Genomic DNA was extracted from blood or tissue samples obtained intravitam or postmortem. We obtained high-coverage exome sequencing data and searched for rare loss-of-function variants. After rigorous filtrations, 12 potentially causal variants were identified. Two out of eight (25%) fatal cases were found to carry novel pathogenic variants in PID genes, including BTK and DNMT3B. This study demonstrates that exome sequencing allows to identify rare, deleterious human genetic variants responsible for fulminant sepsis in apparently healthy children. Diagnosing PIDs in such patients is of high relevance to survivors and affected families. We propose that unusually severe and fatal sepsis cases in previously healthy children should be considered for exome/genome sequencing to search for underlying PIDs.

  9. DIAGNOSTIC UTILITY OF DIFFERENT BLOOD COMPONENTS IN GENE EXPRESSION ANALYSIS OF SEPSIS.

    PubMed

    Maslove, David M; Marshall, John C

    2016-03-01

    Most gene expression studies of sepsis have used either whole blood or specific leukocyte fractions as source tissues for RNA. Data regarding the relative utility of these different tissue sources are lacking. To evaluate the utility of different source tissues in studying gene expression in sepsis. We undertook a systematic analysis of sepsis gene expression studies, including both adult and pediatric cohorts. We used clustering methods to partition samples according to gene expression levels, and compared expression cluster labels to clinical diagnoses. We also quantified the strength of cluster formation based on expression data from different tissue sources using average silhouette widths as a measure of cluster cohesiveness. We included 22 separate expression datasets. Whole blood was used as the source tissue in 15 studies, while leukocyte isolates were used in seven studies. Whole blood samples yielded greater specificity for the diagnosis of sepsis than data from leukocyte isolates (94% vs 78%, P = 0.03). Whole blood-derived data also yielded more cohesive clusters (median silhouette widths 0.28 and 0.19 for whole blood and leukocyte isolates respectively, P < 0.01). Our results support the use of whole blood to derive gene expression data in sepsis studies investigating novel diagnostics and subtype discovery. This strategy has a number of practical advantages, and the resulting data also have potential utility in developing molecular classifications of sepsis syndromes.

  10. An epidemiologic survey of pediatric sepsis in regional hospitals in China.

    PubMed

    Wang, Yuanyuan; Sun, Bo; Yue, Hongni; Lin, Xiaofei; Li, Bing; Yang, Xiaochun; Shan, Chunming; Fan, Yujin; Dong, Maotian; Zhang, Yixing; Lin, Wenlong; Zuo, Xiaofeng; Su, Ping; Heng, Yongbo; Xu, Jinzhong; Kissoon, Niranjan

    2014-11-01

    To determine the prevalence, treatment, and outcomes of sepsis at regional hospitals in Huai'an, Jiangsu, China. Prospective data registry using a descriptive clinical epidemiologic approach through a collaborative network. Pediatric departments in 11 regional city and county referral hospitals serving 843,000 children (exclusive of neonates). All admissions (n = 27,836) of patients from 28 days to 15 years old from September 1, 2010, to August 31, 2011. None. A total of 1,530 patients met the 2005 international consensus definition of sepsis, corresponding to an estimated incidence of 181/100,000 children, with 80% under 5 years old, and in 10% (153), severe sepsis or septic shock developed. The overall case fatality rate for sepsis was 3.5% (53/1,530) or 34.6% (53/153) in those in whom severe sepsis or septic shock developed. Treatment varied widely and in many instances did not conform to international guidelines as reflected by inadequate use of antibiotics, corticosteroids, vasoactive agents, and inotropes. We first report the prevalence and outcome of pediatric sepsis based on a regional hospital network in China. The diverse treatment approaches and practice at low-level clinics suggest the need for clinical implementation of internationally recognized strategy to improve the care standard in resource-limited regional hospitals.

  11. Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients.

    PubMed

    Lakomkin, Nikita; Sathiyakumar, Vasanth; Wick, Brandon; Shen, Michelle S; Jahangir, A Alex; Mir, Hassan; Obremskey, William T; Dodd, Ashley C; Sethi, Manish K

    2017-06-01

    Postoperative sepsis is associated with high mortality and the national costs of septicemia exceed those of any other diagnosis. While numerous studies in the basic orthopedic science literature suggest that traumatic injuries facilitate the development of sepsis, it is currently unclear whether orthopedic trauma patients are at increased risk. The purpose of this study was thus to assess the incidence of sepsis and determine the risk factors that significantly predicted septicemia following orthopedic trauma surgery. 56,336 orthopedic trauma patients treated between 2006 and 2013 were identified in the ACS-NSQIP database. Documentation of postoperative sepsis/septic shock, demographics, surgical variables, and preoperative comorbidities was collected. Chi-squared analyses were used to assess differences in the rates of sepsis between trauma and nontrauma groups. Binary multivariable regressions identified risk factors that significantly predicted the development of postoperative septicemia in orthopedic trauma patients. There was a significant difference in the overall rates of both sepsis and septic shock between orthopedic trauma (1.6%) and nontrauma (0.5%) patients (p < 0.001). For orthopedic trauma patients, ventilator use (OR = 15.1, p = 0.002), history of pain at rest (OR = 2.8, p = 0.036), and prior sepsis (OR = 2.6, p < 0.001) were significantly associated with septicemia. Statistically predictive, modifiable comorbidities included hypertension (OR = 2.1, p = 0.003) and the use of corticosteroids (OR = 2.1, p = 0.016). There is a significantly greater incidence of postoperative sepsis in the trauma cohort. Clinicians should be aware of these predictive characteristics, may seek to counsel at-risk patients, and should consider addressing modifiable risk factors such as hypertension and corticosteroid use preoperatively. Level of evidence Level III.

  12. Sepsis and meningitis in hospitalized children: performance of clinical signs and their prediction rules in a case-control study.

    PubMed

    Verbakel, Jan Y; MacFaul, Roderick; Aertgeerts, Bert; Buntinx, Frank; Thompson, Matthew

    2014-06-01

    Feverish illness is a common presentation to acute pediatric services. Clinical staff faces the challenge of differentiating the few children with meningitis or sepsis from the majority with self-limiting illness. We aimed to determine the diagnostic value of clinical features and their prediction rules (CPR) for identifying children with sepsis or meningitis among those children admitted to a District General Hospital with acute febrile illness. Acutely ill children admitted to a District General Hospital in England were included in this case-control study between 2000 and 2005. We examined the diagnostic accuracy of individual clinical signs and 6 CPRs, including the National Institute for Clinical Excellence "traffic light" system, to determine clinical utility in identifying children with a diagnosis of sepsis or meningitis. Loss of consciousness, prolonged capillary refill, decreased alertness, respiratory effort, and the physician's illness assessment had high positive likelihood ratios (9-114), although with wide confidence intervals, to rule in sepsis or meningitis. The National Institute for Clinical Excellence traffic light system, the modified Yale Observation Scale, and the Pediatric Advanced Warning Score performed poorly with positive likelihood ratios ranging from 1 to 3. The pediatrician's overall illness assessment was the most useful feature to rule in sepsis or meningitis in these hospitalized children. Clinical prediction rules did not effectively rule in sepsis or meningitis. The modified Yale Observation Scale should be used with caution. Single clinical signs could complement these scores to rule in sepsis or meningitis. Further research is needed to validate these CPRs.

  13. Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy.

    PubMed

    Sen, Volkan; Bozkurt, Ibrahim Halil; Aydogdu, Ozgu; Yonguc, Tarik; Yarimoglu, Serkan; Sen, Pinar; Koras, Omer; Degirmenci, Tansu

    2016-10-01

    We evaluated the usefulness of preoperative neutrophil-lymphocyte count ratio (NLCR) in predicting postoperative sepsis after percutaneous nephrolithotomy (PCNL). In total, 487 patients who underwent PCNL for renal stones were included in the present retrospective study. The stone burden, number of tracts and location, operation time, fluoroscopy time, presence of residual stones, and blood transfusion rates were postoperatively recorded in all patients. All patients were followed up for signs of systemic inflammatory response syndrome (SIRS) and sepsis. The association of sepsis/SIRS with the risk factors of infectious complications, including NLCR, was evaluated. SIRS was detected in 91 (18.7%) patients, 25 (5.1%) of whom were diagnosed with sepsis. Stone burden, operation time, irrigation rate, previous surgery, nephrostomy time, access number, blood transfusion, residual stone, postoperative urinary culture, renal pelvis urinary culture, and stone culture were found to be predictive factors for SIRS and sepsis development. Receiver operating characteristic curve analysis revealed an NLCR cutoff of 2.50 for predicting the occurrence of SIRS/sepsis. We found that the incidence of sepsis was significantly higher in patients with NLCR ≥ 2.50 than in patients with NLCR < 2.50 (p = 0.006). Preoperative and postoperative urine culture positivity were associated with high NLCR (p = 0.039 and p = 0.003, respectively). We believe that preoperative NLCR may be a promising additive predictor of bacteremia and postoperative sepsis in patients who undergo PCNL for renal stones. This marker is simple, easily measured, and easy to use in daily practice without extra costs. Copyright © 2016. Published by Elsevier Taiwan.

  14. Kaiser Permanente's performance improvement system, part 3: multisite improvements in care for patients with sepsis.

    PubMed

    Whippy, Alan; Skeath, Melinda; Crawford, Barbara; Adams, Carmen; Marelich, Gregory; Alamshahi, Mezhgan; Borbon, Josefina

    2011-11-01

    In 2008, Kaiser Permanente Northern California implemented an initiative to improve sepsis care. Early detection and expedited implementation of sepsis treatment bundles that include early goal-directed therapy (EGDT) for patients with severe sepsis were implemented. In a top-down, bottom-up approach to performance improvement, teams at 21 medical centers independently decided how to implement treatment bundles, using a "playbook" developed by rapid cycle pilot testing at two sites and endorsed by a sepsis steering committee of regional and medical center clinical leaders. The playbook contained treatment algorithms, standardized order sets and flow charts, best practice alerts, and chart abstraction tools. Regional mentors and improvement advisers within the medical centers supported team-building and rapid implementation. Timely and actionable data allowed ongoing identification of improvement opportunities. A consistent approach to performance improvement propelled local rapid improvement cycles and joint problem solving across facilities. The number of sepsis diagnoses per 1,000 admissions increased from a baseline value of 35.7 in July 2009 to 119.4 in May 2011. The percent of admitted patients who have blood cultures drawn who also have a serum lactate level drawn increased from a baseline of 27% to 97% in May 2011. The percent of patients receiving EGDT who had a second and lower lactate level within six hours increased from 52% at baseline to 92% in May 2011. Twenty-one cross-functional frontline teams redesigned processes of care to provide regionally standardized, evidence-based treatment algorithms for sepsis, substantially increasing the identification and risk stratification of patients with suspected sepsis and the provision of a sepsis care bundle that included EGDT.

  15. Sepsis-associated encephalopathy: not just delirium

    PubMed Central

    Zampieri, Fernando Godinho; Park, Marcelo; Machado, Fabio Santana; Azevedo, Luciano Cesar Pontes

    2011-01-01

    Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. The measurement of brain dysfunction is difficult because there are no specific biomarkers of neuronal injury, and bedside evaluation of cognitive performance is difficult in an intensive care unit. Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations. PMID:22012058

  16. Heparin Reduced Mortality and Sepsis in Severely Burned Children

    PubMed Central

    Zayas, G.J.; Bonilla, A.M.; Saliba, M.J

    2007-01-01

    Summary Objectives. In El Salvador, before 1999, morbidity and mortality in severely burned children were high. In 1998, all children with burns of 40% or larger size died and sepsis was found. With heparin use in 1999, some similarly burned children survived, and sepsis, pain, procedures, and scars were noted to be less. This retrospective study presents the details. Methods. A study was conducted at the National Children's Hospital in El Salvador of all children with burns over 20% size treated in 1998, when no heparin was used, and in 1999, when heparin was added to burns treatment, using an ethics committee approved protocol in use in twelve other countries. Sodium aqueous heparin solution USP from an intestinal source was infused intravenously and applied topically onto burn surfaces and within blisters for the first 1-3 days post-burn. Then heparin, in diminishing doses, was continued only topically until healing. The treatments in 1998 and 1999 were otherwise the same, except that fewer procedures were needed in 1999. Results. There were no significant differences in gender, age, weight, burn aetiology, or burn size between the burned children in 1998 and those in 1999. Burn pain was relieved and pain medicine was not needed in children treated with heparin in 1999. In 1998, one child survived who had a 35% size burn, and the eight children died who had burns of 40% and over. The survival rate was one out of nine (11%). The average burn size was 51.7%. With heparin use in 1999, six of the ten children survived burns of 50.7% average size. The increase in survival with heparin from 11% to 60% and, therefore, the decrease in mortality from 89% to 40% were significant (p < 0.04). Clinical symptoms and positive blood cultures documented bacterial sepsis in the nine children in 1998. In 1999, the blood cultures for sepsis were positive in the four children who died and negative in the six who survived. The nine versus four differences in the incidence of sepsis

  17. The National Criminal Justice Treatment Practices survey: Multilevel survey methods and procedures⋆

    PubMed Central

    Taxman, Faye S.; Young, Douglas W.; Wiersema, Brian; Rhodes, Anne; Mitchell, Suzanne

    2007-01-01

    The National Criminal Justice Treatment Practices (NCJTP) survey provides a comprehensive inquiry into the nature of programs and services provided to adult and juvenile offenders involved in the justice system in the United States. The multilevel survey design covers topics such as the mission and goals of correctional and treatment programs; organizational climate and culture for providing services; organizational capacity and needs; opinions of administrators and staff regarding rehabilitation, punishment, and services provided to offenders; treatment policies and procedures; and working relationships between correctional and other agencies. The methodology generates national estimates of the availability of programs and services for offenders. This article details the methodology and sampling frame for the NCJTP survey, response rates, and survey procedures. Prevalence estimates of juvenile and adult offenders under correctional control are provided with externally validated comparisons to illustrate the veracity of the methodology. Limitations of the survey methods are also discussed. PMID:17383548

  18. Pathways to fitness for practice: National Vocational Qualifications as a foundation of competence in nurse education.

    PubMed

    Grundy, L

    2001-05-01

    Nurse education is currently undergoing major change. This article seeks to examine how National Vocational Qualifications (NVQs) are contributing to the future of nurse education. Criticisms of Project 2000 (P2K) include failure of the programme to produce nurses who are 'fit for practice' at the point of registration. A major criticism was that there is not enough skills-based training included. Following a recent report, recommendations were made which included a move to introduce a competence-based approach in nurse education. This approach is becoming more evident in both pre- and post-registration nurse education. A mapping exercise demonstrated that many of the UKCC competencies for pre-registration nurse education could be mapped to care NVQs. The article concludes that the positive aspects of care NVQs and P2K education should be embraced to enable programmes of nurse education to prepare nurses who are 'fit for practice'. Copyright 2001 Harcourt Publishers Ltd.

  19. Can physicians treat tuberculosis? Report on a national survey of physician practices.

    PubMed Central

    Sumartojo, E M; Geiter, L J; Miller, B; Hale, B E

    1997-01-01

    OBJECTIVES: Researchers examined physicians' treatment strategies for tuberculosis to determine whether they would follow recommendations of the Centers for Disease Control and Prevention and the American Thoracic Society. METHODS: A national survey sampled 1772 physicians. Analyses tested correlates of recommended treatment regimens. RESULTS: Among respondents, 59.4% described a recommended regimen. Specialists; physicians aware of professional publications, treatment recommendations, and reporting requirements; and those having more than 50% of patients in nursing homes were more likely to describe recommended regimens. Physicians who had been in practice longer, relied on personal experience, or had more than 50% of patients receiving Medicaid were less likely to describe recommended regimens. CONCLUSIONS: Physicians who treat tuberculosis require training and support. Policymakers should consider who should treat tuberculosis and how recommended practice should be ensured. PMID:9431292

  20. Emerging drugs for the treatment of sepsis.

    PubMed

    Heming, Nicholas; Lamothe, Laure; Ambrosi, Xavier; Annane, Djillali

    2016-01-01

    The incidence of sepsis, the systemic inflammatory response of the host to an infectious insult, has steadily increased over past decades. This trend is expected to continue. Sepsis is a leading cause of death and disability worldwide. Treatment relies on antibiotics associated to source control and supportive care. Major progress has been made in the understanding and overall management of sepsis. However, there is no specific treatment for sepsis. We searched PubMed and the ClinicalTrials.gov site for English language reports of phase II and III clinical trials pertaining to the field of sepsis. The current review provides a summary of promising candidate treatments for sepsis. We broadly separated candidate drugs into three distinct categories: Blood purification techniques, immunomodulatory drugs and treatments targeting other systems including the heart, the endothelium or coagulation. Efforts to identify an efficient treatment for sepsis are hampered by the broad definition of the syndrome associated with major heterogeneity between patients affected by sepsis. The characterization of homogeneous groups of patients, through biological or clinical markers is unfortunately lacking. Current research remains active. Candidate drugs for sepsis include hemoperfusion with polymyxin B coated fibre devices, modulation of the immune system with treatments such as hydrocortisone, intravenous immunoglobulins, mesenchymal stem cells, GM-CSF or interferon gamma. Candidate drugs acting on the cardiovascular system include short acting beta 1 blockers, levosimendan or selepressin. Finally, promising strategies, involving monoclonal antibodies or protein antagonists, which selectively inhibit bacterial virulence factors are being assessed at the bedside. A much awaited and needed specific treatment for sepsis will hopefully soon emerge.

  1. Practical Side of the Bibliographic Information Retrieval System in the National Museum of Ethnology

    NASA Astrophysics Data System (ADS)

    Kondo, Katsuichi

    The information retrieval system of the National Museum of Ethnology made its debut in 1979 and now enables us to search the books not only in the Museum but in the country and abroad by means of JAPAN MARC & LC MARC. The author presents the outline and the development of the information managing system including the above briefly and secondly the practical case of using our retrieval system in particular. The problems to be solved in the course of the future plan are also mentioned.

  2. Relaxation Practice and Physiologic Regulation in a National Sample of Older Taiwanese

    PubMed Central

    Goldman, Noreen; Lin, Yu-Hsuan; Weinstein, Maxine

    2012-01-01

    Abstract Objectives To compare the effects of relaxation practice and other exercise on a multisystem measure of physiologic dysregulation in a national sample of older Taiwanese. Design The study was a cross-sectional survey. Settings/location The study was conducted in Taiwan. Subjects A population-based sample of 1036 adults aged 53 and older completed an in-home interview and in-hospital physical examination. The final model is based on 934 respondents with complete data. Outcome measures The outcome measures were overall dysregulation, based on 26 biomarkers, and subscores for cardiovascular/metabolic risk factors and inflammatory markers. Results After adjustment for age and sex, overall dysregulation is 0.35 of a standard deviation (SD) lower for practitioners of relaxation techniques compared with nonpractitioners. The effect of exercise is smaller: 0.19 SD difference between those who exercise regularly and those who do not exercise. Similar effects of relaxation practice and regular exercise were found on inflammation, but smaller effects for cardiovascular/metabolic risk factors. In the presence of controls for sociodemographic characteristics, medication use, and a wide range of self-reported and interviewer-assessed health indicators, the effect of relaxation practice is attenuated but remains sizable (-0.19 of a SD for overall dysregulation); regular exercise has a comparable effect (-0.16 of a SD). The effects are similar for the inflammation subscore, but not significant for cardiovascular/metabolic risk factors after adjusting for health status. Conclusions The physiologic benefits of relaxation practice that have been demonstrated in small experimental studies are also evident in the general population of older Taiwanese who practice these techniques in everyday life. Relaxation practice is associated with lower levels of physiologic dysregulation, particularly with respect to inflammation. Among this sample of older adults, the effect appears to

  3. Supporting near-peer teaching in general practice: a national survey.

    PubMed

    van de Mortel, Thea F; Silberberg, Peter L; Ahern, Christine M; Pit, Sabrina W

    2016-05-12

    Training bodies see teaching by junior doctors and vocational trainees in general practice (family medicine) as integral to a doctor's role. While there is a body of literature on teacher training programs, and on peer and near-peer teaching in hospitals and universities, there has been little examination of near-peer teaching in general practice. Near-peer teaching is teaching to those close to oneself but not at the same level in the training continuum. This study investigated the perceptions of key stakeholders on near-peer teaching in general practice, their current near-peer teaching activities, and methods of recruitment and support. A national anonymous online survey was used to obtain data on Australian stakeholders' perceptions of, and processes related to, near-peer teaching in general practice. Recruitment occurred via electronic invitations sent by training providers and stakeholder associations. Separate questionnaires, which were validated via several cycles of review and piloting, were developed for supervisors and learners. The survey included both fixed response and open response questions. Responses (n = 1,122) were obtained from 269 general practitioner supervisors, 221 general practice registrars, 319 prevocational trainees, and 313 medical students. All stakeholder groups agreed that registrars should teach learners in general practice, and 72% of registrars, 68% of prevocational trainees, and 33% of medical students reported having done some teaching in this setting. Three-quarters of supervisors allowed learners to teach. Having another learner observe their consultations was the most common form of teaching for registrars and prevocational trainees. Eight percent of registrars received some remuneration for teaching. The approach used to determine teaching readiness and quality varied greatly between supervisors. Near-peer teaching was supported by the majority of stakeholders, but is underutilised and has poor structural support

  4. Exploring knowledge, attitudes, and practices related to alcohol in Mongolia: a national population-based survey

    PubMed Central

    2013-01-01

    Background The leading cause of mortality in Mongolia is Non-Communicable Disease. Alcohol is recognised by the World Health Organization as one of the four major disease drivers and so, in order to better understand and triangulate recent national burden-of-disease surveys and to inform policy responses to alcohol consumption in Mongolia, a national Knowledge, Attitudes and Practices survey was conducted. Focusing on Non-Communicable Diseases and their risk factors, this publication explores the alcohol-related findings of this national survey. Methods A door-to-door, household-based questionnaire was conducted on 3450 people from across Mongolia. Participants were recruited using a multi-stage random cluster sampling technique, and eligibility was granted to permanent residents of households who were aged between 15 and 64 years. A nationally representative sample size was calculated, based on methodologies aligned with the WHO STEPwise approach to Surveillance. Results Approximately 50% of males and 30% of females were found to be current drinkers of alcohol. Moreover, nine in ten respondents agreed that heavy episodic drinking of alcohol is common among Mongolians, and the harms of daily alcohol consumption were generally perceived to be high. Indeed, 90% of respondents regarded daily alcohol consumption as either ‘harmful’ or ‘very harmful’. Interestingly, morning drinking, suggestive of problematic drinking, was highest in rural men and was associated with lower-levels of education and unemployment. Conclusion This research suggests that Mongolia faces an epidemiological challenge in addressing the burden of alcohol use and related problems. Males, rural populations and those aged 25-34 years exhibited the highest levels of risky drinking practices, while urban populations exhibit higher levels of general alcohol consumption. These findings suggest a focus and context for public health measures addressing alcohol-related harm in Mongolia. PMID

  5. Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards

    SciTech Connect

    Manley, Stephen Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

    2015-06-15

    Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.

  6. Associations among school characteristics and foodservice practices in a nationally representative sample of United States schools.

    PubMed

    Thomson, Jessica L; Tussing-Humphreys, Lisa M; Martin, Corby K; LeBlanc, Monique M; Onufrak, Stephen J

    2012-01-01

    Determine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices. Secondary analysis of cross-sectional data. Nationally representative sample of public and private elementary, middle, and high schools. Data from the 2006 School Health Policies and Practices Study Food Service School Questionnaire, n = 526 for Healthy and Unhealthy Offerings analysis; n = 520 for Healthy Preparation analysis. Scores for healthy/unhealthy foodservice offerings and healthy food preparation practices. Multivariable regression to determine significant associations among school characteristics and offerings/preparation practices. Public schools and schools participating in the United States Department of Agriculture (USDA) Team Nutrition reported more healthy offerings and preparation than private or nonparticipating schools, respectively. Elementary schools reported fewer unhealthy offerings than middle or high schools; middle schools reported fewer unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation, whereas those requiring completion of a foodservice training program reported fewer unhealthy offerings and more healthy preparation than schools without these requirements. Results suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition. Copyright © 2012 Society for Nutrition Education and Behavior. All rights reserved.

  7. Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards.

    PubMed

    Manley, Stephen; Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

    2015-06-01

    Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients.

  8. Regional cancer centre demonstrates voluntary conformity with the national Radiation Oncology Practice Standards

    PubMed Central

    Manley, Stephen; Last, Andrew; Fu, Kenneth; Greenham, Stuart; Kovendy, Andrew; Shakespeare, Thomas P

    2015-01-01

    Radiation Oncology Practice Standards have been developed over the last 10 years and were published for use in Australia in 2011. Although the majority of the radiation oncology community supports the implementation of the standards, there has been no mechanism for uniform assessment or governance. North Coast Cancer Institute's public radiation oncology service is provided across three main service centres on the north coast of NSW. With a strong focus on quality management, we embraced the opportunity to demonstrate conformity with the Radiation Oncology Practice Standards. The Local Health District's Clinical Governance units were engaged to perform assessments of our conformity with the standards and this was signed off as complete on 16 December 2013. The process of demonstrating conformity with the Radiation Oncology Practice Standards has enhanced the culture of quality in our centres. We have demonstrated that self-assessment utilising trained auditors is a viable method for centres to demonstrate conformity. National implementation of the Radiation Oncology Practice Standards will benefit individual centres and the broader radiation oncology community to improve the service delivered to our patients. PMID:26229680

  9. Case-Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors.

    PubMed

    Dermody, Sarah M; Gao, William; McGinn, Johnathan D; Malekzadeh, Sonya

    2017-06-01

    Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.

  10. AWARENESS AND PRACTICE ON BIOMEDICAL WASTE MANAGEMENT AMONG HEALTH CARE PERSONNEL IN KENYATTA NATIONAL HOSPITAL.

    PubMed

    Njiru, M W; Mutai, C; Gikunju, J

    2013-02-01

    The proper handling and disposal of Bio-medical waste (BMW) is very imperative. There are well defined set rules for handling BMW worldwide. Unfortunately, laxity and lack of adequate training and awareness in execution of these rules leads to staid health and environment apprehension. To assessthe awareness and practice regarding biomedical waste management among health care personnel in Kenyatta National Hospital (KNH) DESIGN: A cross sectional study design. Kenyatta National Hospital Doctors, Nurses and support staff who have worked in the institution for more than six months and consented were evaluated. The total level of awareness on biomedical waste management among health care personnel was found to be 60%. The doctors scored 51% which was the lowest score the nurses scored 65% which was the highest score while the support staff scored 55%. As for the practices, the results showed that most of the healthcare personnel were aware of the biomedical waste management practices in the hospital with the lowest scores emerging from doctors and this shows no association between knowledge on biomedical waste management and education. When asked how they would describe the control of waste management in the institution 59% said good and 40% said fair while 1% said poor. The present study therefore outlines the gap between biomedical waste management rules and inadequate state of execution and awareness in practice. It is recommended that enhancement be done to the already existing Hospital Infection Control Committee to supervise all the aspects of biomedical waste management. Periodical training programmes for biomedical waste handling and disposal to the staff with focus on doctors is highlighted.

  11. A National Survey of Primary Care Practice-Based Research Networks

    PubMed Central

    Tierney, William M.; Oppenheimer, Caitlin C.; Hudson, Brenda L.; Benz, Jennifer; Finn, Amy; Hickner, John M.; Lanier, David; Gaylin, Daniel S.

    2007-01-01

    PURPOSE Increasing numbers of primary care practice-based research networks (PBRNs) are being developed in the United States to perform research relevant to everyday practice. To assess the current status and potential value of this resource, we surveyed US primary care PBRNs in operation from late 2003 to early 2004. METHODS We performed a Web-based survey and structured interviews with PBRN directors and administrative officers, assessing PBRNs’ history, size, location, organization, resources, operations, and productivity (funding obtained, studies performed, and articles published). RESULTS Of 111 primary care PBRNs identified, 89 (80%) responded to the survey. The 86 (77%) meeting the criteria for primary care PBRNs contained 1,871 practices, 12,957 physicians (mean 152 per PBRN, median 100), and 14.7 million patients (mean 229,880 per PBRN, median 105,000). Minority and underinsured patients were overrepresented. The average PBRN was young (4.4 ± 5.7 years): one-half had performed 3 or fewer studies. Three-quarters were affiliated with universities. Common research foci included prevention, diabetes, cardiovascular risk factors, and mental health. Respondent PBRNs had published more than 600 articles in peer-reviewed journals. PBRNs studying questions posed by outside researchers had more federal funding (84% vs 27%, P=.006). PBRNs citing funding as a weakness relied more on local resources to fund research projects (70% vs 40%, P=.036). CONCLUSIONS American primary care PBRNs are mainly young, diverse, and pursuing a variety of research foci. Most have university links and provide a dynamic town-gown relationship that could be a vital national resource for improving primary care, translating research into practice, and meeting the National Institutes of Health Roadmap goals. PBRNs merit further attention from both private and public funding agencies and researchers interested in studying the delivery of primary care. PMID:17548852

  12. Etiology, Antibiotic Resistance and Risk Factors for Neonatal Sepsis in a Large Referral Center in Zambia.

    PubMed

    Kabwe, Mwila; Tembo, John; Chilukutu, Lophina; Chilufya, Moses; Ngulube, Francis; Lukwesa, Chileshe; Kapasa, Monica; Enne, Virve; Wexner, Hannah; Mwananyanda, Lawrence; Hamer, Davidson H; Sinyangwe, Sylvestor; Ahmed, Yusuf; Klein, Nigel; Maeurer, Markus; Zumla, Alimuddin; Bates, Matthew

    2016-07-01

    In sub-Saharan Africa, there is scanty data on the causes of neonatal sepsis and antimicrobial resistance among common invasive pathogens that might guide policy and practice. A cross-sectional observational prevalence and etiology study of neonates with suspected sepsis admitted to the neonatal intensive care unit, University Teaching Hospital, Lusaka, Zambia, between October 2013 and May 2014. Data from blood cultures and phenotypic antibiotic susceptibility testing were compared with multivariate analysis of risk factors for neonatal sepsis. Of 313 neonates with suspected sepsis, 54% (170/313) were male; 20% (62/313) were born to HIV-positive mothers; 33% (103/313) had positive blood cultures, of which 85% (88/103) were early-onset sepsis. Klebsiella species was the most prevalent isolate, accounting for 75% (77/103) of cases, followed by coagulase-negative staphylococci [6% (7/103)], Staphylococcus aureus [6% (6/103)], Escherichia coli [5% (5/103)] and Candida species [5% (5/103)]. For Klebsiella species, antibiotic resistance ranged from 96%-99% for World Health Organization-recommended first-line therapy (gentamicin and ampicillin/penicillin) to 94%-97% for third-generation cephalosporins. The prevalence of culture-confirmed sepsis increased from 0 to 39% during the period December 2013 to March 2014, during which time mortality increased 29%-47%; 93% (14/15) of late-onset sepsis and 82% (37/45) of early-onset sepsis aged 4-7 days were admitted >2 days before the onset of symptoms. Culture results for only 25% (26/103) of cases were available before discharge or death. Maternal HIV infection was associated with a reduced risk of neonatal sepsis [odds ratio, 0.46 (0.23-0.93); P = 0.029]. Outbreaks of nosocomial multiantibiotic-resistant infections are an important cause of neonatal sepsis and associated mortality. Reduced risk of neonatal sepsis associated with maternal HIV infection is counterintuitive and requires further investigation.

  13. Exploring the meaning of practicing classroom inquiry from the perspectives of National Board Certified Science Teachers

    NASA Astrophysics Data System (ADS)

    Karaman, Ayhan

    Inquiry has been one of the most prominent terms of the contemporary science education reform movement (Buck, Latta, & Leslie-Pelecky, 2007; Colburn, 2006; Settlage, 2007). Practicing classroom inquiry has maintained its central position in science education for several decades because science education reform documents promote classroom inquiry as the potential savior of science education from its current problems. Likewise, having the capabilities of teaching science through inquiry has been considered by National Board for Professional Teaching Standards [NBPTS] as one of the essential elements of being an accomplished science teacher. Successful completion of National Board Certification [NBC] assessment process involves presenting a clear evidence of enacting inquiry with students. Despite the high-profile of the word inquiry in the reform documents, the same is not true in schools (Crawford, 2007). Most of the science teachers do not embrace this type of approach in their everyday teaching practices of science (Johnson, 2006; Luera, Moyer, & Everett, 2005; Smolleck, Zembal-Saul, & Yoder, 2006; Trumbull, Scarano, & Bonney, 2006). And the specific meanings attributed to inquiry by science teachers do not necessarily match with the original intentions of science education reform documents (Matson & Parsons, 2006; Wheeler, 2000; Windschitl, 2003). Unveiling the various meanings held by science teachers is important in developing better strategies for the future success of science education reform efforts (Jones & Eick, 2007; Keys & Bryan, 2001). Due to the potential influences of National Board Certified Science Teachers [NBCSTs] on inexperienced science teachers as their mentors, examining inquiry conceptions of NBCSTs is called for. How do these accomplished practitioners understand and enact inquiry? The purpose of this dissertation research study was twofold. First, it investigated the role of NBC performance assessment process on the professional development

  14. A prospective study of the practical issues of local involvement in national audit of COPD.

    PubMed

    Roberts, C M; Lowe, D; Barnes, S; Pearson, M G

    2004-05-01

    Variation in quality of local services is of great concern to the government and public. National audit is an important means of providing data of comparative performance but is hampered at local level by poor methodology including audit design, standard setting and data collection tools. A pilot audit of the hospital care of patients admitted with acute chronic obstructive pulmonary disease (COPD) was performed in preparation for a national audit programme and was designed and supported by experts. It was hoped to overcome these barriers. We report a prospective evaluation of the practical issues involved in local participation of hospital audit of COPD care within a national framework. Hospitals were recruited to the study by random selection and voluntary participation. A clinical audit study was completed over an 8-week period immediately followed by a survey of clinicians and audit staff to identify positive and negative issues of participation and the process required to achieve a successful outcome. Forty-one hospitals were invited to participate, 26 (63%) accepted, and four others volunteered to meet the target of 30 enrolled centres. Reasons cited for non-participation were of inadequate resources amongst either clinicians or audit departments or prior engagement in other national or local audit schemes. Following completion of the audit most (81%) participating units reported it was a useful exercise and were willing to be involved in future audits. Negative aspects of involvement included the lack of dedicated time and manpower for audit, poor information technology and inadequate systems for identifying patient diagnoses either at admission or at discharge and incomplete case note entries. Methodological issues such as study design and data collection tools were not cited as important barriers to participation. There is local willingness to be involved in national audit of hospital care of COPD and central provision of expert design of methods and tools

  15. Abnormal heart rate characteristics preceding neonatal sepsis and sepsis-like illness.

    PubMed

    Griffin, M Pamela; O'Shea, T Michael; Bissonette, Eric A; Harrell, Frank E; Lake, Douglas E; Moorman, J Randall

    2003-06-01

    Late-onset neonatal sepsis is a significant cause of morbidity and mortality, and early detection could prove beneficial. Previously, we found that abnormal heart rate characteristics (HRC) of reduced variability and transient decelerations occurred early in the course of neonatal sepsis and sepsis-like illness in infants in a single neonatal intensive care unit (NICU). We hypothesized that this finding can be generalized to other NICUs. We prospectively collected clinical data and continuously measured RR intervals in all infants in two NICUs who stayed for >7 d. We defined episodes of sepsis and sepsis-like illness as acute clinical deteriorations that prompted physicians to obtain blood cultures and start antibiotics. A predictive statistical model yielding an HRC index was developed on a derivation cohort of 316 neonates in the University of Virginia NICU and then applied to the validation cohort of 317 neonates in the Wake Forest University NICU. In the derivation cohort, there were 155 episodes of sepsis and sepsis-like illness in 101 infants, and in the validation cohort, there were 118 episodes in 93 infants. In the validation cohort, the HRC index 1) showed highly significant association with impending sepsis and sepsis-like illness (receiver operator characteristic area 0.75, p < 0.001) and 2) added significantly to the demographic information of birth weight, gestational age, and days of postnatal age in predicting sepsis and sepsis-like illness (p < 0.001). Continuous HRC monitoring is a generally valid and potentially useful noninvasive tool in the early diagnosis of neonatal sepsis and sepsis-like illness.

  16. Sepsis-associated encephalopathy and its differential diagnosis.

    PubMed

    Iacobone, Emanuele; Bailly-Salin, Juliette; Polito, Andrea; Friedman, Diane; Stevens, Robert D; Sharshar, Tarek

    2009-10-01

    Sepsis is often complicated by an acute and reversible deterioration of mental status, which is associated with increased mortality and is consistent with delirium but can also be revealed by a focal neurologic sign. Sepsis-associated encephalopathy is accompanied by abnormalities of electroencephalogram and somatosensory-evoked potentials, increased in biomarkers of brain injury (i.e., neuron-specific enolase, S-100 beta-protein) and, frequently, by neuroradiological abnormalities, notably leukoencephalopathy. Its mechanism is highly complex, resulting from both inflammatory and noninflammatory processes that affect all brain cells and induce blood-brain barrier breakdown, dysfunction of intracellular metabolism, brain cell death, and brain injuries. Its diagnosis relies essentially on neurologic examination that can lead one to perform specific neurologic tests. Electroencephalography is required in the presence of seizure; neuroimaging in the presence of seizure, focal neurologic signs or suspicion of cerebral infection; and both when encephalopathy remains unexplained. In practice, cerebrospinal fluid analysis should be performed if there is any doubt of meningitis. Hepatic, uremic, or respiratory encephalopathy, metabolic disturbances, drug overdose, withdrawal of sedatives or opioids, alcohol withdrawal delirium, and Wernicke's encephalopathy are the main differential diagnoses of sepsis-associated encephalopathy. Patient management is based mainly on controlling infection, organ system failure, and metabolic homeostasis, at the same time avoiding neurotoxic drugs.

  17. Variation in Partnership Health general practice enrolment data related to need and hospital and national records on ethnicity.

    PubMed

    Malcolm, Laurence; Barnett, Ross

    2009-12-01

    To compare enrolment data for ethnicity and deprivation and other classifications in Partnership Health Primary Health Organisation (PHO) general practices with the National Health Index (NHI) data set and hospital discharge data and to analyse use of special access funding. NHI-linked practice data were obtained through Partnership Health and sent directly to New Zealand Health Information Service (NZHIS). The database was linked with the hospital discharge data for the two years ending June 2007, with the NHIs encrypted. Data were analysed for a range of variables and relationships especially related to ethnicity. Data was obtained from atotal of 345 247 patients in 103 practices. Practices varied widely in their data completion including ethnicity, the latter being unavailable in 7.2% of patients. Ethnicity recording in Partnership Health practice was substantially more complete than national NHI records. Maori in the hospital records was 6.1% compared with 7.0% in the Partnership Health records relating to discharged patients (p < .001). Practice use of special access funding varied widely and was unrelated to need. Despite substantial practice database development, findings point to the need for further collaborative and innovative strategies to improve data recording. Issues needing to be addressed nationally include regular updating and correction of the national NHI set from PHO records. PHO data could, with improvements, become the basis for District Health Board databases. The findings support the current national review of the use of special access funding which appears to be seriously inequitable and inefficient.

  18. National survey and point prevalence study of sedation practice in UK critical care.

    PubMed

    Richards-Belle, Alvin; Canter, Ruth R; Power, G Sarah; Robinson, Emily J; Reschreiter, Henrik; Wunsch, Hannah; Harvey, Sheila E

    2016-10-27

    The present study was designed to (1) establish current sedation practice in UK critical care to inform evidence synthesis and potential future primary research and (2) to compare practice reported via a survey with actual practice assessed in a point prevalence study (PPS). UK adult general critical care units were invited to participate in a survey of current sedation practice, and a representative sample of units was invited to participate in a PPS of sedation practice at the patient level. Survey responses were compared with PPS data where both were available. Survey responses were received from 214 (91 %) of 235 eligible critical care units. Of these respondents, 57 % reported having a written sedation protocol, 94 % having a policy of daily sedation holds and 94 % using a sedation scale to assess depth of sedation. In the PPS, across units reporting a policy of daily sedation holds, a median of 50 % (IQR 33-75 %) of sedated patients were considered for a sedation hold. A median of 88 % (IQR 63-100 %) of patients were assessed using the same sedation scale as reported in the survey. Both the survey and the PPS indicated propofol as the preferred sedative and alfentanil, fentanyl and morphine as the preferred analgesics. In most of the PPS units, all patients had received the unit's reported first-choice sedative (median across units 100 %, IQR 64-100 %), and a median of 80 % (IQR 67-100 %) of patients had received the unit's reported first-choice analgesic. Most units (83 %) reported in the survey that sedatives are usually administered in combination with analgesics. Across units that participated in the PPS, 69 % of patients had received a combination of agents - most frequently propofol combined with either alfentanil or fentanyl. Clinical practice reported in the national survey did not accurately reflect actual clinical practice at the patient level observed in the PPS. Employing a mixed methods approach provided a more complete picture of

  19. The Turning Point Social Marketing National Excellence Collaborative: integrating social marketing into routine public health practice.

    PubMed

    Pirani, Sylvia; Reizes, Tom

    2005-01-01

    Social marketing can be an effective tool for achieving public health goals. Social marketing uses concepts from commercial marketing to plan and implement programs designed to bring about behavior change that will benefit individuals and society. Although social marketing principles have been used to address public health problems, efforts have been dominated by message-based, promotion-only strategies, and effective implementation has been hampered by both lack of understanding of and use of all of the components of a social marketing approach and lack of training. The Turning Point initiative's Social Marketing National Excellence Collaborative (SMNEC) was established to promote social marketing principles and practices to improve public health across the nation. After 4 years, the Collaborative's work has resulted in improved understanding of social marketing among participating members and the development of new tools to strengthen the social marketing skills among public health practitioners. The Collaborative has also made advances in incorporating and institutionalizing the practice of social marketing within public health in participating states.

  20. Tailoring National Standards to Early Science Teacher Identities: Building on Personal Histories to Support Beginning Practice

    NASA Astrophysics Data System (ADS)

    Eick, Charles J.

    2009-04-01

    Individual recommendation plans (IRP) for student teaching practice were co-constructed with two methods students based on the select application of National Science Teachers Association’s National Standards for Science Teacher Preparation. Methods students completed a resume, an interview on pedagogical preferences, and a learning styles survey to determine the reform-based standards and pedagogical approaches that better fit their personal histories and identity formation as science teachers. Each case was unique with one student better meeting the Standards of “Issues” and “Science in the Community” and the other student better meeting the standards of “Inquiry” and the “Nature of Science”. Student teachers planned and taught lessons based on their IRP and were mostly successful in meeting their prescribed standards and utilizing their preferred pedagogies. However, their success in use of specific strategies supporting their approach was highly dependent upon classroom context. The use of the IRP process as a reflective tool strengthening identity formation and early practice is discussed.

  1. Harm reduction and women in the Canadian national prison system: policy or practice?

    PubMed

    Rehman, Laurene; Gahagan, Jacqueline; DiCenso, Anne Marie; Dias, Giselle

    2004-01-01

    Applying the principles of harm reduction within the context of incarcerated populations raises a number of challenges. Although some access to harm reduction strategies has been promoted in general society, a divide between what is available and what is advocated continues to exist within the prison system. This paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and Hepatitis C prevention, care, treatment and support. In-depth interviews were conducted with 156 women in Canadian national prisons. Q.S.R. Nudist was used to assist with data management. A constant comparison method was used to derive categories, patterns, and themes. Emergent themes highlighted a gap between access to harm reduction in policy and in practice. Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre-and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada.

  2. [Selective termination of pregnancy for monochorionic twins: a national survey of professional practice].

    PubMed

    Arlicot, C; Potin, J; Simon, E; Perrotin, F

    2014-06-01

    Selective Termination of Pregnancy (STOP) for discordant fetal condition in monochorionic twin pregnancy is a rarely performed procedure raising technical and ethical considerations. There are no epidemiological data available in France concerning STOP and no guideline or scientific consensus on how or when to perform has been published. We conducted a study of national practice using a declarative questionnaire sent by e-mail to each medical coordinator of every 48 Multidisciplinary Center for Prenatal Diagnosis in France. The questions focused on the issues of 2010 and 2011. Two reminders were sent in case of no answer. The response rate to the questionnaire was 56 %; 81 % of centers have experienced at least once during the two years 2010-2011 a discordant fetal anomaly in monochorionic twin pregnancy. Only 59 % of centers perform all the techniques of STOP. When interruption of the umbilical blood flow is considered, bipolar forceps coagulation is the most used (75 %). Achieving STOP during a cesarean section is a common practice (75 % of centers). Locoregional anesthesia is the preferred mode of anesthesia for STOP. STOP on monochorionic twin pregnancy is not practiced in all Multidisciplinary Center for Prenatal Diagnosis in France. The most widely practiced and most studied technique is bipolar forceps coagulation. The option of an expectant management should always be considered and its risks should be balanced with those of STOP. The practice of STOP during cesarean section is not unusual. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. National practices regarding payment to research subjects for participating in pediatric research.

    PubMed

    Weise, Kathryn L; Smith, Martin L; Maschke, Karen J; Copeland, H Liesel

    2002-09-01

    Payment to subjects for participation in research is reportedly common, but no published data documents the nature of this practice. Institutional review boards (IRBs) are responsible for ensuring both the safety and voluntary participation of research subjects, yet guidance from federal and expert pediatric sources regarding appropriate payment approaches is conflicting. Ethical issues of payment for participation of adult versus pediatric research subjects may differ. This empirical study sought to examine current payment practices for participation in pediatric research as reported by IRBs. An 18-question survey regarding payment practices for participation in pediatric research was sent to IRB chairs at member institutions of the National Association of Children's Hospitals and Related Institutions, and to a systematic random sample of IRB chairs listed with the Office for Protection From Research Risks. Descriptive, nonparametric, and qualitative analyses were used to describe institution types, payment practices, and correlations among responses. Data from 128 institutions that conduct pediatric research revealed that payment for participation in pediatric research was allowed by 66% of responding institutions, and practices varied widely among institutions. Most responding IRBs that allowed payment required disclosure of payment before enrollment (during the consent process), following federal guidelines more closely than American Academy of Pediatrics guidelines. An IRB's perception of potential benefits or harms of a study correlated with the amount of payment approved. IRBs must balance the need to recruit pediatric research subjects against the risk of undue influence during the recruitment process. Federal guidelines and expert pediatric opinion differ in recommendations regarding payment; responding IRBs appeared to follow federal guidelines more closely than guidelines proposed by the American Academy of Pediatrics.

  4. ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing-2016.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2017-09-01

    The results of the 2016 ASHP national survey of pharmacy practice in hospital settings are presented. A stratified random sample of pharmacy directors at 1,315 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method offering a choice of completing a paper survey or an online survey. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. The survey response rate was 29.8%. Drug policy development by pharmacy and therapeutics committees continues to be an important strategy for improving prescribing. Strict formulary systems are maintained in 63.0% of hospitals, and 89.7% of hospitals use clinical practice guidelines that include medications. Pharmacists have the authority to order laboratory tests in 89.9% of hospitals and order medications in 86.8% of hospitals. Therapeutic interchange policies are used in 89.2% of hospitals. Electronic health records (EHRs) have been implemented partially or completely in most hospitals (99.1%). Computerized prescriber-order-entry systems with clinical decision support are used in 95.6% of hospitals, and 92.6% of hospitals have barcode-assisted medication administration systems. Transitions-of-care programs are increasing in number, with 34.6% of hospitals now offering discharge prescription services. Pharmacists practice in 39.5% of hospital ambulatory or primary care clinics. The most common service offered by pharmacists to outpatients is anticoagulation management (26.0%). When pharmacists practice in ambulatory care clinics, 64.5% have prescribing authority through collaborative practice agreements. Pharmacists continue to expand their role in improving the prescribing of medications in both hospital and outpatient settings. The adoption of EHRs and medication-use technologies has contributed to this growth. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  5. 76 FR 19971 - Notice of Proposed Changes to the National Handbook of Conservation Practices for the Natural...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-11

    ... all proposed revisions to conservation practice standards used to carry out HEL and wetland provisions... Natural Resources Conservation Service Notice of Proposed Changes to the National Handbook of Conservation Practices for the Natural Resources Conservation Service AGENCY: Natural Resources Conservation Service...

  6. Developing a Best Practice Guide for Increasing High School Student Participation and Satisfaction in the National School Lunch Program

    ERIC Educational Resources Information Center

    Asperin, Amelia Estepa; Castillo, Alexandra

    2010-01-01

    Purpose/Objectives: The purpose of this project was to identify and confirm best practices for increasing high school student participation and satisfaction in school nutrition (SN) programs operating under the regulations of the National School Lunch Program (NSLP). Methods: Using a modified best practices research model (BPRM; Mold & Gregory,…

  7. Developing a Best Practice Guide for Increasing High School Student Participation and Satisfaction in the National School Lunch Program

    ERIC Educational Resources Information Center

    Asperin, Amelia Estepa; Castillo, Alexandra

    2010-01-01

    Purpose/Objectives: The purpose of this project was to identify and confirm best practices for increasing high school student participation and satisfaction in school nutrition (SN) programs operating under the regulations of the National School Lunch Program (NSLP). Methods: Using a modified best practices research model (BPRM; Mold & Gregory,…

  8. The Relationship between Sun Protection Policy and Associated Practices in a National Sample of Early Childhood Services in Australia

    ERIC Educational Resources Information Center

    Ettridge, Kerry A.; Bowden, Jacqueline A.; Rayner, Joanne M.; Wilson, Carlene J.

    2011-01-01

    Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a…

  9. The Relationship between Sun Protection Policy and Associated Practices in a National Sample of Early Childhood Services in Australia

    ERIC Educational Resources Information Center

    Ettridge, Kerry A.; Bowden, Jacqueline A.; Rayner, Joanne M.; Wilson, Carlene J.

    2011-01-01

    Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a…

  10. Promising Partnership Practices, 2002: The 5th Annual Collection from Members of the National Network of Partnership Schools.

    ERIC Educational Resources Information Center

    Jansorn, Natalie Rodriguez, Ed.; Salinas, Karen Clark, Ed.

    This publication highlights 93 exemplary practices of school, family, and community partnerships selected from members of the National Network of Partnerships Schools at Johns Hopkins University, Maryland. Network member sites represent 18 states and 2 Canadian provinces. The publication highlights six types of practices: parenting (e.g., parent…

  11. Five additions to the list of Sepsidae Diptera for Vietnam: Perochaeta cuirassa sp. n., Perochaeta lobo sp. n., Sepsis spura sp. n., Sepsis sepsi Ozerov, 2003 and Sepsis monostigma Thompson, 1869

    PubMed Central

    Ang, Yuchen; Meier, Rudolf

    2010-01-01

    Abstract A recent collecting trip to Vietnam yielded three new species and two new records of Sepsidae (Diptera) for the country. Here we describe two new species in the species-poor genus Perochaeta (Perochaeta cuirassa sp. n. andPerochaeta lobo sp. n.) and one to the largest sepsid genus Sepsis (Sepsis spura sp. n.) which is also found in Sumatra and Sulawesi. Two additional Sepsis species are new records for Vietnam (Sepsis sepsi Ozerov, 2003; Sepsis monostigma Thompson, 1869). We conclude with a discussion of the distribution of Perochaeta and the three Sepsis species. PMID:21594042

  12. The changing immune system in sepsis

    PubMed Central

    Boomer, Jonathan S; Green, Jonathan M; Hotchkiss, Richard S

    2014-01-01

    Sepsis remains the leading cause of death in most intensive care units. Advances in understanding the immune response to sepsis provide the opportunity to develop more effective therapies. The immune response in sepsis can be characterized by a cytokine-mediated hyper-inflammatory phase, which most patients survive, and a subsequent immune-suppressive phase. Patients fail to eradicate invading pathogens and are susceptible to opportunistic organisms in the hypo-inflammatory phase. Many mechanisms are responsible for sepsis-induced immuno-suppression, including apoptotic depletion of immune cells, increased T regulatory and myeloid-derived suppressor cells, and cellular exhaustion. Currently in clinical trial for sepsis are granulocyte macrophage colony stimulating factor and interferon gamma, immune-therapeutic agents that boost patient immunity. Immuno-adjuvants with promise in clinically relevant animal models of sepsis include anti-programmed cell death-1 and interleukin-7. The future of immune therapy in sepsis will necessitate identification of the immunologic phase using clinical and laboratory parameters as well as biomarkers of innate and adaptive immunity. PMID:24067565

  13. Sepsis as a model of SIRS.

    PubMed

    Bhatia, Madhav; He, Min; Zhang, Huili; Moochhala, Shabbir

    2009-01-01

    Sepsis describes a complex clinical syndrome that results from the host inability to regulate the inflammatory response against infection. Despite more than 20 years of extensive study, sepsis and excessive systemic inflammatory response syndrome (SIRS) are still the leading cause of death in intensive care units. The clinical study of sepsis and new therapeutics remains challenging due to the complexity of this disease. Therefore, many animal models have been employed to investigate the pathogenesis of sepsis and to preliminarily test potential therapeutics. However, so far, most therapeutics that have shown promising results in animal models failed in human clinical trials. In this chapter we will present an overview of different experimental animal models of sepsis and compare their advantages and disadvantage. The studies in animal models have greatly improved our understanding about the inflammatory mediators in sepsis. In this chapter we will also highlight the roles of several critical mediators including TNF-a , IL-1b , IL-6, chemokines, substance P, hydrogen sulfide and activated protein C in animal models of sepsis as well as in clinical studies.

  14. Monitoring of the physical exam in sepsis.

    PubMed

    Postelnicu, Radu; Evans, Laura

    2017-06-01

    Monitoring of mental status and peripheral circulatory changes can be accomplished noninvasively in patients in the ICU. Emphasis on physical examination in conditions such as sepsis have gained increased attention as these evaluations can often serve as a surrogate marker for short-term treatment efficacy of therapeutic interventions. Sepsis associated encephalopathy and mental status changes correlate with worse prognosis in patients. Evaluation of peripheral circulation has been shown to be a convenient, easily accessible, and accurate marker for prognosis in patients with septic shock. The purpose of this article is to emphasize the main findings according to recent literature into the monitoring of physical examination changes in patients with sepsis. Several recent studies have expanded our knowledge about the pathophysiology of mental status changes and the clinical assessment of peripheral circulation in patients with sepsis. Sepsis-associated encephalopathy is associated with an increased rate of morbidity and mortality in an intensive care setting. Increased capillary refill time (CRT) and persistent skin mottling are strongly predictive of mortality, whereas temperature gradients can reveal vasoconstriction and more severe organ dysfunction. Monitoring of physical examination changes is a significant and critical intervention in patients with sepsis. Utilizing repeated neurologic evaluations, and assessing CRT, mottling score, and skin temperature gradients should be emphasized as important noninvasive diagnostic tools. The significance of these methods can be incorporated during the utilization of therapeutic strategies in resuscitation protocols in patients with sepsis.

  15. Energy Audit Practices in China: National and Local Experiences and Issues

    SciTech Connect

    Shen, Bo; Price, Lynn; Lu, Hongyou

    2010-12-21

    China has set an ambitious goal of reducing its energy use per unit of GDP by 20% between 2006 and 2010. Since the industrial sector consumes about two-thirds of China's primary energy, many of the country's efforts are focused on improving the energy efficiency of this sector. Industrial energy audits have become an important part of China's efforts to improve its energy intensity. In China, industrial energy audits have been employed to help enterprises indentify energy-efficiency improvement opportunities for achieving the energy-saving targets. These audits also serve as a mean to collect critical energy-consuming information necessary for governments at different levels to supervise enterprises energy use and evaluate their energy performance. To better understand how energy audits are carried out in China as well as their impacts on achieving China's energy-saving target, researchers at the Lawrence Berkeley National Laboratory (LBNL) conducted an in-depth study that combines a review of China's national policies and guidelines on energy auditing and a series of discussions with a variety of Chinese institutions involved in energy audits. This report consists of four parts. First, it provides a historical overview of energy auditing in China over the past decades, describing how and why energy audits have been conducted during various periods. Next, the report reviews current energy auditing practices at both the national and regional levels. It then discusses some of the key issues related to energy audits conducted in China, which underscore the need for improvement. The report concludes with policy recommendations for China that draw upon international best practices and aim to remove barriers to maximizing the potential of energy audits.

  16. Management of obstetric postpartum hemorrhage: a national service evaluation of current practice in the UK

    PubMed Central

    Al Wattar, Bassel H; Tamblyn, Jennifer A; Parry-Smith, William; Prior, Mathew; Van Der Nelson, Helen

    2017-01-01

    Background Postpartum hemorrhage (PPH) continues to be one of the major causes of maternal mortality and morbidity in obstetrics. Variations in practice often lead to adverse maternity outcomes following PPH. Our objective was to assess the current practice in managing PPH in the UK. Methods We performed a national multicenter prospective service evaluation study over one calendar month and compared the current performance to national standards for managing PPH. We used a standardized data collection tool and collected data on patients’ demographics, incidence of PPH, estimated blood loss (EBL), prophylactic and treatment measures, onset of labor, and mode of delivery. Results We collected data from 98 obstetric units, including 3663 cases of primary PPH. Fifty percent of cases were minor PPH (EBL 500–1000 mL, n=1900/3613, 52.6%) and the remaining were moderate PPH (EBL >1000 to <2000 mL, n=1424/3613, 39.4%) and severe PPH (EBL >2000 mL, n=289/3613, 8%). The majority of women received active management of the third stage of labor (3504/3613, 97%) most commonly with Syntometrine intramuscular (1479/3613, 40.9%). More than half required one additional uterotonic agent (2364/3613, 65.4%) most commonly with Syntocinon intravenous infusion (1155/2364, 48.8%). There was a poor involvement of consultant obstetricians and anesthetists in managing PPH cases, which was more prevalent when managing major PPH (p=0.0001). Conclusion There are still variations in managing PPH in the UK against national guidelines. More senior doctor involvement and regular service evaluation are needed to improve maternal outcomes following PPH. PMID:28176919

  17. Oral Radiology Safety Standards Adopted by the General Dentists Practicing in National Capital Region (NCR)

    PubMed Central

    Jayaprakash, K.; Shivalingesh, K.K.; Agarwal, Vartika; Gupta, Bhuvandeep; Anand, Richa; Sharma, Abhinav; Kushwaha, Sumedha

    2016-01-01

    Introduction With advancement in diagnostic techniques, the utilization of radiologic examination has risen to many folds in the last two decades. Ionizing radiations from the radiographic examination carry the potential for harm by inducing carcino-genesis in addition to the diagnostic information extracted. Radiation doses utilized in the course of dental treatment might be low for individual examinations but patients are exposed to repeated examinations very often and many people are exposed during the course of dental care. Therefore, principles of radiation protection and safety are necessary for the dentists to follow to ensure minimum and inevitable exposure. Aim The aim of this study was to investigate the knowledge and behaviour of general dentists practicing in the National Capital Region (NCR) regarding radiation safety during oral radiographic procedures. Materials and Methods The study was a questionnaire based cross-sectional study. A total of 500 general dentists were contacted to participate in the study. The target population entailed of general dentists practicing in the National Capital Region. Data was computed and tabulated in Microsoft excel sheet and statistical analysis was performed with the help of SPSS version 21.0. Results The total response rate recovered was 70.6% and the respondents comprised of 59% and 41% males & females respectively. Only 64.8% of the general dentists contemplated thyroid to be the most important organ for radiation protection. Only 28.8% of the general dentists followed the position & distance rule appropriately. Conclusion The results showed that the knowledge and behaviour of the general dentists and the practices adopted by them regarding radiation safety is not satisfactory. To ensure the following of basic and necessary guidelines for radiation safety and protection, strict rules with penalties should be implemented by the state councils and new and interesting methods of education for this spectrum of the

  18. An evaluation of nurse rostering practices in the National Health Service.

    PubMed

    Silvestro, R; Silvestro, C

    2000-09-01

    An evaluation of nurse rostering practices in the National Health Service The scheduling of nursing time on hospital wards is critical to the delivery of patient care, resource utilization and employee satisfaction. Over the past decade many hospital wards in the United Kingdom (UK) have moved away from the traditional planning of rosters by a single manager, towards more participative processes known as self-rostering and team rostering. This paper tests the hypothesis, developed from the literature, that the three types of rostering approach may be positioned along a continuum. Self-rostering at one extreme, is conducive to staff empowerment, motivation and roster effectiveness, whilst departmental rostering, at the other, leads to perceived autocracy, reduced empowerment, lower levels of staff motivation and roster effectiveness. Team rostering is positioned mid-way on this continuum. This paper reports the findings of an empirical study of nurse rostering practices in the UK National Health Service (NHS), with a view to developing an understanding of the implications of implementing these three rostering approaches and testing the above hypothesis. The survey of rostering practices in 50 NHS wards, and in-depth case studies of seven wards, revealed that each of the three rostering approaches has benefits and limitations and a picture emerges quite different from that implied by the research hypothesis. Whilst the literature suggests that the choice of rostering approach determines the level of perceived autocracy, staff motivation and roster effectiveness, it is proposed in this paper that selection of rostering approach should be contingent upon operational context. The paper concludes with a framework which stipulates that the choice of rostering approach for a ward should be determined on the basis of four contingent variables, namely, ward size, demand variability, demand predictability, and complexity of skill mix. It is recommended that departmental

  19. Mapping the future of environmental health and nursing: strategies for integrating national competencies into nursing practice.

    PubMed

    Larsson, Laura S; Butterfield, Patricia

    2002-01-01

    :Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, "What specific actions can we take to bring environmental health into the mainstream of nursing practice?" This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons-a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five-tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing

  20. Characteristics of medicine-pediatrics practices: results from the national ambulatory medical care survey.

    PubMed

    Fortuna, Robert J; Ting, David Y; Kaelber, David C; Simon, Steven R

    2009-03-01

    Combined medicine-pediatrics (med-peds) training has existed for 40 years, yet little is known about national med-peds practices. A more comprehensive understanding of med-peds practices is important to inform medical students and guide evolving curricula and accreditation standards. The authors used data from the National Ambulatory Medical Care Survey from 2000 to 2006 to characterize the age distribution and types of visits seen by med-peds, internal medicine, pediatric, and family physicians. Forty-three percent of visits to med-peds physicians were from children < or = 18 years of age. Compared with family physicians, med-peds physicians saw a higher proportion of infants and toddlers < or = 2 years of age (21.0% versus 3.7%; P = .002) and children < or = 18 years of age (42.9% versus 15.5%; P = .002), but they treated fewer adults age 65 or older (13.8% versus 21.3%; P = .013). Compared with internists, med-peds physicians saw a greater percentage of visits from adults 19 to 64 years of age (75.8% versus 61.2%) and fewer visits from patients age 65 or older (24.2% versus 38.8%; P = .006). Med-peds physicians, like family physicians and pediatricians, most commonly treated patients for acute problems and reported high levels of continuity of care for patients-pediatric (93.6%) and adult (94.6%). Med-peds physicians care for a considerable proportion of pediatric patients while maintaining high levels of continuity of care for adult and pediatric patients. Within their practices, med-peds physicians treat a larger percentage of pediatric patients than do family physicians, but they see a smaller percentage of elderly patients.

  1. The practice of bullying among Brazilian schoolchildren and associated factors, National School Health Survey 2015.

    PubMed

    Mello, Flávia Carvalho Malta; Silva, Jorge Luiz da; Oliveira, Wanderlei Abadio de; Prado, Rogério Ruscitto do; Malta, Deborah Carvalho; Silva, Marta Angélica Iossi

    2017-09-01

    This study explored associations between bullying and sociodemographic, mental health and risk behavior variables in school age children. This cross-sectional survey analyzed data from the National School Health Survey (PeNSE 2015). A multiple logistic regression analysis checked for factors associated with bullying. Nineteen point eight percent (95%CI 10.5 - 20.0) of the students claimed they practiced bullying. The practice of bullying was more common among students enrolled in private schools, those living with their parents, and those whose mothers have more years of schooling and are gainfully employed (28.1% CI 27.3-28.8). In terms of mental health characteristics, bullying was more common among those feeling alone, suffering from insomnia and with no friends. Looking at family characteristics, those reporting they are physically punished by family members (33.09% CI 33.1-34.6) and miss school without telling their family (28.4% 95% CI 27.9-29.0) are more likely to practice bullying. Bullying was more frequent among those reporting tobacco, alcohol and drug use, and among students claiming to have had sexual relations. The data shows that bullying is significant and interferes in school children's health and the teaching-learning process. This must be addressed looking at youth as protagonists and in an inter-sectoral context.

  2. Workforce characteristics of privately practicing nurse practitioners in Australia: Results from a national survey.

    PubMed

    Currie, Jane; Chiarella, Mary; Buckley, Thomas

    2016-10-01

    Australian private practice nurse practitioner (PPNP) services have grown since legislative changes in 2010 enabled eligible nurse practitioners (NPs) to access reimbursement for care delivered through the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This article provides data from a national survey on the workforce characteristics of PPNPs in Australia. PPNPs in Australia were invited to complete an electronic survey. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. There were 73 completed surveys. One of the intentions of expanding access to MBS and PBS for patients treated by NPs was to increase patients' access to health care through greater flexibility in the healthcare workforce. The results of this survey confirm that the workforce characteristics of PPNPs provide a potentially untapped resource to meet current primary healthcare demand. The findings of this study allow us to understand the characteristics of PPNP services, which are significant for workforce planning. The focus of PPNP practice is toward primary health care with PPNPs working predominantly in general practice settings. The largest age group of PPNPs is over 50 years and means a proportion will be retiring in the next 15 years. ©2016 American Association of Nurse Practitioners.

  3. Sepsis Resuscitation: Fluid Choice and Dose

    PubMed Central

    Semler, Matthew W.; Rice, Todd W.

    2016-01-01

    Synopsis Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding “which fluid” and “in what amount” remain unanswered. Recent advances in understanding the physiologic response to fluid administration, as well as large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research. PMID:27229641

  4. Sepsis Resuscitation: Fluid Choice and Dose.

    PubMed

    Semler, Matthew W; Rice, Todd W

    2016-06-01

    Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding which fluid and in what amount remain unanswered. Recent advances in understanding the physiologic response to fluid administration, and large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Model of meningococcal sepsis in mice].

    PubMed

    Krasnoproshina, L I; Ermakova, L G; Belova, T N; Filippov, Iu V; Efimov, D D

    1978-11-01

    The authors studied a possibility of obtaining experimental meningococcus sepsis model on mice. The use of cyclophosphane, iron compounds, yolk medium produced no significant organism. When 4--5% mucine was injected intraperitoneally together with meningococcus culture mice died with sepsis phenomena. Differences were revealed in the sensitivity of linear and mongrel mice to meningococcus infection--AKR mice proved to be more sensitive. At the same time it was found that mongrel mice weighing from 10 to 12 g could be used to induce meningococcus sepsis.

  6. Pitfalls in the Treatment of Sepsis.

    PubMed

    Peterson, Lars-Kristofer N; Chase, Karin

    2017-02-01

    Sepsis is a challenging, dynamic, pathophysiology requiring expertise in diagnosis and management. Controversy exists as to the most sensitive early indicators of sepsis and sepsis severity. Patients presenting to the emergency department often lack complete history or clinical data that would point to optimal management. Awareness of these potential knowledge gaps is important for the emergency provider managing the septic patient. Specific areas of management including the initiation and management of mechanical ventilation, the appropriate disposition of the patient, and consideration of transfer to higher levels of care are reviewed.

  7. Clinical and microbiological features of maternal sepsis: a retrospective study.

    PubMed

    Abir, G; Akdagli, S; Butwick, A; Carvalho, B

    2017-02-01

    Identifying pregnant women with sepsis is challenging because diagnostic clinical and laboratory criteria overlap with normal pregnant physiologic indices. Our primary study aim was to describe clinical and laboratory characteristics of women diagnosed with sepsis, severe sepsis and septic shock. Our secondary aim was to determine positive predictive values for International Classification of Disease (ICD)-9 billing codes for sepsis, severe sepsis, and septic shock. After gaining Institutional Review Board approval, we identified women with ICD-9 codes for sepsis, severe sepsis and septic shock who were admitted to a single tertiary obstetric center from 2007-2013. Diagnoses were confirmed using criteria from the International Sepsis Definitions Conference report. Demographic, obstetric, vital signs and laboratory data were abstracted by medical chart review. We identified 190 women with sepsis-related ICD-9 codes: of these, 35 (18%) women met the criteria for a clinical diagnosis of sepsis, severe sepsis or septic shock. Twenty (57%) women had a sepsis-related diagnosis after cesarean delivery. Twenty-one (60%) women had one or more pre-existing medical conditions and 19 (54%) women had one or more obstetric-related conditions. The genital tract was the most common site of infection. We observed considerable heterogeneity in maternal vital signs and laboratory indices for women with ICD-9 codes for sepsis, severe sepsis, and septic shock. The positive predictive value for each sepsis-related ICD-9 code was low: 16% (95% CI 10 to 24%) for sepsis, 10% (95% CI 3 to 25%) for severe sepsis and 24% (95% CI 10 to 46%) for septic shock. We identified marked heterogeneity in patient characteristics, clinical features, laboratory indices and microbiological findings among cohorts of women diagnosed with maternal sepsis, severe sepsis or septic shock. Based on our findings, the incidence of maternal sepsis using ICD-9 codes may be significantly overestimated. Copyright

  8. Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

    PubMed Central

    Reinhart, K.; Brunkhorst, F. M.; Bone, H.-G.; Bardutzky, J.; Dempfle, C.-E.; Forst, H.; Gastmeier, P.; Gerlach, H.; Gründling, M.; John, S.; Kern, W.; Kreymann, G.; Krüger, W.; Kujath, P.; Marggraf, G.; Martin, J.; Mayer, K.; Meier-Hellmann, A.; Oppert, M.; Putensen, C.; Quintel, M.; Ragaller, M.; Rossaint, R.; Seifert, H.; Spies, C.; Stüber, F.; Weiler, N.; Weimann, A.; Werdan, K.; Welte, T.

    2010-01-01

    Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources. PMID:20628653

  9. Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI)).

    PubMed

    Reinhart, K; Brunkhorst, F M; Bone, H-G; Bardutzky, J; Dempfle, C-E; Forst, H; Gastmeier, P; Gerlach, H; Gründling, M; John, S; Kern, W; Kreymann, G; Krüger, W; Kujath, P; Marggraf, G; Martin, J; Mayer, K; Meier-Hellmann, A; Oppert, M; Putensen, C; Quintel, M; Ragaller, M; Rossaint, R; Seifert, H; Spies, C; Stüber, F; Weiler, N; Weimann, A; Werdan, K; Welte, T

    2010-06-28

    Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

  10. The United States National Center for Interprofessional Practice and Education: Integrating an informatics approach to interprofessional work.

    PubMed

    Brandt, Barbara F; Cerra, Frank B; Delaney, Connie White

    2015-01-01

    The National Center for Interprofessional Practice and Education, a United States public-private partnership, was formed to provide national leadership, scholarship, evidence, and coordination to advance interprofessional education (IPE) and practice. Many external drivers led to the creation of the partnership that culminated in the National Center: patient safety initiatives, the need for care coordination and transitions efforts, quality improvement imperatives, calls for teamwork and workforce optimization, newly defined national core competencies for interprofessional collaborative practice, practice redesign, escalating health care costs, and state and federal policies. The National Center principals who have served in a variety of senior leadership roles--a clinician, educationalist, and informaticist--recognized the opportunity to leverage the potential that informatics could bring not only to the center but also to the field of IPECP. An informatics approach focuses on collaborative processes and works to address information processing, communications, and data collection. To do so, the National Center created multiple platforms: informatics education, a resource exchange, communication strategy, incubator network, national data repository, and learning system.

  11. An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis.

    PubMed

    Soares, M O; Welton, N J; Harrison, D A; Peura, P; Shankar- Hari, M; Harvey, S E; Madan, J J; Ades, A E; Palmer, S J; Rowan, K M

    2012-01-01

    Sepsis is a syndrome characterised by a systemic inflammatory response to infection that leads to rapid acute organ failure and potentially rapid decline to death. Intravenous immunoglobulin (IVIG), a blood product derived from human donor blood, has been proposed as an adjuvant therapy for sepsis. To describe current practice in the management of adult patients severely ill with sepsis (severe sepsis or septic shock) in the UK; to assess the clinical effectiveness of IVIG for severe sepsis and septic shock and to obtain the appropriate inputs for the relative efficacy parameters, and the key uncertainties associated with these parameters, required to populate the decision model; to develop a decision-analytic model structure and identify key parameter inputs consistent with the decision problem and relevant to an NHS setting; and to populate the decision model and determine the cost-effectiveness of IVIG and to estimate the value of additional primary research. Existing literature on IVIG and severe sepsis. Existing case-mix and outcome data on critical care admissions. Survey data on management of admissions with severe sepsis. Databases searched for clinical effectiveness were Cochrane Infectious Diseases Group Specialized Trials Register, the Cochrane Trials Register, MEDLINE and EMBASE. Dates searched were 1 January 2002 to 2 October 2009 to update previous Cochrane review. Databases searched for cost-effectiveness were NHS Economic Evaluation Database (NHS EED) to 2 October 2009, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations and EMBASE to 20 October 2009. Systematic literature searching with data extraction, descriptive analysis and clinical effectiveness and cost-effectiveness modelling of IVIG in severe sepsis. Additional primary data analysis. Expected value of information (EVI) analysis. Our meta-analysis, the first to simultaneously allow for type of IVIG (IVIG or immunoglobulin M-enriched polyclonal IVIG), choice of control (no treatment or

  12. Sexual health problems managed in Australian general practice: a national, cross sectional survey

    PubMed Central

    Freedman, E; Britt, H; Harrison, C M; Mindel, A

    2006-01-01

    Objectives To ascertain how frequently Australian general practitioners (GPs) identify sexual health (SH) problems, to gain understanding of how SH problems are managed in general practice and to determine the characteristics of GPs who manage them. Methods A secondary analysis of data from the BEACH programme April 2000–March 2003. BEACH is a cross sectional national survey of GP activity: approximately 1000 GPs per year, each records details of 100 consecutive patient encounters. Initially, patient reasons for encounter (RFE), suggestive of a SH problem, were used to derive a list of SH problems (that is, doctor's diagnosis/problem label). Management of these problems was then investigated for all encounters with patients aged 12–49 years. The frequency of SH problems, their management and the characteristics of GPs managing them, were analysed using SAS. Results During 299 000 encounters with 2990 GPs, 3499 (1.17 per 100 encounters) STI/SH problems were managed, the majority (81.1%) in females. The most common in women were genital candidiasis, vaginal symptoms, urinary symptoms, and intermenstrual bleeding, and in men were testicular symptoms, genital warts, and urethritis. Tests to exclude specific STIs were seldom taken and symptomatic management was common. GPs managing SH problems were younger, more likely to be female, have fewer years in practice, work in larger practices; hold FRACGP status (all p = <0.001) than those GPs who managed none. Conclusion Patients seeking medical attention for SH problems are often managed by GPs. Tests to diagnose or exclude specific sexually transmitted infections are seldom ordered and symptomatic management is common. Strategies to improve management of SH problems in general practice need to be developed and evaluated. PMID:16461607

  13. Neo-liberal economic practices and population health: a cross-national analysis, 1980-2004.

    PubMed

    Tracy, Melissa; Kruk, Margaret E; Harper, Christine; Galea, Sandro

    2010-04-01

    Although there has been substantial debate and research concerning the economic impact of neo-liberal practices, there is a paucity of research about the potential relation between neo-liberal economic practices and population health. We assessed the extent to which neo-liberal policies and practices are associated with population health at the national level. We collected data on 119 countries between 1980 and 2004. We measured neo-liberalism using the Fraser Institute's Economic Freedom of the World (EFW) Index, which gives an overall score as well as a score for each of five different aspects of neo-liberal economic practices: (1) size of government, (2) legal structure and security of property rights, (3) access to sound money, (4) freedom to exchange with foreigners and (5) regulation of credit, labor and business. Our measure of population health was under-five mortality. We controlled for potential mediators (income distribution, social capital and openness of political institutions) and confounders (female literacy, total population, rural population, fertility, gross domestic product per capita and time period). In longitudinal multivariable analyses, we found that the EFW index did not have an effect on child mortality but that two of its components: improved security of property rights and access to sound money were associated with lower under-five mortality (p = 0.017 and p = 0.024, respectively). When stratifying the countries by level of income, less regulation of credit, labor and business was associated with lower under-five mortality in high-income countries (p = 0.001). None of the EFW components were significantly associated with under-five mortality in low-income countries. This analysis suggests that the concept of 'neo-liberalism' is not a monolithic entity in its relation to health and that some 'neo-liberal' policies are consistent with improved population health. Further work is needed to corroborate or refute these findings.

  14. From training to practice: the impact of ENGAGE, Ireland's national men's health training programme.

    PubMed

    Osborne, Aoife; Carroll, Paula; Richardson, Noel; Doheny, Martin; Brennan, Lorcan; Lambe, Barry

    2016-12-24

    Ireland's National Men's Health Policy recommended developing training programmes tailored to the needs of those working in health and allied health professionals and ENGAGE was developed to meet that recommendation. This study evaluated the impact of ENGAGE on frontline service providers' self-reported knowledge, skills, capacity and practice up to 5-months post training. Between 2012 and 2015, ENGAGE Trainers (n = 57) delivered 62 1-day training programmes to 810 participants. This study was conducted on a subset of those training days (n = 26) and participants. Quantitative methodologies were used to collect pre (n = 295), post (n = 295) and 5-month post (n = 128) training questionnaire data. Overall, participants were highly satisfied with the training immediately post training (8.60 ± 1.60 out of 10) and at 5-month follow up (8.06 ± 1.43 out of 10). Participants' self-reported level of knowledge, skill and capacity in identifying priorities, engaging men and influencing practice beyond their own organisation increased immediately following training (P < 0.001) and, with the exception of improving capacity to engage men and influencing practice beyond their organisation, these improvements were sustained at 5-month post training (P < 0.001). The vast majority of service providers (93.4%) reported that ENGAGE had impacted their work practice up to 5-month post training. The findings suggest that ENGAGE has succeeded in improving service providers' capacity to engage and work with men; improving gender competency in the delivery of health and health related services may increase the utilisation of such services by men and thereby improve health outcomes for men.

  15. National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014.

    PubMed

    Feldman-Winter, Lori; Szucs, Kinga; Milano, Aubri; Gottschlich, Elizabeth; Sisk, Blake; Schanler, Richard J

    2017-09-18

    The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014. Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs). From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; P < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [P < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems (P < .01). Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary. Copyright © 2017 by the American Academy of Pediatrics.

  16. Diagnostic accuracy of presepsin (sCD14-ST) as a biomarker of infection and sepsis in the emergency department.

    PubMed

    de Guadiana Romualdo, Luis García; Torrella, Patricia Esteban; Acebes, Sergio Rebollo; Otón, María Dolores Albaladejo; Sánchez, Roberto Jiménez; Holgado, Ana Hernando; Santos, Enrique Jiménez; Freire, Alejandro Ortín

    2017-01-01

    Presepsin is a promising biomarker for the diagnosis and prognosis of sepsis. However, results reported about its value to diagnose sepsis in an emergency department (ED) are controversial, probably due to differences in the design of the studies. We have evaluated the diagnostic accuracy of presepsin for infection and sepsis, compared with procalcitonin (PCT) and C-reactive protein (CRP), in patients presenting to the emergency department (ED) with suspected infection. 223 patients with suspected infection were enrolled for the study. Blood samples were collected on admission for measurement of biomarkers. Definitive diagnosis was obtained afterwards by analysis of digital medical records. Receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic accuracy. Infection was confirmed in 200 patients, including 130 with non-complicated infection and 70 with sepsis. Median CRP, PCT and presepsin levels were significantly higher in patients with infection and sepsis. PCT was the biomarker with the highest performance for infection (ROC AUC: 0.910); for sepsis, PCT (ROC AUC: 0.815) and presepsin (ROC AUC: 0.775) shown a similar performance. Although presepsin is a valuable biomarker for diagnosis of infection and sepsis, its diagnostic accuracy in our study does not improve that of PCT. Its introduction in clinical practice is not justified. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Current practice of rapid sequence induction of anaesthesia in the UK - a national survey.

    PubMed

    Sajayan, A; Wicker, J; Ungureanu, N; Mendonca, C; Kimani, P K

    2016-09-01

    The 'classical' technique of rapid sequence induction (RSI) of anaesthesia was described in 1970. With the introduction of new drugs and equipment in recent years, a wide variation in this technique has been used. The role of cricoid pressure is controversial because of the lack of scientific evidence. Moreover, gentle mask ventilation has been recommended in situations such as obesity and critically ill patients, to prevent hypoxaemia during the apnoeic period. In identifying multiple techniques, we conducted a national postal survey to establish the current practice of RSI in the UK. A survey consisting of 17 questions was created and posted to 255 National Health Service (NHS) hospitals in the UK. We included two copies of the questionnaire in each envelope; one to be completed by the airway lead (consultant anaesthetist with responsibility of overseeing the standard of airway training and implementing national airway guidelines and recommendations within their institution) and the other by a trainee in the same department. The difference in responses from consultants and trainees were assessed using the χ(2) test and the Fisher's exact test. In total we received 272 responses (response rate 53%) of which 266 (58% from consultants and 42% from trainees) were analysed. A majority of the respondents (68%) pre-oxygenated by monitoring end-tidal oxygen concentration and 76% of the respondents use 20-25° head up tilt for all RSIs. Propofol is the most commonly used induction agent (64% of all respondents). Opioid has been used by 80% of respondents and only 18% of respondents use suxamethonium for all patients and others choose rocuronium or suxamethonium based on clinical situation. Although 92% of anaesthetists use cricoid pressure, 83% of them never objectively measure the force used. During the apnoeic period 17% of the respondents use gentle mask ventilation. Our survey demonstrated a persistent variation in the practice of RSI amongst the anaesthetists in the

  18. Diet patterns and risk of sepsis in community-dwelling adults: a cohort study.

    PubMed

    Gutiérrez, Orlando M; Judd, Suzanne E; Voeks, Jenifer H; Carson, April P; Safford, Monika M; Shikany, James M; Wang, Henry E

    2015-06-14

    Sepsis is the syndrome of body-wide inflammation triggered by infection and is a major public health problem. Diet plays a vital role in immune health but its association with sepsis in humans is unclear. We examined 21,404 participants with available dietary data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort of 30,239 black and white adults ≥45 years of age living in the US. The primary exposures of interest were five empirically derived diet patterns identified via factor analysis within REGARDS participants: "Convenience" (Chinese and Mexican foods, pasta, pizza, other mixed dishes), "Plant-based" (fruits, vegetables), "Southern" (added fats, fried foods, organ meats, sugar-sweetened beverages), "Sweets/Fats" (sugary foods) and "Alcohol/Salads" (alcohol, green-leafy vegetables, salad dressing). The main outcome of interest was investigator-adjudicated first hospitalized sepsis events. A total of 970 first sepsis events were observed over ~6 years of follow-up. In unadjusted analyses, greater adherence to Sweets/Fats and Southern patterns was associated with higher cumulative incidence of sepsis, whereas greater adherence to the Plant-based pattern was associated with lower incidence. After adjustment for sociodemographic, lifestyle and clinical factors, greater adherence to the Southern pattern remained associated with higher risk of sepsis (hazard ratio [HR] comparing the fourth to first quartile, HR 1.39, 95 % CI 1.11,1.73). Race modified the association of the Southern diet pattern with sepsis (P interaction = 0.01), with the Southern pattern being associated with modestly higher adjusted risk of sepsis in black as compared to white participants (HR comparing fourth vs. first quartile HR 1.42, 95 % CI 0.75,2.67 vs. 1.21, 95 % CI 0.93,1.57, respectively). A Southern pattern of eating was associated with higher risk of sepsis, particularly among black participants. Determining reasons for these findings

  19. Two Decades of Mortality Trends among Patients with Severe Sepsis: A Comparative Meta-analysis

    PubMed Central

    Stevenson, Elizabeth K.; Rubenstein, Amanda R.; Radin, Gregory T.; Wiener, Renda Soylemez; Walkey, Allan J.

    2014-01-01

    Objective Trends in severe sepsis mortality derived from administrative data may be biased by changing ICD-9-CM coding practices. We sought to determine temporal trends in severe sepsis mortality using clinical trial data that does not rely on ICD-9-CM coding and compare mortality trends in trial data to those observed from administrative data. Design We searched MEDLINE for multicenter, randomized trials that enrolled patients with severe sepsis from 1991-2009. We calculated standardized mortality ratios (SMR) for each trial from observed 28-day mortality of usual care participants and predicted mortality from severity of illness scores. To compare mortality trends from clinical trials to administrative data, we identified adult severe sepsis hospitalizations in the Nationwide Inpatient Sample, 1993-2009, using two previously validated algorithms. Setting and Patients Hospitalized patients with severe sepsis or septic shock. Measurements and Main Results Of 3244 potentially eligible articles, we included 36 multicenter severe sepsis trials, with a total of 14,418 participants in a usual care arm. Participants with severe sepsis receiving usual care had a 28-day mortality of 33.2%. Observed mortality decreased 3.0% annually (95% CI 0.8%, 5.0%, p=0.009), decreasing from 46.9% [SMR 0.94, 95% CI (0.86, 1.03)] during years 1991-1995 to 29% [SMR 0.53, (95% CI (0.50, 0.57)] during years 2006-2009 (3.0% annual change). Trends in hospital mortality among patients with severe sepsis identified from administrative data [“Angus definition”: 4.7% annual change, (95% CI 4.1%, 5.3%), p=0.69), “Martin definition”: 3.5% annual change, (95% CI 3.0%, 4.1%, p=0.97)] were similar to trends identified from clinical trials. Conclusion Since 1991, patients with severe sepsis enrolled in usual care arms of multicenter randomized trials have experienced decreasing mortality. The mortality trends identified in clinical trial participants appear similar to those identified using

  20. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*.

    PubMed

    Stevenson, Elizabeth K; Rubenstein, Amanda R; Radin, Gregory T; Wiener, Renda Soylemez; Walkey, Allan J

    2014-03-01

    Trends in severe sepsis mortality derived from administrative data may be biased by changing International Classification of Diseases, 9th Revision, Clinical Modification, coding practices. We sought to determine temporal trends in severe sepsis mortality using clinical trial data that does not rely on International Classification of Diseases, 9th Revision, Clinical Modifications coding and compare mortality trends in trial data with those observed from administrative data. We searched MEDLINE for multicenter randomized trials that enrolled patients with severe sepsis from 1991 to 2009. We calculated standardized mortality ratios for each trial from observed 28-day mortality of usual care participants and predicted mortality from severity-of-illness scores. To compare mortality trends from clinical trials to administrative data, we identified adult severe sepsis hospitalizations in the Nationwide Inpatient Sample, 1993-2009, using two previously validated algorithms. In-patient. Patients with severe sepsis or septic shock. None. Of 3,244 potentially eligible articles, we included 36 multicenter severe sepsis trials, with a total of 14,418 participants in a usual care arm. Participants with severe sepsis receiving usual care had a 28-day mortality of 33.2%. Observed mortality decreased 3.0% annually (95% CI, 0.8%-5.0%; p = 0.009), decreasing from 46.9% (standardized mortality ratio 0.94; 95% CI, 0.86-1.03) during years 1991-1995 to 29% (standardized mortality ratio 0.53; 95% CI, 0.50-0.57) during years 2006-2009 (3.0% annual change). Trends in hospital mortality among patients with severe sepsis identified from administrative data (Angus definition, 4.7% annual change; 95% CI, 4.1%-5.3%; p = 0.69 and Martin definition, 3.5% annual change; 95% CI, 3.0%-4.1%; p = 0.97) were similar to trends identified from clinical trials. Since 1991, patients with severe sepsis enrolled in usual care arms of multicenter randomized trials have experienced decreasing mortality. The

  1. Understanding sepsis: from SIRS to septic shock.

    PubMed

    Hynes-Gay, Patricia; Lalla, Patti; Leo, Maria; Merrill-Bell, Audrey; Nicholson, Marjorie; Villaruel, Elizabeth

    2002-01-01

    Sepsis remains the leading cause of death in non-coronary ICU patients, despite improvements in supportive treatment modalities such as antimicrobial drugs and ventilation therapy. Further, the incidence of sepsis is projected to increase in years to come, related to factors including a rise in immunosuppressed patient populations and more widespread use of invasive lines and procedures. In this article, the authors seek to advance nurses' understanding of sepsis by reviewing the SIRS to septic shock paradigm and using a case study to illustrate how a patient progressed along the continuum. The role of the critical care nurse is an important aspect of the care of these patients. Early identification of patients at risk for, or who are developing, sepsis is crucial in order to improve patient outcomes.

  2. Staghorn calculus endotoxin expression in sepsis.

    PubMed

    McAleer, Irene M; Kaplan, George W; Bradley, John S; Carroll, Stephen F

    2002-04-01

    Staghorn calculi are infrequent and generally are infected stones. Struvite or apatite calculi are embedded with gram-negative bacteria, which can produce endotoxin. Sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. Sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. We present a child with an infected staghorn calculus who developed overwhelming sepsis and died after percutaneous stone manipulation. Endotoxin assay of stone fragments demonstrated an extremely high level of endotoxin despite low colony bacterial culture growth. This is the first reported case in which endotoxin was demonstrated in stone fragments from a child who died of severe sepsis syndrome after percutaneous staghorn stone manipulation.

  3. [Identification of the patient with sepsis].

    PubMed

    Rossi, B; Piazza, C; Moraschini, F; Marchesi, G M; Fumagalli, R

    2004-05-01

    Sepsis may be defined as a clinical syndrome caused by an organism's response to infection. The complex alterations triggered by the infection include inflammation and systemic coagulopathy in the absence of effective fibrinolysis. Possible manifestations vary in entity and severity, ranging from systemic inflammatory response syndrome (SIRS) to septic shock and multiorgan dysfunction syndrome (MODS). The nurse can play a fundamental role in the timely recognition of SIRS and in the early identification of the onset of signs of organ damage. In this way, an additional aid to establishing diagnosis can be provided and targeted treatment instituted. Following a brief presentation of the pathophysiology and epidemiology of sepsis, the manifestations and attendant risks are described, the most appropriate monitoring methods and the main nursing tasks in treating sepsis are discussed. We present the results of our experience in identifying patients with sepsis through the application of selection criteria adopted from clinical studies on the use of activated protein C.

  4. Neuro-oxidative-nitrosative stress in sepsis.

    PubMed

    Berg, Ronan M G; Møller, Kirsten; Bailey, Damian M

    2011-07-01

    Neuro-oxidative-nitrosative stress may prove the molecular basis underlying brain dysfunction in sepsis. In the current review, we describe how sepsis-induced reactive oxygen and nitrogen species (ROS/RNS) trigger lipid peroxidation chain reactions throughout the cerebrovasculature and surrounding brain parenchyma, due to failure of the local antioxidant systems. ROS/RNS cause structural membrane damage, induce inflammation, and scavenge nitric oxide (NO) to yield peroxynitrite (ONOO(-)). This activates the inducible NO synthase, which further compounds ONOO(-) formation. ROS/RNS cause mitochondrial dysfunction by inhibiting the mitochondrial electron transport chain and uncoupling oxidative phosphorylation, which ultimately leads to neuronal bioenergetic failure. Furthermore, in certain 'at risk' areas of the brain, free radicals may induce neuronal apoptosis. In the present review, we define a role for ROS/RNS-mediated neuronal bioenergetic failure and apoptosis as a primary mechanism underlying sepsis-associated encephalopathy and, in sepsis survivors, permanent cognitive deficits.

  5. Chronic kidney disease-induced HMGB1 elevation worsens sepsis and sepsis-induced acute kidney injury

    PubMed Central

    Leelahavanichkul, Asada; Huang, Yuning; Hu, Xuzhen; Zhou, Hua; Tsuji, Takayuki; Chen, Richard; Kopp, Jeffrey B.; Schnermann, Jürgen; Yuen, Peter S.T.; Star, Robert A.

    2012-01-01

    We previously showed that kidney dysfunction/interstitial fibrosis by folate predisposes mice to sepsis mortality (normal/sepsis: 15%; folate/sepsis: 90%); agents that increased survival in normal septic mice were ineffective in the two-stage model. We used a recently characterized 5/6 nephrectomy (Nx) mouse model of progressive chronic kidney disease (CKD) to study how CKD impacts sepsis and acute kidney injury (AKI) induced by cecal ligation-puncture (CLP). CKD intensified sepsis severity (by kidney and liver injury, cytokines, and spleen apoptosis). Accumulation of HMGB1, VEGF, TNF-α, IL-6, or IL-10 was increased in CKD or sepsis alone and to a greater extent in CKD-sepsis, and only part of this effect could be explained by decreased renal clearance. Surprisingly, we found splenic apoptosis in CKD, even in the absence of sepsis. Although sFLT-1 effectively treated sepsis, it was ineffective against CKD-sepsis. Conversely, a single dose of HMGB1-neutralizing antiserum, administered 6h after sepsis alone was ineffective; however, CKD/sepsis was attenuated by anti-HMGB1. Splenectomy transiently decreased circulating HMGB1 levels, which reversed the effectiveness of anti-HMGB1 treatment on CKD/sepsis. We conclude that progressive CKD increases sepsis severity, in part, by reducing renal clearance of cytokines; CKD-induced splenic apoptosis and HMGB1 could be important common mediators for both CKD and sepsis. PMID:21832986

  6. Clinical terminology support for a national ambulatory practice outcomes research network.

    PubMed

    Ricciardi, Thomas N; Lieberman, Michael I; Kahn, Michael G; Masarie, F E

    2005-01-01

    The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial "back-end" information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems.

  7. Interleukin 18: a biomarker for differential diagnosis between adult-onset Still's disease and sepsis.

    PubMed

    Priori, Roberta; Colafrancesco, Serena; Alessandri, Cristiano; Minniti, Antonina; Perricone, Carlo; Iaiani, Giancarlo; Palazzo, Donatella; Valesini, Guido

    2014-06-01

    The differential diagnosis between rheumatic diseases and infectious conditions is a great challenge in clinical practice. Adult-onset Still's disease (AOSD) is a rare systemic inflammatory syndrome that shares several clinical and laboratory variables with sepsis. Interleukin (IL)-18 is overexpressed in AOSD, suggesting a possible role as a disease biomarker. The aim of our study was to detect IL-18 serum levels in a cohort of patients with AOSD and sepsis and to address its possible role as a biomarker for differential diagnosis. A group of unselected patients with AOSD diagnosed according to the Yamaguchi criteria and consecutive patients with sepsis diagnosed according to the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria were enrolled. The clinical and laboratory data were collected. In the AOSD group, disease activity was assessed by Pouchot's and Rau's criteria. IL-18 serum levels were detected by ELISA. Thirty-nine patients with AOSD and 18 patients with sepsis were enrolled. Two out of 18 patients with sepsis (11.1%) also fulfilled the Yamaguchi criteria. A significant difference was found in IL-18 serum levels between patients with active and inactive disease (p < 0.001), and it positively correlated with disease activity (p = 0.0003), ferritin serum level (p = 0.016), and erythrocyte sedimentation rate (p = 0.041). IL-18 was significantly increased in patients with AOSD when compared with sepsis (p = 0.014). For a cutoff of 148.9 pg/ml, this test had a specificity of 78.3% and a sensitivity of 88.6%. We have demonstrated that IL-18 can be a biomarker for differential diagnosis between AOSD and sepsis.

  8. Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt.

    PubMed

    Awad, Hesham A; Mohamed, Maha H; Badran, Nabil F; Mohsen, Manal; Abd-Elrhman, Al-Sayed A

    2016-03-01

    Neonatal sepsis remains a serious problem in any neonatal intensive care unit (NICU). Bacterial organisms have developed increased resistance to commonly used antibiotics. Because not enough data are available from Egypt, the aim of the present study was to determine the causative bacteria and the level of their resistance to commonly used antibiotics in tertiary NICUs in Cairo, Egypt. A 3.5-year retrospective study was carried out at NICUs of the Children's Hospital of Ain Shams University and that of El-Hussein Hospital, Al-Azhar University, Egypt. Records of neonates were reviewed. All neonates with culture-proven sepsis were included in the study. Almost one-third of the admitted neonates (33.4%) were diagnosed as having neonatal sepsis, 32.25% of them culture-proven. Early/late onset sepsis was found in 35.4 and 64.6%, respectively. Gram-negative/gram-positive bacteria was found in 68 to 25.6%. Fungal infection was detected in 9% of the isolates. Escherichia coli was the main pathogen isolated in both early-onset sepsis (41.2%) and late-onset sepsis (24.5%). Overall, 77% of the isolates were multidrug-resistant (60% of gram-positive bacteria and 83.4% of gram-negative bacteria). Nearly 80% (79%) of mortality was caused by multidrug-resistant organisms. Gram-positive and gram-negative bacteria showed high resistance against commonly used antibiotics such as ampicillin, amoxicillin, cefotaxime, ceftriaxone, and gentamicin. There is an alarming increase in antibiotic resistance to the commonly used antibiotics. Continuous surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy. Improvement of infection control practices, avoidance of irrational use of antibiotics, and revision of the protocols are mandatory in the prevention of neonatal sepsis.

  9. Neonatal Infectious Diseases: Evaluation of Neonatal Sepsis

    PubMed Central

    Spearman, Paul W.; Stoll, Barbara J.

    2015-01-01

    Synopsis Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation and early initiation of therapy are required to prevent adverse outcomes. The following chapter reviews recent trends in epidemiology, and provides an update on risk factors, diagnostic methods and management of neonatal sepsis. PMID:23481106

  10. Neonatal infectious diseases: evaluation of neonatal sepsis.

    PubMed

    Camacho-Gonzalez, Andres; Spearman, Paul W; Stoll, Barbara J

    2013-04-01

    Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal, and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation, and early initiation of therapy are required to prevent adverse outcomes. This article reviews recent trends in epidemiology and provides an update on risk factors, diagnostic methods, and management of neonatal sepsis. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. [Sepsis: new findings and developments. Update 2016].

    PubMed

    Kochanek, Matthias; Shimabukuro-Vornhagen, Alexander; von Bergwelt-Baildon, Michael; Böll, Boris

    2016-09-01

    The incidence of sepsis increases in Germany from latest DRG evaluations and also the mortality is still at a high level. The aim of the new Sepsis - 3 definition is to optimize the identification and initiation of therapy. The treatment algorithms by Rivers (EGDT) are getting old. Rapid identification of septic patients, rapid administration of antibiotics and rapid therapy management are crucial. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Gynaecological cancer follow-up: national survey of current practice in the UK

    PubMed Central

    Leeson, Simon; Stuart, Nick; Sylvestre, Yvonne; Hall, Liz; Whitaker, Rhiannon

    2013-01-01

    Objective To establish a baseline of national practice for follow-up after treatment for gynaecological cancer. Design Questionnaire survey. Setting Gynaecological cancer centres and units. Geographical location UK. Participants Members of the British Gynaecological Cancer Society and the National Forum of Gynaecological Oncology Nurses. Interventions A questionnaire survey. Outcome measures To determine schedules of follow-up, who provides it and what routine testing is used for patients who have had previous gynaecological cancer. Results A total of 117 responses were obtained; 115 (98%) reported hospital scheduled regular follow-up appointments. Two involved general practitioners. Follow-up was augmented or replaced by telephone follow-up in 29 responses (25%) and patient-initiated appointments in 38 responses (32%). A total of 80 (68%) cancer specialists also offered combined follow-up clinics with other specialties. Clinical examinations for hospital-based follow-up were mainly performed by doctors (67% for scheduled regular appointments and 63% for patient-initiated appointments) while telephone follow-up was provided in the majority by nurses (76%). Most respondents (76/117 (65%)) provided routine tests, of which 66/76 (87%) reported carrying out surveillance tests for ovarian cancer, 35/76 (46%) for cervical cancer, 8/76 (11%) for vulval cancer and 7/76 (9%) for endometrial cancer. Patients were usually discharged after 5 years (82/117 (70%)), whereas three (3%) were discharged after 4 years, nine (8%) after three years and one (1%) after 2 years. Conclusions Practice varied but most used a standard hospital-based protocol of appointments for 5 years and routine tests were performed usually for women with ovarian cancer. A minority utilised nurse-led or telephone follow-up. General practitioners were rarely involved in routine care. A randomised study comparing various models of follow-up could be considered. PMID:23883880

  13. Gynaecological cancer follow-up: national survey of current practice in the UK.

    PubMed

    Leeson, Simon; Stuart, Nick; Sylvestre, Yvonne; Hall, Liz; Whitaker, Rhiannon

    2013-01-01

    To establish a baseline of national practice for follow-up after treatment for gynaecological cancer. Questionnaire survey. Gynaecological cancer centres and units. Members of the British Gynaecological Cancer Society and the National Forum of Gynaecological Oncology Nurses. A questionnaire survey. To determine schedules of follow-up, who provides it and what routine testing is used for patients who have had previous gynaecological cancer. A total of 117 responses were obtained; 115 (98%) reported hospital scheduled regular follow-up appointments. Two involved general practitioners. Follow-up was augmented or replaced by telephone follow-up in 29 responses (25%) and patient-initiated appointments in 38 responses (32%). A total of 80 (68%) cancer specialists also offered combined follow-up clinics with other specialties. Clinical examinations for hospital-based follow-up were mainly performed by doctors (67% for scheduled regular appointments and 63% for patient-initiated appointments) while telephone follow-up was provided in the majority by nurses (76%). Most respondents (76/117 (65%)) provided routine tests, of which 66/76 (87%) reported carrying out surveillance tests for ovarian cancer, 35/76 (46%) for cervical cancer, 8/76 (11%) for vulval cancer and 7/76 (9%) for endometrial cancer. Patients were usually discharged after 5 years (82/117 (70%)), whereas three (3%) were discharged after 4 years, nine (8%) after three years and one (1%) after 2 years. Practice varied but most used a standard hospital-based protocol of appointments for 5 years and routine tests were performed usually for women with ovarian cancer. A minority utilised nurse-led or telephone follow-up. General practitioners were rarely involved in routine care. A randomised study comparing various models of follow-up could be considered.

  14. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration--2014.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2015-07-01

    The results of the 2014 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are described. A stratified random sample of pharmacy directors at 1435 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 29.7%. Ninety-seven percent of hospitals used automated dispensing cabinets in their medication distribution systems, 65.7% of which used individually secured lidded pockets as the predominant configuration. Overall, 44.8% of hospitals used some form of machine-readable coding to verify doses before dispensing in the pharmacy. Overall, 65% of hospital pharmacy departments reported having a cleanroom compliant with United States Pharmacopeia chapter 797. Pharmacists reviewed and approved all medication orders before the first dose was administered, either onsite or by remote order view, except in procedure areas and emergency situations, in 81.2% of hospitals. Adoption rates of electronic health information have rapidly increased, with the widespread use of electronic health records, computer prescriber order entry, barcodes, and smart pumps. Overall, 31.4% of hospitals had pharmacists practicing in ambulatory or primary care clinics. Transitions-of-care services offered by the pharmacy department have generally increased since 2012. Discharge prescription services increased from 11.8% of hospitals in 2012 to 21.5% in 2014. Approximately 15% of hospitals outsourced pharmacy management operations to a contract pharmacy services provider, an increase from 8% in 2011. Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve the efficiency, safety, and clinical outcomes of medication use in health systems. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  15. A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England.

    PubMed

    Palmer, N A; Pealing, R; Ireland, R S; Martin, M V

    2000-05-27

    To study the therapeutic prescribing of antibiotics by general dental practitioners. A postal questionnaire of National Health Service general dental practitioners in ten English Health Authorities. General dental practitioners (1,544) contracted to provide NHS treatment in the Health Authorities of Liverpool, Wirral, Oxfordshire, Buckinghamshire, Nottingham, North Nottinghamshire, Sheffield, Newcastle, Northumberland and North Tyneside. The questionnaires were analysed and the responses to each question expressed as absolute frequencies. Responses to the questionnaire were received from 929 (60.1%) practitioners. More than 95% of practitioners recognised the need for prescribing antibiotics where there was evidence of spreading infection. Some practitioners (12.5%) prescribed antibiotics for acute pulpitis and (3.3%) for chronic marginal gingivitis. Antibiotics were prescribed by practitioners before drainage of acute abscesses (69%) and by 23% after drainage. Practitioners were generally not influenced by patient's expectations of receiving antibiotics (92%), but would prescribe when under pressure of time (30.3%), if they were unable to make a definitive diagnosis (47.3%), or if treatment had to be delayed (72.5%). Amoxicillin was the most frequently prescribed antibiotic used for most clinical conditions apart from pericoronitis, acute ulcerative gingivitis and dry sockets where metronidazole was the drug of choice. There was a wide variety of dosage, frequency and duration for all the antibiotics used in the treatment of acute dental infections. The results obtained from this questionnaire support the conclusion that the therapeutic prescribing of antibiotics in general dental practice varies widely and is suboptimal. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of the antibiotics in National Health Service general dental practice.

  16. ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2012.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2013-05-01

    The results of the 2012 American Society of Health-System Pharmacists national survey of pharmacy practice in U.S. hospital settings are presented. A stratified random sample of pharmacy directors at 1413 general and children's medical-surgical hospitals were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI's hospital database. In this national probability sample survey, the response rate was 34.0%. The rate of pharmacist monitoring of most patients (i.e., >75%) in hospitals has increased, from 20.3% in 2000 to 46.5% in 2012. Therapeutic drug monitoring programs are in place at most hospitals; at more than 80% of hospitals, pharmacists have the authority to order laboratory tests and adjust medication dosages. A safety culture assessment has been conducted at 72.4% of hospitals. Pharmacists routinely perform discharge counseling in 24.7% of hospitals. At most hospitals, nurses are primarily responsible for medication reconciliation, but 65.9% of pharmacy directors would like pharmacy to have this responsibility. Computerized prescriber order entry is now used in 54.4% of hospitals, with barcode-assisted medication administration used in 65.5% and smart pumps used in 77% of hospitals. The majority of hospitals have fully or partially implemented electronic health records. An increase in the use of remote pharmacist review of medication orders has reduced the percentage of hospitals where orders are not reviewed before a dose is administered to 32%. Pharmacists continue to improve medication use in U.S. hospitals through patient monitoring and education, safety initiatives, collaborative practices with other health care professionals, assisting in the adoption of technologies, and the provision of pharmacy services to outpatients.

  17. Emerging Land Use Practices in Two Year Colleges. A Report of a National Survey of Land Use Practices of Community, Junior and Technical Colleges.

    ERIC Educational Resources Information Center

    Bender, Louis W.

    A national survey was conducted to determine land use practices among a random sample of 192 two-year colleges and to compare findings with results from a 1978 study. The survey solicited a description of the institution; a description of all campus land together with estimates of acreage directly dedicated for educational programs, acreage…

  18. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

    PubMed

    Singer, Mervyn; Deutschman, Clifford S; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R; Chiche, Jean-Daniel; Coopersmith, Craig M; Hotchkiss, Richard S; Levy, Mitchell M; Marshall, John C; Martin, Greg S; Opal, Steven M; Rubenfeld, Gordon D; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C

    2016-02-23

    Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. To evaluate and, as needed, update definitions for sepsis and septic shock. A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment). Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock

  19. Sepsis: From Pathophysiology to Individualized Patient Care

    PubMed Central

    László, Ildikó; Trásy, Domonkos; Molnár, Zsolt; Fazakas, János

    2015-01-01

    Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review. PMID:26258150

  20. [Are statins a therapeutic alternative in sepsis?].

    PubMed

    Carrillo-Esper, Raúl; Rivera-Buendía, Santos; Carrillo-Córdova, Jorge Raúl; Carrillo-Córdova, Luis Daniel

    2007-01-01

    Sepsis continues to be a major cause of morbidity and mortality. Evidence is emerging from observational studies and basic science research that statins might be associated with reduced mortality in sepsis. Statins have diverse immunomodulatory and antiinflammatory properties independent of their lipid-lowering ability. The protective association between statins and sepsis persisted in high-risk subgroups including patients with diabetes mellitus, those with malignancy, and those receiving steroids. This review discusses the basis of these observations and the current place of statin therapy in patients with sepsis. This is a rapidly growing field of fascinating experimental biology. It suggests an urgent need to investigate the pharmacology of these drugs and reappraise their therapeutic indications in critically ill patients. If this finding is supported by prospective controlled trials, statins may play an important role in sepsis related mortality. By the other hand statins are significantly cheaper than other therapies that have been shown to improve outcome in sepsis, and the demonstration of mortality benefit would have enormous cost-benefit implication.

  1. Sepsis: From Pathophysiology to Individualized Patient Care.

    PubMed

    László, Ildikó; Trásy, Domonkos; Molnár, Zsolt; Fazakas, János

    2015-01-01

    Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review.

  2. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.

    PubMed

    Levy, Mitchell M; Fink, Mitchell P; Marshall, John C; Abraham, Edward; Angus, Derek; Cook, Deborah; Cohen, Jonathan; Opal, Steven M; Vincent, Jean-Louis; Ramsay, Graham

    2003-04-01

    In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were to "provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well. The general definitions introduced as a result of that conference have been widely used in practice, and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. Several North American and European intensive care societies agreed to revisit the definitions for sepsis and related conditions. This conference was sponsored by the Society of Critical Care Medicine (SCCM), The European Society of Intensive Care Medicine (ESICM), The American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Surgical Infection Society (SIS). 29 participants attended the conference from Europe and North America. In advance of the conference, subgroups were formed to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiologic data, and coagulation parameters. The present manuscript serves as the final report of the 2001 International Sepsis Definitions Conference. 1. Current concepts of sepsis, severe sepsis and septic shock remain useful to clinicians and researchers. 2. These definitions do not allow precise staging or prognostication of the host response to infection. 3. While SIRS remains a useful concept, the diagnostic criteria for SIRS published in 1992 are overly sensitive and non-specific. 4. An expanded list of signs and symptoms of sepsis may better reflect the clinical

  3. The opportunities and ethics of big data: practical priorities for a national Council of Data Ethics.

    PubMed

    Varley-Winter, Olivia; Shah, Hetan

    2016-12-28

    In order to generate the gains that can come from analysing and linking big datasets, data holders need to consider the ethical frameworks, principles and applications that help to maintain public trust. In the USA, the National Science Foundation helped to set up a Council for Big Data, Ethics and Society, of which there is no equivalent in the UK. In November 2015, the Royal Statistical Society convened a workshop of 28 participants from government, academia and the private sector, and discussed the practical priorities that might be assisted by a new Council of Data Ethics in the UK. This article draws together the views from that meeting. Priorities for policy-makers and others include seeking a public mandate and informing the terms of the social contract for use of data; building professional competence and due diligence on data protection; appointment of champions who are competent to address public concerns; and transparency, across all dimensions. For government data, further priorities include improvements to data access, and development of data infrastructure. In conclusion, we support the establishment of a national Data Ethics Council, alongside wider and deeper engagement of the public to address data ethics dilemmas.This article is part of the themed issue 'The ethical impact of data science'.

  4. The practice of laparoscopic liver surgery in Belgium: a national survey.

    PubMed

    Tomassini, Federico; Scuderi, Vincenzo; Berardi, Giammauro; Dili, Alexandra; D'Hondt, Mathieu; Sergeant, Gregory; Hubert, Catherine; Huysentruyt, Frederik; Berrevoet, Frederik; Lucidi, Valerio; Troisi, Roberto Ivan

    2017-02-01

    Laparoscopic liver surgery (LLS) gained popularity bringing several advantages including decreased morbidity and reduction of length of hospital stay compared to open. To understand practice and evolution of LLS in Belgium, a 20-questions survey was sent to all members of the Royal Belgian Society for Surgery, the Belgian Section of Hepato-Pancreatic and Biliary Surgery and the Belgian Group for Endoscopic Surgery. Thirty-seven surgical units representing 61 surgeons performing LLS in Belgium responded: 50% from regional hospitals, 28% from university and 22% from peripheral hospitals. Replies from high volume centers (>50 liver-surgery/year) were 19%. More than 25% of liver procedures were performed laparoscopically in 35% of centers. LLS is adopted since more than 15-years in 14.5% of centers with an increasing rate reported in 59%. Low relevance of LLS in the hospital organization (26.5%) and lack of time in surgical schedules (12%) or of specific training (9%) are the main barriers for further diffusion. More than 80% of the responders agreed to participate to a national prospective registry. LLS is mainly performed in experienced HPB units with an increasing interest in peripheral centers. A prospective national registry will be useful by providing real data in terms of indications, morbidity and overall evolution.

  5. Using National Health Care Databases and Problem-Based Practice Analysis to Inform Integrated Curriculum Development.

    PubMed

    Baker, Amy J; Raymond, Mark R; Haist, Steven A; Boulet, John R

    2017-04-01

    One challenge when implementing case-based learning, and other approaches to contextualized learning, is determining which clinical problems to include. This article illustrates how health care utilization data, readily available from the National Center for Health Statistics (NCHS), can be incorporated into an educational needs assessment to identify medical problems physicians are likely to encounter in clinical practice. The NCHS survey data summarize patient demographics, diagnoses, and interventions for tens of thousands of patients seen in various settings, including emergency departments (EDs), clinics, and hospitals.Selected data from the National Hospital Ambulatory Medical Care Survey: Emergency Department illustrate how instructional materials can be derived from the results of such public-use health care data. Using fever as the reason for visit to the ED, the patient management path is depicted in the form of a case drill-down by exploring the most common diagnoses, blood tests, diagnostic studies, procedures, and medications associated with fever.Although these types of data are quite useful, they should not serve as the sole basis for determining which instructional cases to include. Additional sources of information should be considered to ensure the inclusion of cases that represent infrequent but high-impact problems and those that illustrate fundamental principles that generalize to other cases.

  6. Regional anaesthesia practice for total knee arthroplasty: French national survey - 2008.

    PubMed

    Bouaziz, H; Bondàr, A; Jochum, D; Fuzier, R; Paqueron, X; Ripart, J; Choquet, O; Belbachir, A; Fletcher, D; Estèbe, J-P

    2010-06-01

    Improved pain management techniques and rehabilitation programs have significantly modified outcome for total knee arthroplasty (TKA). The aim of the survey was to describe the French practice patterns in regional anaesthesia for TKA. Twenty-item questionnaires were distributed to units with significant orthopaedic activity across France. The content referred to the type of orthopaedic activity; anaesthetic and analgesic management; preoperative patient information; technical aspects describing regional anaesthesia and postoperative analgesia. Response rate was 54%. Combined general anaesthesia and perineural catheter was the most frequently used anaesthetic technique. Most of respondents used multimodal analgesia (including femoral nerve catheter by 80%). Written hygiene protocols were rarely available. Sterile gowns were seldom worn. Among antiseptic agents, povidone iodine was most often used. Sedative agents were systematically used by 36% of respondents. Ropivacaine was the preferred local anaesthetic agent. Finally, adjuvants were rarely used. In most cases (58%) the femoral block was performed before induction of general anaesthesia. The catheter was commonly threaded to a length between 5 and 8 cm. The correct position of the catheter tip was verified clinically by majority of respondents. Local anaesthetics were administered by continuous infusion, continuous infusion plus boluses and boluses alone in 44, 36 and 8% of cases. Catheter duration was 48 and 72 h in 45 and 33% of the units and was independent of pain scores. This national survey showed practices in accordance with recent guidelines as well as persistent challenges in regional anaesthesia for TKA. 2010 Elsevier Masson SAS. All rights reserved.

  7. Standard practices for computerized clinical decision support in community hospitals: a national survey

    PubMed Central

    McCormack, James L; Sittig, Dean F; Wright, Adam; McMullen, Carmit; Bates, David W

    2012-01-01

    Objective Computerized provider order entry (CPOE) with clinical decision support (CDS) can help hospitals improve care. Little is known about what CDS is presently in use and how it is managed, however, especially in community hospitals. This study sought to address this knowledge gap by identifying standard practices related to CDS in US community hospitals with mature CPOE systems. Materials and Methods Representatives of 34 community hospitals, each of which had over 5 years experience with CPOE, were interviewed to identify standard practices related to CDS. Data were analyzed with a mix of descriptive statistics and qualitative approaches to the identification of patterns, themes and trends. Results This broad sample of community hospitals had robust levels of CDS despite their small size and the independent nature of many of their physician staff members. The hospitals uniformly used medication alerts and order sets, had sophisticated governance procedures for CDS, and employed staff to customize CDS. Discussion The level of customization needed for most CDS before implementation was greater than expected. Customization requires skilled individuals who represent an emerging manpower need at this type of hospital. Conclusion These results bode well for robust diffusion of CDS to similar hospitals in the process of adopting CDS and suggest that national policies to promote CDS use may be successful. PMID:22707744

  8. National Cancer Institute Biospecimen Evidence-Based Practices: a novel approach to pre-analytical standardization.

    PubMed

    Engel, Kelly B; Vaught, Jim; Moore, Helen M

    2014-04-01

    Variable biospecimen collection, processing, and storage practices may introduce variability in biospecimen quality and analytical results. This risk can be minimized within a facility through the use of standardized procedures; however, analysis of biospecimens from different facilities may be confounded by differences in procedures and inferred biospecimen quality. Thus, a global approach to standardization of biospecimen handling procedures and their validation is needed. Here we present the first in a series of procedural guidelines that were developed and annotated with published findings in the field of human biospecimen science. The series of documents will be known as NCI Biospecimen Evidence-Based Practices, or BEBPs. Pertinent literature was identified via the National Cancer Institute (NCI) Biospecimen Research Database ( brd.nci.nih.gov ) and findings were organized by specific biospecimen pre-analytical factors and analytes of interest (DNA, RNA, protein, morphology). Meta-analysis results were presented as annotated summaries, which highlight concordant and discordant findings and the threshold and magnitude of effects when applicable. The detailed and adaptable format of the document is intended to support the development and execution of evidence-based standard operating procedures (SOPs) for human biospecimen collection, processing, and storage operations.

  9. Pleiotropic regulations of neutrophil receptors response to sepsis.

    PubMed

    Zhang, Huafeng; Sun, Bingwei

    2017-03-01

    Sepsis is a complex clinical condition that causes a high mortality rate worldwide. Numerous studies on the pathophysiology of sepsis have revealed an imbalance in the inflammatory network, thus leading to tissue damage, organ failure, and ultimately death. The impairment of neu-trophil migration is associated with the outcome of sepsis. Literature review was performed on the roles of neutrophil recruitment and neutrophil receptors as pleiotropic regulators during sepsis. Additionally, we systematically classify neutrophil receptors with regard to the neutrophil response during sepsis and discuss the clinical implications of these receptors for the treatment of sepsis. Increasing evidence suggests that there is significant dysfunction in neutrophil recruitment during sepsis, characterized by the failure to migrate to the site of infection. Neutrophil receptors, as pleiotropic regulators, play important roles in the neutrophil response during sepsis. Neutrophil receptors play key roles in chemotactic neutrophil migration and may prove to be suitable targets in future pharmacological therapies for sepsis.

  10. Human Papillomavirus Genotyping Testing Practice in 2014: Results of a College of American Pathologists National Survey.

    PubMed

    Zhao, Chengquan; Crothers, Barbara A; Ghofrani, Mohiedean; Li, Zaibo; Souers, Rhona J; Hussain, Mujtaba; Fan, Fang; Ocal, Idris Tolgay; Goodrich, Kelly; Shen, Rulong; Davey, Diane D

    2016-12-01

    - College of American Pathologists (CAP) surveys are used to establish national benchmarks for laboratories. - To investigate human papillomavirus (HPV) genotyping testing practice patterns in laboratories in 2014. - Data were analyzed from the CAP HPV Genotyping Practices Supplemental Questionnaire distributed to 749 laboratories participating in the CAP Human Papillomavirus (High Risk) for Cytology Program. - Six hundred four of 749 laboratories (80.6%) responded to the survey. More laboratories offered HPV genotyping testing and performed in-house HPV genotyping testing as compared to previous surveys. The Roche cobas HPV test was the most commonly used genotyping method (37.0%; 160 of 433), followed by Hologic Aptima HPV16 18/45 (26.1%; 113 of 433) and Hologic Cervista HPV16/18 (14.3%; 62 of 433). Most laboratories (287 of 399; 71.9%) offered HPV genotyping for high-risk HPV cases regardless of Papanicolaou (Pap) test results and patient age; this pattern was more common in laboratories using cobas. The remaining laboratories specifically offered testing to women with a negative Pap test result at age 30 years and older (65.2%, 73 of 112) or all ages (37.5%, 42 of 112). The median reporting rates of HPV16 and/or HPV18 positivity were 20.6%, 25.7%, 21.1%, and 57.4% for women with positive high-risk HPV adjunctive negative Pap results, atypical squamous cells of undermined significance, low-grade squamous intraepithelial lesion, and high-grade squamous lesion, respectively. - Human papillomavirus genotyping testing has increased. Roche cobas and Hologic Aptima genotype methods were the most common, and laboratories using cobas usually offered genotyping regardless of Pap test result and age. The data provide a baseline and trend of HPV genotyping test practices in 2014.

  11. Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

    PubMed

    Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Godwin, Sandria; Chambers, Delores

    2015-07-01

    Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

  12. Gatekeeping practices of music therapy academic programs and internships: a national survey.

    PubMed

    Hsiao, Feilin

    2014-01-01

    Gatekeeping safeguards access to the practice of a profession to ensure the quality of clinical services. It involves selective admission, continuous evaluation, and timely and ethical decisions in response to trainees with severe professional competency problems (SPCP). To date, little information is available concerning gatekeeping practices in the field of music therapy. This study investigated the extent and outcomes of gatekeeping practices across academic programs and National Roster internship sites approved by the American Music Therapy Association. Specifically, it examined the prevalence of trainees with SPCP, program-wide precautionary measures, common indicators of trainees with SPCP, remedial strategies, and supports and barriers to effective management. Thirty-two academic program directors and 77 internship directors completed an online survey. Responses were compiled into aggregate form (frequencies & percentages) for analysis. Chi-square tests with Yates' correction were applied to compare the differences between academic programs and internships. A significantly higher percentage of academic programs (93.8%) reported having at least one trainee with SPCP over the past 5 years than did internships (66.2%). The most common indicators of competency problems included inadequate music skill development, emotional instability, limited communication skills, deficient interpersonal skills, defensiveness in supervision, and lack of insight. Typical remedial methods included referral to personal therapy, increased supervision, and repetition of practicum or extension of internship. Issues regarding trainees with SPCP are frequently addressed by academic and internship program directors. Improving clarity within professional guidelines and establishing more rigorous and consistent standards across training programs are recommended. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Weight control practices of Division I National Collegiate Athletic Association athletes.

    PubMed

    Wilson, Patrick B; Madrigal, Leilani A; Burnfield, Judith M

    2016-01-01

    Altering body weight can have substantial effects on an athlete's performance and well-being. Limited information is available describing the weight control practices of Division I National Collegiate Athletic Association (NCAA) athletes. Weight control practices data from 188 (138 male and 50 female; 18-23 y) Division I NCAA athletes were analyzed as a part of this cross-sectional, retrospective study. Participants completed questionnaires on weight control practices and weight control nutrition knowledge at the end of their season and were classified into weight-sensitive and less weight-sensitive sports. A higher proportion of females attempted to lose weight than males among less weight-sensitive sports (61% vs. 22%, chi-square = 15.8, p < 0.001). However, the prevalence of weight loss attempts was not different between females and males among weight-sensitive sports (50% vs. 60%, chi-square = 0.5, p = 0.479). The prevalence of weight gain attempts differed by gender for less weight-sensitive sports (65% vs. 4% for males and females, chi-square = 33.5, p < 0.001) but not weight-sensitive sports (24% vs. 9% for males and females, chi-square = 2.1, p = 0.146). Weight control knowledge did not differ between participants attempting versus not attempting to lose weight (Mann-Whitney U = 3340, z = -1.37, p = 0.17). Common maladaptive behaviors used to lose weight included skipping meals and exercising more than usual. Weight loss attempts are common among Division I NCAA athletes, and the differences between males and females may be more pronounced among less weight-sensitive sports. Weight gain attempts are more common in select male sports.

  14. ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education--2009.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2010-04-01

    Results of the 2009 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. A stratified random sample of pharmacy directors at 1364 general and children's medical-surgical hospitals in the United States were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI's hospital database. The response rate was 40.5%. Virtually all hospitals (97.3%) had pharmacists regularly monitor medication therapy in some capacity; nearly half monitored 75% or more of their patients. Over 92% had pharmacists routinely monitor serum medication concentrations or their surrogate markers, and most hospitals allowed pharmacists to order initial serum concentrations (80.1%) and adjust dosages (79.2%). Interdisciplinary committees reviewed adverse drug events in 89.3% of hospitals. Prospective analysis was conducted by 66.2% of hospitals, and retrospective analysis was performed by 73.6%. An assessment of safety culture had been conducted by 62.8% of hospitals. Most hospitals assigned oversight for patient medication education to nursing (89.0%), but many hospitals (68.9%) reported that pharmacists provided medication education to 1-25% of patients. Computerized prescriber-order-entry systems with clinical decision support were in place in 15.4%, bar-code-assisted medication administration systems were used by 27.9%, smart infusion pumps were used in 56.2%, and complete electronic medical record systems were in place in 8.8% of hospitals. The majority of hospitals (64.7%) used an integrated pharmacy practice model using clinical generalists. Pharmacists were significantly involved in monitoring medication therapy. Pharmacists were less involved in medication education activities. Technologies to improve the use of medications were used in an increasing percentage of hospitals. Hospital pharmacy practice was increasingly integrated, with pharmacists having both

  15. Post-Acute Care Use and Hospital Readmission after Sepsis.

    PubMed

    Jones, Tiffanie K; Fuchs, Barry D; Small, Dylan S; Halpern, Scott D; Hanish, Asaf; Umscheid, Craig A; Baillie, Charles A; Kerlin, Meeta Prasad; Gaieski, David F; Mikkelsen, Mark E

    2015-06-01

    The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown. To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P < 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P < 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P < 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.

  16. Laboratory detection of sepsis: biomarkers and molecular approaches.

    PubMed

    Riedel, Stefan; Carroll, Karen C

    2013-09-01

    Sepsis, severe sepsis, and septic shock cause significant morbidity and mortality worldwide. Rapid diagnosis and therapeutic interventions are desirable to improve the overall mortality in patients with sepsis. However, gold standard laboratory diagnostic methods for sepsis, pose a significant challenge to rapid diagnosis of sepsis by physicians and laboratories. This article discusses the usefulness and potential of biomarkers and molecular test methods for a more rapid clinical and laboratory diagnosis of sepsis. Because new technologies are quickly emerging, physicians and laboratories must appreciate the key factors and characteristics that affect the clinical usefulness and diagnostic accuracy of these test methodologies.

  17. Pioneering a National Advanced Practice Leadership Council to Enhance Care Delivery in a Large 19-State Health System.

    PubMed

    Harms, Dixie; Ewen, Julianne Z; Metsker, Matt; Swanson, Jay; Oas, Kimberly H

    This article describes an innovative approach to enhancing the capacity of advanced practice clinicians (APCs) in a large faith-based health system consisting of multiple markets across the United States. With the challenges in health care today, promotion of advanced practice is vital to increasing quality and access to care while maintaining cost-effectiveness. The development of a national Advanced Practice Leadership Council led by the Vice President of Advanced Practice at Catholic Health Initiatives has been a progressive approach in mitigating the challenges facing APCs in today's health care arena. The success of the Council has led to its inclusion on the health system's national clinical governance structure. The authors discuss development of the Council along with specific information regarding various committee work, including APC state regulations, delineation of privileges, quality measures, and total compensation.

  18. Pathophysiology of sepsis and recent patents on the diagnosis, treatment and prophylaxis for sepsis.

    PubMed

    Okazaki, Yasumasa; Matsukawa, Akihiro

    2009-01-01

    Despite advances in the development of powerful antibiotics and intensive care unit, sepsis is still life threatening and the mortality rate remains unchanged for the past three decades. Recent prospective trials with biological response modifiers have shown a modest clinical benefit. The pathological basis of sepsis is initially an excessive inflammatory response against invading pathogens, leading to systemic inflammatory response syndrome (SIRS). Evidence reveals that a variety of inflammatory mediators orchestrate the intense inflammation through complicated cellular interactions. More recent data indicate that most septic patients survive this stage and then subjected to an immunoparalysis phase, termed compensatory anti-inflammatory response syndrome (CARS), which is more fatal than the initial phase. Sepsis is a complicated clinical syndrome with multiple physiologic and immunologic abnormalities. In this review, we summarize the recent understandings of the pathophysiology of sepsis, and introduce recent patents on diagnosis, treatment and prophylaxis for sepsis.

  19. Creating the Evidence through Comparative Effectiveness Research for Interprofessional Education and Collaborative Practice by Deploying a National Intervention Network and a National Data Repository

    PubMed Central

    Pechacek, Judith; Cerra, Frank; Brandt, Barbara; Lutfiyya, May Nawal; Delaney, Connie

    2015-01-01

    Background: There is currently a resurgence of interest in interprofessional education and collaborative practice (IPECP) and its potential to positively impact health outcomes at both the patient level and population level, healthcare delivery, and health professions education. This resurgence of interest led to the creation of the National Center on Interprofessional Collaborative Practice and Education in October 2012. Methods: This paper describes three intertwined knowledge generation strategies of the National Center on Interprofessional Practice and Education: (1) the development of a Nexus Incubator Network, (2) the undertaking of comparative effectiveness research, and (3) the creation of a National Center Data Repository. Results: As these strategies are implemented over time they will result in the production of empirically grounded knowledge regarding the direction and scope of the impact, if any, of IPECP on well-defined health and healthcare outcomes including the possible improvement of the patient experience of care. Conclusions: Among the motivating factors for the National Center and the three strategies adopted and addressed herein is the need for rigorously produced, scientifically sound evidence regarding IPECP and whether or not it has the capacity to positively affect the patient experience of care, the health of populations, and the per capita cost of healthcare. PMID:27417753

  20. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis.

    PubMed

    Bauer, Melissa E; Bateman, Brian T; Bauer, Samuel T; Shanks, Amy M; Mhyre, Jill M

    2013-10-01

    Sepsis is currently the leading cause of direct maternal death in the United Kingdom. In this study, we aimed to determine frequency, temporal trends, and independent associations for severe sepsis during hospitalization for delivery in the United States. Data were obtained from the Nationwide Inpatient Sample for the years 1998 through 2008. The presence of severe sepsis was identified by the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression analysis was used to assess temporal trends for sepsis, severe sepsis, and sepsis-related death and also to identify independent associations of severe sepsis. Of an estimated 44,999,260 hospitalizations for delivery, sepsis complicated 1:3333 (95% confidence interval [CI], 1:3151-1:3540) deliveries, severe sepsis complicated 1:10,823 (95% CI, 1:10,000-1:11,792) deliveries, and sepsis-related death complicated 1:105,263 (95% CI, 1:83,333-1:131,579) deliveries. While the overall frequency of sepsis was stable(P = 0.95), the risk of severe sepsis and sepsis-related death increased during the study period, (P < 0.001) and (P = 0.02), respectively. Independent associations for severe sepsis, with an adjusted odds ratio and lower bound 95% CI higher than 3, include congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematous, and rescue cerclage placement. Maternal severe sepsis and sepsis-related deaths are increasing in the United States. Severe sepsis often occurs in the absence of a recognized risk factor and underscores the need for developing systems of care that increase sensitivity for disease detection across the entire population. Physicians should enhance surveillance in patients with congestive heart failure, chronic liver disease, chronic renal disease, and systemic lupus erythematous and institute early treatment when signs of sepsis are emerging.

  1. Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh

    PubMed Central

    2014-01-01

    Objectives. The objective of this study is to explore the current knowledge, attitude, and practice of family physicians working in family medicine clinics in National Guard Health Affairs (NGHA), Riyadh, toward colorectal cancer (CRC) screening and to identify the barriers of the screening. Methods. Data were collected using a validated self-administered questionnaire adopted from the National Cancer Institute in USA, customized by adding and eliminating questions to be in line with the institution (NGHA) characteristics. Results. Of the 130 physicians, 56.2% of the physicians were not practicing CRC screening although 94.6% considered CRC screening effective. Board certified physicians had higher knowledge score and were practicing CRC screening more when compared to other physicians. Physicians who reported practicing CRC screening scored more on the knowledge score than those not practicing. Male physicians scored better on attitude score than female physicians. The study found that barriers were cited in higher rates among physicians not practicing CRC screening compared with practicing physicians. Lack of patients' awareness was the most cited barrier. Conclusion. Large percentage of family physicians in this study do not practice CRC screening, despite the knowledge level and the positive attitude. PMID:25328703

  2. Prognostic value of procalcitonin (PCT) and/or interleukin-6 (IL-6) plasma levels after multiple trauma for the development of multi organ dysfunction syndrome (MODS) or sepsis.

    PubMed

    Haasper, C; Kalmbach, M; Dikos, G D; Meller, R; Müller, C; Krettek, C; Hildebrand, F; Frink, M

    2010-01-01

    Despite recent advances in treatment of severe injured patients, e.g. due to damage control orthopaedics, multi organ dysfunction syndrome (MODS) and sepsis are major complications in daily practice. During one year 94 patients were prospectively collected. ISS 16, age 18-60 y, primary admission to our level-1 trauma center, survival > 48 hours after trauma. The development of MODS and sepsis were observed and different groups were formed (+/-). Demographic data revealed no significant differences between the subgroups. Comparing groups +MODS and -MODS significant differences on admission day were observed, when PCT showed first on day 2 after trauma differences. Regarding the development of sepsis PCT was advantageous to IL-6 showing significant higher plasma levels in group +sepsis from the first day after trauma. Serum levels of IL-6 and PCT could be useful in early identification of high risk patients to develop posttraumatic MODS. For sepsis PCT is the better prognostic factor.

  3. Burkholderia cepacia sepsis among neonates.

    PubMed

    Patra, Saikat; Bhat Y, Ramesh; Lewis, Leslie Edward; Purakayastha, Jayashree; Sivaramaraju, V Vamsi; Kalwaje E, Vandana; Mishra, Swathi

    2014-11-01

    Burkholderia cepacia is a rare cause of sepsis in newborns and its transmission involves human contact with heavily contaminated medical devices and disinfectants. The authors aimed to determine epidemiology, clinical features, antibiotic sensitivity pattern, complications and outcome of blood culture proven B. cepacia infections in 12 neonates. All neonates were outborn, 5 preterm and 7 term. B. cepacia was isolated from blood in all and concurrently from CSF in three neonates. Lethargy and respiratory distress (41.7 %) were major presenting features. Five newborns (41.7 %) required mechanical ventilation for 3-7 d. Highest bacterial susceptibility was observed for meropenem (100 %), followed by cefoperazone-sulbactam, piperacillin-tazobactam, sulfamethoxazole-trimethoprim (all 83 %), ceftazidime (75 %) and ciprofloxacin (42 %). Piperacillin-tazobactam, ciprofloxacin and cotrimoxazole either singly or in combination led to complete recovery of 11 (91.7 %) newborns; one developed hydrocephalus. Eight of nine infants who completed 6 mo follow up were normal. Prompt recognition and appropriate antibiotic therapy for B. cepacia infection results in complete recovery in majority.

  4. Immunological monitoring to prevent and treat sepsis

    PubMed Central

    2013-01-01

    The clinical, human and economic burden associated with sepsis is huge. Initiatives such as the Surviving Sepsis Campaign aim to effectively reduce risk of death from severe sepsis and septic shock. Nonetheless, although substantial benefits raised from the implementation of this campaign have been obtained, much work remains if we are to realise the full potential promised by this strategy. A deeper understanding of the processes leading to sepsis is necessary before we can design an effective suite of interventions. Dysregulation of the immune response to infection is acknowledged to contribute to the pathogenesis of the disease. Production of both proinflammatory and immunosuppressive cytokines is observed from the very first hours following diagnosis. In addition, hypogammaglobulinemia is often present in patients with septic shock. Moreover, levels of IgG, IgM and IgA at diagnosis correlate directly with survival. In turn, nonsurvivors have lower levels of C4 (a protein of the complement system) than the survivors. Natural killer cell counts and function also seem to have an important role in this disease. HLA-DR in the surface of monocytes and counts of CD4+CD25+ T-regulatory cells in blood could also be useful biomarkers for sepsis. At the genomic level, repression of networks corresponding to major histocompatibility complex antigen presentation is observed in septic shock. In consequence, cumulative evidence supports the potential role of immunological monitoring to guide measures to prevent or treat sepsis in a personalised and timely manner (early antibiotic administration, immunoglobulin replacement, immunomodulation). In conclusion, although diffuse and limited, current available information supports the development of large comprehensive studies aimed to urgently evaluate immunological monitoring as a tool to prevent sepsis, guide its treatment and, as a consequence, diminish the morbidity and mortality associated with this severe condition. PMID

  5. Immune cell phenotype and function in sepsis

    PubMed Central

    Rimmelé, Thomas; Payen, Didier; Cantaluppi, Vincenzo; Marshall, John; Gomez, Hernando; Gomez, Alonso; Murray, Patrick; Kellum, John A.

    2015-01-01

    Cells of the innate and adaptive immune systems play a critical role in the host response to sepsis. Moreover, their accessibility for sampling and their capacity to respond dynamically to an acute threat increases the possibility that leukocytes might serve as a measure of a systemic state of altered responsiveness in sepsis. The working group of the 14th Acute Dialysis Quality Initiative (ADQI) conference sought to obtain consensus on the characteristic functional and phenotypic changes in cells of the innate and adaptive immune system in the setting of sepsis. Techniques for the study of circulating leukocytes were also reviewed and the impact on cellular phenotypes and leukocyte function of non extracorporeal treatments and extracorporeal blood purification therapies proposed for sepsis was analyzed. A large number of alterations in the expression of distinct neutrophil and monocyte surface markers have been reported in septic patients. The most consistent alteration seen in septic neutrophils is their activation of a survival program that resists apoptotic death. Reduced expression of HLA-DR is a characteristic finding on septic monocytes but monocyte antimicrobial function does not appear to be significantly altered in sepsis. Regarding adaptive immunity, sepsis-induced apoptosis leads to lymphopenia in patients with septic shock and it involves all types of T cells (CD4, CD8 and Natural Killer) except T regulatory cells, thus favoring immunosuppression. Finally, numerous promising therapies targeting the host immune response to sepsis are under investigation. These potential treatments can have an effect on the number of immune cells, the proportion of cell subtypes and the cell function. PMID:26529661

  6. Immunological monitoring to prevent and treat sepsis.

    PubMed

    Almansa, Raquel; Wain, John; Tamayo, Eduardo; Andaluz-Ojeda, David; Martin-Loeches, Ignacio; Ramirez, Paula; Bermejo-Martin, Jesús F

    2013-01-25

    The clinical, human and economic burden associated with sepsis is huge. Initiatives such as the Surviving Sepsis Campaign aim to effectively reduce risk of death from severe sepsis and septic shock. Nonetheless, although substantial benefits raised from the implementation of this campaign have been obtained, much work remains if we are to realise the full potential promised by this strategy. A deeper understanding of the processes leading to sepsis is necessary before we can design an effective suite of interventions. Dysregulation of the immune response to infection is acknowledged to contribute to the pathogenesis of the disease. Production of both proinflammatory and immunosuppressive cytokines is observed from the very first hours following diagnosis. In addition, hypogammaglobulinemia is often present in patients with septic shock. Moreover, levels of IgG, IgM and IgA at diagnosis correlate directly with survival. In turn, nonsurvivors have lower levels of C4 (a protein of the complement system) than the survivors. Natural killer cell counts and function also seem to have an important role in this disease. HLA-DR in the surface of monocytes and counts of CD4+CD25+ T-regulatory cells in blood could also be useful biomarkers for sepsis. At the genomic level, repression of networks corresponding to major histocompatibility complex antigen presentation is observed in septic shock. In consequence, cumulative evidence supports the potential role of immunological monitoring to guide measures to prevent or treat sepsis in a personalised and timely manner (early antibiotic administration, immunoglobulin replacement, immunomodulation). In conclusion, although diffuse and limited, current available information supports the development of large comprehensive studies aimed to urgently evaluate immunological monitoring as a tool to prevent sepsis, guide its treatment and, as a consequence, diminish the morbidity and mortality associated with this severe condition.

  7. Tuberculosis screening of migrants to low-burden nations: insights from evaluation of UK practice.

    PubMed

    Pareek, M; Abubakar, I; White, P J; Garnett, G P; Lalvani, A

    2011-05-01

    Tuberculosis (TB) primarily occurs in the foreign-born in European countries, such as the UK, where increasing notifications and the high proportion of foreign-born cases has refocused attention on immigrant (new entrant) screening. We investigated how UK primary care organisations (PCOs) screen new entrants and whether this differs according to TB burden in the PCOs (incidence < 20 or ≥ 20 cases per 100,000 per annum). An anonymous, 20-point questionnaire was sent to all 192 UK PCOs asking which new entrants are screened, who is screened for active TB/latent TB infection (LTBI) and the methods used. Descriptive analyses were undertaken. Categorical responses were compared using the Chi-squared test. 177 (92.2%) out of 192 PCOs responded; all undertook screening action in response to abnormal chest radiographs, but only 107 (60.4%) screened new entrants for LTBI. Few new entrants had active TB diagnosed (median 0.0%, interquartile range (IQR) 0.0-0.5%) but more were identified with LTBI (median 7.85%, IQR 4.30-13.50%). High-burden PCOs were significantly less likely to screen new entrants for LTBI (OR 0.26, 95% CI 0.12-0.54; p<0.0001). Among PCOs screening for LTBI, there was substantial deviation from national guidance in selection of new entrant subgroups and screening method. Considerable heterogeneity and deviation from national guidance exist throughout the UK new entrant screening process, with high-burden regions undertaking the least screening. Forming an accurate picture of current front-line practice will help to inform future development of European new entrant screening policy.

  8. [Geognosy versus Geology: National Modes of Thought and Cultural Practices Concerning Space and Time in Competition].

    PubMed

    Klemun, Marianne

    2015-09-01

    Natural science investigators at the end of the eighteenth century made use of conflicting labels to position their respective preferred fields of activity in the Earth sciences. This mania for labelling marked their break with natural science and the umbrella term 'mineralogy'. In this conflict situation of specialist classifications and explanations, two terms in particular were established: geognosy and geology, which covered the very promising project of research in the areas of the 'origin of the Earth' and the 'formation of the Earth'. These and the associated research goals were subsequently accorded a dazzling career. Proceeding from the conceptual core-meaning in the formation of terms und its semantic spectrum and conceptual shifts in a time of change, my study will look at the identity and heterogeneity functions of geology and geognosy. For whereas in French and English speaking countries the term geology came to be used exclusively (geology, géologie), this was avoided in German, particularly because the term geognosy was preferred. These national differences may be explained with reference to the different cultural and national styles of science: for example the social embedding of geology in the culture of the English gentleman or the French museum culture, and the close connection of 'German' geognosy to mining. A further starting point in the analysis of the double use of both geology and geognosy in German speaking countries until 1840 is provided by the different references to temporalization and spatialization of the two terms. And we should also include the practical implications and the epistemic requirements that were bound up with the defence of geognosy in the German speaking world.

  9. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration--2011.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2012-05-01

    Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic.

  10. The Burden of Invasive Early-Onset Neonatal Sepsis in the United States, 2005–2008

    PubMed Central

    Weston, Emily J.; Pondo, Tracy; Lewis, Melissa M.; Martell-Cleary, Pat; Morin, Craig; Jewell, Brenda; Daily, Pam; Apostol, Mirasol; Petit, Sue; Farley, Monica; Lynfield, Ruth; Reingold, Art; Hansen, Nellie I.; Stoll, Barbara J.; Shane, Andi L.; Zell, Elizabeth; Schrag, Stephanie J.

    2011-01-01

    Background Sepsis in the first 3 days of life is a leading cause of morbidity and mortality among infants. Group B Streptococcus (GBS), historically the primary cause of early-onset sepsis, has declined through widespread use of intrapartum chemoprophylaxis. We estimated the national burden of invasive early-onset sepsis (EOS) cases and deaths in the era of GBS prevention. Methods Population-based surveillance for invasive EOS was conducted in 4 of CDC’s Active Bacterial Core surveillance (ABCs) sites from 2005–2008. We calculated incidence using state and national live birth files. Estimates of the national number of cases and deaths were calculated, standardizing by race and gestational age. Results ABCs identified 658 cases of EOS; 72 (10.9%) were fatal. Overall incidence remained stable during the three years (2005:0.77 cases/1,000 live births; 2008:0.76 cases/1,000 live births). GBS (~38%) was the most commonly reported pathogen followed by Escherichia coli (~24%). Black preterm infants had the highest incidence (5.14 cases/1,000 live births) and case fatality (24.4%). Non-black term infants had the lowest incidence (0.40 cases/1,000 live births) and case fatality (1.6%). The estimated national annual burden of EOS was approximately 3,320 cases (95% CI: 3,060–3,580) including 390 deaths (95% CI: 300–490). Among preterm infants, 1,570 cases (95% CI: 1,400–1,770; 47.3% of the overall) and 360 deaths (95% CI: 280–460; 92.3% of the overall) occurred annually. Conclusions The burden of invasive early-onset sepsis remains substantial in the era of GBS prevention and disproportionately affects preterm and black infants. Identification of strategies to prevent preterm births is needed to reduce the neonatal sepsis burden. PMID:21654548

  11. A case study in technology utilization: Industrial products and practices. [summary of benefits to national economy resulting from space programs

    NASA Technical Reports Server (NTRS)

    1973-01-01

    In pursuit of such missions as Apollo, the National Aeronautics and Space Administration has called into being unique equipment that obviously has little direct application beyond the achievement of mission objectives. Yet, to assume that further direct application of space program hardware is somehow a measure of the industrial benefits accruing to the nation is to misunderstand how the creation of new technology affects modern industrial capability. This document presents a profile of the significant ways in which technological developments in response to aerospace mission requirements have been coupled into industrial practice, with the result being that improved products and processes are now being utilized to benefit the nation.

  12. Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data.

    PubMed

    Zongrone, Amanda; Winskell, Kate; Menon, Purnima

    2012-09-01

    To determine the association between indicators of infant and young child feeding (IYCF) and anthropometric measures of nutritional status among children aged 0-23 months in a nationally representative data set. Data from the 2007 Bangladesh Demographic and Health Survey were used. Analyses were conducted using multiple linear regression and logistic regression analyses adjusted for the complex survey design of the survey, controlling for child, maternal and household characteristics, and including regional dummy variables. Bangladesh. Pairs (n 2096) of last born infants and their mothers. Exclusive breast-feeding under 6 months of age was associated with higher weight-for-height Z-score (effect size (ES) = 0·29; P < 0·05). Appropriate complementary feeding in children aged 6-8 months was associated with higher height-for-age Z-score (HAZ; ES = 0·63; P < 0·01) and higher weight-for-age Z-score (WAZ; ES = 0·30; P < 0·05). Higher dietary diversity index (DDI) was associated with higher HAZ (ES = 0·08; P < 0·01 for every 1 point higher DDI) and higher WAZ (ES = 0·04; P < 0·05). Children who achieved minimum diet diversity had higher HAZ (ES = 0·20; P < 0·05). Logistic regression models confirmed that exclusive breast-feeding was protective against wasting and DDI was protective against stunting and underweight. Our results highlight the importance of IYCF practices as determinants of child growth outcomes in this context, and reinforce the need for interventions that address the spectrum of IYCF