Science.gov

Sample records for predict icu admission

  1. Embedding measurement within existing computerized data systems: scaling clinical laboratory and medical records heart failure data to predict ICU admission.

    PubMed

    Fisher, William P; Burton, Elizabeth C

    2010-01-01

    This study employs existing data sources to develop a new measure of intensive care unit (ICU) admission risk for heart failure patients. Outcome measures were constructed from laboratory, accounting, and medical record data for 973 adult inpatients with primary or secondary heart failure. Several scoring interpretations of the laboratory indicators were evaluated relative to their measurement and predictive properties. Cases were restricted to tests within first lab draw that included at least 15 indicators. After optimizing the original clinical observations, a satisfactory heart failure severity scale was calibrated on a 0-1000 continuum. Patients with unadjusted CHF severity measures of 550 or less were 2.7 times more likely to be admitted to the ICU than those with higher measures. Patients with low HF severity measures (550 or less) adjusted for demographic and diagnostic risk factors are about six times more likely to be admitted to the ICU than those with higher adjusted measures. A nomogram facilitates routine clinical application. Existing computerized data systems could be programmed to automatically structure clinical laboratory reports using the results of studies like this one to reduce data volume with no loss of information, make laboratory results more meaningful to clinical end users, improve the quality of care, reduce errors and unneeded tests, prevent unnecessary ICU admissions, lower costs, and improve patient satisfaction. Existing data typically examined piecemeal form a coherent scale measuring heart failure severity sensitive to increased likelihood of ICU admission. Marked improvements in ROC curves were found for the aggregate measures relative to individual clinical indicators.

  2. Risk factors for methicillin-resistant Staphylococcus aureus colonisation or infection in intensive care units and their reliability for predicting MRSA on ICU admission.

    PubMed

    Callejo-Torre, Fernando; Eiros Bouza, Jose Maria; Olaechea Astigarraga, Pedro; Coma Del Corral, Maria Jesus; Palomar Martínez, Mercedes; Alvarez-Lerma, Francisco; López-Pueyo, Maria Jesús

    2016-09-01

    Predicting methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs) avoids inappropriate antimicrobial empirical treatment and enhances infection control. We describe risk factors for colonisation/infection related to MRSA (MRSA-C/I) in critically ill patients once in the ICU and on ICU admission, and search for an easy-to-use predictive model for MRSA colonisation/infection on ICU admission. This multicentre cohort study included 69,894 patients admitted consecutively (stay>24h) in April-June in the five-year period 2006-2010 from 147 Spanish ICUs participating in the National Surveillance Study of Nosocomial Infections in ICUs (ENVIN-HELICS). Data from all patients included were used to identify risk factors for MRSA-C/I during ICU stays, from admission to discharge, using uni- and multivariable analysis (Poisson regression) to check that the sample to be used to develop the predictive models was representative of standard critical care population. To identify risk factors for MRSA-C/I on ICU admission and to develop prediction models, multivariable logistic regression analysis were then performed only on those admitted in 2010 (n=16950, 2/3 for analysis and 1/3 for subsequent validation). We found that, in the period 2006-2010, 1046 patients were MRSA-C/I. Independent risk factors for MRSA-C/I in ICU were: age>65, trauma or medical patient, high APACHE-II score, admitted from a long-term care facility, urinary catheter, previous antibiotic treatment and skin-soft tissue or post-surgical superficial skin infections. Colonisation with several different MDRs significantly increased the risk of MRSA-C/I. Risk factors on ICU admission were: male gender, trauma critical patient, urgent surgery, admitted from other ICUs, hospital ward or long-term facility, immunosuppression and skin-soft tissue infection. Although the best model to identify carriers of MRSA had a good discrimination (AUC-ROC, 0.77; 95% CI, 0.72-0.82), sensitivity was 67% and

  3. Factors Associated with ICU Admission following Blunt Chest Trauma

    PubMed Central

    Etteri, Massimiliano; Cantaluppi, Francesca; Pina, Paolo; Guanziroli, Massimo; Bianchi, AnnaMaria; Casazza, Giovanni

    2016-01-01

    Background. Blunt chest wall trauma accounts for over 10% of all trauma patients presenting to emergency departments worldwide. When the injury is not as severe, deciding which blunt chest wall trauma patients require a higher level of clinical input can be difficult. We hypothesized that patient factors, injury patterns, analgesia, postural condition, and positive airway pressure influence outcomes. Methods. The study population consisted of patients hospitalized with at least 3 rib fractures (RF) and at least one pulmonary contusion and/or at least one pneumothorax lower than 2 cm. Results. A total of 140 patients were retrospectively analyzed. Ten patients (7.1%) were admitted to intensive care unit (ICU) within the first 72 hours, because of deterioration of the clinical conditions and gas exchange with worsening of chest X-ray/thoracic ultrasound/chest computed tomography. On univariable analysis and multivariable analysis, obliged orthopnea (p = 0.0018) and the severity of trauma score (p < 0.0002) were associated with admission to ICU. Conclusions. Obliged orthopnea was an independent predictor of ICU admission among patients incurring non-life-threatening blunt chest wall trauma. The main therapeutic approach associated with improved outcome is the prevention of pulmonary infections due to reduced tidal volume, namely, upright postural condition and positive airway pressure. PMID:28044070

  4. Trends in Severity of Illness on ICU Admission and Mortality among the Elderly

    PubMed Central

    Fuchs, Lior; Novack, Victor; McLennan, Stuart; Celi, Leo Anthony; Baumfeld, Yael; Park, Shinhyuk; Howell, Michael D.; Talmor, Daniel S.

    2014-01-01

    Background There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU. Methods We conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission. Results Between the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008. Conclusion In a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective. PMID:24699251

  5. Preoperative predictive factors for intensive care unit admission after pulmonary resection*

    PubMed Central

    Pinheiro, Liana; Santoro, Ilka Lopes; Perfeito, João Aléssio Juliano; Izbicki, Meyer; Ramos, Roberta Pulcheri; Faresin, Sonia Maria

    2015-01-01

    Objective: To determine whether the use of a set of preoperative variables can predict the need for postoperative ICU admission. Methods: This was a prospective observational cohort study of 120 patients undergoing elective pulmonary resection between July of 2009 and April of 2012. Prediction of ICU admission was based on the presence of one or more of the following preoperative characteristics: predicted pneumonectomy; severe/very severe COPD; severe restrictive lung disease; FEV1 or DLCO predicted to be < 40% postoperatively; SpO2 on room air at rest < 90%; need for cardiac monitoring as a precautionary measure; or American Society of Anesthesiologists physical status ≥ 3. The gold standard for mandatory admission to the ICU was based on the presence of one or more of the following postoperative characteristics: maintenance of mechanical ventilation or reintubation; acute respiratory failure or need for noninvasive ventilation; hemodynamic instability or shock; intraoperative or immediate postoperative complications (clinical or surgical); or a recommendation by the anesthesiologist or surgeon to continue treatment in the ICU. Results: Among the 120 patients evaluated, 24 (20.0%) were predicted to require ICU admission, and ICU admission was considered mandatory in 16 (66.6%) of those 24. In contrast, among the 96 patients for whom ICU admission was not predicted, it was required in 14 (14.5%). The use of the criteria for predicting ICU admission showed good accuracy (81.6%), sensitivity of 53.3%, specificity of 91%, positive predictive value of 66.6%, and negative predictive value of 85.4%. Conclusions: The use of preoperative criteria for predicting the need for ICU admission after elective pulmonary resection is feasible and can reduce the number of patients staying in the ICU only for monitoring. PMID:25750672

  6. Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission

    PubMed Central

    Kamath, Atul F.; McAuliffe, Caitlin L.; Kosseim, Laura M.; Pio, Finnah; Hume, Eric

    2016-01-01

    Background: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin <3.5 g/dL. Results: The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin <3.0 and <3.5 g/dL translated to 15.4% and 3.8% rates of unplanned ICU admission, respectively, indicating nutritional status to be a factor in postoperative ICU admission. Conclusion: Patients with poor nutritional status must be counseled on the risks of adverse medical complications. PMID:27200389

  7. Interpretable Deep Models for ICU Outcome Prediction

    PubMed Central

    Che, Zhengping; Purushotham, Sanjay; Khemani, Robinder; Liu, Yan

    2016-01-01

    Exponential surge in health care data, such as longitudinal data from electronic health records (EHR), sensor data from intensive care unit (ICU), etc., is providing new opportunities to discover meaningful data-driven characteristics and patterns ofdiseases. Recently, deep learning models have been employedfor many computational phenotyping and healthcare prediction tasks to achieve state-of-the-art performance. However, deep models lack interpretability which is crucial for wide adoption in medical research and clinical decision-making. In this paper, we introduce a simple yet powerful knowledge-distillation approach called interpretable mimic learning, which uses gradient boosting trees to learn interpretable models and at the same time achieves strong prediction performance as deep learning models. Experiment results on Pediatric ICU dataset for acute lung injury (ALI) show that our proposed method not only outperforms state-of-the-art approaches for morality and ventilator free days prediction tasks but can also provide interpretable models to clinicians. PMID:28269832

  8. Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

    PubMed Central

    Orsini, Jose; Rajayer, Salil; Ahmad, Noeen; Din, Nanda; Morante, Joaquin; Malik, Ryan; Shim, Ahmed

    2016-01-01

    Background Studies have shown that patients admitted to hospitals on weekends and after-hours experience worse outcome than those admitted on weekdays and daytime hours. Although admissions of patients to intensive care units (ICUs) occur 24 hours a day, not all critical care units maintain the same level of staffing during nighttime, weekends, and holidays. This raises concerns in view of evidence showing that the organizational structure of an ICU influences the outcome of critically ill patients. The objective of this study is to evaluate the effects of day and time of admission to ICU on patients’ outcome. Methods A single-center, prospective, observational study was conducted among all consecutive admissions to ICU in a community teaching hospital during a 4-month period. Results A total of 282 patients were admitted during the study period. Their mean age was 59.5 years (median 59, range 17–96), and the majority were male (157, 55.7%). Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 18.9 (median 33, range 1–45), and mean ICU length of stay was 3.1 days (median 2, range 1–19). Of the patients, 104 patients (36.9%) were admitted during weekends and 178 (63.1%) during weekdays. A total of 122 patients (43.3%) were admitted after-hours, constituting 68.5% of all admissions during weekdays. Fifty-six patients (19.9%) were admitted during daytime hours, representing 31.5% of all weekday admissions. Forty-five patients (15.9%) died in ICU. Compared to patients admitted on weekends, those admitted on weekdays had increased ICU mortality (operating room (OR)=0.437; 95% confidence interval=0.2054–0.9196; p=0.0293). Conclusion Admissions to ICU during weekends were not independently associated with increased mortality. A linear relationship between weekdays and after-hours admissions to ICU with mortality was observed at our institution. PMID:27987290

  9. Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired Pneumonia

    PubMed Central

    Laserna, Elena; Sibila, Oriol; Aguilar, Patrick R.; Mortensen, Eric M.; Anzueto, Antonio; Blanquer, Jose M.; Sanz, Francisco; Rello, Jordi; Marcos, Pedro J.; Velez, Maria I.; Aziz, Nivin

    2012-01-01

    Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of Paco2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal Paco2 (35-45 mm Hg), 194 patients (42%) had a Paco2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a Paco2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal Paco2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, Paco2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality. PMID:22677348

  10. Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

    PubMed Central

    Brunot, Vincent; Landreau, Liliane; Corne, Philippe; Platon, Laura; Besnard, Noémie; Buzançais, Aurèle; Daubin, Delphine; Serre, Jean Emmanuel; Molinari, Nicolas; Klouche, Kada

    2016-01-01

    Background The association between mortality and time of admission to ICU has been extensively studied but remains controversial. We revaluate the impact of time of admission on ICU mortality by retrospectively investigating a recent (2006–2014) and large ICU cohort with on-site intensivist coverage. Patients and Methods All adults (≥ 18 years) admitted to a tertiary care medical ICU were included in the study. Patients' characteristics, medical management, and mortality were prospectively collected. Patients were classified according to their admission time: week working days on- and off-hours, and weekends. ICU mortality was the primary outcome and adjusted Hazard-ratios (HR) of death were analysed by multivariate Cox model. Results 2,428 patients were included: age 62±18 years; male: 1,515 (62%); and median SAPSII score: 38 (27–52). Overall ICU mortality rate was 13.7%. Admissions to ICU occurred during open-hours in 680 cases (28%), during night-time working days in 1,099 cases (45%) and during weekends in 649 cases (27%). Baseline characteristics of patients were similar between groups except that patients admitted during the second part of night (00:00 to 07:59) have a significantly higher SAPS II score than others. ICU mortality was comparable between patients admitted during different time periods but was significantly higher for those admitted during the second part of the night. Multivariate analysis showed however that admission during weeknights and weekends was not associated with an increased ICU mortality as compared with open-hours admissions. Conclusion Time of admission, especially weeknight and weekend (off-hour admissions), did not influence the prognosis of ICU patients. The higher illness severity of patients admitted during the second part of the night (00:00–07:59) may explain the observed increased mortality. PMID:28033395

  11. Differential Prediction Generalization in College Admissions Testing

    ERIC Educational Resources Information Center

    Aguinis, Herman; Culpepper, Steven A.; Pierce, Charles A.

    2016-01-01

    We introduce the concept of "differential prediction generalization" in the context of college admissions testing. Specifically, we assess the extent to which predicted first-year college grade point average (GPA) based on high-school grade point average (HSGPA) and SAT scores depends on a student's ethnicity and gender and whether this…

  12. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule

    PubMed Central

    Renaud, Bertrand; Labarère, José; Coma, Eva; Santin, Aline; Hayon, Jan; Gurgui, Mercé; Camus, Nicolas; Roupie, Eric; Hémery, François; Hervé, Jérôme; Salloum, Mirna; Fine, Michael J; Brun-Buisson, Christian

    2009-01-01

    Introduction To identify risk factors for early (< three days) intensive care unit (ICU) admission of patients hospitalised with community-acquired pneumonia (CAP) and not requiring immediate ICU admission, and to stratify the risk of ICU admission on days 1 to 3. Methods Using the original data from four North American and European prospective multicentre cohort studies of patients with CAP, we derived and validated a prediction rule for ICU admission on days 1 to 3 of emergency department (ED) presentation, for patients presenting with no obvious reason for immediate ICU admission (not requiring immediate respiratory or circulatory support). Results A total of 6560 patients were included (4593 and 1967 in the derivation and validation cohort, respectively), 303 (4.6%) of whom were admitted to an ICU on days 1 to 3. The Risk of Early Admission to ICU index (REA-ICU index) comprised 11 criteria independently associated with ICU admission: male gender, age younger than 80 years, comorbid conditions, respiratory rate of 30 breaths/minute or higher, heart rate of 125 beats/minute or higher, multilobar infiltrate or pleural effusion, white blood cell count less than 3 or 20 G/L or above, hypoxaemia (oxygen saturation < 90% or arterial partial pressure of oxygen (PaO2) < 60 mmHg), blood urea nitrogen of 11 mmol/L or higher, pH less than 7.35 and sodium less than 130 mEq/L. The REA-ICU index stratified patients into four risk classes with a risk of ICU admission on days 1 to 3 ranging from 0.7 to 31%. The area under the curve was 0.81 (95% confidence interval (CI) = 0.78 to 0.83) in the overall population. Conclusions The REA-ICU index accurately stratifies the risk of ICU admission on days 1 to 3 for patients presenting to the ED with CAP and no obvious indication for immediate ICU admission and therefore may assist orientation decisions. PMID:19358736

  13. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions

    PubMed Central

    Driesen, Babiche E. J. M.; Merten, Hanneke; Ludikhuize, Jeroen; van der Spoel, Johannes I.; Kramer, Mark H. H.; Nanayakkara, Prabath W. B.

    2016-01-01

    Background An unplanned ICU admission of an inpatient is a serious adverse event (SAE). So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS) was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU. Methods Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system. Results Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%), which were mainly failures in monitoring the patient. They were followed by disease-related (45%), patient-related causes (7, 5%), and organisational root causes (3%). In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record. Conclusions This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted. PMID:27537689

  14. Predicting Academic Success Using Admission Profiles

    ERIC Educational Resources Information Center

    Davidovitch, Nitza; Soen, Dan

    2015-01-01

    This study, conducted at a tertiary education institution in Israel, following two previous studies, was designed to deal again with a question that is a topic of debate in Israel and worldwide: Is there justification for the approach that considers restrictive university admission policies an efficient tool for predicting students' success at the…

  15. Surgical intensive care unit admission variables predict subsequent readmission.

    PubMed

    Lissauer, Matthew E; Diaz, Jose J; Narayan, Mayur; Shah, Paulesh K; Hanna, Nader N

    2013-06-01

    Intensive care unit (ICU) readmissions are associated with increased resource use. Defining predictors may improve resource use. Surgical ICU patients requiring readmission will have different characteristics than those who do not. We conducted a retrospective cohort study of a prospectively maintained database. The Acute Physiology and Chronic Health Evaluation (APACHE) IV quality database identified patients admitted January 1 through December 31, 2011. Patients were divided into groups: NREA = patients admitted to the ICU, discharged, and not readmitted versus REA = patients admitted to the ICU, discharged, and readmitted. Comparisons were made at index admission, not readmission. Categorical variables were compared by Fisher's exact testing and continuous variables by t test. Multivariate logistic regression identified independent predictors of readmission. There were 765 admissions. Seventy-seven patients required readmission 94 times (12.8% rate). Sixty-two patients died on initial ICU admission. Admission severity of illness was significantly higher (APACHE III score: 69.54 ± 21.11 vs 54.88 ± 23.48) in the REA group. Discharge acute physiology scores were equal between groups (47.0 ± 39.2 vs 44.2 ± 34.0, P = nonsignificant). In multivariate analysis, REA patients were more likely admitted to emergency surgery (odds ratio, 1.9; 95% confidence interval, 1.01 ± 3.5) more likely to have a history of immunosuppression (2.7, 1.4 ± 5.3) or higher Acute Physiology Score (1.02; 1.0 ± 1.03) than NREA. Patients who require ICU readmission have a different admission profile than those who do not "bounce back." Understanding these differences may allow for quality improvement projects such as instituting different discharge criteria for different patient populations.

  16. Triage decisions for ICU admission: Report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine.

    PubMed

    Blanch, Lluís; Abillama, Fayez François; Amin, Pravin; Christian, Michael; Joynt, Gavin M; Myburgh, John; Nates, Joseph L; Pelosi, Paolo; Sprung, Charles; Topeli, Arzu; Vincent, Jean-Louis; Yeager, Susan; Zimmerman, Janice

    2016-12-01

    Demand for intensive care unit (ICU) resources often exceeds supply, and shortages of ICU beds and staff are likely to persist. Triage requires careful weighing of the benefits and risks involved in ICU admission while striving to guarantee fair distribution of available resources. We must ensure that the patients who occupy ICU beds are those most likely to benefit from the ICU's specialized technology and professionals. Although prognosticating is not an exact science, preference should be given to patients who are more likely to survive if admitted to the ICU but unlikely to survive or likely to have more significant morbidity if not admitted. To provide general guidance for intensivists in ICU triage decisions, a task force of the World Federation of Societies of Intensive and Critical Care Medicine addressed 4 basic questions regarding this process. The team made recommendations and concluded that triage should be led by intensivists considering input from nurses, emergency medicine professionals, hospitalists, surgeons, and allied professionals. Triage algorithms and protocols can be useful but can never supplant the role of skilled intensivists basing their decisions on input from multidisciplinary teams. Infrastructures need to be organized efficiently both within individual hospitals and at the regional level. When resources are critically limited, patients may be refused ICU admission if others may benefit more on the basis of the principle of distributive justice.

  17. Interpretable Topic Features for Post-ICU Mortality Prediction

    PubMed Central

    Luo, Yen-Fu; Rumshisky, Anna

    2016-01-01

    Electronic health records provide valuable resources for understanding the correlation between various diseases and mortality. The analysis of post-discharge mortality is critical for healthcare professionals to follow up potential causes of death after a patient is discharged from the hospital and give prompt treatment. Moreover, it may reduce the cost derived from readmissions and improve the quality of healthcare. Our work focused on post-discharge ICU mortality prediction. In addition to features derived from physiological measurements, we incorporated ICD-9-CM hierarchy into Bayesian topic model learning and extracted topic features from medical notes. We achieved highest AUCs of 0.835 and 0.829 for 30-day and 6-month post-discharge mortality prediction using baseline and topic proportions derived from Labeled-LDA. Moreover, our work emphasized the interpretability of topic features derived from topic model which may facilitates the understanding and investigation of the complexity between mortality and diseases. PMID:28269879

  18. Study or Evidence-Based Practice (EBP) Project : Prediction of Sepsis in the Burn ICU Patient

    DTIC Science & Technology

    2012-05-15

    suspected infection ? Study Aims: a) Develop a multivariable predictive model for detection of bacteremia in the burned ICU patient using 12...clinical measures associated with presence of infection (temperature, heart rate, respiratory rate, platelet count, insulin resistance, feeding intolerance...independent group of burn ICU patients during periods of documented sepsis and absence of infection ; Hypothesis: A multivariate prediction model will

  19. icuARM-II: improving the reliability of personalized risk prediction in pediatric intensive care units

    PubMed Central

    Cheng, Chih-Wen; Chanani, Nikhil; Maher, Kevin; Wang

    2016-01-01

    Clinicians in intensive care units (ICUs) rely on standardized scores as risk prediction models to predict a patient’s vulnerability to life-threatening events. Conventional Current scales calculate scores from a fixed set of conditions collected within a specific time window. However, modern monitoring technologies generate complex, temporal, and multimodal patient data that conventional prediction models scales cannot fully utilize. Thus, a more sophisticated model is needed to tailor individual characteristics and incorporate multiple temporal modalities for a personalized risk prediction. Furthermore, most scales models focus on adult patients. To address this needdeficiency, we propose a newly designed ICU risk prediction system, called icuARM-II, using a large-scaled pediatric ICU database from Children’s Healthcare of Atlanta. This novel database contains clinical data collected in 5,739 ICU visits from 4,975 patients. We propose a temporal association rule mining framework giving clinicians a potential to perform predict risks prediction based on all available patient conditions without being restricted by a fixed observation window. We also develop a new metric that can rigidly assesses the reliability of all all generated association rules. In addition, the icuARM-II features an interactive user interface. Using the icuARM-II, our results demonstrated showed a use case of short-term mortality prediction using lab testing results, which demonstrated a potential new solution for reliable ICU risk prediction using personalized clinical data in a previously neglected population. PMID:27532061

  20. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients.

    PubMed

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46-26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.

  1. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients

    PubMed Central

    Dalboni, Maria Aparecida; Beraldo, Daniel de Oliveira; Quinto, Beata Marie Redublo; Blaya, Rosângela; Narciso, Roberto; Oliveira, Moacir; Monte, Júlio César Martins; Durão, Marcelino de Souza; Cendoroglo, Miguel; Pavão, Oscar Fernando; Batista, Marcelo Costa

    2013-01-01

    Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46–26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis. PMID:24967238

  2. Evaluating the Predictive Validity of Graduate Management Admission Test Scores

    ERIC Educational Resources Information Center

    Sireci, Stephen G.; Talento-Miller, Eileen

    2006-01-01

    Admissions data and first-year grade point average (GPA) data from 11 graduate management schools were analyzed to evaluate the predictive validity of Graduate Management Admission Test[R] (GMAT[R]) scores and the extent to which predictive validity held across sex and race/ethnicity. The results indicated GMAT verbal and quantitative scores had…

  3. Predicting Prolonged Stay in the ICU Attributable to Bleeding in Patients Offered Plasma Transfusion

    PubMed Central

    Ngufor, Che; Murphree, Dennis; Upadhyaya, Sudhi; Madde, Nageswar; Pathak, Jyotishman; Carter, Rickey; Kor, Daryl

    2016-01-01

    In blood transfusion studies, plasma transfusion (PPT) and bleeding are known to be associated with risk of prolonged ICU length of stay (ICU-LOS). However, as patients can show significant heterogeneity in response to a treatment, there might exists subgroups with differential effects. The existence and characteristics of these subpopulations in blood transfusion has not been well-studied. Further, the impact of bleeding in patients offered PPT on prolonged ICU-LOS is not known. This study presents a causal and predictive framework to examine these problems. The two-step approach first estimates the effect of bleeding in PPT patients on prolonged ICU-LOS and then estimates risks of bleeding and prolonged ICU-LOS. The framework integrates a classification model for risks prediction and a regression model to predict actual LOS. Results showed that the effect of bleeding in PPT patients significantly increases risk of prolonged ICU-LOS (55%, p=0.00) while no bleeding significantly reduces ICU-LOS (4%, p=0.046). PMID:28269892

  4. Utility of serum concentration of protein S100 at admission to the medical intensive care unit in prediction of permanent neurological injury

    PubMed Central

    Knapik, Małgorzata; Partyka, Robert; Broll, Iwona; Cieśla, Daniel; Wawrzyńczyk, Maciej; Kokocińska, Danuta; Jałowiecki, Przemysław

    2016-01-01

    Introduction Admission to the intensive care unit (ICU) may be preceded by dramatic events leading to permanent neurological injury. Plasma S100 protein levels are proved to be clinically useful in predicting neurological outcome following cardiac arrest. It is unclear, however, whether this may be extrapolated to a broader population of ICU patients. Aim To assess the utility of plasma S100 protein in predicting death, permanent neurological damage, or unfavourable outcome at admission to the intensive care unit. Material and methods The concentration of plasma S100 protein was established in 102 patients on admission to the ICU, regardless of their neurological status and the reason for admission. The majority of patients were admitted with various cardiac diseases, excluding trauma patients. The patients were classified into three groups with the following binary outcomes: permanent neurological deficit or restoration of consciousness; unfavourable outcome (death or survival with permanent neurological deficit) or favourable outcome; and death or survival. Results Plasma S100 protein levels at admission facilitated the identification of patients who later developed a permanent neurological deficit or regained consciousness (p < 0.0001). All patients with plasma S100 protein over 0.532 μg/l at ICU admission either developed a permanent neurological deficit or had an unfavourable outcome (death or survival with permanent neurological deficit). However, sensitivity for this cut-off value was only 48% and 40%, respectively. Conclusions Plasma S100 protein levels over 0.532 μg/l are specific but not sensitive for both permanent neurological deficit and unfavourable outcome when assessed in a heterogeneous population at admission to the ICU. PMID:28096833

  5. A Freshman Admissions Prediction Equation: An Evaluation and Recommendation.

    ERIC Educational Resources Information Center

    Chou, Tungshan; Huberty, Carl J.

    The effectiveness of the freshman admissions prediction equation (FAPE) at the University of Georgia (Athens) was studied, using data for 3,378 freshman (1,490 males and 1,888 females) in 1987-88. For the 1987-88 data, a previous (1982) prediction equation functioned poorly in terms of predictive accuracy. New prediction models were constructed…

  6. Comparison of Proposed Modified and Original Sequential Organ Failure Assessment Scores in Predicting ICU Mortality: A Prospective, Observational, Follow-Up Study

    PubMed Central

    Gholipour Baradari, Afshin; Daneshiyan, Maryam; Aarabi, Mohsen; Talebiyan Kiakolaye, Yaser; Nouraei, Seyed Mahmood; Zamani Kiasari, Alieh; Habibi, Mohammad Reza; Emami Zeydi, Amir; Sadeghi, Faegheh

    2016-01-01

    Background. The sequential organ failure assessment (SOFA) score has been recommended to triage critically ill patients in the intensive care unit (ICU). This study aimed to compare the performance of our proposed MSOFA and original SOFA scores in predicting ICU mortality. Methods. This prospective observational study was conducted on 250 patients admitted to the ICU. Both tools scores were calculated at the beginning, 24 hours of ICU admission, and 48 hours of ICU admission. Diagnostic odds ratio and receiver operating characteristic (ROC) curve were used to compare the two scores. Results. MSOFA and SOFA predicted mortality similarly with an area under the ROC curve of 0.837, 0.992, and 0.977 for MSOFA 1, MSOFA 2, and MSOFA 3, respectively, and 0.857, 0.988, and 0.988 for SOFA 1, SOFA 2, and SOFA 3, respectively. The sensitivity and specificity of MSOFA 1 in cut-off point 8 were 82.9% and 68.4%, respectively, MSOFA 2 in cut-off point 9.5 were 94.7% and 97.1%, respectively, and MSOFA 3 in cut-off point of 9.3 were 97.4% and 93.1%, respectively. There was a significant positive correlation between the MSOFA 1 and the SOFA 1 (r: 0.942), 24 hours (r: 0.972), and 48 hours (r: 0.960). Conclusion. The proposed MSOFA and the SOFA scores had high diagnostic accuracy, sensitivity, and specificity for predicting mortality. PMID:28116220

  7. Simplified Mortality Score for the Intensive Care Unit (SMS-ICU): protocol for the development and validation of a bedside clinical prediction rule

    PubMed Central

    Perner, Anders; Krag, Mette; Hjortrup, Peter Buhl; Haase, Nicolai; Holst, Lars Broksø; Marker, Søren; Collet, Marie Oxenbøll; Jensen, Aksel Karl Georg; Møller, Morten Hylander

    2017-01-01

    Introduction Mortality prediction scores are widely used in intensive care units (ICUs) and in research, but their predictive value deteriorates as scores age. Existing mortality prediction scores are imprecise and complex, which increases the risk of missing data and decreases the applicability bedside in daily clinical practice. We propose the development and validation of a new, simple and updated clinical prediction rule: the Simplified Mortality Score for use in the Intensive Care Unit (SMS-ICU). Methods and analysis During the first phase of the study, we will develop and internally validate a clinical prediction rule that predicts 90-day mortality on ICU admission. The development sample will comprise 4247 adult critically ill patients acutely admitted to the ICU, enrolled in 5 contemporary high-quality ICU studies/trials. The score will be developed using binary logistic regression analysis with backward stepwise elimination of candidate variables, and subsequently be converted into a point-based clinical prediction rule. The general performance, discrimination and calibration of the score will be evaluated, and the score will be internally validated using bootstrapping. During the second phase of the study, the score will be externally validated in a fully independent sample consisting of 3350 patients included in the ongoing Stress Ulcer Prophylaxis in the Intensive Care Unit trial. We will compare the performance of the SMS-ICU to that of existing scores. Ethics and dissemination We will use data from patients enrolled in studies/trials already approved by the relevant ethical committees and this study requires no further permissions. The results will be reported in accordance with the Transparent Reporting of multivariate prediction models for Individual Prognosis Or Diagnosis (TRIPOD) statement, and submitted to a peer-reviewed journal. PMID:28279999

  8. The Course of Skin and Serum Biomarkers of Advanced Glycation Endproducts and Its Association with Oxidative Stress, Inflammation, Disease Severity, and Mortality during ICU Admission in Critically Ill Patients: Results from a Prospective Pilot Study

    PubMed Central

    Meertens, John H.; Nienhuis, Hans L.; Lefrandt, Joop D.; Schalkwijk, Casper G.; Nyyssönen, Kristiina; Ligtenberg, Jack J. M.; Smit, Andries J.; Zijlstra, Jan G.; Mulder, D. J.

    2016-01-01

    Background Advanced glycation end products (AGEs) have been implicated in multiple organ failure, predominantly via their cellular receptor (RAGE) in preclinical studies. Little is known about the time course and prognostic relevance of AGEs in critically ill human patients, including those with severe sepsis. Objective 1) To explore the reliability of Skin Autofluorescence (AF) as an index of tissue AGEs in ICU patients, 2) to compare its levels to healthy controls, 3) to describe the time course of AGEs and influencing factors during ICU admission, and 4) to explore their association with disease severity, outcome, and markers of oxidative stress and inflammation. Methods Skin AF, serum N"-(carboxyethyl)lysine (CEL), N"-(carboxymethyl)lysine (CML), and soluble RAGE (sRAGE) were serially measured for a maximum of 7 days in critically ill ICU patients with multiple organ failure and compared to age-matched healthy controls. Correlations with (changes in) clinical parameters of disease severity, LDL dienes, and CRP were studied and survival analysis for in-hospital mortality was performed. Results Forty-five ICU patients (age: 59±15 years; 60% male), and 37 healthy controls (59±14; 68%) were included. Skin AF measurements in ICU patients were reproducible (CV right-left arm: 13%, day-to-day: 10%), with confounding effects of skin reflectance and plasma bilirubin levels. Skin AF was higher in ICU patients vs healthy controls (2.7±0.7 vs 1.8±0.3 au; p<0.001). Serum CEL (23±10 vs, 16±3 nmol/gr protein; p<0.001), LDL dienes (19 (15–23) vs. 9 (8–11) μmol/mmol cholesterol; <0.001), and sRAGE (1547 (998–2496) vs. 1042 (824–1388) pg/ml; p = 0.003) were significantly higher in ICU patients compared to healthy controls, while CML was not different (27 (20–39) vs 29 (25–33) nmol/gr protein). While CRP and LDL dienes decreased significantly, Skin AF and serum AGEs and sRAGE did not change significantly during the first 7 days of ICU admission. CML and CEL

  9. Application of Predictive Nursing Reduces Psychiatric Complications in ICU Patients after Neurosurgery

    PubMed Central

    LIU, Qiong; ZHU, Hui

    2016-01-01

    Background: Our aim was to investigate the effects of clinical application of perioperative predictive nursing on reducing psychiatric complications in Intensive Care Unit (ICU) patients after neurosurgery. Methods: A total of 129 patients who underwent neurosurgery and received intensive care were enrolled in our study from February 2013 to February 2014. These patients were divided into two groups: the experimental group (n=68) receiving predictive nursing before and after operation, and the control group (n=61) with general nursing. Clinical data including length of ICU stay, duration of the patients’ psychiatric symptoms, form and incidence of adverse events, and patient satisfaction ratings were recorded, and their differences between the two groups were analyzed. Results: The duration of psychiatric symptoms and the length of ICU stay for patients in the experimental group were significantly shorter than those in the control group (P<0.05). The incidence of adverse events and psychiatric symptoms, such as sensory and intuition disturbance, thought disturbance, emotional disorder, and consciousness disorder, in the experimental group was significantly lower than that in the control group (P<0.05). Patient satisfaction ratings were significantly higher in the experimental group than those in the control group (P<0.05). Conclusion: Application of predictive nursing on ICU patients who undergo neurosurgery could effectively reduce the incidence of psychiatric symptoms as well as other adverse events. Our study provided clinical evidences to encourage predictive nursing in routine settings for patients in critical conditions. PMID:27252916

  10. Individual Organ Failure and Concomitant Risk of Mortality Differs According to the Type of Admission to ICU – A Retrospective Study of SOFA Score of 23,795 Patients

    PubMed Central

    Bingold, Tobias M.; Lefering, Rolf; Zacharowski, Kai; Meybohm, Patrick; Waydhas, Christian; Rosenberger, Peter; Scheller, Bertram

    2015-01-01

    Introduction Organ dysfunction or failure after the first days of ICU treatment and subsequent mortality with respect to the type of intensive care unit (ICU) admission is poorly elucidated. Therefore we analyzed the association of ICU mortality and admission for medical (M), scheduled surgery (ScS) or unscheduled surgery (US) patients mirrored by the occurrence of organ dysfunction/failure (OD/OF) after the first 72h of ICU stay. Methods For this retrospective cohort study (23,795 patients; DIVI registry; German Interdisciplinary Association for Intensive Care Medicine (DIVI)) organ dysfunction or failure were derived from the Sequential Organ Failure Assessment (SOFA) score (excluding the Glasgow Coma Scale). SOFA scores were collected on admission to ICU and 72h later. For patients with a length of stay of at least five days, a multivariate analysis was performed for individual OD/OF on day three. Results M patients had the lowest prevalence of cardiovascular failure (M 31%; ScS 35%; US 38%), and the highest prevalence of respiratory (M 24%; ScS 13%; US 17%) and renal failure (M 10%; ScS 6%; US 7%). Risk of death was highest for M- and ScS-patients in those with respiratory failure (OR; M 2.4; ScS 2.4; US 1.4) and for surgical patients with renal failure (OR; M 1.7; ScS 2.7; US 2.4). Conclusion The dynamic evolution of OD/OF within 72h after ICU admission and mortality differed between patients depending on their types of admission. This has to be considered to exclude a systematic bias during multi-center trials. PMID:26241475

  11. Who Dies after ICU Discharge? Retrospective Analysis of Prognostic Factors for In-Hospital Mortality of ICU Survivors

    PubMed Central

    2017-01-01

    We investigated the causes of inpatient death after intensive care unit (ICU) discharge and determined predictors of in-hospital mortality in Korea. Using medical ICU registry data of Seoul National University Hospital, we performed a retrospective cohort study involving patients who were discharged alive from their first ICU admission with at least 24 hours of ICU length of stay (LOS). From January 2011 to August 2013, 723 patients were admitted to ICU and 383 patients were included. The estimated in-hospital mortality rate was 11.7% (45/383). The most common cause of death was respiratory failure (n = 25, 56%) followed by sepsis and cancer progression; the causes of hospital death and ICU admission were the same in 64% of all deaths; sudden unexpected deaths comprised about one-fifth of all deaths. In order to predict in-hospital mortality among ICU survivors, multivariate analysis identified presence of solid tumor (odds ratio [OR], 4.06; 95% confidence interval [CI], 2.01–8.2; P < 0.001), hematologic disease (OR, 4.75; 95% CI, 1.51–14.96; P = 0.013), Sequential Organ Failure Assessment (SOFA) score upon ICU admission (OR, 1.08; 95% CI, 0.99–1.17; P = 0.075), and hemoglobin (Hb) level (OR, 0.67; 95% CI, 0.52–0.86; P = 0.001) and platelet count (Plt) (OR, 0.99; 95% CI, 0.99–1.00; P = 0.033) upon ICU discharge as significant factors. In conclusion, a significant proportion of in-hospital mortality is predictable and those who die in hospital after ICU discharge tend to be severely-ill, with comorbidities of hematologic disease and solid tumor, and anemic and thrombocytopenic upon ICU discharge. PMID:28145659

  12. A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting.

    PubMed

    Florman, Jeffrey E; Cushing, Deborah; Keller, Lynne A; Rughani, Anand I

    2017-03-03

    OBJECTIVE Selecting the appropriate patients undergoing craniotomy who can safely forgo postoperative intensive care unit (ICU) monitoring remains a source of debate. Through a multidisciplinary work group, the authors redefined their institutional care process for postoperative monitoring of patients undergoing elective craniotomy to include transfer from the postanesthesia care unit (PACU) to the neurosurgical floor. The hypothesis was that an appropriately selected group of patients undergoing craniotomy could be safely managed outside the ICU in the postoperative period. METHODS The work group developed and implemented a protocol for transfer of patients to the neurosurgical floor after 4-hour recovery in the PACU following elective craniotomy for supratentorial tumor. Criteria included hemodynamically stable adults without significant new postoperative neurological impairment. Data were prospectively collected including patient demographics, clinical characteristics, surgical details, postoperative complications, and events surrounding transfer to a higher level of care. RESULTS Of the first 200 consecutive patients admitted to the floor, 5 underwent escalation of care in the first 48 hours. Three of these escalations were for agitation, 1 for seizure, and 1 for neurological change. Ninety-eight percent of patients meeting criteria for transfer to the floor were managed without incident. No patient experienced a major complication or any permanent morbidity or mortality following this care pathway. CONCLUSIONS Care of patients undergoing uneventful elective supratentorial craniotomy for tumor on a neurosurgical floor after 4 hours of PACU monitoring appears to be a safe practice in this patient population. This tailored practice safely optimized hospital resources, is financially responsible, and is a strong tool for improving health care value.

  13. ICU Blood Pressure Variability May Predict Nadir of Respiratory Depression After Coronary Artery Bypass Surgery

    PubMed Central

    Costa, Anne S. M.; Costa, Paulo H. M.; de Lima, Carlos E. B.; Pádua, Luiz E. M.; Campos, Luciana A.; Baltatu, Ovidiu C.

    2016-01-01

    Objectives: Surgical stress induces alterations on sympathovagal balance that can be determined through assessment of blood pressure variability. Coronary artery bypass graft surgery (CABG) is associated with postoperative respiratory depression. In this study we aimed at investigating ICU blood pressure variability and other perioperative parameters that could predict the nadir of postoperative respiratory function impairment. Methods: This prospective observational study evaluated 44 coronary artery disease patients subjected to coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB). At the ICU, mean arterial pressure (MAP) was monitored every 30 min for 3 days. MAP variability was evaluated through: standard deviation (SD), coefficient of variation (CV), variation independent of mean (VIM), and average successive variability (ASV). Respiratory function was assessed through maximal inspiratory (MIP) and expiratory (MEP) pressures and peak expiratory flow (PEF) determined 1 day before surgery and on the postoperative days 3rd to 7th. Intraoperative parameters (volume of cardioplegia, CPB duration, aortic cross-clamp time, number of grafts) were also monitored. Results: Since, we aimed at studying patients without confounding effects of postoperative complications on respiratory function, we had enrolled a cohort of low risk EuroSCORE (European System for Cardiac Operative Risk Evaluation) with < 2. Respiratory parameters MIP, MEP, and PEF were significantly depressed for 4–5 days postoperatively. Of all MAP variability parameters, the ASV had a significant good positive Spearman correlation (rho coefficients ranging from 0.45 to 0.65, p < 0.01) with the 3-day nadir of PEF after cardiac surgery. Also, CV and VIM of MAP were significantly associated with nadir days of MEP and PEF. None of the intraoperative parameters had any correlation with the postoperative respiratory depression. Conclusions: Variability parameters ASV, CV, and VIM of the MAP

  14. Investigating Postgraduate College Admission Interviews: Generalizability Theory Reliability and Incremental Predictive Validity

    ERIC Educational Resources Information Center

    Arce-Ferrer, Alvaro J.; Castillo, Irene Borges

    2007-01-01

    The use of face-to-face interviews is controversial for college admissions decisions in light of the lack of availability of validity and reliability evidence for most college admission processes. This study investigated reliability and incremental predictive validity of a face-to-face postgraduate college admission interview with a sample of…

  15. How do COPD comorbidities affect ICU outcomes?

    PubMed Central

    Ongel, Esra Akkutuk; Karakurt, Zuhal; Salturk, Cuneyt; Takir, Huriye Berk; Burunsuzoglu, Bunyamin; Kargin, Feyza; Ekinci, Gulbanu H; Mocin, Ozlem; Gungor, Gokay; Adiguzel, Nalan; Yilmaz, Adnan

    2014-01-01

    Background and aim Chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) frequently require admission to the intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed to determine whether comorbidities and clinical variables present at ICU admission are predictive of ICU mortality. Methods A retrospective, observational cohort study was performed in a tertiary teaching hospital’s respiratory ICU using data collected between January 2008 and December 2012. Previously diagnosed COPD patients who were admitted to the ICU with ARF were included. Patients’ demographics, comorbidities, body mass index (BMI), ICU admission data, application of noninvasive and invasive MV (NIV and IMV, respectively), cause of ARF, length of ICU and hospital stay, and mortality were recorded from their files. Patients were grouped according to mortality (survival versus non-survival), and all the variables were compared between the two groups. Results During the study period, a total of 1,013 COPD patients (749 male) with a mean age (standard deviation) of 70±10 years met the inclusion criteria. Comorbidities of the non-survival group (female/male, 40/131) were significantly higher compared with the survival group (female/male, 224/618): arrhythmia (24% vs 11%), hypertension (42% vs 34%), coronary artery disease (28% vs 11%), and depression (7% vs 3%) (P<0.001, P<0.035, P<0.001, and P<0.007, respectively). Logistic regression revealed the following mortality risk factors: need of IMV, BMI <20 kg/m2, pneumonia, coronary artery disease, arrhythmia, hypertension, chronic hypoxia, and higher acute physiology and chronic health evaluation II (APACHE II) scores. The respective odds ratios, confidence intervals, and P-values for each of these were as follows: 27.7, 15.7–49.0, P<0.001; 6.6, 3.5–412.7, P<0.001; 5.1, 2.9–8.8, P<0.001; 2.9, 1.5–5.6, P<0.001; 2.7, 1.4–5.2, P<0.003; 2.6, 1.5–4.4, P<0.001; 2.2, 1.2–3.9, P<0

  16. Psychiatric Inpatient Admissions of Adults with Intellectual Disabilities: Predictive Factors

    ERIC Educational Resources Information Center

    Cowley, Amy; Newton, Jonathan; Sturmey, Peter; Bouras, Nick; Holt, Geraldine

    2005-01-01

    Information on admission to psychiatric inpatient units is lacking from the literature on contemporary services for people with intellectual disability and mental health needs. Here we report on predictors of admission for a cohort of 752 adults from this population living in community settings; 83 were admitted. We also report on two subsamples…

  17. Validity of the Medical College Admission Test for Predicting MD-PhD Student Outcomes

    ERIC Educational Resources Information Center

    Bills, James L.; VanHouten, Jacob; Grundy, Michelle M.; Chalkley, Roger; Dermody, Terence S.

    2016-01-01

    The Medical College Admission Test (MCAT) is a quantitative metric used by MD and MD-PhD programs to evaluate applicants for admission. This study assessed the validity of the MCAT in predicting training performance measures and career outcomes for MD-PhD students at a single institution. The study population consisted of 153 graduates of the…

  18. Validity of the Optometry Admission Test in Predicting Performance in Schools and Colleges of Optometry.

    ERIC Educational Resources Information Center

    Kramer, Gene A.; Johnston, JoElle

    1997-01-01

    A study examined the relationship between Optometry Admission Test scores and pre-optometry or undergraduate grade point average (GPA) with first and second year performance in optometry schools. The test's predictive validity was limited but significant, and comparable to those reported for other admission tests. In addition, the scores…

  19. Predicting MBA Student Success and Streamlining the Admissions Process

    ERIC Educational Resources Information Center

    Pratt, William R.

    2015-01-01

    Within this study the author examines factors commonly employed as master of business administration applicant evaluation criteria to see if these criteria are important in determining an applicant's potential for success. The findings indicate that the Graduate Management Admissions Test (GMAT) is not a significant predictor of student success…

  20. The technology acceptance model: predicting nurses' intention to use telemedicine technology (eICU).

    PubMed

    Kowitlawakul, Yanika

    2011-07-01

    The purposes of this study were to determine factors and predictors that influence nurses' intention to use the eICU technology, to examine the applicability of the Technology Acceptance Model in explaining nurses' intention to use the eICU technology in healthcare settings, and to provide psychometric evidence of the measurement scales used in the study. The study involved 117 participants from two healthcare systems. The Telemedicine Technology Acceptance Model was developed based on the original Technology Acceptance Model that was initially developed by Fred Davis in 1986. The eICU Acceptance Survey was used as an instrument for the study. Content validity was examined, and the reliability of the instrument was tested. The results show that perceived usefulness is the most influential factor that influences nurses' intention to use the eICU technology. The principal factors that influence perceived usefulness are perceived ease of use, support from physicians, and years working in the hospital. The model fit was reasonably adequate and able to explain 58% of the variance (R = 0.58) in intention to use the eICU technology with the nursing sample.

  1. Diagnosis of invasive candidiasis in the ICU

    PubMed Central

    2011-01-01

    Invasive candidiasis ranges from 5 to 10 cases per 1,000 ICU admissions and represents 5% to 10% of all ICU-acquired infections, with an overall mortality comparable to that of severe sepsis/septic shock. A large majority of them are due to Candida albicans, but the proportion of strains with decreased sensitivity or resistance to fluconazole is increasingly reported. A high proportion of ICU patients become colonized, but only 5% to 30% of them develop an invasive infection. Progressive colonization and major abdominal surgery are common risk factors, but invasive candidiasis is difficult to predict and early diagnosis remains a major challenge. Indeed, blood cultures are positive in a minority of cases and often late in the course of infection. New nonculture-based laboratory techniques may contribute to early diagnosis and management of invasive candidiasis. Both serologic (mannan, antimannan, and betaglucan) and molecular (Candida-specific PCR in blood and serum) have been applied as serial screening procedures in high-risk patients. However, although reasonably sensitive and specific, these techniques are largely investigational and their clinical usefulness remains to be established. Identification of patients susceptible to benefit from empirical antifungal treatment remains challenging, but it is mandatory to avoid antifungal overuse in critically ill patients. Growing evidence suggests that monitoring the dynamic of Candida colonization in surgical patients and prediction rules based on combined risk factors may be used to identify ICU patients at high risk of invasive candidiasis susceptible to benefit from prophylaxis or preemptive antifungal treatment. PMID:21906271

  2. Predicting Appropriate Admission of Bronchiolitis Patients in the Emergency Department: Rationale and Methods

    PubMed Central

    Stone, Bryan L; Johnson, Michael D; Nkoy, Flory L

    2016-01-01

    Background In young children, bronchiolitis is the most common illness resulting in hospitalization. For children less than age 2, bronchiolitis incurs an annual total inpatient cost of $1.73 billion. Each year in the United States, 287,000 emergency department (ED) visits occur because of bronchiolitis, with a hospital admission rate of 32%-40%. Due to a lack of evidence and objective criteria for managing bronchiolitis, ED disposition decisions (hospital admission or discharge to home) are often made subjectively, resulting in significant practice variation. Studies reviewing admission need suggest that up to 29% of admissions from the ED are unnecessary. About 6% of ED discharges for bronchiolitis result in ED returns with admission. These inappropriate dispositions waste limited health care resources, increase patient and parental distress, expose patients to iatrogenic risks, and worsen outcomes. Existing clinical guidelines for bronchiolitis offer limited improvement in patient outcomes. Methodological shortcomings include that the guidelines provide no specific thresholds for ED decisions to admit or to discharge, have an insufficient level of detail, and do not account for differences in patient and illness characteristics including co-morbidities. Predictive models are frequently used to complement clinical guidelines, reduce practice variation, and improve clinicians’ decision making. Used in real time, predictive models can present objective criteria supported by historical data for an individualized disease management plan and guide admission decisions. However, existing predictive models for ED patients with bronchiolitis have limitations, including low accuracy and the assumption that the actual ED disposition decision was appropriate. To date, no operational definition of appropriate admission exists. No model has been built based on appropriate admissions, which include both actual admissions that were necessary and actual ED discharges that were

  3. A reappraisal of ICU and long-term outcome of allogeneic hematopoietic stem cell transplantation patients and reassessment of prognosis factors: results of a 5-year cohort study (2009-2013).

    PubMed

    Platon, L; Amigues, L; Ceballos, P; Fegueux, N; Daubin, D; Besnard, N; Larcher, R; Landreau, L; Agostini, C; Machado, S; Jonquet, O; Klouche, K

    2016-02-01

    Epidemiology and prognosis of complications related to allogeneic hematopoietic stem cell transplant (HSCT) recipients requiring admission to intensive care unit (ICU) have not been reassessed precisely in the past few years. We performed a retrospective single-center study on 318 consecutive HSCT patients (2009-2013), analyzing outcome and factors prognostic of ICU admission. Among these patients, 73 were admitted to the ICU. In all, 32 patients (40.3%) died in ICU, 46 at hospital discharge (63%) and 61 (83.6%) 1 year later. Survivors had a significantly lower sequential organ failure assessment (SOFA) score, serum lactate and bilirubin upon ICU admission. Catecholamine support, mechanical ventilation (MV) and/or renal replacement therapy during ICU stay, a delayed organ support and an active graft versus host disease (GvHD) significantly worsen the outcome. By multivariate analysis, the worsening of SOFA score from days 1 to 3, the need for MV and the occurrence of an active GvHD were predictive of mortality. In conclusion, the incidence of HSCT-related complications requiring an admission to an ICU was at 22%, with an ICU mortality rate of 44%, and 84% 1 year later. A degradation of SOFA score at day 3 of ICU, need of MV and occurrence of an active GvHD are main predictive factors of mortality.

  4. Predictive model of length of stay and discharge destination in neuroscience admissions

    PubMed Central

    Stecker, M. M.; Stecker, M.; Falotico, J.

    2017-01-01

    Background: The purpose of this study was to try and determine the best predictors of hospital length of stay and discharge destination in patients admitted to a neuroscience service. Methods: Valid data was collected for 170 patients. Variables included age, gender, location prior to admission, principle diagnosis, various physiological measurements upon admission, comorbidity, independence in various activities of daily living prior to admission, length of stay, and disposition upon discharge. Study design was a correlational descriptive study performed through the analysis of data and the development and validation of statistically significant factors in determining the length of stay. Results: All factors with a strong (P < 0.05) relationship with the length of stay were entered into a forward stepwise linear regression with length of stay as the dependent variable. The three most significant variables in predicting length of stay in this study were admission from an outpatient setting, modified Rankin score on admission, and systolic blood pressure on admission. Conclusions: Functional status at admission, specifically, a higher modified Rankin score and a lower systolic blood pressure along with the acquisition of deep vein thrombosis, catheter associated urinary tract infections, intubation, and admission to an intensive care unit all have a statistically significant effect on the hospital length of stay. PMID:28217396

  5. Predicting trauma admissions: the effect of weather, weekday, and other variables.

    PubMed

    Friede, Kevin A; Osborne, Marc C; Erickson, Darin J; Roesler, Jon S; Azam, Arsalan; Croston, J Kevin; McGonigal, Michael D; Ney, Arthur L

    2009-11-01

    One of the challenges all hospitals, especially designated trauma centers, face is how to make sure they have adequate staffing on various days of the week and at various times of the year. A number of studies have explored whether factors such as weather, temporal variation, holidays, and events that draw mass gatherings may be useful for predicting patient volume. This article looks at the effects of weather, mass gatherings, and calendar variables on daily trauma admissions at the three Level I trauma hospitals in the Minneapolis-St. Paul metropolitan area. Using ARIMA statistical modeling, we found that weekends, summer, lack of rain, and snowfall were all predictive of daily trauma admissions; holidays and mass gatherings such as sporting events were not. The forecasting model was successful in reflecting the pattern of trauma admissions; however, it's usefulness was limited in that the predicted range of daily trauma admissions was much narrower than the observed number of admissions. Nonetheless, the observed pattern of increased admission in the summer months and year-round on Saturdays should be helpful in resource planning.

  6. Using Admission Assessments to Predict Final Grades in a College Music Program

    ERIC Educational Resources Information Center

    Lehmann, Andreas C.

    2014-01-01

    Entrance examinations and auditions are common admission procedures for college music programs, yet few researchers have attempted to look at the long-term predictive validity of such selection processes. In this study, archival data from 93 student records of a German music academy were used to predict development of musicianship skills over the…

  7. Overview: What's Worked and What Hasn't as a Guide towards Predictive Admissions Tool Development

    ERIC Educational Resources Information Center

    Siu, Eric; Reiter, Harold I.

    2009-01-01

    Admissions committees and researchers around the globe have used diligence and imagination to develop and implement various screening measures with the ultimate goal of predicting future clinical and professional performance. What works for predicting future job performance in the human resources world and in most of the academic world may not,…

  8. Risk of Death Influences Regional Variation in Intensive Care Unit Admission Rates among the Elderly in the United States

    PubMed Central

    2016-01-01

    Rationale The extent to which geographic variability in ICU admission across the United States is driven by patients with lower risk of death is unknown. Objectives To determine whether patients at low to moderate risk of death contribute to geographic variation in ICU admission. Methods Retrospective cohort of hospitalizations among Medicare beneficiaries (age > 64 years) admitted for ten common medical and surgical diagnoses (2004 to 2009). We examined population-adjusted rates of ICU admission per 100 hospitalizations in 304 health referral regions (HRR), and estimated the relative risk of ICU admission across strata of regional ICU and risk of death, adjusted for patient and regional characteristics. Measurement and Main Results ICU admission rates varied nearly two-fold across HRR quartiles (quartile 1 to 4: 13.6, 17.3, 20.0, and 25.2 per 100 hospitalizations, respectively). Observed mortality for patients in regions (quartile 4) with the greatest ICU use was 17% compared to 21% in regions with lowest ICU use (quartile 1) (p<0.001). After adjusting for patient and regional characteristics, including regional differences in ICU, skilled nursing, and long-term acute care bed capacity, individuals’ risk of death modified the relationship between regional ICU use and an individual’s risk of ICU admission (p for interaction<0.001). Region was least important in predicting ICU admission among patients with high (quartile 4) risk of death (RR 1.27, 95% CI 1.22–1.31, for high versus low ICU use regions), and most important for patients with moderate (quartile 2; RR 1.63, 95% CI 1.53–1.72, quartile 3; RR 1.56 95% CI 1.47–1.65) and low (quartile 1) risk of death (RR 1.50, 95% CI 1.41–1.59). Conclusions There is wide variation in in ICU use by geography, independent of ICU beds and physician supply, for patients with low and moderate risks of death. PMID:27898697

  9. Admission Laboratory Results to Enhance Prediction Models of Postdischarge Outcomes in Cardiac Care.

    PubMed

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Predictive modeling for postdischarge outcomes of inpatient care has been suboptimal. This study evaluated whether admission numerical laboratory data added to administrative models from New York and Minnesota hospitals would enhance the prediction accuracy for 90-day postdischarge deaths without readmission (PD-90) and 90-day readmissions (RA-90) following inpatient care for cardiac patients. Risk-adjustment models for the prediction of PD-90 and RA-90 were designed for acute myocardial infarction, percutaneous cardiac intervention, coronary artery bypass grafting, and congestive heart failure. Models were derived from hospital claims data and were then enhanced with admission laboratory predictive results. Case-level discrimination, goodness of fit, and calibration were used to compare administrative models (ADM) and laboratory predictive models (LAB). LAB models for the prediction of PD-90 were modestly enhanced over ADM, but negligible benefit was seen for RA-90. A consistent predictor of PD-90 and RA-90 was prolonged length of stay outliers from the index hospitalization.

  10. Re-Examination of Traditional Admissions Criteria in Predicting Academic Success in a Counselor Education Program

    ERIC Educational Resources Information Center

    Hatchett, Gregory T.; Lawrence, Christopher; Coaston, Susannah C.

    2017-01-01

    The purpose of this study was to re-evaluate the validity of traditional admissions criteria--UGPA and GRE scores--in predicting academic success for students admitted to a counselor education program in the United States. In contrast to prior research, we also included the newer GRE-Analytical Writing scores in our analyses. In general, we found…

  11. Sex-Specific Differential Prediction of College Admission Tests: A Meta-Analysis

    ERIC Educational Resources Information Center

    Fischer, Franziska T.; Schult, Johannes; Hell, Benedikt

    2013-01-01

    This is the first meta-analysis that investigates the differential prediction of undergraduate and graduate college admission tests for women and men. Findings on 130 independent samples representing 493,048 students are summarized. The underprediction of women's academic performance (d = 0.14) and the overprediction of men's academic performance…

  12. Predicting First-Quarter Test Scores from the New Medical College Admission Test.

    ERIC Educational Resources Information Center

    Cullen, Thomas J.; And Others

    1980-01-01

    The predictive validity of the new Medical College Admission Test as it relates to end-of-quarter examinations in anatomy, histology, physiology, biochemistry, and "ages of man" is presented. Results indicate that the Science Knowledge assessment areas of chemistry and physics and the Science Problems subtest were most useful in…

  13. Predicting Performance during Clinical Years from the New Medical College Admission Test.

    ERIC Educational Resources Information Center

    Caroline, Jan D.; And Others

    1983-01-01

    The results of a predictive validity study of the new Medical College Admission Test (MCAT) using criteria from the clinical years of undergraduate medical education are discussed. The criteria included course grades and faculty ratings of clerks in internal medicine, surgery, obstetrics and gynecology, pediatrics, and psychiatry. (Author/MLW)

  14. On-Admission Pressure Ulcer Prediction Using the Nursing Needs Score

    PubMed Central

    Setoguchi, Yoko; Mitani, Kazue; Abe, Yoshiro; Hashimoto, Ichiro; Moriguchi, Hiroki

    2015-01-01

    Background Pressure ulcers (PUs) are considered a serious problem in nursing care and require preventive measures. Many risk assessment methods are currently being used, but most require the collection of data not available on admission. Although nurses assess the Nursing Needs Score (NNS) on a daily basis in Japanese acute care hospitals, these data are primarily used to standardize the cost of nursing care in the public insurance system for appropriate nurse staffing, and have never been used for PU risk assessment. Objective The objective of this study was to predict the risk of PU development using only data available on admission, including the on-admission NNS score. Methods Logistic regression was used to generate a prediction model for the risk of developing PUs after admission. A random undersampling procedure was used to overcome the problem of imbalanced data. Results A combination of gender, age, surgical duration, and on-admission total NNS score (NNS group B; NNS-B) was the best predictor with an average sensitivity, specificity, and area under receiver operating characteristic curve (AUC) of 69.2% (6920/100), 82.8% (8280/100), and 84.0% (8400/100), respectively. The model with the median AUC achieved 80% (4/5) sensitivity, 81.3% (669/823) specificity, and 84.3% AUC. Conclusions We developed a model for predicting PU development using gender, age, surgical duration, and on-admission total NNS-B score. These results can be used to improve the efficiency of nurses and reduce the number of PU cases by identifying patients who require further examination. PMID:25673118

  15. Utilizing Chinese Admission Records for MACE Prediction of Acute Coronary Syndrome

    PubMed Central

    Hu, Danqing; Huang, Zhengxing; Chan, Tak-Ming; Dong, Wei; Lu, Xudong; Duan, Huilong

    2016-01-01

    Background: Clinical major adverse cardiovascular event (MACE) prediction of acute coronary syndrome (ACS) is important for a number of applications including physician decision support, quality of care assessment, and efficient healthcare service delivery on ACS patients. Admission records, as typical media to contain clinical information of patients at the early stage of their hospitalizations, provide significant potential to be explored for MACE prediction in a proactive manner. Methods: We propose a hybrid approach for MACE prediction by utilizing a large volume of admission records. Firstly, both a rule-based medical language processing method and a machine learning method (i.e., Conditional Random Fields (CRFs)) are developed to extract essential patient features from unstructured admission records. After that, state-of-the-art supervised machine learning algorithms are applied to construct MACE prediction models from data. Results: We comparatively evaluate the performance of the proposed approach on a real clinical dataset consisting of 2930 ACS patient samples collected from a Chinese hospital. Our best model achieved 72% AUC in MACE prediction. In comparison of the performance between our models and two well-known ACS risk score tools, i.e., GRACE and TIMI, our learned models obtain better performances with a significant margin. Conclusions: Experimental results reveal that our approach can obtain competitive performance in MACE prediction. The comparison of classifiers indicates the proposed approach has a competitive generality with datasets extracted by different feature extraction methods. Furthermore, our MACE prediction model obtained a significant improvement by comparison with both GRACE and TIMI. It indicates that using admission records can effectively provide MACE prediction service for ACS patients at the early stage of their hospitalizations. PMID:27649220

  16. Predictive validity of the Biomedical Admissions Test: an evaluation and case study.

    PubMed

    McManus, I C; Ferguson, Eamonn; Wakeford, Richard; Powis, David; James, David

    2011-01-01

    There has been an increase in the use of pre-admission selection tests for medicine. Such tests need to show good psychometric properties. Here, we use a paper by Emery and Bell [2009. The predictive validity of the Biomedical Admissions Test for pre-clinical examination performance. Med Educ 43:557-564] as a case study to evaluate and comment on the reporting of psychometric data in the field of medical student selection (and the comments apply to many papers in the field). We highlight pitfalls when reliability data are not presented, how simple zero-order associations can lead to inaccurate conclusions about the predictive validity of a test, and how biases need to be explored and reported. We show with BMAT that it is the knowledge part of the test which does all the predictive work. We show that without evidence of incremental validity it is difficult to assess the value of any selection tests for medicine.

  17. The prognostic significance of the Birmingham Vasculitis Activity Score (BVAS) with systemic vasculitis patients transferred to the intensive care unit (ICU)

    PubMed Central

    Biscetti, Federico; Carbonella, Angela; Parisi, Federico; Bosello, Silvia Laura; Schiavon, Franco; Padoan, Roberto; Gremese, Elisa; Ferraccioli, Gianfranco

    2016-01-01

    Abstract Systemic vasculitides represent a heterogeneous group of diseases that share clinical features including respiratory distress, renal dysfunction, and neurologic disorders. These diseases may often cause life-threatening complications requiring admission to an intensive care unit (ICU). The aim of the study was to evaluate the validity and responsiveness of Birmingham Vasculitis Activity Score (BVAS) score to predict survival in patients with systemic vasculitides admitted to ICU. A retrospective study was carried out from 2004 to 2014 in 18 patients with systemic vasculitis admitted to 2 different Rheumatology divisions and transferred to ICU due to clinical worsening, with a length of stay beyond 24 hours. We found that ICU mortality was significantly associated with higher BVAS scores performed in the ward (P = 0.01) and at the admission in ICU (P = 0.01), regardless of the value of Acute Physiology And Chronic Health Evaluation (APACHE II) scores (P = 0.50). We used receiver-operator characteristic (ROC) curve analysis to evaluate the possible cutoff value for the BVAS in the ward and in ICU and we found that a BVAS > 8 in the ward and that a BVAS > 10 in ICU might be a useful tool to predict in-ICU mortality. BVAS appears to be an excellent tool for assessing ICU mortality risk of systemic vasculitides patients admitted to specialty departments. Our experience has shown that performing the assessment at admission to the ward is more important than determining the evaluation before the clinical aggravation causing the transfer to ICU. PMID:27902615

  18. High MELD score and extended operating time predict prolonged initial ICU stay after liver transplantation and influence the outcome

    PubMed Central

    Stratigopoulou, Panagiota; Paul, Andreas; Hoyer, Dieter P.; Kykalos, Stylianos; Saner, Fuat H.; Sotiropoulos, Georgios C.

    2017-01-01

    Background The aim of the present study is to determine the incidence of a prolonged (>3 days) initial ICU-stay after liver transplantation (LT) and to identify risk factors for it. Patients and methods We retrospectively analyzed data of adult recipients who underwent deceased donor first-LT at the University Hospital Essen between 11/2003 and 07/2012 and showed a primary graft function. Results Of the 374 recipients, 225 (60.16%) had prolonged ICU-stay. On univariate analysis, donor INR, high doses of vasopressors, “rescue-offer” grafts, being hospitalized at transplant, high urgency cases, labMELD, alcoholic cirrhosis, being on renal dialysis and length of surgery were associated with prolonged ICU-stay. After multivariate analysis, only the labMELD and the operation’s length were independently correlated with prolonged ICU-stay. Cut-off values for these variables were 19 and 293.5 min, respectively. Hospital stay was longer for patients with a prolonged initial ICU-stay (p<0.001). Survival rates differed significantly between the two groups at 3 months, 1-year and 5-years after LT (p<0.001). Conclusions LabMELD and duration of LT were identified as independent predictors for prolonged ICU-stay after LT. Identification of recipients in need of longer ICU-stay could contribute to a more evidenced-based and cost-effective use of ICU facilities in transplant centers. PMID:28319169

  19. The Effectiveness of Traditional Admissions Criteria in Predicting College and Graduate Success for American and International Students

    ERIC Educational Resources Information Center

    Fu, Yanfei

    2012-01-01

    This study examines the effectiveness of traditional admissions criteria, including prior GPA, SAT, GRE, and TOEFL in predicting undergraduate and graduate academic success for American and international students at a large public university in the southwestern United States. Included are the admissions and enrollment data for 25,017 undergraduate…

  20. Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery

    PubMed Central

    Ranucci, Marco; Ballotta, Andrea; Castelvecchio, Serenella; Baryshnikova, Ekaterina; Brozzi, Simonetta; Boncilli, Alessandra

    2010-01-01

    Background Operative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the operative mortality. This study investigates the association between a number of parameters at the admission in the intensive care unit and the operative mortality, and verifies the hypothesis that including these parameters into the preoperative risk models may increase the accuracy of prediction of the operative mortality. Methodology 929 adult patients who underwent cardiac surgery were admitted to the study. The preoperative risk profile was assessed using the logistic EuroSCORE and the ACEF score. A number of parameters recorded at the admission in the intensive care unit were explored for univariate and multivariable association with the operative mortality. Principal Findings A heart rate higher than 120 beats per minute and a blood lactate value higher than 4 mmol/L at the admission in the intensive care unit were independent predictors of operative mortality, with odds ratio of 6.7 and 13.4 respectively. Including these parameters into the logistic EuroSCORE and the ACEF score increased their accuracy (area under the curve 0.85 to 0.88 for the logistic EuroSCORE and 0.81 to 0.86 for the ACEF score). Conclusions A double-stage assessment of operative mortality risk provides a higher accuracy of the prediction. Elevated blood lactates and tachycardia reflect a condition of inadequate cardiac output. Their inclusion in the assessment of the severity of the clinical conditions after cardiac surgery may offer a useful tool to introduce more sophisticated hemodynamic monitoring techniques. Comparison between the predicted operative mortality risk before and after the operation may offer an assessment of the operative performance. PMID:21042411

  1. Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU

    PubMed Central

    2011-01-01

    Background Thousands of children experience cardiac arrest events every year in pediatric intensive care units. Most of these children die. Cardiac arrest prediction tools are used as part of medical emergency team evaluations to identify patients in standard hospital beds that are at high risk for cardiac arrest. There are no models to predict cardiac arrest in pediatric intensive care units though, where the risk of an arrest is 10 times higher than for standard hospital beds. Current tools are based on a multivariable approach that does not characterize deterioration, which often precedes cardiac arrests. Characterizing deterioration requires a time series approach. The purpose of this study is to propose a method that will allow for time series data to be used in clinical prediction models. Successful implementation of these methods has the potential to bring arrest prediction to the pediatric intensive care environment, possibly allowing for interventions that can save lives and prevent disabilities. Methods We reviewed prediction models from nonclinical domains that employ time series data, and identified the steps that are necessary for building predictive models using time series clinical data. We illustrate the method by applying it to the specific case of building a predictive model for cardiac arrest in a pediatric intensive care unit. Results Time course analysis studies from genomic analysis provided a modeling template that was compatible with the steps required to develop a model from clinical time series data. The steps include: 1) selecting candidate variables; 2) specifying measurement parameters; 3) defining data format; 4) defining time window duration and resolution; 5) calculating latent variables for candidate variables not directly measured; 6) calculating time series features as latent variables; 7) creating data subsets to measure model performance effects attributable to various classes of candidate variables; 8) reducing the number of

  2. Using an Artificial Neural Networks (ANNs) Model for Prediction of Intensive Care Unit (ICU) Outcome and Length of Stay at Hospital in Traumatic Patients

    PubMed Central

    Gholipour, Changiz; Rahim, Fakher; Fakhree, Abolghasem

    2015-01-01

    Introduction Currently applications of artificial neural network (ANN) models in outcome predicting of patients have made considerable strides in clinical medicine. This project aims to use a neural network for predicting survival and length of stay of patients in the ward and the intensive care unit (ICU) of trauma patients and to obtain predictive power of the current method. Materials and Methods We used Neuro-Solution software (NS), a leading-edge neural network software for data mining to create highly accurate and predictive models using advanced preprocessing techniques, intelligent automated neural network topology through cutting-edge distributed computing. This ANN model was used based on back-propagation, feed forward, and fed by Trauma and injury severity score (TRISS) components, biochemical findings, risk factors and outcome of 95 patients. In the next step a trained ANN was used to predict outcome, ICU and ward length of stay for 30 test group patients by processing primary data. Results The sensitivity and specificity of an ANN for predicting the outcome of traumatic patients in this study calculated 75% and 96.26%, respectively. 93.33% of outcome predictions obtained by ANN were correct. In 3.33% of predictions, results of ANN were optimistic and 3.33% of cases predicted ANN results were worse than the actual outcome of patients. Neither difference in average length of stay in the ward and ICU with predicted ANN results, were statistically significant. Correlation coefficient of two variables of ANN prediction and actual length of stay in hospital was equal to 0.643. Conclusion Using ANN model based on clinical and biochemical variables in patients with moderate to severe traumatic injury, resulted in satisfactory outcome prediction when applied to a test set. PMID:26023581

  3. Does information available at admission for delivery improve prediction of vaginal birth after cesarean?

    PubMed

    Grobman, William A; Lai, Yinglei; Landon, Mark B; Spong, Catherine Y; Leveno, Kenneth J; Rouse, Dwight J; Varner, Michael W; Moawad, Atef H; Simhan, Hyagriv N; Harper, Margaret; Wapner, Ronald J; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; O'Sullivan, Mary J; Sibai, Baha M; Langer, Oded; Thorp, John M; Ramin, Susan M; Mercer, Brian M

    2009-11-01

    We sought to construct a predictive model for vaginal birth after cesarean (VBAC) that combines factors that can be ascertained only as the pregnancy progresses with those known at initiation of prenatal care. Using multivariable modeling, we constructed a predictive model for VBAC that included patient factors known at the initial prenatal visit as well as those that only become evident as the pregnancy progresses to the admission for delivery. We analyzed 9616 women. The regression equation for VBAC success included multiple factors that could not be known at the first prenatal visit. The area under the curve for this model was significantly greater ( P < 0.001) than that of a model that included only factors available at the first prenatal visit. A prediction model for VBAC success, which incorporates factors that can be ascertained only as the pregnancy progresses, adds to the predictive accuracy of a model that uses only factors available at a first prenatal visit.

  4. Disaggregating Activities of Daily Living Limitations for Predicting Nursing Home Admission

    PubMed Central

    Fong, Joelle H; Mitchell, Olivia S; Koh, Benedict S K

    2015-01-01

    Objective To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts. Data Sources We used panel data from the Health and Retirement Study (HRS) for years 1998–2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801). Study Design We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables. Principal Findings Of the six ADL limitations, bathing difficulty emerged as the strongest predictor of subsequent nursing home placement across cohorts. Eating and dressing limitations were also influential in driving admissions among more recent cohorts. Using simple ADL counts for analysis yielded similar adjusted R2s; however, the amount of explained variance doubled when we allowed the ADL disability measures to time-vary rather than remain static. Conclusions Looking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures. PMID:25256014

  5. Staphylococcus aureus carriage at admission predicts early-onset pneumonia after burn trauma.

    PubMed

    Fournier, A; Voirol, P; Krähenbühl, M; Bonnemain, C-L; Fournier, C; Dupuis-Lozeron, E; Pantet, O; Pagani, J-L; Revelly, J-P; Sadeghipour, F; Eggimann, P; Que, Y-A

    2017-03-01

    Early-onset pneumonia (EOP) is frequent after burn trauma, increasing morbidity in the critical resuscitation phase, which may preclude early aggressive management of burn wounds. Currently, however, preemptive treatment is not recommended. The aim of this study was to identify predictive factors for EOP that may justify early empirical antibiotic treatment. Data for all burn patients requiring ≥4 h mechanical ventilation (MV) who were admitted between January 2001 and October 2012 were extracted from the hospital's computerized information system. We reviewed EOP episodes (≤7 days) among patients who underwent endotracheal aspiration (ETA) within 5 days after admission. Univariate and multivariate analyses were performed to identify independent factors associated with EOP. Logistic regression was used to identify factors predicting EOP development. During the study period, 396 burn patients were admitted. ETA was performed within 5 days in 204/290 patients receiving ≥4 h MV. One hundred and eight patients developed EOP; 47 cases were caused by Staphylococcus aureus, 37 by Haemophilus influenzae, and 23 by Streptococcus pneumoniae. Among the 33 patients showing S. aureus positivity on ETA samples, 16 (48.5 %) developed S. aureus EOP. Among the 156 S. aureus non-carriers, 16 (10.2 %) developed EOP. Staphylococcus aureus carriage independently predicted EOP (p < 0.0001). We identified S. aureus carriage as an independent and strong predictor of EOP. As rapid point-of-care testing for S. aureus is readily available, we recommend testing of all patients at admission for burn trauma and the consideration of early preemptive treatment in all positive patients. Further studies are needed to evaluate this new strategy.

  6. Characteristics and Outcomes of Elderly Patients Refused to ICU

    PubMed Central

    Pintado, María-Consuelo; Villa, Patricia; González-García, Natalia; Luján, Jimena; Molina, Rocío; Trascasa, María; López-Ramos, Esther; Martínez, Cristina; Cambronero, José-Andrés; de Pablo, Raúl

    2013-01-01

    Background. There are few data regarding the process of deciding which elderly patients are refused to ICU admission, their characteristics, and outcome. Methods. Prospective longitudinal observational cohort study. We included all consecutive patients older than 75 years, who were evaluated for admission to but were refused to treatment in ICU, during 18 months, with 12-month followup. We collected demographic data, ICU admission/refusal reasons, previous functional and cognitive status, comorbidity, severity of illness, and hospital and 12-month mortality. Results. 338 elderly patients were evaluated for ICU admission and 88 were refused to ICU (26%). Patients refused because they were “too ill to benefit” had more comorbidity and worse functional and mental situation than those admitted to ICU; there were no differences in illness severity. Hospital mortality rate of the whole study cohort was 36.3%, higher in patients “too ill to benefit” (55.6% versus 35.8%, P < 0.01), which also have higher 1-year mortality (73.7% versus 42.5%, P < 0.01). High comorbidity, low functional status, unavailable ICU beds, and age were associated with refusal decision on multivariate analysis. Conclusions. Prior functional status and comorbidity, not only the age or severity of illness, can help us more to make the right decision of admitting or refusing to ICU patients older than 75 years. PMID:24453879

  7. Predicting AKI in emergency admissions: an external validation study of the acute kidney injury prediction score (APS)

    PubMed Central

    Hodgson, L E; Dimitrov, B D; Roderick, P J; Venn, R; Forni, L G

    2017-01-01

    Objectives Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). Design, setting and participants External validation in a single UK non-specialist acute hospital (2013–2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). Methods Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. Results HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13–18%) and negative predictive value 94% (93–94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). Conclusions On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs

  8. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network

    PubMed Central

    Tsai, Pei-Fang (Jennifer); Chen, Po-Chia; Chen, Yen-You; Song, Hao-Yuan; Lin, Hsiu-Mei; Lin, Fu-Man; Huang, Qiou-Pieng

    2016-01-01

    For hospitals' admission management, the ability to predict length of stay (LOS) as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN) models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS), heart failure (HF), and acute myocardial infarction (AMI) in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed. PMID:27195660

  9. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda

    PubMed Central

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  10. Validity of the Medical College Admission Test for predicting MD-PhD student outcomes.

    PubMed

    Bills, James L; VanHouten, Jacob; Grundy, Michelle M; Chalkley, Roger; Dermody, Terence S

    2016-03-01

    The Medical College Admission Test (MCAT) is a quantitative metric used by MD and MD-PhD programs to evaluate applicants for admission. This study assessed the validity of the MCAT in predicting training performance measures and career outcomes for MD-PhD students at a single institution. The study population consisted of 153 graduates of the Vanderbilt Medical Scientist Training Program (combined MD-PhD program) who matriculated between 1963 and 2003 and completed dual-degree training. This population was divided into three cohorts corresponding to the version of the MCAT taken at the time of application. Multivariable regression (logistic for binary outcomes and linear for continuous outcomes) was used to analyze factors associated with outcome measures. The MCAT score and undergraduate GPA (uGPA) were treated as independent variables; medical and graduate school grades, time-to-PhD defense, USMLE scores, publication number, and career outcome were dependent variables. For cohort 1 (1963-1977), MCAT score was not associated with any assessed outcome, although uGPA was associated with medical school preclinical GPA and graduate school GPA (gsGPA). For cohort 2 (1978-1991), MCAT score was associated with USMLE Step II score and inversely correlated with publication number, and uGPA was associated with preclinical GPA (mspGPA) and clinical GPA (mscGPA). For cohort 3 (1992-2003), the MCAT score was associated with mscGPA, and uGPA was associated with gsGPA. Overall, MCAT score and uGPA were inconsistent or weak predictors of training metrics and career outcomes for this population of MD-PhD students.

  11. Cumulative lactate and hospital mortality in ICU patients

    PubMed Central

    2013-01-01

    Background Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction. Methods Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admitted between 2001 and 2007 were analyzed. Baseline characteristics, all lactate measurements, and in-hospital mortality were recorded. The time integral of arterial blood lactate levels above the upper normal threshold of 2.2 mmol/L (lactate-time-integral), maximum lactate (max-lactate), and time-to-first-normalization were calculated. Survivors and nonsurvivors were compared and receiver operating characteristic (ROC) analysis were applied. Results A total of 20,755 lactate measurements were analyzed. Data are srpehown as median [interquartile range]. In nonsurvivors (n = 405) lactate-time-integral (192 [0–1881] min·mmol/L) and time-to-first normalization (44.0 [0–427] min) were higher than in hospital survivors (n = 1846; 0 [0–134] min·mmol/L and 0 [0–75] min, respectively; all p < 0.001). Normalization of lactate <6 hours after ICU admission revealed better survival compared with normalization of lactate >6 hours (mortality 16.6% vs. 24.4%; p < 0.001). AUC of ROC curves to predict in-hospital mortality was the largest for max-lactate, whereas it was not different among all other lactate derived variables (all p > 0.05). The area under the ROC curves for admission lactate and lactate-time-integral was not different (p = 0.36). Conclusions Hyperlactatemia is associated with in-hospital mortality in a heterogeneous ICU population. In our patients, lactate peak values predicted in-hospital mortality equally well as lactate-time-integral of arterial blood lactate levels above the upper normal threshold. PMID:23446002

  12. Severity assessment tools in ICU patients with 2009 influenza A (H1N1) pneumonia.

    PubMed

    Pereira, J M; Moreno, R P; Matos, R; Rhodes, A; Martin-Loeches, I; Cecconi, M; Lisboa, T; Rello, J

    2012-10-01

    The aim of this study was to determine if severity assessment tools (general severity of illness and community-acquired pneumonia specific scores) can be used to guide decisions for patients admitted to the intensive care unit (ICU) due to pandemic influenza A pneumonia. A prospective, observational, multicentre study included 265 patients with a mean age of 42 (±16.1) years and an ICU mortality of 31.7%. On admission to the ICU, the mean pneumonia severity index (PSI) score was 103.2 ± 43.2 points, the CURB-65 score was 1.7 ± 1.1 points and the PIRO-CAP score was 3.2 ± 1.5 points. None of the scores had a good predictive ability: area under the ROC for PSI, 0.72 (95% CI, 0.65-0.78); CURB-65, 0.67 (95% CI, 0.59-0.74); and PIRO-CAP, 0.64 (95% CI, 0.56-0.71). The PSI score (OR, 1.022 (1.009-1.034), p 0.001) was independently associated with ICU mortality; however, none of the three scores, when used at ICU admission, were able to reliably detect a low-risk group of patients. Low risk for mortality was identified in 27.5% of patients using PIRO-CAP, but above 40% when using PSI (I-III) or CURB65 (<2). Observed mortality was 13.7%, 13.5% and 19.4%, respectively. Pneumonia-specific scores undervalued severity and should not be used as instruments to guide decisions in the ICU.

  13. Can the US minimum data set be used for predicting admissions to acute care facilities?

    PubMed

    Abbott, P A; Quirolgico, S; Candidate, D; Manchand, R; Canfield, K; Adya, M

    1998-01-01

    This paper is intended to give an overview of Knowledge Discovery in Large Datasets (KDD) and data mining applications in healthcare particularly as related to the Minimum Data Set, a resident assessment tool which is used in US long-term care facilities. The US Health Care Finance Administration, which mandates the use of this tool, has accumulated massive warehouses of MDS data. The pressure in healthcare to increase efficiency and effectiveness while improving patient outcomes requires that we find new ways to harness these vast resources. The intent of this preliminary study design paper is to discuss the development of an approach which utilizes the MDS, in conjunction with KDD and classification algorithms, in an attempt to predict admission from a long-term care facility to an acute care facility. The use of acute care services by long term care residents is a negative outcome, potentially avoidable, and expensive. The value of the MDS warehouse can be realized by the use of the stored data in ways that can improve patient outcomes and avoid the use of expensive acute care services. This study, when completed, will test whether the MDS warehouse can be used to describe patient outcomes and possibly be of predictive value.

  14. The Relative Predictive Validity of ACT Scores and High School Grades in Making College Admission Decisions. Issues in College Success

    ERIC Educational Resources Information Center

    ACT, Inc., 2008

    2008-01-01

    Postsecondary institutions often consider students' high school grades and ACT scores when making admission decisions. This issue brief summarizes ACT research on the relative weights of ACT scores and high school grades for predicting college persistence as well as selected indicators of academic success in college. (Contains 1 table and 3…

  15. Use of admissions data to predict student success in postsecondary freshman science

    NASA Astrophysics Data System (ADS)

    Anderson, Amie K.

    The purpose of this study was to determine if significant relationships exist for any of the variables, age, gender, previous GPA, test scores (ACT, Compass), number of accumulated credits, and student success in Biology. This study strived to determine what academic/admissions data can be used to determine the likelihood of student success in Biology. A quantitative correlational study using stepwise multiple regression analysis was used for this study. The study was a retrospective study. Data was composed of a convenience archival sample from the institutional database. Multiple regression analysis was conducted to determine the effect each independent variable has on the dependent variable of student success. For the data set ACT, the variables math score, prealg score, writing score, reading score, and previous GPA were all significant. For data set CMP the variable of student's age was not significant, but the other variables were significant. For the Blanks data set, the only variable of significance was gender. Using stepwise multiple regression analysis the data sets produced regression models showing predictability based on stepwise significance. For Blanks data set, the variables previous hours earned, gender, age, and previous GPA were used. For the ACT data set, math score and reading score were used. For the CMP data set the variables included math score, writing score, previous GPA, gender, reading score, and previous hours earned. The level of predictability of the regression equation for the ACT data set and Blank data set was low. However, the predictability for the CMP data set was moderate. The highest percent of variance explained by the regression models was 11.6% of the CMP data set.

  16. Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001 - 2010

    PubMed Central

    Oud, Lavi

    2017-01-01

    Background ICU admission is uncommon among obstetric patients. Nevertheless, the epidemiology of ICU utilization is considered to be a useful proxy for study of severe maternal morbidity and near-miss events. However, there is paucity of population-level studies in obstetric patients in the United States. Methods The Texas Inpatient Public Use Data File and state-based reports were used to identify pregnancy-associated hospitalizations and those involving admission to ICU (n = 158,410) for the years 2001 - 2010. The clinical characteristics, outcomes, and the overall incidence and temporal trends of ICU admission were examined and stratified analyses of pregnancy outcomes were performed in specific categories of pregnancy-associated hospitalizations. In addition, ICU utilization among hospitalizations with maternal complications and organ dysfunction was evaluated. Results Chronic comorbidities (9.7%) and presence of organ dysfunction (6.2%) were uncommon among ICU admissions, with 26.5% having high severity of illness. The incidence of ICU admission was 39.0 per 1,000 pregnancy-associated hospitalizations-years. Marked variability was found in ICU admission both across pregnancy outcomes (ranging from 0.6 per 1,000 abortions-years to 85.9 per 1,000 stillbirths-years) and categories of pregnancy-associated hospitalizations (ranging from 32.1 per 1,000 delivery hospitalizations-years to 144.8 per 1,000 postpartum hospitalizations-years). The incidence of ICU admission rose 68% among pregnancy-associated hospitalizations and for all examined subgroups, except abortion. Preeclampsia/eclampsia (23.3%) and obstetric hemorrhage (6.9%) were the most common maternal complications among ICU admissions. Four hundred fourteen women (0.3%) died, while 97.6% were discharged home. Conclusions This study documents the highest incidence of ICU utilization in obstetric patients in the US to date. The findings suggest low threshold for obstetric ICU admissions in the state and do

  17. Previous hospital admissions and disease severity predict the use of antipsychotic combination treatment in patients with schizophrenia

    PubMed Central

    2011-01-01

    Background Although not recommended in treatment guidelines, previous studies have shown a frequent use of more than one antipsychotic agent among patients with schizophrenia. The main aims of the present study were to explore the antipsychotic treatment regimen among patients with schizophrenia in a catchment area-based sample and to investigate clinical characteristics associated with antipsychotic combination treatment. Methods The study included 329 patients diagnosed with schizophrenia using antipsychotic medication. Patients were recruited from all psychiatric hospitals in Oslo. Diagnoses were obtained by use of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Additionally, Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS) and number of hospitalisations and pharmacological treatment were assessed. Results Multiple hospital admissions, low GAF scores and high PANSS scores, were significantly associated with the prescription of combination treatment with two or more antipsychotics. The use of combination treatment increased significantly from the second hospital admission. Combination therapy was not significantly associated with age or gender. Regression models confirmed that an increasing number of hospital admission was the strongest predictor of the use of two or more antipsychotics. Conclusions Previous hospital admissions and disease severity measured by high PANSS scores and low GAF scores, predict the use of antipsychotic combination treatment in patients with schizophrenia. Future studies should further explore the use of antipsychotic drug treatment in clinical practice and partly based on such data establish more robust treatment guidelines for patients with persistently high symptom load. PMID:21812996

  18. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis

    PubMed Central

    2011-01-01

    Introduction Intensive care is generally regarded as expensive, and as a result beds are limited. This has raised serious questions about rationing when there are insufficient beds for all those referred. However, the evidence for the cost effectiveness of intensive care is weak and the work that does exist usually assumes that those who are not admitted do not survive, which is not always the case. Randomised studies of the effectiveness of intensive care are difficult to justify on ethical grounds; therefore, this observational study examined the cost effectiveness of ICU admission by comparing patients who were accepted into ICU after ICU triage to those who were not accepted, while attempting to adjust such comparison for confounding factors. Methods This multi-centre observational cohort study involved 11 hospitals in 7 EU countries and was designed to assess the cost effectiveness of admission to intensive care after ICU triage. A total of 7,659 consecutive patients referred to the intensive care unit (ICU) were divided into those accepted for admission and those not accepted. The two groups were compared in terms of cost and mortality using multilevel regression models to account for differences across centres, and after adjusting for age, Karnofsky score and indication for ICU admission. The analyses were also stratified by categories of Simplified Acute Physiology Score (SAPS) II predicted mortality (< 5%, 5% to 40% and >40%). Cost effectiveness was evaluated as cost per life saved and cost per life-year saved. Results Admission to ICU produced a relative reduction in mortality risk, expressed as odds ratio, of 0.70 (0.52 to 0.94) at 28 days. When stratified by predicted mortality, the odds ratio was 1.49 (0.79 to 2.81), 0.7 (0.51 to 0.97) and 0.55 (0.37 to 0.83) for <5%, 5% to 40% and >40% predicted mortality, respectively. Average cost per life saved for all patients was $103,771 (€82,358) and cost per life-year saved was $7,065 (€5,607). These

  19. The Gender Difference: Validity of Standardized Admission Tests in Predicting MBA Performance.

    ERIC Educational Resources Information Center

    Hancock, Terence

    1999-01-01

    Of 120 female and 149 male master of business administration (MBA) students, women performed significantly less well on the Graduate Management Admission Test (GMAT). There were no differences in overall MBA grade point average, indicating no strong correlation between the GMAT and MBA performance. (SK)

  20. Outcome Prediction of Eating Disorders: Can Admission Data Forecast Outcome Needs at Discharge.

    DTIC Science & Technology

    1997-07-18

    admission Global Assessment of Functioning versus women with Anorexia Nervosa (AN); those with AN were positively linked to a family history of mood...trend. Although limited by available data, several significant findings were noted. Women diagnosed with Bulimia Nervosa (BN) had significantly higher

  1. The Predictive Power of Personal Statements in Admissions: A Meta-Analysis and Cautionary Tale

    ERIC Educational Resources Information Center

    Murphy, Sara C.; Klieger, David M.; Borneman, Matthew J.; Kuncel, Nathan R.

    2009-01-01

    Personal statements are a widely used and popular predictor in academic admissions; however, relatively little is known about their effectiveness as a predictor of student performance. This study involved a meta-analysis of the relationships of personal statements to measures of student performance (e.g., GPA) and other predictors. An initial…

  2. Use of Admissions Data to Predict Student Success in Postsecondary Freshman Science

    ERIC Educational Resources Information Center

    Anderson, Amie K.

    2014-01-01

    The purpose of this study was to determine if significant relationships exist for any of the variables, age, gender, previous GPA, test scores (ACT, Compass), number of accumulated credits, and student success in Biology. This study strived to determine what academic/admissions data can be used to determine the likelihood of student success in…

  3. Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

    PubMed Central

    Ergün, Recai; Çalışkan, Taner; Aydın, Kutlay; Tokur, Murat Emre; Cömert, Bilgin

    2016-01-01

    Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; p = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients. PMID:28025592

  4. Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture?

    PubMed

    Brown, Carlos V R; Kasotakis, George; Wilcox, Alison; Rhee, Peter; Salim, Ali; Demetriades, Demetrios

    2005-09-01

    Pelvic angiography plays an increasing role in the management of pelvic fractures (PFs). Little has been written regarding the size of pelvic hematoma on admission computed tomography (CT) and how it relates to angiography results after PF. This is a retrospective review of trauma patients with PF who underwent an admission abdominal/pelvic CT scan and pelvic angiography from 2001 to 2003. CT pelvic hematoma was measured and classified as minimal or significant based on hematoma dimensions. Presence of a contrast blush on CT scan was also documented. Thirty-seven patients underwent an admission CT scan and went on to pelvic angiography. Of the 22 patients with significant pelvic hematoma, 73 per cent (n = 16) had bleeding at angiography. Fifteen patients had minimal pelvic hematoma, with 67 per cent (n = 10) showing active bleeding at angiography. In addition, five of six patients (83%) with no pelvic hematoma had active bleeding at angiography. Six patients had a blush on CT scan, with five of these (83%) having a positive angiogram. But, 22 of 31 (71%) patients with no blush on CT scan had bleeding at angiography. The absence of a pelvic hematoma or contrast blush should not alter indications for pelvic angiography, as they do not reliably exclude active pelvic bleeding.

  5. Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm.

    PubMed

    Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars

    2015-12-01

    We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important predictor of the number of self-harm admissions to general hospitals(B = 1.52, p < .01). Dysregulation predicted self-harm directly (B = 0.28, p < .05), and also through PTSD [corrected]. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients.

  6. Beyond the Intensive Care Unit (ICU): Countywide Impact of Universal ICU Staphylococcus aureus Decolonization

    PubMed Central

    Lee, Bruce Y.; Bartsch, Sarah M.; Wong, Kim F.; McKinnell, James A.; Cui, Eric; Cao, Chenghua; Kim, Diane S.; Miller, Loren G.; Huang, Susan S.

    2016-01-01

    A recent trial showed that universal decolonization in adult intensive care units (ICUs) resulted in greater reductions in all bloodstream infections and clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) than either targeted decolonization or screening and isolation. Since regional health-care facilities are highly interconnected through patient-sharing, focusing on individual ICUs may miss the broader impact of decolonization. Using our Regional Healthcare Ecosystem Analyst simulation model of all health-care facilities in Orange County, California, we evaluated the impact of chlorhexidine baths and mupirocin on all ICU admissions when universal decolonization was implemented for 25%, 50%, 75%, and 100% of ICU beds countywide (compared with screening and contact precautions). Direct benefits were substantial in ICUs implementing decolonization (a median 60% relative reduction in MRSA prevalence). When 100% of countywide ICU beds were decolonized, there were spillover effects in general wards, long-term acute-care facilities, and nursing homes resulting in median 8.0%, 3.0%, and 1.9% relative MRSA reductions at 1 year, respectively. MRSA prevalence decreased by a relative 3.2% countywide, with similar effects for methicillin-susceptible S. aureus. We showed that a large proportion of decolonization's benefits are missed when accounting only for ICU impact. Approximately 70% of the countywide cases of MRSA carriage averted after 1 year of universal ICU decolonization were outside the ICU. PMID:26872710

  7. Predicting frequent hospital admission risk in Singapore: a retrospective cohort study to investigate the impact of comorbidities, acute illness burden and social determinants of health

    PubMed Central

    Liu, Nan; Wang, Sijia; Thumboo, Julian; Ong, Marcus Eng Hock; Lee, Kheng Hock

    2016-01-01

    Objectives To evaluate the impact of comorbidities, acute illness burden and social determinants of health on predicting the risk of frequent hospital admissions. Design Multivariable logistic regression was used to associate the predictive variables extracted from electronic health records and frequent hospital admission risk. The model's performance of our predictive model was evaluated using a 10-fold cross-validation. Setting A single tertiary hospital in Singapore. Participants All adult patients admitted to the hospital between 1 January 2013 and 31 May 2014 (n=25 244). Main outcome measure Frequent hospital admissions, defined as 3 or more inpatient admissions within 12 months of discharge. Area under the receiver operating characteristic curve (AUC) of the predictive model, and the sensitivity, specificity and positive predictive values for various cut-offs. Results 4322 patients (17.1%) met the primary outcome. 11 variables were observed as significant predictors and included in the final regression model. The strongest independent predictor was treatment with antidepressants in the past 1 year (adjusted OR 2.51, 95% CI 2.26 to 2.78). Other notable predictors include requiring dialysis and treatment with intravenous furosemide during the index admission. The predictive model achieved an AUC of 0.84 (95% CI 0.83 to 0.85) for predicting frequent hospital admission risk, with a sensitivity of 73.9% (95% CI 72.6% to 75.2%), specificity of 79.1% (78.5% to 79.6%) and positive predictive value of 42.2% (95% CI 41.1% to 43.3%) at the cut-off of 0.235. Conclusions We have identified several predictors for assessing the risk of frequent hospital admissions that achieved high discriminative model performance. Further research is necessary using an external validation cohort. PMID:27742630

  8. Evacuation of the ICU

    PubMed Central

    Niven, Alexander S.; Beninati, William; Fang, Ray; Einav, Sharon; Rubinson, Lewis; Kissoon, Niranjan; Devereaux, Asha V.; Christian, Michael D.; Grissom, Colin K.; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

    2014-01-01

    BACKGROUND: Despite the high risk for patient harm during unanticipated ICU evacuations, critical care providers receive little to no training on how to perform safe and effective ICU evacuations. We reviewed the pertinent published literature and offer suggestions for the critical care provider regarding ICU evacuation. The suggestions in this article are important for all who are involved in pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: The Evacuation and Mobilization topic panel used the American College of Chest Physicians (CHEST) Guidelines Oversight Committee’s methodology to develop seven key questions for which specific literature searches were conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Based on current best evidence, we provide 13 suggestions outlining a systematic approach to prepare for and execute an effective ICU evacuation during a disaster. Interhospital and intrahospital collaboration and functional ICU communication are critical for success. Pre-event planning and preparation are required for a no-notice evacuation. A Critical Care Team Leader must be designated within the Hospital Incident Command System. A three-stage ICU Evacuation Timeline, including (1) no immediate threat, (2) evacuation threat, and (3) evacuation implementation, should be used. Detailed suggestions on ICU evacuation, including regional planning, evacuation drills, patient transport preparation and equipment, patient prioritization and distribution for evacuation, patient information and tracking, and federal and international evacuation assistance systems, are also provided. CONCLUSIONS: Successful ICU evacuation during a disaster requires

  9. Process modeling of ICU patient flow: effect of daily load leveling of elective surgeries on ICU diversion.

    PubMed

    Kolker, Alexander

    2009-02-01

    Despite the considerable number of publications on ICU patient flow and analysis of its variability, a basic and practically important question remained unanswered: what maximum number of elective surgeries per day should be scheduled (along with the competing demand from emergency surgeries) in order to reduce diversion in an ICU with fixed bed capacity to an acceptable low level, or prevent it at all? The goal of this work was to develop a methodology to answer this question. An ICU patient flow simulation model was developed to establish a quantitative link between the daily load leveling of elective surgeries (elective schedule smoothing) and ICU diversion. It was demonstrated that by scheduling not more than four elective surgeries per day ICU diversion due to 'no ICU beds' would be practically eliminated. However this would require bumping 'extra' daily surgeries to the block time day of another week which could be up to 2 months apart. Because not all patients could wait that long for their elective surgery, another more practical scenario was tested that would also result in a very low ICU diversion: bumping 'extra' daily elective surgeries within less than 2 weeks apart, scheduling not more than five elective surgeries per day, and strict adherence to the ICU admission/ discharge criteria.

  10. Clinical prediction rules in community-acquired pneumonia: lies, damn lies and statistics.

    PubMed

    Abers, M S; Musher, D M

    2014-07-01

    A variety of prediction scores have been developed to identify at the time of presentation patients with community-acquired pneumonia at risk for intensive care unit (ICU) admission or death within 30 days. The effectiveness of each scoring score is typically assessed by calculation of the area under the receiver-operator characteristic curve (AUROC). Although this statistical parameter is helpful in determining the discriminatory value of a score, it assumes equal importance of false negatives and false positives in the tradeoff between sensitivity and specificity. Because patient safety takes precedence over cost, the balance between limiting false negatives (unnecessarily strict ICU admission policy) and false positives (unnecessarily liberal ICU admission policy) should favor the reduction of false negatives. Instead of using AUROC as the primary measure to evaluate prediction rules, we propose the use of sensitivity as a more appropriate alternative.

  11. Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia

    PubMed Central

    Valley, Thomas S.; Sjoding, Michael W.; Ryan, Andrew M.; Iwashyna, Theodore J.; Cooke, Colin R.

    2016-01-01

    IMPORTANCE Among patients whose need for intensive care is uncertain, the relationship of intensive care unit (ICU) admission with mortality and costs is unknown. OBJECTIVE To estimate the relationship between ICU admission and outcomes for elderly patients with pneumonia. DESIGN, SETTING, AND PATIENTS Retrospective cohort study of Medicare beneficiaries (aged >64 years) admitted to 2988 acute care hospitals in the United States with pneumonia from 2010 to 2012. EXPOSURES ICU admission vs general ward admission. MAIN OUTCOMES AND MEASURES Primary outcome was 30-day all-cause mortality. Secondary outcomes included Medicare spending and hospital costs. Patient and hospital characteristics were adjusted to account for differences between patients with and without ICU admission. To account for unmeasured confounding, an instrumental variable was used—the differential distance to a hospital with high ICU admission (defined as any hospital in the upper 2 quintiles of ICU use). RESULTS Among 1 112 394 Medicare beneficiaries with pneumonia, 328 404 (30%) were admitted to the ICU. In unadjusted analyses, patients admitted to the ICU had significantly higher 30-day mortality, Medicare spending, and hospital costs than patients admitted to a general hospital ward. Patients (n = 553 597) living closer than the median differential distance (<3.3 miles) to a hospital with high ICU admission were significantly more likely to be admitted to the ICU than patients living farther away (n = 558 797) (36%for patients living closer vs 23%for patients living farther, P < .001). In adjusted analyses, for the 13%of patients whose ICU admission decision appeared to be discretionary (dependent only on distance), ICU admission was associated with a significantly lower adjusted 30-day mortality (14.8%for ICU admission vs 20.5%for general ward admission, P = .02; absolute decrease, −5.7%[95%CI, −10.6%, −0.9%]), yet there were no significant differences in Medicare spending or hospital

  12. ICU Director Data

    PubMed Central

    Ogbu, Ogbonna C.; Coopersmith, Craig M.

    2015-01-01

    Improving value within critical care remains a priority because it represents a significant portion of health-care spending, faces high rates of adverse events, and inconsistently delivers evidence-based practices. ICU directors are increasingly required to understand all aspects of the value provided by their units to inform local improvement efforts and relate effectively to external parties. A clear understanding of the overall process of measuring quality and value as well as the strengths, limitations, and potential application of individual metrics is critical to supporting this charge. In this review, we provide a conceptual framework for understanding value metrics, describe an approach to developing a value measurement program, and summarize common metrics to characterize ICU value. We first summarize how ICU value can be represented as a function of outcomes and costs. We expand this equation and relate it to both the classic structure-process-outcome framework for quality assessment and the Institute of Medicine’s six aims of health care. We then describe how ICU leaders can develop their own value measurement process by identifying target areas, selecting appropriate measures, acquiring the necessary data, analyzing the data, and disseminating the findings. Within this measurement process, we summarize common metrics that can be used to characterize ICU value. As health care, in general, and critical care, in particular, changes and data become more available, it is increasingly important for ICU leaders to understand how to effectively acquire, evaluate, and apply data to improve the value of care provided to patients. PMID:25846533

  13. Identifying Life-Threatening Admissions for Drug Dependence or Abuse (ILIADDA): Derivation and Validation of a Model.

    PubMed Central

    Nguyen, Tri-Long; Boudemaghe, Thierry; Leguelinel-Blache, Géraldine; Eiden, Céline; Kinowski, Jean-Marie; Le Manach, Yannick; Peyrière, Hélène; Landais, Paul

    2017-01-01

    Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1st, 2009 and December 31st, 2014. We split our study cohort at the center level to create a derivation cohort and a validation cohort. We developed a multivariate logistic model including patient’s age, sex, entrance mode and diagnosis as predictors of a composite primary outcome of in-hospital death or ICU admission. A total of 2,747 (4.2%) patients died or were admitted to ICU. The risk of death or ICU admission was mainly associated with the consumption of opioids, followed by cocaine and other narcotics. Particularly, methadone poisoning was associated with a substantial risk (OR: 35.70, 95% CI [26.94–47.32], P < 0.001). In the validation cohort, our model achieved good predictive properties in terms of calibration and discrimination (c-statistic: 0.847). This allows an accurate identification of life-threatening admissions in drug users to support an early and appropriate management. PMID:28290530

  14. [Pain and fear in the ICU].

    PubMed

    Chamorro, C; Romera, M A

    2015-10-01

    Pain and fear are still the most common memories that refer patients after ICU admission. Recently an important politician named the UCI as the branch of the hell. It is necessary to carry out profound changes in terms of direct relationships with patients and their relatives, as well as changes in environmental design and work and visit organization, to banish the vision that our society about the UCI. In a step which advocates for early mobilization of critical patients is necessary to improve analgesia and sedation strategies. The ICU is the best place for administering and monitoring analgesic drugs. The correct analgesia should not be a pending matter of the intensivist but a mandatory course.

  15. Intrahospital teleradiology: ER to the ICU connection

    NASA Astrophysics Data System (ADS)

    Lattner, Stefanie; Herron, John M.; Fuhrman, Carl R.; Towers, Jeffrey D.; Thaete, F. Leland; Gur, David

    1994-05-01

    Availability of initial radiographic images acquired in the Emergency Department (ED) for patients admitted to an Intensive Care Unit (ICU) has been a problem in our operations. It is not uncommon that images from the ED are delivered to the appropriate ICU several hours after admission, and this problem is typically magnified `off hours'. We installed a film digitizer in the ED and required technologists to digitize all chest radiographs as they came out of the film processor. These images are archived and transmitted to a workstation located near one of our busier medical ICUs. The system has been operational for eight months, and it provides reliable timely access to such images. Careful review of a large number of cases clearly demonstrated that such a system is not only feasible, but extremely effective in improving both perceptions and actual quality of radiology services in this difficult environment. Image quality was found to be acceptable for this purpose.

  16. Predicting economic and medical outcomes based on risk adjustment for congenital heart surgery classification of pediatric cardiovascular surgical admissions.

    PubMed

    Raucci, Frank J; Hoke, Tracey R; Gutgesell, Howard P

    2014-12-01

    The Risk Adjustment for Congenital Heart Surgery (RACHS-1) classification is an established method for predicting mortality for congenital heart disease surgery. It is unknown if this extends to the cost of hospitalization or if differences in economic and medical outcomes exist in certain subpopulations. Using data obtained from the University HealthSystem Consortium, we examined inpatient resource use by patients with International Classification of Diseases, Ninth Revision, procedure codes representative of RACHS-1 classifications 1 through 5 and 6 from 2006 to 2012. A total of 15,453 pediatric congenital heart disease surgical admissions were analyzed, with overall mortality of 4.5% (n = 689). As RACHS-1 classification increased, the total cost of hospitalization, hospital charges, total length of stay, length of intensive care unit stay, and mortality increased. Even when controlled for RACHS-1 classification, black patients (n = 2034) had higher total costs ($96,884 ± $3,392, p = 0.003), higher charges ($318,313 ± $12,018, p <0.001), and longer length of stay (20.4 ± 0.7 days, p <0.001) compared with white patients ($85,396 ± $1,382, $285,622 ± $5,090, and 18.0 ± 0.3 days, respectively). Hispanic patients had similarly disparate outcomes ($104,292 ± $2,759, $351,371 ± $10,627, and 23.0 ± 0.6 days, respectively) and also spent longer in the intensive care unit (14.9 ± 0.5 days, p <0.001). In conclusion, medical and economic measures increased predictably with increased procedure risk, and admissions for black and Hispanic patients were longer and more expensive than those of their white counterparts but without increased mortality.

  17. Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes

    PubMed Central

    Al-Rashid, Fadi; Kahlert, Philipp; Selge, Friederike; Hildebrandt, Heike; Patsalis, Polycarpos-Christos; Totzeck, Matthias; Mummel, Petra; Rassaf, Tienush; Jánosi, Rolf Alexander

    2016-01-01

    Background Several studies have found that standard risk scores inaccurately reflect risk in TAVI cohorts. The assessment of mortality risk upon post-interventional ICU admission is important to optimizing clinical management. This study sought to determine outcomes and factors affecting mortality in patients admitted to the intensive care unit (ICU) after transcatheter aortic valve implantation (TAVI), and to analyze and compare the predictive values of SAPS II and EuroSCORE. Methods and Findings 214 consecutive patients treated with transfemoral TAVI (2006–2012) admitted to the ICU in an academic tertiary-care university hospital, were included in this retrospective data analysis. The overall 30-day mortality rate was 7%. Non-survivors at 30-days and survivors showed differences in the rates of catecholamine therapy upon ICU admission (93 vs. 29%; p<0.001), stroke (20 vs. 1%;p<0.001), sepsis (27 vs. 2%;p<0.001), kidney injury (83 vs. 56%; log-rank p<0.001), catecholamine therapy (88 vs. 61%;log-rank p<0.001) and vascular complications (60 vs. 17%; p<0.001). Mean SAPS II score and predicted mortality were higher in non-survivors (38.1±7.0 vs. 29.9±6.2;p<0.001 and 23.1±11.7 vs. 10.5±8.2;p<0.001, retrospectively), whereas the logistic EuroSCORE could not discriminate between the groups (p = 0.555). Among the biochemical parameters, the maximum values of creatinine, procalcitonin, and troponin I during the first 48 h after ICU admission were significantly higher in non-survivors. Multivariate analysis of baseline characteristics and complications associated with two-year mortality showed no significant results. Conclusions The SAPS II is a good tool for estimating ICU mortality immediately after performing the TAVI procedure and provides valuable information for other known predictors of mortality. PMID:27880819

  18. Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit.

    PubMed

    Gupta, Sunanda; Naithani, Udita; Doshi, Vimla; Bhargava, Vaibhav; Vijay, Bhavani S

    2011-03-01

    A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed. During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, P<0.05) with more patients presenting with obstetric complications (91.66%, n=22, P<0.01) as compared to medical complications (8.32% n=2). Obstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%, P=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

  19. Comparison of count-based multimorbidity measures in predicting emergency admission and functional decline in older community-dwelling adults: a prospective cohort study

    PubMed Central

    Wallace, Emma; McDowell, Ronald; Bennett, Kathleen; Fahey, Tom; Smith, Susan M

    2016-01-01

    Objectives Multimorbidity, defined as the presence of 2 or more chronic medical conditions in an individual, is associated with poorer health outcomes. Several multimorbidity measures exist, and the challenge is to decide which to use preferentially in predicting health outcomes. The study objective was to compare the performance of 5 count-based multimorbidity measures in predicting emergency hospital admission and functional decline in older community-dwelling adults attending primary care. Setting 15 general practices (GPs) in Ireland. Participants n=862, ≥70 years, community-dwellers followed-up for 2 years (2010–2012). Exposure at baseline: Five multimorbidity measures (disease counts, selected conditions counts, Charlson comorbidity index, RxRisk-V, medication counts) calculated using GP medical record and linked national pharmacy claims data. Primary outcomes (1) Emergency admission and ambulatory care sensitive (ACS) admission (GP medical record) and (2) functional decline (postal questionnaire). Statistical analysis Descriptive statistics and measure discrimination (c-statistic, 95% CIs), adjusted for confounders. Results Median age was 77 years and 53% were women. Prevalent rates ranged from 37% to 91% depending on which measure was used to define multimorbidity. All measures demonstrated poor discrimination for the outcome of emergency admission (c-statistic range: 0.62, 0.65), ACS admission (c-statistic range: 0.63, 0.68) and functional decline (c-statistic range: 0.55, 0.61). Medication-based measures were equivalent to diagnosis-based measures. Conclusions The choice of measure may have a significant impact on prevalent rates. Five multimorbidity measures demonstrated poor discrimination in predicting emergency admission and functional decline, with medication-based measures equivalent to diagnosis-based measures. Consideration of multimorbidity in isolation is insufficient for predicting these outcomes in community settings. PMID:27650770

  20. Predictors and outcome of obstetric admissions to intensive care unit: A comparative study.

    PubMed

    Jain, Shruti; Guleria, Kiran; Vaid, Neelam B; Suneja, Amita; Ahuja, Sharmila

    2016-01-01

    This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson's Chi-square test and Fisher's exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care.

  1. Using an admissions exam to predict student success in an ADN program.

    PubMed

    Gallagher, P A; Bomba, C; Crane, L R

    2001-01-01

    Nursing faculty strive to admit students who are likely to successfully complete the nursing curriculum and pass NCLEX-RN. The high cost of academic preparation and the nursing shortage make this selection process even more critical. The authors discuss how one community college nursing program examined academic achievement measures to determine how well they predicted student success. Results provided faculty with useful data to improve the success and retention of nursing.

  2. Reduced Responsiveness of Blood Leukocytes to Lipopolysaccharide Does not Predict Nosocomial Infections in Critically Ill Patients.

    PubMed

    van Vught, Lonneke A; Wiewel, Maryse A; Hoogendijk, Arie J; Scicluna, Brendon P; Belkasim-Bohoudi, Hakima; Horn, Janneke; Schultz, Marcus J; van der Poll, Tom

    2015-08-01

    Critically ill patients show signs of immune suppression, which is considered to increase vulnerability to nosocomial infections. Whole-blood stimulation is frequently used to test the function of the innate immune system. We here assessed the association between whole-blood leukocyte responsiveness to lipopolysaccharide (LPS) and subsequent occurrence of nosocomial infections in critically ill patients admitted to the intensive care unit (ICU). All consecutive critically ill patients admitted to the ICU between April 2012 and June 2013 with two or more systemic inflammatory response syndrome criteria and an expected length of ICU stay of more than 24 h were enrolled. Age- and sex-matched healthy individuals were included as controls. Blood was drawn the first morning after ICU admission and stimulated ex vivo with 100 ng/mL ultrapure LPS for 3 h. Tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-6 were measured in supernatants. Seventy-three critically ill patients were included, of whom 10 developed an ICU-acquired infection. Compared with healthy subjects, whole-blood leukocytes of patients were less responsive to ex vivo stimulation with LPS, as reflected by strongly reduced tumor necrosis factor-α, IL-1β, and IL-6 levels in culture supernatants. Results were not different between patients who did and those who did not develop an ICU-acquired infection. The extent of reduced LPS responsiveness of blood leukocytes in critically ill patients on the first day after ICU admission does not relate to the subsequent development of ICU-acquired infections. These results argue against the use of whole-blood stimulation as a functional test applied early after ICU admission to predict nosocomial infection.

  3. Assessing the predictive validity of the admission process in a master's level speech language pathology program.

    PubMed

    Kjelgaard, Margaret M; Guarino, A J

    2012-10-01

    Astin's Input-Environment-Outcome (I-E-O) model served as the theoretical foundation to assess (a) undergraduate GPA, (b) undergraduate Speech Language Pathology majors, and (c, d) GRE-Q and GRE-V scores (Input) as predictors of students' graduate GPA (Environment), and graduate GPA as a predictor of PRAXIS scores (Outcome). The sample for this study was 122 students who completed the Speech-Language Pathology Program in recent academic cycles at a graduate school in the northeastern United States. The sample was representative of other programs in the country in terms of gender, undergraduate GPA, and GRE scores. Results appear to support the predictive validity of the linear combination of the input predictors of the environment variable (GPA) and of the environment variable on the outcome, i.e., PRAXIS scores.

  4. Reasons for ICU demand and long-term follow-up of a chronic obstructive pulmonary disease cohort.

    PubMed

    Takir, Huriye Berk; Karakurt, Zuhal; Salturk, Cuneyt; Kargin, Feyza; Balci, Merih; Yalcinsoy, Murat; Ozmen, Ipek; Yazicioglu, Ozlem Mocin; Gungor, Gokay; Burunsuzoğlu, Bünyamin; Adiguzel, Nalan

    2014-12-01

    Acute respiratory failure (ARF) can necessitate mechanical ventilation and intensive care unit (ICU) admission in patients with COPD. We evaluated the reasons COPD patients are admitted to the ICU and assessed long-term outcomes in a retrospective cohort study in a respiratory level-III ICU of a teaching government hospital between November 2007 and April 2012. All COPD patients admitted to ICU for the first time were enrolled and followed for 12 months. Patient characteristics, body mass index (BMI), long-term oxygen therapy (LTOT), non-invasive ventilation (LT-NIV) at home, COPD co-morbidities, reasons for ICU admission, ICU data, length of stay, prescription of new LTOT and LT-NIV, and ICU mortality were recorded. Patient survival after ICU discharge was evaluated by Kaplan-Meier survival analysis. A total of 962 (710 male) patients were included. The mean age was 70 (SD 10). The major reasons for ICU admission were COPD exacerbation (66.7%) and pneumonia (19.7%). ICU and hospital mortality were 11.4%, 12.5% respectively, and 842 patients were followed-up. The new LT-NIV prescription rate was 15.8%. The 6-month 1, 2, 3, and 5-year mortality rates were 24.5%, 33.7%, 46.9%, 58.9% and 72.5%, respectively. Long-term survival was negatively affected by arrhythmia (p < 0.013) and pneumonia (p < 0.025). LT-NIV use (p < 0.016) with LTOT (p < 0.038) increase survival. Pulmonary infection can be a major reason for ICU admission and determining outcome after ICU discharge. Unlike arrhythmia and pneumonia, LT-NIV can improve long-term survival in eligible COPD patients.

  5. Shocking Admission

    ERIC Educational Resources Information Center

    Hoover, Eric; Millman, Sierra

    2007-01-01

    Marilee Jones's career had been a remarkable success. She joined Massachusetts Institute of Technology's (MIT's) admissions office in 1979, landing a job in Cambridge at a time when boys ruled the sandbox of the admissions profession. Her job was to help MIT recruit more women, who then made up less than one-fifth of the institute's students. She…

  6. Comparison of admission random glucose, fasting glucose, and glycated hemoglobin in predicting the neurological outcome of acute ischemic stroke: a retrospective study

    PubMed Central

    Sung, Jia-Ying; Chen, Chin-I; Hsieh, Yi-Chen; Chen, Yih-Ru; Wu, Hsin-Chiao; Chan, Lung; Hu, Chaur-Jong; Hu, Han-Hwa; Chiou, Hung-Yi

    2017-01-01

    Background Hyperglycemia is a known predictor of negative outcomes in stroke. Several glycemic measures, including admission random glucose, fasting glucose, and glycated hemoglobin (HbA1c), have been associated with bad neurological outcomes in acute ischemic stroke, particularly in nondiabetic patients. However, the predictive power of these glycemic measures is yet to be investigated. Methods This retrospective study enrolled 484 patients with acute ischemic stroke from January 2009 to March 2013, and complete records of initial stroke severity, neurological outcomes at three months, and glycemic measures were evaluated. We examined the predictive power of admission random glucose, fasting glucose, and HbA1c for neurological outcomes in acute ischemic stroke. Furthermore, subgroup analyses of nondiabetic patients and patients with diabetes were performed separately. Results Receiver operating characteristic (ROC) analysis revealed that admission random glucose and fasting glucose were significant predictors of poor neurological outcomes, whereas HbA1c was not (areas under the ROC curve (AUCs): admission random glucose = 0.564, p = 0.026; fasting glucose = 0.598, p = 0.001; HbA1c = 0.510, p = 0.742). Subgroup analyses of nondiabetic patients and those with diabetes revealed that only fasting glucose predicts neurological outcomes in patients with diabetes, and the AUCs of these three glycemic measures did not differ between the two groups. A multivariate logistic regression analysis of the study patients indicated that only age, initial stroke severity, and fasting glucose were independent predictors of poor neurological outcomes, whereas admission random glucose and HbA1c were not (adjusted odds ratio: admission random glucose = 1.002, p = 0.228; fasting glucose = 1.005, p = 0.039; HbA1c = 1.160, p = 0.076). Furthermore, subgroup multivariate logistic regression analyses of nondiabetic patients and those with diabetes indicated that none of the three glycemic

  7. Real-time prognosis of ICU physiological data streams.

    PubMed

    Sow, Daby; Biem, Alain; Sun, Jimeng; Hu, Jianying; Ebadollahi, Shahram

    2010-01-01

    This paper presents a system capable of predicting in real-time the evolution of Intensive Care Unit (ICU) physiological patient data streams. It leverages a state of the art stream computing platform to host analytics capable of making such prognosis in real time. The focus is on online algorithms that do not require a training phase. We use Fading-Memory Polynomial filters [8] on the frequency domain to predict windows of ICU data streams. We report on both the system and the performance of this approach when applied to traces of more than 1500 ICU patients obtained from the MIMIC-II database [1].

  8. Ability of admissions criteria to predict early academic performance among students of health science colleges at King Saud University, Saudi Arabia.

    PubMed

    Alhadlaq, Adel M; Alshammari, Osama F; Alsager, Saleh M; Neel, Khalid A Fouda; Mohamed, Ashry G

    2015-06-01

    The aim of this study was to evaluate the ability of admissions criteria at King Saud University (KSU), Riyadh, Saudi Arabia, to predict students' early academic performance at three health science colleges (medicine, dentistry, and pharmacy). A retrospective cohort study was conducted with data from the records of students enrolled in the three colleges from the 2008-09 to 2010-11 academic years. The admissions criteria-high school grade average (HSGA), aptitude test (APT) score, and achievement test (ACT) score-were the independent variables. The dependent variable was the average of students' first- and second-year grade point average (GPA). The results showed that the ACT was a better predictor of the students' early academic performance than the HSGA (β=0.368, β=0.254, respectively). No significant relationship was found between the APT and students' early academic performance (β=-0.019, p>0.01). The ACT was most predictive for pharmacy students (β=0.405), followed by dental students (β =0.392) and medical students (β=0.195). Overall, the current admissions criteria explained only 25.5% of the variance in the students' early academic performance. While the ACT and HSGA were found to be predictive of students' early academic performance in health colleges at KSU, the APT was not a strong predictor. Since the combined current admissions criteria for the health science colleges at KSU were weak predictors of the variance in early academic performance, it may be necessary to consider noncognitive evaluation methods during the admission process.

  9. Recovery post ICU.

    PubMed

    Jones, Christina

    2014-10-01

    Many ICU patients struggle to recovery following critical illness and may be left with physical, cognitive and psychological problems, which have a negative impact on their quality of life. Gross muscle mass loss and weakness can take some months to recover after the patients' Intensive Care Unit (ICU) discharge, in addition critical illness polyneuropathies can further complicate physical recovery. Psychological problems such as anxiety, depression and post traumatic stress disorder (PTSD) are common and have an negative impact on the patients' ability to engage in rehabilitation after ICU discharge. Finally cognitive deficit affecting memory can be a significant problem. The first step in helping patients to recover from such a devastating illness is to recognise those who have the greatest need and target interventions. Research now suggests that there are interventions that can accelerate physical recovery and reduce the incidence of psychological problems such as anxiety, depression and PTSD. Cognitive rehabilitation, however, is still in its infancy. This review will look at the research into patients' recovery and what can be done to improve this where needed.

  10. Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study.

    PubMed

    Ala-Kokko, Tero I; Mutt, Shivaprakash J; Nisula, Sara; Koskenkari, Juha; Liisanantti, Janne; Ohtonen, Pasi; Poukkanen, Meri; Laurila, Jouko J; Pettilä, Ville; Herzig, Karl-Heinz

    2016-01-01

    Introduction Low levels of vitamin D have been associated with increased mortality in patients that are critically ill. This study explored whether vitamin D levels were associated with 90-day mortality in severe sepsis or septic shock. Methods Plasma vitamin D levels were measured on admission to the intensive care unit (ICU) in a prospective multicentre observational study. Results 610 patients with severe sepsis were included; of these, 178 (29%) had septic shock. Vitamin D deficiency (<50 nmol/L) was present in 333 (55%) patients. The 90-day mortality did not differ among patients with or without vitamin D deficiency (28.3% vs. 28.5%, p = 0.789). Diabetes was more common among patients deficient compared to those not deficient in vitamin D (30% vs. 18%, p < 0.001). Hospital-acquired infections at admission were more prevalent in patients with a vitamin D deficiency (31% vs. 16%, p < 0.001). A multivariable adjusted Cox regression model showed that low vitamin D levels could not predict 90-day mortality (<50 nmol/L: hazard ratio (HR) 0.99 (95% CI: 0.72-1.36), p > 0.9; and <25 nmol/L: HR 0.44 (95% CI: 0.22-0.87), p = 0.018). Conclusions Vitamin D deficiency detected upon ICU admission was not associated with 90-day mortality in patients with severe sepsis or septic shock. Key messages In severe sepsis and septic shock, a vitamin D deficiency upon ICU admission was not associated with increased mortality. Compared to patients with sufficient vitamin D, patients with deficient vitamin D more frequently exhibited diabetes, elevated C-reactive protein levels, and hospital-acquired infections upon ICU admission, and they more frequently developed acute kidney injury.

  11. Admission white blood cell count predicts short-term clinical outcomes in patients with uncomplicated Stanford type B acute aortic dissection

    PubMed Central

    Chen, Zhao-Ran; Huang, Bi; Lu, Hai-Song; Zhao, Zhen-Hua; Hui, Ru-Tai; Yang, Yan-Min; Fan, Xiao-Han

    2017-01-01

    Objectives Inflammation has been shown to be related with acute aortic dissection (AAD). The present study aimed to evaluate the association of white blood cell counts (WBCc) on admission with both in-hospital and long-term all-cause mortality in patients with uncomplicated Stanford type B AAD. Methods From 2008 to 2010, a total of 377 consecutive patients with uncomplicated type B AAD were enrolled and then followed up. Clinical data and WBCc on admission were collected. The primary end points were in-hospital death and long-term all-cause death. Results The in-hospital death rate was 4.2%, and the long-term all-cause mortality rate was 6.9% during a median follow-up of 18.9 months. WBCc on admission was identified as a risk factor for in-hospital death by univariate Cox regression analysis as both a continuous variable and a categorical variable using a cut off of 11.0 × 109 cell/L (all P < 0.05). After adjusting for age, sex and other risk factors, elevated admission WBCc was still a significant predictor for in-hospital death as both a continuous variable [hazard ratio (HR): 1.052, 95% CI: 1.024–1.336, P = 0.002] and a categorical variable using a cut off of 11.0 × 109 cell/L (HR: 2.056, 95% CI: 1.673–5.253, P = 0.034). No relationship was observed between WBCc on admission and long-term all-cause death. Conclusions Our results indicate that elevated WBCc upon admission might be used as a predictor for increased risk of in-hospital death in uncomplicated type B AAD. There might be no predictive value of WBCc for the long-term survival of type B AAD. PMID:28270842

  12. Telemedicine Intervention Improves ICU Outcomes

    PubMed Central

    Sadaka, Farid; Palagiri, Ashok; Trottier, Steven; Deibert, Wendy; Gudmestad, Donna; Sommer, Steven E.; Veremakis, Christopher

    2013-01-01

    Telemedicine for the intensive care unit (Tele-ICU) was founded as a means of delivering the clinical expertise of intensivists located remotely to hospitals with inadequate access to intensive care specialists. This was a retrospective pre- and postintervention study of adult patients admitted to a community hospital ICU. The patients in the preintervention period (n = 630) and during the Tele-ICU period (n = 2193) were controlled for baseline characteristics, acute physiologic scores (APS), and acute physiologic and health evaluation (APACHE IV) scores. Mean APS scores were 37.1 (SD, 22.8) and 37.7 (SD, 19.4) (P = 0.56), and mean APACHE IV scores were 49.7 (SD, 24.8) and 50.4 (SD, 21.0) (P = 0.53), respectively. ICU mortality was 7.9% during the preintervention period compared with 3.8% during the Tele-ICU period (odds ratio (OR) = 0.46, 95% confidence interval (CI), 0.32–0.66, P < 0.0001). ICU LOS in days was 2.7 (SD, 4.1) compared with 2.2 (SD, 3.4), respectively (hazard ratio (HR) = 1.16, 95% CI, 1.00–1.40, P = 0.01). Implementation of Tele-ICU intervention was associated with reduced ICU mortality and ICU LOS. This suggests that there are benefits of a closed Tele-ICU intervention beyond what is provided by daytime bedside physicians. PMID:23365729

  13. Predicting Mortality in Low-Income Country ICUs: The Rwanda Mortality Probability Model (R-MPM)

    PubMed Central

    Kiviri, Willy; Fowler, Robert A.; Mueller, Ariel; Novack, Victor; Banner-Goodspeed, Valerie M.; Weinkauf, Julia L.; Talmor, Daniel S.; Twagirumugabe, Theogene

    2016-01-01

    Introduction Intensive Care Unit (ICU) risk prediction models are used to compare outcomes for quality improvement initiatives, benchmarking, and research. While such models provide robust tools in high-income countries, an ICU risk prediction model has not been validated in a low-income country where ICU population characteristics are different from those in high-income countries, and where laboratory-based patient data are often unavailable. We sought to validate the Mortality Probability Admission Model, version III (MPM0-III) in two public ICUs in Rwanda and to develop a new Rwanda Mortality Probability Model (R-MPM) for use in low-income countries. Methods We prospectively collected data on all adult patients admitted to Rwanda’s two public ICUs between August 19, 2013 and October 6, 2014. We described demographic and presenting characteristics and outcomes. We assessed the discrimination and calibration of the MPM0-III model. Using stepwise selection, we developed a new logistic model for risk prediction, the R-MPM, and used bootstrapping techniques to test for optimism in the model. Results Among 427 consecutive adults, the median age was 34 (IQR 25–47) years and mortality was 48.7%. Mechanical ventilation was initiated for 85.3%, and 41.9% received vasopressors. The MPM0-III predicted mortality with area under the receiver operating characteristic curve of 0.72 and Hosmer-Lemeshow chi-square statistic p = 0.024. We developed a new model using five variables: age, suspected or confirmed infection within 24 hours of ICU admission, hypotension or shock as a reason for ICU admission, Glasgow Coma Scale score at ICU admission, and heart rate at ICU admission. Using these five variables, the R-MPM predicted outcomes with area under the ROC curve of 0.81 with 95% confidence interval of (0.77, 0.86), and Hosmer-Lemeshow chi-square statistic p = 0.154. Conclusions The MPM0-III has modest ability to predict mortality in a population of Rwandan ICU patients. The R

  14. Innovative designs for the smart ICU: Part 2: The ICU.

    PubMed

    Halpern, Neil A

    2014-03-01

    Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU can be conceptualized into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including its infrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated computers, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room, on-call suite, conference rooms, and offices), and the universal support services (infection prevention, finishings and flooring, staff communications, signage and wayfinding, security, and fire and safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. A balanced approach to centralized and decentralized monitoring and logistics also offers great flexibility. Synchronization of the universal support services in the ICU with the hospital's existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts.

  15. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study

    PubMed Central

    2011-01-01

    Introduction When the number of patients who require intensive care is greater than the number of beds available, intensive care unit (ICU) entry flow is obstructed. This phenomenon has been associated with higher mortality rates in patients that are not admitted despite their need, and in patients that are admitted but are waiting for a bed. The purpose of this study is to evaluate if a delay in ICU admission affects mortality for critically ill patients. Methods A prospective cohort of adult patients admitted to the ICU of our institution between January and December 2005 were analyzed. Patients for whom a bed was available were immediately admitted; when no bed was available, patients waited for ICU admission. ICU admission was classified as either delayed or immediate. Confounding variables examined were: age, sex, originating hospital ward, ICU diagnosis, co-morbidity, Acute Physiology and Chronic Health Evaluation (APACHE) II score, therapeutic intervention, and Sequential Organ Failure Assessment (SOFA) score. All patients were followed until hospital discharge. Results A total of 401 patients were evaluated; 125 (31.2%) patients were immediately admitted and 276 (68.8%) patients had delayed admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P = 0.002). The fraction of mortality risk attributable to ICU delay was 30% (95% confidence interval (CI): 11.2% to 44.8%). Each hour of waiting was independently associated with a 1.5% increased risk of ICU death (hazard ratio (HR): 1.015; 95% CI 1.006 to 1.023; P = 0.001). Conclusions There is a significant association between time to admission and survival rates. Early admission to the ICU is more likely to produce positive outcomes. PMID:21244671

  16. Predicting Different Grades in Different Ways for Selective Admission: Disentangling the First-Year Grade Point Average

    ERIC Educational Resources Information Center

    Steenman, Sebastiaan C.; Bakker, Wieger E.; van Tartwijk, Jan W. F.

    2016-01-01

    The first-year grade point average (FYGPA) is the predominant measure of student success in most studies on university admission. Previous cognitive achievements measured with high school grades or standardized tests have been found to be the strongest predictors of FYGPA. For this reason, standardized tests measuring cognitive achievement are…

  17. Endotracheal intubation in the ICU.

    PubMed

    Lapinsky, Stephen E

    2015-06-17

    Endotracheal intubation in the ICU is a high-risk procedure, resulting in significant morbidity and mortality. Up to 40% of cases are associated with marked hypoxemia or hypotension. The ICU patient is physiologically very different from the usual patient who undergoes intubation in the operating room, and different intubation techniques should be considered. The common operating room practice of sedation and neuromuscular blockade to facilitate intubation may carry significant risk in the ICU patient with a marked oxygenation abnormality, particularly when performed by the non-expert. Preoxygenation is largely ineffective in these patients and oxygen desaturation occurs rapidly on induction of anesthesia, limiting the time available to secure the airway. The ICU environment is less favorable for complex airway management than the operating room, given the frequent lack of availability of additional equipment or additional expert staff. ICU intubations are frequently carried out by trainees, with a lesser degree of airway experience. Even in the presence of a non-concerning airway assessment, these patients are optimally managed as a difficult airway, utilizing an awake approach. Endotracheal intubation may be achieved by awake direct laryngoscopy in the sick ICU patient whose level of consciousness may be reduced by sepsis, hypercapnia or hypoxemia. As the patient's spontaneous respiratory efforts are not depressed by the administration of drugs, additional time is available to obtain equipment and expertise in the event of failure to secure the airway. ICU intubation complications should be tracked as part of the ICU quality improvement process.

  18. Copeptin Predicts Mortality in Critically Ill Patients

    PubMed Central

    Krychtiuk, Konstantin A.; Honeder, Maria C.; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S.

    2017-01-01

    Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. Methods In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Results Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Conclusion Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU. PMID:28118414

  19. Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

    PubMed Central

    Eizadi-Mood, Nastaran; Sabzghabaee, Ali Mohammad; Hosseini, Hossein; Soltaninejad, Forough; Massoumi, Gholamreza; Farajzadegan, Ziba; Yaraghi, Ahmad

    2015-01-01

    Background: Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. Purpose: In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. Methods: In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients’ clinical outcome. Findings: On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. Conclusions: Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy. PMID:26543310

  20. Significant but reasonable radiation exposure from computed tomography-related medical imaging in the ICU.

    PubMed

    Slovis, Benjamin H; Shah, Kaushal H; Yeh, D Dante; Seethala, Raghu; Kaafarani, Haytham M A; Eikermann, Matthias; Raja, Ali S; Lee, Jarone

    2016-04-01

    Admission to an intensive care unit (ICU) is associated with increased medical imaging and radiation exposure, yet few studies have estimated the risk of cancer associated with these examinations. The purpose of this study was to review computed tomography (CT) scans performed on patients admitted to two urban academic ICUs, predict their radiation exposure, and calculate their estimated lifetime attributable risk of cancer (LAR). An electronic chart review was performed on all CT scans performed between January 2007 and December 2011. The estimated effective dose of radiation was calculated for each CT, and the LAR for each patient was predicted. Mean radiation exposure was 22.2 ± 25.0 mSv with a mean LAR of 0.1 ± 0.2 % and a median of 0.6 % with a range of <0.001 to 3.4 %. Our cohort received radiation doses higher than recommended by guidelines; however, the critical nature of their admission may have warranted these imaging studies. Estimated risk of cancer in this population was overall low.

  1. ICU telemedicine and critical care mortality: a national effectiveness study

    PubMed Central

    Kahn, Jeremy M; Le, Tri Q.; Barnato, Amber E.; Hravnak, Marilyn; Kuza, Courtney C.; Pike, Francis; Angus, Derek C.

    2015-01-01

    Background Intensive care unit (ICU) telemedicine is an increasingly common strategy for improving the outcome of critical care, but its overall impact is uncertain. Objectives To determine the effectiveness of ICU telemedicine in a national sample of hospitals and quantify variation in effectiveness across hospitals. Research design We performed a multi-center retrospective case-control study using 2001–2010 Medicare claims data linked to a national survey identifying United States hospitals adopting ICU telemedicine. We matched each adopting hospital (cases) to up to 3 non-adopting hospitals (controls) based on size, case-mix and geographic proximity during the year of adoption. Using ICU admissions from 2 years before and after the adoption date, we compared outcomes between case and control hospitals using a difference-in-differences approach. Results 132 adopting case hospitals were matched to 389 similar non-adopting control hospitals. The pre- and post-adoption unadjusted 90-day mortality was similar in both case hospitals (24.0% vs. 24.3%, p=0.07) and control hospitals (23.5% vs. 23.7%, p<0.01). In the difference-in-differences analysis, ICU telemedicine adoption was associated with a small relative reduction in 90-day mortality (ratio of odds ratios: 0.96, 95% CI = 0.95–0.98, p<0.001). However, there was wide variation in the ICU telemedicine effect across individual hospitals (median ratio of odds ratios: 1.01; interquartile range 0.85–1.12; range 0.45–2.54). Only 16 case hospitals (12.2%) experienced statistically significant mortality reductions post-adoption. Hospitals with a significant mortality reduction were more likely to have large annual admission volumes (p<0.001) and be located in urban areas (p=0.04) compared to other hospitals. Conclusions Although ICU telemedicine adoption resulted in a small relative overall mortality reduction, there was heterogeneity in effect across adopting hospitals, with large-volume urban hospitals

  2. The implementation of an Intensive Care Information System allows shortening the ICU length of stay.

    PubMed

    Levesque, Eric; Hoti, Emir; Azoulay, Daniel; Ichai, Philippe; Samuel, Didier; Saliba, Faouzi

    2015-04-01

    Intensive care information systems (ICIS) implemented in intensive care unit (ICU) were shown to improve patient safety, reduce medical errors and increase the time devolved by medical/nursing staff to patients care. Data on the real impact of ICIS on patient outcome are scarce. This study aimed to evaluate the effects of ICIS on the outcome of critically-ill patients. From January 2004 to August 2006, 1,397 patients admitted to our ICU were enrolled in this observational study. This period was divided in two phases: before the implementation of ICIS (BEFORE) and after implementation of ICIS (AFTER). We compared standard ICU patient's outcomes: mortality, length of stay in ICU, hospital stay, and the re-admission rate depending upon BEFORE and AFTER. Although patients admitted AFTER were more severely ill than those of BEFORE (SAPS II: 32.1±17.5 vs. 30.5±18.5, p=0.014, respectively), their ICU length of stay was significantly shorter (8.4±15.2 vs. 6.8±12.9 days; p=0.048) while the re-admission rate and mortality rate were similar (4.4 vs. 4.2%; p=0.86, and 9.6 vs 11.2% p=0.35, respectively) in patients admitted AFTER. We observed that the implementation of ICIS allowed shortening of ICU length of stay without altering other patient outcomes.

  3. Blood Leukocyte Count on Admission Predicts Cardiovascular Events in Patients with Acute Non-ST Elevation Myocardial Infarction.

    PubMed

    Dharma, Surya; Hapsari, Rosmarini; Siswanto, Bambang B; van der Laarse, Arnoud; Jukema, J Wouter

    2015-06-01

    We aim to test the hypothesis that blood leukocyte count adds prognostic information in patients with acute non-ST-elevation myocardial infarction (non-STEMI). A total of 585 patients with acute non-STEMI (thrombolysis in myocardial infarction risk score ≥ 3) were enrolled in this cohort retrospective study. Blood leukocyte count was measured immediately after admission in the emergency department. The composite of death, reinfarction, urgent revascularization, and stroke during hospitalization were defined as the primary end point of the study. The mean age of the patients was 61 ± 9.6 years and most of them were male (79%). Using multivariate Cox regression analysis involving seven variables (history of smoking, hypertension, heart rate > 100 beats/minute, serum creatinine level > 1.5 mg/dL, blood leukocyte count > 11,000/µL, use of β-blocker, and use of angiotensin-converting enzyme inhibitor), leukocyte count > 11,000/µL demonstrated to be a strong predictor of the primary end point (hazard ratio = 3.028; 95% confidence interval = 1.69-5.40, p < 0.001). The high blood leukocyte count on admission is an independent predictor of cardiovascular events in patients with acute non-STEMI.

  4. Why women perform better in college than admission scores would predict: Exploring the roles of conscientiousness and course-taking patterns.

    PubMed

    Keiser, Heidi N; Sackett, Paul R; Kuncel, Nathan R; Brothen, Thomas

    2016-04-01

    Women typically obtain higher subsequent college GPAs than men with the same admissions test score. A common reaction is to attribute this to a flaw in the admissions test. We explore the possibility that this underprediction of women's performance reflects gender differences in conscientiousness and college course-taking patterns. In Study 1, we focus on using the ACT to predict performance in a single, large course where performance is decomposed into cognitive (exam and quiz scores) and less cognitive, discretionary components (discussion and extra credit points). The ACT does not underpredict female's cognitive performance, but it does underpredict female performance on the less cognitive, discretionary components of academic performance, because it fails to measure and account for the personality trait of conscientiousness. In Study 2, we create 2 course-difficulty indices (Course Challenge and Mean Aptitude in Course) and add them to an HLM regression model to see if they reduce the degree to which SAT scores underpredict female performance. Including Course Challenge does result in a modest reduction of the gender coefficient; however, including Mean Aptitude in Course does not. Thus, differences in course-taking patterns is a partial (albeit small) explanation for the common finding of differential prediction by gender.

  5. To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

    PubMed Central

    2013-01-01

    Background Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity. A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills. Method Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models. Results Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks. In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the

  6. Maternal mortality and morbidity: epidemiology of intensive care admissions in pregnancy.

    PubMed

    Senanayake, H; Dias, T; Jayawardena, A

    2013-12-01

    Maternal mortality reviews are used globally to assess the quality of health-care services. With the decline in the number of maternal deaths, it has become difficult to derive meaningful conclusions that could have an impact on quality of care using maternal mortality data. The emphasis has recently shifted to severe acute maternal morbidity (SAMM), as an adjunct to maternal mortality reviews. Due to its heterogeneity, there are difficulties in recognising SAMM. The problem of identifying SAMM accurately is the main issue in investigating them. However, admission to an intensive care unit (ICU) provides an unambiguous, management-based inclusion criterion for a SAMM. ICU data are available across health-care settings prospectively and retrospectively, making them a tool that could be studied readily. However, admission to the ICU depends on many factors, such as accessibility and the availability of high-dependency units, which will reduce the need for ICU admission. Thresholds for admission vary widely and are generally higher in facilities that handle a heavier workload. In addition, not all women with SAMM receive intensive care. However, women at the severe end of the spectrum of severe morbidity will almost invariably receive intensive care. Notwithstanding these limitations, the epidemiology of intensive care admissions in pregnancy will provide valuable data about women with severe morbidity. The overall rate of obstetric ICU admission varies from 0.04% to 4.54%.

  7. Admission serum albumin is predicitve of outcome in critically ill trauma patients.

    PubMed

    Sung, Jin; Bochicchio, Grant V; Joshi, Manjari; Bochicchio, Kelly; Costas, Ainhoa; Tracy, Kate; Scalea, Thomas M

    2004-12-01

    There is a paucity of data evaluating serum albumin on admission as a predictor of outcome in adult trauma patients. Our objectives were to evaluate whether or not hypoalbuminemia on admission is a predictor of adverse outcome in trauma patients. Prospective data was collected daily on 1023 patients over a 2-year period. Patients were stratified by serum albumin level on admission, age, gender, injury severity, and comorbid conditions. Outcome was measured by ICU and hospital length of stay, ventilator days, incidence of infection, and mortality. Student t test, chi2, and multilinear regression analysis were used to determine level of significance. Blunt injuries accounted for the majority (78%) of the admissions. The mean age of the study population was 43+/-21 years with a mean Injury Severity Score (ISS) of 21.4+/-12. The majority of patients were male (74.5%). The mean albumin level on admission was 2.9+/-1.8. Five hundred ninety-three (58%) patients were admitted with a serum albumin level of > or =2.6 as compared to 430 patients (42%) with an admission albumin level of <2.6. Patients with a lower serum albumin level were found to have a significantly greater ICU (17.1 vs 14.2 days) and hospital length of stay (17.3 vs 20.1 days, P'< 0.05), ventilator days (11.1 vs 13.5 days, P < 0.05), and mortality (P = 0.008) when matched for age and injury severity. The relative risk of infection and mortality increased greater than 2.5-fold in patients with increased age and low serum albumin when analyzed by multilinear regression analysis, P < 0.001. An admission serum albumin level of <2.6 g/dL is a significant independent predictor of morbidity and mortality in trauma patients. The combination of increased age and low albumin level was most predictive of infection and mortality. Early nutrition should be considered in these high-risk patients.

  8. Elevated Omentin Serum Levels Predict Long-Term Survival in Critically Ill Patients

    PubMed Central

    Luedde, Mark; Benz, Fabian; Niedeggen, Jennifer; Vucur, Mihael; Hippe, Hans-Joerg; Spehlmann, Martina E.; Schueller, Florian; Loosen, Sven; Frey, Norbert; Trautwein, Christian; Koch, Alexander; Luedde, Tom; Tacke, Frank

    2016-01-01

    Introduction. Omentin, a recently described adipokine, was shown to be involved in the pathophysiology of inflammatory and infectious diseases. However, its role in critical illness and sepsis is currently unknown. Materials and Methods. Omentin serum concentrations were measured in 117 ICU-patients (84 with septic and 33 with nonseptic disease etiology) admitted to the medical ICU. Results were compared with 50 healthy controls. Results. Omentin serum levels of critically ill patients at admission to the ICU or after 72 hours of ICU treatment were similar compared to healthy controls. Moreover, circulating omentin levels were independent of sepsis and etiology of critical illness. Notably, serum concentrations of omentin could not be linked to concentrations of inflammatory cytokines or routinely used sepsis markers. While serum levels of omentin were not predictive for short term survival during ICU treatment, low omentin concentrations were an independent predictor of patients' overall survival. Omentin levels strongly correlated with that of other adipokines (e.g., leptin receptor or adiponectin), which have also been identified as prognostic markers in critical illness. Conclusions. Although circulating omentin levels did not differ between ICU-patients and controls, elevated omentin levels were predictive for an impaired patients' long term survival. PMID:27867249

  9. Retrospective study on prognostic importance of serum procalcitonin and amino-terminal pro-brain natriuretic peptide levels as compared to Acute Physiology and Chronic Health Evaluation IV Score on Intensive Care Unit admission, in a mixed Intensive Care Unit population

    PubMed Central

    Mehta, Chitra; Dara, Babita; Mehta, Yatin; Tariq, Ali M.; Joby, George V.; Singh, Manish K.

    2016-01-01

    Background: Timely decision making in Intensive Care Unit (ICU) is very essential to improve the outcome of critically sick patients. Conventional scores like Acute Physiology and Chronic Health Evaluation (APACHE IV) are quite cumbersome with calculations and take minimum 24 hours. Procalcitonin has shown to have prognostic value in ICU/Emergency department (ED) in disease states like pneumonia, sepsis etc. NTproBNP has demonstrated excellent diagnostic and prognostic importance in cardiac diseases. It has also been found elevated in non-cardiac diseases. We chose to study the prognostic utility of these markers on ICU admission. Settings and Design: Retrospective observational study. Materials and Methods: A Retrospective analysis of 100 eligible patients was done who had undergone PCT and NTproBNP measurements on ICU admission. Their correlations with all cause mortality, length of hospital stay, need for ventilator support, need for vasopressors were performed. Results: Among 100 randomly selected ICU patients, 28 were non-survivors. NTproBNP values on admission significantly correlated with all cause mortality (P = 0.036, AUC = 0.643) and morbidity (P = 0.000, AUC = 0.763), comparable to that of APACHE-IV score. PCT values on admission did not show significant association with mortality, but correlated well with morbidity and prolonged hospital length of stay (AUC = 0.616, P = 0.045). Conclusion: The current study demonstrated a good predictive value of NTproBNP, in terms of mortality and morbidity comparable to that of APACHE-IV score. Procalcitonin, however, was found to have doubtful prognostic importance. These findings need to be confirmed in a prospective larger study. PMID:27052066

  10. Index Blood Tests and National Early Warning Scores within 24 Hours of Emergency Admission Can Predict the Risk of In-Hospital Mortality: A Model Development and Validation Study

    PubMed Central

    Mohammed, Mohammed A.; Rudge, Gavin; Watson, Duncan; Wood, Gordon; Smith, Gary B.; Prytherch, David R.; Girling, Alan; Stevens, Andrew

    2013-01-01

    Background We explored the use of routine blood tests and national early warning scores (NEWS) reported within ±24 hours of admission to predict in-hospital mortality in emergency admissions, using empirical decision Tree models because they are intuitive and may ultimately be used to support clinical decision making. Methodology A retrospective analysis of adult emergency admissions to a large acute hospital during April 2009 to March 2010 in the West Midlands, England, with a full set of index blood tests results (albumin, creatinine, haemoglobin, potassium, sodium, urea, white cell count and an index NEWS undertaken within ±24 hours of admission). We developed a Tree model by randomly splitting the admissions into a training (50%) and validation dataset (50%) and assessed its accuracy using the concordance (c-) statistic. Emergency admissions (about 30%) did not have a full set of index blood tests and/or NEWS and so were not included in our analysis. Results There were 23248 emergency admissions with a full set of blood tests and NEWS with an in-hospital mortality of 5.69%. The Tree model identified age, NEWS, albumin, sodium, white cell count and urea as significant (p<0.001) predictors of death, which described 17 homogeneous subgroups of admissions with mortality ranging from 0.2% to 60%. The c-statistic for the training model was 0.864 (95%CI 0.852 to 0.87) and when applied to the testing data set this was 0.853 (95%CI 0.840 to 0.866). Conclusions An easy to interpret validated risk adjustment Tree model using blood test and NEWS taken within ±24 hours of admission provides good discrimination and offers a novel approach to risk adjustment which may potentially support clinical decision making. Given the nature of the clinical data, the results are likely to be generalisable but further research is required to investigate this promising approach. PMID:23734195

  11. Delirium and sedation in the ICU.

    PubMed

    Frontera, Jennifer A

    2011-06-01

    Delirium is defined by a fluctuating level of attentiveness and has been associated with increased ICU mortality and poor cognitive outcomes in both general ICU and neurocritical care populations. Sedation use in the ICU can contribute to delirium. Limiting ICU sedation allows for the diagnosis of underlying acute neurological insults associated with delirium and leads to shorter mechanical ventilation time, shorter length of stay, and improved 1 year mortality rates. Identifying the underlying etiology of delirium is critical to developing treatment paradigms.

  12. The Use of Learning Styles and Admission Criteria in Predicting Academic Performance and Retention of College Freshmen.

    ERIC Educational Resources Information Center

    Garton, Bryan L.; Dyer, James E.; King, Brad O.

    2000-01-01

    College freshmen (n=326) who preferred field-independent and field-neutral learning styles had higher grade point averages. High school grade point average and ACT scores were the best predictors of freshman academic performance. Learning style and ACT scores best predicted student retention. (SK)

  13. Characterisation of Candida within the Mycobiome/Microbiome of the Lower Respiratory Tract of ICU Patients

    PubMed Central

    Krause, Robert; Halwachs, Bettina; Thallinger, Gerhard G.; Klymiuk, Ingeborg; Gorkiewicz, Gregor; Hoenigl, Martin; Prattes, Jürgen; Valentin, Thomas; Heidrich, Katharina; Buzina, Walter; Salzer, Helmut J. F.; Rabensteiner, Jasmin; Prüller, Florian; Raggam, Reinhard B.; Meinitzer, Andreas; Moissl-Eichinger, Christine; Högenauer, Christoph; Quehenberger, Franz; Kashofer, Karl; Zollner-Schwetz, Ines

    2016-01-01

    Whether the presence of Candida spp. in lower respiratory tract (LRT) secretions is a marker of underlying disease, intensive care unit (ICU) treatment and antibiotic therapy or contributes to poor clinical outcome is unclear. We investigated healthy controls, patients with proposed risk factors for Candida growth in LRT (antibiotic therapy, ICU treatment with and without antibiotic therapy), ICU patients with pneumonia and antibiotic therapy and candidemic patients (for comparison of truly invasive and colonizing Candida spp.). Fungal patterns were determined by conventional culture based microbiology combined with molecular approaches (next generation sequencing, multilocus sequence typing) for description of fungal and concommitant bacterial microbiota in LRT, and host and fungal biomarkes were investigated. Admission to and treatment on ICUs shifted LRT fungal microbiota to Candida spp. dominated fungal profiles but antibiotic therapy did not. Compared to controls, Candida was part of fungal microbiota in LRT of ICU patients without pneumonia with and without antibiotic therapy (63% and 50% of total fungal genera) and of ICU patients with pneumonia with antibiotic therapy (73%) (p<0.05). No case of invasive candidiasis originating from Candida in the LRT was detected. There was no common bacterial microbiota profile associated or dissociated with Candida spp. in LRT. Colonizing and invasive Candida strains (from candidemic patients) did not match to certain clades withdrawing the presence of a particular pathogenic and invasive clade. The presence of Candida spp. in the LRT rather reflected rapidly occurring LRT dysbiosis driven by ICU related factors than was associated with invasive candidiasis. PMID:27206014

  14. Hospital-wide infection control practice and Meticillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU): an observational study

    PubMed Central

    Workman, Rella

    2014-01-01

    Summary Objectives To estimate trends in infection/colonisation with meticillin-resistant Staphylococcus aureus (MRSA) in an intensive care unit (ICU). Design Observational study of results of ICU admission and weekly screens for MRSA. Setting and Participants All ICU admissions in 2001–2012. Interventions ICU admissions were screened for MRSA throughout. In late 2006, screening was extended to the whole hospital and extra measures taken in ICU. Main outcome measures Prevalence of MRSA in ICU admissions and number acquiring MRSA therein. Results In all, 366 of 6565 admissions to ICU were MRSA positive, including 270 of 4466 coming from within the hospital in which prevalence increased with time prior to transfer to ICU. Prevalence in this group was 9.4% (8.2–10.6) in 2001–2006, decreasing to 3.4% (2.3–4.5) in 2007–2009 and 1.3% (0.6–2.0) in 2010–2012, p < 0.001, due to decreased prevalence in those spending >5 days on wards before ICU admission: 18.9% (15.6–22.2) in 2001–2006, 7.1% (4.0–10.2) in 2007–2009 and 1.6% (0.1–3.1) in 2010–2012, p < 0.001. In addition, 201 patients acquired MRSA within ICU, the relative risk being greater when known positives present: 4.34 (3.98–4.70), p < 0.001. Acquisition rate/1000 bed days decreased from 13.3 (11.2–15.4) in 2001–2006 to 3.6 (2.6–4.6) in 2007–2012, p < 0.0001. Of 41 ICU-acquired MRSA bacteraemias, 38 were in 2001–2006. The risk of bacteraemia in those acquiring MRSA decreased from 25% (18.1–31.9) in 2001–2006 to 6.1% (0–12.8) thereafter, p = 0.022. Conclusions Following better hospital-wide infection control, fewer MRSA-positive patients were admitted to ICU with a parallel decrease in acquisition therein. Better practice there reduced the risk of bacteraemia. PMID:25383196

  15. Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients: Post-Hoc Analyses of the SUP-ICU Inception Cohort Study

    PubMed Central

    Møller, Morten Hylander; Krag, Mette; Perner, Anders; Hjortrup, Peter Buhl

    2016-01-01

    Purpose Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II and the initial SOFA score for in-hospital and 90-day mortality in a contemporary international cohort. Methods This was a post-hoc study of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) inception cohort study, which included acutely ill adults from ICUs across 11 countries (n = 1034). We compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores. Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow’s goodness-of-fit Ĉ-statistic. Results AUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77–0.83) for SAPS II and 0.73 (95% CI 0.69–0.76) for initial SOFA score (P<0.001 for the comparison). Calibration of the customised SAPS II for predicting in-hospital mortality was adequate (P = 0.60). Discrimination of SAPS II was reduced compared with the original SAPS II validation sample (AUROC 0.80 vs. 0.86; P = 0.001). AUROC for 90-day mortality was 0.79 (95% CI 0.76–0.82; P = 0.74 for comparison with in-hospital mortality) for SAPS II and 0.71 (95% CI 0.68–0.75; P = 0.66 for comparison with in-hospital mortality) for the initial SOFA score. Conclusions The predictive performance of SAPS II was similar for in-hospital and 90-day mortality and superior to that of the initial SOFA score, but SAPS II’s performance has decreased over time. Use of a contemporary severity score with improved predictive

  16. Do personality traits assessed on medical school admission predict exit performance? A UK-wide longitudinal cohort study.

    PubMed

    MacKenzie, R K; Dowell, J; Ayansina, D; Cleland, J A

    2016-10-04

    Traditional methods of assessing personality traits in medical school selection have been heavily criticised. To address this at the point of selection, "non-cognitive" tests were included in the UK Clinical Aptitude Test, the most widely-used aptitude test in UK medical education (UKCAT: http://www.ukcat.ac.uk/ ). We examined the predictive validity of these non-cognitive traits with performance during and on exit from medical school. We sampled all students graduating in 2013 from the 30 UKCAT consortium medical schools. Analysis included: candidate demographics, UKCAT non-cognitive scores, medical school performance data-the Educational Performance Measure (EPM) and national exit situational judgement test (SJT) outcomes. We examined the relationships between these variables and SJT and EPM scores. Multilevel modelling was used to assess the relationships adjusting for confounders. The 3343 students who had taken the UKCAT non-cognitive tests and had both EPM and SJT data were entered into the analysis. There were four types of non-cognitive test: (1) libertariancommunitarian, (2) NACE-narcissism, aloofness, confidence and empathy, (3) MEARS-self-esteem, optimism, control, self-discipline, emotional-nondefensiveness (END) and faking, (4) an abridged version of 1 and 2 combined. Multilevel regression showed that, after correcting for demographic factors, END predicted SJT and EPM decile. Aloofness and empathy in NACE were predictive of SJT score. This is the first large-scale study examining the relationship between performance on non-cognitive selection tests and medical school exit assessments. The predictive validity of these tests was limited, and the relationships revealed do not fit neatly with theoretical expectations. This study does not support their use in selection.

  17. Effectiveness of pre-admission data and letters of recommendation to predict students who will need professional behavior intervention during clinical rotations in the United States

    PubMed Central

    2016-01-01

    The study aimed at finding the value of letters of recommendation in predicting professional behavior problems in the clinical portion of a Doctor of Physical Therapy program learning cohorts from 2009-2014 in the United States. De-identified records of 137 Doctor of Physical Therapy graduates were examined by the descriptive statistics and comparison analysis. Thirty letters of recommendation were investigated based on grounded theory from 10 student applications with 5 randomly selected students of interest and 5 non-students of interest. Critical thinking, organizational skills, and judgement were statistically significant and quantitative differentiating characteristics. Qualitatively, significant characteristics of the student of interest included effective communication and cultural competency. Meanwhile, those of nonstudents of interest included conflicting personality descriptor, commitment to learning, balance, teamwork skills, potential future success, compatible learning skills, effective leadership skills, and emotional intelligence. Emerged significant characteristics did not consistently match common non-professional behavior issues encountered in clinic. Pre-admission data and letters of recommendation appear of limited value in predicting professional behavior performance in clinic. PMID:27378011

  18. Effectiveness of pre-admission data and letters of recommendation to predict students who will need professional behavior intervention during clinical rotations in the United States.

    PubMed

    Engelhard, Chalee; Leugers, Rebecca; Stephan, Jenna

    2016-01-01

    The study aimed at finding the value of letters of recommendation in predicting professional behavior problems in the clinical portion of a Doctor of Physical Therapy program learning cohorts from 2009-2014 in the United States. De-identified records of 137 Doctor of Physical Therapy graduates were examined by the descriptive statistics and comparison analysis. Thirty letters of recommendation were investigated based on grounded theory from 10 student applications with 5 randomly selected students of interest and 5 non-students of interest. Critical thinking, organizational skills, and judgement were statistically significant and quantitative differentiating characteristics. Qualitatively, significant characteristics of the student of interest included effective communication and cultural competency. Meanwhile, those of nonstudents of interest included conflicting personality descriptor, commitment to learning, balance, teamwork skills, potential future success, compatible learning skills, effective leadership skills, and emotional intelligence. Emerged significant characteristics did not consistently match common non-professional behavior issues encountered in clinic. Pre-admission data and letters of recommendation appear of limited value in predicting professional behavior performance in clinic.

  19. A Comparison of Intensive Care Unit Mortality Prediction Models through the Use of Data Mining Techniques

    PubMed Central

    Kim, Woojae; Park, Rae Woong

    2011-01-01

    Objectives The intensive care environment generates a wealth of critical care data suited to developing a well-calibrated prediction tool. This study was done to develop an intensive care unit (ICU) mortality prediction model built on University of Kentucky Hospital (UKH)'s data and to assess whether the performance of various data mining techniques, such as the artificial neural network (ANN), support vector machine (SVM) and decision trees (DT), outperform the conventional logistic regression (LR) statistical model. Methods The models were built on ICU data collected regarding 38,474 admissions to the UKH between January 1998 and September 2007. The first 24 hours of the ICU admission data were used, including patient demographics, admission information, physiology data, chronic health items, and outcome information. Results Only 15 study variables were identified as significant for inclusion in the model development. The DT algorithm slightly outperformed (AUC, 0.892) the other data mining techniques, followed by the ANN (AUC, 0.874), and SVM (AUC, 0.876), compared to that of the APACHE III performance (AUC, 0.871). Conclusions With fewer variables needed, the machine learning algorithms that we developed were proven to be as good as the conventional APACHE III prediction. PMID:22259725

  20. Derivation of a cardiac arrest prediction model using ward vital signs

    PubMed Central

    Churpek, Matthew M.; Yuen, Trevor C.; Park, Seo Young; Meltzer, David O.; Hall, Jesse B.; Edelson, Dana P.

    2012-01-01

    Objective Rapid response team (RRT) activation criteria were created using expert opinion and have demonstrated variable accuracy in previous studies. We developed a cardiac arrest risk triage (CART) score to predict cardiac arrest (CA) and compared it to the Modified Early Warning Score (MEWS), a commonly cited RRT activation criterion. Design A retrospective cohort study. Setting An academic medical center in the United States. Patients All patients hospitalized from November 2008 to January 2011 who had documented ward vital signs were included in the study. These patients were divided into three cohorts: patients who suffered a CA on the wards, patients who had a ward to intensive care unit (ICU) transfer, and patients who had neither of these outcomes (controls). Interventions None. Measurements and Main Results Ward vital signs from admission until discharge, ICU transfer, or ward CA were extracted from the medical record. Multivariate logistic regression was used to predict CA, and the CART score was calculated using the regression coefficients. The model was validated by comparing its accuracy for detecting ICU transfer to the MEWS. Each patient’s maximum score prior to CA, ICU transfer, or discharge was used to compare the areas under the receiver operating characteristic curves (AUC) between the two models. Eighty-eight CA patients, 2820 ICU transfers, and 44519 controls were included in the study. The CART score more accurately predicted CA than the MEWS (AUC 0.84 vs. 0.76;P=0.001). At a specificity of 89.9%, the CART score had a sensitivity of 53.4% compared to 47.7% for the MEWS. The CART score also predicted ICU transfer better than the MEWS (AUC 0.71 vs. 0.67;P<0.001). Conclusions The CART score is simpler and more accurately detected CA and ICU transfer than the MEWS. Implementation of this tool may decrease RRT resource utilization and provide a better opportunity to improve patient outcomes than the MEWS. PMID:22584764

  1. icuARM-An ICU Clinical Decision Support System Using Association Rule Mining

    PubMed Central

    Chanani, Nikhil; Venugopalan, Janani; Maher, Kevin; Wang, May Dongmei

    2013-01-01

    The rapid development of biomedical monitoring technologies has enabled modern intensive care units (ICUs) to gather vast amounts of multimodal measurement data about their patients. However, processing large volumes of complex data in real-time has become a big challenge. Together with ICU physicians, we have designed and developed an ICU clinical decision support system icuARM based on associate rule mining (ARM), and a publicly available research database MIMIC-II (Multi-parameter Intelligent Monitoring in Intensive Care II) that contains more than 40,000 ICU records for 30,000+patients. icuARM is constructed with multiple association rules and an easy-to-use graphical user interface (GUI) for care providers to perform real-time data and information mining in the ICU setting. To validate icuARM, we have investigated the associations between patients' conditions such as comorbidities, demographics, and medications and their ICU outcomes such as ICU length of stay. Coagulopathy surfaced as the most dangerous co-morbidity that leads to the highest possibility (54.1%) of prolonged ICU stay. In addition, women who are older than 50 years have the highest possibility (38.8%) of prolonged ICU stay. For clinical conditions treatable with multiple drugs, icuARM suggests that medication choice can be optimized based on patient-specific characteristics. Overall, icuARM can provide valuable insights for ICU physicians to tailor a patient's treatment based on his or her clinical status in real time. PMID:27170860

  2. Using Old and New SAT® Scores for Admission: A Closer Look at Concordant Scores in Predictive Models. Research Report 2016-17

    ERIC Educational Resources Information Center

    Marini, Jessica P.; Shaw, Emily J.; Young, Linda

    2016-01-01

    During the transition period between the use of exclusively old SAT® scores and the use of exclusively new SAT scores, college admission offices will be receiving both types of scores from students. Making an admission decision based on new SAT scores can be challenging at first because institutions have methods, procedures, and models based on…

  3. Statistical Analysis Aiming at Predicting Respiratory Tract Disease Hospital Admissions from Environmental Variables in the City of São Paulo

    PubMed Central

    de Sousa Zanotti Stagliorio Coêlho, Micheline; Luiz Teixeira Gonçalves, Fabio; do Rosário Dias de Oliveira Latorre, Maria

    2010-01-01

    This study is aimed at creating a stochastic model, named Brazilian Climate and Health Model (BCHM), through Poisson regression, in order to predict the occurrence of hospital respiratory admissions (for children under thirteen years of age) as a function of air pollutants, meteorological variables, and thermal comfort indices (effective temperatures, ET). The data used in this study were obtained from the city of São Paulo, Brazil, between 1997 and 2000. The respiratory tract diseases were divided into three categories: URI (Upper Respiratory tract diseases), LRI (Lower Respiratory tract diseases), and IP (Influenza and Pneumonia). The overall results of URI, LRI, and IP show clear correlation with SO2 and CO, PM10 and O3, and PM10, respectively, and the ETw4 (Effective Temperature) for all the three disease groups. It is extremely important to warn the government of the most populated city in Brazil about the outcome of this study, providing it with valuable information in order to help it better manage its resources on behalf of the whole population of the city of Sao Paulo, especially those with low incomes. PMID:20706674

  4. Rational fluid management in today's ICU practice

    PubMed Central

    2013-01-01

    Intravenous fluid therapy has evolved significantly over time. From the initial report of the first intravenous administration of sodium-chloride-based solution to the development of goal-directed fluid therapy using novel dynamic indices, efforts have focused on improving patient outcomes. The goal of this review is to provide a brief overview of current concepts for intravenous fluid administration in the ICU. Results of recently published clinical trials suggesting harmful effects of starch-based solutions on critically ill patients are discussed. Concepts for goal-directed fluid therapy and new modalities for the assessment of fluid status as well as for the prediction of responsiveness to different interventions will continue to emerge. Advances in technology will have to be critically evaluated for their ability to improve outcomes in different clinical scenarios. PMID:23514431

  5. Determination of functional prognosis in hospitalized patients following an intensive care admission

    PubMed Central

    Ferreira, Natália A; Lopes, Agnaldo José; Ferreira, Arthur S; Ntoumenopoulos, George; Dias, Jerffesson; Guimaraes, Fernando S

    2016-01-01

    AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission. METHODS Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality (KATZ Index of Independence in Activities of Daily Living) and muscle strength (MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit (ICU), in the Ward (WARD) and the total time of hospital stay (TOT). RESULTS Considering the functional outcome (ΔKATZ), the variables that significantly contributed to the model (P < 0.05) were the KATZ and MRC on admission, age, sepsis (no), and total length of stay (TLS). Regarding the muscle strength outcome model (ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex (female). The variable age (AUC = 0.664) discriminated the ΔKATZICU. The variables age (AUC = 0.712), KATZ in ICU (AUC = 0.590) and on ward admission (AUC = 0.746), and MRC on ward admission (AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission (AUC = 0.621) and TLS (AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII (AUC = 0.661) and MRC on ICU admission (AUC = 0.653) were discriminative. MRC on ICU (AUC = 0.681) and ward admission (AUC = 0.553) were discriminative for ΔMRCWARD. TLS (AUC = 0.649) and MRC on ward admission (AUC = 0.696) discriminative for the ΔMRCTOT. CONCLUSION Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period

  6. The Research Agenda in ICU Telemedicine

    PubMed Central

    Hill, Nicholas S.; Lilly, Craig M.; Angus, Derek C.; Jacobi, Judith; Rubenfeld, Gordon D.; Rothschild, Jeffrey M.; Sales, Anne E.; Scales, Damon C.; Mathers, James A. L.

    2011-01-01

    ICU telemedicine uses audiovisual conferencing technology to provide critical care from a remote location. Research is needed to best define the optimal use of ICU telemedicine, but efforts are hindered by methodological challenges and the lack of an organized delivery approach. We convened an interdisciplinary working group to develop a research agenda in ICU telemedicine, addressing both methodological and knowledge gaps in the field. To best inform clinical decision-making and health policy, future research should be organized around a conceptual framework that enables consistent descriptions of both the study setting and the telemedicine intervention. The framework should include standardized methods for assessing the preimplementation ICU environment and describing the telemedicine program. This framework will facilitate comparisons across studies and improve generalizability by permitting context-specific interpretation. Research based on this framework should consider the multidisciplinary nature of ICU care and describe the specific program goals. Key topic areas to be addressed include the effect of ICU telemedicine on the structure, process, and outcome of critical care delivery. Ideally, future research should attempt to address causation instead of simply associations and elucidate the mechanism of action in order to determine exactly how ICU telemedicine achieves its effects. ICU telemedicine has significant potential to improve critical care delivery, but high-quality research is needed to best inform its use. We propose an agenda to advance the science of ICU telemedicine and generate research with the greatest potential to improve patient care. PMID:21729894

  7. A Population-Based Analysis of Ethnic Differences in Admission to the Intensive Care Unit after Stroke

    PubMed Central

    Fletcher, Jeffrey J.; Morgenstern, Lewis B.; Lisabeth, Lynda D.; Sánchez, Brisa N.; Skolarus, Lesli E.; Smith, Melinda A.; Garcia, Nelda M.; Zahuranec, Darin B.

    2012-01-01

    Background Mexican Americans (MAs) have shown lower post-stroke mortality compared to non-Hispanic whites (NHWs). Limited evidence suggests race/ethnic differences exist in intensive care unit (ICU)admissions following stroke. Our objective was to investigate the association of ethnicity with admission to the ICU following stroke. Methods Cases of intracerebral hemorrhage and acute ischemic stroke were prospectively ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project for the period January, 2000 through December, 2009. Logistic regression models fitted within the generalized additive model framework were used to test associations between ethnicity and ICU admission and potential confounders. An interaction term between age and ethnicity was investigated in the final model. Results A total 1,464 cases were included in analysis. MAs were younger, more likely to have diabetes, and less likely to have atrial fibrillation, health insurance, or high school diploma than NHWs. On unadjusted analysis, there was a trend toward MAs being more likely to be admitted to ICU than NHWs (34.6% versus 30.3%; OR=1.22; 95% CI 0.98–1.52; p=0.08). However, on adjusted analysis, no overall association between MA ethnicity and ICU admission (OR=1.13; 95% CI 0.85–1.50) was found. When an interaction term for age and ethnicity was added to this model, there was only borderline evidence for effect modification by age of the ethnicity/ICU relationship (p=0.16). Conclusions No overall association between ethnicity and ICU admission was observed in this community. ICU utilization alone does not likely explain ethnic differences in survival following stroke between MAs and NHWs. PMID:22892883

  8. Waterlow score as a surrogate marker for predicting adverse outcome in acute pancreatitis

    PubMed Central

    Gillick, K; Elbeltagi, H; Bhattacharya, S

    2016-01-01

    Introduction Introduced originally to stratify risk for developing decubitus ulcers, the Waterlow scoring system is recorded routinely for surgical admissions. It is a composite score, reflecting patients’ general condition and co-morbidities. The aim of this study was to investigate whether the Waterlow score can be used as an independent surrogate marker to predict severity and adverse outcome in acute pancreatitis. Methods In this retrospective analysis, a consecutive cohort was studied of 250 patients presenting with acute pancreatitis, all of whom had their Waterlow score calculated on admission. Primary outcome measures were length of hospital stay and mortality. Secondary outcome measures included rate of intensive care unit (ICU) admission and development of complications such as peripancreatic free fluid, pancreatic necrosis and pseudocyst formation. Correlation of the Waterlow score with some known markers of disease severity and outcomes was also analysed. Results The Waterlow score correlated strongly with the most commonly used marker of disease severity, the Glasgow score (analysis of variance, p=0.0012). Inpatient mortality, rate of ICU admission and length of hospital stay increased with a higher Waterlow score (Mann–Whitney U test, p=0.0007, p=0.049 and p=0.0002 respectively). There was, however, no significant association between the Waterlow score and the incidence of three known complications of pancreatitis: presence of peripancreatic fluid, pancreatic pseudocyst formation and pancreatic necrosis. Receiver operating characteristic curve analysis demonstrated good predictive power of the Waterlow score for mortality (area under the curve [AUC]: 0.73), ICU admission (AUC: 0.65) and length of stay >7 days (AUC: 0.64). This is comparable with the predictive power of the Glasgow score and C-reactive protein. Conclusions The Waterlow score for patients admitted with acute pancreatitis could provide a useful tool in prospective assessment of

  9. Seeking the Admission Hybrid

    ERIC Educational Resources Information Center

    Lucido, Jerome A.

    2012-01-01

    When one thinks of seminal publications in college admission, the first piece that comes to mind is B. Alden Thresher's "College Admissions in the Public Interest" (1966). Thresher's work, relevant to this day, is credited with being the foundational document of the admission profession. McDonough and Robertson's 1995 study, commissioned by NACAC,…

  10. Predictive value of C-reactive protein in critically ill patients after abdominal surgery

    PubMed Central

    Sapin, Frédéric; Biston, Patrick; Piagnerelli, Michael

    2017-01-01

    OBJECTIVES: The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU) after abdominal surgery. METHODS: We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable (F; left the ICU alive, without modification of the antibiotic regimen) and unfavorable (D; death in the ICU, surgical revision with or without modification of the antibiotic regimen or just modification of the regimen). We then compared the highest C-reactive protein level on the first day of admission between the two groups. RESULTS: A total of 308 patients were included: 86 patients had an unfavorable outcome (group D) and 222 had a favorable outcome (group F). The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis. CONCLUSIONS: A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death. PMID:28226029

  11. Heart, Lung Problems May Not Always Need ICU Care

    MedlinePlus

    ... Heart, Lung Problems May Not Always Need ICU Care Study finds no difference in death rates, but higher ... for COPD patients in the ICU or regular care, the study found. The researchers also found that ICU patients ...

  12. Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology

    PubMed Central

    2015-01-01

    Over the last 10 years we have significantly reduced hospital mortality from sepsis and critical illness. However, the evidence reveals that over the same period we have tripled the number of patients being sent to rehabilitation settings. Further, given that as many as half of the deaths in the first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 50-70% of ICU "survivors" will suffer cognitive impairment and 60-80% of "survivors" will suffer functional impairment or ICU-acquired weakness (ICU-AW). These observations demand that we as intensive care providers ask the following questions: "Are we creating survivors ... or are we creating victims?" and "Do we accomplish 'Pyrrhic Victories' in the ICU?" Interventions to address ICU-AW must have a renewed focus on optimal nutrition, anabolic/anticatabolic strategies, and in the future employ the personalized muscle and exercise evaluation techniques utilized by elite athletes to optimize performance. Specifically, strategies must include optimal protein delivery (1.2-2.0 g/kg/day), as an athlete would routinely employ. However, as is clear in elite sports performance, optimal nutrition is fundamental but alone is often not enough. We know burn patients can remain catabolic for 2 years post burn; thus, anticatabolic agents (i.e., beta-blockers) and anabolic agents (i.e., oxandrolone) will probably also be essential. In the near future, evaluation techniques such as assessing lean body mass at the bedside using ultrasound to determine nutritional status and ultrasound-measured muscle glycogen as a marker of muscle injury and recovery could be utilized to help find the transition from the acute phase of critical illness to the recovery phase. Finally, exercise physiology testing that evaluates muscle substrate utilization during exercise can be used to diagnose muscle mitochondrial dysfunction and

  13. Winning the war against ICU-acquired weakness: new innovations in nutrition and exercise physiology.

    PubMed

    Wischmeyer, Paul E; San-Millan, Inigo

    2015-01-01

    Over the last 10 years we have significantly reduced hospital mortality from sepsis and critical illness. However, the evidence reveals that over the same period we have tripled the number of patients being sent to rehabilitation settings. Further, given that as many as half of the deaths in the first year following ICU admission occur post ICU discharge, it is unclear how many of these patients ever returned home. For those who do survive, the latest data indicate that 50-70% of ICU "survivors" will suffer cognitive impairment and 60-80% of "survivors" will suffer functional impairment or ICU-acquired weakness (ICU-AW). These observations demand that we as intensive care providers ask the following questions: "Are we creating survivors ... or are we creating victims?" and "Do we accomplish 'Pyrrhic Victories' in the ICU?" Interventions to address ICU-AW must have a renewed focus on optimal nutrition, anabolic/anticatabolic strategies, and in the future employ the personalized muscle and exercise evaluation techniques utilized by elite athletes to optimize performance. Specifically, strategies must include optimal protein delivery (1.2-2.0 g/kg/day), as an athlete would routinely employ. However, as is clear in elite sports performance, optimal nutrition is fundamental but alone is often not enough. We know burn patients can remain catabolic for 2 years post burn; thus, anticatabolic agents (i.e., beta-blockers) and anabolic agents (i.e., oxandrolone) will probably also be essential. In the near future, evaluation techniques such as assessing lean body mass at the bedside using ultrasound to determine nutritional status and ultrasound-measured muscle glycogen as a marker of muscle injury and recovery could be utilized to help find the transition from the acute phase of critical illness to the recovery phase. Finally, exercise physiology testing that evaluates muscle substrate utilization during exercise can be used to diagnose muscle mitochondrial dysfunction and

  14. Better prognostic marker in ICU - APACHE II, SOFA or SAP II!

    PubMed Central

    Naqvi, Iftikhar Haider; Mahmood, Khalid; Ziaullaha, Syed; Kashif, Syed Mohammad; Sharif, Asim

    2016-01-01

    Objectives: This study was designed to determine the comparative efficacy of different scoring system in assessing the prognosis of critically ill patients. Methods: This was a retrospective study conducted in medical intensive care unit (MICU) and high dependency unit (HDU) Medical Unit III, Civil Hospital, from April 2012 to August 2012. All patients over age 16 years old who have fulfilled the criteria for MICU admission were included. Predictive mortality of APACHE II, SAP II and SOFA were calculated. Calibration and discrimination were used for validity of each scoring model. Results: A total of 96 patients with equal gender distribution were enrolled. The average APACHE II score in non-survivors (27.97+8.53) was higher than survivors (15.82+8.79) with statistically significant p value (<0.001). The average SOFA score in non-survivors (9.68+4.88) was higher than survivors (5.63+3.63) with statistically significant p value (<0.001). SAP II average score in non-survivors (53.71+19.05) was higher than survivors (30.18+16.24) with statistically significant p value (<0.001). Conclusion: All three tested scoring models (APACHE II, SAP II and SOFA) would be accurate enough for a general description of our ICU patients. APACHE II has showed better calibration and discrimination power than SAP II and SOFA. PMID:27882011

  15. Innovative Designs for the Smart ICU.

    PubMed

    Halpern, Neil A

    2014-03-01

    Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU can be conceptualized into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including its infrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated computers, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room, on-call suite, conference rooms, and offices), and the universal support services (infection prevention, finishings and flooring, staff communications, signage and wayfinding, security, and fire and safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. A balanced approach to centralized and decentralized monitoring and logistics also offers great flexibility. Synchronization of the universal support services in the ICU with the hospital's existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts.

  16. Outcomes of Older Adults With Sepsis at Admission to an Intensive Care Unit

    PubMed Central

    Rowe, Theresa; Araujo, Katy L. B.; Van Ness, Peter H.; Pisani, Margaret A.; Juthani-Mehta, Manisha

    2016-01-01

    Background. Sepsis is a major cause of morbidity and mortality among older adults. The main goals of this study were to assess the association of sepsis at intensive care unit (ICU) admission with mortality and to identify predictors associated with increased mortality in older adults. Methods. We conducted a prospective cohort study of 309 participants ≥60 years admitted to an ICU. Sepsis was defined as 2 of 4 systemic inflammatory response syndrome criteria plus a documented infection within 2 calendar days before or after admission. The main outcome measure was time to death within 1 year of ICU admission. Sepsis was evaluated as a predictor for mortality in a Cox proportional hazards model. Results. Of 309 participants, 196 (63%) met the definition of sepsis. Among those admitted with and without sepsis, 75 (38%) vs 20 (18%) died within 1 month of ICU admission (P < .001) and 117 (60%) vs 48 (42%) died within 1 year (P < .001). When adjusting for baseline characteristics, sepsis had a significant impact on mortality (hazard ratio [HR] = 1.80; 95% confidence interval [CI], 1.28–2.52; P < .001); however, after adjusting for baseline characteristics and process covariates (antimicrobials and vasopressor use within 48 hours of admission), the impact of sepsis on mortality became nonsignificant (HR = 1.26; 95% CI, .87–1.84; P = .22). Conclusions. The diagnosis of sepsis in older adults upon ICU admission was associated with an increase in mortality compared with those admitted without sepsis. After controlling for early use of antimicrobials and vasopressors for treatment, the association of sepsis with mortality was reduced. PMID:26925430

  17. Propranolol, post-traumatic stress disorder, and intensive care: incorporating new advances in psychiatry into the ICU.

    PubMed

    Gardner, Andrew John; Griffiths, John

    2014-12-19

    Post-traumatic stress disorder (PTSD) is a common complication of an ICU admission. Rarely is there a continuation of care, which is aimed at screening for and treating this debilitating disease. Current treatment options for PTSD are held back by inconsistent efficacy, poor evidence, and a lack of understanding of its psychopathology. Without 'gold standard' assessment techniques to diagnose PTSD after an ICU admission, the development of care pathways is hindered. This paper advocates for two interwoven advances in psychiatric care (specifically for PTSD) after ICU: (1) incorporate the monitoring and treating of psychiatric co-morbidities during extended patient follow-up, and (2) rapidly adopting the latest research to maximize its benefit. The discovery that memories were not fixed, but malleable to change, set off a sequence of experiments that have revolutionized the approach to treating PTSD. It is hoped that the phenomenon of reconsolidation can be exploited therapeutically. In the act of remembering and re-storing traumatic memories, propranolol can act to dissociate the state of sympathetic arousal from their recollection. Often, ICU patients have multiple physical co-morbidities that may be exacerbated, or their treatment disrupted, by such a pervasive psychological condition. The rapid uptake of new techniques, aimed at reducing PTSD after ICU admission, is necessary to maximize the quality of care given to patients. Increasingly, the realization that the role of intensive care specialists may extend beyond the ICU is changing clinical practice. As this field advances, intensivists and psychiatrists alike must collaborate by using the latest psychopharmacology to treat their patients and combat the psychological consequences of experiencing the extremes of physiological existence.

  18. Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers

    PubMed Central

    Petrinec, Amy B.; Mazanec, Polly M.; Burant, Christopher J.; Hoffer, Alan; Daly, Barbara J.

    2015-01-01

    Objective To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. Design A single-group descriptive longitudinal correlational study. Setting Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Patients Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU. Interventions None. Measurements and Main Results Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing post-traumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p = 0.01) and emotion-focused (p < 0.01) coping decreased over time while avoidant coping (p = 0.20) use remained stable. Coping strategies 30 days after hospitalization (R2 = 0.50, p < 0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2 = 0.30, p = 0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of post-traumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Conclusions Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients. PMID:25785520

  19. Effects of the Economy on the Admission Process: 2008-09. National Association for College Admission Counseling, September 2009

    ERIC Educational Resources Information Center

    National Association for College Admission Counseling, 2009

    2009-01-01

    The 2008-09 college admission cycle took place during a period of heightened economic uncertainty. When added to the annual uncertainty of the admission process--for both students seeking college admission offers and colleges seeking to predict their annual enrollment yield--the economic environment caused great concern among colleges and students…

  20. Assessing Practical Intelligence in Business School Admissions: A Supplement to the Graduate Management Admissions Test

    ERIC Educational Resources Information Center

    Hedlund, Jennifer; Wilt, Jeanne M.; Nebel, Kristina L.; Ashford, Susan J.; Sternberg, Robert J.

    2006-01-01

    The Graduate Management Admission Test (GMAT) is the most widely used measure of managerial potential in MBA admissions. GMAT scores, although predictive of grades in business school, leave much of the variance in graduate school performance unexplained. The GMAT also produces disparities in test scores between groups, generating the potential for…

  1. Admission Factors Predicting Family Medicine Specialty Choice: A Literature Review and Exploratory Study among Students in the Rural Medical Scholars Program

    ERIC Educational Resources Information Center

    Avery, Daniel M., Jr.; Wheat, John R.; Leeper, James D.; McKnight, Jerry T.; Ballard, Brent G.; Chen, Jia

    2012-01-01

    Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural…

  2. Questioning the need for ICU level of care in pediatric patients following elective uncomplicated craniotomy for brain tumors.

    PubMed

    Gabel, Brandon C; Martin, Joel; Crawford, John R; Levy, Michael

    2016-05-01

    OBJECTIVE The object of this study is to address what factors may necessitate the need for intensive care monitoring after elective uncomplicated craniotomy in pediatric patients who are initially managed in a non-intensive care unit setting postoperatively. METHODS A retrospective chart review was undertaken for all patients who underwent elective craniotomy for brain tumor between April of 2007 and April of 2012 and who were directly admitted to the floor postoperatively. Factors such as age, tumor type, craniotomy location, neurological comorbidities, reason for transfer to intensive care unit (ICU) level of care (if applicable), time between admittance to floor and transfer to ICU level of care, and reason for transfer to ICU level of care were assessed. RESULTS Adjusted logistic regression found 2 significant positive predictors of postoperative transfer to the ICU after initial admission to the floor: primitive neuroectodermal tumor pathology (OR 44.10, 95% CI 1.24-1572.16, p = 0.04), and repeat craniotomy during the same hospitalization (OR 13.97, 95% CI 1.21-160.66, p = 0.03). Conversely, 1 negative factor was found: low-grade glioma pathology (OR 0.05, 95% CI 0.00-0.87, p = 0.04). CONCLUSIONS Select pediatric patients may not require ICU level of care after elective uncomplicated pediatric craniotomy. Additional studies are needed to adequately address which patients would benefit from initial ICU admittance following elective craniotomies for brain tumors.

  3. Prognosis for recovery from multiple organ system failure: the accuracy of objective estimates of chances for survival. The French Multicentric Group of ICU Research.

    PubMed

    Rauss, A; Knaus, W A; Patois, E; Le Gall, J R; Loirat, P

    1990-01-01

    This study evaluated the accuracy and reliability of predictions for recovery from multiple organ system failure (OSF). A previous analysis had provided estimates of the probabilities of recovery from various combinations of OSF for 2,843 intensive care unit (ICU) patients treated in 13 U.S. hospitals. These estimates were applied prospectively to 2,405 ICU admissions in 27 French hospitals. Despite variations in the incidences of underlying disease and the distributions of OSF between the two countries, clinical outcomes were similar for the 5,248 total patients. In both countries, two OSFs persisting for more than one day resulted in a hospital death rate of 60%. Hospital mortality rates for patients with three or more OSFs persisting after one day consistently exceeded 90%. Isolated neurologic failure had the poorest overall prognosis, but various other combinations of OSFs did not result in significantly different outcomes. The stability of the prognostic estimates in the two countries suggests that, despite pathogenetic variations, persistent multiple OSF results in consistent clinical outcomes. These mortality projections provide firm reference data for assessing efficacy of new treatments within institutions with similar standards of care. The narrow confidence intervals associated with these estimates also provide objectively defined opportunities to review future treatment plans for individual patients.

  4. Relationship between thyroid function and ICU mortality: a prospective observation study

    PubMed Central

    2012-01-01

    Introduction Although nonthyroidal illness syndrome is considered to be associated with adverse outcome in ICU patients, the performance of thyroid hormone levels in predicting clinical outcome in ICU patients is unimpressive. This study was conducted to assess the prognostic value of the complete thyroid indicators (free triiodothyronine (FT3), total triiodothyronine; free thyroxine, total thyroxine, thyroid-stimulating hormone and reverse triiodothyronine) in unselected ICU patients. Methods A total of 480 consecutive patients without known thyroid diseases were screened for eligibility and followed up during their ICU stay. We collected each patient's baseline characteristics, including the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and thyroid hormone, N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) levels. The primary outcome was ICU mortality. Potential predictors were analyzed for possible association with outcomes. We also evaluated the ability of thyroid hormones together with APACHE II score to predict ICU mortality by calculation of net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices. Results Among the thyroid hormone indicators, FT3 had the greatest power to predict ICU mortality, as suggested by the largest area under the curve (AUC) of 0.762 ± 0.028. The AUC for FT3 level was less than that for APACHE II score (0.829 ± 0.022) but greater than that for NT-proBNP level (0.724 ± 0.030) or CRP level (0.689 ± 0.030). Multiple regression analysis revealed that FT3 level (standardized β = -0.600, P = 0.001), APACHE II score (standardized β = 0.912, P < 0.001), NT-proBNP level (standardized β = 0.459, P = 0.017) and CRP level (standardized β = 0.367, P = 0.030) could independently predict primary outcome. The addition of FT3 level to APACHE II score gave an NRI of 54.29% (P < 0.001) and an IDI of 36.54% (P < 0.001). The level of FT3 was significantly

  5. Vasospasm Risk in Surgical ICU Patients With Grade I Subarachnoid Hemorrhage

    PubMed Central

    Lessen, Samantha; Keene, Adam

    2016-01-01

    Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. The initial hemorrhage causes death in approximately 25% of patients, with most subsequent mortality being attributable to delayed cerebral ischemia (DCI). Delayed cerebral ischemia generally occurs on post-bleed days 4 through 20, with the incidence peaking at day 8. Because of the risks of DCI, patients with SAH are usually monitored in an intensive care unit (ICU) for 14 to 21 days. Unfortunately, prolonged ICU admissions are expensive and are associated with well-documented risks to patients. We hypothesized that a subset of patients who are at low risk of DCI should be safe to transfer out of the ICU early. All patients admitted to Montefiore Medical Center from 2008 to 2013 with grade I SAH who had their aneurysms successfully protected, had an uncomplicated postoperative course, and had no clinical or ultrasonographic evidence of DCI after day 8 were retrospectively studied. The primary outcome was clinical or ultrasonographic evidence of the development of DCI after day 8. Secondary outcomes included length of ICU and hospital stay and hospital mortality. Forty patients who met the above-mentioned criteria were identified. Of these, only 1 (2.5%) developed ultrasonographic evidence of DCI after day 8 but required no intervention. The mean length of stay in the ICU was until post-bleed day 13, and the mean hospital length of stay was until post-bleed day 14. The in-hospital mortality was 0 of 40. Thus, we identified a low-risk subset of patients with grade I SAH who may be candidates for early transfer out of the ICU. PMID:26740854

  6. Lunar phases and psychiatric hospital admissions.

    PubMed

    Gorvin, J J; Roberts, M S

    1994-12-01

    To assess the lunar hypothesis as predictive of mental health emergencies and antisocial behavior, the relation of the lunar hypothesis and the occurrence of psychiatric hospital admissions of developmentally disabled adults was examined. The full moon phase of the lunar cycle did not explain a higher rate of hospital admission and accounted for only .007% of the variance. A critique of the methodology in prior research led to the suggestion that more immediate stressors and environmental factors are more plausible contributing factors to hospital admission.

  7. What Admissions Officials Think

    ERIC Educational Resources Information Center

    Hoover, Eric

    2008-01-01

    Over the past two decades, college admissions has become a prime-time preoccupation. Most people know at least something about the process, especially if they have a teenager in high school and a college guide on their coffee table. Nonetheless, widespread public misconceptions persist about admissions requirements, the selection process, and the…

  8. The Administration of Admissions

    ERIC Educational Resources Information Center

    Campbell, Clifford C.

    1978-01-01

    Among all the tasks of the admissions officer in developing a successful marketing program, the hardest may be that of convincing other college administrators of the importance of admissions to the institution's survival. Discussed are long-range planning, budgeting, staff selection and training, and implementing a plan. (Author/LBH)

  9. Technology in International Admissions

    ERIC Educational Resources Information Center

    White, Elizabeth

    2012-01-01

    In a relatively short time, technology applications have become an essential feature of the admissions business. They make the jobs of international admissions professionals easier in many ways, allowing for more robust communication with applicants and counselors, a streamlined application process, and quicker access to information about…

  10. Combination of high-sensitivity troponin I and N-terminal pro-B-type natriuretic peptide predicts future hospital admission for heart failure in high-risk hypertensive patients with preserved left ventricular ejection fraction.

    PubMed

    Okuyama, Ryunosuke; Ishii, Junnichi; Takahashi, Hiroshi; Kawai, Hideki; Muramatsu, Takashi; Harada, Masahide; Yamada, Akira; Motoyama, Sadako; Matsui, Shigeru; Naruse, Hiroyuki; Sarai, Masayoshi; Hasegawa, Midori; Watanabe, Eiichi; Suzuki, Atsushi; Hayashi, Mutsuharu; Izawa, Hideo; Yuzawa, Yukio; Ozaki, Yukio

    2017-02-02

    Additional risk stratification may provide more aggressive and focalized preventive treatment to high-risk hypertensive patients according to the Japanese hypertension guidelines. We prospectively investigated the predictive value of high-sensitivity troponin I (hsTnI), both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for incident heart failure (HF) in high-risk hypertensive patients with preserved left ventricular ejection fraction (LVEF). Baseline hsTnI and NT-proBNP levels and echocardiography data were obtained for 493 Japanese hypertensive outpatients (mean age, 68.5 years) with LVEF ≥ 50%, no symptomatic HF, and at least one of the following comorbidities: stage 3-4 chronic kidney disease, diabetes mellitus, and stable coronary artery disease. During a mean follow-up period of 86.1 months, 44 HF admissions occurred, including 31 for HF with preserved ejection fraction (HFpEF) and 13 for HF with reduced ejection fraction (HFrEF; LVEF <50%). Both hsTnI (p < 0.01) and NT-proBNP (p < 0.005) levels were significant independent predictors of HF admission. Furthermore, when the patients were stratified into 4 groups according to increased hsTnI (≥highest tertile value of 10.6 pg/ml) and/or increased NT-proBNP (≥highest tertile value of 239.7 pg/ml), the adjusted relative risks for patients with increased levels of both biomarkers versus neither biomarker were 13.5 for HF admission (p < 0.0001), 9.45 for HFpEF (p = 0.0009), and 23.2 for HFrEF (p = 0.003). Finally, the combined use of hsTnI and NT-proBNP enhanced the C-index (p < 0.05), net reclassification improvement (p = 0.0001), and integrated discrimination improvement (p < 0.05) to a greater extent than that of any single biomarker. The combination of hsTnI and NT-proBNP, which are individually independently predictive of HF admission, could improve predictions of incident HF in high-risk hypertensive patients but could

  11. Staff Acceptance of Tele-ICU Coverage

    PubMed Central

    Chan, Paul S.; Cram, Peter

    2011-01-01

    Background: Remote coverage of ICUs is increasing, but staff acceptance of this new technology is incompletely characterized. We conducted a systematic review to summarize existing research on acceptance of tele-ICU coverage among ICU staff. Methods: We searched for published articles pertaining to critical care telemedicine systems (aka, tele-ICU) between January 1950 and March 2010 using PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Health, Web of Science, and the Cochrane Library and abstracts and presentations delivered at national conferences. Studies were included if they provided original qualitative or quantitative data on staff perceptions of tele-ICU coverage. Studies were imported into content analysis software and coded by tele-ICU configuration, methodology, participants, and findings (eg, positive and negative staff evaluations). Results: Review of 3,086 citations yielded 23 eligible studies. Findings were grouped into four categories of staff evaluation: overall acceptance level of tele-ICU coverage (measured in 70% of studies), impact on patient care (measured in 96%), impact on staff (measured in 100%), and organizational impact (measured in 48%). Overall acceptance was high, despite initial ambivalence. Favorable impact on patient care was perceived by > 82% of participants. Staff impact referenced enhanced collaboration, autonomy, and training, although scrutiny, malfunctions, and contradictory advice were cited as potential barriers. Staff perceived the organizational impact to vary. An important limitation of available studies was a lack of rigorous methodology and validated survey instruments in many studies. Conclusions: Initial reports suggest high levels of staff acceptance of tele-ICU coverage, but more rigorous methodologic study is required. PMID:21051386

  12. Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population

    PubMed Central

    Pedersen, Mark R.; Choi, Myunghan; Brink, Jeffrey A.

    2016-01-01

    Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period. PMID:27980860

  13. Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population.

    PubMed

    Pedersen, Mark R; Choi, Myunghan; Brink, Jeffrey A; Seetharam, Anil B

    2016-01-01

    Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14, p = 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28, p < 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.

  14. Student Admission and Attendance.

    ERIC Educational Resources Information Center

    Majestic, Ann L.

    1988-01-01

    Considers the North Carolina statutes that define the process for admitting students to public schools and ensuring their attendance. Examines cases relating to issues of school admission and compulsory attendance. (MLF)

  15. Hospice Admission Assessment.

    PubMed

    Moon, Paul J

    2017-04-01

    Hospice admission assessment is a pivotal encounter for patient/family and hospice representative. For patient/family, the admission is the threshold by which a particular level of care can commence and, symbolically, a certain marker in health status trajectory is reached. For hospice representative, the admission episode is an occasion to inaugurate an ambience that can serve to frame future hospice care experiences for the patient/family. Through a narrative lens, hospice admission assessment can be seen as experiential time and space, where patient's and family's stories are mindfully and deliberately witnessed and explored. Through the practice of narrative mining, the hospice representative can better understand others' offered stories of reality, which will better inform the plan of palliation and hospice care.

  16. The relationship between Vitamin D, clinical outcomes and mortality rate in ICU patients: A prospective observational study

    PubMed Central

    Vosoughi, Nooshin; Kashefi, Parviz; Abbasi, Behnood; Feizi, Awat; Askari, Gholamreza; Azadbakht, Leila

    2016-01-01

    Background: According to the high prevalence of Vitamin D deficiency, a few studies have been conducted to clarify the relationship between 25-hydroxyvitamin D (25(OH)D) and clinical outcomes in critically ill patients. The objective of this study was to determine this probable association. Materials and Methods: Serum 25(OH)D, C-reactive protein, malnutrition measurements, and Intensive Care Unit (ICU)-acquired infection from 185 patients in ICU were assessed in the first 24 h of admission and they were followed for the other outcomes. Results: About 93.5% of patients were classified as deficient and insufficient while the others were categorized in sufficient group. 25(OH)D status was not significantly associated with mortality rate (P = 0.66), and no significant differences in ventilation time were observed (P = 0.97). Sufficient group left the ICU sooner, but the difference was not significant (P = 0.75). Besides the results of relationship between 25(OH)D concentration and nutritional status (P = 0.69) were not significant. In addition, sufficient group suffered from infection more than insufficient patients, but this relationship was not significant (P = 0.11). Conclusion: In this study, we found that 25(OH)D insufficiency is common in ICU patients, but no significant association between low 25(OH)D levels and ICU outcomes were observed. Hence, because of vital roles of Vitamin D in human's body, comprehensive study should conduct to determine the decisive results. PMID:27904620

  17. Comparison of Two Diagnostic Scores of Disseminated Intravascular Coagulation in Pregnant Women Admitted to the ICU

    PubMed Central

    Ducloy-Bouthors, Anne Sophie

    2016-01-01

    Objective To compare the validity of two previously published diagnostic scores of disseminated intravascular coagulation (DIC) in pregnant women admitted to ICU for an acute thrombotic or hemorrhagic complication of delivery and postpartum. Methods This was a population based retrospective study of 154 patients admitted to ICU for severe delivery and postpartum complications in a University Hospital. A recently published score (adapted to physiological changes of pregnancy and based on three components: platelet count, prothrombin time difference and fibrinogen) was compared to the International Society for Thrombosis and Hemostasis (ISTH) score (based on four components: platelet count, fibrinogen, prothrombin time, and fibrin related marker). Both scores were calculated at delivery, ICU admission (day 0), day 1 and day 2 during the postpartum ICU stay. The validity of both scores was assessed by comparison with the consensual and blinded analysis of two experts. The sensitivity, specificity, and area under the curve (AUC) of each score were calculated at each time and overall by generalized linear mixed model. The agreement between the two scores was evaluated by the Kappa coefficient. Results The new score had a sensitivity of 0.78, a specificity of 0.97 (p <0.01) and a global AUC of 96% while the ISTH score had a sensitivity of 0.31, a specificity of 0.99 and an AUC of 94% (p <0.01). The Kappa coefficient of correlation between both scores was 0.35. The lower sensitivity of the ISTH score was mainly explained by the lack of fibrinogen and fibrin-related peptides thresholds adapted to the physiological changes of coagulation induced by pregnancy. Conclusion The new DIC score seem highly discriminant in the subset of patients admitted to the ICU after delivery for an acute specific complication. The ISTH score is not recommended in pregnant women because of its poor sensitivity. PMID:27861597

  18. Involvement of ICU families in decisions: fine-tuning the partnership

    PubMed Central

    2014-01-01

    Families of patients are not simple visitors to the ICU. They have just been separated from a loved one, often someone they live with, either abruptly or, in nearly half the cases, because a chronic condition has suddenly worsened. They must cope with a serious illness of a loved one, while having to adapt to the unfamiliar and intimidating ICU environment. In many cases, the outcome of the critical illness is uncertain, a situation that causes considerable distress to the relatives. As shown by our research group and others, families exhibit symptoms of anxiety (70%) and depression (35%) in the first few days after admission, as well as symptoms of stress (33%) and difficulty understanding the information delivered by the healthcare staff (50%). Furthermore, relatives of patients who die in the ICU are at risk for psychiatric syndromes such as generalized anxiety, panic attacks, depression, and posttraumatic stress syndrome. In this setting of psychological distress, families are asked to consider sharing in healthcare decisions about their loved one in the ICU. This article aims to foster the debate about the shared decision-making process. We have three objectives: to transcend the overly simplistic position that opposes paternalism and autonomy, to build a view founded only on an evaluation of actual practice and experience in the field, and to keep the focus squarely on the patient. Families want information and communication time from the staff. Nurses and physicians need to understand that families can share in decisions only if the entire ICU staff actively promotes family involvement and, of course, if the family wants to participate in all or part of the decision-making process. PMID:25593753

  19. Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality

    PubMed Central

    Jung, Jae Jun; Cho, Jong Ho; Hong, Tae Hee; Kim, Hong Kwan; Choi, Yong Soo; Kim, Jhingook; Shim, Young Mog

    2016-01-01

    Background The aim of this study was to identify risk factors associated with mortality in patients re‐admitted to an intensive care unit (ICU) after initial recovery from major lung resection. Methods We retrospectively reviewed the case records of all patients who underwent major lung resection between February 2011 and May 2013. A total of 1916 patients underwent major resection surgery for various lung diseases, 63 (3.3%) of which required ICU admission after initial recovery. We analyzed preoperative and perioperative data, including ICU factors and outcomes. Results The patient group included 57 men (90.5%) with a mean age of 65.3 years. Pathologic diagnosis was malignancy in 92.1% of patients, while 7.9% had benign disease. Open thoracotomy was performed in 84.1%, whereas minimally invasive approaches were performed in 15.9%. In‐hospital mortality occurred in 16 (25.4%) patients. Patients were classified as either survivors (n = 47, 74.6%) or non‐survivors (n = 16, 25.4%). The most common reason for ICU readmission was pulmonary complication (n = 50, 79.4%). Thirty‐one patients (49.2%) required mechanical ventilation, seven (11.1%) required extracorporeal membrane oxygenation, and three (4.8%) required renal support. Multivariate analysis showed that acute respiratory distress syndrome (ARDS) and delirium were independent risk factors for in‐hospital mortality. In addition, delirium frequently occurred in patients with ARDS. Conclusion ARDS and delirium were independent risk factors for in‐hospital mortality in patients who were readmitted to the ICU after major lung resection. Future studies are needed to determine if the prevention of delirium and ARDS can improve postoperative outcomes for patients with lung cancer. PMID:27925393

  20. Psychological implications of admission to critical care.

    PubMed

    Pattison, Natalie

    Admission to critical care can have far-reaching psychological effects because of the distinct environment. Critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The debate around the phenomenon of intensive care unit (ICU) syndrome is discussed with reference to current thinking. After critical care, patients may experience amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams and nightmares. Nursing care for patients while in the critical care environment can have a positive effect on psychological well-being. Facilitating communication, explaining care and rationalizing interventions, ensuring patients are oriented as to time and place, reassuring patients about transfer, providing patients,where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial effect on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for them to access further intervention if desired. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.

  1. [Nursing workload and occurrence of incidents and adverse events in ICU patients].

    PubMed

    Novaretti, Marcia Cristina Zago; Santos, Edzangela de Vasconcelos; Quitério, Ligia Maria; Daud-Gallotti, Renata Mahfuz

    2014-01-01

    This prospective cohort study aimed to identify the influence of nursing work overload on the occurrence of incidents without injury and adverse events in 399 patients hospitalized in Intensive Care Units (ICU). For data collection, a structured questionnaire was administered and an analysis of medical records was performed. In these admissions, approximately 78% of incidents without injury and adverse events in patients were related to the sphere of Nursing. These occurrences were attributed to overwork, increased the number of days of hospitalization and the risk of death of patients. It is essential that nursing managers work on the staff hospital management avoiding work overload to contribute for patient safety.

  2. Innovative designs for the smart ICU: Part 3: Advanced ICU informatics.

    PubMed

    Halpern, Neil A

    2014-04-01

    This third and final installment of this series on innovative designs for the smart ICU addresses the steps involved in conceptualizing, actualizing, using, and maintaining the advanced ICU informatics infrastructure and systems. The smart ICU comprehensively and electronically integrates the patient in the ICU with all aspects of care, displays data in a variety of formats, converts data to actionable information, uses data proactively to enhance patient safety, and monitors the ICU environment to facilitate patient care and ICU management. The keys to success in this complex informatics design process include an understanding of advanced informatics concepts, sophisticated planning, installation of a robust infrastructure capable of both connectivity and interoperability, and implementation of middleware solutions that provide value. Although new technologies commonly appear compelling, they are also complicated and challenging to incorporate within existing or evolving hospital informatics systems. Therefore, careful analysis, deliberate testing, and a phased approach to the implementation of innovative technologies are necessary to achieve the multilevel solutions of the smart ICU.

  3. Risk factors for maternal deaths in unplanned obstetric admissions to the intensive care unit-lessons for sub-Saharan Africa.

    PubMed

    Okafor, Ugochukwu V; Efetie, Efenae R; Amucheazi, Adaobi

    2011-12-01

    This study was undertaken to determine the risk factors for maternal deaths in unplanned or unbooked obstetric admissions to the intensive care unit of a tertiary health centre. Hospital records of unbooked obstetric admissions to the intensive care unit of the hospital from January 1997 to December 2006 were retrospectively reviewed. Data collected included patients' demographics, diagnosis, duration of stay in the ICU and patient outcome. The intensive care unit records showed that there were 25 unbooked obstetric admissions. Major diagnoses for unplanned admissions to the ICU were preeclampsia/eclampsia (41.1%), obstetric haemorrhage (37.5%), and respiratory distress (12.5%). There were 12 deaths (48%). Organ dysfunction on admission, massive blood loss and late presentation were the risk factors for mortality. The high maternal mortality was mainly due to limited supply of blood products and inadequate prenatal care resulting in disease severity.

  4. Prognostic value of on admission arterial PCO2 in hospitalized patients with community-acquired pneumonia

    PubMed Central

    Yassin, Zeynab; Saadat, Mohammad; Abtahi, Hamidreza; Rahimi Foroushani, Abbas

    2016-01-01

    Background There is little data about the correlation between the outcome of community acquired pneumonia (CAP) and the hypercapnic type respiratory failure. In this study we prospectively investigated the prognostic significance of first arterial CO2 tension in patients hospitalized with CAP. Methods In this prospective study patients with CAP, admitted to a general hospital were included. PaCO2 was measured for each subject in an arterial blood sample drawn in the first 2 hours and its correlations with three major outcomes were evaluated: intensive care unit (ICU) admission, duration of admission and mortality in 30 days. Results A total of 114 patients (mean age: 60.9±18.3; male: 51.8%) diagnosed with CAP were included. Significant relationship was not found between PaCO2 and mortality (P=0.544) or ICU admission (P=0.863). However advanced age, associated CHF, high BUN levels, high CURB-65 scores, associated pleural effusion in chest X-ray and being admitted to the ICU (P=0.012, 0.004, 0.003, <0.001, 0.045 and <0.001 respectively) were all significant prognostic factors of higher mortality risks. Prognostic factors for ICU admission were a history of malignancy (P=0.004), higher CURB-65 (P<0.001) scores and concomitant pleural effusion (P=0.028) in chest X-ray. Hypercapnic patients hospitalized for longer duration compared with normocapnic subjects. Furthermore, patients with lower pH (P=0.041) and pleural effusions (P=0.002) were hospitalized longer than the others. Conclusions There was less prominent prognostic value regarding on-admission PaCO2 in comparison to other factors such as CURB-65. Considering the inconsistent results of surveys conducted on prognostic value of PaCO2 for CAP outcomes, further investigations are required to reach a consensus on this matter. PMID:27867552

  5. Interactivity Centered Usability Evaluation (ICUE) for Course Management Systems

    ERIC Educational Resources Information Center

    Yoon, Sangil

    2010-01-01

    ICUE (Interactivity Centered Usability Evaluation) is an enhanced usability testing protocol created by the researcher. ICUE augments the facilitator's role for usability testing, and offers strategies in developing and presenting usability tasks during a testing session. ICUE was designed to address weaknesses found in the usability evaluation of…

  6. ICU nurses' experiences in providing terminal care.

    PubMed

    Espinosa, Laura; Young, Anne; Symes, Lene; Haile, Brenda; Walsh, Teresa

    2010-01-01

    At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.

  7. Partnership for a healthy work environment: tele-ICU/ICU collaborative.

    PubMed

    Goran, Susan F; Mullen-Fortino, Margaret

    2012-01-01

    The tele-intensive care unit (ICU) provides a remote monitoring system that adds an additional layer of support for critically ill patients. However, to optimize contributions, the bedside team must incorporate this resource into the patient's plan of care. Using the American Association of Critical-Care Nurses' Healthy Work Environment Standards as a platform, we can create and nurture a new partnership model. Strategies that embrace the standards of skilled communication, true collaboration, and effective decision making become mutual goals for improving patient safety and outcomes. Joint communication guidelines facilitate timely and meaningful communication. Trust and the desire to cooperate encourage provider engagement to strengthen collaboration. The use of tele-ICU technology can assist in the interpretation and transformation of data to affect decision making at all levels to influence patient care. Through the lens of the healthy work environment, the tele-ICU/ICU partnership provides enhanced opportunities for improved patient care and team satisfaction.

  8. The Admissions Equity Struggle

    ERIC Educational Resources Information Center

    Freedman, Eric

    2012-01-01

    It has been a long, litigious road from Heman Sweatt, an African-American mail carrier who wanted to attend the prestigious, all-White law school at the University of Texas at Austin in 1946, to Abigail Fisher, a White high school student who failed to win undergraduate admission to the same university a half-century later. Depending on what the…

  9. A Revised Admissions Standard for One Community College Nursing Program

    ERIC Educational Resources Information Center

    Lown, Maris A.

    2010-01-01

    Predicting success on the NCLEX-RN is of paramount importance to nursing programs as they are held accountable for this outcome by accrediting agencies and by boards of nursing. This action research study examined the relationship between the NET admission test, anatomy and physiology grades, grade point average (GPA) on admission to the program…

  10. Modeling Preferential Admissions at Elite Liberal Arts Colleges

    ERIC Educational Resources Information Center

    Cockburn, Sally; Hewitt, Gordon; Kelly, Timothy

    2013-01-01

    This paper presents the results of a model that simulates the effects of varying preferential admissions policies on the academic profile of a set of 35 small liberal arts colleges. An underlying assumption is that all schools in the set use the same ratio of preferential to non-preferential admissions. The model predicts that even drastic changes…

  11. Loneliness and nursing home admission among rural older adults.

    PubMed

    Russell, D W; Cutrona, C E; de la Mora, A; Wallace, R B

    1997-12-01

    In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education, income, mental status, physical health, morale, and social contact, that were also predictive of nursing home admission. Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.

  12. Admissions Criteria in Teacher Education.

    ERIC Educational Resources Information Center

    Schwanke, Dean

    1981-01-01

    A review of the literature on the topic of admissions criteria in teacher education is presented. Bibliographic annotations review surveys, studies, models, and guidelines on various aspects of admissions criteria, as well as attracting and retaining quality students. (JN)

  13. An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care

    PubMed Central

    Peltonen, Laura-Maria; McCallum, Louise; Siirala, Eriikka; Haataja, Marjaana; Lundgrén-Laine, Heljä; Salanterä, Sanna; Lin, Frances

    2015-01-01

    The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review. PMID:26558286

  14. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure.

    PubMed

    Mokart, Djamel; Lambert, Jérôme; Schnell, David; Fouché, Louis; Rabbat, Antoine; Kouatchet, Achille; Lemiale, Virginie; Vincent, François; Lengliné, Etienne; Bruneel, Fabrice; Pene, Frederic; Chevret, Sylvie; Azoulay, Elie

    2013-08-01

    Acute respiratory failure (ARF) is the leading reason for intensive care unit (ICU) admission in patients with cancer. The aim of this study was to identify early predictors of death in patients with cancer admitted to the ICU for ARF who were not intubated at admission. We conducted analysis of a prospective randomized controlled trial including 219 patients with cancer with ARF in which day-28 mortality was a secondary endpoint. Mortality at day 28 was 31.1%. By multivariate analysis, independent predictors of day-28 mortality were: age (odds ratio [OR] 1.30/10 years, 95% confidence interval [CI] [1.01-1.68], p = 0.04), more than one line of chemotherapy (OR 2.14, 95% CI [1.08-4.21], p = 0.03), time between respiratory symptoms onset and ICU admission > 2 days (OR 2.50, 95% CI [1.25-5.02], p = 0.01), oxygen flow at admission (OR 1.07/L, 95% CI [1.00-1.14], p = 0.04) and extra-respiratory symptoms (OR 2.84, 95%CI [1.30-6.21], p = 0.01). After adjustment for the logistic organ dysfunction (LOD) score at admission, only time between respiratory symptoms onset and ICU admission > 2 days and LOD score were independently associated with day-28 mortality. Determinants of death include both factors non-amenable to change, and delay in ARF management. These results suggest that early intensive care management of patients with cancer with ARF may translate to better survival.

  15. Bedside ultrasonography in the ICU: part 2.

    PubMed

    Beaulieu, Yanick; Marik, Paul E

    2005-09-01

    This is the second of a two-part review on the application of bedside ultrasonography in the ICU. In this part, the following procedures will be covered: (1) echocardiography and cardiovascular diagnostics (second part); (2) the use of bedside ultrasound to facilitate central-line placement and to aid in the care of patients with pleural effusions and intra-abdominal fluid collections; (3) the role of hand-carried ultrasound in the ICU; and (4) the performance of bedside ultrasound by the intensivist. The safety and utility of bedside ultrasonography performed by adequately trained intensivists has now been well demonstrated. This technology, as a powerful adjunct to the physical examination, will become an indispensable tool in the management of critically ill patients.

  16. Implementing an ICU outreach team model.

    PubMed

    Wolfe, Betty

    2008-01-01

    There is an increasing need for critical care expertise outside of the intensive care unit (ICU). This is particularly related to high acuity levels and limited nursing resources. Teams of critical care health care providers have been formed to meet this need. Team structure and services provided vary according to the organization's need and the resources available. In this article, the process of establishing an ICU outreach team without additional resources, in a 200-bed tertiary care hospital in central Saskatchewan is presented. The team responds to calls from within the hospital to provide critical care expertise to patients about whom the professional caregiver is concerned, or patients who have early warning signs of physiological distress. Implementation of the team has been successful in improving timely patient care, providing a resource for nurses to access for their patients, and providing an opportunity for education and support for nurses on inpatient units.

  17. A path to precision in the ICU.

    PubMed

    Maslove, David M; Lamontagne, Francois; Marshall, John C; Heyland, Daren K

    2017-04-03

    Precision medicine is increasingly touted as a groundbreaking new paradigm in biomedicine. In the ICU, the complexity and ambiguity of critical illness syndromes have been identified as fundamental justifications for the adoption of a precision approach to research and practice. Inherently protean diseases states such as sepsis and acute respiratory distress syndrome have manifestations that are physiologically and anatomically diffuse, and that fluctuate over short periods of time. This leads to considerable heterogeneity among patients, and conditions in which a "one size fits all" approach to therapy can lead to widely divergent results. Current ICU therapy can thus be seen as imprecise, with the potential to realize substantial gains from the adoption of precision medicine approaches. A number of challenges still face the development and adoption of precision critical care, a transition that may occur incrementally rather than wholesale. This article describes a few concrete approaches to addressing these challenges.First, novel clinical trial designs, including registry randomized controlled trials and platform trials, suggest ways in which conventional trials can be adapted to better accommodate the physiologic heterogeneity of critical illness. Second, beyond the "omics" technologies already synonymous with precision medicine, the data-rich environment of the ICU can generate complex physiologic signatures that could fuel precision-minded research and practice. Third, the role of computing infrastructure and modern informatics methods will be central to the pursuit of precision medicine in the ICU, necessitating close collaboration with data scientists. As work toward precision critical care continues, small proof-of-concept studies may prove useful in highlighting the potential of this approach.

  18. Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy

    PubMed Central

    2012-01-01

    Introduction Ventilator-associated pneumonia (VAP) may contribute to the mortality associated with acute respiratory distress syndrome (ARDS). We aimed to determine the incidence, outcome, and risk factors of bacterial VAP complicating severe ARDS in patients ventilated by using a strictly standardized lung-protective strategy. Methods This prospective epidemiologic study was done in all the 339 patients with severe ARDS included in a multicenter randomized, placebo-controlled double-blind trial of cisatracurium besylate in severe ARDS patients. Patients with suspected VAP underwent bronchoalveolar lavage to confirm the diagnosis. Results Ninety-eight (28.9%) patients had at least one episode of microbiologically documented bacterial VAP, including 41 (41.8%) who died in the ICU, compared with 74 (30.7%) of the 241 patients without VAP (P = 0.05). After adjustment, age and severity at baseline, but not VAP, were associated with ICU death. Cisatracurium besylate therapy within 2 days of ARDS onset decreased the risk of ICU death. Factors independently associated with an increased risk to develop a VAP were male sex and worse admission Glasgow Coma Scale score. Tracheostomy, enteral nutrition, and the use of a subglottic secretion-drainage device were protective. Conclusions In patients with severe ARDS receiving lung-protective ventilation, VAP was associated with an increased crude ICU mortality which did not remain significant after adjustment. PMID:22524447

  19. Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?

    PubMed Central

    Nicolini, Edson A.; Nunes, Roosevelt S.; Santos, Gabriela V.; da Silva, Silvana Lia; Carreira, Mariana M.; Pellison, Fernanda G.; Menegueti, Mayra G.; Auxiliadora-Martins, Maria; Bellissimo-Rodrigues, Fernando; Feres, Marcus A.; Basile-Filho, Anibal

    2017-01-01

    Abstract Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase. One thousand five hundred and ninety-nine surgical patients (58.8% males; mean age of 60.6 ± 14.4 years) admitted to the ICU in the postoperative period were retrospectively studied. The patients were classified according to their serum sodium levels (mmol/L) at admission as normonatremia (135–145), hyponatremia (<135), and hypernatremia (>145). APACHE II, SAPS III, and SOFA were recorded. The capability of each index to predict mortality of ICU and hospital mortality of patients was analyzed by multiple logistic regression. Hyponatremia did not have an influence on mortality in the ICU with a relative risk (RR) = 0.95 (0.43–2.05) and hospital mortality of RR = 1.40 (0.75–2.59). However, this association was greater in patients with hypernatremia mortality in the ICU (RR = 3.33 [95% confidence interval, CI 1.58–7.0]) and also in hospital mortality (RR = 2.9 [ 95% CI = 1.51–5.55). The pairwise comparison of ROC curves among the different prognostic indexes (APACHE II, SAPS III, SOFA) did not show statistical significance. The comparison of these indexes with serum sodium levels for general population, hyponatremia, and normonatremia was statistically significant (P < .001). For hypernatremia, the AUC and 95% CI for APACHE II, SAPS III, SOFA, and serum sodium level were 0.815 (0.713–0.892), 0.805 (0.702–0.885), 0.885 (0.794–0.945), and 0.663 (0.549–0.764), respectively. The comparison among the prognostic indexes was not statistically significant. Only SOFA score had a statistic difference compared with hypernatremia (P < .02). The serum sodium levels at admission, especially hypernatremia, may be used as an

  20. A Validation Study of the Prediction Equation Used in Determining Freshman Admissions to the University of Washington During the 1978-1979 Academic Year.

    ERIC Educational Resources Information Center

    de Wolf, Virginia A.

    The predictive validity of the equation used for determining entrance into the University of Washington's freshman class during the 1978-79 academic year is examined. The sample was comprised of all freshmen entering the university directly from high school in autumn quarter 1974 who had been tested through the Washington Pre-College Test Battery…

  1. Predictive Validity of Grade Point Averages and of the Miller Analogies Test for Admission to a Doctoral Program in Educational Leadership

    ERIC Educational Resources Information Center

    Young, I. Phillip

    2007-01-01

    This manuscript evaluates the predictive validity of several predictors used to delimit an initial applicant pool of doctoral candidates at the department/program level. Particular predictors addressed in this manuscript are measures of past academic performance and of future academic potential. Past academic performance is assessed by grade point…

  2. Clinical Application of AIMS65 Scores to Predict Outcomes in Patients with Upper Gastrointestinal Hemorrhage

    PubMed Central

    Sharma, Manik; John, Anil K; Al-Ejji, Khalid Mohsin; Wani, Hamidulla; Sultan, Khaleel; Al-Mohannadi, Muneera; Yakoob, Rafie; Derbala, Moutaz; Al-Dweik, Nazeeh; Butt, Muhammed Tariq; Al-Kaabi, Saad Rashid

    2015-01-01

    Background/Aims To evaluate the ability of the recently proposed albumin, international normalized ratio (INR), mental status, systolic blood pressure, age >65 years (AIMS65) score to predict mortality in patients with acute upper gastrointestinal bleeding (UGIB). Methods AIMS65 scores were calculated in 251 consecutive patients presenting with acute UGIB by allotting 1 point each for albumin level <30 g/L, INR >1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. Results Intensive care unit (ICU) admission, endoscopic therapy, or surgery were required in 51 patients (20.3%), 64 (25.5%), and 12 (4.8%), respectively. The predictive accuracy of AIMS65 scores ≥2 was high for blood transfusion (area under the receiver operator characteristic curve [AUROC], 0.59), ICU admission (AUROC, 0.61), and mortality (AUROC, 0.74). The overall mortality was 10.3% (n=26), and was 3%, 7.8%, 20%, 36%, and 40% for AIMS65 scores of 0, 1, 2, 3, and 4, respectively; these values were significantly higher in those with scores ≥2 (30.9%) than in those with scores <2 (4.5%, p<0.001). Conclusions AIMS65 is a simple, accurate, non-endoscopic risk score that can be applied early (within 12 hours of hospital admission) in patients with acute UGIB. AIMS65 scores ≥2 predict high in-hospital mortality. PMID:26473120

  3. Intensive care and pregnancy: Epidemiology and general principles of management of obstetrics ICU patients during pregnancy.

    PubMed

    Zieleskiewicz, Laurent; Chantry, Anne; Duclos, Gary; Bourgoin, Aurelie; Mignon, Alexandre; Deneux-Tharaux, Catherine; Leone, Marc

    2016-10-01

    In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary. This team must work effectively together with regular staff aiming to evaluate daily the need to maintain the patient in intensive care unit or to prompt delivery. Keeping mother and baby together and fetal well-being must be balanced with the need of specialized advanced life support for the mother. The maternal physiological changes imply various consequences on management. The uterus aorto-caval compression implies tilting left the parturient. In case of cardiac arrest, uterus displacement and urgent cesarean delivery are needed. The high risk of aspiration and difficult tracheal intubation must be anticipated. Even during acute respiratory distress syndrome, hypoxemia and permissive hypercapnia must be avoided due to their negative impact on the fetus. Careful analysis of the benefit-risk ratio is needed before all drug administration. Streptococcal toxic shock syndrome and perineal fasciitis must be feared and a high level of suspicion of sepsis must be maintained. Finally the potential benefits of an ultrasound-based management are detailed.

  4. Comparison of anxiety, depression, and post-traumatic stress symptoms in relatives of ICU patients in an American and an Indian public hospital

    PubMed Central

    Kulkarni, Hrishikesh S.; Kulkarni, Karishma R.; Mallampalli, Antara; Parkar, Shubhangi R.; Karnad, Dilip R.; Guntupalli, Kalpalatha K.

    2011-01-01

    Context: An intensive care unit (ICU) admission of a patient causes considerable stress among relatives. Whether this impact differs among populations with differing sociocultural factors is unknown. Aims: The aim was to compare the psychological impact of an ICU admission on relatives of patients in an American and Indian public hospital. Settings and Design: A cross-sectional study was carried out in ICUs of two tertiary care hospitals, one each in major metropolitan cities in the USA and India. Materials and Methods: A total of 90 relatives visiting patients were verbally administered a questionnaire between 48 hours and 72 hours of ICU admission that included the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory-II (BDI-II) and Impact of Events Scale-Revised (IES-R) for post-traumatic stress response. Statistical Analysis: Statistical analysis was done using the Mann-Whitney and chi-square tests. Results: Relatives in the Indian ICU had more anxiety symptoms (median HADS-A score 11 [inter-quartile range 9-13] vs. 4 [1.5-6] in the American cohort; P<0.0001), more depression symptoms (BDI-II score 14 [8.5-19] vs. 6 [1.5-10.5], P<0.0001) but a comparable post-traumatic stress response (IES-R score>30). 55% of all relatives had an incongruous perception regarding “change in the patient's condition” compared to the objective change in severity of illness. “Change in worry” was incongruous compared to the perception of improvement of the patient's condition in 78% of relatives. Conclusions: Relatives of patients in the Indian ICU had greater anxiety and depression symptoms compared to those in the American cohort, and had significant differences in factors that may be associated with this psychological impact. Both groups showed substantial discordance between the perceived and objective change in severity of illness. PMID:22013306

  5. Patient-Specific Predictive Modeling Using Random Forests: An Observational Study for the Critically Ill

    PubMed Central

    2017-01-01

    Background With a large-scale electronic health record repository, it is feasible to build a customized patient outcome prediction model specifically for a given patient. This approach involves identifying past patients who are similar to the present patient and using their data to train a personalized predictive model. Our previous work investigated a cosine-similarity patient similarity metric (PSM) for such patient-specific predictive modeling. Objective The objective of the study is to investigate the random forest (RF) proximity measure as a PSM in the context of personalized mortality prediction for intensive care unit (ICU) patients. Methods A total of 17,152 ICU admissions were extracted from the Multiparameter Intelligent Monitoring in Intensive Care II database. A number of predictor variables were extracted from the first 24 hours in the ICU. Outcome to be predicted was 30-day mortality. A patient-specific predictive model was trained for each ICU admission using an RF PSM inspired by the RF proximity measure. Death counting, logistic regression, decision tree, and RF models were studied with a hard threshold applied to RF PSM values to only include the M most similar patients in model training, where M was varied. In addition, case-specific random forests (CSRFs), which uses RF proximity for weighted bootstrapping, were trained. Results Compared to our previous study that investigated a cosine similarity PSM, the RF PSM resulted in superior or comparable predictive performance. RF and CSRF exhibited the best performances (in terms of mean area under the receiver operating characteristic curve [95% confidence interval], RF: 0.839 [0.835-0.844]; CSRF: 0.832 [0.821-0.843]). RF and CSRF did not benefit from personalization via the use of the RF PSM, while the other models did. Conclusions The RF PSM led to good mortality prediction performance for several predictive models, although it failed to induce improved performance in RF and CSRF. The distinction

  6. Admission of hematopoietic cell transplantation patients to the intensive care unit at the Pontificia Universidad Católica de Chile Hospital.

    PubMed

    Escobar, Karen; Rojas, Patricio; Ernst, Daniel; Bertin, Pablo; Nervi, Bruno; Jara, Veronica; Garcia, Maria Jose; Ocqueteau, Mauricio; Sarmiento, Mauricio; Ramirez, Pablo

    2015-01-01

    Patients undergoing hematopoietic cell transplantation (HCT) can have complications that require management in the intensive care unit (ICU). We conducted a retrospective study of patients undergoing HCT between 2007 and 2011 with admission to the ICU. We analyzed 97 patients, with an average age of 37 (range, 15 to 68). The main indications for HCT were hematologic malignancies (84%, n = 82). Ninety percent (n = 87) received myeloablative conditioning. Thirty-one percent were admitted (autologous transplant recipients 15%, allogeneic transplant recipients 34%, and umbilical cord blood [UCB] transplant recipients 48%) with an average length of stay of 19 days (range, 1 to 73 days). The average time between transplantation and transfer was 15 days. The main causes of admission were acute respiratory failure (63%) and septic shock (20%). ICU mortality was 20% for autologous transplantations and 64% for allogeneic transplantations (adult donor and UCB combined). On average, patients died 108 days after the transplantation (range, 4 to 320 days). One-year overall survival, comparing patients entering the ICU with those never admitted, was 16% versus 82% (P < .0001) for allogeneic transplantations (adult donor and UCB combined) and 80% versus 89% (P = not significant) for autologous transplantations. Acute graft-versus-host disease was significantly associated with death in ICU after UCB HCT. ICU support is satisfactory in about one half of patients admitted, characterized by a short and medium term prognosis not as unfavorable as has been previously reported.

  7. Bispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients.

    PubMed

    Sackey, P V; Radell, P J; Granath, F; Martling, C R

    2007-06-01

    Bispectral index (BIS) is used for monitoring anaesthetic depth with inhaled anaesthetic agents in the operating room but has not been evaluated as a monitor of sedation depth in the intensive care unit (ICU) setting with these agents. If BIS could predict sedation depth in ICU patients, patient disturbances could be reduced and oversedation avoided. Twenty ventilator-dependent ICU patients aged 27 to 80 years were randomised to sedation with isoflurane via the AnaConDa or intravenous midazolam. BIS (A-2000 XP, version 3.12), electromyogram activity (EMG) and Signal Quality Index were measured continuously. Hourly clinical evaluation of sedation depth according to Bloomsbury Sedation Score (Bloomsbury) was performed. The median BIS value during a 10-minute interval prior to the clinical evaluation at the bedside was compared with Bloomsbury. Nurses performing the clinical sedation scoring were blinded to the BIS values. End-tidal isoflurane concentration was measured and compared with Bloomsbury. Correlation was poor between BIS and Bloomsbury in both groups (Spearman's rho 0.012 in the isoflurane group and -0.057 in the midazolam group). Strong correlation was found between BIS and EMG (Spearman's rho 0.74). Significant correlation was found between end-tidal isoflurane concentration and Bloomsbury (Spearman's rho 0.47). In conclusion, BIS XP does not reliably predict sedation depth as measured by clinical evaluation in non-paralysed ICU patients sedated with isoflurane or midazolam. EMG contributes significantly to BIS values in isoflurane or midazolam sedated, non-paralysed ICU patients. End-tidal isoflurane concentration appeared to be a better indicator of clinical sedation depth than BIS.

  8. Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure.

    PubMed

    Santarelli, Simona; Russo, Veronica; Lalle, Irene; De Berardinis, Benedetta; Navarin, Silvia; Magrini, Laura; Piccoli, Antonio; Codognotto, Marta; Castello, Luigi Maria; Avanzi, Gian Carlo; Villacorta, Humberto; Precht, Bernardo Luiz Campanário; de Araújo Porto, Pilar Barreto; Villacorta, Aline Sterque; Di Somma, Salvatore

    2016-12-16

    Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65-0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655-0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29-0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68-0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.

  9. The impact of delays to admission from the emergency department on inpatient outcomes

    PubMed Central

    2010-01-01

    Background We sought to determine the impact of delays to admission from the Emergency Department (ED) on inpatient length of stay (LOS), and IP cost. Methods We conducted a retrospective analysis of 13,460 adult (≥ 18 yrs) ED visits between April 1 2006 and March 30 2007 at a tertiary care teaching hospital with two ED sites in which the mode of disposition was admission to ICU, surgery or inpatient wards. We defined ED Admission Delay as ED time to decision to admit > 12 hours. The primary outcomes were IP LOS, and total IP cost. Results Approximately 11.6% (n = 1558) of admitted patients experienced admission delay. In multivariate analysis we found that admission delay was associated with 12.4% longer IP LOS (95% CI 6.6% - 18.5%) and 11.0% greater total IP cost (6.0% - 16.4%). We estimated the cumulative impact of delay on all delayed patients as an additional 2,183 inpatient days and an increase in IP cost of $2,109,173 at the study institution. Conclusions Delays to admission from the ED are associated with increased IP LOS and IP cost. Improving patient flow through the ED may reduce hospital costs and improve quality of care. There may be a business case for investments to reduce emergency department admission delays. PMID:20618934

  10. Impact of Delayed Admission to the Intensive Care Unit from the Emergency Department upon Sepsis Outcomes and Sepsis Protocol Compliance

    PubMed Central

    Price, Lori Lyn; Andoh-Duku, Augustine; LaCamera, Peter

    2017-01-01

    Rationale. The impact of emergency department length of stay (EDLOS) upon sepsis outcomes needs clarification. We sought to better understand the relationship between EDLOS and both outcomes and protocol compliance in sepsis. Methods. We performed a retrospective observational study of septic patients admitted to the ICU from the ED between January 2012 and December 2015 in a single tertiary care teaching hospital. 287 patients with severe sepsis and septic shock were included. Study population was divided into patients with EDLOS < 6 hrs (early admission) versus ≥6 hours (delayed admission). We assessed the impact of EDLOS on hospital mortality, compliance with sepsis protocol, and resuscitation. Statistical significance was determined by chi-square test. Results. Of the 287 septic ED patients, 137 (47%) were admitted to the ICU in <6 hours. There was no significant in-hospital mortality difference between early and delayed admissions (p = 0.68). Both groups have similar compliance with the 3-hour protocol (p = 0.77). There was no significant difference in achieving optimal resuscitation within 12 hours (p = 0.35). Conclusion. We found that clinical outcomes were not significantly different between early and delayed ICU admissions. Additionally, EDLOS did not impact compliance with the sepsis protocol with the exception of repeat lactate draw.

  11. Use of Improving Palliative Care in the ICU (Intensive Care Unit) Guidelines for a Palliative Care Initiative in an ICU

    PubMed Central

    Mun, Eluned; Nakatsuka, Craig; Umbarger, Lillian; Ruta, Ruth; McCarty, Tracy; Machado, Cynthia; Ceria-Ulep, Clementina

    2017-01-01

    Objective: For improved utilization of the existing palliative care team in the intensive care unit (ICU), a process was needed to identify patients who might need a palliative care consultation in a timelier manner. Methods: A systematic method to create a new program that would be compatible with our specific ICU environment and patient population was developed. A literature review revealed a fairly extensive array of reports and numerous clinical practice guidelines, which were assessed for information and strategies that would be appropriate for our unit. Results: The recommendations provided by the Center to Advance Palliative Care from its Improving Palliative Care in the ICU project were used to successfully implement a new palliative care initiative in our ICU. Conclusion: The guidelines provided by the Improving Palliative Care in the ICU project were an important tool to direct the development of a new palliative care ICU initiative. PMID:28241905

  12. An Evaluation of the Pharmacy College Admissions Test as a Tool for Pharmacy College Admissions Committees.

    ERIC Educational Resources Information Center

    Kelley, Katherine A.; Secnik, Kristina; Boye, Mark E.

    2001-01-01

    Investigated the capacity of the Pharmacy College Admissions Test (PCAT) to predict success in pharmacy school. Found demographic differences in PCAT scores, and that the PCAT used in combination with pre-pharmacy grade point average is meaningful in assessing applicants to pharmacy school; applicants with PCAT composite percentile scores below 40…

  13. Summarising Complex ICU Data in Natural Language

    PubMed Central

    Hunter, Jim; Freer, Yvonne; Gatt, Albert; Logie, Robert; McIntosh, Neil; van der Meulen, Marian; Portet, François; Reiter, Ehud; Sripada, Somayajulu; Sykes, Cindy

    2008-01-01

    It has been shown that summarizing complex multichannel physiological and discrete data in natural language (text) can lead to better decision-making in the intensive care unit (ICU). As part of the BabyTalk project, we describe a prototype system (BT-45) which can generate such textual summaries automatically. Although these summaries are not yet as good as those generated by human experts, we have demonstrated experimentally that they lead to as good decision-making as can be achieved through presenting the same data graphically. PMID:18998961

  14. Unplanned Intensive Care Unit Admission following Elective Surgical Adverse Events: Incidence, Patient Characteristics, Preventability, and Outcome

    PubMed Central

    Meziane, Mohammed; El Jaouhari, Sidi Driss; ElKoundi, Abdelghafour; Bensghir, Mustapha; Baba, Hicham; Ahtil, Redouane; Aboulaala, Khalil; Balkhi, Hicham; Haimeur, Charki

    2017-01-01

    Context: Adverse events (AEs) are a persistent and an important reason for Intensive Care Unit (ICU) admission. They lead to death, disability at the time of discharge, unplanned ICU admission (UIA), and prolonged hospital stay. They impose large financial costs on health-care systems. Aims: This study aimed to determine the incidence, patient characteristics, type, preventability, and outcome of UIA following elective surgical AE. Settings and Design: This is a single-center prospective study. Methods: Analysis of 15,372 elective surgical procedures was performed. We defined UIA as an ICU admission that was not anticipated preoperatively but was due to an AE occurring within 5 days after elective surgery. Statistical Analysis: Descriptive analysis using SPSS software version 18 was used for statistical analysis. Results: There were 75 UIA (0.48%) recorded during the 2-year study period. The average age of patients was 54.64 ± 18.02 years. There was no sex predominance, and the majority of our patients had an American Society of Anesthesiologist classes 1 and 2. Nearly 29% of the UIA occurred after abdominal surgery and 22% after a trauma surgery. Regarding the causes of UIA, we observed that 44 UIA (58.7%) were related to surgical AE, 24 (32%) to anesthetic AE, and 7 (9.3%) to postoperative AE caused by care defects. Twenty-three UIA were judged as potentially preventable (30.7%). UIA was associated with negative outcomes, including increased use of ICU-specific interventions and high mortality rate (20%). Conclusions: Our analysis of UIA is a quality control exercise that helps identify high-risk patient groups and patterns of anesthesia or surgical care requiring improvement.

  15. Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review.

    PubMed

    Lataifeh, I; Amarin, Z; Zayed, F; Al-Mehaisen, L; Alchalabi, H; Khader, Y

    2010-05-01

    The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted.

  16. Predictive value of grade point average (GPA), Medical College Admission Test (MCAT), internal examinations (Block) and National Board of Medical Examiners (NBME) scores on Medical Council of Canada qualifying examination part I (MCCQE-1) scores

    PubMed Central

    Roy, Banibrata; Ripstein, Ira; Perry, Kyle; Cohen, Barry

    2016-01-01

    Background To determine whether the pre-medical Grade Point Average (GPA), Medical College Admission Test (MCAT), Internal examinations (Block) and National Board of Medical Examiners (NBME) scores are correlated with and predict the Medical Council of Canada Qualifying Examination Part I (MCCQE-1) scores. Methods Data from 392 admitted students in the graduating classes of 2010–2013 at University of Manitoba (UofM), College of Medicine was considered. Pearson’s correlation to assess the strength of the relationship, multiple linear regression to estimate MCCQE-1 score and stepwise linear regression to investigate the amount of variance were employed. Results Complete data from 367 (94%) students were studied. The MCCQE-1 had a moderate-to-large positive correlation with NBME scores and Block scores but a low correlation with GPA and MCAT scores. The multiple linear regression model gives a good estimate of the MCCQE-1 (R2 =0.604). Stepwise regression analysis demonstrated that 59.2% of the variation in the MCCQE-1 was accounted for by the NBME, but only 1.9% by the Block exams, and negligible variation came from the GPA and the MCAT. Conclusions Amongst all the examinations used at UofM, the NBME is most closely correlated with MCCQE-1. PMID:27103953

  17. Sleep disturbance in older ICU patients

    PubMed Central

    Sterniczuk, Roxanne; Rusak, Benjamin; Rockwood, Kenneth

    2014-01-01

    Maintaining a stable and adequate sleeping pattern is associated with good health and disease prevention. As a restorative process, sleep is important for supporting immune function and aiding the body in healing and recovery. Aging is associated with characteristic changes to sleep quantity and quality, which make it more difficult to adjust sleep–wake rhythms to changing environmental conditions. Sleep disturbance and abnormal sleep–wake cycles are commonly reported in seriously ill older patients in the intensive care unit (ICU). A combination of intrinsic and extrinsic factors appears to contribute to these disruptions. Little is known regarding the effect that sleep disturbance has on health status in the oldest of old (80+), a group, who with diminishing physiological reserve and increasing prevalence of frailty, is at a greater risk of adverse health outcomes, such as cognitive decline and mortality. Here we review how sleep is altered in the ICU, with particular attention to older patients, especially those aged ≥80 years. Further work is required to understand what impact sleep disturbance has on frailty levels and poor outcomes in older critically ill patients. PMID:25018625

  18. Prognostic value of ICU-acquired hypernatremia in patients with neurological dysfunction

    PubMed Central

    Hu, Bei; Han, Qianpeng; Mengke, Nashun; He, Kairan; Zhang, Yiqin; Nie, Zhiqiang; Zeng, Hongke

    2016-01-01

    Abstract Many studies have indicated that hypernatremia is associated with increased mortality. In this study, we aimed to explore the relationship between intensive care unit (ICU)-acquired hypernatremia and the prognosis of critically neurological patients. Based on serum sodium level in the ICU, 450 patients were divided into 3 groups: 222 had normal serum sodium, 142 had mild hypernatremia, and 86 had severe hypernatremia. Kaplan–Meier and multivariable binary logistic regression analyses were performed to evaluate the prognostic value of hypernatremia in critically neurological patients. Receiver operating characteristic (ROC) curve was constructed for serum sodium levels to determine their roles in predicting ICU mortality. Hypernatremia was significantly related with age, Glasgow Coma Scale (GCS) score, serum sodium, APACHE II score, and serum creatinine. Moreover, the different treatment outcome including mechanical ventilation, the days of stayed in ICU, and Glasgow Outcome Scale score had correlation with serum sodium levels. Old ages, GCS score, therapeutic intervention scoring system (TISS) score, APACHE II score, serum sodium peak, and so on were all associated with the mortality. In addition, hypernatremia was an independent prognostic factor for critically neurological patients by logistic regression analysis (odds ratio = 1.192, 95% confidence interval = 1.135–1.252, P = 0.000). Moreover, we got the sensitivity of 79.4% and specificity of 74.5% in the ROC analysis between peak serum sodium and the mortality. The area under the ROC curve was 0.844, and the optimal cutoff value was 147.55. Our results showed that ICU-acquired hypernatremia may be a potential prognosis marker for critically neurological patients. PMID:27583842

  19. Beyond Correlations: Usefulness of High School GPA and Test Scores in Making College Admissions Decisions

    ERIC Educational Resources Information Center

    Sawyer, Richard

    2013-01-01

    Correlational evidence suggests that high school GPA is better than admission test scores in predicting first-year college GPA, although test scores have incremental predictive validity. The usefulness of a selection variable in making admission decisions depends in part on its predictive validity, but also on institutions' selectivity and…

  20. Effect of oral beta-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study

    PubMed Central

    2010-01-01

    Introduction Acute respiratory failure (ARF) is responsible for about one-third of intensive care unit (ICU) admissions and is associated with adverse outcomes. Predictors of short- and long-term outcomes in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess the effects of oral beta-blockers in unselected ICU patients with ARF included in the BASEL-II-ICU study. Methods The BASEL II-ICU study was a prospective, multicenter, randomized, single-blinded, controlled trial of 314 (mean age 70 (62 to 79) years) ICU patients with ARF evaluating impact of a B-type natriuretic peptide- (BNP) guided management strategy on short-term outcomes. Results In-hospital mortality was 16% (51 patients) and one-year mortality 41% (128 patients). Multivariate analysis assessed that oral beta-blockers at admission were associated with a lower risk of both in-hospital (HR 0.33 (0.14 to 0.74) P = 0.007) and one-year mortality (HR 0.29 (0.16 to 0.51) P = 0.0003). Kaplan-Meier analysis confirmed the lower mortality in ARF patients when admitted with oral beta-blocker and further shows that the beneficial effect of oral beta-blockers at admission holds true in the two subgroups of patients with ARF related to cardiac or non-cardiac causes. Kaplan-Meier analysis also shows that administration of oral beta-blockers before hospital discharge gives striking additional beneficial effects on one-year mortality. Conclusions Established beta-blocker therapy appears to be associated with a reduced mortality in ICU patients with acute respiratory failure. Cessation of established therapy appears to be hazardous. Initiation of therapy prior to discharge appears to confer benefit. This finding was seen regardless of the cardiac or non-cardiac etiology of respiratory failure. Trial registration clinicalTrials.gov Identifier: NCT00130559 PMID:21047406

  1. Relationship between patient race and survival following admission to intensive care among patients of primary care physicians.

    PubMed Central

    Horner, R D; Lawler, F H; Hainer, B L

    1991-01-01

    This study investigated the existence of racial differences in the survival of patients admitted to intensive care by family physicians and general internists for circulatory illnesses. The study population consisted of 249 consecutive patients admitted by these specialists to an ICU in a tertiary care hospital in Pitt County, North Carolina, during the June 1985 to June 1986 period. Logistic regression was used to specify the unique effect of race on ICU patient survival in-hospital, controlling for potential confounding factors such as disease severity, type of health insurance, and case mix. Black patients were almost three times more likely than white patients to die in-hospital following admission to the ICU (RR = 2.9, 95 percent I = 1.5, 5.6). Most of this difference in survival was explained by racial differences in disease severity. PMID:1917504

  2. Cost and effectiveness of omega-3 fatty acid supplementation in Chinese ICU patients receiving parenteral nutrition

    PubMed Central

    Wu, Guo Hao; Gao, Jian; Ji, Chun Yan; Pradelli, Lorenzo; Xi, Qiu Lei; Zhuang, Qiu Lin

    2015-01-01

    Background and objectives Clinical evidence supports the use of omega-3 polyunsaturated fatty acid (PUFA)-enriched lipid emulsions in place of standard lipid emulsions in parenteral nutrition (PN) for intensive care unit (ICU) patients, but uptake may be limited by higher costs. We compared clinical and economic outcomes for these two types of lipid emulsion in the Chinese ICU setting. Methods We developed a pharmacoeconomic discrete event simulation model, based on efficacy data from an international meta-analysis and patient characteristics, resource consumption, and unit costs from a Chinese institutional setting. Probabilistic sensitivity analyses were undertaken to assess the effects of uncertainty around input parameters. Model predictive validity was assessed by comparing results with data observed in a patient subset not used in the modeling. Results The model predicted that omega-3 PUFA-enriched emulsion (Omegaven® 10% fish oil emulsion) would dominate standard lipid emulsions, with better clinical outcomes and lower overall health care costs (mean savings ~10,000 RMB), mainly as a result of faster recovery and shorter hospital stay (by ~6.5 days). The external validation process confirmed the reliability of the model predictions. Conclusion Omega-3 PUFA-enriched lipid emulsions improved clinical outcome and decreased overall costs in Chinese ICU patients requiring PN. PMID:26170701

  3. The Changing College Admissions Scene.

    ERIC Educational Resources Information Center

    Sjogren, Cliff

    1983-01-01

    Discusses the status of college admissions and some of the forces that influenced college admissions policies during each of four three-year periods: the Sputnik Era (1957-60), the Postwar Baby Boom Era (1964-67), the "New Groups" Era (1971-74), and the Stable Enrollment Era (1978-81). (PGD)

  4. Optimal Admission to Higher Education

    ERIC Educational Resources Information Center

    Albaek, Karsten

    2017-01-01

    This paper analyses admission decisions when students from different high school tracks apply for admission to university programmes. I derive a criterion that is optimal in the sense that it maximizes the graduation rates of the university programmes. The paper contains an empirical analysis that documents the relevance of theory and illustrates…

  5. Daily enteral feeding practice on the ICU: attainment of goals and interfering factors

    PubMed Central

    Binnekade, JM; Tepaske, R; Bruynzeel, P; Mathus-Vliegen, EMH; de Hann, RJ

    2005-01-01

    Background The purpose of this study was to evaluate the daily feeding practice of enterally fed patients in an intensive care unit (ICU) and to study the impact of preset factors in reaching predefined optimal nutritional goals. Methods The feeding practice of all ICU patients receiving enteral nutrition for at least 48 hours was recorded during a 1-year period. Actual intake was expressed as the percentage of the prescribed volume of formula (a success is defined as 90% or more). Prescribed volume (optimal intake) was guided by protocol but adjusted to individual patient conditions by the intensivist. The potential barriers to the success of feeding were assessed by multivariate analysis. Results Four-hundred-and-three eligible patients had a total of 3,526 records of feeding days. The desired intake was successful in 52% (1,842 of 3,526) of feeding days. The percentage of successful feeding days increased from 39% (124 of 316) on day 1 to 51% (112 of 218) on day 5. Average ideal protein intake was 54% (95% confidence interval (CI) 52 to 55), energy intake was 66% (95% CI 65 to 68) and volume 75% (95% CI 74 to 76). Factors impeding successful nutrition were the use of the feeding tube to deliver contrast, the need for prokinetic drugs, a high Therapeutic Intervention Score System category and elective admissions. Conclusion The records revealed an unsatisfactory feeding process. A better use of relative successful volume intake, namely increasing the energy and protein density, could enhance the nutritional yield. Factors such as an improper use of tubes and feeding intolerance were related to failure. Meticulous recording of intake and interfering factors helps to uncover inadequacies in ICU feeding practice. PMID:15987393

  6. SAT Wars: The Case for Test-Optional College Admissions

    ERIC Educational Resources Information Center

    Soares, Joseph A., Ed.

    2011-01-01

    What can a college admissions officer safely predict about the future of a 17-year-old? Are the best and the brightest students the ones who can check off the most correct boxes on a multiple-choice exam? Or are there better ways of measuring ability and promise? In this penetrating and revealing look at high-stakes standardized admissions tests,…

  7. Predicting Hospital Admissions With Poisson Regression Analysis

    DTIC Science & Technology

    2009-06-01

    East and Four West. Four East is where bariatric , general, neurologic, otolaryngology (ENT), ophthalmologic, orthopedic, and plastic surgery ...where care is provided for cardiovascular, thoracic, and vascular surgery patients. Figure 1 shows a bar graph for each unit, giving the proportion of...provided at NMCSD, or a study could be conducted on the amount of time that patients generally wait for elective surgeries . There is also the

  8. Occupational Health Hazards in ICU Nursing Staff

    PubMed Central

    Shimizu, Helena Eri; Couto, Djalma Ticiani; Merchán-Hamann, Edgar; Branco, Anadergh Barbosa

    2010-01-01

    This study analyzed occupational health hazards for Intensive Care Unit (ICU) nurses and nursing technicians, comparing differences in the number and types of hazards which occur at the beginning and end of their careers. A descriptive cross-sectional study was carried out with 26 nurses and 96 nursing technicians from a public hospital in the Federal District, Brazil. A Likert-type work-related symptom scale (WRSS) was used to evaluate the presence of physical, psychological, and social risks. Data were analyzed with the use of the SPSS, version 12.0, and the Kruskal-Wallis test for statistical significance and differences in occupational health hazards at the beginning and at the end of the workers' careers. As a workplace, ICUs can cause work health hazards, mostly physical, to nurses and nursing technicians due to the frequent use of physical energy and strength to provide care, while psychological and social hazards occur to a lesser degree. PMID:21994814

  9. Assisted living nursing practice: admission assessment.

    PubMed

    Mitty, Ethel; Flores, Sandi

    2007-01-01

    Admission assessment, generally conducted by a registered nurse, is autonomous, without opportunity for dialogue with colleagues and other health care professionals and bounded by the nurse's knowledge and skills, state regulations, facility practices, and marketing. The fact that some states permit admission and retention of nursing home level-of-care residents and provision of end-of-life care means that the assessment has to be able to predict the resident's likely trajectory of well-being as well as chronic illness exacerbation. The nurse must have a clear perspective on staff competencies and judge whether additional education or training will be necessary. This article reviews assessment standards of practice as put forth by the American Assisted Living Nurses Association as part of its application for recognition of assisted living nursing as specialty nursing practice by the American Nurses Association. The role of the Licensed Practical Nurse/Licensed Vocational Nurse in resident assessment is also discussed.

  10. Assessment of Cell-Cycle Arrest Biomarkers to Predict Early and Delayed Acute Kidney Injury

    PubMed Central

    Bell, Max; Larsson, Anders; Venge, Per; Bellomo, Rinaldo; Mårtensson, Johan

    2015-01-01

    Purpose. To assess urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein 7 ([TIMP-2]·[IGFBP7]), urinary neutrophil gelatinase-associated lipocalin (NGAL), and urinary cystatin-C as acute kidney injury predictors (AKI) exploring the association of nonrenal factors with elevated biomarker levels. Methods. We studied 94 patients with urine collected within 48 hours of ICU admission and no AKI at sampling. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. Predictive performance was assessed by the area under the receiver operating characteristics (ROC) curve. Associations between biomarkers and clinical factors were assessed by multivariate linear regression. Results. Overall, 19 patients (20%) developed AKI within 48 hours. [TIMP-2]·[IGFBP7], NGAL, or cystatin-C admission levels did not differ between patients without AKI and patients developing AKI. [TIMP-2]·[IGFBP7], NGAL, and cystatin-C were poor AKI predictors (ROC areas 0.34–0.51). Diabetes was independently associated with higher [TIMP-2]·[IGFBP7] levels (P = 0.02) but AKI was not (P = 0.24). Sepsis was independently associated with higher NGAL (P < 0.001) and cystatin-C (P = 0.003) levels. Conclusions. Urinary [TIMP-2]·[IGFBP7], NGAL, and cystatin-C should be used cautiously as AKI predictors in general ICU patients since urine levels of these biomarkers are affected by factors other than AKI and their performance can be poor. PMID:25866432

  11. 28 CFR 549.42 - Involuntary admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.42 Involuntary admission... voluntarily consent either to psychiatric admission or to medication, is subject to judicial...

  12. 32 CFR 242.5 - Admission procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... HEALTH SCIENCES § 242.5 Admission procedures. (a) Application—(1) Civilians. Civilians seeking admission to the School of Medicine shall make direct application following instructions published in...

  13. Environmental triggers of hospital admissions for school-age children with asthma in two British cities.

    PubMed

    Julious, Steven A; Jain, Ritika; Mason, Suzanne

    2012-10-01

    Research has reported seasonal peaks in asthma in school age asthmatic children. The study aimed to assess if hospital admissions could be predicted from the possible environmental triggers using data from two British cities: Aberdeen and Doncaster. However, there were no consistent patterns across the two cities with no clear evidence that hospital admissions could be predicted from environmental data.

  14. Peritraumatic reactions and posttraumatic stress disorder symptoms after psychiatric admission.

    PubMed

    Ladois-Do Pilar Rei, Agnès; Bui, Eric; Bousquet, Benjamin; Simon, Naomi M; Rieu, Julie; Schmitt, Laurent; Billard, Julien; Rodgers, Rachel; Birmes, Philippe

    2012-01-01

    The present study aimed to explore exposure to stressful events during a psychiatric admission and the predictive power of peritraumatic distress and dissociation in the development of posttraumatic stress disorder (PTSD) symptoms after exposure to such events. Psychiatric inpatients (N = 239) were asked to report exposure to stressful events during their admission within 48 hours of being admitted. Individuals reporting at least one stressful event during admission (n = 70, 29%) were assessed for peritraumatic dissociation and distress in relation to this event and, 5 weeks later, were reassessed for PTSD symptoms. Eight participants (12.3%) scored above the cutoff for probable PTSD. Multiple regression analyses revealed that peritraumatic distress was a significant predictor of 5-week PTSD symptoms. Our findings suggest that individuals experiencing increased peritraumatic distress in relation to a stressful event experienced during a psychiatric admission might be at risk of PTSD symptoms and might benefit from increased attention.

  15. An ICU nurse with a history of tremors.

    PubMed

    Lurati, Ann

    2015-01-01

    A 52-year-old female working as a registered nurse in the ICU developed tremors with fine motor activities in stressful situations. She was evaluated by a neurologist and was diagnosed with physiological tremors. Implications for practice are explored.

  16. Sleep in the ICU: potential mechanisms and clinical implications.

    PubMed

    Hardin, Kimberly A

    2009-07-01

    Patients in the ICU are known to have severely disrupted sleep with disturbed circadian pattern, decreased nocturnal sleep time, abnormally increased stages 1 and 2 sleep, and reduced or absent deep sleep. Recent data reveal that a subpopulation of critically ill patients manifests unique EEG sleep patterns. The etiology of sleep disruption in the ICU includes the inherent nature of the environment, medications, ventilator-patient interaction, and the effect of acute illness. How sleep disruption contributes to outcomes in critically ill patients, such as recovery time and weaning from mechanical ventilation, is unknown. This article reviews the literature describing sleep in ICU patients, including recent investigations in patients who require mechanical ventilation, factors that affect sleep in critically ill patients, and the potential mechanisms and clinical implications of disturbed sleep in the ICU setting with directions to consider for future investigations.

  17. Early Standard Electroencephalogram Abnormalities Predict Mortality in Septic Intensive Care Unit Patients

    PubMed Central

    Azabou, Eric; Magalhaes, Eric; Braconnier, Antoine; Yahiaoui, Lyria; Moneger, Guy; Heming, Nicholas; Annane, Djillali; Mantz, Jean; Chrétien, Fabrice; Durand, Marie-Christine; Lofaso, Frédéric; Porcher, Raphael; Sharshar, Tarek

    2015-01-01

    Introduction Sepsis is associated with increased mortality, delirium and long-term cognitive impairment in intensive care unit (ICU) patients. Electroencephalogram (EEG) abnormalities occurring at the acute stage of sepsis may correlate with severity of brain dysfunction. Predictive value of early standard EEG abnormalities for mortality in ICU septic patients remains to be assessed. Methods In this prospective, single center, observational study, standard EEG was performed, analyzed and classified according to both Synek and Young EEG scales, in consecutive patients acutely admitted in ICU for sepsis. Delirium, coma and the level of sedation were assessed at the time of EEG recording; and duration of sedation, occurrence of in-ICU delirium or death were assessed during follow-up. Adjusted analyses were carried out using multiple logistic regression. Results One hundred ten patients were included, mean age 63.8 (±18.1) years, median SAPS-II score 38 (29–55). At the time of EEG recording, 46 patients (42%) were sedated and 22 (20%) suffered from delirium. Overall, 54 patients (49%) developed delirium, of which 32 (29%) in the days after EEG recording. 23 (21%) patients died in the ICU. Absence of EEG reactivity was observed in 27 patients (25%), periodic discharges (PDs) in 21 (19%) and electrographic seizures (ESZ) in 17 (15%). ICU mortality was independently associated with a delta-predominant background (OR: 3.36; 95% CI [1.08 to 10.4]), absence of EEG reactivity (OR: 4.44; 95% CI [1.37–14.3], PDs (OR: 3.24; 95% CI [1.03 to 10.2]), Synek grade ≥ 3 (OR: 5.35; 95% CI [1.66–17.2]) and Young grade > 1 (OR: 3.44; 95% CI [1.09–10.8]) after adjustment to Simplified Acute Physiology Score (SAPS-II) at admission and level of sedation. Delirium at the time of EEG was associated with ESZ in non-sedated patients (32% vs 10%, p = 0.037); with Synek grade ≥ 3 (36% vs 7%, p< 0.05) and Young grade > 1 (36% vs 17%, p< 0.001). Occurrence of delirium in the days after

  18. Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

    PubMed Central

    Malak, Sandra; Sotto, Jean-Jacques; Ceccaldi, Joël; Colombat, Philippe; Casassus, Philippe; Jaulmes, Dominique; Rochant, Henri; Cheminant, Morgane; Beaussant, Yvan; Zittoun, Robert; Bordessoule, Dominique

    2014-01-01

    Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice. PMID:25349612

  19. SMART approaches for reducing nosocomial infections in the ICU.

    PubMed

    Kollef, Marin

    2008-08-01

    Nosocomial infections are problematic in the ICU because of their frequency, morbidity, and mortality. The most common ICU infections are pneumonia, bloodstream infection, and urinary tract infection, most of which are device related. Surgical site infection is common in surgical ICUs, and Clostridium difficile-associated diarrhea is occurring with increasing frequency. Prospective observational studies confirm that use of evidence-based guidelines can reduce the rate of these ICU infections, especially when simple tactics are bundled. To increase the likelihood of success, follow the specific, measurable, achievable, relevant, and time bound (SMART) approach. Choose specific objectives that precisely define and quantify desired outcomes, such as reducing the nosocomial ICU infection rate of an institution by 25%. To measure the objective, monitor staff adherence to tactics and infection rates, and provide feedback to ICU staff. Make objectives achievable and relevant by engaging stakeholders in the selection of specific tactics and steps for implementation. Nurses and other stakeholders can best identify the tactics that are achievable within their busy ICUs. Unburden the bedside provider by taking advantage of new technologies that reduce nosocomial infection rates. Objectives should also be relevant to the institution so that administrators provide adequate staffing and other resources. Appoint a team to champion the intervention and collaborate with administrators and ICU staff. Provide ongoing communication to reinforce educational tactics and fine-tune practices over time. Make objectives time bound; set dates for collecting baseline and periodic data, and a completion date for evaluating the success of the intervention.

  20. A Software Communication Tool for the Tele-ICU

    PubMed Central

    Pimintel, Denise M.; Wei, Shang Heng; Odor, Alberto

    2013-01-01

    The Tele Intensive Care Unit (tele-ICU) supports a high volume, high acuity population of patients. There is a high-volume of incoming and outgoing calls, especially during the evening and night hours, through the tele-ICU hubs. The tele-ICU clinicians must be able to communicate effectively to team members in order to support the care of complex and critically ill patients while supporting and maintaining a standard to improve time to intervention. This study describes a software communication tool that will improve the time to intervention, over the paper-driven communication format presently used in the tele-ICU. The software provides a multi-relational database of message instances to mine information for evaluation and quality improvement for all entities that touch the tele-ICU. The software design incorporates years of critical care and software design experience combined with new skills acquired in an applied Health Informatics program. This software tool will function in the tele-ICU environment and perform as a front-end application that gathers, routes, and displays internal communication messages for intervention by priority and provider. PMID:24551398

  1. Factors correlating with delayed trauma center admission following traumatic brain injury

    PubMed Central

    2013-01-01

    Background Delayed admission to appropriate care has been shown increase mortality following traumatic brain injury (TBI). We investigated factors associated with delayed admission to a hospital with neurosurgical expertise in a cohort of TBI patients in the intensive care unit (ICU). Methods A retrospective analysis of all TBI patients treated in the ICUs of Helsinki University Central Hospital was carried out from 1.1.2009 to 31.12.2010. Patients were categorized into two groups: direct admission and delayed admission. Patients in the delayed admission group were initially transported to a local hospital without neurosurgical expertise before inter-transfer to the designated hospital. Multivariate logistic regression was utilized to identify pre-hospital factors associated with delayed admission. Results Of 431 included patients 65% of patients were in the direct admission groups and 35% in the delayed admission groups (median time to admission 1:07h, IQR 0:52–1:28 vs. 4:06h, IQR 2:53–5:43, p <0.001). In multivariate analysis factors increasing the likelihood of delayed admission were (OR, 95% CI): male gender (3.82, 1.60-9.13), incident at public place compared to home (0.26, 0.11-0.61), high energy trauma (0.05, 0.01-0.28), pre-hospital physician consultation (0.15, 0.06-0.39) or presence (0.08, 0.03-0.22), hypotension (0.09, 0.01-0.93), major extra cranial injury (0.17, 0.05-0.55), abnormal pupillary light reflex (0.26, 0.09-0.73) and severe alcohol intoxication (12.44, 2.14-72.38). A significant larger proportion of patients in the delayed admission group required acute craniotomy for mass lesion when admitted to the neurosurgical hospital (57%, 21%, p< 0.001). No significant difference in 6-month mortality was noted between the groups (p= 0.814). Conclusion Delayed trauma center admission following TBI is common. Factors increasing likelihood of this were: male gender, incident at public place compared to home, low energy trauma, absence of pre

  2. 22 CFR 229.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Admission. 229.300 Section 229.300 Foreign... and Recruitment Prohibited § 229.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§...

  3. 22 CFR 229.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Admission. 229.300 Section 229.300 Foreign... and Recruitment Prohibited § 229.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§...

  4. 22 CFR 146.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Admission. 146.300 Section 146.300 Foreign... Recruitment Prohibited § 146.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§ 146.300...

  5. 10 CFR 1042.300 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Admission. 1042.300 Section 1042.300 Energy DEPARTMENT OF... Prohibited § 1042.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient to which §§ 1042.300 through...

  6. 44 CFR 68.9 - Admissible evidence.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Admissible evidence. 68.9 Section 68.9 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... admissible. (b) Documentary and oral evidence shall be admissible. (c) Admissibility of non-expert...

  7. College Admissions Policies for the 1970's.

    ERIC Educational Resources Information Center

    College Entrance Examination Board, New York, NY.

    The papers included in this collection are (1) "Problems and Issues Confronting the Admissions Community" by Clyde Vroman; (2) "Frozen Assumptions in Admissions" by B. Alden Thresher; (3) "The Effect of Federal Programs on Admissions Policies" by John F. Morse; (4) "State Plans for Higher Education and Their Influence on Admissions" by Charles W.…

  8. 45 CFR 618.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by...

  9. Trend of Decreased Length of Stay in the Intensive Care Unit (ICU) and in the Hospital with Palliative Care Integration into the ICU

    PubMed Central

    Mun, Eluned; Ceria-Ulep, Clementina; Umbarger, Lillian; Nakatsuka, Craig

    2016-01-01

    Context Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? Objective Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. Design A program was developed that followed recommendations from the Center to Advance Palliative Care’s Improving Palliative Care in the ICU project. This program included selecting trigger criteria and a care model, forming guidelines, and developing evaluation criteria. The early identification of multiple measures led to proactive meetings with ICU patients’ families and/or palliative care consultations. Main Outcome Measures Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS. Results A comparison between pre- and postintervention data showed positive trends in measured outcomes, including increased early identification of advance directives, code status, and goals of care along with a decrease in ICU LOS and hospital LOS. In addition, the number of ICU family meetings and palliative care consultations increased. Conclusion It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS. PMID:27644048

  10. The Association Between Colonization With Carbapenemase-Producing Enterobacteriaceae and Overall ICU Mortality: An Observational Cohort Study

    PubMed Central

    Wekesa, Ann N.; Gniadkowski, Marek; Antoniadou, Anastasia; Giamarellou, Helen; Petrikkos, George L.; Skiada, Anna; Brun-Buisson, Christian; Bonten, Marc J. M.; Derde, Lennie P. G.

    2015-01-01

    Objectives: Infections caused by carbapenemase-producing Enterobacteriaceae are increasing worldwide, especially in ICUs, and have been associated with high mortality rates. However, unequivocally demonstrating causality of such infections to death is difficult in critically ill patients because of potential confounding and competing events. Here, we quantified the effects of carbapenemase-producing Enterobacteriaceae carriage on patient outcome in two Greek ICUs with carbapenemase-producing Enterobacteriaceae endemicity. Design: Observational cohort study. Setting: Two ICUs with carbapenemase-producing Enterobacteriaceae endemicity. Patients: Patients admitted to the ICU with an expected length of ICU stay of at least 3 days were included. Interventions: None. Measurements and Main Results: Carbapenemase-producing Enterobacteriaceae colonization was established through screening in perineum swabs obtained at admission and twice weekly and inoculated on chromogenic plates. Detection of carbapenemases was performed phenotypically, with confirmation by polymerase chain reaction. Risk factors for ICU mortality were evaluated using cause-specific hazard ratios and subdistribution hazard ratios, with carbapenemase-producing Enterobacteriaceae colonization as time-varying covariate. One thousand seven patients were included, 36 (3.6%) were colonized at admission, and 96 (9.5%) acquired carbapenemase-producing Enterobacteriaceae colonization during ICU stay, and 301 (29.9%) died in ICU. Of 132 carbapenemase-producing Enterobacteriaceae isolates, 125 (94.7%) were Klebsiella pneumoniae and 74 harbored K. pneumoniae carbapenemase (56.1%), 54 metallo-β-lactamase (40.9%), and four both (3.0%). Carbapenemase-producing Enterobacteriaceae colonization was associated with a statistically significant increase of the subdistribution hazard ratio for ICU mortality (subdistribution hazard ratio = 1.79; 95% CI, 1.31–2.43), not explained by an increased daily hazard of dying (cause

  11. An ICU Preanesthesia Evaluation Form Reduces Missing Preoperative Key Information

    PubMed Central

    Chuy, Katherine; Yan, Zhe; Fleisher, Lee; Liu, Renyu

    2013-01-01

    Background A comprehensive preoperative evaluation is critical for providing anesthetic care for patients from the intensive care unit (ICU). There has been no preoperative evaluation form specific for ICU patients that allows for a rapid and focused evaluation by anesthesia providers, including junior residents. In this study, a specific preoperative form was designed for ICU patients and evaluated to allow residents to perform the most relevant and important preoperative evaluations efficiently. Methods The following steps were utilized for developing the preoperative evaluation form: 1) designed a new preoperative form specific for ICU patients; 2) had the form reviewed by attending physicians and residents, followed by multiple revisions; 3) conducted test releases and revisions; 4) released the final version and conducted a survey; 5) compared data collection from new ICU form with that from a previously used generic form. Each piece of information on the forms was assigned a score, and the score for the total missing information was determined. The score for each form was presented as mean ± standard deviation (SD), and compared by unpaired t test. A P value < 0.05 was considered statistically significant. Results Of 52 anesthesiologists (19 attending physicians, 33 residents) responding to the survey, 90% preferred the final new form; and 56% thought the new form would reduce perioperative risk for ICU patients. Forty percent were unsure whether the form would reduce perioperative risk. Over a three month period, we randomly collected 32 generic forms and 25 new forms. The average score for missing data was 23 ± 10 for the generic form and 8 ± 4 for the new form (P = 2.58E-11). Conclusions A preoperative evaluation form designed specifically for ICU patients is well accepted by anesthesia providers and helped to reduce missing key preoperative information. Such an approach is important for perioperative patient safety. PMID:23853741

  12. What Is the Best Pulmonary Physiotherapy Method in ICU?

    PubMed Central

    Kuyrukluyildiz, Ufuk; Binici, Orhan; Kupeli, İlke; Erturk, Nurel; Gulhan, Barış; Akyol, Fethi; Ozcicek, Adalet; Onk, Didem; Karabakan, Guldane

    2016-01-01

    Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p < 0.001). The PO2 levels increased in the study group at 72nd hour (p = 0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU. PMID:27445542

  13. Theory-Based University Admissions Testing for a New Millennium

    ERIC Educational Resources Information Center

    Sternberg, Robert J.

    2004-01-01

    This article describes two projects based on Robert J. Sternberg's theory of successful intelligence and designed to provide theory-based testing for university admissions. The first, Rainbow Project, provided a supplementary test of analytical, practical, and creative skills to augment the SAT in predicting college performance. The Rainbow…

  14. Cognitive Styles in Admission Procedures for Assessing Candidates of Architecture

    ERIC Educational Resources Information Center

    Casakin, Hernan; Gigi, Ariela

    2016-01-01

    Cognitive style has a strong predictive power in academic and professional success. This study investigated the cognitive profile of candidates studying architecture. Specifically, it explored the relation between visual and verbal cognitive styles, and the performance of candidates in admission procedures. The cognitive styles of candidates who…

  15. "Noncognitive" Measures: The Next Frontier in College Admissions

    ERIC Educational Resources Information Center

    Hoover, Eric

    2013-01-01

    The handyman has a tool for everything, but the admissions dean is not so lucky: He must make do with just a few. Every year, presidents and professors expect freshmen who are curious, determined, and hungry for challenges. The traditional metrics of merit, however, can't reveal such qualities. Standardized-test scores may or may not predict a…

  16. Health and social consequences of an alcohol-related admission to critical care: a qualitative study

    PubMed Central

    McPeake, Joanne; Forrest, Ewan; Quasim, Tara; Kinsella, John; O'Neill, Anna

    2016-01-01

    Objective To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design In-depth, semistructured interviews with participants (patients) 3–7 months post intensive care discharge. Setting The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. Participants 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. Interventions None. Measurements and main results Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. Conclusions There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated. PMID:27048633

  17. The Relation of Student Engagement and Other Admission Metrics to Master of Accounting Student Performance

    ERIC Educational Resources Information Center

    Buckless, Frank; Krawczyk, Kathy

    2016-01-01

    This paper examines whether the use of student engagement (SE) information as part of the admissions process can help us to predict student academic success in Master of Accounting (MAC) programs. The association of SE, undergraduate grade point average (UGPA), and Graduate Management Admissions Test (GMAT) score to academic performance was tested…

  18. BSW Program Admission Policies: Is There Empirical Support for What We Do?

    ERIC Educational Resources Information Center

    Coyle, James P.; Carter, Irene M.; Leslie, Donald R.

    2011-01-01

    Social work admission criteria are used to ensure student academic competence, identify personal characteristics associated with success in social work education and practice, predict success in class and field work, and promote diversity of the student body. However, evidence that supports the effectiveness of these admission policies is…

  19. The Ambiguous Effect of GP Competition: The Case of Hospital Admissions.

    PubMed

    Islam, M Kamrul; Kjerstad, Egil

    2016-10-14

    In the theoretical literature on general practitioner (GP) behaviour, one prediction is that intensified competition induces GPs to provide more services resulting in fewer hospital admissions. This potential substitution effect has drawn political attention in countries looking for measures to reduce the growth in demand for hospital care. However, intensified competition may induce GPs to secure hospital admissions a signal to attract new patients and to keep the already enlisted ones satisfied, resulting in higher admission rates at hospitals. Using both static and dynamic panel data models, we aim to enhance the understanding of whether such relations are causal. Results based on ordinary least square (OLS) models indicate that aggregate inpatient admissions are negatively associated with intensified competition both in the full sample and for the sub-sample patients aged 45 to 69, while outpatient admissions are positively associated. Fixed-effect estimations do not confirm these results though. However, estimations of dynamic models show significant negative (positive) effects of GP competition on aggregate inpatient (outpatient) admissions in the full sample and negative effects on aggregate inpatient admissions and emergency admissions for the sub-sample. Thus, intensified GP competition may reduce inpatient hospital admissions by inducing GPs to provide more services, whereas, the alternative hypothesis seems valid for outpatient admissions. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.

  20. Systeme International in the ICU in the United States.

    PubMed

    Clark, David E; Laeseke, Paul F

    2010-04-01

    This article provides a brief review of the Système International (SI) and demonstrates how its routine use for measurements in the ICU might improve education and patient safety in the United States. We apply standard information on SI to common ICU situations. We contrast the confusion and waste from obsolete and/or nonstandard systems of measurement still used in the United States to the clarity and consistency that would result from converting to SI. Examples are drawn from basic weights and measures, electrolyte and other chemical solutions, acid-base physiology, blood gas analysis, BPs, vascular resistances, trauma kinematics, indirect calorimetry, cardiac work, and work of breathing. In addition to simplifying physiologic measurements and relationships, SI provides a common language for international collaboration and communication. Because it would thus improve critical care practice, SI should be increasingly accepted in the United States and especially promoted in the ICU.

  1. Tight glycemic control in the ICU - is the earth flat?

    PubMed

    Steil, Garry M; Agus, Michael S D

    2014-06-27

    Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.

  2. It takes teamwork... the role of nurses in ICU design.

    PubMed

    Redden, Pamela H; Evans, Jennie

    2014-01-01

    The changing economic environment in health care is pushing the health care construction industry to produce facilities which support improvements in patient care, patient experience, patient safety, staff satisfaction, and financial outcomes. The successful design, construction, and operation of a new or renovated intensive care unit (ICU) requires the participation of intensive care nurses to achieve success. A partnership between the architect and nurse, definition of the desired operational processes, and knowledge of evidence-based design are the foundations of good design. Hospital executives who support the participation of nurses in ICU facility projects will gain an efficient and safe intensive care facility.

  3. 32 CFR 242.5 - Admission procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... HEALTH SCIENCES § 242.5 Admission procedures. (a) Application—(1) Civilians. Civilians seeking admission... conditionally select candidates to fill available class spaces. Those conditionally selected shall be the...

  4. Use of a Structured Mirrors Intervention Does Not Reduce Delirium Incidence But May Improve Factual Memory Encoding in Cardiac Surgical ICU Patients Aged Over 70 Years: A Pilot Time-Cluster Randomized Controlled Trial

    PubMed Central

    Giraud, Kimberly; Pontin, Megan; Sharples, Linda D.; Fletcher, Paul; Dalgleish, Tim; Eden, Allaina; Jenkins, David P.; Vuylsteke, Alain

    2016-01-01

    Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients. Methods: This was a pilot time-cluster randomized controlled trial at a 32-bed ICU, enrolling 223 patients aged 70 years and over, admitted to ICU after elective or urgent cardiac surgery from October 29, 2012 to June 23, 2013. The Mirrors Group received a structured mirrors intervention at set times (e.g., following change in mental status). The Usual Care Group received the standard care without mirrors. Primary outcome was ICU delirium incidence; secondary outcomes were ICU delirium days, ICU days with altered mental status or inattention, total length of ICU stay, physical mobilization (balance confidence) at ICU discharge, recall of factual and delusional ICU memories at 12 weeks, Health-Related Quality of Life at 12 weeks, and acceptability of the intervention. Results: The intervention was not associated with a significant reduction in ICU delirium incidence [Mirrors: 20/115 (17%); Usual Care: 17/108 (16%)] or duration [Mirrors: 1 (1–3); Usual Care: 2 (1–8)]. Use of the intervention on ICU was predictive of significantly higher recall of factual (but not delusional) items at 12 weeks after surgery (p = 0.003) and acceptability was high, with clinicians using mirrors at 86% of all recorded hourly observations. The intervention did not significantly impact on other secondary outcomes. Conclusion: Use of a structured mirrors intervention on the post-operative ICU does not

  5. Temporal Trends of the Clinical, Resource Use and Outcome Attributes of ICU-Managed Candidemia Hospitalizations: A Population-Level Analysis

    PubMed Central

    Oud, Lavi

    2016-01-01

    Background There are mixed findings on the longitudinal patterns of the incidence of intensive care unit (ICU)-managed candidemia, with scarcity of reports on the corresponding evolving patterns of patients’ clinical characteristics and outcomes. No population-level data were reported on the temporal trends of the attributes, care and outcomes of ICU-managed adults with candidemia. Methods The Texas Inpatient Public Use Data File was used to identify hospitalizations aged 18 years or older with a diagnosis of candidemia and ICU admission (C-ICU hospitalizations) between 2001 and 2010. Temporal trends of the demographics, clinical features, use of healthcare resources, and short-term outcomes were examined. Average annual percent changes (AAPCs) were derived. Results C-ICU hospitalizations (n = 7,552) became (AAPC) increasingly younger (age ≥ 65 years: -1.0%/year). The Charslon comorbidity index rose 4.2%/year, while the mean number of organ failures (OFs) increased by 8.2%/year, with a fast rise in the rate of those developing ≥ 3 OFs (+15.5%/year). Between 2001 and 2010, there was no significant change in utilization of mechanical ventilation and new hemodialysis among C-ICU hospitalizations with reported respiratory and renal failures (68.9% vs. 73.3%, P = 0.3653 and 15.5% vs. 21.8%, P = 0.8589, respectively). Hospital length of stay or total hospital charges remained unchanged during study period. Hospital mortality decreased between 2001 and 2010 from 39.3% to 23.8% (-5.2%/year). The majority of hospital survivors (61.6%) were discharged to another facility, and increasingly to long-term acute care hospitals, with routine home discharge decreasing to 11% by 2010. Conclusions C-ICU hospitalizations demonstrated increasing comorbidity burden and rising development of OF, and matching rise in use of selected life-support interventions, though with unchanged in-hospital fiscal impact. There has been marked decrease in hospital mortality, but survivors had

  6. Exploration of nursing doctoral admissions and performance outcomes.

    PubMed

    Megginson, Lucy

    2011-09-01

    This research aims to identify current admission criteria and academic performance outcomes in nursing PhD programs. A descriptive exploratory design was used to survey all American Association of Colleges of Nursing PhD programs (N = 110) via a Web-mediated standardized survey; the response rate was 51% (n = 56). Conclusions indicate six diverse yet complementary admission criteria: graduate grade point average (GPA), Graduate Record Examinations ® scores, writing samples, letters of recommendation, interviews, and research match with faculty. Findings also indicated that admission criteria largely lack predictive validity testing in regard to academic performance outcomes and are deficient in internal reliability. Academic performance outcomes included comprehensive examination, ongoing minimum graduate GPA of 3.0, formal dissertation, time to degree attainment, degree attainment, time to candidacy, type of employment after graduation, and publications and grants as a student and at 5 years postgraduation.

  7. 18 CFR 1317.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Admission. 1317.300 Section 1317.300 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1317.300 Admission. (a) General....

  8. 18 CFR 1317.300 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Admission. 1317.300 Section 1317.300 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1317.300 Admission. (a) General....

  9. 38 CFR 23.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Admission. 23.300 Section 23.300 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 23.300 Admission. (a) General....

  10. 18 CFR 1317.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Admission. 1317.300 Section 1317.300 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1317.300 Admission. (a) General....

  11. 36 CFR 1211.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Admission. 1211.300 Section 1211.300 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION GENERAL RULES... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1211.300 Admission. (a) General....

  12. An Economic Model for Selective Admissions

    ERIC Educational Resources Information Center

    Haglund, Alma

    1978-01-01

    The author presents an economic model for selective admissions to postsecondary nursing programs. Primary determinants of the admissions model are employment needs, availability of educational resources, and personal resources (ability and learning potential). As there are more applicants than resources, selective admission practices are…

  13. 17 CFR 12.33 - Admissions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... REPARATIONS Discovery § 12.33 Admissions. (a) Request for admissions. Any party may, within the time permitted... truth of any matters set forth in the request that relate to statements or opinions of fact or of the...) Reply. Each matter of which an admission is requested shall be separately set forth. The matter...

  14. Admission to Medical Education in Ten Countries.

    ERIC Educational Resources Information Center

    Burn, Barbara B., Ed.

    As part of a study of access and admission to higher education in Germany and the United States, a group of papers on medical admissions in various countries was commissioned. The papers presented in this book reveal wide differences in admissions policies and procedures. Barbara Burn examines some of the major issues in a foreword: representation…

  15. The Journal of College Admission Ethics Series.

    ERIC Educational Resources Information Center

    Loveland, Elaina C., Ed.; Raynor, Joyce, Ed.

    This book is the first significant body of literature on ethics in college admission published by the National Association for College Admission Counseling. The series is a select compilation of articles on ethics published in the Journal of College Admission in 1998 and 1999. The book is a source of information for the beginning and experienced…

  16. Reducing admissions for people with diabetes.

    PubMed

    Allan, Belinda

    Reversing the rise in emergency hospital admissions is an NHS priority. These admissions impact on elective capacity and waiting times and are unsustainable. The risk of hospitalisation for people with diabetes is almost twice that for others. Commissioners need to address admissions associated with diabetes and new guidance offers best-practice solutions.

  17. The Role of Noncognitive Assessment in Admissions

    ERIC Educational Resources Information Center

    Hoerle, Heather

    2014-01-01

    Confident that understanding and employing new approaches to assessment is a top priority for admissions professionals, the Secondary School Admission Test Board (SSATB) recently launched a Think Tank on the Future of Admission Assessment, with a two-year timeline and a charge to educate its membership and inspire greater innovation in admissions…

  18. Merit and Competition in Selective College Admissions

    ERIC Educational Resources Information Center

    Killgore, Leslie

    2009-01-01

    Using interview data from 34 admissions officers at 17 elite colleges, this paper compares two perspectives shaping admissions policy. Admissions officers apply a "merit" perspective that relies on indicators of student academic and nonacademic achievement. They also employ a "competition" perspective that evaluates student characteristics…

  19. Toward a Sociology of Law School Admissions.

    ERIC Educational Resources Information Center

    Erlanger, Howard S.

    1984-01-01

    The law school admission process plays a major role in determining the social class origins and ethnic composition of the bar, and perhaps also the nonlegal skills lawyers will have. Research is incomplete; consideration of admission criteria, the composition and processes of admissions committees, and applicant self-selection is advisable. (MSE)

  20. 29 CFR 36.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 36.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or...

  1. 10 CFR 1042.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1042.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission,...

  2. 10 CFR 1042.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1042.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission,...

  3. 29 CFR 36.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 36.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or...

  4. 29 CFR 36.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 36.300 Admission. (a) General. No person shall, on the basis of sex, be denied admission, or...

  5. 7 CFR 501.2 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Admission. 501.2 Section 501.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON U.S. MEAT ANIMAL RESEARCH CENTER, CLAY CENTER, NEBRASKA § 501.2 Admission. Admission to...

  6. 7 CFR 501.2 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Admission. 501.2 Section 501.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON U.S. MEAT ANIMAL RESEARCH CENTER, CLAY CENTER, NEBRASKA § 501.2 Admission. Admission to...

  7. 7 CFR 501.2 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Admission. 501.2 Section 501.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON U.S. MEAT ANIMAL RESEARCH CENTER, CLAY CENTER, NEBRASKA § 501.2 Admission. Admission to...

  8. 7 CFR 501.2 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Admission. 501.2 Section 501.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON U.S. MEAT ANIMAL RESEARCH CENTER, CLAY CENTER, NEBRASKA § 501.2 Admission. Admission to...

  9. 7 CFR 501.2 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Admission. 501.2 Section 501.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON U.S. MEAT ANIMAL RESEARCH CENTER, CLAY CENTER, NEBRASKA § 501.2 Admission. Admission to...

  10. The Evolution of College Admission Requirements

    ERIC Educational Resources Information Center

    Beale, Andrew V.

    2012-01-01

    The development of college admissions requirements during the seventeenth and eighteenth centuries was basically the story of the admission policies and practices at Harvard College. Candidates for admission were examined on their ability to read and translate Latin and Greek, and a careful check was made of their character and background. With…

  11. Early ICU Standardized Rehabilitation Therapy for the Critically Inijured Burn Patient

    DTIC Science & Technology

    2013-10-01

    AD_________________ Award Number: W81XWH-12-1-0550 TITLE: Early ICU Standardized Rehabilitation ... ICU Standardized Rehabilitation Therapy for the Critically Inijured Burn Patient 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-12-1-0550 5c...randomized controlled trial to determine whether early ICU rehabilitation , for Burn Intensive Care Unit (BICU) patients requiring mechanical ventilation

  12. Nosocomial infections in the ICU: Pens and spectacles as fomites.

    PubMed

    Murad, Haris Farooq; Inam Pal, Khowaja Mohammad

    2016-10-01

    Nosocomial infections are a major cause of morbidity and mortality. Non-medical objects known as fomites may have a role in their genesis. We investigated the significance of writing pens and spectacles as fomites. The study was conducted at Aga Khan University Hospital, Karachi, from July 2013 to September 2013. Cultures were taken from pens and/or spectacles of resident nurses, doctors and nursing assistants in intensive care unit (ICU). Organisms important in ICU nosocomial infections were targeted. Seven rounds of sampling over 3 weeks led to 55 pen and 5 spectacle samples. Growth was seen in 3(5.5%) pen samples and 1(20%) spectacle sample. Two (3.6%) pen cultures grew acinetobacter, 1)1.8%) grew candida and acinetobacter, and i spectacle culture grew vancomycin-resistant enterococcus faecium (VRE). Two out of the 4 (50%) personnel managing all ICU beds had growth. During the study, one or more ICU patients had infection with the same organisms. Pens and spectacles may be responsible for the spread of organisms like acinetobacter and VRE. Personnel managing multiple beds are more likely to carry contaminated fomites.

  13. Design and implementation of an ICU incident registry.

    PubMed

    van der Veer, Sabine; Cornet, Ronald; de Jonge, Evert

    2005-01-01

    Due to its complexity intensive care is vulnerable to errors. On the ICU Adults of the AMC (Amsterdam, the Netherlands) the available registries used for error reporting did not give insight in the occurrence of unwanted events, and did not lead to preventive measures. Therefore, a new registry has been developed on the basis of a literature study on the various terms and definitions that refer to unintended events, and on the methods to register and monitor them. As this registry intends to provide an overall insight into errors, a neutral term ('incident') -which does not imply guilt or blame- has been sought together with a broad definition. The attributes of an incident further describe the unwanted event, but they should not form an impediment for the ICU nurses and physicians to report. The properties of a registry that contribute to making it accessible and user friendly have been determined. This has resulted in an electronic registry where incidents can be reported rapidly, voluntarily, anonymously and free of legal consequences. Evaluation is required to see if the new registry indeed provides the ICU management with the intended information on the current situation on incidents. For further refinement of the design, additional development and adjustments are required. However, we expect that the awareness of errors of the ICU personnel has already improved, forming the first step to increased patient safety.

  14. Design and implementation of an ICU incident registry.

    PubMed

    van der Veer, Sabine; Cornet, Ronald; de Jonge, Evert

    2007-01-01

    Due to its complexity intensive care is vulnerable to errors. On the ICU adults of the AMC (Amsterdam, The Netherlands) the available registries used for error reporting did not give insight in the occurrence of unwanted events, and did not lead to preventive measures. Therefore, a new registry has been developed on the basis of a literature study on the various terms and definitions that refer to unintended events, and on the methods to register and monitor them. As this registry intends to provide an overall insight into errors, a neutral term ('incident') -- which does not imply guilt or blame -- has been sought together with a broad definition. The attributes of an incident further describe the unwanted event, but they should not form an impediment for the ICU nurses and physicians to report. The properties of a registry that contribute to making it accessible and user friendly have been determined. This has resulted in an electronic registry where incidents can be reported rapidly, voluntarily, anonymously and free of legal consequences. Evaluation is required to see if the new registry indeed provides the ICU management with the intended information on the current situation on incidents. For further refinement of the design, additional development and adjustments are required. However, we expect that the awareness of errors of the ICU personnel has already improved, forming the first step to increased patient safety.

  15. Toxicology in the ICU: part 3: natural toxins.

    PubMed

    Levine, Michael; Ruha, Anne-Michelle; Graeme, Kim; Brooks, Daniel E; Canning, Joshua; Curry, Steven C

    2011-11-01

    This is the third article of a three-part series that reviews the care of poisoned patients in the ICU. This article focuses on natural toxins, such as heavy metals and those produced by plants, mushrooms, arthropods, and snakes. The first article discussed the general approach to the patient, including laboratory testing; the second article focused on specific toxic agents, grouped into categories.

  16. Equivalences between nonuniform exponential dichotomy and admissibility

    NASA Astrophysics Data System (ADS)

    Zhou, Linfeng; Lu, Kening; Zhang, Weinian

    2017-01-01

    Relationship between exponential dichotomies and admissibility of function classes is a significant problem for hyperbolic dynamical systems. It was proved that a nonuniform exponential dichotomy implies several admissible pairs of function classes and conversely some admissible pairs were found to imply a nonuniform exponential dichotomy. In this paper we find an appropriate admissible pair of classes of Lyapunov bounded functions which is equivalent to the existence of nonuniform exponential dichotomy on half-lines R± separately, on both half-lines R± simultaneously, and on the whole line R. Additionally, the maximal admissibility is proved in the case on both half-lines R± simultaneously.

  17. Considering Practical Uses of Advanced Placement® Information in College Admission. Research Note 2014-1

    ERIC Educational Resources Information Center

    Shaw, Emily J.; Marini, Jessica; Mattern, Krista D.

    2014-01-01

    The Study evaluated the predictive validity of various operationalizations of AP® Exam and course information that could be used to make college admission decisions. The incremental validity of different AP variables, above and beyond traditional admission measures such as SAT® and high school grade point average (HSGPA), in predicting first-year…

  18. Straddling the fence: ICU nurses advocating for hospice care.

    PubMed

    Borowske, Deborah

    2012-03-01

    A key factor in nurses' experiencing moral distress is their feeling of powerlessness to initiate discussions about code status, EOL issues, or patients' preferences. Moreover, nurses encounter physicians who give patients and their families a false picture of recovery or, worse, block EOL discussions from occurring. Since its release in 1995, the landmark study of almost 10,000 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) reported a widespread gap with physicians' discussions in honest prognosis and EOL issues. Since the SUPPORT report, other studies have validated patients' and their families' preference for realistic discussions of disease trajectory and life expectancy. Unfortunately, the phenomenon of physicians failing to discuss bad news or terminal disease trajectory persists. Moreover, with a burgeoning geriatric population, coupled with advances in medical treatments, a growing segment of chronically ill patients are admitted to the ICU. With these communication shortcomings, it becomes an essential element of practice for the ICU nurse to initiate discussions about healthcare goals, preferences, and choices. The ICU nurse must be integral in fostering those discussions, particularly in cases where the family asks if hospice should be considered. Nurses have a long history of patient advocacy, with both the American Nurses Association and the American Association of Critical-Care Nurses stating that nurses have a duty to educate and promote dialogue about patients' preferences, goals, and EOL issues. With these tenets in the forefront, the ICU nurse is an integral member of the healthcare team, working with patients and their families to distinguish between what can be done and what should be done. Too often, hospice is thought of as a last resort. Rather, it is a model of care that centers on the belief that each of us has the right to die pain free and with dignity, and that our families

  19. Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission*

    PubMed Central

    Silva, Denise Rossato; da Silva, Larissa Pozzebon; Dalcin, Paulo de Tarso Roth

    2014-01-01

    Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment. PMID:25029651

  20. Who is on the medical team?: Shifting the boundaries of belonging on the ICU.

    PubMed

    Rodriquez, Jason

    2015-11-01

    Medical teamwork promises to improve communication and collaboration in the healthcare industry, yet critics argue teamwork is little more than a new managerial discourse to obscure traditional workplace hierarchies. Based on 300 h of participant-observation and 35 interviews with staff of a medical intensive care unit at an academic medical center, this article argues that teamwork is neither a panacea for coordinating complex care nor is it simply a discourse to control workers; rather, it is an ongoing social activity characterized by boundary-work, negotiation, and resistance over the terms of membership. This study identifies three processual and temporal phases of families' participation in medical teams: (1) Constructing Teamwork, (2) Deflection and Resistance, and (3) Reintegration. Staff leveraged ambiguities in the meaning of teamwork to manage patients' family members' participation on the ICU Team. Family involvement changed in patterned ways that reflected the power staff had to define the team and the character of teamwork. Families participated on the team at admission, but their involvement narrowed considerably as staff implemented diagnostic and treatment plans. When staff determined a patient was appropriate for palliation, families were reintegrated back into a leading role on the team as surrogate decision-makers. This study advances current understandings of medical teamwork, staff-family interactions, and it highlights the value of qualitative methods in social-science research about medicine.

  1. An Evaluation of the Usefulness of Extracorporeal Liver Support Techniques in Patients Hospitalized in the ICU for Severe Liver Dysfunction Secondary to Alcoholic Liver Disease

    PubMed Central

    Piechota, Mariusz; Piechota, Anna

    2016-01-01

    Background The mortality rate in patients with severe liver dysfunction secondary to alcoholic liver disease (ALD) who do not respond to the standard treatment is exceptionally high. Objectives The main aim of this study was to evaluate the usefulness of applying extracorporeal liver support techniques to treat this group of patients. Patients and Methods The data from 23 hospital admissions of 21 patients with ALD who were admitted to the department of anesthesiology and intensive therapy (A&IT) at the Dr Wł. Biegański Regional Specialist Hospital in Łódź between March 2013 and July 2015 were retrospectively analyzed. Results A total of 111 liver dialysis procedures were performed during the 23 hospitalizations, including 13 dialyses using fractionated plasma separation and adsorption (FPSA) with the Prometheus® system, and 98 procedures using the single pass albumin dialysis (SPAD) system. Upon admission to the intensive care unit (ICU), the median (interquartile range [IQR]) Glasgow coma scale (GCS), sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation (APACHE) II, and simplified acute physiology score (SAPS) II scores were 15 (14 - 15), 9 (7 - 13), 17 (14 - 24), and 32 (22 - 50), respectively. The ICU, 30-day, and three-month mortality rates were 43.48%, 39.13%, and 73.91%, respectively. As determined by the receiver operative characteristic (ROC) analysis for single-factor models, the significant predictors of death in the ICU included the patients’ SOFA, APACHE II, SAPS II, and model of end-stage liver disease modified by the united network for organ sharing (MELD UNOS Modification) scores; the duration of stay (in days) in the A&IT Department; and bile acid, creatinine and albumin levels upon ICU admission. The ROC analysis indicated the significant discriminating power of the SOFA, APACHE II, SAPS II, and MELD UNOS modification scores on the three-month mortality rate. Conclusions The application of

  2. Automated Detection of Benzodiazepine Dosage in ICU Patients through a Computational Analysis of Electrocardiographic Data

    PubMed Central

    Spadafore, Maxwell T.; Syed, Zeeshan; Rubinfeld, Ilan S.

    2015-01-01

    To enable automated maintenance of patient sedation in an intensive care unit (ICU) setting, more robust, quantitative metrics of sedation depth must be developed. In this study, we demonstrated the feasibility of a fully computational system that leverages low-quality electrocardiography (ECG) from a single lead to detect the presence of benzodiazepine sedatives in a subject’s system. Starting with features commonly examined manually by cardiologists searching for evidence of poisonings, we generalized the extraction of these features to a fully automated process. We tested the predictive power of these features using nine subjects from an intensive care clinical database. Features were found to be significantly indicative of a binary relationship between dose and ECG morphology, but we were unable to find evidence of a predictable continuous relationship. Fitting this binary relationship to a classifier, we achieved a sensitivity of 89% and a specificity of 95%. PMID:26958308

  3. Prognostic outcomes after the initiation of an electronic telemedicine intensive care unit (eICU) in a rural health system.

    PubMed

    Zawada, Edward T; Kapaska, David; Herr, Pat; Aaronson, Michael; Bennett, Joann; Hurley, Brian; Bishop, Donald; Dagher, Hikmat; Kovaleski, David; Melanson, Tina; Burdge, Kelly; Johnson, Thomas

    2006-09-01

    APACHE (Acute Physiology and Chronic Health Evaluation) mortality predictions and other outcomes are reported after the initiation of a telemedicine intensivist staffing program to monitor the intensive care unit patients of a rural health system. Mortality, length of ICU stay, and length of hospital stay were significantly less than predicted. Length of stay was identical to one year previously in the largest hospital reported, but the case mix index of severity had increased. More severely ill patients were being treated without increase in length of stay.

  4. Improved survival among ICU-hospitalized patients with community-acquired pneumonia by unidentified organisms: a multicenter case-control study.

    PubMed

    Rello, J; Diaz, E; Mañez, R; Sole-Violan, J; Valles, J; Vidaur, L; Zaragoza, R; Gattarello, S

    2017-01-01

    A retrospective analysis from prospectively collected data was conducted in intensive care units (ICUs) at 33 hospitals in Europe comparing the trend in ICU survival among adults with severe community-acquired pneumonia (CAP) due to unknown organisms from 2000 to 2015. The secondary objective was to establish whether changes in antibiotic policies were associated with different outcomes. ICU mortality decreased (p = 0.02) from 26.9 % in the first study period (2000-2002) to 15.7 % in the second period (2008-2015). Demographic data and clinical severity at admission were comparable between groups, except for age over 65 years and incidence of cardiomyopathy. Over time, patients received higher rates of combination therapy (94.3 vs. 77.2 %; p < 0.01) and early (<3 h) antibiotic delivery (72.9 vs. 50.3 %; p < 0.01); likewise, the 2008-2015 group was more likely to receive adequate antibiotic prescription [as defined by the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines] than the 2000-2002 group (70.7 vs. 48.2 %; p < 0.01). Multivariate analysis showed an independent association between decreased ICU mortality and early (<3 h) antibiotic administration [odds ratio (OR) 3.48 [1.70-7.15], p < 0.01] or adequate antibiotic prescription according to guidelines (OR 2.22 [1.11-4.43], p = 0.02). In conclusion, our findings suggest that ICU mortality in severe CAP due to unidentified organisms has decreased in the last 15 years. Several changes in management and better compliance with guidelines over time were associated with increased survival.

  5. Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors.

    PubMed

    Lagier, D; Platon, L; Chow-Chine, L; Sannini, A; Bisbal, M; Brun, J-P; Blache, J-L; Faucher, M; Mokart, D

    2016-09-01

    Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5-y period. We sought to identify prognostic factors of long-term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13-2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13-2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52-3.31) were associated with long-term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42-0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42-0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X-ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome.

  6. [The teaching-learning process in ICU: a phenomenological study].

    PubMed

    Guedes, Glauteice Freitas; Ohara, Conceição Vieira da Silva; Silva, Gilberto Tadeu Reis da

    2008-01-01

    This study aimed to understanding the meaning attributed by teaching staff throughout the traineeship from nursing under graduation course in intensive care on the teaching and learning process. It's a study of phenomenological qualitative approach. The data were obtained through the following guiding question: 'How do you live the teaching-learning process at the ICU traineeship?'. From the subjects' descriptions, four open categories came up: 'An awakening to ICU', 'A searching for how to teaching Nursing in Intensive Care', 'A connection between the teaching staff and the students' and 'A meaningful experience'. This study showed that this living experience, which is shared, permits an approaching and the meeting of the teaching staff with the students in this setting, facilitating the teaching-learning process.

  7. Integrating forensic science into nursing processes in the ICU.

    PubMed

    Hoyt, Constance A

    2006-01-01

    The critical care nurse is in an ideal position to assume responsibilities related to the identification of forensic cases and the preservation of associated evidence. Victims of child and elder abuse and neglect, individuals involved in vehicular or industrial accidents, substance abusers, and incarcerated populations are among the several types of patients that are likely to managed in the intensive care unit (ICU). Hospitals and their personnel assume considerable liability in such cases for detecting, collecting, and preserving evidence, as well as for reporting and referring the cases to appropriate law enforcement or judicial authorities. The Joint Commission for the Accreditation of Healthcare Organizations has published specific regulatory guidance to ensure that all healthcare personnel are properly educated to assume certain forensic responsibilities. The orientation and in-service programs of the ICU nurse should include specific guidance regarding forensic principles, practices, and procedures.

  8. 45 CFR 2555.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Admission. 2555.300 Section 2555.300 Public... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 2555.300 Admission. (a) General. No..., by any recipient to which §§ 2555.300 through 2555.310 apply, except as provided in §§ 2555.225...

  9. 6 CFR 17.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 6 Domestic Security 1 2012-01-01 2012-01-01 false Admission. 17.300 Section 17.300 Domestic... in Admission and Recruitment Prohibited § 17.300 Admission. (a) General. No person shall, on the... which §§ 17.300 through 17.310 apply, except as provided in §§ 17.225 and 17.230. (b)...

  10. 40 CFR 5.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Admission. 5.300 Section 5.300... in Admission and Recruitment Prohibited § 5.300 Admission. (a) General. No person shall, on the basis... which §§ 5.300 through §§ 5.310 apply, except as provided in §§ 5.225 and 5.230. (b)...

  11. 15 CFR 8a.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Admission. 8a.300 Section 8a.300... in Admission and Recruitment Prohibited § 8a.300 Admission. (a) General. No person shall, on the... which §§ 8a.300 through §§ 8a.310 apply, except as provided in §§ 8a.225 and §§ 8a.230. (b)...

  12. 45 CFR 2555.300 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Admission. 2555.300 Section 2555.300 Public... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 2555.300 Admission. (a) General. No..., by any recipient to which §§ 2555.300 through 2555.310 apply, except as provided in §§ 2555.225...

  13. 14 CFR 1253.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Admission. 1253.300 Section 1253.300... in Admission and Recruitment Prohibited § 1253.300 Admission. (a) General. No person shall, on the... which §§ 1253.300 through §§ 1253.310 apply, except as provided in §§ 1253.225 and §§ 1253.230....

  14. [Bacterial parotitis in an immunocompromised patient in adult ICU].

    PubMed

    Vassal, O; Bernet, C; Wallet, F; Friggeri, A; Piriou, V

    2013-09-01

    Bacterial parotitis is a common childhood disease with a favorable outcome. Staphylococcus aureus is the most frequently involved pathogen. Clinical presentation in adult patients can be misleading, Onset occurs in patients with multiple comorbidities, making diagnosis difficult--particularly in ICU. Different pathogens are found in adults with worse outcomes observed. We report here the case of a critically ill patient and discuss diagnosis and management of bacterial parotitis.

  15. Feasibility of noise reduction by a modification in ICU environment.

    PubMed

    Luetz, A; Weiss, B; Penzel, T; Fietze, I; Glos, M; Wernecke, K D; Bluemke, B; Dehn, A M; Willemeit, T; Finke, A; Spies, C

    2016-07-01

    Noise is a proven cause of wakefulness and qualitative sleep disturbance in critically ill patients. A sound pressure level reduction can improve sleep quality, but there are no studies showing the feasibility of such a noise reduction in the intensive care unit (ICU) setting. Considering all available evidence, we redesigned two ICU rooms with the aim of investigating the physiological and clinical impact of a healing environment, including a noise reduction and day-night variations of sound level. Within an experimental design, we recorded 96 h of sound-pressure levels in standard ICU rooms and the modified ICU rooms. In addition, we performed a sound source observation by human observers. Our results show that we reduced A-weighted equivalent sound pressure levels and maximum sound pressure levels with our architectural interventions. During night-time, the modification led to a significant decrease in 50 dB threshold overruns from 65.5% to 39.9% (door side) and from 50% to 10.5% (window side). Sound peaks of more than 60 decibels were significantly reduced from 62.0% to 26.7% (door side) and 59.3% to 30.3% (window side). Time-series analysis of linear trends revealed a significantly more distinct day-night pattern in the modified rooms with lower sound levels during night-times. Observed sound sources during night revealed four times as many talking events in the standard room compared to the modified room. In summary, we show that it is feasible to reduce sound pressure levels using architectural modifications.

  16. Interprofessional collaboration in the ICU: how to define?

    PubMed

    Rose, Louise

    2011-01-01

    The intensive care unit (ICU) is a dynamic, complex and, at times, highly stressful work environment that involves ongoing exposure to the complexities of interprofessional team functioning. Failures of communication, considered examples of poor collaboration among health care professionals, are the leading cause of inadvertent harm across all health care settings. Evidence suggests effective interprofessional collaboration results in improved outcomes for critically ill patients. One recent study demonstrated a link between low standardized mortality ratios and self-identified levels of collaboration. The aim of this paper is to discuss determinants and complexities of interprofessional collaboration, the evidence supporting its impact on outcomes in the ICU, and interventions designed to foster better interprofessional team functioning. Elements of effective interprofessional collaboration include shared goals and partnerships including explicit, complementary and interdependent roles; mutual respect; and power sharing. In the ICU setting, teams continually alter due to large staff numbers, shift work and staff rotations through the institution. Therefore, the ideal 'unified' team working together to provide better care and improve patient outcomes may be difficult to sustain. Power sharing is one of the most complex aspects of interprofessional collaboration. Ownership of specialized knowledge, technical skills, clinical territory, or even the patient, may produce interprofessional conflict when ownership is not acknowledged. Collaboration by definition implies interdependency as opposed to autonomy. Yet, much nursing literature focuses on achievement of autonomy in clinical decision-making, cited to improve job satisfaction, retention and patient outcomes. Autonomy of health care professionals may be an inappropriate goal when striving to foster interprofessional collaboration. Tools such as checklists, guidelines and protocols are advocated, by some, as ways

  17. Temporal variation in major trauma admissions

    PubMed Central

    Kieffer, WKM; Michalik, DV; Gallagher, K; McFadyen, I; Bernard, J; Rogers, BA

    2016-01-01

    Introduction Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions. Methods Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed. Results There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543). Conclusions The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network. PMID:26741676

  18. Clinical review: Early patient mobilization in the ICU

    PubMed Central

    2013-01-01

    Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial. We performed a detailed analytical review of the literature using multiple relevant key terms in order to provide a comprehensive assessment of current knowledge on EM in critically ill patients. We found that the term EM remains undefined and encompasses a range of heterogeneous interventions that have been used alone or in combination. Nonetheless, several studies suggest that different forms of EM may be both safe and feasible in ICU patients, including those receiving mechanical ventilation. Unfortunately, these studies of EM are mostly single center in design, have limited external validity and have highly variable control treatments. In addition, new technology to facilitate EM such as cycle ergometry, transcutaneous electrical muscle stimulation and video therapy are increasingly being used to achieve such EM despite limited evidence of efficacy. We conclude that although preliminary low-level evidence suggests that EM in the ICU is safe, feasible and may yield clinical benefits, EM is also labor-intensive and requires appropriate staffing models and equipment. More research is thus required to identify current standard practice, optimal EM techniques and appropriate outcome measures before EM can be introduced into the routine care of critically ill patients. PMID:23672747

  19. Clostridium difficile Associated Risk of Death Score (CARDS): A novel severity score to predict mortality among hospitalized patients with Clostridium difficile infection

    PubMed Central

    Kassam, Zain; Fabersunne, Camila Cribb; Smith, Mark B.; Alm, Eric J.; Kaplan, Gilaad G.; Nguyen, Geoffrey C.; Ananthakrishnan, Ashwin N.

    2016-01-01

    Background Clostridium difficile infection (CDI) is public health threat and associated with significant mortality. However, there is a paucity of objectively derived CDI severity scoring systems to predict mortality. Aims To develop a novel CDI risk score to predict mortality entitled: Clostridium difficile Associated Risk of Death Score (CARDS). Methods We obtained data from the United States 2011 Nationwide Inpatient Sample (NIS) database. All CDI-associated hospitalizations were identified using discharge codes (ICD-9-CM, 008.45). Multivariate logistic regression was utilized to identify independent predictors of mortality. CARDS was calculated by assigning a numeric weight to each parameter based on their odds ratio in the final logistic model. Predictive properties of model discrimination were assessed using the c-statistic and validated in an independent sample using the 2010 NIS database. Results We identified 77,776 hospitalizations, yielding an estimate of 374,747 cases with an associated diagnosis of CDI in the United States, 8% of whom died in the hospital. The 8 severity score predictors were identified on multivariate analysis: age, cardiopulmonary disease, malignancy, diabetes, inflammatory bowel disease, acute renal failure, liver disease and ICU admission, with weights ranging from −1 (for diabetes) to 5 (for ICU admission). The overall risk score in the cohort ranged from 0 to 18. Mortality increased significantly as CARDS increased. CDI-associated mortality was 1.2% with a CARDS of 0 compared to 100% with CARDS of 18. The model performed equally well in our validation cohort. Conclusion CARDS is a promising simple severity score to predict mortality among those hospitalized with CDI. PMID:26849527

  20. Association between air pollution and hospital admission: Case study at three monitoring stations in Malaysia

    NASA Astrophysics Data System (ADS)

    Zahari, Marina; Zin@Ibrahim, Wan Zawiah Wan; Ismail, Noriszura; Ni, Tan Hui

    2014-06-01

    The relationships between the exposure of pollutants towards hospitalized admission and mortality have been identified in several studies on Asian cities such as Taipei, Bangkok and Tokyo. In Malaysia, evidence on the health risks associated with exposure to pollutants is limited. In this study, daily time-series data were analysed to estimate risks of cardiovascular and respiratory hospitalized admissions associated with particulate matter ≤ 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide, sulphur dioxide, and ozone concentrations in Klang Valley during 2004-2009. Daily counts of hospital admissions for cardiovascular and respiratory outcomes were obtained from eleven hospitals while pollutants data were taken from several air quality monitoring stations located nearest to the hospitals. These data were fitted with Generalised Additive Poisson regression models. Additionally, temperature, humidity, and time data were also included to allow for potential effect of weather and time-varying influences on hospital admissions. CO showed the most significant (P < 0.05) relationship to cardiovascular admissions. An increment of 1 ppm in CO predicted an increase of 4% to 20% in cardiovascular admissions. Respiratory admissions were associated with PM10, which had about 1% increase in risk of admission per 10 ug/m3 increment in PM10. Exposure to CO and PM10 increases the risk of hospitalization for cardiovascular and respiratory illnesses in Klang Valley, Malaysia.

  1. Urinary cadmium levels predict mortality of patients with acute heart failure

    PubMed Central

    Hsu, Ching-Wei; Weng, Cheng-Hao; Lee, Cheng-Chia; Lin-Tan, Dan-Tzu; Chu, Pao-Hsien; Chen, Kuan-Hsing; Yen, Tzung-Hai; Huang, Wen-Hung

    2017-01-01

    Background Acute heart failure (AHF) is a serious condition that is associated with increased mortality in critically ill patients. Previous studies indicated that environmental exposure to cadmium increases mortality of general populations. However, the relationship of cadmium exposure and mortality is unclear for AHF patients. Materials and methods A total of 153 patients with AHF in intensive care units (ICUs) met the inclusion criteria and were followed up for 6 months. Demographic data, AHF etiology, hematological and biochemical data, and hospital mortality were recorded. The scores of two predictive systems (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II]) for mortality in critically ill patients were calculated, and urinary cadmium levels were recorded. Results At the end of the follow-up period, the mortality rate was 24.8%. The survivors (n=115) had higher urinary cadmium levels on day 1 (D1UCd) of ICU admission than non-survivors (n=38). A multiple linear regression analysis revealed a positive correlation between D1UCd and acute kidney injury, but a negative correlation between D1UCd and the level of serum albumin. A multivariate Cox analysis indicated that D1UCd was an independent predictor of mortality in AHF patients. For each increment of 1 μg of D1UCd, the hazard ratio for ICU mortality was 1.20 (95% confidence interval [CI]: 1.09–1.32, P<0.001). The area under the receiver operating characteristic curve for D1UCd was 0.84 (95% CI: 0.78–0.91), better than the values for the SOFA and APACHE II systems. Conclusion The D1UCd may serve as a single predictor of hospital mortality for AHF patients in the ICU. Because of the high mortality and smaller sample size, more investigations are required to confirm these observations and elucidate the underlying mechanisms. PMID:28392700

  2. Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study

    PubMed Central

    Howard, R; Avery, A; Howard, P; Partridge, M

    2003-01-01

    Objective: To describe the drugs and types of medicine management problems most frequently associated with preventable drug related admissions to an acute medical admissions unit. Design: Observation study. Setting: Medical admissions unit in a teaching hospital in Nottingham, UK. Participants: 4093 patients seen by pharmacists on the medical admissions unit between 1 January and 30 June 2001. Main outcome measures: Proportion of admissions that were drug related and preventable, classification of the underlying causes of preventable drug related admissions, and identification of drugs most commonly associated with preventable drug related admissions. Results: Of the admissions seen by pharmacists, 265 (6.5%) were judged to be drug related and 178 (67%) of these were judged to be preventable. Preventable admissions were mainly due to problems with prescribing (63 cases (35%)), monitoring (46 cases (26%)), and adherence to medication (53 cases (30%)). The drugs most commonly implicated were NSAIDs, antiplatelets, antiepileptics, hypoglycaemics, diuretics, inhaled corticosteroids, cardiac glycosides, and beta-blockers. Conclusions: Potentially preventable drug related morbidity was associated with 4.3% of admissions to a medical admissions unit. In 91% of cases these admissions were related to problems with either prescribing, monitoring, or adherence. PMID:12897361

  3. Effect of Weekend Admissions on the Treatment Process and Outcomes of Internal Medicine Patients: A Nationwide Cross-Sectional Study.

    PubMed

    Huang, Chun-Che; Huang, Yu-Tung; Hsu, Nin-Chieh; Chen, Jin-Shing; Yu, Chong-Jen

    2016-02-01

    Many studies address the effect of weekend admission on patient outcomes. This population-based study aimed to evaluate the relationship between weekend admission and the treatment process and outcomes of general internal medicine patients in Taiwan.A total of 82,340 patients (16,657 weekend and 65,683 weekday admissions) aged ≥20 years and admitted to the internal medicine departments of 17 medical centers between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. A generalized estimating equation (GEE) analysis was used to compare patients admitted on weekends and those admitted on weekdays.Patients who were admitted on weekends were more likely to undergo intubation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.16-1.39; P < 0.001) and/or mechanical ventilation (OR, 1.25; 95% CI, 1.15-1.35; P < 0.001), cardio-pulmonary resuscitation (OR: 1.45; 95% CI: 1.05-2.01; P = 0.026), and be transferred to the intensive care unit (ICU) (OR: 1.16; 95% CI: 1.03-1.30; P = 0.015) compared with those admitted on weekdays. Weekend-admitted patients also had higher odds of in-hospital mortality (OR: 1.19; 95% CI: 1.09-1.30; P < 0.001) and hospital treatment cost (OR: 1.04; 95% CI: 1.01-1.06; P = 0.008) than weekday-admitted patients.General internal medicine patients who were admitted on weekends experienced more intensive care procedures and higher ICU admission, in-hospital mortality, and treatment cost. Intensive care utilization may serve as early indicator of poorer outcomes and a potential entry point to offer preventive intervention before proceeding to intensive treatment.

  4. 28 CFR 54.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Administration DEPARTMENT OF JUSTICE (CONTINUED) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 54.300 Admission. (a) General. No person shall, on the basis of sex, be...

  5. 14 CFR 1253.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient...

  6. Lexical Profiles of Thailand University Admission Tests

    ERIC Educational Resources Information Center

    Cherngchawano, Wirun; Jaturapitakkul, Natjiree

    2014-01-01

    University Admission Tests in Thailand are important documents which reflect Thailand's education system. To study at a higher education level, all students generally need to take the University Admission Tests designed by the National Institute of Educational Testing Service (NIETS). For the English test, vocabulary and reading comprehension is…

  7. 7 CFR 15a.21 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 1 2014-01-01 2014-01-01 false Admission. 15a.21 Section 15a.21 Agriculture Office of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited §...

  8. 7 CFR 15a.21 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 1 2011-01-01 2011-01-01 false Admission. 15a.21 Section 15a.21 Agriculture Office of the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited §...

  9. 45 CFR 618.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on... shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by...

  10. 45 CFR 618.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on... shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by...

  11. 45 CFR 618.300 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on... shall, on the basis of sex, be denied admission, or be subjected to discrimination in admission, by...

  12. 7 CFR 503.2 - Admission.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Admission. 503.2 Section 503.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON PLUM ISLAND ANIMAL DISEASE CENTER § 503.2 Admission. No person will be admitted to PIADC,...

  13. 7 CFR 503.2 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 6 2013-01-01 2013-01-01 false Admission. 503.2 Section 503.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON PLUM ISLAND ANIMAL DISEASE CENTER § 503.2 Admission. No person will be admitted to PIADC,...

  14. 7 CFR 503.2 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Admission. 503.2 Section 503.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON PLUM ISLAND ANIMAL DISEASE CENTER § 503.2 Admission. No person will be admitted to PIADC,...

  15. 7 CFR 503.2 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 6 2014-01-01 2014-01-01 false Admission. 503.2 Section 503.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON PLUM ISLAND ANIMAL DISEASE CENTER § 503.2 Admission. No person will be admitted to PIADC,...

  16. Unethical Admissions: Academic Integrity in Question.

    PubMed

    Ansah, Richard Hannis; Aikhuele, Daniel O; Yao, Liu

    2016-11-28

    The increasing unethical practices of graduates' admissions have heightened concerns about the integrity of the academy. This article informs this important subject that affects the students, admission systems, and the entire scientific community, thus, representing an approach against scholarly black market activities including falsified documents and unethical practices by consultants and students' recruitment agencies.

  17. 7 CFR 503.2 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Admission. 503.2 Section 503.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL RESEARCH SERVICE, DEPARTMENT OF AGRICULTURE CONDUCT ON PLUM ISLAND ANIMAL DISEASE CENTER § 503.2 Admission. No person will be admitted to PIADC,...

  18. Profile in Action: Linking Admission and Retention

    ERIC Educational Resources Information Center

    Cortes, Carla M.

    2013-01-01

    A profile-oriented retention strategy embraces the admission process as a powerful lever in improving retention and completion rates and recognizes that the student profile can be shaped by changes in admission policies or priorities--even within the current market position of the institution. In addition, the student body can be oriented toward…

  19. Grade Inflation and Law School Admissions

    ERIC Educational Resources Information Center

    Wongsurawat, Winai

    2008-01-01

    Purpose: The purpose of this paper is to evaluate the evidence on whether grade inflation has led to an increasing emphasis on standardized test scores as a criterion for law school admissions. Design/methodology/approach: Fit probabilistic models to admissions data for American law schools during the mid to late 1990s, a period during which…

  20. Strategies and Trends in Admissions Research

    ERIC Educational Resources Information Center

    Fincher, Cameron

    1975-01-01

    Noting that the technical service rendered by the national testing agencies may be an undesirable tradeoff for the active involvement of admissions workers in admissions research, the author suggests that the use of decision theory, quasi-actuarial assessment, quasi-experimental design, and program evaluation strategies would place admissions…

  1. Alphabetical Order Effects in School Admissions

    ERIC Educational Resources Information Center

    Jurajda, Štepán; Münich, Daniel

    2016-01-01

    If school admission committees use alphabetically sorted lists of applicants in their evaluations, one's position in the alphabet according to last name initial may be important in determining access to selective schools. Jurajda and Münich (2010) "Admission to Selective Schools, Alphabetically". "Economics of Education…

  2. Why Do We Stay in Admissions?

    ERIC Educational Resources Information Center

    Piersol, Marion Kandel; And Others

    1993-01-01

    Admission counselors (n=200) completed surveys about employment, title, on-the-job training, travel, and availability and satisfaction with certain responsibilities. Most satisfying admission responsibilities were program organization and implementation, applicant review and decision, and formal presentations. Least satisfying were telemarketing,…

  3. An Admissions Race that's Already Won

    ERIC Educational Resources Information Center

    Stevens, Mitchell L.

    2008-01-01

    The author recently spent a year and a half in the admissions office of a highly selective Eastern college as an ethnographer, seeking to understand just how admissions officers make their decisions. He accompanied them on recruitment trips to high schools and college fairs, helped manage their offices' relentless current of visitors and mail, and…

  4. College Admission Professionals: Who Are We Now?

    ERIC Educational Resources Information Center

    Rapelye, Janet Lavin

    1999-01-01

    Reflects on roles that admission professionals hold within the academic community. Explains that admission professionals are educators and business managers; bring in revenue; and serve as advisors to the president, as spokespeople to alumni/ae, and if fortunate, as counselors to students. Suggests that counselors focus on students because they…

  5. 49 CFR 25.300 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Office of the Secretary of Transportation NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 25.300 Admission. (a) General. No person shall, on the basis of sex, be...

  6. 40 CFR 5.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... of sex, be denied admission, or be subjected to discrimination in admission, by any recipient...

  7. 45 CFR 86.21 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... of sex, be denied admission, or be subjected to discrimination in admission, by any recipient...

  8. 22 CFR 146.300 - Admission.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 146.300 Admission. (a) General. No person shall, on the basis of sex, be...

  9. 28 CFR 54.300 - Admission.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Administration DEPARTMENT OF JUSTICE (CONTINUED) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 54.300 Admission. (a) General. No person shall, on the basis of sex, be...

  10. 43 CFR 41.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Lands: Interior Office of the Secretary of the Interior NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... basis of sex, be denied admission, or be subjected to discrimination in admission, by any recipient...

  11. 45 CFR 86.21 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex... of sex, be denied admission, or be subjected to discrimination in admission, by any recipient...

  12. Admission to Law School: New Measures

    ERIC Educational Resources Information Center

    Shultz, Marjorie M.; Zedeck, Sheldon

    2012-01-01

    Standardized tests have been increasingly controversial over recent years in high-stakes admission decisions. Their role in operationalizing definitions of merit and qualification is especially contested, but in law schools this challenge has become particularly intense. Law schools have relied on the Law School Admission Test (LSAT) and an INDEX…

  13. Short- and Long-Term Validity of High School GPA for Admission to Colleges outside the United States

    ERIC Educational Resources Information Center

    Al-Hattami, Abdulghani

    2014-01-01

    High school GPA is the only admission criterion that is currently used by many colleges in Yemen to select their potential students. Its predictive validity was investigated to ensure the accuracy of the admission decisions in these colleges. The relationship between students' persistence in the 4 years of college and high school GPA was studied…

  14. The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children

    PubMed Central

    Chen, I-Chen; Lin, Ming-Yen; Liu, Yi-Ching; Cheng, Hsiao-Chi; Wu, Jiunn-Ren; Hsu, Jong-Hau; Dai, Zen-Kong

    2017-01-01

    Transthoracic ultrasound (TUS) has recently become a valuable tool in the diagnosis of community-acquired pneumonia (CAP). This study assessed the association between TUS findings and clinical outcome in children with CAP. The medical records of pediatric patients hospitalized with CAP who underwent transthoracic ultrasonography within 48 hours of admission were retrospectively reviewed. Associations between the TUS findings and patient outcome were analyzed, including intensive care unit (ICU) admission, length of hospital stay, and tube thoracotomy. The study enrolled 142 patients (median age, 60 months): 28 (19.7%) required ICU admission, 14 (9.89%) underwent tube thoracotomy, and 26 (18.3%) had a hospital stay > 9 days. Multifocal involvement seen by TUS were independently associated with ICU admission, a prolonged hospital stay, and tube thoracotomy (p = 0.0027, p = 0.02, and p = 0.0262, respectively). A pleural effusion and fluid bronchogram were independent predictors of a longer hospital stay (p = 0.003 and p = 0.006, respectively). In addition, a fluid bronchogram was an independent predictor of tube thoracotomy (p = 0.0262). Conclusion TUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children. PMID:28301494

  15. Innovative designs for the smart ICU: part 1: from initial thoughts to occupancy.

    PubMed

    Halpern, Neil A

    2014-02-01

    Designing a smart ICU is a time-consuming, complex, multiphased, political, and costly exercise. This process begins with two notions: First, all hospital parties agree that a new or renovated ICU is required, and second, the hospital has agreed to allocate space, personnel, and fiscal resources for the project. In this first of a three-part series on innovative designs for the smart ICU, we will explore the roles of the ICU design team in managing the design process. The team must be administratively empowered, knowledgeable, and forward thinking. The first charge of the design team is to develop a clear vision for the goals, look and feel, and functionality of the new ICU. This vision must be guided by the imperative to positively impact patients, staff, and visitors. The team must concentrate on innovative but practical ideas that are in compliance with building codes and design guidelines and address issues related to renovation vs new construction. Mock-ups, both physical and computer generated, and a simulation laboratory for advanced technologies should be used to test design assumptions and reveal problems well in advance of actual ICU construction and technology implementation. Technology platforms need to be standardized within the ICU and equipment purchases protected against early obsolescence. The ramifications and expectations of the new ICU must be thoughtfully considered and dealt with during the design process. Last, it is essential that the design group continue its involvement in the new ICU during construction, occupancy, and post occupancy.

  16. Invasive mould infections in the ICU setting: complexities and solutions.

    PubMed

    Bassetti, Matteo; Bouza, Emilio

    2017-03-01

    Infections caused by filamentous fungi represent a major burden in the ICU. Invasive aspergillosis is emerging in non-neutropenic individuals with predisposing conditions, e.g. corticosteroid treatment, chronic obstructive pulmonary disease, liver cirrhosis, solid organ cancer, HIV infection and transplantation. Diagnosis is challenging because the signs and symptoms are non-specific, and initiation of additional diagnostic examinations is often delayed because clinical suspicion is low. Isolation of an Aspergillus species from the respiratory tract in critically ill patients, and tests such as serum galactomannan, bronchoalveolar lavage 1-3-β-d-glucan and specific PCR should be interpreted with caution. ICU patients should start adequate antifungal therapy upon suspicion of invasive aspergillosis, without awaiting definitive proof. Voriconazole, and now isavuconazole, are the drugs of choice. Mucormycosis is a rare, but increasingly prevalent disease that occurs mainly in patients with uncontrolled diabetes mellitus, immunocompromised individuals or previously healthy patients with open wounds contaminated with Mucorales. A high proportion of cases are diagnosed in the ICU. Rapidly progressing necrotizing lesions in the rhino-sinusal area, the lungs or skin and soft tissues are the characteristic presentation. Confirmation of diagnosis is based on demonstration of tissue invasion by non-septate hyphae, and by new promising molecular techniques. Control of underlying predisposing conditions, rapid surgical resection and administration of liposomal amphotericin B are the main therapeutic actions, but new agents such as isavuconazole are a promising alternative. Patients with mucormycosis receive a substantial part of their care in ICUs and, despite advances in diagnosis and treatment, mortality remains very high.

  17. An Electronic Tool for the Evaluation and Treatment of Sepsis in the ICU: A Randomized Controlled Trial

    PubMed Central

    Semler, Matthew W.; Weavind, Liza; Hooper, Michael H.; Rice, Todd W.; Gowda, Supriya Srinivasa; Nadas, Andras; Song, Yanna; Martin, Jason B.; Bernard, Gordon R.; Wheeler, Arthur P.

    2015-01-01

    Objective To determine whether addition of an electronic sepsis evaluation and management tool to electronic sepsis alerting improves compliance with treatment guidelines and clinical outcomes in septic intensive care unit patients. Design A pragmatic randomized trial. Setting Medical and surgical intensive care units of an academic, tertiary care medical center Patients Four hundred and seven patients admitted during a 4-month period to the medical or surgical intensive care unit with a diagnosis of sepsis established at the time of admission or in response to an electronic sepsis alert. Interventions Patients were randomized to usual care or the availability of an electronic tool capable of importing, synthesizing, and displaying sepsis-related data from the medical record, using logic rules to offer individualized evaluations of sepsis severity and response to therapy, informing users about evidence-based guidelines, and facilitating rapid order entry. Measurements and Main Results There was no difference between the electronic tool (218 patients) and usual care (189 patients) with regard to the primary outcome of time to completion of all indicated Surviving Sepsis Campaign 6 hour Sepsis Resuscitation Bundle elements (Hazard Ratio 1.98, 95% Confidence Interval 0.75 – 5.20, p=0.159) or time to completion of each element individually. ICU mortality, ICU-free days, and ventilator-free days did not differ between intervention and control. Providers used the tool to enter orders in only 28% of available cases. Conclusions A comprehensive electronic sepsis evaluation and management tool is feasible and safe but did not influence guideline compliance or clinical outcomes, perhaps due to low utilization. PMID:25867906

  18. Application of the Sequential Organ Failure Assessment Score to predict outcome in critically ill dogs: preliminary results.

    PubMed

    Ripanti, D; Dino, G; Piovano, G; Farca, A

    2012-08-01

    In human medicine the Sequential Organ Failure Assessment (SOFA) score is one of the most commonly organ dysfunction scoring systems used to assess critically ill patients and to predict the outcome in Intensive Care Units (ICUs). It is composed of scores from six organ systems (respiratory, cardiovascular, hepatic, coagulation, renal, and neurological) graded according to the degree of the dysfunction. The aim of the current study was to describe the applicability of the SOFA score in assessing the outcome of critically ill dogs. A total of 45 dogs admitted to the ICU was enrolled. Among these, 40 dogs completed the study: 50 % survived and left the veterinary clinic. The SOFA score was computed for each dog every 24 hours for the first 3 days of ICU stay, starting on the day of admission. A statistically significant correlation between SOFA score and death or survival was found. Most of the dogs showing an increase of the SOFA score in the first 3 days of hospitalization died, whereas the dogs with a decrease of the score survived. These results suggest that the SOFA score system could be considered a useful indicator of prognosis in ICUs hospitalized dogs.

  19. Population pharmacokinetics of meropenem during continuous infusion in surgical ICU patients.

    PubMed

    Kees, Martin G; Minichmayr, Iris K; Moritz, Stefan; Beck, Stefanie; Wicha, Sebastian G; Kees, Frieder; Kloft, Charlotte; Steinke, Thomas

    2016-03-01

    Continuous infusion of meropenem is a candidate strategy for optimization of its pharmacokinetic/pharmacodynamic profile. However, plasma concentrations are difficult to predict in critically ill patients. Steady-state concentrations of meropenem were determined prospectively during continuous infusion in 32 surgical ICU patients (aged 21-85 years, body weight 55-125 kg, APACHE II 5-29, measured creatinine clearance 22.7-297 mL/min). Urine was collected for the quantification of renal clearance of meropenem and creatinine. Cystatin C was measured as an additional marker of renal function. Population pharmacokinetic models were developed using NONMEM(®) , which described total meropenem clearance and its relationship with several estimates of renal function (measured creatinine clearance CLCR , Cockcroft-Gault formula CLCG , Hoek formula, 1/plasma creatinine, 1/plasma cystatin C) and other patient characteristics. Any estimate of renal function improved the model performance. The strongest association of clearance was found with CLCR (typical clearance = 11.3 L/h × [1 + 0.00932 × (CLCR  - 80 mL/min)]), followed by 1/plasma cystatin C; CLCG was the least predictive covariate. Neither age, weight, nor sex was found to be significant. These models can be used to predict dosing requirements or meropenem concentrations during continuous infusion. The covariate CLCR offers the best predictive performance; if not available, cystatin C may provide a promising alternative to plasma creatinine.

  20. Merit and Admissions Policy: Case Studies from Pakistan. Discussion Paper Series No. 59 D.

    ERIC Educational Resources Information Center

    Klitgaard, Robert E.; And Others

    Studies were conducted to determine whether measures of intellectual merit that are used as criteria for admission to the University of Karachi in Pakistan have predictive validity. The predictive validity of the intermediate examination score was studied with recent graduates of the pharmacy, medicine, and engineering schools. Additional studies…

  1. Selection of Advantaged and Disadvantaged South African Students for University Admission.

    ERIC Educational Resources Information Center

    Skuy, Mervin; And Others

    1996-01-01

    A South African study explored predictors of success among 18 educationally disadvantaged and 8 advantaged students in a University of Witwatersrand developmental studies program. Results showed academic success was considerably less predictable among disadvantaged students. Universally-used admission criteria were not predictive for either group;…

  2. [Can children visit their relatives in an adult ICU?].

    PubMed

    Blot, François; Foubert, Audrey; Kervarrec, Cécile; Laversa, Nathalie; Lemens, Cécile; Minet, Monik; Petetin, Olivier; Raynard, Bruno; Wolff, Frédéric; Delmas, Valérie; de Frettes, Marie-Aimée Fourrel; Lacaze, Marilène; Marchand, Vincent; Méquio, Carine; Rhié, Karine; Rousseau, Isabelle; Rivet, Elisabeth; Moreau, Delphine; Estphan, Georges; Lavergne, Sandrine; Nitenberg, Gérard

    2007-07-01

    For the last three years, our oncology ICU (intensive care unit) has been opened to visiting children between 0 and 18 years. Our objective was to attempt to decrease the psychological burden in critically ill cancer patients and their children. We report here the evaluation of this new policy. Encouraged by the child psychologists in our hospital, we first recorded the opinions of the nursing staff, patients and relatives about this innovative approach. As our preliminary findings were favourable, a liberalised greeting and education policy for visiting children was implemented. A dedicated procedure was followed in order to provide children with a better understanding of their parent's disease, to alleviate any traumatic experience the visit might cause and to create an environment where mutual confidence would reign. After 2 years, each visiting child, patient, accompanying parent and the nursing staff were directly questioned using a specifically designed questionnaire. The daily lives of the staff, children, families and patients themselves appeared to be dramatically improved, even in the most difficult medical situations. Based on these promising results, the new policy has definitively been adopted in our unit. We propose that children ought to be allowed to visit a parent in the ICU and that this policy warrants evaluation in other types of units.

  3. Acute kidney injury: Renal disease in the ICU.

    PubMed

    Seller-Pérez, G; Más-Font, S; Pérez-Calvo, C; Villa-Díaz, P; Celaya-López, M; Herrera-Gutiérrez, M E

    2016-01-01

    Acute kidney injury (AKI) in the ICU frequently requires costly supportive therapies, has high morbidity, and its long-term prognosis is not as good as it has been presumed so far. Consequently, AKI generates a significant burden for the healthcare system. The problem is that AKI lacks an effective treatment and the best approach relies on early secondary prevention. Therefore, to facilitate early diagnosis, a broader definition of AKI should be established, and a marker with more sensitivity and early-detection capacity than serum creatinine - the most common marker of AKI - should be identified. Fortunately, new classification systems (RIFLE, AKIN or KDIGO) have been developed to solve these problems, and the discovery of new biomarkers for kidney injury will hopefully change the way we approach renal patients. As a first step, the concept of renal failure has changed from being a "static" disease to being a "dynamic process" that requires continuous evaluation of kidney function adapted to the reality of the ICU patient.

  4. 43 CFR 4.1141 - Admissions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... directed serves on the requesting party— (1) A sworn statement denying specifically the relevant matters of which an admission is requested; (2) A sworn statement setting forth in detail the reasons why he...

  5. 43 CFR 4.1141 - Admissions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... directed serves on the requesting party— (1) A sworn statement denying specifically the relevant matters of which an admission is requested; (2) A sworn statement setting forth in detail the reasons why he...

  6. 43 CFR 4.1141 - Admissions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... directed serves on the requesting party— (1) A sworn statement denying specifically the relevant matters of which an admission is requested; (2) A sworn statement setting forth in detail the reasons why he...

  7. Marketing in Admissions: The Information System Approach.

    ERIC Educational Resources Information Center

    Wofford, O. Douglas; Timmerman, Ed

    1982-01-01

    A marketing information system approach for college admissions is outlined that includes objectives, information needs and sources, a data collection format, and information evaluation. Coordination with other institutional information systems is recommended. (MSE)

  8. The Parent Role in College Admission.

    ERIC Educational Resources Information Center

    Krugman, Mary K.

    1990-01-01

    Discusses techniques secondary school counselors can use to help parents understand and negotiate the college admissions process, including encouraging parental self-assessment; assisting parents to assess student; giving parents special tips; and maintaining open and ethical communication. (ABL)

  9. 28 CFR 549.42 - Involuntary admission.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... SERVICES Administrative Safeguards for Psychiatric Treatment and Medication § 549.42 Involuntary admission. A court determination is necessary for involuntary hospitalization for psychiatric treatment. A sentenced inmate, not currently committed for psychiatric treatment, who is not able or willing...

  10. Social Engagement After Nursing Home Admission: Racial and Ethnic Disparities and Risk Factors.

    PubMed

    Bliss, Donna; Harms, Susan; Eberly, Lynn E; Savik, Kay; Gurvich, Olga; Mueller, Christine; Wyman, Jean F; Virnig, Beth

    2015-11-26

    Older adults admitted to nursing homes (NHs) are at risk for low social engagement, which has associations with medical, psychological, and social well-being. Minorities may be at a disadvantage for social engagement because of their racial or ethnic group identity. This study assessed whether there were racial/ethnic disparities in social engagement among older adults (N = 15,927) at 1 year after their NH admission using multi-level predictors. No racial or ethnic-based disparities in social engagement were found; hence, an analysis of risk factors at NH admission that predicted low social engagement at 1 year for all residents was conducted. Significant risk factors for low social engagement were low social engagement at admission, deficits in activities in daily living and cognition, problems with vision and communication, and residing in an NH in an urban community. Results highlight the importance of initiating interventions to increase social engagement at the time of NH admission.

  11. Effectiveness of Using Incentives to Improve Parolee Admission and Attendance in Community Addiction Treatment

    PubMed Central

    Prendergast, Michael L.; Hall, Elizabeth A.; Grossman, Jason; Veliz, Robert; Gregorio, Liliana; Warda, Umme S.; Van Unen, Kory; Knight, Chloe

    2017-01-01

    This study is a randomized effectiveness trial of the use of incentives to improve treatment utilization among parolees in community treatment. In prison, Admission phase parolees were randomized to Admission Incentive (N=31) or Education (N=29). Attendance phase parolees entering community treatment were randomized to Attendance Incentive (N=104) or Education (N=98). There was no main effect for incentives in either study phase. Neither admission to community treatment (Incentive 60%, Education 64%; p =.74), nor intervention completion (Incentive 22%; Education 27%; p =.46) appeared to be impacted. Time-in-treatment was predicted by age, first arrest age, and type of parole status (Cox regression p<.05), but not by treatment group. Providing incentives did not increase the likelihood that parolees enrolled in or stayed in community treatment. In light of this finding, criminal justice practitioners who are considering incentives to increase admission or retention should be aware that they may not produce the desired outcomes.

  12. The effect of ICU telemedicine on mortality and length of stay.

    PubMed

    Kohl, Benjamin A; Fortino-Mullen, Margaret; Praestgaard, Amy; Hanson, C William; Dimartino, Joseph; Ochroch, E Andrew

    2012-07-01

    We conducted a retrospective, observational study of patient outcomes in two intensive care units in the same hospital. The surgical ICU (SICU) implemented telemedicine and electronic medical records, while the medical ICU (MICU) did not. Medical charts were reviewed for a one-year period before telemedicine and a one-year period afterwards. In the SICU, records were obtained for 246 patients before and 1499 patients after implementation; in the MICU, records were obtained for 220 patients and 285 patients in the same periods. The outcomes of interest were ICU length of stay and mortality, and hospital length of stay and mortality. Outcome variables were severity-adjusted using APACHE scoring. A bootstrap method, with 1000 replicates, was used to assess stability of the findings. The adjusted ICU length of stay, ICU mortality, and hospital mortality for the SICU patients all decreased significantly after the implementation of telemedicine. There was no change in adjusted outcome variables in the MICU patients. Implementation of telemedicine and electronic records in the surgical ICU was associated with a profound reduction in severity-adjusted ICU length of stay, ICU mortality, and hospital mortality. However, it is not possible to conclude definitively that the observed associations seen in the SICU were due to the intervention.

  13. Dimensions and Role-Specific Mediators of Surrogate Trust in the ICU

    PubMed Central

    Hutchison, Paul J.; McLaughlin, Katie; Corbridge, Tom; Michelson, Kelly N.; Emanuel, Linda; Sporn, Peter H. S.; Crowley-Matoka, Megan

    2016-01-01

    Objective In the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient’s prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU. Design Prospective qualitative study. Setting Medical ICU of a major urban university hospital. Subjects Surrogate decision makers of intubated, mechanically ventilated patients in the medical ICU. Measurements and Main Results Semistructured interviews focused on surrogates’ general experiences in the ICU and on their trust in the clinicians caring for the patient. Interviews were audio-recorded, transcribed verbatim, and coded by two reviewers. Constant comparison was used to identify themes pertaining to trust. Thirty surrogate interviews revealed five dimensions of trust in ICU clinicians: technical competence, communication, honesty, benevolence, and interpersonal skills. Most surrogates emphasized the role of nurses in trust formation, frequently citing their technical competence. Trust in physicians was most commonly related to honesty and the quality of their communication with surrogates. Conclusions Interventions to improve trust in the ICU should be role-specific, since surrogate expectations are different for physicians and nurses with regard to behaviors relevant to trust. Further research is needed to confirm our findings and explore the impact of trust modification on clinician-family conflict. PMID:27513360

  14. Immigration, moving house and psychiatric admissions.

    PubMed

    Johansson, L M; Sundquist, J; Johansson, S E; Bergman, B

    1998-08-01

    This study was designed to elucidate psychiatric admission rates for native Swedes and foreign-born individuals during the period 1991-1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in-patient care had been reduced. Tests of differences between Swedes and foreign-born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign-born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign-born males under 55 years of age and foreign-born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign-born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign-born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness.

  15. Perme Intensive Care Unit Mobility Score and ICU Mobility Scale: translation into Portuguese and cross-cultural adaptation for use in Brazil

    PubMed Central

    Kawaguchi, Yurika Maria Fogaça; Nawa, Ricardo Kenji; Figueiredo, Thais Borgheti; Martins, Lourdes; Pires-Neto, Ruy Camargo

    2016-01-01

    ABSTRACT Objective: To translate the Perme Intensive Care Unit Mobility Score and the ICU Mobility Scale (IMS) into Portuguese, creating versions that are cross-culturally adapted for use in Brazil, and to determine the interobserver agreement and reliability for both versions. Methods: The processes of translation and cross-cultural validation consisted in the following: preparation, translation, reconciliation, synthesis, back-translation, review, approval, and pre-test. The Portuguese-language versions of both instruments were then used by two researchers to evaluate critically ill ICU patients. Weighted kappa statistics and Bland-Altman plots were used in order to verify interobserver agreement for the two instruments. In each of the domains of the instruments, interobserver reliability was evaluated with Cronbach's alpha coefficient. The correlation between the instruments was assessed by Spearman's correlation test. Results: The study sample comprised 103 patients-56 (54%) of whom were male-with a mean age of 52 ± 18 years. The main reason for ICU admission (in 44%) was respiratory failure. Both instruments showed excellent interobserver agreement (κ > 0.90) and reliability (α > 0.90) in all domains. Interobserver bias was low for the IMS and the Perme Score (−0.048 ± 0.350 and −0.06 ± 0.73, respectively). The 95% CIs for the same instruments ranged from −0.73 to 0.64 and −1.50 to 1.36, respectively. There was also a strong positive correlation between the two instruments (r = 0.941; p < 0.001). Conclusions: In their versions adapted for use in Brazil, both instruments showed high interobserver agreement and reliability. PMID:28117473

  16. [The factors inducing status asthmaticus and changes in physical examination on admission to intensive care unit].

    PubMed

    Karwat, Krzysztof

    2002-01-01

    During the last 10 years 342 patients with status asthmaticus were admitted (mean age 42 years, 63% female) to ICU of Pneumonology Department in Warsaw Medical University. After admission respiratory rate (mean 28/min), heart rate (mean 121 beats/min), blood pressure (mean 139/83 mmHg), pulsus paradoxus (mean 19.9 mmHg) and peak expiratory flow rate (mean 109.3 L/min) were recorded. Arterial blood gas tension was analyzed as well. Mean PaO2 was 65.7 mmHg (range 31.4-128 mmHg) and mean PaCO2 was 39.1 mmHg (range 18-130.9 mmHg). Electrocardiography showed p-pulmonale in 24.4% of cases. 18.9% of the patients had ST-T changes and rotation of heart axis in 9% of cases. X-ray examination performed on admission showed changes characteristic for pneumonia in 15 patients. Status asthmaticus was caused by infection in 57.6%, exercise 6.1%, emotion and stress 3.2%, allergens 2.3% of cases. Underlying factors were unknown in 24.3%.

  17. The "Admissions" Side of BCCAT: An Update. Special Report

    ERIC Educational Resources Information Center

    British Columbia Council on Admissions and Transfer, 2008

    2008-01-01

    To spearhead increased emphasis on admissions, the British Columbia Council on Admissions and Transfer (BCCAT) formed an Admissions Committee in Fall 2003. The committee recognized the importance of institutional autonomy in determining admissions policies and processes at each institution. Following initiation of the Student Transitions Project…

  18. Risk factors for tracheobronchial acquisition of resistant Gram-negative bacterial pathogens in mechanically ventilated ICU patients.

    PubMed

    Papakonstantinou, Ilias; Angelopoulos, Epameinondas; Baraboutis, Ioannis; Perivolioti, Efstathia; Parisi, Maria; Psaroudaki, Zoe; Kampisiouli, Efstathia; Argyropoulou, Athina; Nanas, Serafeim; Routsi, Christina

    2015-10-01

    The aim of this study was to identify risk factors for tracheobronchial acquisition with the most common resistant Gram-negative bacteria in the intensive care unit (ICU) during the first week after intubation and mechanical ventilation. Tracheobronchial and oropharyngeal cultures were obtained at admission, after 48 hours, and after 7 days of mechanical ventilation. Patient characteristics, interventions, and antibiotic usage were recorded. Among 71 eligible patients with two negative bronchial cultures for resistant Gram-negative bacteria (at admission and within 48 hours), 41 (58%) acquired bronchial resistant Gram-negative bacteria by day 7. Acquisition strongly correlated with presence of the same pathogens in the oropharynx: Acinetobacter baumannii [odds ratio (OR) = 20·2, 95% confidence interval (CI): 5·5-73·6], Klebsiella pneumoniae (OR = 8·0, 95% CI: 1·9-33·6), and Pseudomonas aeruginosa (OR = 27, 95%: CI 2·7-273). Bronchial acquisition with resistant K. pneumoniae also was associated with chronic liver disease (OR = 3·9, 95% CI: 1·0-15·3), treatment with aminoglycosides (OR = 4·9, 95% CI: 1·4-18·2), tigecycline (OR = 4·9, 95% CI: 1·4-18·2), and linezolid (OR = 3·9, 95% CI: 1·1-15·0). In multivariate analysis, treatment with tigecycline and chronic liver disease were independently associated with bronchial resistant K. pneumoniae acquisition. Our results show a high incidence of tracheobronchial acquisition with resistant Gram-negative microorganisms in the bronchial tree of newly intubated patients. Oropharynx colonization with the same pathogens and specific antibiotics use were independent risk factors.

  19. Variable-Domain Functional Regression for Modeling ICU Data.

    PubMed

    Gellar, Jonathan E; Colantuoni, Elizabeth; Needham, Dale M; Crainiceanu, Ciprian M

    2014-12-01

    We introduce a class of scalar-on-function regression models with subject-specific functional predictor domains. The fundamental idea is to consider a bivariate functional parameter that depends both on the functional argument and on the width of the functional predictor domain. Both parametric and nonparametric models are introduced to fit the functional coefficient. The nonparametric model is theoretically and practically invariant to functional support transformation, or support registration. Methods were motivated by and applied to a study of association between daily measures of the Intensive Care Unit (ICU) Sequential Organ Failure Assessment (SOFA) score and two outcomes: in-hospital mortality, and physical impairment at hospital discharge among survivors. Methods are generally applicable to a large number of new studies that record a continuous variables over unequal domains.

  20. [Family participation in premature care in neonatal ICU].

    PubMed

    Gaíva, Maria Aparecida Munhoz; Scochi, Carmen Gracinda Silvan

    2005-01-01

    This study aimed at analyzing the family participation in the premature assistance in a university hospital neonatal ICU. Data were collected from the participant observation. Results showed that despite of the mother's presence in the daily life of their premature children placed in a hospital, family isn't inserted in the work process and mothers are the only ones who take part of the cares. This participation basically happens in the execution of maternity care, especially at the medium risk unity, the mother and premature family are less welcomed and there isn't any partnership between the care team and the family, there aren't team interventions in order to turn premature family in autonomous subject to promote health and life quality to baby's life.

  1. Using an alternating pressure mattress to offload heels in ICU.

    PubMed

    Masterson, Sarah; Younger, Caroline

    2014-08-12

    The heel continues to be one of the most common sites of pressure damage. This article reviews the anatomy and physiology of the heel and explores significant risk factors, including those found in the critically ill patient. Interventions to prevent heel pressure ulceration by offloading the heel are explored. An evaluation of the Nimbus 4 alternating pressure mattress was undertaken within an intensive care unit (ICU) to consider the efficacy of its unique Wound Valve Technology, which is designed to help prevent heel pressure ulceration. During the evaluation period none of the patients using the Nimbus 4 developed a pressure ulcer. Staff observed that the Wound Valves provided effective pressure redistribution and, although the cells frequently needed to be adjusted, patient safety was maintained throughout. The Wound Valves were most effective on patients who were less prone to voluntary movement.

  2. [The challenge of Web 2.0-based ICU>].

    PubMed

    Vázquez, G; Roca, J; Blanch, L

    2009-03-01

    Intensive medicine has the opportunity to create an interactive virtual community using Web 2.0. The main feature of this new web generation is to convert the user into an active element of the virtual world, allowing the passive, information-searching user to become one who creates, shares, participates and closely relates to it. These features make it possible for the clinical sphere, the researcher and the innovator to coincide, thus providing interaction not only among the members of the virtual community but also with citizens and patients. The creation of a Web 2.0-based ICU> represents an opportunity for improvement as well as an added value for intensive medicine.

  3. Major Research Efforts of the Law School Admission Council. Law School Admission Research.

    ERIC Educational Resources Information Center

    Hart, Frederick M.; Evans, Franklin R.

    Research conducted by the Law School Admission Council since the development of the Law School Admission Test (LSAT) in 1948 is described. An overview of the research topics is provided, and relevant published reports are cited in 61 footnotes. The following topics of study are discussed: (1) use and validity of traditional predictors of law…

  4. Multiple hospital admissions in a calendar year.

    PubMed

    Newton, J; Goldacre, M

    1993-09-01

    Hospital in-patient workload is routinely measured as episodes of care. We report on the extent to which counts of episodes of care differ from counts of patients treated in different specialties and in different age groups. Linked records of hospital care in a population of 1.9 million people, collected over an 11-year period (1976-1986), were analysed. The all-ages multiple admission ratio (the number of admissions per 100 people admitted in the same specialty and year) varied between specialties from 102 to 171. Medical specialties tended to have higher ratios than surgical ones. The influence of age on multiple admission ratios varied between specialties, although in general the ratios increased with increasing age. There were progressive but small increases in multiple admission ratios over the period studied in a number of specialties but, by and large, stability over time was more striking than any change. The information presented could be used to estimate person-based admission rates from available episode-based data where the former are not available. This should be helpful both in managing hospital resources and in purchasing care on behalf of resident populations. Purchasers in particular should be aware of numbers of people being treated as well as the numbers of episodes of care provided.

  5. [Medical examination prior to trade school admission].

    PubMed

    Hursidić-Radulović, Azra; Decković-Vukres, Vlasta

    2005-01-01

    Regulation on medical examination prior to apprenticeship is built in the Act on Trades and Crafts. Medical examinations of the students before admission to secondary craft schools have been done regularly since 1993. Between 11,000 and 14,000 students are admitted to secondary craft schools in the Republic of Croatia annually. According to statistics, about 10% of students have obvious health problems, about 5% of students have healt problems which vitally limit their capacity in particular crafts. This statistic refers to about 3% of the examined students. Medical examinations of students prior to admission to craft schools represent a particular sort of health capacity examinations. The paper includes applications for the most freqent trades and crafts, and findings of the craft school admission examinations.

  6. [Involuntary admission of addict during early pregnancy].

    PubMed

    Hondius, Adger J K; Stikker, Tineke E; Wennink, J M B Hanneke; Honig, Adriaan

    2012-01-01

    A 30-year-old cocaine-dependent woman was 16 weeks pregnant. Because of possible endangerment of the fetus, an involuntary provisional admission was authorized. Of particular interest is the application of the Dutch Act on Formal Admissions to Psychiatric Hospitals for the primary diagnosis 'addiction' and the fact that the fetus was regarded as a legal 'other'. In severe cases of addiction combined with pregnancy an earlier intervention is needed and arrangement of accelerated legal custody of the newborn before birth should be considered. For the protection of the unborn, we advocate a stricter application of the United Nations Convention on the Rights of the Child. Information for addicted women with preconception counselling can help prevent a compulsory admission.

  7. Association between antipsychotic/antidepressant drug treatments and hospital admissions in schizophrenia assessed using a mental health case register

    PubMed Central

    Cardinal, Rudolf N; Savulich, George; Mann, Louisa M; Fernández-Egea, Emilio

    2015-01-01

    Background: The impact of psychotropic drug choice upon admissions for schizophrenia is not well understood. Aims: To examine the association between antipsychotic/antidepressant use and time in hospital for patients with schizophrenia. Methods: We conducted an observational study, using 8 years’ admission records and electronically generated drug histories from an institution providing secondary mental health care in Cambridgeshire, UK, covering the period 2005–2012 inclusive. Patients with a coded ICD-10 diagnosis of schizophrenia were selected. The primary outcome measure was the time spent as an inpatient in a psychiatric unit. Antipsychotic and antidepressant drugs used by at least 5% of patients overall were examined for associations with admissions. Periods before and after drug commencement were compared for patients having pre-drug admissions, in mirror-image analyses correcting for overall admission rates. Drug use in one 6-month calendar period was used to predict admissions in the next period, across all patients, in a regression analysis accounting for the effects of all other drugs studied and for time. Results: In mirror-image analyses, sulpiride, aripiprazole, clozapine, and olanzapine were associated with fewer subsequent admission days. In regression analyses, sulpiride, mirtazapine, venlafaxine, and clozapine–aripiprazole and clozapine–amisulpride combinations were associated with fewer subsequent admission days. Conclusions: Use of these drugs was associated with fewer days in hospital. Causation is not implied and these findings require confirmation by randomized controlled trials. PMID:27336041

  8. Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit.

    PubMed

    Ament, Jared D; Greenan, Krista N; Tertulien, Patrick; Galante, Joseph M; Nishijima, Daniel K; Zwienenberg, Marike

    2017-04-07

    OBJECTIVE Approximately 475,000 children are treated for traumatic brain injury (TBI) in the US each year; most are classified as mild TBI (Glasgow Coma Scale [GCS] Score 13-15). Patients with positive findings on head CT, defined as either intracranial hemorrhage or skull fracture, regardless of severity, are often transferred to tertiary care centers for intensive care unit (ICU) monitoring. This practice creates a significant burden on the health care system. The purpose of this investigation was to derive a clinical decision rule (CDR) to determine which children can safely avoid ICU care. METHODS The authors retrospectively reviewed patients with mild TBI who were ≤ 16 years old and who presented to a Level 1 trauma center between 2008 and 2013. Data were abstracted from institutional TBI and trauma registries. Independent covariates included age, GCS score, pupillary response, CT characteristics, and Injury Severity Score. A composite outcome measure, ICU-level care, was defined as cardiopulmonary instability, transfusion, intubation, placement of intracranial pressure monitor or other invasive monitoring, and/or need for surgical intervention. Stepwise logistic regression defined significant predictors for model inclusion with p < 0.10. The authors derived the CDR with binary recursive partitioning (using a misclassification cost of 20:1). RESULTS A total of 284 patients with mild TBI were included in the analysis; 40 (14.1%) had ICU-level care. The CDR consisted of 5 final predictor variables: midline shift > 5 mm, intraventricular hemorrhage, nonisolated head injury, postresuscitation GCS score of < 15, and cisterns absent. The CDR correctly identified 37 of 40 patients requiring ICU-level care (sensitivity 92.5%; 95% CI 78.5-98.0) and 154 of 244 patients who did not require an ICU-level intervention (specificity 63.1%; 95% CI 56.7-69.1). This results in a negative predictive value of 98.1% (95% CI 94.1-99.5). CONCLUSIONS The authors derived a clinical

  9. 40 CFR 89.604 - Conditional admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., the importer must store the nonroad engine at a location where the Administrator has reasonable access...) CONTROL OF EMISSIONS FROM NEW AND IN-USE NONROAD COMPRESSION-IGNITION ENGINES Importation of Nonconforming Nonroad Engines § 89.604 Conditional admission. (a) A nonroad engine offered for importation under §...

  10. The National Center Test for University Admissions

    ERIC Educational Resources Information Center

    Watanabe, Yoshinori

    2013-01-01

    This article describes the National Center Test for University Admissions, a unified national test in Japan, which is taken by 500,000 students every year. It states that implementation of the Center Test began in 1990, with the English component consisting only of the written section until 2005, when the listening section was first implemented…

  11. 34 CFR 106.15 - Admissions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... higher education, and public institutions of undergraduate higher education. (e) Public institutions of undergraduate higher education. Subpart C does not apply to any public institution of undergraduate higher... 34 Education 1 2014-07-01 2014-07-01 false Admissions. 106.15 Section 106.15 Education...

  12. 34 CFR 106.15 - Admissions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... higher education, and public institutions of undergraduate higher education. (e) Public institutions of undergraduate higher education. Subpart C does not apply to any public institution of undergraduate higher... 34 Education 1 2011-07-01 2011-07-01 false Admissions. 106.15 Section 106.15 Education...

  13. 34 CFR 106.15 - Admissions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... higher education, and public institutions of undergraduate higher education. (e) Public institutions of undergraduate higher education. Subpart C does not apply to any public institution of undergraduate higher... 34 Education 1 2012-07-01 2012-07-01 false Admissions. 106.15 Section 106.15 Education...

  14. 34 CFR 106.15 - Admissions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... higher education, and public institutions of undergraduate higher education. (e) Public institutions of undergraduate higher education. Subpart C does not apply to any public institution of undergraduate higher... 34 Education 1 2010-07-01 2010-07-01 false Admissions. 106.15 Section 106.15 Education...

  15. 34 CFR 106.15 - Admissions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... higher education, and public institutions of undergraduate higher education. (e) Public institutions of undergraduate higher education. Subpart C does not apply to any public institution of undergraduate higher... 34 Education 1 2013-07-01 2013-07-01 false Admissions. 106.15 Section 106.15 Education...

  16. PREP: Outreach to Online Learners through Admissions

    ERIC Educational Resources Information Center

    Gupton, Preeti

    2016-01-01

    Librarians have collaborated with academic departments within their institutions for decades now, working with professors and administrators to bring information literacy skills to students. The librarians at National American University decided to extend this collaboration to a non-academic unit, the admissions department of the university. The…

  17. 18 CFR 1317.220 - Admissions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Admissions. 1317.220 Section 1317.220 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE...

  18. 18 CFR 1317.220 - Admissions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Admissions. 1317.220 Section 1317.220 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE...

  19. 18 CFR 1317.220 - Admissions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Admissions. 1317.220 Section 1317.220 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE...

  20. Open Admissions: The Pros and Cons.

    ERIC Educational Resources Information Center

    Barzun, Jacques; And Others

    The Council for Basic Education sponsored an all-day symposium on open admissions in 1971. This booklet contains the full text of the addresses given on that occasion, as well as the major part of the discussion among the panelists and answers to questions from the audience. The aim of the symposium was not only to provide information about…

  1. Foreign Language, the Classics, and College Admissions.

    ERIC Educational Resources Information Center

    LaFleur, Richard A.

    1993-01-01

    This article reports the results of a survey, funded by the American Classical League (ACL) and conducted during 1990-91, that assessed attitudes toward high school foreign-language study, in particular the study of Latin and Greek, in the college admissions process. (21 references) (VWL)

  2. Beyond Admission: The Challenge for Access.

    ERIC Educational Resources Information Center

    Roger, Angela; Sutherland, Margaret

    1992-01-01

    The Scottish Wider Access Programme (SWAP) aims to increase adults' access to higher education. Interviews with SWAP students and educators revealed that SWAP had been invaluable in preparing nontraditional students for admission to higher education. Issues include improving teaching methods geared toward mature students, providing support…

  3. The Admissions Criteria of Secondary Free Schools

    ERIC Educational Resources Information Center

    Morris, Rebecca

    2014-01-01

    This paper presents the results of an analysis of the admissions criteria used by the first two waves of secondary Free Schools in England. The type of criteria and their ranked order is explored and their potential impact on the school composition is considered. The findings demonstrate the diversity of criteria being used by this new type of…

  4. 15 CFR 8a.220 - Admissions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Admissions. 8a.220 Section 8a.220 Commerce and Foreign Trade Office of the Secretary of Commerce NONDISCRIMINATION ON THE BASIS OF SEX IN... institution. (c) Application of §§ 8a.300 through .310. Except as provided in paragraphs (d) and (e) of...

  5. Reporting Subscores from College Admission Tests

    ERIC Educational Resources Information Center

    Lyren, Per-Erik

    2009-01-01

    The added value of reporting subscores on a college admission test (SweSAT) was examined in this study. Using a CTT-derived objective method for determining the value of reporting subscores, it was concluded that there is added value in reporting section scores (Verbal/Quantitative) as well as subtest scores. These results differ from a study of…

  6. 40 CFR 5.300 - Admission.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Admission. 5.300 Section 5.300 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of...

  7. 40 CFR 5.300 - Admission.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Admission. 5.300 Section 5.300 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of...

  8. "Stealth Applicants" Are Changing the Admissions Equation

    ERIC Educational Resources Information Center

    Hoover, Eric

    2008-01-01

    Jeff Rickey is a numbers guy. But three years ago, a colleague asked him about something he'd never counted: applicants who came out of nowhere. The question intrigued Mr. Rickey, dean of admissions and financial aid at Earlham College in Indiana. He found that 17 percent of the college's applicants that year had not called, taken a tour, or…

  9. 10 CFR 2.708 - Admissions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Admissions. 2.708 Section 2.708 Energy NUCLEAR REGULATORY COMMISSION RULES OF PRACTICE FOR DOMESTIC LICENSING PROCEEDINGS AND ISSUANCE OF ORDERS Rules for Formal... the request is directed serves on the requesting party either: (i) A sworn statement...

  10. EARLY SCHOOL ADMISSIONS PROJECT, PROMISING PRACTICES.

    ERIC Educational Resources Information Center

    Baltimore City Public Schools, MD.

    THE EXPERIMENTAL PROJECT ATTEMPTS TO DETERMINE WHETHER EARLY ADMISSION TO SCHOOL CAN OVERCOME BARRIERS TO LEARNING WHICH ENVIRONMENTAL FACTORS SEEM TO IMPOSE. A DEPRIVED CHILD OFTEN DOES NOT RECEIVE ATTENTION, AFFECTION, OR GUIDANCE WITHIN HIS HOME. THE YOUNG CHILD SHOULD BE HELPED TO DEVELOP A WHOLESOME SELF-CONCEPT, TO ACQUIRE THE DRIVE TO…

  11. Hospital admissions before and after shipyard closure.

    PubMed Central

    Iversen, L.; Sabroe, S.; Damsgaard, M. T.

    1989-01-01

    To determine the effect of job loss on health an investigation was made of admissions to hospitals in 887 men five years before and three years after the closure of a Danish shipyard. The control group comprised 441 men from another shipyard. The information on hospital admissions was obtained from the Danish national register of patients. The relative risk of admission in the control group dropped significantly in terms of the number of men admitted from the study group from 1.29 four to five years before closure to 0.74 in the three years after closure. This was especially true of admissions due to accidents (1.33 to 0.46) and diseases of the digestive system (4.53 to 1.03). For diseases of the circulatory system, particularly cardiovascular diseases, the relative risk increased from 0.8 to 1.60, and from 1.0 to 2.6 respectively. These changes in risk of illness after redundancy are probably a consequence of a change from the effects of a high risk work environment to the effects of psychosocial stresses such as job insecurity and unemployment. PMID:2511968

  12. University Admissions. Policy Note. Number 3

    ERIC Educational Resources Information Center

    Group of Eight (NJ1), 2012

    2012-01-01

    University admissions, like many other aspects of the higher education sector, are going through a time of significant change. From 2012, universities will receive full funding under the Commonwealth Grants Scheme (CGS) for as many places as they offer. Previously, the Government limited the number of funded places, with a tolerance band for…

  13. Hazards of Hospitalization: Residence Prior to Admission Predicts Outcomes

    ERIC Educational Resources Information Center

    Friedman, Susan M.; Mendelson, Daniel A.; Bingham, Karilee W.; McCann, Robert M.

    2008-01-01

    Purpose: Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during…

  14. The Validity of the Graduate Management Admissions Test for Non-U.S. Students

    ERIC Educational Resources Information Center

    Koys, Daniel J.

    2005-01-01

    In this study, the author examined the validity of the Graduate Management Admissions Test (GMAT) for non-U.S. students (N = 75) through a predictive validation procedure in which applicants were given the predictor test but the test results were not used to admit students. The author's business school admitted students to three overseas MBA…

  15. At Wake Forest U., Admissions Has Become "More Art than Science"

    ERIC Educational Resources Information Center

    Hoover, Eric

    2009-01-01

    The admissions process is awash in numbers. Students accumulate grade-point averages and test scores. Colleges use statistical models to predict enrollment outcomes, and they tout their place in commercial rankings. In many ways, numbers simplify this complex enterprise. However, they have come to carry undue weight, says Martha Blevins Allman,…

  16. Admission Scores as a Predictor of Academic Success in the Fiji School of Medicine

    ERIC Educational Resources Information Center

    Ezeala, Christian C.; Swami, Niraj S.; Lal, Nilesh; Hussain, Shagufta

    2012-01-01

    Secondary education in Fiji ends with the Form 7 examination. Predictive validity for academic success of Form 7 scores which form the basis for admission into the Bachelor of Medicine Bachelor of Surgery programme of the Fiji School of Medicine was examined via a cohort of 129 students. Success rates for year 1 in 2008, 2009, and 2010 were 90.7…

  17. Impact of a structured ICU training programme in resource-limited settings in Asia

    PubMed Central

    Lubell, Yoel; Cooper, Ben S.; Mohanty, Sanjib; Alam, Shamsul; Karki, Arjun; Pattnaik, Rajya; Maswood, Ahmed; Haque, R.; Pangeni, Raju; Schultz, Marcus J.; Dondorp, Arjen M.

    2017-01-01

    Objective To assess the impact on ICU performance of a modular training program in three resource-limited general adult ICUs in India, Bangladesh, and Nepal. Method A modular ICU training programme was evaluated using performance indicators from June 2009 to June 2012 using an interrupted time series design with an 8 to 15 month pre-intervention and 18 to 24 month post-intervention period. ICU physicians and nurses trained in Europe and the USA provided training for ICU doctors and nurses. The training program consisted of six modules on basic intensive care practices of 2–3 weeks each over 20 months. The performance indicators consisting of ICU mortality, time to ICU discharge, rate at which patients were discharged alive from the ICU, discontinuation of mechanical ventilation or vasoactive drugs and duration of antibiotic use were extracted. Stepwise changes and changes in trends associated with the intervention were analysed. Results Pre-Training ICU mortality in Rourkela (India), and Patan (Nepal) Chittagong (Bangladesh), was 28%, 41% and 62%, respectively, compared to 30%, 18% and 51% post-intervention. The intervention was associated with a stepwise reduction in cumulative incidence of in-ICU mortality in Chittagong (adjusted subdistribution hazard ratio [aSHR] (95% CI): 0.62 (0.40, 0.97), p = 0.03) and Patan (aSHR 0.16 (0.06, 0.41), p<0.001), but not in Rourkela (aSHR: 1.17 (0.75, 1.82), p = 0.49). The intervention was associated with earlier discontinuation of vasoactive drugs at Rourkela (adjusted hazard ratio for weekly change [aHR] 1.08 (1.03, 1.14), earlier discontinuation of mechanical ventilation in Chittagong (aHR 2.97 (1.24, 7.14), p = 0.02), and earlier ICU discharge in Patan (aHR 1.87 (1.02, 3.43), p = 0.04). Conclusion This structured training program was associated with a decrease in ICU mortality in two of three sites and improvement of other performance indicators. A larger cluster randomised study assessing process outcomes and longer

  18. The Probabilistic Admissible Region with Additional Constraints

    NASA Astrophysics Data System (ADS)

    Roscoe, C.; Hussein, I.; Wilkins, M.; Schumacher, P.

    The admissible region, in the space surveillance field, is defined as the set of physically acceptable orbits (e.g., orbits with negative energies) consistent with one or more observations of a space object. Given additional constraints on orbital semimajor axis, eccentricity, etc., the admissible region can be constrained, resulting in the constrained admissible region (CAR). Based on known statistics of the measurement process, one can replace hard constraints with a probabilistic representation of the admissible region. This results in the probabilistic admissible region (PAR), which can be used for orbit initiation in Bayesian tracking and prioritization of tracks in a multiple hypothesis tracking framework. The PAR concept was introduced by the authors at the 2014 AMOS conference. In that paper, a Monte Carlo approach was used to show how to construct the PAR in the range/range-rate space based on known statistics of the measurement, semimajor axis, and eccentricity. An expectation-maximization algorithm was proposed to convert the particle cloud into a Gaussian Mixture Model (GMM) representation of the PAR. This GMM can be used to initialize a Bayesian filter. The PAR was found to be significantly non-uniform, invalidating an assumption frequently made in CAR-based filtering approaches. Using the GMM or particle cloud representations of the PAR, orbits can be prioritized for propagation in a multiple hypothesis tracking (MHT) framework. In this paper, the authors focus on expanding the PAR methodology to allow additional constraints, such as a constraint on perigee altitude, to be modeled in the PAR. This requires re-expressing the joint probability density function for the attributable vector as well as the (constrained) orbital parameters and range and range-rate. The final PAR is derived by accounting for any interdependencies between the parameters. Noting that the concepts presented are general and can be applied to any measurement scenario, the idea

  19. Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture

    Technology Transfer Automated Retrieval System (TEKTRAN)

    It is not well established if and to what extent mild to moderate cognitive impairment predicts mortality and risk of nursing home admission after hip fracture. To investigate prospectively whether and to what extent mild to moderate cognitive impairment, contributes to mortality and admission to nu...

  20. Preliminary Identification of Coping Profiles Relevant to Surrogate Decision Making in the ICU

    PubMed Central

    Hopkins, Ramona O.; Wilson, Emily L.; Orme, James F.; Beesley, Sarah J.; Kuttler, Kathryn; Brown, Samuel M.

    2016-01-01

    Objective The Intensive Care Unit (ICU) is a stressful environment for families of critically ill patients and these individuals are at risk to develop persistent psychological morbidity. Our study objective was to identify individual differences in coping with stress and information presentation preferences of respondents exposed to a simulated ICU experience. Methods Participants were recruited from a university and two community populations. Participants completed questionnaires that measured demographic information and characteristics that may be relevant to an individual’s ICU experience. Quality of life was measured by the EQ-5D, personality dimensions were examined with the abbreviated Big Five inventory, coping with stress was assessed with Brief COPE. Shared decision making preferences were assessed by the Degner Control Preferences Scale (CPS) and information seeking style was assessed with the Miller Behavioral Style Scale (MBSS). Social support was examined using an abbreviated version of the Social Relationship Index. Participants also completed a vignette-based simulated ICU experience, in which they made a surrogate decision on behalf of a loved one in the ICU. Results Three hundred forty-three participants completed the study. Three distinct coping profiles were identified: adaptive copers, maladaptive copers, and disengaged copers. Profiles differed primarily on coping styles, personality, quality of their closest social relationship, and history of anxiety and depression. Responses to the simulated ICU decision making experience differed across profiles. Disengaged copers (15%) were more likely to elect to refuse dialysis on behalf of an adult sibling compared to adaptive copers (7%) or maladaptive copers (5%) (p = 0.03). Notably, the MBSS and the CPS did not differ by coping profile. Conclusion Distinct coping profiles are associated with differences in responses to a simulated ICU experience. Tailoring communication and support to specific

  1. Oxidative status in ICU patients with septic shock.

    PubMed

    Karapetsa, Maria; Pitsika, Marina; Goutzourelas, Nikos; Stagos, Dimitrios; Tousia Becker, Aphrodite; Zakynthinos, Epaminondas

    2013-11-01

    The aim of this pilot study was to investigate variability of oxidative stress during sepsis evolution. ICU patients with the diagnosis of septic shock were included. Thiobarbituric-acid reactive substances, total antioxidant capacity, protein carbonyls in plasma, reduced, oxidized glutathione and catalase activity in erythrocyte lysate were assessed in the 1st, 3rd, 5th and 8th day after sepsis appearance. A total of 17 patients were divided in two groups: survivors (n=7) and non-survivors (n=10). APACHE II was 11.5 ± 5.4 and 19.9 ± 4.97 in survivors and non-survivors respectively (p=0.005), while mean age and SOFA score at sepsis diagnosis, were similar between the two groups. GSH levels, catalase activity and protein carbonyls presented significant different course in time between survivors and non-survivors (p<0.05). Catalase activity was significantly higher in survivors (238.8 ± 51.5) than non-survivors (166.4 ± 40.2; p=0.005), while protein carbonyls levels were significantly lower in survivors (0.32 ± 0.09) than non-survivors (0.48 ± 0.16; p=0.036) on the 1st day. Yet, non-survivors exhibited a declining course in GSH levels during time, while GSH levels were maintained in survivors. Conclusively, a longstanding antioxidant deficiency in non-surviving patients was noted. This phenomenon was clearly prominent in patients' erythrocytes.

  2. The nearest and dearest: a lifeline for ICU patients.

    PubMed

    Bergbom, I; Askwall, A

    2000-12-01

    This study was designed to examine, describe and elucidate patients' experiences of the presence and visits of the nearest and their participation in the care process during their stay in the ICU. Five patients, three men and two women, were interviewed for about one hour each. A hermeneutic approach was used when the texts from the interviews were interpreted and analysed. The theoretical frame of interpretation was based on Tillich's theory concerning 'The courage to be' and Eriksson's theory on 'Suffering'. It was found that suffering from severe disease or injury results in not only a threat against the person as an individual, but also against the individual as a part in the world, with consequent feelings of estrangement and the fear of meaninglessness. The threat can, however, be neutralized by the nearests' presence and visits. These represent fellowship, togetherness and participation and thus can help to maintain the patient's identity and individuality. By experiencing this, patients as individuals may be able to affirm themselves and their 'courage to be' will be given strength and support.

  3. Evaluation of Mental Workload among ICU Ward's Nurses

    PubMed Central

    Mohammadi, Mohsen; Mazloumi, Adel; Kazemi, Zeinab; Zeraati, Hojat

    2015-01-01

    Background: High level of workload has been identified among stressors of nurses in intensive care units (ICUs). The present study investigated nursing workload and identified its influencing perfor­mance obstacles in ICUs. Methods: This cross-sectional study was conducted, in 2013, on 81 nurses working in ICUs in Imam Khomeini Hospital in Tehran, Iran. NASA-TLX was applied for assessment of workload. Moreover, ICUs Performance Obstacles Questionnaire was used to identify performance obstacles associated with ICU nursing. Results: Physical demand (mean=84.17) was perceived as the most important dimensions of workload by nurses. The most critical performance obstacles affecting workload included: difficulty in finding a place to sit down, hectic workplace, disorganized workplace, poor-conditioned equipment, waiting for using a piece of equipment, spending much time seeking for supplies in the central stock, poor quality of medical materials, delay in getting medications, unpredicted problems, disorganized central stock, outpatient surgery, spending much time dealing with family needs, late, inadequate, and useless help from nurse assistants, and ineffective morning rounds (P-value<0.05). Conclusion: Various performance obstacles are correlated with nurses' workload, affirms the significance of nursing work system characteristics. Interventions are recommended based on the results of this study in the work settings of nurses in ICUs. PMID:26933647

  4. Enhanced in vivo protein synthesis in circulating immune cells of ICU patients.

    PubMed

    Januszkiewicz, Anna; Klaude, Maria; Loré, Karin; Andersson, Jan; Ringdén, Olle; Rooyackers, Olav; Wernerman, Jan

    2007-11-01

    Insufficient function of the immune system contributes to a poor prognosis in intensive care unit (ICU) patients. However, the immune system function is not easily monitored and evaluated. In vivo protein synthesis determination in immune competent cells offers a possibility to quantify immunological activation. The aim of this descriptive study was to determine the in vivo fractional protein synthesis rate (FSR) in immune cells of ICU patients during the initial phase of the critical illness. Patients (n = 20) on ventilator treatment in the general ICU were studied during their first week of ICU stay. FSR was determined in circulating T lymphocytes, mononuclear cells, the whole population of blood leukocytes, and in stationary immune cells of palatine tonsils during a 90-min period by a flooding technique. Healthy, adult subjects (n = 11), scheduled for elective ear, nose, and throat surgery served as a control group. The FSR in leukocytes and mononuclear cells of ICU patients was higher compared with the control group. In contrast, the FSR of circulating T lymphocytes and of tonsillar cells was not different from that in the healthy subjects. In summary, the ICU patients showed a distinct polarization of metabolic responses during the initial phase of the critical illness. The in vivo rate of protein synthesis was high in the circulating mononuclear cells and leukocytes, reflecting enhanced metabolic activity in these cell populations. Determination of the in vivo protein synthesis rate may be used as a tool to obtain additional information on activation of the immune system.

  5. Predictive Models for Identification of Hospitalized Patients Harboring KPC-Producing Klebsiella pneumoniae

    PubMed Central

    Trecarichi, Enrico Maria; Tumietto, Fabio; Del Bono, Valerio; De Rosa, Francesco Giuseppe; Bassetti, Matteo; Losito, Angela Raffaella; Tedeschi, Sara; Saffioti, Carolina; Corcione, Silvia; Giannella, Maddalena; Raffaelli, Francesca; Pagani, Nicole; Bartoletti, Michele; Spanu, Teresa; Marchese, Anna; Cauda, Roberto; Viscoli, Claudio; Viale, Pierluigi

    2014-01-01

    The production of Klebsiella pneumoniae carbapenemases (KPCs) by Enterobacteriaceae has become a significant problem in recent years. To identify factors that could predict isolation of KPC-producing K. pneumoniae (KPCKP) in clinical samples from hospitalized patients, we conducted a retrospective, matched (1:2) case-control study in five large Italian hospitals. The case cohort consisted of adult inpatients whose hospital stay included at least one documented isolation of a KPCKP strain from a clinical specimen. For each case enrolled, we randomly selected two matched controls with no KPCKP-positive cultures of any type during their hospitalization. Matching involved hospital, ward, and month/year of admission, as well as time at risk for KPCKP isolation. A subgroup analysis was also carried out to identify risk factors specifically associated with true KPCKP infection. During the study period, KPCKP was isolated from clinical samples of 657 patients; 426 of these cases appeared to be true infections. Independent predictors of KPCKP isolation were recent admission to an intensive care unit (ICU), indwelling urinary catheter, central venous catheter (CVC), and/or surgical drain, ≥2 recent hospitalizations, hematological cancer, and recent fluoroquinolone and/or carbapenem therapy. A Charlson index of ≥3, indwelling CVC, recent surgery, neutropenia, ≥2 recent hospitalizations, and recent fluoroquinolone and/or carbapenem therapy were independent risk factors for KPCKP infection. Models developed to predict KPCKP isolation and KPCKP infection displayed good predictive power, with the areas under the receiver-operating characteristic curves of 0.82 (95% confidence interval [CI], 0.80 to 0.84) and 0.82 (95% CI, 0.80 to 0.85), respectively. This study provides novel information which might be useful for the clinical management of patients harboring KPCKP and for controlling the spread of this organism. PMID:24733460

  6. Guideposts of an Effective Admissions Program for the Private School.

    ERIC Educational Resources Information Center

    Johnson, Raymond E.

    1980-01-01

    Describes fundamental guideposts for an effective private school admissions program. Included are a clear statement of purpose, informative literature, clearly stated admission requirements, standardized testing, a cooperative faculty, image positioning and a recruiting plan. (RC)

  7. Acute and Chronic Effects of Particles on Hospital Admissions in New-England

    PubMed Central

    Kloog, Itai; Coull, Brent A.; Zanobetti, Antonella; Koutrakis, Petros; Schwartz, Joel D.

    2012-01-01

    Background Many studies have reported significant associations between exposure to PM2.5 and hospital admissions, but all have focused on the effects of short-term exposure. In addition all these studies have relied on a limited number of PM2.5 monitors in their study regions, which introduces exposure error, and excludes rural and suburban populations from locations in which monitors are not available, reducing generalizability and potentially creating selection bias. Methods Using our novel prediction models for exposure combining land use regression with physical measurements (satellite aerosol optical depth) we investigated both the long and short term effects of PM2.5 exposures on hospital admissions across New-England for all residents aged 65 and older. We performed separate Poisson regression analysis for each admission type: all respiratory, cardiovascular disease (CVD), stroke and diabetes. Daily admission counts in each zip code were regressed against long and short-term PM2.5 exposure, temperature, socio-economic data and a spline of time to control for seasonal trends in baseline risk. Results We observed associations between both short-term and long-term exposure to PM2.5 and hospitalization for all of the outcomes examined. In example, for respiratory diseases, for every10-µg/m3 increase in short-term PM2.5 exposure there is a 0.70 percent increase in admissions (CI = 0.35 to 0.52) while concurrently for every10-µg/m3 increase in long-term PM2.5 exposure there is a 4.22 percent increase in admissions (CI = 1.06 to 4.75). Conclusions As with mortality studies, chronic exposure to particles is associated with substantially larger increases in hospital admissions than acute exposure and both can be detected simultaneously using our exposure models. PMID:22529923

  8. Interviewing strategically to elicit admissions from guilty suspects.

    PubMed

    Tekin, Serra; Granhag, Pär Anders; Strömwall, Leif; Giolla, Erik Mac; Vrij, Aldert; Hartwig, Maria

    2015-06-01

    In this article we introduce a novel interviewing tactic to elicit admissions from guilty suspects. By influencing the suspects' perception of the amount of evidence the interviewer holds against them, we aimed to shift the suspects' counterinterrogation strategies from less to more forthcoming. The proposed tactic (SUE-Confrontation) is a development of the Strategic Use of Evidence (SUE) framework and aims to affect the suspects' perception by confronting them with statement-evidence inconsistencies. Participants (N = 90) were asked to perform several mock criminal tasks before being interviewed using 1 of 3 interview techniques: (a) SUE-Confrontation, (b) Early Disclosure of Evidence, or (c) No Disclosure of Evidence. As predicted, the SUE-Confrontation interview generated more statement-evidence inconsistencies from suspects than the Early Disclosure interview. Importantly, suspects in the SUE-Confrontation condition (vs. Early and No disclosure conditions) admitted more self-incriminating information and also perceived the interviewer to have had more information about the critical phase of the crime (the phase where the interviewer lacked evidence). The findings show the adaptability of the SUE-technique and how it may be used as a tool for eliciting admissions.

  9. Reclaiming the Educational Role of Chief Admission Officers.

    ERIC Educational Resources Information Center

    McDonough, Patricia; Robertson, Larry

    1995-01-01

    Describes changes that have occurred in high schools, colleges, and the entrepreneurial admission sector. Relates the evolution of the admission officer's job since the early 1960s and the profession's rapid growth. Details the hybrid role of marketer and educator for chief admissions officers, and issues a call for professional standards. (RJM)

  10. Female and Male Admission to Graduate School: An Illustrative Inquiry

    ERIC Educational Resources Information Center

    Maxwell, Scott E.; Jones, Lyle V.

    1976-01-01

    Female and male admission rates to four graduate programs at a university were compared over a two year time period to assess possible sex bias in admission procedures. The overall results showed that sex played only a modest role in admission decisions. (Author/DEP)

  11. Behind the Scenes, Admissions Offices Conquer Mounds of Mail

    ERIC Educational Resources Information Center

    Farrell, Elizabeth F.

    2008-01-01

    If coming back to work after winter break seems daunting, consider the plight of college-admissions officials. While most high-school students are breathing a sigh of relief after finally submitting their applications, those on the receiving end are rolling up their sleeves. January is crunch time for many admissions offices. Admissions officers…

  12. 45 CFR 618.305 - Preference in admission.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 3 2011-10-01 2011-10-01 false Preference in admission. 618.305 Section 618.305 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.305 Preference in admission....

  13. 45 CFR 618.305 - Preference in admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Preference in admission. 618.305 Section 618.305 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.305 Preference in admission....

  14. 45 CFR 618.305 - Preference in admission.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Preference in admission. 618.305 Section 618.305 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.305 Preference in admission....

  15. 45 CFR 618.305 - Preference in admission.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 3 2012-10-01 2012-10-01 false Preference in admission. 618.305 Section 618.305 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION... Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 618.305 Preference in admission....

  16. The Roles of Testing and Diversity in College Admissions.

    ERIC Educational Resources Information Center

    Clarke, Marguerite; Shore, Arnold

    In order to understand the roles of test scores and diversity characteristics (including race and ethnicity) in the admission process, National Board researchers interviewed admissions directors who worked at selective public and private institutions are well as admissions consultants in the summer and fall of 1999. This report presents an…

  17. Equity of Access. New Approaches to Minority Admissions

    ERIC Educational Resources Information Center

    Bingham, Rebecca Saady

    1978-01-01

    One new approach to the admission of minorities to medical schools is that of the Simulated Minority Admission Exercises (SMAE). It sensitizes admission committee members to the different backgrounds of minority applicants and teaches them to evaluate them more effectively. (Author/AM)

  18. 49 CFR 511.34 - Requests for admission.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... for the admission, for the purposes of the pending proceeding only, of the truth of any matters within... served upon any party after filing of the answer. Each matter as to which an admission is requested shall be separately set forth. (b) Procedure for response. The matter as to which an admission is...

  19. 6 CFR 17.305 - Preference in admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Preference in admission. 17.305 Section 17.305... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 17.305 Preference in admission. A...

  20. 18 CFR 1317.305 - Preference in admission.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Preference in admission... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1317.305 Preference in admission....

  1. 49 CFR 1114.3 - Admissibility of business records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 8 2013-10-01 2013-10-01 false Admissibility of business records. 1114.3 Section... § 1114.3 Admissibility of business records. Any writing or record, whether in the form of an entry in a... be admissible as evidence thereof if it appears that it was made in the regular course of...

  2. 49 CFR 1114.3 - Admissibility of business records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Admissibility of business records. 1114.3 Section... § 1114.3 Admissibility of business records. Any writing or record, whether in the form of an entry in a... be admissible as evidence thereof if it appears that it was made in the regular course of...

  3. 49 CFR 1114.3 - Admissibility of business records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 8 2012-10-01 2012-10-01 false Admissibility of business records. 1114.3 Section... § 1114.3 Admissibility of business records. Any writing or record, whether in the form of an entry in a... be admissible as evidence thereof if it appears that it was made in the regular course of...

  4. 42 CFR 456.122 - Evaluation criteria for admission review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Evaluation criteria for admission review. 456.122...: Review of Need for Admission 1 § 456.122 Evaluation criteria for admission review. The UR plan must provide that— (a) The committee develops written medical care criteria to assess the need for...

  5. Eliminating Standardized Tests in College Admissions: The New Affirmative Action?

    ERIC Educational Resources Information Center

    Zwick, Rebecca

    1999-01-01

    Eliminating the Scholastic Aptitude Test for college admissions might seem a form of covert affirmative action. Although it is possible to design a workable admissions policy that excludes standardized tests (as 15 percent of colleges have done), banishing admissions tests to further a social-policy goal indirectly is unsound policy. (Contains 25…

  6. Secondary infection and clinical aspects after pandemic swine–origin influenza a (H1N1) admission in an Iranian critical care unite

    PubMed Central

    Hashemian, Seyed Mohammadreza; Tabarsi, Payam; Nadji, Seyed Alireza; Jamaati, Hamidreza; Mohajerani, Seyed Amir; Shamaee, Massoud; Chitsazan, Mandana; Radmand, Golnar; Maadani, Mohammadreza; Mansouri, Seyed Davoud

    2014-01-01

    Objective: A new flu virus (H1N1) swine origin and cause of human infection with acute lung disease was published in the world and led to many patients were admitted in intensive care unit (ICU). Materials and Methods: In a prospective descriptive study, all ICU patients in a pulmonary disease specialist hospital between April 2010 and July 2011 with confirmed infection (H1N1) were evaluated. Information including demographic, clinical and microbiology using Statistical Package for Social Sciences (SPSS) software version 16 was studied and classified. Results: Of 46 patients hospitalized with confirmed diagnosis of swine flu pneumonia (H1N1), 20 cases (43.7%) admitted in ICU out of which 10 cases were males (50%), the mean age was 36.9 and the range was 21-66 years. Nine patients (45%) had underlying diseases. Most underlying disease was respiratory disease in which four cases (20%) were of asthma and one patient had chronic obstructive pulmonary disease (COPD). No admission of pregnant patient with swine flu was reported in the ICU. Cough and sputum were the most frequent symptoms (19 patients equal 95%). Four patients (20%) were admitted with decreased level of consciousness and five cases (25%) died during hospitalization. Conclusion: It seems, swine flu with high mortality and transfer rates is a worldwide health problem. Because of limited treatment regimen, the risk of secondary infection and high need to intensive care in H1N1 pneumonia, environmental control, including vaccination of high risk people and public announcement, make determining role in controlling of this disease. PMID:25625063

  7. OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records

    PubMed Central

    Chen, Jonathan H; Podchiyska, Tanya

    2016-01-01

    Objective: To answer a “grand challenge” in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com’s product recommender. Materials and Methods: EMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender’s ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients. Results: Compared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10−10) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10−16). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. Discussion: Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from “correct” ones. Conclusions: Collaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. “interesting” suggestions). PMID:26198303

  8. Lasers, the Price of Admission in 2045

    DTIC Science & Technology

    2015-04-01

    altitude. Water vapor, pollutants , and other particles in the air , which are more prevalent at lower altitudes, cause absorption and scattering. These...AU/ACSC/DAYTON, J/AY15 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY LASERS, THE PRICE OF ADMISSION IN 2045 by John G. Dayton, Maj, USAF...the Degree of MASTER OF OPERATIONAL ARTS AND SCIENCE Advisors: Lt Col Paul P. Clemans, Maj Thomas E. Kiesling Maxwell Air Force Base, Alabama

  9. Modern Approach to SAH in Intensive Care Unit (ICU)

    PubMed Central

    Bruder, N.; Velly, L.; Codaccioni, J.-L.

    2008-01-01

    Summary SAH is still a severe pathology carrying a high risk of death or severe neurological morbidity. New diagnostic, monitoring and therapeutic methods are available for the detection and treatment of vasospasm. This includes transcranial Doppler, CT or MRI perfusion scan, protein S100B dosage, cerebral blood flow monitoring at the bedside. Medical treatment of vasospasm relies on increased blood pressure and dobutamine. Emergency balloon angioplasty or arterial vasodilator infusion is mandatory in case of vasospam-induced ischemic deficit. Despite several medical advances in the treatment of subarachnoid haemorrhage (SAH) due to aneurysm rupture, particularly interventional neuroradiology, it remains a potentially devastating illness with a high mortality rate. The most important determinant of outcome is neurologic state on arrival in the hospital, assessed with the World Federation of Neurological Surgeons (WFNS) scale (table 1)1. Delayed cerebral ischemia due to cerebral vasospasm and medical complications due to SAH have both a major impact on outcome. The cooperative aneurysm study, including 457 patients with SAH, showed that the proportion of deaths from medical complications (23%) was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture (2). Thus, the aim of ICU management is to prevent or to limit the consequences of vasospasm and to treat medical complications that can have an adverse effect on the brain. Table 1Classification of the World Federation of Neurological Surgeons (WFNS)GradeGlasgow Coma ScoreMotor deficitGOS 1-3 at 6 months (%)*I  15     absent13II 13-14absent20III13-14present42IV7-12  present or absent51V 3-6   present or absent68GOS: Glasgow Outcome Score (1-3 : dead, persistent vegetative state or severe disability) PMID:20557769

  10. Forecasting peak asthma admissions in London: an application of quantile regression models.

    PubMed

    Soyiri, Ireneous N; Reidpath, Daniel D; Sarran, Christophe

    2013-07-01

    Asthma is a chronic condition of great public health concern globally. The associated morbidity, mortality and healthcare utilisation place an enormous burden on healthcare infrastructure and services. This study demonstrates a multistage quantile regression approach to predicting excess demand for health care services in the form of asthma daily admissions in London, using retrospective data from the Hospital Episode Statistics, weather and air quality. Trivariate quantile regression models (QRM) of asthma daily admissions were fitted to a 14-day range of lags of environmental factors, accounting for seasonality in a hold-in sample of the data. Representative lags were pooled to form multivariate predictive models, selected through a systematic backward stepwise reduction approach. Models were cross-validated using a hold-out sample of the data, and their respective root mean square error measures, sensitivity, specificity and predictive values compared. Two of the predictive models were able to detect extreme number of daily asthma admissions at sensitivity levels of 76 % and 62 %, as well as specificities of 66 % and 76 %. Their positive predictive values were slightly higher for the hold-out sample (29 % and 28 %) than for the hold-in model development sample (16 % and 18 %). QRMs can be used in multistage to select suitable variables to forecast extreme asthma events. The associations between asthma and environmental factors, including temperature, ozone and carbon monoxide can be exploited in predicting future events using QRMs.

  11. Characteristics of delayed admission to stroke unit.

    PubMed

    Silvestrelli, Giorgio; Parnetti, Lucilla; Tambasco, Nicola; Corea, Francesco; Capocchi, Giuseppe

    2006-01-01

    Early admission to stroke unit (SU) and factors that may cause admission delay represent relevant issues to obtain an optimal management of acute stroke. This study was aimed at recording timing from clinical onset to admission to our SU and to identify the reasons for delay. We prospectively examined acute stroke patients consecutively admitted to the Perugia SU. Baseline characteristics of stroke patients, stroke type and etiology, time from symptom onset to arrival in the SU were obtained from the Hospital-Based Perugia Stroke Registry. 60.8% of 2,213 consecutive stroke patients admitted to the SU arrived within 6 hrs and 39.2% after 6 hrs. Underestimation of symptoms was the cause of delay in 48.7% of cases. Younger age, especially for females, ischemic stroke, mild and/or unspecific symptoms and the underestimation of symptoms seem to be the main reasons for delayed arrival in the SU. To increase the proportion of stroke patients arriving in the SU within 3 hr of symptom onset, it is necessary to improve public and general practitioner awareness of stroke through educational programs.

  12. Development of a daily mortality probability prediction model from Intensive Care Unit patients using a discrete-time event history analysis.

    PubMed

    Huang, Ying Che; Chang, Kuang Yi; Lin, Shih Pin; Chen, Kung; Chan, Kwok Hon; Chang, Polun

    2013-08-01

    As studies have pointed out, severity scores are imperfect at predicting individual clinical chance of survival. The clinical condition and pathophysiological status of these patients in the Intensive Care Unit might differ from or be more complicated than most predictive models account for. In addition, as the pathophysiological status changes over time, the likelihood of survival day by day will vary. Actually, it would decrease over time and a single prediction value cannot address this truth. Clearly, alternative models and refinements are warranted. In this study, we used discrete-time-event models with the changes of clinical variables, including blood cell counts, to predict daily probability of mortality in individual patients from day 3 to day 28 post Intensive Care Unit admission. Both models we built exhibited good discrimination in the training (overall area under ROC curve: 0.80 and 0.79, respectively) and validation cohorts (overall area under ROC curve: 0.78 and 0.76, respectively) to predict daily ICU mortality. The paper describes the methodology, the development process and the content of the models, and discusses the possibility of them to serve as the foundation of a new bedside advisory or alarm system.

  13. Complexity in College Admission: Fact or Urban Myth. Research Findings of Parent and Student Perceptions of Complexity in College Admission

    ERIC Educational Resources Information Center

    College Board Advocacy & Policy Center, 2010

    2010-01-01

    In September 2007, the College Board formed the Task Force on Admissions in the 21st Century in response to a request from the Guidance and Admission Assembly Council (GAA Council) to more closely examine the high-school-to-college transition process. Each spring, at the conclusion of the college admission cycle, there is much discussion in the…

  14. A Role for Marketing in College Admissions. Papers Presented at the Colloquium on College Admissions, May 16-l8, 1976.

    ERIC Educational Resources Information Center

    College Entrance Examination Board, New York, NY.

    This collection stresses the need for informed and more sophisticated marketing techniques for college admissions officers to help them cope with the decreasing number of prospective college students. The importance of the college admissions office is increasing as admissions becomes a more crucial element to the colleges' financial well-being.…

  15. Universal Glove and Gown Use and Acquisition of Antibiotic resistant bacteria in the ICU: A Randomized Trial

    PubMed Central

    Harris, Anthony D; Pineles, Lisa; Belton, Beverly; Johnson, J. Kristie; Shardell, Michelle; Loeb, Mark; Newhouse, Robin; Dembry, Louise; Braun, Barbara; Perencevich, Eli N; Hall, Kendall K.; Morgan, Daniel J

    2014-01-01

    Importance Antibiotic-resistant bacteria are associated with increased patient morbidity and mortality. It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of antibiotic-resistant bacteria. Objective To assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care. Design, Setting, and Participants Cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from January 4, 2012, to October 4, 2012. Interventions In the intervention ICUs, all health care workers were required to wear gloves and gowns for all patient contact and when entering any patient room. Main Outcomes and Measures The primary outcome was acquisition of MRSA or VRE based on surveillance cultures collected on admission and discharge from the ICU. Secondary outcomes included individual VRE acquisition, MRSA acquisition, frequency of health care worker visits, hand hygiene compliance, health care–associated infections, and adverse events. Results From the 26 180 patients included, 92 241 swabs were collected for the primary outcome. Intervention ICUs had a decrease in the primary outcome of MRSA or VRE from 21.35 acquisitions per 1000 patient-days (95% CI, 17.57 to 25.94) in the baseline period to 16.91 acquisitions per 1000 patient-days (95% CI, 14.09 to 20.28) in the study period, whereas control ICUs had a decrease in MRSA or VRE from 19.02 acquisitions per 1000 patient-days (95% CI, 14.20 to 25.49) in the baseline period to 16.29 acquisitions per 1000 patient-days (95% CI, 13.48 to 19.68) in the study period, a difference in changes that was not statistically significant (difference, −1.71 acquisitions per 1000 person-days, 95% CI, −6.15 to 2.73; P = .57). For key secondary outcomes, there was no difference in VRE acquisition with the

  16. Variation in rates of hospital admission for appendicitis in Wales.

    PubMed Central

    West, R R; Carey, M J

    1978-01-01

    In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission. PMID:656866

  17. Methicillin-resistant Staphylococcus aureus infection or colonization present at hospital admission: multivariable risk factor screening to increase efficiency of surveillance culturing.

    PubMed

    Haley, Clinton C; Mittal, Deepa; Laviolette, Amanda; Jannapureddy, Sai; Parvez, Najma; Haley, Robert W

    2007-09-01

    Identifying methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection present at admission has become important in reducing subsequent nosocomial transmission, but the most efficient surveillance methods remain to be defined. We performed anterior nares surveillance cultures of all patients upon admission to and discharge from the general internal medicine floor in our community hospital over a 7-week period, and patients completed a questionnaire on MRSA risk factors. Of the 401 patients, 41 (10.2%) had MRSA upon admission. Of the 48 risk measures analyzed, 10 were significantly associated with admission MRSA, and 7 of these were independently associated in stepwise logistic regression analysis. Factor analysis identified eight latent variables that contained most of the predictive information in the 48 risk measures. Repeat logistic regression analysis including the latent variables revealed three independent risk measures for admission MRSA: a nursing home stay (relative risk [RR], 6.18; 95% confidence interval [95% CI], 3.56 to 10.72; P < 0.0001), prior MRSA infection (RR, 3.97; 95% CI, 1.94 to 8.12; P = 0.0002), and the third latent variable (factor 3; RR, 3.14; 95% CI, 1.56 to 6.31; P = 0.0013), representing the combined effects of homelessness, jail stay, promiscuity, intravenous drug use, and other drug use. Multivariable models had greater sensitivity at detecting admission MRSA than any single risk measure and allowed detection of 78% to 90% of admission MRSA from admission surveillance cultures on 46% to 58% of admissions. If confirmed in additional studies, multivariable questionnaire screening at admission might identify a subset of admissions for surveillance cultures that would more efficiently identify most admission MRSA.

  18. MIMIC II: a massive temporal ICU patient database to support research in intelligent patient monitoring

    NASA Technical Reports Server (NTRS)

    Saeed, M.; Lieu, C.; Raber, G.; Mark, R. G.

    2002-01-01

    Development and evaluation of Intensive Care Unit (ICU) decision-support systems would be greatly facilitated by the availability of a large-scale ICU patient database. Following our previous efforts with the MIMIC (Multi-parameter Intelligent Monitoring for Intensive Care) Database, we have leveraged advances in networking and storage technologies to develop a far more massive temporal database, MIMIC II. MIMIC II is an ongoing effort: data is continuously and prospectively archived from all ICU patients in our hospital. MIMIC II now consists of over 800 ICU patient records including over 120 gigabytes of data and is growing. A customized archiving system was used to store continuously up to four waveforms and 30 different parameters from ICU patient monitors. An integrated user-friendly relational database was developed for browsing of patients' clinical information (lab results, fluid balance, medications, nurses' progress notes). Based upon its unprecedented size and scope, MIMIC II will prove to be an important resource for intelligent patient monitoring research, and will support efforts in medical data mining and knowledge-discovery.

  19. Temporal Informative Analysis in Smart-ICU Monitoring: M-HealthCare Perspective.

    PubMed

    Bhatia, Munish; Sood, Sandeep K

    2016-08-01

    The rapid introduction of Internet of Things (IoT) Technology has boosted the service deliverance aspects of health sector in terms of m-health, and remote patient monitoring. IoT Technology is not only capable of sensing the acute details of sensitive events from wider perspectives, but it also provides a means to deliver services in time sensitive and efficient manner. Henceforth, IoT Technology has been efficiently adopted in different fields of the healthcare domain. In this paper, a framework for IoT based patient monitoring in Intensive Care Unit (ICU) is presented to enhance the deliverance of curative services. Though ICUs remained a center of attraction for high quality care among researchers, still number of studies have depicted the vulnerability to a patient's life during ICU stay. The work presented in this study addresses such concerns in terms of efficient monitoring of various events (and anomalies) with temporal associations, followed by time sensitive alert generation procedure. In order to validate the system, it was deployed in 3 ICU room facilities for 30 days in which nearly 81 patients were monitored during their ICU stay. The results obtained after implementation depicts that IoT equipped ICUs are more efficient in monitoring sensitive events as compared to manual monitoring and traditional Tele-ICU monitoring. Moreover, the adopted methodology for alert generation with information presentation further enhances the utility of the system.

  20. One-Year Outcome of Geriatric Hip-Fracture Patients following Prolonged ICU Treatment

    PubMed Central

    Eschbach, Daphne; Bliemel, Christopher; Oberkircher, Ludwig; Aigner, Rene; Hack, Juliana; Bockmann, Benjamin; Ruchholtz, Steffen; Buecking, Benjamin

    2016-01-01

    Purpose. Incidence of geriatric fractures is increasing. Knowledge of outcome data for hip-fracture patients undergoing intensive-care unit (ICU) treatment, including invasive ventilatory management (IVM) and hemodiafiltration (CVVHDF), is sparse. Methods. Single-center prospective observational study including 402 geriatric hip-fracture patients. Age, gender, the American Society of Anesthesiologists (ASA) classification, and the Barthel index (BI) were documented. Underlying reasons for prolonged ICU stay were registered, as well as assessed procedures like IVM and CVVHDF. Outcome parameters were in-hospital, 6-month, and 1-year mortality and need for nursing care. Results. 15% were treated > 3 days and 68% < 3 days in ICU. Both cohorts had similar ASA, BI, and age. In-hospital, 6-month, and 12-month mortality of ICU > 3d cohort were significantly increased (p = 0.001). Most frequent indications were cardiocirculatory pathology followed by respiratory failure, renal impairment, and infection. 18% of patients needed CVVHDF and 41% IVM. In these cohorts, 6-month mortality ranged > 80% and 12-month mortality > 90%. 100% needed nursing care after 6 and 12 months. Conclusions. ICU treatment > 3 days showed considerable difference in mortality and nursing care needed after 6 and 12 months. Particularly, patients requiring CVVHDF or IVM had disastrous long-term results. Our study may add one further element in complex decision making serving this vulnerable patient cohort. PMID:26881228

  1. Forecasting asthma-related hospital admissions in London using negative binomial models.

    PubMed

    Soyiri, Ireneous N; Reidpath, Daniel D; Sarran, Christophe

    2013-05-01

    Health forecasting can improve health service provision and individual patient outcomes. Environmental factors are known to impact chronic respiratory conditions such as asthma, but little is known about the extent to which these factors can be used for forecasting. Using weather, air quality and hospital asthma admissions, in London (2005-2006), two related negative binomial models were developed and compared with a naive seasonal model. In the first approach, predictive forecasting models were fitted with 7-day averages of each potential predictor, and then a subsequent multivariable model is constructed. In the second strategy, an exhaustive search of the best fitting models between possible combinations of lags (0-14 days) of all the environmental effects on asthma admission was conducted. Three models were considered: a base model (seasonal effects), contrasted with a 7-day average model and a selected lags model (weather and air quality effects). Season is the best predictor of asthma admissions. The 7-day average and seasonal models were trivial to implement. The selected lags model was computationally intensive, but of no real value over much more easily implemented models. Seasonal factors can predict daily hospital asthma admissions in London, and there is a little evidence that additional weather and air quality information would add to forecast accuracy.

  2. Wavelet frames and admissibility in higher dimensions

    NASA Astrophysics Data System (ADS)

    Führ, Hartmut

    1996-12-01

    This paper is concerned with the relations between discrete and continuous wavelet transforms on k-dimensional Euclidean space. We start with the construction of continuous wavelet transforms with the help of square-integrable representations of certain semidirect products, thereby generalizing results of Bernier and Taylor. We then turn to frames of L2(Rk) and to the question, when the functions occurring in a given frame are admissible for a given continuous wavelet transform. For certain frames we give a characterization which generalizes a result of Daubechies to higher dimensions.

  3. Novel Representation of Clinical Information in the ICU: Developing User Interfaces which Reduce Information Overload.

    PubMed

    Pickering, B W; Herasevich, V; Ahmed, A; Gajic, O

    2010-01-01

    The introduction of electronic medical records (EMR) and computerized physician order entry (CPOE) into the intensive care unit (ICU) is transforming the way health care providers currently work. The challenge facing developers of EMR's is to create products which add value to systems of health care delivery. As EMR's become more prevalent, the potential impact they have on the quality and safety, both negative and positive, will be amplified. In this paper we outline the key barriers to effective use of EMR and describe the methodology, using a worked example of the output. AWARE (Ambient Warning and Response Evaluation), is a physician led, electronic-environment enhancement program in an academic, tertiary care institution's ICU. The development process is focused on reducing information overload, improving efficiency and eliminating medical error in the ICU.

  4. Teamwork and team training in the ICU: where do the similarities with aviation end?

    PubMed

    Reader, Tom W; Cuthbertson, Brian H

    2011-01-01

    The aviation industry has made significant progress in identifying the skills and behaviors that result in effective teamwork. Its conceptualization of teamwork, development of training programs, and design of assessment tools are highly relevant to the intensive care unit (ICU). Team skills are important for maintaining safety in both domains, as multidisciplinary teams must work effectively under highly complex, stressful, and uncertain conditions. However, there are substantial differences in the nature of work and structure of teams in the ICU in comparison with those in aviation. While intensive care medicine may wish to use the advances made by the aviation industry for conceptualizing team skills and implementing team training programs, interventions must be tailored to the highly specific demands of the ICU.

  5. Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record*

    PubMed Central

    Dyer, Edward; Mohan, Vishnu; Gold, Jeffrey A.

    2017-01-01

    Objectives: Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. Design: Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters’ paper prerounding notes. Setting: Twenty-six-bed academic medical ICU with a well-established electronic health record. Subjects: ICU rounds presenter (medical student or resident physician), interprofessional rounding team. Interventions: None. Measurements and Main Results: During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. Conclusion: Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized

  6. Innovative use of tele-ICU in long-term acute care hospitals.

    PubMed

    Mullen-Fortino, Margaret; Sites, Frank D; Soisson, Michael; Galen, Julie

    2012-01-01

    Tele-intensive care units (ICUs) typically provide remote monitoring for ICUs of acute care, short-stay hospitals. As part of a joint venture project to establish a long-term acute level of care, Good Shepherd Penn Partners became the first facility to use tele-ICU technology in a nontraditional setting. Long-term acute care hospitals care for patients with complex medical problems. We describe describes the benefits and challenges of integrating a tele-ICU program into a long-term acute care setting and the impact this model of care has on patient care outcomes.

  7. A Model to Predict Duration of Ventilation and 30-Day Mortality in Patients with Traumatic Injuries

    DTIC Science & Technology

    2014-12-02

    Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...2 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98...383 PATTERN OF HOSPITAL ADMISSIONS AND OUTCOME OF ACUTE ALUMINIUM PHOSPHIDE POISONING IN AN INDIAN ICU RANVIR SINGH1, diptimala agrawal2, vivek

  8. Development of a Maximum Admissions Index for Freshman Admissions to the University of Washington.

    ERIC Educational Resources Information Center

    Lunneborg, Clifford E.

    A new technique has been developed for admitting new freshman students at the University of Washington. Previously, an Admissions Index (AI) was used, in which the high school grade point average (HSGPA) was assigned twice the weight of the composite verbal and quantitative scores from the Washington Pre-College Test Battery (WPC). To offset the…

  9. Challenges in College Admissions. A Report of a Survey of Undergraduate Admissions Policies, Practices, and Procedures.

    ERIC Educational Resources Information Center

    Breland, Hunter M.; And Others

    The report summarizes undergraduate admissions policies, practices, and procedures at two- and four-year colleges and universities as of 1992. Information was drawn from a national survey, the third of a series conducted since 1979. A total of 2,024 institutions responded to the survey. An introductory chapter describes the surveys, their…

  10. Students Selection for University Course Admission at the Joint Admissions Board (Kenya) Using Trained Neural Networks

    ERIC Educational Resources Information Center

    Wabwoba, Franklin; Mwakondo, Fullgence M.

    2011-01-01

    Every year, the Joint Admission Board (JAB) is tasked to determine those students who are expected to join various Kenyan public universities under the government sponsorship scheme. This exercise is usually extensive because of the large number of qualified students compared to the very limited number of slots at various institutions and the…

  11. Underrepresented Minorities in Medical School Admissions: A Qualitative Study.

    PubMed

    Hadinger, Margaret A

    2017-01-01

    Phenomenon: This study explored Black/African American and Hispanic/Latino medical students' perceptions of the medical school admissions process. Previous research has explored other elements of the medical education continuum. However, little is known regarding minorities' perceptions of navigating the medical school admissions process. To address this gap in the literature, this exploratory study suggests a conceptual model describing why minorities apply to medical school and the influences affecting their admissions experience.

  12. Accuracy of caregivers’ recall of hospital admissions: implications for research

    PubMed Central

    Burakevych, Nataliia; McKinlay, Christopher Joel Dorman; Alsweiler, Jane Marie; Harding, Jane Elizabeth

    2015-01-01

    Aim To determine the accuracy of caregivers’ recall of hospital admissions in early childhood. Methods Prospective cohort study of babies born at risk of neonatal hypoglycaemia at Waikato Hospital, New Zealand, a regional public hospital and sole provider of acute inpatient care to over 100,000 children. Caregivers’ recall of children’s hospital admissions up to 4.5 years were compared with medical records. Accuracy of recall was related to neonatal and socio-demographic characteristics. Results Out of 267 children, 179 (67%) visited hospital and 106 (40%) were admitted at least once. The most frequent reasons for admission were for respiratory (29%) and gastrointestinal (18%) problems. Of 106 children admitted to hospital, 27 (25%) caregivers did not recall the admission and only 37 (35%) accurately recalled the number of admissions. The accuracy of recall was lower for gastrointestinal (38%) and surgical (40%) problems, while recall of respiratory (64%) and ear, nose and throat (60%) admissions was more accurate. Low socio-economic status and multiple admissions were associated with less accurate recall of number of admissions. Conclusion Caregivers do not accurately report hospital admissions. Questionnaire data about use of hospital facilities should be interpreted cautiously, and may not be sufficiently accurate for use in research studies. PMID:26355393

  13. Correlation of admissions statistics to graduate student success in medical physics.

    PubMed

    Burmeister, Jay; McSpadden, Erin; Rakowski, Joseph; Nalichowski, Adrian; Yudelev, Mark; Snyder, Michael

    2014-01-06

    The purpose of this work is to develop metrics for evaluation of medical physics graduate student performance, assess relationships between success and other quantifiable factors, and determine whether graduate student performance can be accurately predicted by admissions statistics. A cohort of 108 medical physics graduate students from a single institution were rated for performance after matriculation based on final scores in specific courses, first year graduate Grade Point Average (GPA), performance on the program exit exam, performance in oral review sessions, and faculty rating. Admissions statistics including matriculating program (MS vs. PhD); undergraduate degree type, GPA, and country; graduate degree; general and subject GRE scores; traditional vs. nontraditional status; and ranking by admissions committee were evaluated for potential correlation with the performance metrics. GRE verbal and quantitative scores were correlated with higher scores in the most difficult courses in the program and with the program exit exam; however, the GRE section most correlated with overall faculty rating was the analytical writing section. Students with undergraduate degrees in engineering had a higher faculty rating than those from other disciplines and faculty rating was strongly correlated with undergraduate country. Undergraduate GPA was not statistically correlated with any success metrics investigated in this study. However, the high degree of selection on GPA and quantitative GRE scores during the admissions process results in relatively narrow ranges for these quantities. As such, these results do not necessarily imply that one should not strongly consider traditional metrics, such as undergraduate GPA and quantitative GRE score, during the admissions process. They suggest that once applicants have been initially filtered by these metrics, additional selection should be performed via the other metrics shown here to be correlated with success. The parameters used

  14. Medical School Application Interview Score Has Limited Predictive Validity for Performance on a Fourth Year Clinical Practice Examination

    ERIC Educational Resources Information Center

    Basco, William T., Jr.; Lancaster, Carol J.; Gilbert, Gregory E.; Carey, Maura E.; Blue, Amy V.

    2008-01-01

    Background and purpose: Data supporting the predictive validity of the medical school admission interview are mixed. This study tested the hypothesis that the admission interview is predictive of interpersonal interactions between medical students and standardized patients. Method: We determined correlations between admission interview scores and…

  15. Admissions Criteria and Academic Performance in the AFIT Graduate Cost Analysis Program

    DTIC Science & Technology

    2007-11-02

    included scores from the Graduate Record Examination (GRE) and the Graduate Management Admissions Test ( GMAT ), undergraduate cumulative and math grade point...measures of the applicant’s time in military service. Predictive models were developed using stepwise linear regression. This research found the GMAT is more...the GMAT Verbal score, UGPA, and a dichotomous indicator of prior service as a member of the military enlisted corps.

  16. A discriminant function model for admission at undergraduate university level

    NASA Astrophysics Data System (ADS)

    Ali, Hamdi F.; Charbaji, Abdulrazzak; Hajj, Nada Kassim

    1992-09-01

    The study is aimed at predicting objective criteria based on a statistically tested model for admitting undergraduate students to Beirut University College. The University is faced with a dual problem of having to select only a fraction of an increasing number of applicants, and of trying to minimize the number of students placed on academic probation (currently 36 percent of new admissions). Out of 659 new students, a sample of 272 students (45 percent) were selected; these were all the students on the Dean's list and on academic probation. With academic performance as the dependent variable, the model included ten independent variables and their interactions. These variables included the type of high school, the language of instruction in high school, recommendations, sex, academic average in high school, score on the English Entrance Examination, the major in high school, and whether the major was originally applied for by the student. Discriminant analysis was used to evaluate the relative weight of the independent variables, and from the analysis three equations were developed, one for each academic division in the College. The predictive power of these equations was tested by using them to classify students not in the selected sample into successful and unsuccessful ones. Applicability of the model to other institutions of higher learning is discussed.

  17. Data, collaboration reduce sepsis mortality rates, improve use of ICU resources.

    PubMed

    2016-01-01

    Two different hospital systems have made sizable dents in their sepsis mortality rates through a collaborative process between emergency and ICU staff. At Northwest Hospital in Randallstown, MD, success occurred, in part, by lowering the threshold for transfer of emergency patients with signs of sepsis to the ICU. Voorhees, NJ-based Kennedy Health has lowered sepsis mortality rates by taking steps to integrate the care of sepsis patients between the ED and the ICU, and slashing the time required to deliver bundle-oriented care. Research conducted at Northwest Hospital shows that sepsis mortality decreased by nearly half, going from 14.38% before intervention to 7.85% following implementation of the lower ICU thresholds. Clinical leaders at Kennedy Health report that they have lowered sepsis mortality from the mid-20% range to less than 12% through a collaborative approach involving all stakeholders. Sources from both hospitals stress the importance of using data to achieve buy-in to improvement efforts, and giving interventions enough time to take hold.

  18. Psychological support for families of ICU patients: longitudinal documentation of the service.

    PubMed

    Demetriadou, E; Kokkinou, M; Metaxas, G; Kyriakides, E; Kyprianou, T

    2016-09-09

    This study is the first systematic effort to investigate psychological services provided to relatives of ICU patients at Nicosia General Hospital. Documentation of psychological sessions provided to relatives of ICU patients for the years 2011-2014 was analyzed. To investigate possible differences in the total number of sessions for the referenced years, the records were analyzed using patients' demographics, the outcome of hospitalization and the total number of sessions with relatives. A questionnaire was sent to the ICU staff aiming to identify their perception towards the need for psychological support. A total number of 863 psychological sessions were conducted with 640 relatives of 345 patients hospitalized in the ICU. Results indicate that more sessions are recorded when the outcome of younger patients' condition worsens, whereas the number of sessions decreases for older patients' families. When comparing the personnel's beliefs, regarding the importance of providing psychological services to different age groups, significant difference was found suggesting that the older the patient the less sessions they believe are required indicating a possible ageism bias.

  19. Reducing iatrogenic risks: ICU-acquired delirium and weakness--crossing the quality chasm.

    PubMed

    Vasilevskis, Eduard E; Ely, E Wesley; Speroff, Theodore; Pun, Brenda T; Boehm, Leanne; Dittus, Robert S

    2010-11-01

    ICUs are experiencing an epidemic of patients with acute brain dysfunction (delirium) and weakness, both associated with increased mortality and long-term disability. These conditions are commonly acquired in the ICU and are often initiated or exacerbated by sedation and ventilation decisions and management. Despite > 10 years of evidence revealing the hazards of delirium, the quality chasm between current and ideal processes of care continues to exist. Monitoring of delirium and sedation levels remains inconsistent. In addition, sedation, ventilation, and physical therapy practices proven successful at reducing the frequency and severity of adverse outcomes are not routinely practiced. In this article, we advocate for the adoption and implementation of a standard bundle of ICU measures with great potential to reduce the burden of ICU-acquired delirium and weakness. Individual components of this bundle are evidence based and can help standardize communication, improve interdisciplinary care, reduce mortality, and improve cognitive and functional outcomes. We refer to this as the "ABCDE bundle," for awakening and breathing coordination, delirium monitoring, and exercise/early mobility. This evidence-based bundle of practices will build a bridge across the current quality chasm from the "front end" to the "back end" of critical care and toward improved cognitive and functional outcomes for ICU survivors.

  20. Drug Resistance of Pseudomonas aeruginosa and Enterobacter cloacae Isolated from ICU, Babol, Northern Iran

    PubMed Central

    Bayani, Masoomeh; Siadati, Sepideh; Rajabnia, Ramzan; Taher, Ali Asghar

    2013-01-01

    Multidrug resistant (MDR) bacteria are spread throughout the world which causes nosocomial infections, especially in Intensive Care Unit (ICU). This study aimed to investigate the resistance pattern of Pseudomonas aeruginosa and Enterobacter cloacae isolated from patients in the ICU. During 2011-2012, 30 isolates for each P. aeruginosa and E. cloacae were collected from the patients who acquired nosocomial infection after admition to the ICU at the hospitals affiliated to Babol University of Medical Sciences, Babol, northern Iran. Antimicrobial susceptibility test was performed for five category antibiotics by microdilution method. The data were analyzed by SPSS version 20 and p<0.05 was considered statistically significant. The highest resistance rate of P. aeruginosa was seen to amikacin (53.3%) followed by ceftazidime (43.3%). Also, 16.7% of E. cloacae was resistant to ceftazidime. Among P. aeruginosa isolates,18 (60%) were MDR while no E. cloacae isolates were MDR. The significant correlation was only demonstrated between MDR P. aeruginosa and the reason of hospitalization (P=0.004). In conclusion, there was alarming amount of P. aeruginosa MDR in patients in the ICU which could lead to a hazardous outcome for the patients. Therefore, new prevention policies regarding to hospital infection should be established. Also, the periodical assessment of bacterial resistance pattern particularly in ICUs should be performed. PMID:24551814

  1. Inter-rater Agreement on Identification of Electrographic Seizures and Periodic Discharges in ICU EEG Recordings

    PubMed Central

    Halford, J.J.; Shiau, D.; Desrochers, J.A.; Kolls, B.J.; Dean, B.C.; Waters, C.G.; Azar, N.J.; Haas, K.F.; Kutluay, E.; Martz, G.U.; Sinha, S.R.; Kern, R.T.; Kelly, K.M.; Sackellares, J.C.; LaRoche, S.M.

    2015-01-01

    Objective This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings. Methods Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-hour EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC). Results Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k = 0.58 vs. 0.38; p < 0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test. Conclusions IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA. Significance This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature. PMID:25481336

  2. Developing, implementing, and evaluating a multifaceted quality improvement intervention to promote sleep in an ICU.

    PubMed

    Kamdar, Biren B; Yang, Jessica; King, Lauren M; Neufeld, Karin J; Bienvenu, O Joseph; Rowden, Annette M; Brower, Roy G; Collop, Nancy A; Needham, Dale M

    2014-01-01

    Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). To supplement previously published results of this QI intervention, the present article describes the specific QI framework used to develop and implement this intervention, which consists of 4 steps: (a) summarizing the evidence to create a list of sleep-promoting interventions, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education and regular project evaluation. Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives.

  3. Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses✩

    PubMed Central

    Morris, David S.; Schweickert, William; Holena, Daniel; Handzel, Robert; Sims, Carrie; Pascual, Jose L.; Sarani, Babak

    2013-01-01

    Introduction Although rapid response systems (RRS) have been shown to decrease the incidence of cardiac arrest (CA), there are no studies evaluating optimal staffing. We hypothesize that there are no outcome differences between ICU physician and senior resident led events. Methods A retrospective study of the RRS database at a single, academic hospital was performed from July 1, 2006 to May 31, 2010. Surgical patients and those in the ICU were excluded. Daytime (D) was defined as 7 am–5 pm Monday through Friday, and weekends were defined as 5 pm on Friday to 6:59 am on Monday. The nurse to patient ratio is constant during all shifts. An ICU physician leads daytime events on weekdays whereas night/weekend (NW) events are led by residents. NW events were compared against D events using chi square or Fischer’s exact test. Significance was defined as p < 0.05. Results A total of 1404 events were reviewed with 534 (38%) D and 870 (62%) NW events. Respiratory and staff concerns were more likely during NW compared to D (50% vs. 39% and 46% vs. 34%, p < 0.001, respectively). Following RRS activation, no difference was noted between D and NW periods in the incidence of progression to CA, transfer to ICU, or hospital mortality. Invasive procedures were more common in the NW period. Conclusion Resident-led RRS may have similar outcomes to attending intensivist led events. Prospective studies are needed to determine the ideal team composition. PMID:22841611

  4. Osteoporosis Self-Assessment Tool for Asians Can Predict Neurologic Prognosis in Patients with Isolated Moderate Traumatic Brain Injury

    PubMed Central

    Chan, Hon-Man; Huang, Shiuh-Lin; Lin, Chih-Lung; Kwan, Aij-Lie; Lou, Yun-Ting; Chen, Chao-Wen

    2015-01-01

    Objectives Osteoporosis Self-Assessment Tool for Asians (OSTA) has been proved to be a simple and effective tool for recognizing osteoporosis risk. Our previous study has demonstrated that the preoperative OSTA index was a good prognostic predictor for stage II and III colon cancer patients after surgery. We aim to evaluate the value of OSTA index in prognostication of isolated traumatic brain injury with moderate severity (GCS 9-13). Methods We retrospectively reviewed all patients visiting Kaohsiung Medical University Hospital emergency department due to isolated moderate traumatic brain injury from Jan. 2010 to Dec. 2012. Background data (including the OSTA index), clinical presentations, management and outcomes (ICU admission days, total admission days, complications, Glasgow outcome score (GOS) at discharge, mortality) of the patients were recorded for further analysis. Our major outcome was good neurologic recovery defined as GOS of 5. Pearson chi-square test and the Mann-Whitney U test were used to compare demographic features. Multiple logistic regression was used to identify independent risk factors. Results 107 isolated moderate TBI patients were studied. 40 patients (37.4%) showed good recovery and 10 (9.3%) died at discharge. The univariate analysis revealed that younger age, higher OSTA index, lower ISS, lower AIS-H, and avoidance to neurosurgery were associated with better neurologic outcome for all moderate TBI patients. Multivariate analysis revealed that lower ISS, higher OSTA, and the avoidance of neurosurgery were independent risk factors predicting good neurologic recovery. Conclusion Higher ISS, lower OSTA index and exposure to neurosurgery were the independent risk factors for poorer recovery from isolated moderate TBI. In addition to labeling the cohort harboring osteoporotic risk, OSTA index could predict neurologic prognosis in patients with isolated moderate traumatic brain injury. PMID:26186582

  5. An Empirical Comparison of Key Statistical Attributes Among Potential ICU Quality Indicators*

    PubMed Central

    Brown, Sydney E. S.; Ratcliffe, Sarah J.; Halpern, Scott D.

    2014-01-01

    Objective Good quality indicators should have face validity, relevance to patients, and be able to be measured reliably. Beyond these general requirements, good quality indicators should also have certain statistical properties, including sufficient variability to identify poor performers, relative insensitivity to severity adjustment, and the ability to capture what providers do rather than patients' characteristics. We assessed the performance of candidate indicators of ICU quality on these criteria. Indicators included ICU readmission, mortality, several length of stay outcomes, and the processes of venous-thromboembolism and stress ulcer prophylaxis provision. Design Retrospective cohort study Setting One hundred thirty-eight U.S. ICUs from 2001-2008 in the Project IMPACT database. Patients Two hundred sixty-eight thousand eight hundred twenty-four patients discharged from U.S. ICUs. Interventions None. Measurements and Main Results We assessed indicators' (1) variability across ICU-years; (2) degree of influence by patient vs. ICU and hospital characteristics using the Omega statistic; (3) sensitivity to severity adjustment by comparing the area under the receiver operating characteristic curve (AUC) between models including vs. excluding patient variables, and (4) correlation between risk adjusted quality indicators using a Spearman correlation. Large ranges of among-ICU variability were noted for all quality indicators, particularly for prolonged length of stay (4.7–71.3%) and the proportion of patients discharged home (30.6–82.0%), and ICU and hospital characteristics outweighed patient characteristics for stress ulcer prophylaxis (ω, 0.43; 95% CI, 0.34–0.54), venous thromboembolism prophylaxis (ω, 0.57; 95% CI, 0.53–0.61), and ICU readmissions (ω, 0.69; 95% CI, 0.52–0.90). Mortality measures were the most sensitive to severity adjustment (area under the receiver operating characteristic curve % difference, 29.6%); process measures were the

  6. Hospital admissions among male drivers in Denmark

    PubMed Central

    Hannerz, H; Tuchsen, F

    2001-01-01

    OBJECTIVES—To facilitate decisions about interventions and to establish baseline values for future evaluation of preventive efforts, the aim of the present study was to elucidate the disease pattern among male professional drivers in Denmark. The study differentiated between drivers of goods vehicles and drivers of passenger transport.
METHODS—Cohorts of all 20-59 year old Danish male professional drivers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardised hospital admission ratios (SHRs) and time trends (1981-97) for many diagnostic aggregations.
RESULTS—SHRs for diseases in practically all systems and organs of the body were higher among professional drivers than they were in the male working population at large. Also drivers of passenger transport, compared with drivers of goods vehicles, had significantly high SHRs due to infectious and parasitic diseases, diseases of the circulatory system, and diseases of the respiratory system, and significantly lower rates of injury. For both driver groups, the SHRs for acute myocardial infarction increased with time whereas the SHR for acute gastritis decreased, and for drivers of passenger transport an increasing SHR for chronic obstructive pulmonary disease, was found over time.
CONCLUSION—Drivers of passenger transport and drivers of goods vehicles differ in their disease patterns. The results support the hypothesis that preventive efforts are needed in both groups, but underline that different strategies are required for different categories of drivers.


Keywords: professional drivers; hospital admissions; surveillance system PMID:11245742

  7. 28 CFR 54.305 - Preference in admission.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 54.305 Preference in admission. A recipient to... or predominantly members of one sex, if the giving of such preference has the effect...

  8. 14 CFR 1253.305 - Preference in admission.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1253.305 Preference in admission. A... students only or predominantly members of one sex, if the giving of such preference has the effect...

  9. The Confidence Game in Honors Admissions and Retention

    ERIC Educational Resources Information Center

    Guzy, Annmarie

    2013-01-01

    Annmarie Guzy, an expert with almost three decades of experience in post-secondary honors education, responds to Jerry Herron's essay, "Notes toward an Excellent Marxist-Elitist Honors Admissions Policy," which argues that "a well-conceived admissions policy tells us much more than whom to recruit; it becomes the basis for a…

  10. 6 CFR 17.305 - Preference in admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 17.305 Preference in admission. A recipient... only or predominantly members of one sex, if the giving of such preference has the effect...

  11. 14 CFR 1253.305 - Preference in admission.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Admission and Recruitment Prohibited § 1253.305 Preference in admission. A... students only or predominantly members of one sex, if the giving of such preference has the effect...

  12. University Exceptional Admission during the Republic of China

    ERIC Educational Resources Information Center

    Tao, Li

    2014-01-01

    The stories of many universities' exceptive admission during the republic period of China were widely circulated. The typical example of these universities' exceptional admission was the very product of special historical condition, which had its own characteristics, but also conforms to the general rule, so it can be cited. To select special…

  13. Failure as a Criterion for Medical School Admission.

    ERIC Educational Resources Information Center

    Greer, David S.; Aronson, Stanley M.

    1980-01-01

    Admissions committees, it is suggested, should regard a failure experience as an opportunity to examine characteristics of candidates which may otherwise be inapparent. Current admissions criteria do not adequately address the social responsibilities and humanitarian goals of medical education. (Author/MLW)

  14. 14 CFR 125.315 - Admission to flight deck.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...,000 POUNDS OR MORE; AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Flight Operations § 125.315 Admission to flight deck. (a) No person may admit any person to the flight deck of an airplane unless the... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Admission to flight deck. 125.315...

  15. 14 CFR 125.315 - Admission to flight deck.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...,000 POUNDS OR MORE; AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Flight Operations § 125.315 Admission to flight deck. (a) No person may admit any person to the flight deck of an airplane unless the... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Admission to flight deck. 125.315...

  16. 14 CFR 125.315 - Admission to flight deck.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...,000 POUNDS OR MORE; AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Flight Operations § 125.315 Admission to flight deck. (a) No person may admit any person to the flight deck of an airplane unless the... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Admission to flight deck. 125.315...

  17. 14 CFR 125.315 - Admission to flight deck.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...,000 POUNDS OR MORE; AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Flight Operations § 125.315 Admission to flight deck. (a) No person may admit any person to the flight deck of an airplane unless the... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Admission to flight deck. 125.315...

  18. 14 CFR 125.315 - Admission to flight deck.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...,000 POUNDS OR MORE; AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Flight Operations § 125.315 Admission to flight deck. (a) No person may admit any person to the flight deck of an airplane unless the... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Admission to flight deck. 125.315...

  19. 28 CFR 541.47 - Admission to control unit.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Admission to control unit. 541.47 Section... INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Control Unit Programs § 541.47 Admission to control unit. Staff shall provide an inmate admitted to a control unit with: (a) Notice of the projected duration...

  20. WICS: A Model for College and University Admissions

    ERIC Educational Resources Information Center

    Sternberg, Robert J.; Bonney, Christina R.; Gabora, Liane; Merrifield, Maegan

    2012-01-01

    This article outlines shortcomings of currently used university admissions tests and discusses ways in which they could potentially be improved, summarizing two projects designed to enhance college and university admissions. The projects were inspired by the augmented theory of successful intelligence, according to which successful intelligence…