1225 Records downloaded - Wed Jan 24 17:30:41 UTC 2018 RECORD 1 TITLE Spatial methods for evaluating critical care and trauma transport: A scoping review AUTHOR NAMES Vasilyeva K. Widener M.J. Galvagno S.M. Ginsberg Z. AUTHOR ADDRESSES (Vasilyeva K.; Widener M.J., michael.widener@utoronto.ca) Department of Geography and Planning, University of Toronto St. George, 100 St. George St, Toronto, Canada. (Galvagno S.M.) Department of Anesthesiology and the Program in Trauma, R Adams Cowley Shock Trauma Center University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, United States. (Ginsberg Z.) Kettering Medical Center, Departments of Emergency Medicine & Critical Care, 3535 Southern Blvd, Kettering, United States. CORRESPONDENCE ADDRESS M.J. Widener, Department of Geography and Planning, University of Toronto St. George, 100 St. George St, Toronto, Canada. Email: michael.widener@utoronto.ca SOURCE Journal of Critical Care (2018) 43 (265-270). Date of Publication: 1 Feb 2018 ISSN 1557-8615 (electronic) 0883-9441 BOOK PUBLISHER W.B. Saunders ABSTRACT Purpose The objective of this scoping review is to inform future applications of spatial research regarding transportation of critically ill patients. We hypothesized that this review would reveal gaps and limitations in the current research regarding use of spatial methods for critical care and trauma transport research. Materials and methods Four online databases, Ovid Medline, PubMed, Embase and Scopus, were searched. Studies were selected if they used geospatial methods to analyze a patient transports dataset. 12 studies were included in this review. Results Majority of the studies employed spatial methods only to calculate travel time or distance even though methods and tools for more complex spatial analyses are widely available. Half of the studies were found to focus on hospital bypass, 2 studies focused on transportation (air or ground) mode selection, 2 studies compared predicted versus actual travel times, and 2 studies used spatial modeling to understand spatial variation in travel times. Conclusions There is a gap between the availability of spatial tools and their usage for analyzing and improving medical transportation. The adoption of geospatially guided transport decisions can meaningfully impact healthcare expenditures, especially in healthcare systems looking to strategically control expenditures with minimum impact on patient outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care medical geography patient transport spatial analysis EMTREE MEDICAL INDEX TERMS air medical transport emergency health service geographic information system human review statistical model systematic review traffic and transport travel EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170872890 PUI L619600261 DOI 10.1016/j.jcrc.2017.08.039 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcrc.2017.08.039 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 2 TITLE Skin-to-skin hospital transfers are physiologically sound and empower parents AUTHOR NAMES Kjellberg M. AUTHOR ADDRESSES (Kjellberg M., mattias.kjellberg@akademiska.se) Neonatal Transport Service, Department of Neonatal Intensive Care, Uppsala University Childrens Hospital, Uppsala, Sweden. CORRESPONDENCE ADDRESS M. Kjellberg, Neonatal Transport Service, Department of Neonatal Intensive Care, Uppsala University Childrens Hospital, Uppsala, Sweden. Email: mattias.kjellberg@akademiska.se SOURCE Acta Paediatrica, International Journal of Paediatrics (2018) 107:1 (165). Date of Publication: 1 Jan 2018 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS human medical staff neonatal intensive care unit note parent patient safety priority journal EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170875243 PUI L619712125 DOI 10.1111/apa.14129 FULL TEXT LINK http://dx.doi.org/10.1111/apa.14129 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 3 TITLE Highlights in this issue AUTHOR NAMES Käll A. Lagercrantz H. AUTHOR ADDRESSES (Käll A.; Lagercrantz H., hugo.lagercrantz@actapaediatrica.se) Acta Paediatrica, Stockholm, Sweden. SOURCE Acta Paediatrica, International Journal of Paediatrics (2018) 107:1 (6-7). Date of Publication: 1 Jan 2018 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com EMTREE DRUG INDEX TERMS (MAJOR FOCUS) oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost control delivery room dyslexia health personnel attitude neonatal intensive care unit patient transport practice guideline prematurity professional-patient relationship EMTREE MEDICAL INDEX TERMS clinical outcome editorial health practitioner human medical staff parent priority journal resuscitation CAS REGISTRY NUMBERS oxygen (7782-44-7) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170875244 PUI L619712127 DOI 10.1111/apa.14146 FULL TEXT LINK http://dx.doi.org/10.1111/apa.14146 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 4 TITLE The really organized and detailed transporting of inpatients: The road trip study AUTHOR NAMES Kapileshwarkar Y. Cashen K. Shah J. Tilford B. AUTHOR ADDRESSES (Kapileshwarkar Y.; Cashen K.; Shah J.; Tilford B.) Children's Hospital of Michigan, Detroit, United States. CORRESPONDENCE ADDRESS Y. Kapileshwarkar, Children's Hospital of Michigan, Detroit, United States. SOURCE Critical Care Medicine (2018) 46 Supplement 1 (625). Date of Publication: 1 Jan 2018 CONFERENCE NAME 47th Society of Critical Care Medicine Critical Care Congress, SCCM 2018 CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2018-02-25 to 2018-02-28 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Inter and intra-facility transport has focused on adverse events (AEs) because the transport of critically ill patients puts them at risk for morbidity and mortality. Few studies have identified a tool for transporting patients to a new PICU. We developed a novel QI tool for transporting patients to a new PICU in a large tertiary care facility. The objective of this study was to evaluate the efficiency of a standardized tool, identify missing equipment and describe the frequency and severity of AEs. Methods: A transport safety tool was developed with multidisciplinary input. The tool addressed patient features, equipment, medications and availability of resources for transport. The tool was used in a simulated move and modified for consistency then utilized during the actual move. The tool was reviewed to identify failures and adverse events. Minor failures included missed assessment, equipment or chart. Major failures included missing respiratory equipment, circulatory equipment/monitoring, or critical medications. Minor AEs were defined as any event where the patient remained stable. Major AEs included an event requiring intervention to improve cardiorespiratory status. Data are reported as frequency (n) with proportion (%) or median with IQR. Univariate analyses were performed using the Wilcoxon rank sum or Fisher's exact tests. Statistical analysis was performed using SPSS version 21. Results: Included were 27 transports. The median age was 24 months IQR (6, 108). Median weight was 18 kg IQR (6.8, 28). In this cohort, 63% of patients had a diagnosis of congenital heart disease, 15% had chronic respiratory failure, 11% had a primary neurologic diagnosis, 11% had a primary oncologic diagnosis. 19 episodes of minor failures and 17 major failures were identified. The median preparation time was 15 minutes IQR (9.7, 28.6). The median travel time was 7 minutes IQR (4, 7). 12 (44%) patients suffered an AE during transport. Major AEs requiring intervention occurred in 18.5% of transports and minor AEs occurred in 26%. Patients receiving mechanical ventilation (MV) were more likely to suffer major AEs compared to patients without MV (80% vs. 5%, p = 0.001). AEs were not associated with the need for inotropic support (p = 0.15). No patient had a severe life-threatening event during transport. Conclusions: Using a novel standardized tool to transport PICU patients to a new unit was feasible, efficient and useful in identifying missing patient assessments, equipment, and medications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient EMTREE MEDICAL INDEX TERMS adverse event artificial ventilation child chronic respiratory failure clinical article cohort analysis congenital heart disease controlled study data analysis software diagnosis female human inotropism male monitoring nervous system patient assessment preschool child respiratory equipment simulation tertiary care center travel univariate analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620080662 DOI 10.1097/01.ccm.0000529287.19017.65 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000529287.19017.65 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 5 TITLE Elective transfers of preterm neonates to regional centres on non-invasive respiratory support is cost effective and increases tertiary care bed capacity AUTHOR NAMES Zein H. Yusuf K. Paul R. Kowal D. Thomas S. AUTHOR ADDRESSES (Zein H., hussein.zein@ucalgary.ca; Yusuf K.; Thomas S.) Section of Neonatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. (Paul R.; Kowal D.) Foothills Medical Centre, Calgary, Canada. CORRESPONDENCE ADDRESS H. Zein, Section of Neonatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. Email: hussein.zein@ucalgary.ca SOURCE Acta Paediatrica, International Journal of Paediatrics (2018) 107:1 (52-56). Date of Publication: 1 Jan 2018 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com ABSTRACT Aim: Managing capacity at regional facilities caring for sick neonates is increasingly challenging. This study estimated the clinical and economic impact of the elective transfer of stable infants requiring nasal continuous positive airway pressure (NCPAP) from level three to level two neonatal intensive care units (NICUs) within an established clinical network of five NICUs. Methods: We retrospectively analysed the records of 99 stable infants transferred on NCPAP between two level three NICUs and three level two NICUs in Calgary, Canada, between June 2014 and May 2016. Results: The median gestational age and weight at birth were 28 weeks and 955 g, and the median corrected gestational age and weight at transfer were 33 weeks and 1597 g, respectively. This resulted in cost savings of $2.65 million Canadian dollars during the two-year study period, and 848 level three NICU days were freed up for potentially sick neonates. There were no adverse events associated with the transfers. Conclusion: The elective transfer of stable neonates on NCPAP from level three to level two NICUs within an established clinical network led to substantial cost savings, was safe and increased the bed capacity at the two level three NICUs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital bed capacity neonatal intensive care unit noninvasive ventilation patient transport positive end expiratory pressure prematurity (disease management) tertiary health care EMTREE MEDICAL INDEX TERMS article birth weight Canada cost control cost effectiveness analysis female gestational age human infant major clinical study male priority journal retrospective study EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170703954 PUI L618655371 DOI 10.1111/apa.14059 FULL TEXT LINK http://dx.doi.org/10.1111/apa.14059 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 6 TITLE Near-infrared spectroscopy use in critical care transport in a patient with multifactorial shock AUTHOR NAMES Walenta T. Parker J. Turner-Nelson K. Maurer J. AUTHOR ADDRESSES (Walenta T.; Parker J.; Turner-Nelson K.; Maurer J.) Children's Hospital of Wisconsin, Wauwatosa, United States. CORRESPONDENCE ADDRESS T. Walenta, Children's Hospital of Wisconsin, Wauwatosa, United States. SOURCE Critical Care Medicine (2018) 46 Supplement 1 (147). Date of Publication: 1 Jan 2018 CONFERENCE NAME 47th Society of Critical Care Medicine Critical Care Congress, SCCM 2018 CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2018-02-25 to 2018-02-28 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: A 14 year old patient with a history of truncus arteriosus, status post repair, presented to an outside hospital ER in respiratory distress. The information relayed to our transport referral center included vital signs reported as Temp 36.6 °C, RR 26, HR 144, BP 113/52 with sPO2 95% on 4L via oxymask. Additional information included severe RV to PA conduit stenosis seen on echo with poor visualization of function, no urine output over 2 days and cool, mottled extremities. He received a 500 ml normal saline bolus and antibiotics were initiated. Methods: Our transport team was dispatched via helicopter. Upon arrival, initial vital signs obtained by our transport team were: Temp 36.5° C, HR 153, RR 48, BP 81/52 MAP 62, SpO2 96% on 8L oxymask with an initial assessment indicating that the patient was alert and oriented x3, tachypneic with bilateral wheezes and mild retractions. Patient was tachycardic with a right bundle branch block, mottled, dusky, cyanotic, with a capillary refill time of greater than 7 seconds. Within 10 minutes the patients BP was unobtainable, HR 150, RR 51, SpO2 100% and upon placement of near-infrared spectroscopy (NIRs), the cerebral (cNIRs) was 71 and renal (rNIRs) was 39. An epinephrine drip was initiated for poor perfusion and low renal (rNIRs) signifying late stages of shock. Within 5 minutes of initiation, the patient developed unobtainable renal NIRs despite having an improved BP of 83/46 and therefore the epinephrine drip was titrated up until improvement in rNIRs. Subsequent vital signs were a BP 90/42, HR 146, RR 66, sPO2 100%, cNIRs 64, rNIRs 45 a norepinephrine drip was also initiated. Vital signs after initiation of norepinephrine were HR 142, BP 91/51, RR 56, sPO2 99%, cNIRs 75 and rNIRs 53. Upon return to the receiving hospital the patient required initiation of mechanical circulatory support Results: In this patient scenario, NIRs monitoring helped us escalate inotropic support rapidly in a pre-cardiac arrest state. NIRs assisted in decision making when we were unable to rely on vitals or exam findings to demonstrate a change in perfusion. EMTREE DRUG INDEX TERMS antibiotic agent epinephrine noradrenalin sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care near infrared spectroscopy EMTREE MEDICAL INDEX TERMS adolescent arterial trunk assisted circulation brain clinical article decision making diuresis heart arrest heart right bundle branch block helicopter human inotropism learning limb male monitoring patient referral perfusion respiratory distress stenosis tachycardia vital sign wheezing CAS REGISTRY NUMBERS epinephrine (51-43-4, 55-31-2, 6912-68-1) noradrenalin (1407-84-7, 51-41-2) sodium chloride (7647-14-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620081791 DOI 10.1097/01.ccm.0000528349.63041.87 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000528349.63041.87 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 7 TITLE Using polyethylene plastic bag to prevent moderate hypothermia during transport in very low birth weight infants: a randomized trial AUTHOR NAMES Hu X.-J. Wang L. Zheng R.-Y. Lv T.-C. Zhang Y.-X. Cao Y. Huang G.-Y. AUTHOR ADDRESSES (Hu X.-J.; Wang L.; Zheng R.-Y.; Lv T.-C.; Zhang Y.-X.; Cao Y.; Huang G.-Y., gyhuang@shmu.edu.cn) Neonatal Intensive Care Unit, Children’s Hospital of Fudan University, Shanghai, China. (Huang G.-Y., gyhuang@shmu.edu.cn) Shanghai Key Laboratory of Birth Defects, Shanghai, China. CORRESPONDENCE ADDRESS G.-Y. Huang, Neonatal Intensive Care Unit, Children’s Hospital of Fudan University, Shanghai, China. Email: gyhuang@shmu.edu.cn SOURCE Journal of Perinatology (2017) (1-5). Date of Publication: 27 Dec 2017 ISSN 1476-5543 (electronic) 0743-8346 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Objective: Hypothermia remains a significant problem among very low birth weight (VLBW) infants. The use of occlusive polyethylene plastic bags immediately after birth has been proven to be effective for preterm infants to reduce hypothermia. This study aims to determine whether placing VLBW infants in plastic bags during transport reduces hypothermia. Study design: Study infants were randomly assigned to a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a polyethylene plastic bag during transport. The primary outcome measures were axillary temperature before and after transport and the occurrence of moderate hypothermia upon neonatal intensive care unit admission. Result: The 108 VLBW infants recruited into the study were randomized to the plastic bag (n = 54) group or to standard group (n = 54) and had similar baseline characteristics. VLBW infants in the plastic bag group had a lower rate of moderate hypothermia (3.7 vs 27.8%; risk ratio 0.10; confidence interval 0.02–0.46; P < 0.001) and higher axillary temperatures (36.4 ± 0.4 °C vs 35.9 ± 0.9 °C; P = 0.001) upon NICU admission compared to infants receiving standard care. Conclusion: Placing VLBW infants in polyethylene plastic bags during transport reduces the occurrence of hypothermia, especially moderate hypothermia. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polyethylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hypothermia very low birth weight EMTREE MEDICAL INDEX TERMS axilla temperature drug therapy female human infant lower limb major clinical study male neonatal intensive care unit outcome assessment prevention randomized controlled trial study design thermoregulation trunk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170907679 PUI L619981034 DOI 10.1038/s41372-017-0028-0 FULL TEXT LINK http://dx.doi.org/10.1038/s41372-017-0028-0 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 8 TITLE Feasibility and Safety of Controlled Active Hypothermia Treatment during Transport in Neonates with Hypoxic-Ischemic Encephalopathy AUTHOR NAMES Szakmar E. Kovacs K. Meder U. Nagy A. Szell A. Bundzsity B. Somogyvari Z. Szabo A.J. Szabo M. Jermendy A. AUTHOR ADDRESSES (Szakmar E.; Kovacs K.; Meder U.; Szabo A.J.; Szabo M.; Jermendy A., jermendy.agnes@med.semmelweis-univ.hu) 1st Department of Paediatrics, Semmelweis University, 53 Bokay ut, Budapest, Hungary. (Nagy A.; Szell A.; Bundzsity B.; Somogyvari Z.) Neonatal Emergency and Transport Services of Peter Cerny Foundation, Budapest, Hungary. (Szabo A.J.) MTA-SE Pediatric and Nephrology Research Group, Budapest, Hungary. CORRESPONDENCE ADDRESS A. Jermendy, 1st Department of Paediatrics, Semmelweis University, 53 Bokay ut, Budapest, Hungary. Email: jermendy.agnes@med.semmelweis-univ.hu SOURCE Pediatric Critical Care Medicine (2017) 18:12 (1159-1165). Date of Publication: 1 Dec 2017 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objectives: To evaluate the feasibility and safety of controlled active hypothermia versus standard intensive care during neonatal transport in patients with hypoxic-ischemic encephalopathy. Design: Cohort study with a historic control group. Setting: All infants were transported by Neonatal Emergency & Transport Services to a Level-III neonatal ICU. Patients: Two hundred fourteen term newborns with moderate-to-severe hypoxic-ischemic encephalopathy. An actively cooled group of 136 newborns were compared with a control group of 78 newborns. Interventions: Controlled active hypothermia during neonatal transport. Measurements and Main Results: Key measured variables were timing of hypothermia initiation, temperature profiles, and vital signs during neonatal transport. Hypothermia was initiated a median 2.58 hours earlier in the actively cooled group compared with the control group (median 1.42 [interquartile range, 0.83-2.07] vs 4.0 [interquartile range, 2.08-5.79] hours after birth, respectively; p < 0.0001), and target temperature was also achieved a median 1.83 hours earlier (median 2.42 [1.58-3.63] vs 4.25 [2.42-6.08] hours after birth, respectively; p < 0.0001). Blood gas values and vital signs were comparable between the two groups with the exception of heart rate, which was significantly lower in the actively cooled group. The number of infants in the target temperature range (33-34°C) on arrival was 79/136 (58.1%) and the rate of overcooling was 16/136 (11.8%) in the actively cooled group. In the overcooled infants, Apgar scores, pH, base deficit, and eventual death rate (7/16; 43.8%) indicated more severe asphyxia suggesting poor temperature control in this subgroup of patients. Adverse events leading to pulmonary or circulatory failure were not observed in either groups during the transport period. Conclusions: Therapeutic hypothermia during transport is feasible and safe, allowing for significantly earlier initiation and achievement of target temperature, possibly providing further benefit for neonates with hypoxic-ischemic encephalopathy. EMTREE DRUG INDEX TERMS base EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) controlled active hypothermia hypoxic ischemic encephalopathy (therapy) induced hypothermia patient transport EMTREE MEDICAL INDEX TERMS Apgar score article asphyxia blood gas cohort analysis controlled study disease severity human intensive care ischemia lung insufficiency major clinical study mortality rate neonatal intensive care unit newborn pH priority journal retrospective study temperature vital sign EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170864097 PUI L619574067 DOI 10.1097/PCC.0000000000001339 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000001339 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 9 TITLE The influence of insurance type on interfacility pediatric emergency department transfers AUTHOR NAMES Rees C.A. Pryor S. Choi B. Senthil M.V. Tsarouhas N. Myers S.R. Monuteaux M.C. Bachur R.G. Li J. AUTHOR ADDRESSES (Rees C.A., chrisrees2@gmail.com; Monuteaux M.C., Michael.Monuteaux@childrens.harvard.edu; Bachur R.G., Richard.Bachur@childrens.harvard.edu; Li J., Joyce.Li@childrens.harvard.edu) Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, BCH 3066, Boston, United States. (Pryor S., stephanie.pryor@seattlechildrens.org) Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, United States. (Choi B., bc134109@bcm.edu) Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, Suite A2210, Houston, United States. (Senthil M.V., VenepallyM@email.chop.edu; Tsarouhas N., TSAROUHAS@email.chop.edu; Myers S.R., MYERSS@email.chop.edu) Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, United States. CORRESPONDENCE ADDRESS C.A. Rees, Boston Children's Hospital, Division of Emergency Medicine, 300 Longwood Avenue, BCH 3066, Boston, United States. Email: chrisrees2@gmail.com SOURCE American Journal of Emergency Medicine (2017) 35:12 (1907-1909). Date of Publication: 1 Dec 2017 ISSN 1532-8171 (electronic) 0735-6757 BOOK PUBLISHER W.B. Saunders ABSTRACT Background Disparities exist in the care children receive in the emergency department (ED) based on their insurance type. It is unknown if these differences exist among children transferred from outside EDs to pediatric tertiary care EDs. Objective To compare reasons for transfer and services received at pediatric tertiary care EDs between children with private and public insurance. Methods We performed a secondary analysis of a multicenter survey of ED providers transferring patients to pediatric tertiary care EDs in three major U.S. cities. Risk differences (RD) and 95% confidence intervals (CI) were calculated to compare reasons for transfer and care received at pediatric tertiary care EDs based on insurance type. Results There were 561 surveys completed by transferring providers describing reasons for transfer to pediatric tertiary care EDs with 52.2% of patients with private insurance and 47.8% with public insurance. We found no significant differences between privately and publicly insured children in reason for transfer for subspecialty consultation or need for admission. We found no significant differences in frequency of admission, radiologic studies, or ED procedures at the receiving facilities. However, a greater proportion of privately insured children had a subspecialty consultation at receiving facilities compared to publicly insured children (RD 9.7, 95% CI 2.0 to 17.4). Conclusions Transferred pediatric patients with private insurance were more likely to have subspecialty consultations than children with public insurance. Further studies are needed to better characterize the interplay between patients’ insurance type and both the request for, and the provision of, ED subspecialty consultations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward health insurance patient transport pediatric emergency medicine EMTREE MEDICAL INDEX TERMS article attributable risk child comparative study consultation funding health survey hospital admission human medical record review medically uninsured pediatric intensive care unit priority journal secondary analysis tertiary health care EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170526979 MEDLINE PMID 28743480 (http://www.ncbi.nlm.nih.gov/pubmed/28743480) PUI L617459968 DOI 10.1016/j.ajem.2017.07.048 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajem.2017.07.048 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 10 TITLE Optimizing Outcomes in Regionalized Perinatal Care: Integrating Maternal and Neonatal Emergency Referral, Triage, and Transport AUTHOR NAMES Stewart M.J. Smith J. Boland R.A. AUTHOR ADDRESSES (Stewart M.J., michael.stewart@rch.org.au; Smith J.; Boland R.A.) Paediatric Infant Perinatal Emergency Retrieval, Royal Children’s Hospital, Level 2, East Building, 50 Flemington Road, Parkville, Australia. (Stewart M.J., michael.stewart@rch.org.au; Boland R.A.) Clinical Sciences, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Australia. (Stewart M.J., michael.stewart@rch.org.au) Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, 50 Flemington Road, Parkville, Australia. (Boland R.A.) Department of Obstetrics and Gynecology, University of Melbourne, 7th Floor, Royal Women’s Hospital, 20 Flemington Road, Parkville, Australia. CORRESPONDENCE ADDRESS M.J. Stewart, Paediatric Infant Perinatal Emergency Retrieval, Royal Children’s Hospital, Level 2, East Building, 50 Flemington Road, Parkville, Australia. Email: michael.stewart@rch.org.au SOURCE Current Treatment Options in Pediatrics (2017) 3:4 (313-326). Date of Publication: 1 Dec 2017 ISSN 2198-6088 (electronic) BOOK PUBLISHER Springer International Publishing ABSTRACT The purpose of integrating emergency maternal referral and triage capability into a neonatal retrieval service is to improve the effectiveness of regionalized perinatal care and to ensure opportunities for in utero transfer are maximized. Evidence for the effectiveness of regionalized perinatal care is presented, emphasizing the striking difference in survival of outborn extremely preterm (EPT) infants compared with inborn EPT infants. Barriers to achieving high rates of in utero transfer are identified and strategies to address preventable factors discussed. There is evidence of variation in rates of outborn extremely preterm births. As birth in transit is a rare event, this variation suggests there are opportunities for significant improvement in areas with high rates of outborn extremely preterm births. Variation in the level of risk aversion by triaging obstetricians and transport platform providers may be a significant preventable factor in deciding if a particular high-risk pregnant woman is deemed safe to transfer. Collaboration between obstetricians triaging these referrals and their neonatal retrieval colleagues within an integrated service is proposed as a model to address such issues. The integrated perinatal emergency referral and retrieval service is a key component of a system structured to support regionalized care. We propose this service should sit below the regional entity responsible for clinical governance that provides an imprimatur to ensure timely and equitable access to perinatal services for high-risk women and their newborn infants. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service maternal care newborn care patient referral perinatal care EMTREE MEDICAL INDEX TERMS antepartum hemorrhage health care quality human leukomalacia mortality rate neonatal intensive care unit obstetrician premature labor prevalence priority journal regionalization resuscitation review EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170753253 PUI L618962268 DOI 10.1007/s40746-017-0103-y FULL TEXT LINK http://dx.doi.org/10.1007/s40746-017-0103-y COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 11 TITLE Effect of Transition From a Unit-Based Team to External Transport Team for a Pediatric Critical Care Unit AUTHOR NAMES Cummings B.M. Kaliannan K. Yager P.H. Noviski N. AUTHOR ADDRESSES (Cummings B.M., bmcummings@partners.org; Kaliannan K.; Yager P.H.; Noviski N.) Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, United States. CORRESPONDENCE ADDRESS B.M. Cummings, Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, 175 Cambridge St (520), Boston, United States. Email: bmcummings@partners.org SOURCE Journal of Intensive Care Medicine (2017) 32:10 (597-602). Date of Publication: 1 Dec 2017 ISSN 1525-1489 (electronic) 0885-0666 BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT Objective: Pediatric hospitals must consider staff, training, and direct costs required to maintain a pediatric specialized transport team, balanced with indirect potential benefits of marketing and referral volume. The effect of transitioning a unit-based transport team to an external service on the pediatric intensive care unit (PICU) is unknown, but information is needed as hospital systems focus on population management. We examined the impact on PICU transports after transition to an external transport vendor. Methods: Single-center retrospective review performed of PICU admissions, referrals, and transfers during baseline, post-, and maintenance period with a total of 9-year follow-up. Transfer volume was analyzed during pre-, post-, and maintenance phase with descriptive statistics and statistical process control charts from 1999 to 2012. Results: Total PICU admissions increased with an annual growth rate of 3.7%, with mean annual 626 admissions prior to implementation to the mean of 890 admissions at the end of period, P <.001. The proportion of transport to total admissions decreased from 27% to 21%, but mean annual transports were unchanged, 175 to 183, P =.6, and mean referrals were similar, 186 to 203, P =.8. Seasonal changes in transport volume remained as a predominant source of variability. Annual transport refusals increased initially in the postimplementation phase, mean 11 versus 33, P <.03, but similar to baseline in the maintenance phase, mean 20/year, P =.07. Patient refusals were due to bed and staffing constraints, with 7% due to the lack of transport vendor availability. Conclusion: In a transition to a regional transport service, PICU transport volume was maintained in the long-term follow-up and total PICU admissions increased. Further research on the direct and indirect impact of transport regionalization is needed to determine the optimal cost–benefit and quality of care as health-care systems focus on population management. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient care pediatric intensive care unit population dynamics teamwork transitional care EMTREE MEDICAL INDEX TERMS article feedback system follow up funding growth rate health care quality health care system hospital admission hospital planning patient referral patient transport priority journal process control retrospective study seasonal variation EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170795959 PUI L619208604 DOI 10.1177/0885066616662815 FULL TEXT LINK http://dx.doi.org/10.1177/0885066616662815 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 12 TITLE Penumbral freeze: Travel distance and delays provide an opportunity to study prerecanalization therapy neuroprotection AUTHOR NAMES Blacker D.J. AUTHOR ADDRESSES (Blacker D.J., davidblackermd@hotmail.com) Department of Neurology, Charles Gairdner Hospital, Perron Institute for Neurological and Translational Science, Nedlands, Australia. CORRESPONDENCE ADDRESS D.J. Blacker, Department of Neurology, Charles Gairdner Hospital, Perron Institute for Neurological and Translational Science, Nedlands, Australia. Email: davidblackermd@hotmail.com SOURCE Future Neurology (2017) 12:4 (185-188). Date of Publication: 1 Dec 2017 ISSN 1748-6971 (electronic) 1479-6708 BOOK PUBLISHER Future Medicine Ltd., info@futuremedicine.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia neuroprotection patient transport penumbral freeze prerecanalization therapy recanalization surgical technique time to treatment EMTREE MEDICAL INDEX TERMS blood clot lysis brain tissue clinical decision making health care access health care facility human mechanical thrombectomy neuroimaging priority journal review stroke unit telehealth therapy delay EMBASE CLASSIFICATIONS Radiology (14) Public Health, Social Medicine and Epidemiology (17) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170805516 PUI L619268307 DOI 10.2217/fnl-2017-0025 FULL TEXT LINK http://dx.doi.org/10.2217/fnl-2017-0025 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 13 TITLE Multiple intra-hospital transports during relocation to a new critical care unit AUTHOR NAMES O’Leary R.-A. Conrick-Martin I. O’Loughlin C. Curran M.-R. Marsh B. AUTHOR ADDRESSES (O’Leary R.-A., ruthaoibheann@yahoo.co.uk; Conrick-Martin I.; O’Loughlin C.; Curran M.-R.; Marsh B.) Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland. CORRESPONDENCE ADDRESS R.-A. O’Leary, Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland. Email: ruthaoibheann@yahoo.co.uk SOURCE Irish Journal of Medical Science (2017) 186:4 (815-820). Date of Publication: 1 Nov 2017 ISSN 1863-4362 (electronic) 0021-1265 BOOK PUBLISHER Springer London ABSTRACT Objective: Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit. Design: Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase. Setting: The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries. Participants: All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors. Main outcome measures: Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times. Results: Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%. Conclusion: Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit intra hospital transport traffic and transport EMTREE MEDICAL INDEX TERMS artery catheter article clinical article device failure heart transplantation hospital bed hospital discharge hospital mortality human hypotension information service information technology laboratory personnel lung transplantation manager medical staff nursing outcome assessment patient care personal experience pharmacist prospective study spine injury EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160820570 PUI L613201966 DOI 10.1007/s11845-016-1528-1 FULL TEXT LINK http://dx.doi.org/10.1007/s11845-016-1528-1 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 14 TITLE Risk factors for unplanned transfer to the intensive care unit after emergency department admission: Methodological issues AUTHOR NAMES Safiri S. Ayubi E. AUTHOR ADDRESSES (Safiri S.) Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran. (Ayubi E., aubi65@gmail.com) Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (Ayubi E., aubi65@gmail.com) Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. CORRESPONDENCE ADDRESS E. Ayubi, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Email: aubi65@gmail.com SOURCE American Journal of Emergency Medicine (2017) 35:10 (1573). Date of Publication: 1 Oct 2017 ISSN 1532-8171 (electronic) 0735-6757 BOOK PUBLISHER W.B. Saunders EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hypercapnia intensive care unit patient transport risk factor EMTREE MEDICAL INDEX TERMS cross-sectional study disease association emergency ward epidemiological data general condition deterioration hospital admission human letter longitudinal study outcome assessment patient risk priority journal risk assessment EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170365187 PUI L616339775 DOI 10.1016/j.ajem.2017.04.031 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajem.2017.04.031 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 15 TITLE Safety hazards during intrahospital transport: A prospective observational study AUTHOR NAMES Bergman L.M. Pettersson M.E. Chaboyer W.P. Carlström E.D. Ringdal M.L. AUTHOR ADDRESSES (Bergman L.M., lina.bergman@gu.se; Pettersson M.E.; Chaboyer W.P.; Carlström E.D.; Ringdal M.L.) Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. (Pettersson M.E.) Vascular Department, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden. (Chaboyer W.P.) Menzies Health Institute Queensland, Griffith University, Southport, Australia. (Carlström E.D.) University College of Southeast Norway, Notodden, Norway. (Ringdal M.L.) Department of Anesthesiology and Intensive Care, Kungälvs Hospital, Kungälv, Sweden. CORRESPONDENCE ADDRESS L.M. Bergman, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Email: lina.bergman@gu.se SOURCE Critical Care Medicine (2017) 45:10 (e1043-e1049). Date of Publication: 1 Oct 2017 ISSN 1530-0293 (electronic) 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objective: To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients. Design: A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months. Setting: The study was undertaken at two ICUs in one university hospital. Patients: Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians. Interventions: None. Measurements and Main Results: Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4-10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes. Conclusions: Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health hazard patient safety patient transport EMTREE MEDICAL INDEX TERMS article clinical handover content analysis critically ill patient equipment design human intensive care intensive care unit interhospital cooperation interpersonal communication nurse observational study participant observation physician priority journal prospective study risk factor university hospital workload workplace EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170754515 MEDLINE PMID 28787292 (http://www.ncbi.nlm.nih.gov/pubmed/28787292) PUI L618978848 DOI 10.1097/CCM.0000000000002653 FULL TEXT LINK http://dx.doi.org/10.1097/CCM.0000000000002653 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 16 TITLE Long distance heart transplantation: a tale of two cities AUTHOR NAMES Jain P. Prichard R.A. Connellan M.B. Dhital K.K. Macdonald P.S. AUTHOR ADDRESSES (Jain P., pankaj185@gmail.com; Prichard R.A.; Connellan M.B.; Dhital K.K.; Macdonald P.S.) Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia. (Prichard R.A.) University of Technology, Sydney, Australia. (Connellan M.B.; Dhital K.K.; Macdonald P.S.) Department of Medicine, University of New South Wales, Sydney, Australia. (Dhital K.K.; Macdonald P.S.) Victor Chang Cardiac Research Institute, Sydney, Australia. CORRESPONDENCE ADDRESS P. Jain, Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia. Email: pankaj185@gmail.com SOURCE Internal Medicine Journal (2017) 47:10 (1202-1205). Date of Publication: 1 Oct 2017 ISSN 1445-5994 (electronic) 1444-0903 BOOK PUBLISHER Blackwell Publishing, info@asia.blackpublishing.com.au ABSTRACT In this ‘paired’ case report, we describe two heart transplants performed 3 days apart at our centre. Both cases involved very prolonged transportation time of the donor heart. In one case, the donor heart was transported in an ice chest, while in the other case the organ was transported using a normothermic ex vivo perfusion (NEVP) system. The additional retrieval costs incurred by the use NEVP were more than offset by the reduction in subsequent inpatient costs. EMTREE DRUG INDEX TERMS glyceryl trinitrate hypertensive agent inotropic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart transplantation patient transport EMTREE MEDICAL INDEX TERMS aortic clamping article brain death brain hemorrhage cardiac index cardiac resynchronization therapy cardiopulmonary bypass complete heart block congestive cardiomyopathy extracorporeal oxygenation extubation heart catheterization heart failure heart left ventricle ejection fraction heart muscle biopsy heart output heart size human hypertrophic cardiomyopathy intensive care unit lung edema normothermic ex vivo perfusion perfusion postoperative period priority journal recurrent disease reperfusion tertiary care center transesophageal echocardiography transthoracic echocardiography venoarterial extracorporeal membrane oxygenation CAS REGISTRY NUMBERS glyceryl trinitrate (55-63-0, 80738-44-9) EMBASE CLASSIFICATIONS Radiology (14) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170709272 PUI L618682031 DOI 10.1111/imj.13568 FULL TEXT LINK http://dx.doi.org/10.1111/imj.13568 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 17 TITLE Early complications in patients who undergo surgery for complex pediatric spinal deformity and are transferred to the pediatric intensive care unit. Retrospective cohort study AUTHOR NAMES Martínez Gonzélez C. Egea Gémez R.M. Certucha Barragén J. Gonzélez Diaz R. AUTHOR ADDRESSES (Martínez Gonzélez C.; Certucha Barragén J.; Gonzélez Diaz R.) Hospital Infantil Niño Jesús, Madrid, Spain. (Egea Gémez R.M.) Hospital Universitario De Móstoles, Madrid, Spain. CORRESPONDENCE ADDRESS C. Martínez Gonzélez, Hospital Infantil Niño Jesús, Madrid, Spain. SOURCE European Spine Journal (2017) 26:10 (2688-2691). Date of Publication: 1 Oct 2017 CONFERENCE NAME 31. Congreso Nacional de la Sociedad Espanola de Columna Vertebral, GEER 2017 CONFERENCE LOCATION San Sebastian, Spain CONFERENCE DATE 2017-06-02 to 2017-06-03 ISSN 1432-0932 BOOK PUBLISHER Springer Verlag ABSTRACT Introduction: In deformity surgery, assessing surgical complications, as well as the outcome of the procedure, is a very common practice; however, immediate medical complications are frequently omitted in our research studies. In the present study, we aim to analyze the most frequent postoperative medical complications in corrective complex pediatric deformity surgeries. Materials and methods: Retrospective cohort study of patients who underwent surgery due to scoliosis and were transferred to the pediatric intensive care unit (PICU) between 2014 and 2016; 81 patients (43 idiopathic scoliosis, 24 neurological, 7 neuromuscular, 4 congenital, and 3 syndromic) were included in the study. Mean age was 15 years (2-19 years). We analyzed the various complications, their cause, and the treatment/treatment length to overcome the complications. Furthermore, we studied the management of postoperative pain and the differences between the various diagnostic groups. Results: The mean stay in the PICU was 3.71 days (3% of total hospital stay). The most frequent complications were hemodynamic alterations, seen in 26/81 study participants who required inotropic agents: dopamine in eight cases and dopamine + adrenaline in one case. Twenty-two (22) from the 81 study patients experienced some kind of renal disturbance (metabolic or lactic acidosis and SIADH), from which 14 required bicarbonate. Six cases of sepsis were identified (1 central line catheter), 3 surgical site infections, and 12 pneumonias. In 60 cases, morphine-derivatives were used for pain control, whilst for the remaining patients lower ladder analgesics-as per the WHO-were administered. Conclusions: The most frequent complications were hemodynamic alterations, followed by renal and infectious difficulties. The complications occurred more often in neuromuscular patients. Being aware on the potential adverse outcomes after scoliosis surgery, allows improving the management of our patients, as well as prevent their inadequate control. Achieving a stabilization over the first 24 h and an effective control of pain facilitates patient progression. EMTREE DRUG INDEX TERMS analgesic agent bicarbonate dopamine inotropic agent morphine derivative EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cohort analysis pediatric intensive care unit retrospective study spine malformation EMTREE MEDICAL INDEX TERMS adolescent adverse outcome central venous catheter child complication controlled study diagnosis related group drug therapy female hemodynamics hospitalization human idiopathic scoliosis inappropriate vasopressin secretion lactic acidosis major clinical study male metabolic acidosis peroperative complication pneumonia postoperative pain sepsis surgery surgical infection CAS REGISTRY NUMBERS bicarbonate (144-55-8, 71-52-3) dopamine (51-61-6, 62-31-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619082716 DOI 10.1007/s00586-017-5270-9 FULL TEXT LINK http://dx.doi.org/10.1007/s00586-017-5270-9 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 18 TITLE Transfer of Neonates with Critical Congenital Heart Disease Within a Regionalized Network AUTHOR NAMES Swartz M.F. Cholette J.M. Orie J.M. Jacobs M.L. Jacobs J.P. Alfieris G.M. AUTHOR ADDRESSES (Swartz M.F., Michael_swartz@urmc.rochester.edu; Cholette J.M.; Alfieris G.M.) Pediatric Cardiac Consortium of Upstate New York, New York, United States. (Swartz M.F., Michael_swartz@urmc.rochester.edu; Cholette J.M.; Orie J.M.; Alfieris G.M.) University of Rochester Medical Center, Rochester, United States. (Jacobs M.L.) Division of Cardiac Surgery, Johns Hopkins University, Baltimore, United States. (Jacobs J.P.) Division of Cardiac Surgery, Johns Hopkins All Children’s Heart Institute, St. Petersburg, United States. (Swartz M.F., Michael_swartz@urmc.rochester.edu) Strong Memorial Hospital, 601 Elmwood Ave, Box Surg/Cardiac, Rochester, United States. CORRESPONDENCE ADDRESS M.F. Swartz, Strong Memorial Hospital, 601 Elmwood Ave, Box Surg/Cardiac, Rochester, United States. Email: Michael_swartz@urmc.rochester.edu SOURCE Pediatric Cardiology (2017) 38:7 (1350-1358). Date of Publication: 1 Oct 2017 ISSN 1432-1971 (electronic) 0172-0643 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Regionalization of pediatric cardiac surgical care varies between and within states. In most geographic regions, at least some neonates with critical heart disease are transferred from their birth hospital to a different hospital for surgery. The impact of neonatal transfer for surgery, particularly over a considerable distance (>10 miles), has been largely unexplored. We sought to examine the impact of transferring neonates for cardiac surgery. We queried the New York State Cardiac Surgery database (2005–2014) from a single institution to identify neonates born within the cardiac surgery center and those transferred for surgery. Outcomes were compared between groups, with subgroup analysis of neonates with single ventricle anatomy. 113 surgical neonates were born at the cardiac surgery center, and 268 were transferred to the cardiac surgery center. Median transfer distance was 91 (IQR 73, 94) miles. Age at operation and the need for preoperative ventilation were significantly lower in neonates born at the cardiac surgery center. In addition, single ventricle anatomy was more prevalent among those born at the cardiac surgery center (48.7 vs. 31.3%; p = 0.001). However, postoperative outcomes were the same—30-day survival was similar across groups (birth: 89% vs. transfer: 90%; p = 0.7), and for those with single ventricle palliation (birth: 81% vs. transfer: 81%; p = 0.9). Within our regionalized network, we found no difference in 30-day survival between neonates either born or transferred to a cardiac surgery center, which supports the use of a regionalized network of hospitals to the care of children with congenital heart disease. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart disease (surgery) critical illness (surgery) patient transport regionalization EMTREE MEDICAL INDEX TERMS age article artificial ventilation controlled study female heart single ventricle heart surgery human length of stay major clinical study male neonatal intensive care unit newborn newborn death palliative therapy prenatal diagnosis preoperative care survival treatment outcome EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170509860 PUI L617341321 DOI 10.1007/s00246-017-1668-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00246-017-1668-8 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 19 TITLE Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom AUTHOR NAMES Boyd L.R. Borawski J. Lairet J. Limkakeng A.T. AUTHOR ADDRESSES (Boyd L.R.; Borawski J.; Limkakeng A.T.) Emergency Medicine, Duke University Medical Center, Durham, North Carolina, USA (Lairet J.) Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA SOURCE Journal of the Royal Army Medical Corps (2017) 163:5 (342-346). Date of Publication: 1 Oct 2017 ISSN 0035-8665 ABSTRACT INTRODUCTION: Our understanding of the expertise and equipment required to air transport injured soldiers with severe traumatic brain injuries (TBIs) continue to evolve.METHODS: We conducted a retrospective chart review of characteristics, interventions required and short-term outcomes of patients with severe TBI managed by the US Air Force Critical Care Air Transport Teams (CCATTs) deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom between 1 June 2007 and 31 August 2010. Patients were cared for based on guidelines given by the Brain Trauma Foundation and the Joint Theater Trauma System by non-neurosurgeon physicians with dedicated neurocritical care training. We report basic characteristics, injuries, interventions required and complications during transport.RESULTS: Intracranial haemorrhage was the most common diagnosis in this cohort. Most injuries were weapon related. During this study, there were no reported in-flight deaths. The majority of patients were mechanically ventilated. There were 45 patients who required at least one vasopressor to maintain adequate tissue perfusion, including four patients who required three or more. Some patients required intracranial pressure (ICP) management, treatment of diabetes insipidus and/or seizure prophylaxis medications.CONCLUSIONS: Air transport personnel must be prepared to provide standard critical care but also care specific to TBIs, including ICP control and management of diabetes insipidus. Although these patients and their potential complications are traditionally managed by neurosurgeons, those providers without neurosurgical backgrounds can be provided this training to help fill a wartime need. This study provides data for the future development of air transport guidelines for validating and clearing flight surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) statistics and numerical data traumatic brain injury (epidemiology, therapy) EMTREE MEDICAL INDEX TERMS air medical transport female human intensive care male military medicine patient transport retrospective study treatment outcome war LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28385926 (http://www.ncbi.nlm.nih.gov/pubmed/28385926) PUI L619834696 DOI 10.1136/jramc-2016-000743 FULL TEXT LINK http://dx.doi.org/10.1136/jramc-2016-000743 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 20 TITLE The impact of neonatal transfer on follow up screening for retinopathy of prematurity - Data from a Tertiary Care Children's Hospital in NSW Australia AUTHOR NAMES Burbidge A. Bhate M. AUTHOR ADDRESSES (Burbidge A., andyburbidge88@gmail.com) Hunter New England Area Health Service, Newcastle, Australia. (Burbidge A., andyburbidge88@gmail.com) University of Newcastle, Newcastle, Australia. (Burbidge A., andyburbidge88@gmail.com) Hunter Medical Research Institute, Newcastle, Australia. (Bhate M.) Department of Ophthalmology, Hunter New England Area Health Service, Newcastle, Australia. CORRESPONDENCE ADDRESS A. Burbidge, Hunter New England Area Health Service, Newcastle, Australia. Email: andyburbidge88@gmail.com SOURCE Clinical and Experimental Ophthalmology (2017) 45 Supplement 1 (126). Date of Publication: 1 Oct 2017 CONFERENCE NAME 49th Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists CONFERENCE LOCATION Perth, WA, Australia CONFERENCE DATE 2017-10-28 to 2017-11-01 ISSN 1442-9071 BOOK PUBLISHER Blackwell Publishing ABSTRACT Purpose: The aim of this study was to investigate the impact of neonatal transfer within a geographically large regional health care model on follow-up retinal screening for neonates investigated for ROP. Methods: A retrospective review was conducted on two-hundred-ninety-one neonates born less than 32 weeks gestation age; or, weighing <1251grams, who consecutively underwent ROP screening during their admissions between 1stSeptember 2014 and 30th June 2016, at the John Hunter Children's Hospital Neonatal Intensive Care Unit (NICU); a large regional tertiary referral center. Variables assessed included: screening outcomes, transfer and follow-up trends. Data was extracted and analyzed with SPSS statistical software via Wilcoxon rank sum test and relative risk ratios. Results: A total of 291 neonates were screened for ROP. 94.2% (n=274) infants survived until discharge. Of surviving infants 64.96% (n= 178) had no ROP identified. A total of 17.15% (n= 47) were diagnosed with ROP. A further 17.88% (n= 49) were transferred prior to screening. The relative risk for infants failing to meet scheduled follow-up ophthalmic care, as a result of the transfer process was 0.8750, [95% confidence interval CI (0.3802- 2.0140)] when compared to the non-transferred cohort. Mean distance of transfer was 145.55kms (Range 7- 561km's) occurring at 37.5 weeks gestational age (SD = 3.2 weeks). Conclusion: Our study demonstrates that neonatal transfer contributes significant complexity to timely ROP screening service delivery. Large geographical distances and transfers, present additional barriers, which may be detrimental to follow-up eye care. Our findings emphasize the importance of a centralized, scheduled ROP screening examination post NICU discharge. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia follow up retrolental fibroplasia tertiary care center EMTREE MEDICAL INDEX TERMS child clinical assessment controlled study data analysis software diagnosis eye care female gestational age human infant major clinical study male neonatal intensive care unit newborn rank sum test retina retrospective study risk factor treatment failure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619285008 DOI 10.1111/ceo.13054/full FULL TEXT LINK http://dx.doi.org/10.1111/ceo.13054/full COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 21 TITLE The impact of Italian regionalisation on transporting neonatal patients back from the neonatal intensive care unit to the referring level two unit AUTHOR NAMES Bellini C. Risso F.M. Ramenghi L.A. AUTHOR ADDRESSES (Bellini C., carlobellini@ospedale-gaslini.ge.it; Risso F.M.; Ramenghi L.A.) Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, IRCCS Istituto Giannina Gaslini, Genoa, Italy. CORRESPONDENCE ADDRESS C. Bellini, Neonatal Intensive Care Unit, Neonatal Emergency Transport Service, IRCCS Istituto Giannina Gaslini, Genoa, Italy. Email: carlobellini@ospedale-gaslini.ge.it SOURCE Acta Paediatrica, International Journal of Paediatrics (2017) 106:8 (1358). Date of Publication: 1 Aug 2017 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neonatal intensive care unit newborn care patient transport regionalization EMTREE MEDICAL INDEX TERMS article feces culture human medical literature newborn practice guideline prematurity priority journal shared decision making very low birth weight EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170290892 PUI L615604229 DOI 10.1111/apa.13821 FULL TEXT LINK http://dx.doi.org/10.1111/apa.13821 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 22 TITLE Introducing high-flow nasal cannula to the neonatal transport environment AUTHOR NAMES Boyle M.A. Dhar A. Broster S. AUTHOR ADDRESSES (Boyle M.A., mijkboyle@yahoo.com; Dhar A.; Broster S.) Acute Neonatal Transfer Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. CORRESPONDENCE ADDRESS M.A. Boyle, Acute Neonatal Transfer Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. Email: mijkboyle@yahoo.com SOURCE Acta Paediatrica, International Journal of Paediatrics (2017) 106:8 (1363). Date of Publication: 1 Aug 2017 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assisted ventilation nasal cannula newborn care patient transport EMTREE MEDICAL INDEX TERMS human neonatal intensive care unit note patient risk priority journal standard EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170425253 PUI L616781160 DOI 10.1111/apa.13910 FULL TEXT LINK http://dx.doi.org/10.1111/apa.13910 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 23 TITLE Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review AUTHOR NAMES Synnot A. Karlsson A. Brichko L. Chee M. Fitzgerald M. Misra M.C. Howard T. Mathew J. Rotter T. Fiander M. Gruen R.L. Gupta A. Dharap S. Fahey M. Stephenson M. O'Reilly G. Cameron P. Mitra B. AUTHOR ADDRESSES (Synnot A.; Stephenson M.) Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. (Synnot A.) Cochrane Consumers and Communication, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. (Synnot A.; Chee M.; Fitzgerald M.; Howard T.; Mathew J.; Fahey M.; O'Reilly G.; Cameron P.; Mitra B., biswadev.mitra@monash.edu) National Trauma Research Institute, Melbourne, Australia. (Synnot A.) Central Clinical School, Monash University, Melbourne, Australia. (Karlsson A.) Lund University, Lund, Sweden. (Brichko L.; Fitzgerald M.; Mathew J.; Gupta A.; O'Reilly G.; Cameron P.; Mitra B., biswadev.mitra@monash.edu) The Alfred Hospital, Melbourne, Australia. (Misra M.C.; Gupta A.) JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. (Rotter T.) College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada. (Fiander M.) Information Specialist (consultant), Canada. (Gruen R.L.) Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. (Dharap S.) Lokmanya Tilak Municipal General Hospital, Mumbai, India. (Stephenson M.) Ambulance Victoria, Melbourne, Australia. (O'Reilly G.; Cameron P.; Mitra B., biswadev.mitra@monash.edu) School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. () CORRESPONDENCE ADDRESS B. Mitra, National Trauma Research Institute, Melbourne, Australia. Email: biswadev.mitra@monash.edu SOURCE Journal of Evidence-Based Medicine (2017) 10:3 (212-221). Date of Publication: 1 Aug 2017 ISSN 1756-5391 (electronic) 1756-5383 BOOK PUBLISHER Blackwell Publishing, info@asia.blackpublishing.com.au ABSTRACT Objective: This systematic review aimed to determine the effect of prehospital notification systems for major trauma patients on overall (<30 days) and early (<24 hours) mortality, hospital reception, and trauma team presence (or equivalent) on arrival, time to critical interventions, and length of hospital stay. Methods: Experimental and observational studies of prehospital notification compared with no notification or another type of notification in major trauma patients requiring emergency transport were included. Risk of bias was assessed using the Cochrane ACROBAT-NRSI tool. A narrative synthesis was conducted and evidence quality rated using the GRADE criteria. Results: Three observational studies of 72,423 major trauma patients were included. All were conducted in high-income countries in hospitals with established trauma services, with two studies undertaking retrospective analysis of registry data. Two studies reported overall mortality, one demonstrating a reduction in mortality; (adjusted odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39 to 0.94, 72,073 participants); and the other demonstrating a nonsignificant change (OR 0.61, 95% CI 0.23 to 1.64, 81 participants). The quality of this evidence was rated as very low. Conclusion: Limited research on the topic constrains conclusive evidence on the effect of prehospital notification on patient-centered outcomes after severe trauma. Composite interventions that combine prehospital notification with effective actions on arrival to hospital such as trauma bay availability, trauma team presence, and early access to definitive management may provide more robust evidence towards benefits of early interventions during trauma reception and resuscitation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blunt trauma emergency care medical information patient transport penetrating trauma prehospital notification EMTREE MEDICAL INDEX TERMS article disease severity health care availability health care cost high income country human intensive care unit length of stay low income country middle income country mortality rate priority journal resuscitation systematic review thorax radiography time to treatment EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170617388 PUI L618087576 DOI 10.1111/jebm.12256 FULL TEXT LINK http://dx.doi.org/10.1111/jebm.12256 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 24 TITLE Assessing guidelines for burn referrals in a resource-constrained setting: Demographic and clinical factors associated with inter-facility transfer AUTHOR NAMES Klingberg A. Wallis L. Rode H. Stenberg T. Laflamme L. Hasselberg M. AUTHOR ADDRESSES (Klingberg A., anders.klingberg@ki.se; Stenberg T.; Laflamme L.; Hasselberg M.) Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, Stockholm, Sweden. (Wallis L.) Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X24, Bellville, South Africa. (Rode H.) Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa. (Laflamme L.) University of South Africa, Preller Street, Pretoria, South Africa. CORRESPONDENCE ADDRESS A. Klingberg, Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, Stockholm, Sweden. Email: anders.klingberg@ki.se SOURCE Burns (2017) 43:5 (1070-1077). Date of Publication: 1 Aug 2017 ISSN 1879-1409 (electronic) 0305-4179 BOOK PUBLISHER Elsevier Ltd ABSTRACT Aim The aim was to assess demographic and clinical factors associated with inter-facility referrals for patients with burns in a resource-constrained setting. Methods This was a cross-sectional case review of patients presenting with a burn at the trauma unit at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town, South Africa. Results Six hundred and eleven—(71%) children were referred to the burns or the intensive care unit and 253 children were treated and discharged from the trauma unit. Of those admitted as inpatients 94% fulfilled at least one of the criteria for referral and 80% of those treated and discharged fulfilled the criteria for referral. Conclusions Almost three out of four children evaluated at the trauma unit were referred to the burns unit for further management. However, a large number of patients were treated and discharged from the trauma unit despite being eligible for referral. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn patient referral EMTREE MEDICAL INDEX TERMS article chemical burn child clinical feature cross-sectional study demography electric burn female hospital admission human infant intensive care unit major clinical study male preschool child scald school child EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170276959 PUI L615407154 DOI 10.1016/j.burns.2017.01.035 FULL TEXT LINK http://dx.doi.org/10.1016/j.burns.2017.01.035 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 25 TITLE The T3 Trial: Triage, Treatment and Transfer of patients with stroke in emergency departments AUTHOR NAMES Middleton S. Levi C. Dale S. Wah Cheung N. McInnes E. Considine J. D'Este C. Cadilhac D. Grimshaw J. Gerraty R. Craig L. Schadewaldt V. McElduff P. Fitzgerald M. Quinn C. Cadigan G. Denisenko S. Longworth M. Ward J. AUTHOR ADDRESSES (Middleton S.; Dale S.; McInnes E.; Craig L.; Schadewaldt V.) St Vincent's Health Australia Sydney, Australian Catholic University, Darlinghurst, Australia. (Levi C.) Centre for Translational Neuroscience and Mental Health, Newcastle, Australia. (Wah Cheung N.) Centre for Diabetes and Endocrinology Research, Westmead Hospital, University of Sydney, Westmead, Australia. (Considine J.) Deakin University, Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Burwood, Australia. (D'Este C.) National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australia. (Cadilhac D.) School of Clinical Sciences, Monash Health, Monash Clayton, Australia. (Grimshaw J.) Ottawa Health Research Institute, University of Ottawa, Ottawa, Canada. (Gerraty R.) Department of Medicine, Epworth Hospital, Richmond, Australia. (McElduff P.) School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. (Fitzgerald M.) Monash University, Swinburne University of Technology, Melbourne, Australia. (Quinn C.) Prince of Wales Hospital of Wales, Sydney, Australia. (Cadigan G.) Statewide Stroke Clinical Network, Brisbane, Australia. (Denisenko S.) Victorian Stroke Clinical Network, Melbourne, Australia. (Longworth M.) Stroke Services NSW, Sydney, Australia. (Ward J.) University of Ottawa, Ottawa, Canada. (Ward J.) University of Notre Dame Australia, Broome, Australia. CORRESPONDENCE ADDRESS S. Middleton, St Vincent's Health Australia Sydney, Australian Catholic University, Darlinghurst, Australia. SOURCE International Journal of Stroke (2017) 12:2 Supplement 1 (15). Date of Publication: 1 Aug 2017 CONFERENCE NAME 2017 SMART STROKES Conference CONFERENCE LOCATION Gold Coast, QLD, Australia CONFERENCE DATE 2017-08-10 to 2017-08-11 ISSN 1747-4949 BOOK PUBLISHER SAGE Publications Inc. ABSTRACT Background & Aims: The T3 cluster randomised trial aimed to improve Triage, Treatment and Transfer (T3) of patients with acute stroke in emergency departments (EDs). Methods: Our prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment, randomised EDs 1:1 to receive either the T3 intervention or no support (control EDs). Our evidence-based intervention targeted: (1) Triage: patients with suspected stroke assigned to Australian Triage Scale category 1 or 2 (seen within 10 minutes); (2) Treatment: screening for tPA eligibility and administration of tPA where applicable; protocols for management of fever, hyperglycaemia and swallowing; and (3) rapid Transfer from ED to the stroke unit, implemented using (i) workshops to determine barriers and solutions; (ii) education; (iii) use of clinical opinion leaders; (iv) email, telephone and site visit reminders. Primary outcome: 90-days post-admission death or dependency (mRS>2). Secondary outcomes: 90-day: health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and in-hospital quality-of-care outcomes: triage practices; monitoring and management for thrombolysis, fever, hyperglycaemia, swallowing; and transfer practices. Results: Of the 26 eligible sites from three states and one territory in Australia, all (100%) agreed to participate with 2253 patients consenting (pre-implementation n=645; post-implementation n=1608). Of these, 1879 will be analysed (pre-implementation n=574; post-implementation n=1305). In the post-implementation cohort, 751 patients were randomised to the intervention group and 554 to the control group. Data currently are being analysed. Conclusion: This large trial will provide rigorous evidence for assisted implementation of nurse-initiated ED stroke protocols aiming to improve outcomes for patients with stroke. EMTREE DRUG INDEX TERMS endogenous compound tissue plasminogen activator EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service emergency ward female male stroke unit EMTREE MEDICAL INDEX TERMS Australia Barthel index blood clot lysis control group controlled clinical trial controlled study death e-mail education evidence based nursing evidence based practice center fever health status human hyperglycemia leadership major clinical study monitoring nurse parallel design randomized controlled trial Rankin scale screening Short Form 36 swallowing telephone treatment outcome CAS REGISTRY NUMBERS tissue plasminogen activator (105913-11-9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617955282 DOI 10.1177/1747493017714154 FULL TEXT LINK http://dx.doi.org/10.1177/1747493017714154 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 26 TITLE Comments AUTHOR NAMES Konakondla S. Schirmer C.M. AUTHOR ADDRESSES (Konakondla S.) Danville, United States. (Schirmer C.M.) Wilkes Barre, United States. SOURCE Neurosurgery (2017) 81:2 (249-250). Date of Publication: 1 Aug 2017 ISSN 1524-4040 (electronic) 0148-396X BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE DRUG INDEX TERMS clopidogrel warfarin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neurosurgery patient transport EMTREE MEDICAL INDEX TERMS anticoagulation brain hemorrhage deterioration disease severity Glasgow coma scale health care delivery human hydrocephalus major clinical study mortality neurological intensive care unit neurosurgeon note priority journal risk factor treatment outcome CAS REGISTRY NUMBERS clopidogrel (113665-84-2, 120202-66-6, 90055-48-4, 94188-84-8) warfarin (129-06-6, 2610-86-8, 3324-63-8, 5543-58-8, 81-81-2) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Drug Literature Index (37) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170569470 PUI L617701491 DOI 10.1093/neuros/nyx012 FULL TEXT LINK http://dx.doi.org/10.1093/neuros/nyx012 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 27 TITLE Interfacility Transport Shock Index Is Associated With Decreased Survival in Children AUTHOR NAMES Jennings R.M. Kuch B.A. Felmet K.A. Orr R.A. Carcillo J.A. Fink E.L. AUTHOR ADDRESSES (Jennings R.M.) From the *University of Pittsburgh School of Medicine and †Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA; and ‡Oregon Health and Science University, Portland, OR. (Kuch B.A.; Felmet K.A.; Orr R.A.; Carcillo J.A.; Fink E.L.) CORRESPONDENCE ADDRESS R.M. Jennings, From the *University of Pittsburgh School of Medicine and †Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA; and ‡Oregon Health and Science University, Portland, OR. SOURCE Pediatric Emergency Care (2017). Date of Publication: 11 Jul 2017 ISSN 1535-1815 (electronic) 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT BACKGROUND: Shock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center. METHODS: We studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children’s Hospital of Pittsburgh by our critical care transport team. Subjects were divided into 4 age groups: group 1 (<1 year), group 2 (1–3 years), group 3 (4–11 years), and group 4 (≥12 years). Children were also grouped into sepsis or nonsepsis group based on the International Classification of Diseases, Ninth Revision categories. Primary outcome was survival to hospital discharge. RESULTS: Of 3519 children studied, 493 (14%) had sepsis. Initial shock index decreased with increasing age: group 1, 1.45 ± 0.42 (mean ± SD); group 2, 1.35 ± 0.32; group 3, 1.20 ± 0.34; and group 4, 1.00 ± 0.32 (P < 0.001). Initial shock index was increased in children with sepsis versus those with no sepsis overall and in all age groups (all P < 0.05). Initial shock index showed a trend for association with survival in univariate analysis (P = 0.05) but was not associated with survival in a multivariable logistic regression. Highest quartile of shock index was associated with need for intensive care unit admission posttransport. CONCLUSIONS: Increased shock index in children requiring intrafacility transport was associated with hospital discharge diagnosis of sepsis but not hospital survival. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female male shock EMTREE MEDICAL INDEX TERMS adult child controlled study diagnosis hospital discharge human infant intensive care unit International Classification of Diseases logistic regression analysis major clinical study sepsis tertiary care center univariate analysis vital sign young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170502370 PUI L617304034 DOI 10.1097/PEC.0000000000001205 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0000000000001205 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 28 TITLE The need for setting standards in critical care transfers AUTHOR NAMES Venter M. Stanton D. Conradie N. Jordaan L. Venter C. Stassen W. AUTHOR ADDRESSES (Venter M., monique.venter@netcare.co.za; Stanton D.) Netcare (Pty) Ltd., Netcare 911, Midrand, South Africa. (Conradie N.) Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa. (Conradie N.; Stassen W.) Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa. (Jordaan L.) Department of Emergency Medical Care, Faculty of Health Sciences, Cape Peninsula University of Technology, Cape Town, South Africa. (Venter M., monique.venter@netcare.co.za; Venter C.; Stassen W.) Critical Care Retrieval Services, ER24, Johannesburg, South Africa. CORRESPONDENCE ADDRESS M. Venter, Critical Care Retrieval Services, ER24, Johannesburg, South Africa. Email: monique.venter@netcare.co.za SOURCE Southern African Journal of Critical Care (2017) 33:1 (32). Date of Publication: 1 Jul 2017 ISSN 2078-676X (electronic) 1562-8264 BOOK PUBLISHER South African Medical Association, Lansdale Building, Gardener Way, Pinelands, Cape Town, South Africa. publishing@samedical.org EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS critically ill patient emergency care human letter postgraduate education scope of practice treatment outcome EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170510466 PUI L617342990 DOI 10.7196/SAJCC.2017.v33i1.319 FULL TEXT LINK http://dx.doi.org/10.7196/SAJCC.2017.v33i1.319 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 29 TITLE Outcome of paediatric patients with congenital heart disease transferred from their regional cardiac intensive care unit to a unit with transplant and mechanical support capability AUTHOR NAMES Cardoso B. Simpson E. Ferguson L. Llevadias J. Chilà T. Guillèn M. Thiru Y. De Rita F. Hasan A. Crossland D.S. AUTHOR ADDRESSES (Cardoso B.; Simpson E.; Ferguson L.; Llevadias J.; Guillèn M.; Thiru Y.) Freeman Hospital, Department of Paediatric Intensive Care, Newcastle Upon Tyne, United Kingdom. (De Rita F.; Hasan A.) Freeman Hospital, Department of Cardiothoracic Surgery, Newcastle Upon Tyne, United Kingdom. (Crossland D.S.) Freeman Hospital, Epartment of Paediatric Cardiology, Newcastle Upon Tyne, United Kingdom. (Chilà T.) CORRESPONDENCE ADDRESS B. Cardoso, Freeman Hospital, Department of Paediatric Intensive Care, Newcastle Upon Tyne, United Kingdom. SOURCE Cardiology in the Young (2017) 27:4 (S77-S78). Date of Publication: 1 Jul 2017 CONFERENCE NAME 7th World Congress of Pediatric Cardiology and Cardiac Surgery CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2017-07-16 to 2017-07-21 ISSN 1467-1107 BOOK PUBLISHER Cambridge University Press ABSTRACT Background: Children with congenital heart disease (CHD) admitted to a Paediatric Cardiac Intensive Care Unit (PCICU) who exhaust conventional therapy or surgical options may be transferred to a PCICU with transplant and mechanical support capability for further management. We aimed to describe the management and outcome of this group- not all of whom are referred 'for transplant'. Materials and Methods: Retrospective analysis of the records of patients with CHD and circulatory failure transferred from their regional PCICU between January 2011 and January 2016. Patients with cardiomyopathy were excluded. Results: Twenty-seven patients were transferred and overall survival was 78% at 1 month and 61% at 1 year. 59.3% were male, median age 9.8 months IQR 4.4-44.6 months and 11 (41%) had univentricular physiology. Eight (29.6%) were transferred on ECMO. Seventeen patients were listed for cardiac transplant: 12 transplanted, 5 deaths on waiting list, 2 post-transplant deaths (day 102 and 109). Six VADs were undertaken as bridge to transplant (3 transplanted, 3 deaths onlist). Six patients were managed conventionally (4 further surgery, 2 medical/ ECMO only), all survived. Four patients were considered unsuitable for any further intervention including transplant. There was no difference in mortality between univentricular and biventricular circulations (p = 0.346) or those transferred on ECMO vs non-ECMO (p =0.476). Survival was lower at <1 year of age compared to >1 year (survival at 30 days 64% v. 92%; one year 44% v. 77%, p= 0.051). Conclusions: Although transplant is effective for CHD patients transferred acutely to a quaternary PCICU, mortality on the waiting list is a serious issue, partially due to limited mechanical support options for these patients. A carefully selected sub-group can be managed successfully with medical therapy and conventional surgery and this should be an integral part of the management offered by such PCICUs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart disease coronary care unit EMTREE MEDICAL INDEX TERMS cardiomyopathy child clinical article death female heart graft hospital admission human infant information processing male mortality overall survival physiology retrospective study shock surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620076943 DOI 10.1017/S104795111700110X FULL TEXT LINK http://dx.doi.org/10.1017/S104795111700110X COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 30 TITLE Use of point of care laboratory testing during critical care interfacility transport AUTHOR NAMES Collopy K. Langston B. Powers W.F. AUTHOR ADDRESSES (Collopy K.; Langston B.; Powers W.F.) AirLink/VitaLink Critical Care Transport, New Hanover Regional Medical Center, Wilmington, United States. CORRESPONDENCE ADDRESS K. Collopy, AirLink/VitaLink Critical Care Transport, New Hanover Regional Medical Center, Wilmington, United States. SOURCE Air Medical Journal (2017) 36:4 (209-211). Date of Publication: 1 Jul 2017 CONFERENCE NAME 2017 Critical Care Transport Medicine Conference CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2017-04-10 to 2017-04-12 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Laboratory data is used to drive more than 70% of medical care decisions.1 Point of Care laboratory Testing (POCT) is one of the fastest growing areas of laboratory testing, as it has shown to reduce both time from first contact to intervention as well as length of stay within emergency departments.2,3 To date there is limited literature describing the use of POCT in critical care transport4 though its reliability and cost-effectiveness have been previously studied.5 This study aims to describe the use of POCT in critical care transport using the EPOC® blood analyzer (Alere, Inc), a CLIA-moderate complexity testing system. AirLink/VitaLink Critical Care Transport is (Figure Presented) accredited by the College of American Pathology to perform moderate complexity POCT as an independent laboratory. Methods: This is an IRB approved retrospective review of all patients transported by our adult Critical Care Team between 1 Oct 2013 and 31 Sept 2015. Patients transported by neonatal ICU and basic life support teams were excluded. Transports were screened for attempted POCT testing via the EPOC® blood analyzer where blood analysis occurs with a single test cartridge (Figure 1). Patients who received waived-POCT testing only (e.g. via glucometer) were not included in the final analysis. Patient Care Records were screened to determine patient age, sex, complaint, diagnosis, POCT success, and reason for inability to complete testing (if applicable). During the study period, patient care protocols did not mandate POCT. Teams were permitted to perform lab testing based on anticipated potential benefit given the patient's condition, as noted in patient care protocol including POCT (Figure 2). Results: Critical care transport teams treated 11,454 patients during the study period. POCT labs were attempted on 659 transports (5.75%) with a 95.78% success rate (n=632). Patients had a mean age of 58 years and 56.3% were males. POCT was most frequently performed when patients had a chief complaint of: respiratory distress, altered mental state, abdominal pain, or weakness/dizziness (Figure 3). POCT most frequently resulted in patient care changes when patients complained of: respiratory failure, unresponsiveness, fever, respiratory distress, and altered mental state (>10 patients) (Figure 4). Conclusions: Point of Care Lab Testing using the EPOC® blood analyzer was successfully performed during 95.78% of attempts and most frequently altered patient care for patients with chief complaint of respiratory failure, unresponsiveness, fevers, respiratory distress, and altered mental state. This information may be helpful in standardizing the use of POCT during critical care transport medicine, foster protocol development and facilitate patient care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neonatal intensive care unit EMTREE MEDICAL INDEX TERMS abdominal pain adult analyzer blood analysis clinical trial college cost effectiveness analysis diagnosis dizziness emergency ward female fever human information processing length of stay major clinical study male medical care medicine mental health middle aged newborn pathology patient care reliability respiratory distress respiratory failure retrospective study weakness LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617549258 DOI 10.1016/j.amj.2017.04.011 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2017.04.011 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 31 TITLE 2017 Critical Care Transport Medicine Conference AUTHOR ADDRESSES SOURCE Air Medical Journal (2017) 36:4. Date of Publication: 1 Jul 2017 CONFERENCE NAME 2017 Critical Care Transport Medicine Conference CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2017-04-10 to 2017-04-12 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT The proceedings contain 11 papers. The topics discussed include: mobilization time among neonatal/pediatric transport teams: the ground and air medical quality in transport (GAMUT) collaborative; use of point of care laboratory testing during critical care interfacility transport; assessing lift-off times for a hospital-based helicopter transport program; asthma scores may be a reliable tool to determine the need for advanced asthma management in the pediatric patient; does the use of video laryngoscopy improve first time success rates overall success rates in HEMS?; identification of a pre-arrest systolic blood pressure inflection point for air medical cardiopulmonary arrest victims; and tranexamic acid: promise or panacea - the impact of air medical administration of tranexamic acid on morbidity, mortality and length of stay. EMTREE DRUG INDEX TERMS tranexamic acid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care medicine EMTREE MEDICAL INDEX TERMS asthma cardiopulmonary arrest child doctor patient relation drug therapy helicopter human instrument validation laryngoscopy length of stay morbidity mortality newborn systolic blood pressure victim videorecording CAS REGISTRY NUMBERS tranexamic acid (1197-18-8, 701-54-2) LANGUAGE OF ARTICLE English PUI L617549278 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 32 TITLE Transfer of KPC-2 carbapenemase from Klebsiella pneumoniae to Enterobacter cloacae in a patient receiving meropenem therapy AUTHOR NAMES Martins E.R. Estofolete C.F. Zequini A.B. Cerdeira L. de Oliveira Garcia D. Bueno M.F.C. Francisco G.R. de Andrade L.N. da Costa Darini A.L. Tolentino F.M. Casella T. Lincopan N. Nogueira M.C.L. AUTHOR ADDRESSES (Martins E.R., evelin.rod.martins@gmail.com; Estofolete C.F., cassiafestofolete@gmail.com; Casella T., tiago_casella@yahoo.com.br; Nogueira M.C.L., ml.nogueira@famerp.br) Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil. (Estofolete C.F., cassiafestofolete@gmail.com; Zequini A.B., andressa.zequini@yahoo.com.br; Nogueira M.C.L., ml.nogueira@famerp.br) Hospital de Base de São José do Rio Preto, São José do Rio Preto, Brazil. (Cerdeira L., lcerdeira@gmail.com; Lincopan N., lincopan@usp.br) Departamento de Análises Clínicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil. (de Oliveira Garcia D., dogarcia@yahoo.com; Bueno M.F.C., mf.campagnari@gmail.com; Francisco G.R., gabis.francisco@gmail.com) Instituto Adolfo Lutz, São Paulo, Brazil. (de Andrade L.N., leoandrade02es@gmail.com; da Costa Darini A.L., aldarini@fcfrp.usp.br) Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, Ribeirão Preto, Brazil. (Tolentino F.M., fernandaTollentino@hotmail.com; Casella T., tiago_casella@yahoo.com.br) Universidade Estadual Paulista “Júlio de Mesquita Filho”, São José do Rio Preto, Brazil. (Tolentino F.M., fernandaTollentino@hotmail.com) Instituto Adolfo Lutz, São José do Rio Preto, Brazil. (Lincopan N., lincopan@usp.br) Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil. CORRESPONDENCE ADDRESS M.C.L. Nogueira, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil. Email: ml.nogueira@famerp.br SOURCE Diagnostic Microbiology and Infectious Disease (2017) 88:3 (287-289). Date of Publication: 1 Jul 2017 ISSN 1879-0070 (electronic) 0732-8893 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT The horizontal transfer of a plasmid bearing the bla(KPC-2) gene from K. pneumoniae to E. cloacae infecting the respiratory tract of a patient during meropenem therapy was elucidated. This finding is particularly worrisome, since these drugs are of last resort for multidrug-resistant Gram-negative pathogens. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) amikacin ciprofloxacin colistimethate meropenem EMTREE DRUG INDEX TERMS piperacillin plus tazobactam EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial gene blaKPC2 gene Enterobacter cloacae Klebsiella pneumoniae EMTREE MEDICAL INDEX TERMS antibiotic resistance antibiotic sensitivity aortic aneurysm article artificial ventilation bacterial strain bacterium isolate brain ischemia Brazil cause of death cold sweat computer assisted tomography congestive heart failure consciousness disorder coronary care unit deterioration diabetes mellitus dyspnea emergency ward endoprosthesis epigastric pain gene sequence hospital admission hospital discharge human hypertension intubation mental disease nonhuman pallor plasmid pleura effusion pneumonia polymerase chain reaction priority journal septic shock tachypnea tracheal aspiration procedure trypanosomiasis CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) ciprofloxacin (85721-33-1) colistimethate (12705-41-8, 8068-28-8) meropenem (96036-03-2) EMBASE CLASSIFICATIONS Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170296128 PUI L615634678 DOI 10.1016/j.diagmicrobio.2017.04.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.diagmicrobio.2017.04.004 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 33 TITLE A Workflow-Driven Formal Methods Approach to the Generation of Structured Checklists for Intrahospital Patient Transfers AUTHOR NAMES Manataki A. Fleuriot J. Papapanagiotou P. AUTHOR ADDRESSES (Manataki A., A.Manataki@ed.ac.uk; Fleuriot J., jdf@inf.ed.ac.uk; Papapanagiotou P., pe.p@ed.ac.uk) School of Informatics, University of Edinburgh, Edinburgh, United Kingdom. SOURCE IEEE Journal of Biomedical and Health Informatics (2017) 21:4 (1156-1162) Article Number: 7489005. Date of Publication: 1 Jul 2017 ISSN 2168-2194 BOOK PUBLISHER Institute of Electrical and Electronics Engineers Inc. ABSTRACT Intrahospital transfers are a common but hazardous aspect of hospital care, with a large number of incidents posing a threat to patient safety. A growing body of work advocates the use of checklists for minimizing intrahospital transfer risk, but the majority of existing checklists are not guaranteed to be error-free and are difficult to adapt to different clinical settings or changing hospital policies. This paper details an approach that addresses these challenges through the employment of workflow technologies and formal methods for generating structured checklists. A three-phased methodology is proposed, where intrahospital transfer processes are first conceptualized, then rigorously composed into workflows that are mechanically verified, and finally, translated into a set of checklists that support hospital staff while maintaining the dependencies between different transfer tasks. A case study is presented, highlighting the feasibility of this approach, and the correctness and maintainability benefits brought by the logical underpinning of this methodology. A checklist evaluation is discussed, with promising results regarding their usefulness. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) checklist patient transport process model workflow EMTREE MEDICAL INDEX TERMS employment feasibility study hospital personnel human LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170507109 MEDLINE PMID 27305690 (http://www.ncbi.nlm.nih.gov/pubmed/27305690) PUI L617287447 DOI 10.1109/JBHI.2016.2579881 FULL TEXT LINK http://dx.doi.org/10.1109/JBHI.2016.2579881 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 34 TITLE A Case of Succinyl-CoA:3-Oxoacid CoA Transferase Deficiency Presenting with Severe Acidosis in a 14-Month-Old Female: Evidence for Pathogenicity of a Point Mutation in the OXCT1 Gene AUTHOR NAMES Zheng D.J. Hooper M. Spencer-Manzon M. Pierce R.W. AUTHOR ADDRESSES (Zheng D.J.; Hooper M.; Spencer-Manzon M.; Pierce R.W., Richard.pierce@yale.edu) Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States (Spencer-Manzon M.) Department of Genetics, Yale School of Medicine, New Haven, Connecticut, United States CORRESPONDENCE ADDRESS R.W. Pierce, Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, P.O. Box 208064, New Haven, CT 06520-8064, United States Email: Richard.pierce@yale.edu SOURCE Journal of Pediatric Intensive Care (2017). Date of Publication: 12 Jun 2017 ISSN 2146-4626 (electronic) 2146-4618 BOOK PUBLISHER Georg Thieme Verlag, kunden.service@thieme.de ABSTRACT We describe a case of succinyl-CoA:3-oxoacid CoA transferase (SCOT) deficiency in an otherwise healthy 14 month-old female. She presented with lethargy, tachypnea, and hyperpnea with hypoglycemia and a severe anion gap metabolic acidosis. Early management included correction of the acidosis and metabolic support with dextrose and insulin. Inborn errors of metabolism are rare outside the neonatal period. However, SCOT deficiency may present at older ages. Maintaining a high index of suspicion, immediate transfer to a pediatric intensive care unit, and prompt metabolic support are key to achieving a favorable outcome. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) 3 oxoacid coenzyme A transferase EMTREE DRUG INDEX TERMS endogenous compound glucose insulin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ketoacidosis pathogenicity point mutation EMTREE MEDICAL INDEX TERMS case report child female human hyperpnea hypoglycemia inborn error of metabolism infant lethargy metabolic acidosis newborn newborn period pediatric intensive care unit population based case control study tachypnea LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170531424 PUI L617480564 DOI 10.1055/s-0037-1604270 FULL TEXT LINK http://dx.doi.org/10.1055/s-0037-1604270 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 35 TITLE Helicopter Transport From the Scene of Injury: Are There Improved Outcomes for Pediatric Trauma Patients? AUTHOR NAMES Farach S.M. Walford N.E. Bendure L. Amankwah E.K. Danielson P.D. Chandler N.M. AUTHOR ADDRESSES (Farach S.M.) From the *Division of Pediatric Surgery, †Clinical and Translational Research Organization, All Childrenʼs Hospital Johns Hopkins Medicine, St Petersburg, FL. (Walford N.E.; Bendure L.; Amankwah E.K.; Danielson P.D.; Chandler N.M.) CORRESPONDENCE ADDRESS S.M. Farach, From the *Division of Pediatric Surgery, †Clinical and Translational Research Organization, All Childrenʼs Hospital Johns Hopkins Medicine, St Petersburg, FL. SOURCE Pediatric Emergency Care (2017). Date of Publication: 6 Jun 2017 ISSN 1535-1815 (electronic) 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT BACKGROUND: There is conflicting data to support the routine use of helicopter transport (HT) for the transfer of trauma patients. The purpose of this study was to evaluate outcomes for trauma patients transported via helicopter from the scene of injury to a regional pediatric trauma center. METHODS: The institutional trauma registry was queried for trauma patients presenting from January 2000 through March 2012. Of 9119 patients, 1709 patients who presented from the scene were selected for further evaluation. This cohort was stratified into HT and ground transport (GT) for analysis. Associations between mode of transport and outcomes were estimated using odds ratios and 95% confidence intervals from multivariable logistic regression models. RESULTS: Seven hundred twenty-five patients (42.4%) presented via HT, whereas 984 (57.6%) presented via GT. Patients arriving by HT had a higher Injury Severity Score, lower Glasgow Coma Scale, were less likely to undergo surgery within 3 hours, more likely to present after motorized trauma, and had longer intensive care unit (ICU) and hospital length of stay (LOS). Multivariate analysis controlling for Injury Severity Score, Glasgow Coma Scale, mechanism of injury, scene distance, and time to arrive to the hospital revealed that patients arriving by HT were more likely to have longer hospital LOS compared with those arriving by GT (odds ratios = 2.3, 95% confidence interval = 1.00–5.28, P = 0.049). However, no statistically significant association was observed for prehospital intubation, surgery within 3 hours, ICU admissions, or ICU LOS. CONCLUSIONS: Although patients arriving by helicopter are more severely injured and arrive from greater distances, when controlling for injuries, scene distance, and time to hospital arrival, only hospital LOS was significantly affected by HT. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood injury female helicopter male EMTREE MEDICAL INDEX TERMS confidence interval emergency health service Glasgow coma scale human intensive care unit intubation length of stay logistic regression analysis major clinical study model multivariate analysis odds ratio register surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170413030 PUI L616682156 DOI 10.1097/PEC.0000000000001190 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0000000000001190 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 36 TITLE GES-14-producing acinetobacter baumannii isolates in a neonatal intensive care unit in Tunisia are associated with a typical middle east clone and a transferable plasmid AUTHOR NAMES Mabrouk A. Grosso F. Botelho J. Achour W. Hassen A.B. Peixe L. AUTHOR ADDRESSES (Mabrouk A.) Faculté des Sciences de Bizerte, Université de Carthage, Tunis, Tunisia. (Mabrouk A.; Achour W.; Hassen A.B.) Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis, Tunisia. (Grosso F.; Botelho J.; Peixe L., lpeixe@ff.up.pt) Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, UCIBIO-REQUIMTE, Porto, Portugal. (Achour W.; Hassen A.B.) Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia. CORRESPONDENCE ADDRESS L. Peixe, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, UCIBIO-REQUIMTE, Porto, Portugal. Email: lpeixe@ff.up.pt SOURCE Antimicrobial Agents and Chemotherapy (2017) 61:6 Article Number: e00142-17. Date of Publication: 1 Jun 2017 ISSN 1098-6596 (electronic) 0066-4804 BOOK PUBLISHER American Society for Microbiology, Journals@asmusa.org EMTREE DRUG INDEX TERMS amikacin aminoglycoside derivative gentamicin imipenem kanamycin meropenem piperacillin plus tazobactam plasmid DNA quinolone derivative rifampicin spectinomycin streptomycin tobramycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter baumannii EMTREE MEDICAL INDEX TERMS bacterium isolate DNA replication origin homologous recombination human infrared spectroscopy letter Middle East neonatal intensive care unit nonhuman open reading frame plasmid priority journal respiratory tract infection Tunisia CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) imipenem (64221-86-9) kanamycin (11025-66-4, 61230-38-4, 8063-07-8) meropenem (96036-03-2) rifampicin (13292-46-1) spectinomycin (1695-77-8, 21736-83-4, 23312-56-3) streptomycin (57-92-1) tobramycin (32986-56-4) EMBASE CLASSIFICATIONS Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170383467 PUI L616382708 DOI 10.1128/AAC.00142-17 FULL TEXT LINK http://dx.doi.org/10.1128/AAC.00142-17 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 37 TITLE Network analysis: A novel method for mapping neonatal acute transport patterns in California AUTHOR NAMES Kunz S.N. Zupancic J.A.F. Rigdon J. Phibbs C.S. Lee H.C. Gould J.B. Leskovec J. Profit J. AUTHOR ADDRESSES (Kunz S.N., skunz@bidmc.harvard.edu; Zupancic J.A.F.) Division of Newborn Medicine, Harvard Medical School, Boston, United States. (Kunz S.N., skunz@bidmc.harvard.edu; Zupancic J.A.F.) Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose 3, Boston, United States. (Rigdon J.) Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, United States. (Phibbs C.S.; Lee H.C.; Gould J.B.; Profit J.) Department of Pediatrics-Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, United States. (Phibbs C.S.) Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, United States. (Lee H.C.; Gould J.B.; Profit J.) California Perinatal Quality Care Collaborative, Stanford, United States. (Leskovec J.) Department of Computer Science, Stanford University, Stanford, United States. CORRESPONDENCE ADDRESS S.N. Kunz, Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rose 3, Boston, United States. Email: skunz@bidmc.harvard.edu SOURCE Journal of Perinatology (2017) 37:6 (702-708). Date of Publication: 1 Jun 2017 ISSN 1476-5543 (electronic) 0743-8346 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Objective:The objectives of this study are to use network analysis to describe the pattern of neonatal transfers in California, to compare empirical sub-networks with established referral regions and to determine factors associated with transport outside the originating sub-network.Study design:This cross-sectional database study included 6546 infants <28 days old transported within California in 2012. After generating a graph representing acute transfers between hospitals (n=6696), we used community detection techniques to identify more tightly connected sub-networks. These empirically derived sub-networks were compared with state-defined regional referral networks. Reasons for transfer between empirical sub-networks were assessed using logistic regression.Results:Empirical sub-networks showed significant overlap with regulatory regions (P<0.001). Transfer outside the empirical sub-network was associated with major congenital anomalies (P<0.001), need for surgery (P=0.01) and insurance as the reason for transfer (P<0.001).Conclusion:Network analysis accurately reflected empirical neonatal transfer patterns, potentially facilitating quantitative, rather than qualitative, analysis of regionalized health care delivery systems. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) analytic method network analysis patient transport EMTREE MEDICAL INDEX TERMS article California congenital malformation (congenital disorder, surgery) construct validity controlled study cross-sectional study female health care delivery health insurance human infant major clinical study male measurement accuracy neonatal intensive care unit population research regionalization EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170219408 PUI L614979254 DOI 10.1038/jp.2017.20 FULL TEXT LINK http://dx.doi.org/10.1038/jp.2017.20 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 38 TITLE Proton Pump Inhibitor Administration Triggers Encephalopathy in Cirrhotic Patients by Modulating Blood–Brain Barrier Drug Transport AUTHOR NAMES Assaraf J. Weiss N. Thabut D. AUTHOR ADDRESSES (Assaraf J.) Unité de Soins Intensifs d'Hépato-gastroentérologie, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France. (Weiss N.) Brain Liver Pitié-Salpêtrière Study Group and Unité de Réanimation Neurologique, Fédération de Neurologie, Pôle des Maladies du Système Nerveux, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France. (Thabut D.) Unité de Soins Intensifs d'Hépato-gastroentérologie and Brain Liver Pitié-Salpêtrière Study Group, Groupement Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France. SOURCE Gastroenterology (2017) 152:8 (2077). Date of Publication: 1 Jun 2017 ISSN 1528-0012 (electronic) 0016-5085 BOOK PUBLISHER W.B. Saunders EMTREE DRUG INDEX TERMS (MAJOR FOCUS) proton pump inhibitor (adverse drug reaction) EMTREE DRUG INDEX TERMS ABC transporter (endogenous compound) ABC transporter subfamily B (endogenous compound) ammonia (endogenous compound) antibiotic agent endotoxin (endogenous compound) fluconazole multidrug resistance protein 1 (endogenous compound) quinolone derivative toxin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood brain barrier drug transport hepatic encephalopathy (side effect, side effect) liver cirrhosis EMTREE MEDICAL INDEX TERMS ammonia blood level concentration response disease association drug brain level drug use dysbiosis gastrointestinal hemorrhage hospital admission human hyperammonemia intensive care unit intestine flora letter medical history Model For End Stage Liver Disease Score patient risk priority journal prospective study risk assessment risk factor self medication CAS REGISTRY NUMBERS ammonia (14798-03-9, 51847-23-5, 7664-41-7) fluconazole (86386-73-4) multidrug resistance protein (149200-37-3, 208997-77-7) EMBASE CLASSIFICATIONS Drug Literature Index (37) Adverse Reactions Titles (38) Gastroenterology (48) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170398114 PUI L616583411 DOI 10.1053/j.gastro.2016.10.049 FULL TEXT LINK http://dx.doi.org/10.1053/j.gastro.2016.10.049 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 39 TITLE What do patients who are not transported by the Smur understand about the information provided by the physician? ORIGINAL (NON-ENGLISH) TITLE Que comprennent les patients laissés sur place par le Smur quant aux informations communiquées par le médecin ? AUTHOR NAMES Sanchez A. Bejinariu L. Schaeffer M. Pelaccia T. AUTHOR ADDRESSES (Sanchez A.) Service d’accueil des urgences du centre hospitalier de Haguenau, 64, avenue du Professeur Leriche, Haguenau, France. (Bejinariu L.) Service d’accueil des urgences du centre hospitalier de Sélestat, 23, avenue Louis Pasteur, Sélestat, France. (Schaeffer M.) Service de biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, Strasbourg, France. (Pelaccia T., pelaccia@unistra.fr) Service d’aide médicale urgente du Bas-Rhin, hôpitaux universitaires de Strasbourg, 70, rue de l’Engelbreit, Strasbourg, France. (Pelaccia T., pelaccia@unistra.fr) Centre de formation et de recherche en pédagogie des sciences de la santé (CFRPS), faculté de médecine, université de Strasbourg, 4, rue Kirschleger, Strasbourg, France. CORRESPONDENCE ADDRESS T. Pelaccia, Service d’accueil des urgences du centre hospitalier de Haguenau, 64, avenue du Professeur Leriche, Haguenau, France. Email: pelaccia@unistra.fr SOURCE Annales Francaises de Medecine d'Urgence (2017) 7:3 (159-165). Date of Publication: 1 Jun 2017 ISSN 2108-6591 (electronic) 2108-6524 BOOK PUBLISHER Springer-Verlag France, 22, Rue de Palestro, Paris, France. york@springer-paris.fr ABSTRACT Objectives: The quality of communication between a physician and a patient is the main determinant of the patient’s compliance. Poor communication generates misunderstandings that increase the risk of morbidity and mortality, and engages the physician’s legal responsibility. Previous research has shown that physicians communicate badly with their patients, including in emergency departments. In this study, we assessed the level of understanding of patients who have not been transported by the mobile emergency and intensive care unit (Smur) with respect to the diagnosis, treatment, recommended follow-up and reasons for calling back the emergency medical assistance service. Methods: We conducted a monocentric prospective observational study. The aim was to compare the untransported patient’s level of understanding after their management by the Smur and the information provided to the patient by the physician. Phone interviews were held with the patients. Physicians completed a self-administered questionnaire. Results: 81% of the patients who had not been transported by the Smur did not understand information transmitted by the physician in at least one of the four areas studied. Both patients and physicians were unaware of this lack of understanding. Conclusion: A vast majority of untransported patients who have been managed by the Smur insufficiently understand the instructions given by the physician. These results should draw our attention to the need to implement remedial and risk management measures, in particular, as regards the training of emergency physicians. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) doctor patient relation emergency medicine emergency physician female male EMTREE MEDICAL INDEX TERMS clinical study controlled study diagnosis follow up human intensive care unit interview observational study questionnaire risk management LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 20170470404 PUI L617005003 DOI 10.1007/s13341-017-0744-2 FULL TEXT LINK http://dx.doi.org/10.1007/s13341-017-0744-2 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 40 TITLE Pre-analytic of ammonia: Stability, transport and temperature of centrifugation AUTHOR NAMES Favresse J. Despas N. AUTHOR ADDRESSES (Favresse J., julien.favresse@uclouvain.be) Cliniques Universitaires Saint Luc, Belgium. (Despas N.) Cliniques Universitaires Saint-Luc, Belgium. CORRESPONDENCE ADDRESS J. Favresse, Cliniques Universitaires Saint Luc, Belgium. Email: julien.favresse@uclouvain.be SOURCE Clinical Chemistry and Laboratory Medicine (2017) 55 Supplement 1 (S1067). Date of Publication: 1 Jun 2017 CONFERENCE NAME 22nd IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine, 25th Meeting of the Balkan Clinical Laboratory Federation, 15th National Congress of GSCC-CB CONFERENCE LOCATION Athens, Greece CONFERENCE DATE 2017-06-11 to 2017-06-15 ISSN 1437-4331 BOOK PUBLISHER Walter de Gruyter GmbH ABSTRACT Background: Ammonia is particularly sensitive to pre-analytical requirements with errors from contamination, collection or sampling handling. Pre-analytical errors could account for ammonia values 2-3 times upper normal range and may be confusing for the clinician. We designed a study protocol to assess multiple factors affecting the pre-analytic of ammonia. Methods: In the first protocol, we evaluated the post-decantation stability of ammonia in 20 volunteers and 11 intensive care unit (ICU) patients according to the temperature (T°C) of centrifugation (4°C vs room T°C). In the second protocol, four blood samples were drawn from 21 healthy volunteers and 20 ICU patients. The first sample was conserved at room T°C and spun at room T°C (3.500 rpm, 10 min), the second conserved at room T°C and spun at 4°C, the third conserved in icy water and spun at room T°C and the last conserved in icy water and spun at 4°C. All these samples were stored for 30 min before centrifugation. Finally, blood from 20 volunteers and two ICU patients was used to test the performance of Crioplast® containers in comparison to icy water. Samples were left for 30 and 60 min in icy water and then spun at 4°C before measurement. Results: The stability study showed non-statistical difference between samples spun at 4°C and at room T°C for healthy and ICU patients (P > 0.05). The period of stability in healthy subjects achieved 1h30 and at least 4h30 in ICU patients. In healthy volunteers, ammonia values for samples left in icy water and spun at 4°C were statistically lower compared to all other combined conditions, especially in comparison to samples left and spun at room T°C (absolute difference of 28.7%, P = 0.0001). However, no statistical difference was observed in ICU patients (P > 0.05). The lower red blood cell count of ICU patients may explain this difference (3.3 x 10∧6; normal range 4-6 x 10∧6). The Crioplast® device brought results in agreement with samples conserved in icy water for 30 and 60 min (P > 0.05). Conclusions: All routine samples must be kept in icy water or in Crioplast® containers and be spun at 4°C. The major reason is to avoid false elevated ammonia values leading to unnecessary additional blood sampling and laboratory testing. Discussion between physicians and biologists is primordial to reach such pre-analytical requirements. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) ammonia EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) centrifugation EMTREE MEDICAL INDEX TERMS blood sampling clinical article container doctor patient relation drug combination erythrocyte count female human intensive care unit male volunteer CAS REGISTRY NUMBERS ammonia (14798-03-9, 51847-23-5, 7664-41-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616773029 DOI 10.1515/cclm-2017-5031 FULL TEXT LINK http://dx.doi.org/10.1515/cclm-2017-5031 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 41 TITLE Impact of relocation and environmental cleaning on reducing the incidence of healthcare-associated infection in NICU AUTHOR NAMES Li Q.-F. Xu H. Ni X.-P. Lin R. Jin H. Wei L.-Y. Liu D. Shen L.-H. Zha J. Xu X.-F. Wu B. AUTHOR ADDRESSES (Li Q.-F.; Liu D.) Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China. (Lin R.; Xu X.-F.; Wu B., fbygk@zju.edu.cn) Department of Infection Control, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China. (Xu H.; Ni X.-P.; Jin H.; Wei L.-Y.; Shen L.-H.; Zha J.) Department of Disinfection Surveillance and Vector Control, Hangzhou Center for Disease Control and Prevention, Hangzhou, China. CORRESPONDENCE ADDRESS B. Wu, Department of Infection Control, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road, Hangzhou, China. Email: fbygk@zju.edu.cn SOURCE World Journal of Pediatrics (2017) 13:3 (217-221). Date of Publication: 1 Jun 2017 ISSN 1867-0687 (electronic) 1708-8569 BOOK PUBLISHER Institute of Pediatrics of Zhejiang University, wjpch@zju.edu.cn ABSTRACT Background: Hospital environment remains a risk for healthcare-associated infections (HAIs). This was a prospective study to evaluate the comprehensive impact of relocating a neonatal intensive care unit (NICU) to a new facility and improved environmental cleaning practice on the presence of methicillin-resistant Staphylococcus aureus (MRSA) on inanimate surfaces and the incident rate of HAIs. Methods: New environmental cleaning measures were adopted after the NICU was moved to a new and better-designed location. The effect of moving and the new environmental cleaning practice was investigated by comparing the positive number of MRSA on ward surfaces and the incidence density of HAIs between the baseline and intervention periods. Results: Only 2.5% of environmental surfaces were positive for MRSA in the intervention period compared to 44.0% in the baseline period (P<0.001). Likewise, the total incident rate of HAIs declined from 16.8 per 1000 cot-days to 10.0 per 1000 cot-days (P<0.001). Conclusion: The comprehensive measures of relocating the NICU to a new facility design with improved environmental cleaning practice are effective and significantly reduce the incidence of HAIs. EMTREE DRUG INDEX TERMS disinfectant agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cleaning healthcare associated infection (prevention) hospital infection (prevention) infection control neonatal intensive care unit EMTREE MEDICAL INDEX TERMS article catheter infection controlled study disinfection human incubator infection rate length of stay major clinical study methicillin resistant Staphylococcus aureus monitor newborn prospective study syringe ventilator associated pneumonia EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170058982 PUI L614134296 DOI 10.1007/s12519-017-0001-1 FULL TEXT LINK http://dx.doi.org/10.1007/s12519-017-0001-1 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 42 TITLE Impact of post-graduate year training level on unplanned floor to intensive care unit transfers within 24 hours from the emergency department AUTHOR NAMES Solano J. Ilg A. Bilello L. Chiu D.T. AUTHOR ADDRESSES (Solano J.; Ilg A.; Bilello L.; Chiu D.T.) Beth Israel Deaconess Medical Center, Harvard Medical School, United States. CORRESPONDENCE ADDRESS J. Solano, Beth Israel Deaconess Medical Center, Harvard Medical School, United States. SOURCE Academic Emergency Medicine (2017) 24 Supplement 1 (S66-S67). Date of Publication: 1 May 2017 CONFERENCE NAME 2017 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2017 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2017-05-16 to 2017-05-19 ISSN 1553-2712 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Background: Emergency medicine (EM) residents are supervised by attending physicians and, therefore, the residents' post-graduate year (PGY) should not have a negative impact on patient care. Unexpected floor to intensive care unit (ICU) transfers may be an indication of an adverse event or error (AEE) as these transfers have been shown to have higher mortality rates than patients admitted directly to the ICU. It is unclear if the level of EM resident training correlates with AEE in this patient population. Methods: We performed a retrospective study at an academic tertiary care center with an affiliated three year EM residency. A member of the ED quality assurance (QA) committee reviewed all patient cases presenting to the ED between 12/01/2010 to 05/31/2016 who had a floor to ICU transfer within the first 24 hours of admission. The primary outcome measure is an AEE, as adjudicated and defined by the QA committee. Adverse events are circumstances that cause patient harm, while errors represent violations of the standard of care. The variable of primary interest is EM PGY level. The expected number of AEEs per EM class was calculated by taking the total number of AEEs and dividing by 3. Chi squared test was performed to test the null hypothesis that there is no difference between EM PGY level and AEE rates. Results: A total of 921 floor to ICU transfers were reviewed and 29 involved an AEE attributable to an EM resident. This represents an AEE rate of 3.1%. Eight AEEs were attributed to a PGY1, 19 attributed to a PGY2 and 2 attributed to a PGY3. Chi squared test yielded a p < 0.001, rejecting the null hypothesis. Conclusion: There is an association between PGY level and AEEs for floor to ICU transfers. This may be due to the increased acuity and complexity of patients seen by the PGY2 residents. However, it may be due to decreased supervision of PGY2 residents with comparison to the PGY1 residents and may present an opportunity for quality improvement. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward intensive care unit postgraduate student EMTREE MEDICAL INDEX TERMS controlled study emergency medicine error female health care quality human human experiment male null hypothesis patient harm resident retrospective study tertiary care center total quality management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616280004 DOI 10.1111/acem.13203 FULL TEXT LINK http://dx.doi.org/10.1111/acem.13203 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 43 TITLE Assessment of post-graduate year training and unplanned floor to intensive care unit transfer within 24 hours from the emergency department AUTHOR NAMES Bilello L. Ilg A. Solano J. Chiu D.T. AUTHOR ADDRESSES (Bilello L.; Ilg A.; Solano J.; Chiu D.T.) Beth Israel Deaconess Medical Center, Harvard Medical School, United States. CORRESPONDENCE ADDRESS L. Bilello, Beth Israel Deaconess Medical Center, Harvard Medical School, United States. SOURCE Academic Emergency Medicine (2017) 24 Supplement 1 (S67). Date of Publication: 1 May 2017 CONFERENCE NAME 2017 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2017 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2017-05-16 to 2017-05-19 ISSN 1553-2712 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Background: Academic emergency departments (ED) utilize residents of different post-graduate year (PGY) training levels to provide clinical care for patients under the supervision of attending physicians. Admitted patients that have an unplanned transfer from the floor to the intensive care unit (ICU) within 24 hours have been shown to have higher mortality and are a potential focus for quality improvement. It is unclear if the level of training of the EM resident correlates with unplanned transfers. Methods: We performed a retrospective chart review with a primary outcome measure of unplanned floor to ICU transfers within 24 hours after ED admission. The variable of primary interest is PGY level. The study was done at an urban, academic tertiary care referral center with an affiliated 3 year EM residency. All patients presenting to the ED between 07/01/2012 to 06/30/2015 were eligible. Logistic regression was used to test for significance and to control for confounders such as emergency severity index (ESI), age, gender, unstable vital signs at triage, changes from ED observation to full hospital admission, ED length of stay (LOS), and time to doctor. Odds ratios (OR) with 95% confidence interval (CI) were used as the primary effect estimate. Results: We reviewed the records of 60,609 admitted patients and found 1,769 (2.9%) were unplanned transfers from floor to ICU within 24 hours. The odds ratio for each resident PGY level and attending physicians are as follows: PGY1 0.47 (CI 0.39-0.49), PGY2 0.43 (CI 0.38-0.48), PGY3 0.42 (CI 0.37-0.47) and attendings 0.21 (CI 0.20-0.22). There is an inverse relationship between the ORs of unplanned floor to ICU transfers and EM PGY level. This is not statistically significant as all p-values are greater than 0.05. Unstable vital signs at triage, age, ESI, ED LOS, ED observation status that required admission, time of arrival to time seen by physician, and gender were significant predictors of unplanned floor to ICU in 24 hours with a p-value of < 0.05. Conclusions: This data shows that there was no significant difference between the PGY training level of the EM resident and unplanned floor to ICU transfer within the first 24 hours. Identification of variables significantly related with unplanned floor to ICU transfer within 24 hours may be valuable to prevent this adverse event. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward intensive care unit postgraduate student EMTREE MEDICAL INDEX TERMS adverse drug reaction confidence interval emergency health service female gender hospital admission human length of stay logistic regression analysis major clinical study male medical record review odds ratio patient referral prevention resident side effect statistical significance tertiary health care vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616280018 DOI 10.1111/acem.13203 FULL TEXT LINK http://dx.doi.org/10.1111/acem.13203 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 44 TITLE Anticipation and management of the difficult paediatric airway in the emergency department: A series of cases encountered by a regional critical care transport service AUTHOR NAMES Parkins K. Kanaris C. Bordoni J. Emsden S. Phatak R. Pritchard L. AUTHOR ADDRESSES (Parkins K.; Kanaris C.; Bordoni J.) Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, United Kingdom. (Parkins K.; Kanaris C.; Bordoni J.; Emsden S.; Phatak R.; Pritchard L.) North West and North Wales Transport Service, Warrington, United Kingdom. (Phatak R.) Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom. CORRESPONDENCE ADDRESS K. Parkins, Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, United Kingdom. SOURCE Archives of Disease in Childhood (2017) 102 Supplement 1 (A179-A180). Date of Publication: 1 May 2017 CONFERENCE NAME Annual Conference of the Royal College of Paediatrics and Child Health, RCPCH 2017 CONFERENCE LOCATION Birmingham, United Kingdom CONFERENCE DATE 2017-05-24 to 2017-05-26 ISSN 1468-2052 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Centralisation of children's services in the UK has decreased exposure of district general hospital (DGH) emergency department staff to paediatric airway management, especially in critically ill children. Regional Retrieval Teams such as the North West and North Wales Paediatric Transport Service (NWTS) provide advice and support but cannot be considered as the primary difficult airway management team leading to challenging scenarios, particularly for DGH teams managing patients with predicted or known difficult airways. Early recognition of the difficult airway is vital in decreasing morbidity and mortality, and anxiety for those involved. Prompt assembling of a competent multidisciplinary team in the emergency department, with appropriate equipment, drugs, monitoring as well as planning for failure or deterioration represents a major challenge. The difficult airway is the clinical situation in which a conventionally trained anaesthetist experiences difficulties with facemask ventilation, tracheal intubation, or both. Difficult intubation occurs approximately 0.42% in all elective paediatric tertiary intubations. Of these 0.08% occur in healthy children, increasing to 0.24% in the under ones. Difficult mask ventilation occurs in approximately 0.02%. Can't intubate can't ventilate situations occurs1 in 10-50,000 in adults. Paucity of published data on incidence of difficult airway during emergency intubation for respiratory failure is unknown, but likely to be significantly higher. NWTS data revealed 11.2% incidence of grade 2 or above laryngoscopy (357 intubations of critically sick 1-5 year olds); and in under 2 year olds 21% complication risk such as hypotension or hypoxia. We describe 8 cases referred to North West and North Wales Paediatric Transport Service (NWTS) from different emergency departments across the North West of the UK, that highlight importance of anticipating problems managing paediatric airways, and the proposed regional difficult airway and intubation guideline. The guideline highlights the importance of alternative plans required to ensure a successful outcome. Equipment and monitoring ideally should be standardised across all hospital departments where a critically sick child/neonate may present. Education and regular training in airway management reduces the risk of paediatric airway difficulties. Regional paediatric intensive care transport teams can facilitate access to specialist equipment and transfer to tertiary specialised units when required. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) case study emergency ward respiration control EMTREE MEDICAL INDEX TERMS anesthesist anxiety child complication critically ill patient deterioration education endotracheal intubation exposure female general hospital hospital department human hypotension hypoxia information retrieval laryngoscopy major clinical study male monitoring morbidity mortality newborn practice guideline respiratory failure Wales LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616987348 DOI 10.1136/archdischild-2017-313087.449 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2017-313087.449 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 45 TITLE Weaning from prolonged veno-venous extracorporeal membrane oxygenation (ECMO) after transfer to a specialized ECMO center-a retrospective study AUTHOR NAMES Seiler F. Trudzinski F.C. Hörsch S. Kamp A. Metz C. Alqudrah M. Wehrfritz H. Muellenbach R.M. Haake H. Bals R. Lepper P.M. AUTHOR ADDRESSES (Seiler F.; Trudzinski F.C.; Kamp A.; Metz C.; Alqudrah M.; Wehrfritz H.; Bals R.; Lepper P.M.) Department of Internal Medicine V-Pneumology, Allergology, and Critical Care Medicine, Germany. (Seiler F.; Trudzinski F.C.; Hörsch S.; Kamp A.; Metz C.; Alqudrah M.; Wehrfritz H.; Bals R.; Lepper P.M.) ECLS Centre Saar, Germany. (Hörsch S.) Department of Anesthesiology, Intensive Care Medicine, and Pain Medicine, University Hospital of Saarland, Homburg/Saar, Germany. (Muellenbach R.M.) Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Klinikum Kassel, Campus Kassel of the University of Southampton, Kassel, Germany. (Haake H.) Department of Cardiology, Electrophysiology and Intensive Care Medicine, Kliniken Maria Hilf, Mönchengladbach, Germany. CORRESPONDENCE ADDRESS F. Seiler, Department of Internal Medicine V-Pneumology, Allergology, and Critical Care Medicine, Germany. SOURCE European Journal of Heart Failure (2017) 19 Supplement 2 (48). Date of Publication: 1 May 2017 CONFERENCE NAME 6th Euro-ELSO Annual Congress CONFERENCE LOCATION Maastricht, Netherlands CONFERENCE DATE 2017-05-04 to 2017-05-07 ISSN 1878-1314 BOOK PUBLISHER John Wiley and Sons Ltd ABSTRACT Introduction/Aim: Veno-venous extracorporeal membrane oxygenation (vV-ECMO) is increasingly used as a rescue therapy in severe respiratory failure. In patients with pre-existent lung diseases or persistent lung injury weaning from vV-ECMO can be challenging. This study sought to investigate outcomes of patients transferred to a specialized ECMO centre after prolonged ECMO therapy. Methods: Retrospective analysis of all patients treated at our medical intensive care unit (ICU) between 01/2013 and 07/2016 who were transferred from an external ICU after>8 days on vV-ECMO. Results: We identified 10 patients on ECMO for>8 days. Prior to transfer, patients underwent ECMO therapy for 18 (9-34)±9.5 days. Total time on ECMO was 46 (16-135)±33 days. 9/10 patients were weaned from ECMO in the first 28 days after transfer, 7 after at least partial lung recovery, 2 after salvage lung transplant (10±8.3 ECMO-free days at day 28). No patient died or needed re-initiation of ECMO therapy at day 28. Conclusion: Weaning from vV-ECMO was feasible even after prolonged ECMO courses and salvage lung transplant could be avoided in most cases. Patients may benefit from transfer to a specialized ECMO centre. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extracorporeal oxygenation retrospective study vein weaning EMTREE MEDICAL INDEX TERMS clinical article female human lung male medical intensive care unit remission LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616170764 DOI 10.1002/ejhf.869 FULL TEXT LINK http://dx.doi.org/10.1002/ejhf.869 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 46 TITLE A protocol designed to reduce inhospital delays in treatment with intravenous thrombolysis also allows to reduce time to groin puncture for endovascular treatment AUTHOR NAMES Iglesias Mohedano A.M. García Pastor A. Díaz Otero F. Vázquez Alen P. Fernández Bullido Y. Del Valle Diéguez M. Saura Lorente J. Castro Reyes E. Villoria Medina F. Fortea Gil F. Gil Núnez A. AUTHOR ADDRESSES (Iglesias Mohedano A.M.; García Pastor A.; Díaz Otero F.; Vázquez Alen P.; Fernández Bullido Y.; Gil Núnez A.) Hospital General Universitario Gregorio Maranõ N, Neurology Department-Vascular Neurology Section, Madrid, Spain. (Del Valle Diéguez M.; Saura Lorente J.; Castro Reyes E.; Villoria Medina F.; Fortea Gil F.) Hospital General Universitario Gregorio Maranõ N, Radiology Department-Neuroradiology Section, Madrid, Spain. CORRESPONDENCE ADDRESS A.M. Iglesias Mohedano, Hospital General Universitario Gregorio Maranõ N, Neurology Department-Vascular Neurology Section, Madrid, Spain. SOURCE European Stroke Journal (2017) 2:1 Supplement 1 (244). Date of Publication: 1 May 2017 CONFERENCE NAME 3rd European Stroke Organisation Conference, ESOC 2017 CONFERENCE LOCATION Prague, Czech Republic CONFERENCE DATE 2017-05-16 to 2017-05-18 ISSN 2396-9881 BOOK PUBLISHER SAGE Publications Ltd ABSTRACT Background and Aims: To determine if a protocol originally designed to reduce in-hospital time to intravenous thrombolysis (IVT) in acute ischemic stroke is also effective reducing time to endovascular treatment. Method: A series of interventions aimed to reduce IVT treatment delays were implemented in a tertiary care hospital in February 2014. Consecutive ischemic stroke patients treated with endovascular treatment were prospectively registered. In-hospital delays of endovascular treatment were analyzed before (pre-intervention period: January 2011-January 2014) and after the new protocol (post-intervention period: February 2014-December 2016). Endovascular treatment is only available in our institution during office hours. Intra-hospital strokes and patients transferred from other hospitals with part of their work-up complete were excluded. Results: 50 patients. Mean age (SD) 64.8 (13.9). 46% were males. 16 patients were included before and 34 after the new protocol. Among these patients, 32% were treated previously with IVT. Median time in minutes before/after the new interventions were respectively: Door-toimaging 20/15 (p=0.06); Door-to-IVT 48/32 (p=0.02); imaging-to-groin puncture 106/54 (p=0.002); door-to-groin puncture 122/76 (p=0.001); door-to-reperfusion 162/154 (p=0.71); endovascular procedure time 73/90 (p=0.51). Time from imaging-to-groin puncture in patients with/ without IVT performed was 116/54 minutes respectively (p<0.001). When IVT was initiated on CT table this interval was reduced to 51 minutes. Conclusion: Interventions aimed to reduce in-hospital delays to IVT appear to be also effective reducing time to groin puncture. IVT was identified as delaying factor for endovascular treatment when not started on CT table. Other more specific measures should be implemented in order to reduce endovascular procedure time and conclusively time to reperfusion. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood clot lysis inguinal region puncture EMTREE MEDICAL INDEX TERMS brain ischemia clinical article endovascular surgery female human human tissue imaging male reperfusion stroke patient tertiary care center therapy delay LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616966596 DOI 10.1177/2396987317705242 FULL TEXT LINK http://dx.doi.org/10.1177/2396987317705242 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 47 TITLE The t3 trial: Triage, treatment and transfer of patients with stroke in emergency departments AUTHOR NAMES Middleton S. Levi C. Dale S. Cheung N.W. McInnes E. Considine J. D'Este C. Cadilhac D. Grimshaw J. Gerraty R. Craig L. Schadewaldt V. McElduff P. Fitzgerald M. Quinn C. Cadigan G. Denisenko S. Longworth M. Ward J. AUTHOR ADDRESSES (Middleton S.; Dale S.; McInnes E.; Craig L.; Schadewaldt V.) St Vincent's Health Australia Sydney SVHAS and Australian Catholic University ACU, Nursing Research Institute, Sydney, Australia. (Levi C.) University of Newcastle, Centre for Translational Neuroscience and Mental Health, Newcastle, Australia. (Cheung N.W.) University of Sydney and Westmead Hospital, Centre for Diabetes and Endocrinology Research, Sydney, Australia. (Considine J.) Deakin University, Nursing and Midwifery Research Centre School of Nursing and Midwifery, Burwood, Australia. (D'Este C.) Australian National University, National Centre for Epidemiology and Population Health NCEPH, Canberra, Australia. (Cadilhac D.) Monash University, Stroke and Ageing Research-School of Clinical Sciences, Clayton, Australia. (Cadilhac D.) University of Melbourne, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia. (Grimshaw J.) University of Ottawa, Department of Medicine, Canada. (Grimshaw J.) Ottawa Health Research Institute, Clinical Epidemiology Program, Canada. (Gerraty R.) Monash University, Department of Medicine, Clayton, Australia. (Gerraty R.) Epworth Hospital, Neurosciences Clinical Institute, Richmond, Australia. (McElduff P.) University of Newcastle, School of Medicine and Public Health, Newcastle, Australia. (Fitzgerald M.) Monash University, Central Clinical School, Clayton, Australia. (Fitzgerald M.) Swinburne University of Technology, Faculty of Science-Engineering and Technology, Hawthorn, Australia. (Quinn C.) Prince of Wales Hospital, Speech Pathology, Sydney, Australia. (Cadigan G.) Royal Brisbane and Women's Hospital, Statewide Stroke Clinical Network, Hertson, Australia. (Denisenko S.) Department of Health Victoria, Victorian Stroke Clinical Network, Melbourne, Australia. (Longworth M.) Agency for Clinical Innovation, Stroke Services NSW, Sydney, Australia. (Ward J.) University of Ottawa, School of Epidemiology-Public Health and Preventive Medicine, Canada. (Ward J.) University of Notre Dame Australia, Nulungu Research Institute, Broome, Australia. CORRESPONDENCE ADDRESS S. Middleton, St Vincent's Health Australia Sydney SVHAS and Australian Catholic University ACU, Nursing Research Institute, Sydney, Australia. SOURCE European Stroke Journal (2017) 2:1 Supplement 1 (490-491). Date of Publication: 1 May 2017 CONFERENCE NAME 3rd European Stroke Organisation Conference, ESOC 2017 CONFERENCE LOCATION Prague, Czech Republic CONFERENCE DATE 2017-05-16 to 2017-05-18 ISSN 2396-9881 BOOK PUBLISHER SAGE Publications Ltd ABSTRACT Background and Aims: Placeholder abstract number: AS01-007]. The T3 cluster randomised trial aimed to improve Triage, Treatment and Transfer (T3) of patients with acute stroke in emergency departments (EDs) Method: Our prospective, multicentre, parallel group, cluster randomised trial with blinded outcome assessment, randomised EDs 1:1 to receive either the T3 intervention or no support (control EDs). Our evidence-based intervention targeted: (1) Triage: patients with suspected stroke assigned to Australian Triage Scale category 1 or 2 (seen within 10 minutes); (2) Treatment: screening for tPA eligibility and administration of tPA where applicable; protocols for management of fever, hyperglycaemia and swallowing; and (3) rapid Transfer from ED to the stroke unit, implemented using (i) workshops to determine barriers and solutions; (ii) education; (iii) use of clinical opinion leaders; (iv) email, telephone and site visit reminders. Primary outcome: 90-days post-admission death or dependency (mRS>2). Secondary outcomes: 90-day: health status (SF-36), functional dependency (Barthel Index), quality of life (EQ-5D); and inhospital quality-of-care outcomes: triage practices; monitoring and management for thrombolysis, fever, hyperglycaemia, swallowing; and transfer practices. Results: Of the 26 eligible sites from three states and one territory in Australia, all (100%) agreed to participate with 2253 patients consenting (pre-implementation n=645; post-implementation n=1608). Of these, 1875 will be analysed (pre-implementation n=574; post-implementation n=1301). In the post-implementation cohort, 749 patients were randomised to the intervention group and 552 to the control group. Data currently are being analysed. Conclusion: This large trial will provide rigorous evidence for assisted implementation of nurse-initiated ED stroke protocols aiming to improve outcomes for patients with stroke. EMTREE DRUG INDEX TERMS endogenous compound tissue plasminogen activator EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service emergency ward female male stroke unit EMTREE MEDICAL INDEX TERMS Australia Barthel index blood clot lysis clinical trial control group controlled clinical trial controlled study death e-mail education evidence based nursing evidence based practice center fever health status human hyperglycemia leadership major clinical study monitoring nurse parallel design randomized controlled trial Rankin scale screening Short Form 36 swallowing telephone treatment outcome CAS REGISTRY NUMBERS tissue plasminogen activator (105913-11-9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616967245 DOI 10.1177/2396987317706897 FULL TEXT LINK http://dx.doi.org/10.1177/2396987317706897 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 48 TITLE Newly-developed in-house ELISA methods: For measuring serum ferritin, soluble transferrin receptor, C-reactive protein and alpha-1-acid glycoprotein AUTHOR NAMES Esmaeili R. Zhang M. Mapango C. Pfeiffer C.M. AUTHOR ADDRESSES (Esmaeili R.; Zhang M.; Mapango C.; Pfeiffer C.M.) Centers for Disease Control and Prevention, Chamblee, United States. CORRESPONDENCE ADDRESS R. Esmaeili, Centers for Disease Control and Prevention, Chamblee, United States. SOURCE FASEB Journal (2017) 31:1 Supplement 1. Date of Publication: 1 Apr 2017 CONFERENCE NAME Experimental Biology 2017, EB CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2017-04-22 to 2017-04-26 ISSN 1530-6860 BOOK PUBLISHER FASEB ABSTRACT Assessment of population iron status has been an importantelement in nutrition surveys to identify the population groups at risk for iron deficiency and to monitor the impact of iron intervention. The commercially available kit assays performed on clinical analyzers to measure biomarkers of iron and inflammation status require specimen volumes and resources that are usually not available in nutrition surveys conducted in low resource settings. The goal of this project was to develop in-house ELISA assays for testing serum ferrit in (FER), soluble transferrin receptor (sTfR), C-reactive protein (CRP), and alpha-1-acidglycoprotein (AGP) that require small specimen volume and are inexpensive and simple to perform; furthermore, to evaluate the potential application of these methods in nutrition surveys. We developed four sandwich ELISA assays by screening and pairing commercially available capture and detection(conjugated with horse radish peroxidase) antibodies for FER, sTfR, CRP, and AGP. We optimized the assay conditions for each analyte with regards to plate coating procedure, antibody concentration, sample dilution, incubation time, washing procedure, and timing for color development for detection. Each ELISA plate contained a 6-point (FER) or 8-point calibration curve (sTfR, CRP and AGP), 2 levels of quality control samples, 1 adjuster sample, 1 blank sample and 32 unknown samples (duplicate measurement each). Twenty-five μL of serum was sufficient to test all four biomarkers. The reportable ranges were 8-360 ng/mL for FER, 0.1-15μg/mL for sTfR, 0.3-38 μg/mL for CRP, and 0.064-8.2 mg/mL for AGP. The intra- and interassay variability was acceptable:7% (n=6) and 7% (n=25) for FER, 11% (n=6) and 8% (n=25) for sTfR, 5% (n=6) and 13%(n=40) for CRP, and 6% (n=6) and 12% (n=12) for AGP, respectively. We observed complete dilution linearity recovery (2-fold dilution below or above routine dilution): 101±5% for FER, 101±14% for sTfR, 103±7% for CRP, and 100±9% for AGP. However, the sTfR assay exhibited a concentration dependent bias. An initial comparison between the in-house ELISA assays and the Roche Mod PE clinical analyzer demonstrated good correlation (Pearson r=0.99 (n=82) for FER, r=0.95 (n=38)for sTfR, and r=0.99 (n=33) for CRP) and an acceptable mean difference of -6% for FER, -3% for sTfR, and -7% for CRP. For AGP, the comparison between the in-house ELISA and the Quantikine AGP kit showed a weaker correlation (Pearson r=0.7 (n=18))and a high mean difference of 75%. However, our AGP ELISA assay (0.642 mg/mL)produced comparable results to the international reference material ERM-DA470(0.656 mg/mL). In conclusion, the performance for these four in-house ELIS Aassays is acceptable with regards to sensitivity, precision, dilution linearity recovery, and agreement with commercially available methods or in the case of AGP, with an international standard. These inhouse ELISA assays require only a small specimen volume and are designed for use as a routine procedure. They allow the laboratory control over assay long-term stability. To evaluate their robustness for nutrition surveys, we plan to conduct more experiments in a routine assay setting. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) C reactive protein CD71 antigen orosomucoid EMTREE DRUG INDEX TERMS antibody endogenous compound horseradish peroxidase EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) drug solubility ELISA kit ferritin blood level EMTREE MEDICAL INDEX TERMS analyzer calibration dilution human human tissue incubation time major clinical study nutrition quality control screening CAS REGISTRY NUMBERS C reactive protein (9007-41-4) orosomucoid (79921-18-9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616959451 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 49 TITLE An audit of pregnancis complicated by preeclampsia necessitating in-utero transfer AUTHOR NAMES Reilly S. Brennecke S. Smith J. Boland R. AUTHOR ADDRESSES (Reilly S.) University of Melbourne, Australia. (Brennecke S.) Royal Women's Hospital, Department of Maternal Fetal Medicine, Melbourne, Australia. (Smith J.; Boland R.) Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Melbourne, Australia. CORRESPONDENCE ADDRESS S. Reilly, University of Melbourne, Australia. SOURCE Journal of Paediatrics and Child Health (2017) 53 Supplement 2 (84). Date of Publication: 1 Apr 2017 CONFERENCE NAME 21st Annual Congress of the Perinatal Society of Australia and New Zealand, PSANZ CONFERENCE LOCATION Canberra, ACT, Australia CONFERENCE DATE 2017-04-02 to 2017-04-05 ISSN 1440-1754 BOOK PUBLISHER Blackwell Publishing ABSTRACT Background: Pre-eclampsia poses significant risks to mother and fetus. Women with pre-eclampsia at high risk of adverse outcomes may require transfer to a higher level of care for optimal management. In Victoria, Australia, a single centralised service, the Paediatric Infant Perinatal Emergency Retrieval (PIPER), coordinates in-utero transfers of high-risk pregnancies. Our aim was to describe clinical features and outcomes of a populationbased cohort of women with a diagnosis of preeclampsia referred to PIPER and subsequently transferred in-utero. Methods: We conducted a retrospective audit of consecutive pregnancies referred to PIPER over a two-year period (01.01.2013-31.12.2014). Inclusion criteria were a primary diagnosis of pre-eclampsia,?20 weeks' gestation and transferred in-utero. Perinatal characteristics, transfer details and outcomes up to 7 days post transfer were recorded. Results: 199 transfers met inclusion criteria. Of these, 146 (73%) presented with severe pre-eclampsia. A wide range of clinical features (n = 24) was reported. Overall, 59% of transfers were for maternal indications, 24% for a combination of maternal and fetal indications, 12% for fetal indications and 5% were not specified. 156 (78%) women were transferred to a tertiary centre and 43 (22%) to a Level 5 maternity service. Within 7 days, 153 (77%) women gave birth to 165 live-born and 3 stillborn infants. Mean gestational age at birth was 30.9 weeks (SD 3.3). 29 women required high dependency/intensive care unit admission. No maternal deaths were reported. Conclusion: This audit gives insight into the complexity of clinical presentations and outcomes of women diagnosed with preeclampsia and transferred in-utero. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) preeclampsia EMTREE MEDICAL INDEX TERMS clinical article clinical feature diagnosis emergency female fetus gestational age human infant information retrieval intensive care unit male maternal death LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617840356 DOI 10.1111/jpc.13494_248 FULL TEXT LINK http://dx.doi.org/10.1111/jpc.13494_248 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 50 TITLE Nurse only retrieval:Act neonatal emergency transport team AUTHOR NAMES Watson W. Colwill D. Carlisle H. AUTHOR ADDRESSES (Watson W.; Colwill D.) Department of Neonatology, Centenary Hospital for Women and Children, Australia. (Carlisle H.) Department of Neonatology, Canberra Hospital, Canberra, Australia. CORRESPONDENCE ADDRESS W. Watson, Department of Neonatology, Centenary Hospital for Women and Children, Australia. SOURCE Journal of Paediatrics and Child Health (2017) 53 Supplement 2 (111-112). Date of Publication: 1 Apr 2017 CONFERENCE NAME 21st Annual Congress of the Perinatal Society of Australia and New Zealand, PSANZ CONFERENCE LOCATION Canberra, ACT, Australia CONFERENCE DATE 2017-04-02 to 2017-04-05 ISSN 1440-1754 BOOK PUBLISHER Blackwell Publishing ABSTRACT Background: In 2008 a partnership between NETS NSW and ACT was formed to retrieve preterm and sick neonates in the ACT and regional NSW. As part of the service nurses undertake retrieval of neonates without medical support (nurse only). The aim of this study was to assess the impact of nurse only retrieval. Method: A prospective audit is in progress to assess nurse only and medically led retrievals from Jan 2015-Dec 2016. Data being reviewed includes: Number, region, staff required, age and time taken. Records were reviewed to identify reason for transfer and any incidents. Data analysis was undertaken using excel 2010. Results: Since January 2015 the ACT NETS team have undertaken 123 retrievals from ACT and NSW regional hospitals 28% (35) were nurse only. Results to date highlight differences between the retrieval populations. 34%(12/35) of nurse only retrievals compared to 58% (51/88) of medical led retrievals occurred within 24 hours of birth. A nurse only retrieval was more likely from General Practitioner led special care units (52% vs 31%). There have been no adverse events during retrievals. Review of the service has highlighted the benefits of nurse initiated telephone conferencing and monthly multidisciplinary meetings to audit retrievals. On-going developments include the introduction of Telehealth at triage and at point of nursing assessment to assist in accurate diagnosis and safe transfer. Conclusion: Nurse only retrievals were safe with nursing assessments accurate. Nurse only retrievals are cost effective and beneficial in meeting the need of transporting stable neonates to a tertiary hospital. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service information retrieval nurse EMTREE MEDICAL INDEX TERMS data analysis diagnosis general practitioner human intensive care unit newborn nursing assessment staff telehealth telephone tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617847939 DOI 10.1111/jpc.13494_349 FULL TEXT LINK http://dx.doi.org/10.1111/jpc.13494_349 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 51 TITLE Determination of reference range of gamma glutamyl transferase in the neonatal intensive care unit AUTHOR NAMES Kim D.B. Lim G. Oh K.W. AUTHOR ADDRESSES (Kim D.B.; Lim G., jinadmb@hanmail.net; Oh K.W.) Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. CORRESPONDENCE ADDRESS G. Lim, Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea. Email: jinadmb@hanmail.net SOURCE Journal of Maternal-Fetal and Neonatal Medicine (2017) 30:6 (670-672). Date of Publication: 19 Mar 2017 ISSN 1476-4954 (electronic) 1476-7058 BOOK PUBLISHER Taylor and Francis Ltd, healthcare.enquiries@informa.com ABSTRACT Objective: We aimed to establish the reference range of gamma glutamyl transferase (GGT) in the first week of life at each gestational age (GA). Methods: This retrospective study included infants born and admitted before 7 days of age with no apparent congenital liver disease during four consecutive years. Early GGT levels measured at 3–7 days of age were analyzed according to GA. Differences according to sex, mode of delivery, small for gestational age, and the predictability for cholestasis were analyzed. Results: We analyzed early GGT values in 2091 neonates. The average reference value in neonates (156.7 ± 98.2 IU/L) was much higher than that in adults. The GGT values were significantly higher in preterm than in term infants and in male infants than in female infants. Mode of delivery and small for gestational age were not significantly related to GGT level. Early GGT had no predictive value for cholestasis occurrence. Conclusions: Early GGT levels were much higher in neonates, especially preterm infants with GA of 31–35 weeks. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) gamma glutamyltransferase (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neonatal intensive care unit EMTREE MEDICAL INDEX TERMS article cholestasis female gestational age hospital admission human infant major clinical study male newborn obstetric delivery priority journal retrospective study sex small for date infant CAS REGISTRY NUMBERS gamma glutamyltransferase (85876-02-4) EMBASE CLASSIFICATIONS Anesthesiology (24) Clinical and Experimental Biochemistry (29) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160387840 MEDLINE PMID 27124251 (http://www.ncbi.nlm.nih.gov/pubmed/27124251) PUI L610463359 DOI 10.1080/14767058.2016.1182974 FULL TEXT LINK http://dx.doi.org/10.1080/14767058.2016.1182974 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 52 TITLE Transferring patients home to die: what is the potential population in UK critical care units? AUTHOR NAMES Coombs M.A. Darlington A.-S.E. Long-Sutehall T. Pattison N. Richardson A. AUTHOR ADDRESSES (Coombs M.A.) Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand (Darlington A.-S.E.) Faculty of Health Sciences, University of Southampton, Southampton, UK (Long-Sutehall T.) Faculty of Health Sciences, University of Southampton, Southampton, UK (Pattison N.) Royal Marsden NHS Foundation Trust, London, UK (Richardson A.) Faculty of Health Sciences, University of Southampton, Southampton, UK SOURCE BMJ supportive & palliative care (2017) 7:1 (98-101). Date of Publication: 1 Mar 2017 ISSN 2045-4368 (electronic) ABSTRACT RESULTS: 7844 patients were admitted over a 12-month period. 422 (5.4%) patients died. Using the criteria developed 100 (23.7%) patients could have potentially been transferred home to die. Of these 41 (41%) patients were diagnosed with respiratory disease. 53 (53%) patients were conscious, 47 (47%) patients were self-ventilating breathing room air/oxygen via a mask. 20 (20%) patients were ventilated via an endotracheal tube. 76 (76%) patients were not requiring inotropes/vasopressors. Mean time between discussion about treatment withdrawal and time of death was 36.4 h (SD=46.48). No patients in this cohort were transferred home.CONCLUSIONS: A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.OBJECTIVES: Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.METHODS: Medical notes of all patients who died in, or within 5 days of discharge from seven critical care units across two hospital sites over a 12-month period were reviewed. Inclusion/exclusion criteria were developed and applied to identify the number of patients who had potential to be transferred home to die and demographic and clinical data (eg, conscious state, respiratory and cardiac support therapies) collected. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) statistics and numerical data EMTREE MEDICAL INDEX TERMS epidemiology hospital discharge human intensive care terminal care treatment withdrawal United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26628534 (http://www.ncbi.nlm.nih.gov/pubmed/26628534) PUI L614631756 DOI 10.1136/bmjspcare-2014-000834 FULL TEXT LINK http://dx.doi.org/10.1136/bmjspcare-2014-000834 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 53 TITLE A clinical audit of pleural procedures performed at a new general secondary hospital AUTHOR NAMES Ramakrishnan S. Clarke S. Manners D. Jones S. Piccolo F. AUTHOR ADDRESSES (Ramakrishnan S.; Clarke S.) Sir Charles Gairdner Hospital, Nedlands, Australia. (Ramakrishnan S.; Clarke S.; Manners D.; Jones S.; Piccolo F.) SJOG Midland Public and Private Hospital, Midland, Australia. CORRESPONDENCE ADDRESS S. Ramakrishnan, Sir Charles Gairdner Hospital, Nedlands, Australia. SOURCE Respirology (2017) 22 Supplement 2 (158). Date of Publication: 1 Mar 2017 CONFERENCE NAME Annual Scientific Meeting of the New Zealand Branch of the Thoracic Society of Australia and New Zealand, TSANZ and the Australian and New Zealand Society of Respiratory Science, ANZSRS 2017 CONFERENCE LOCATION Canberra, ACT, Australia CONFERENCE DATE 2017-03-24 to 2017-03-28 ISSN 1440-1843 BOOK PUBLISHER Blackwell Publishing ABSTRACT Introduction and Aims: St John of God Midland Public and Private Hospital is a general secondary hospital that services outer metropolitan Perth. Medical admissions are managed by general physicians with consulting specialities including respiratory medicine. We describe the pleural procedures performed since the hospital opened. Methods: A retrospective audit was performed of pleural procedures from December 2015 to September 2016. Data was obtained from an electronic worksheet prospectively collated by the respiratory service at the hospital. Complications were defined as minor, if they were unwanted but did not cause any harm, or major, complications if they necessitated another procedure or caused harm. Complications were further classified as clinical or operational. Results: Eighty-four pleural procedures were performed on seventyfive patients. Most were performed (n = 54; 64%), or directly supervised (n = 9; 11%) by respiratory physicians, and involved the insertion of an intercostal catheter as opposed to thoracocentesis alone (n = 62; 74% vs n = 21; 25%). Common aetiologies were malignancy (n = 28; 33%), pleural infection (n = 14; 17%) and parapneumonic effusion (n = 9; 11%). Seventeen individuals (20%) had intra-pleural therapies. The total complication rate was 28.5% (n = 24), comprising four (5%) major clinical complications (presumed iatrogenic pleural infection, post thoracocentesis pneumothorax requiring drainage, subcutaneous emphysema, post thrombolysis pleural bleed) and three (4%) major operational complications (intra-hospital transfer for intercostal catheter insertion, urgent radiology intervention after equipment failure and repeat procedure needed after cytology sample not sent). There were seven minor clinical and ten minor operational complications. Three patients required transfer to a tertiary hospital. Conclusions: The majority of pleural interventions have been led by the respiratory medicine service at SJOG Midland with a low rate of major clinical complications. Links with supportive tertiary care respiratory and cardiothoracic units are required for more complex cases. Ongoing audit is crucial to guide resource requirements, system improvements and education to minimise future complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit secondary care center thoracocentesis EMTREE MEDICAL INDEX TERMS blood clot lysis catheter cytology device failure education female human infection major clinical study male malignant neoplasm medicine patient transport physician pneumothorax radiology repeat procedure subcutaneous emphysema tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617841360 DOI 10.1111/resp.13010 FULL TEXT LINK http://dx.doi.org/10.1111/resp.13010 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 54 TITLE Pa o (2)/F io (2) Ratio Derived from the Sp o (2)/F io (2) Ratio to Improve Mortality Prediction Using the Pediatric Index of Mortality-3 Score in Transported Intensive Care Admissions∗ AUTHOR NAMES Ray S. Rogers L. Pagel C. Raman S. Peters M.J. Ramnarayan P. AUTHOR ADDRESSES (Ray S., Samiran.ray@gosh.nhs.uk; Raman S.; Peters M.J.; Ramnarayan P.) Respiratory Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom. (Ray S., Samiran.ray@gosh.nhs.uk; Pagel C.; Peters M.J.; Ramnarayan P.) Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. (Rogers L.; Pagel C.) UCL Clinical Operational Research Unit, London, United Kingdom. CORRESPONDENCE ADDRESS S. Ray, Respiratory Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom. Email: Samiran.ray@gosh.nhs.uk SOURCE Pediatric Critical Care Medicine (2017) 18:3 (e131-e136). Date of Publication: 1 Mar 2017 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objectives: To derive a relationship between the Spo(2)/Fio(2) ratio and Pao(2)/Fio(2) ratio across the entire range of Spo(2) values (0-100%) and to evaluate whether mortality prediction using the Pediatric Index of Mortality-3 can be improved by the use of Pao(2)/Fio(2) values derived from Spo(2)/Fio(2). Design: Retrospective analysis of prospectively collected data. Setting: A regional PICU transport service. Patients: Children transported to a PICU. Interventions: None. Measurements and Main Results: The relationship between Spo(2)/Fio(2) and Pao(2)/Fio(2) across the entire range of Spo(2) values was first studied using several mathematical models in a derivation cohort (n = 1,235) and then validated in a separate cohort (n = 306). The best Spo(2)/Fio(2)-Pao(2)/Fio(2) relationship was chosen according to the ability to detect respiratory failure (Pao(2)/Fio(2) ≤ 200). The discrimination of the original Pediatric Index of Mortality-3 score and a derived Pediatric Index of Mortality-3 score (where Spo(2)/Fio(2)-derived Pao(2)/Fio(2) values were used in place of missing Pao(2)/Fio(2) values) were compared in a different cohort (n = 1,205). The best Spo(2)/Fio(2)-Pao(2)/Fio(2) relationship in 1,703 Spo(2)/Fio(2)-to-Pao(2)/Fio(2) data pairs was a linear regression equation of ln[PF] regressed on ln[SF]. This equation identified children with a Pao(2)/Fio(2) less than or equal to 200 with a specificity of 73% and sensitivity of 61% in children with Spo(2) less than 97% (92% and 33%, respectively, when Spo(2) ≥ 97%) in the validation cohort. Pao(2)/Fio(2) derived from Spo(2)/Fio(2) (derived Pao(2)/Fio(2)) was better at predicting PICU mortality (area under receiver operating characteristic curve, 0.64; 95% CI, 0.55-0.73) compared with the original Pao(2)/Fio(2) (area under receiver operating characteristic curve, 0.54; 95% CI, 0.49-0.59; p = 0.02). However, there was no difference in the original and derived Pediatric Index of Mortality-3 scores and their discriminatory ability for mortality. Conclusions: Spo(2)-based metrics perform no worse than arterial blood gas-based metrics in mortality prediction models. Future Pediatric Index of Mortality score versions may be improved by the inclusion of risk factors based on oxygen saturation values, especially in settings where Pao(2) values are missing in a significant proportion of cases. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood oxygen tension childhood mortality oxygen saturation Pediatric Index of Mortality 3 Score scoring system EMTREE MEDICAL INDEX TERMS arterial gas article child cohort analysis comparative study discriminant analysis hospital admission human infant intensive care unit major clinical study mathematical model newborn observational study prediction preschool child priority journal prospective study respiratory failure retrospective study sensitivity and specificity United Kingdom validation study EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Hematology (25) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170081154 MEDLINE PMID 28121834 (http://www.ncbi.nlm.nih.gov/pubmed/28121834) PUI L614243853 DOI 10.1097/PCC.0000000000001075 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000001075 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 55 TITLE How Much Does ICU Structure Account for Variation in Mobility Practices between Acute Respiratory Distress Syndrome Network Hospitals? AUTHOR NAMES Taito S. Sarada K. Yasuda H. AUTHOR ADDRESSES (Taito S.; Sarada K.) Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan. (Yasuda H.) Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan. SOURCE Critical Care Medicine (2017) 45:3 (e329-e330). Date of Publication: 1 Mar 2017 ISSN 1530-0293 (electronic) 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adult respiratory distress syndrome clinical practice intensive care unit mobility practice patient transport EMTREE MEDICAL INDEX TERMS body mass hospital human letter obesity priority journal risk safety United States EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170140902 PUI L614528142 DOI 10.1097/CCM.0000000000002194 FULL TEXT LINK http://dx.doi.org/10.1097/CCM.0000000000002194 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 56 TITLE Passive hypothermia (≥35 - <36°C) during transport of newborns with hypoxicischaemic encephalopathy AUTHOR NAMES Sellam A. Lode N. Ayachi A. Jourdain G. Dauger S. Jones P. AUTHOR ADDRESSES (Sellam A.; Lode N.; Jones P., sejjprj@ucl.ac.uk) SMUR Pédiatrique, AP-HP, Hôpital Robert Debré, Paris, France. (Ayachi A.) SMUR Pédiatrique, AP-HP, Hôpital André Gregoire, Montreuil-sous-Bois, France. (Jourdain G.) SMUR Pédiatrique, AP-HP, Hôpital Clamart, France. (Dauger S.; Jones P., sejjprj@ucl.ac.uk) Réanimation Pédiatrique (PICU), Hôpital Robert Debré, Paris, France. (Jones P., sejjprj@ucl.ac.uk) Portex Unit, Critical Care Group - Portex Unit, Institute of Child Health, University College London, London, United Kingdom. (Jones P., sejjprj@ucl.ac.uk) London School of Hygiene and Tropical Medicine, London, United Kingdom. SOURCE PLoS ONE (2017) 12:3 Article Number: e0170100. Date of Publication: 1 Mar 2017 ISSN 1932-6203 (electronic) BOOK PUBLISHER Public Library of Science, plos@plos.org ABSTRACT Background Hypothermia initiated in the first six hours of life in term infants with hypoxic ischemic encephalopathy reduces the risk of death and severe neurological sequelae. Our study's principal objective was to evaluate transport predictors potentially influencing arrival in NICU (Neonatal Intensive Care Unit) at a temperature ≥35-<36°C. Methodology/Principal findings A multi-centric, prospective cohort study was conducted during 18 months by the three Neonatal Transport Teams and 13 NICUs. Newborns were selected for inclusion according to biological and clinical criteria before transport using passive hypothermia using a target temperature of ≥35-<36°C. Data on 120 of 126 inclusions were available for analysis. Thirtythree percent of the children arrived in NICU with the target temperature of ≥35-<36°C. The mean temperature for the whole group of infants on arrival in NICU was 35.4°C (34.3-36.5). The median age of all infants on arrival in NICU was 3h03min [2h25min-3h56min]. Three infants arrived in NICU with a temperature of <33°C and eleven with a temperature ≥37°C. Adrenaline during resuscitation was associated with a lower mean temperature on arrival in NICU. Conclusions/Significance Our strategy using ≥35-<36°C passive hypothermia combined with short transport times had little effect on temperature after the arrival of Neonatal Transport Team although did reduce numbers of infants arriving in NICU in deep hypothermia. For those infants where hypothermia was discontinued in NICU our strategy facilitated re-warming. Re-adjustment to a lower target temperature to ≥34.5-<35.5°C may reduce the proportion of infants with high/normothermic temperatures. EMTREE DRUG INDEX TERMS epinephrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hypoxic ischemic encephalopathy (therapy) induced hypothermia passive hypothermia EMTREE MEDICAL INDEX TERMS adult article cohort analysis controlled study female human infant major clinical study male multicenter study neonatal intensive care unit newborn newborn transport outcome assessment patient transport prediction prospective study resuscitation temperature sensitivity treatment response CAS REGISTRY NUMBERS epinephrine (51-43-4, 55-31-2, 6912-68-1) EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170191480 PUI L614714207 DOI 10.1371/journal.pone.0170100 FULL TEXT LINK http://dx.doi.org/10.1371/journal.pone.0170100 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 57 TITLE Drip 'n Ship Versus Mothership for Endovascular Treatment: Modeling the Best Transportation Options for Optimal Outcomes AUTHOR NAMES Milne M.S.W. Holodinsky J.K. Hill M.D. Nygren A. Qiu C. Goyal M. Kamal N. AUTHOR ADDRESSES (Milne M.S.W.; Nygren A.) Department of Biomedical Engineering, Schulich School of Engineering, Calgary, Canada. (Hill M.D.; Kamal N., nrkamal@ucalgary.ca) Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada. (Hill M.D.; Goyal M.) Departments of Medicine, Radiology and Community Health Sciences, Canada. (Holodinsky J.K.; Hill M.D.) Departments of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada. (Qiu C.) Department of Mathematics and Statistics, Faculty of Science, University of Calgary, Canada. CORRESPONDENCE ADDRESS N. Kamal, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Canada. Email: nrkamal@ucalgary.ca SOURCE Stroke (2017) 48:3 (791-794). Date of Publication: 1 Mar 2017 ISSN 1524-4628 (electronic) 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Background and Purpose - There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip 'n Ship) or with PSC bypass and direct transport to the CSC (Mothership). Ideal transportation options were mapped based on the location of their endovascular-capable CSCs and nonendovascular-capable PSCs. Methods - Probability models for endovascular treatment were developed from the ESCAPE trial's (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) decay curves and for alteplase treatment were extracted from the Get With The Guidelines decay curve. The time on-scene, needle-to-door-out time at the PSC, door-to-needle time at the CSC, and door-to-reperfusion time were assumed constant at 25, 20, 30, and 115 minutes, respectively. Emergency medical services transportation times were calculated using Google's Distance Matrix Application Programming Interface interfaced with MATLAB's Mapping Toolbox to create map visualizations. Results - Maps were generated for multiple onset-to-first medical response times and door-to-needle times at the PSCs of 30, 60, and 90. These figures demonstrate the transportation option that yields the better modeled outcome in specific regions. The probability of good outcome is shown. Conclusions - Drip 'n Ship demonstrates that a PSC that is in close proximity to a CSC remains significant only when the PSC is able to achieve a door-to-needle time of ≤30 minutes when the CSC is also efficient. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alteplase (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia (drug therapy, disease management, drug therapy, surgery) endovascular surgery fibrinolytic therapy patient transport practice guideline stroke unit EMTREE MEDICAL INDEX TERMS article brain perfusion clinical outcome emergency health service human map mathematical model priority journal probability reperfusion time to treatment CAS REGISTRY NUMBERS alteplase (105857-23-6) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170159442 MEDLINE PMID 28100764 (http://www.ncbi.nlm.nih.gov/pubmed/28100764) PUI L614623349 DOI 10.1161/STROKEAHA.116.015321 FULL TEXT LINK http://dx.doi.org/10.1161/STROKEAHA.116.015321 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 58 TITLE Paediatric retrieval services: is it better to 'stay and play' or 'scoop and run'? AUTHOR NAMES Lodwick G. Edwards L. AUTHOR ADDRESSES (Lodwick G.) Clinical Fellow, Paediatric Intensive Care Department, Birmingham Children's Hospital, Birmingham B4 6NH (Edwards L.) Consultant, Paediatric Intensive Care Department, Birmingham Children's Hospital, Birmingham SOURCE British journal of hospital medicine (London, England : 2005) (2017) 78:2 (118). Date of Publication: 2 Feb 2017 ISSN 1750-8460 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) organization and management patient transport pediatric intensive care unit point of care system EMTREE MEDICAL INDEX TERMS human nonbiological model patient care United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 28165792 (http://www.ncbi.nlm.nih.gov/pubmed/28165792) PUI L616925675 DOI 10.12968/hmed.2017.78.2.118 FULL TEXT LINK http://dx.doi.org/10.12968/hmed.2017.78.2.118 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 59 TITLE Complications and benefits of intrahospital transport of adult intensive care unit patients AUTHOR NAMES Harish M. Janarthanan S. Siddiqui S. Chaudhary H. Prabu N. Divatia J. Kulkarni A. AUTHOR ADDRESSES (Harish M.; Janarthanan S.; Siddiqui S.; Chaudhary H.; Prabu N.; Kulkarni A., kaivalyaak@yahoo.co.in) Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India. (Divatia J.) Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India. CORRESPONDENCE ADDRESS A. Kulkarni, Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India. Email: kaivalyaak@yahoo.co.in SOURCE Indian Journal of Critical Care Medicine (2017) 21:2 (112). Date of Publication: 1 Feb 2017 ISSN 1998-359X (electronic) 0972-5229 BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS APACHE artificial ventilation heart arrest human incidence intensive care letter resuscitation Sequential Organ Failure Assessment Score ventilated patient EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170125473 PUI L614456268 DOI 10.4103/ijccm.IJCCM_26_17 FULL TEXT LINK http://dx.doi.org/10.4103/ijccm.IJCCM_26_17 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 60 TITLE Influence of Immediate Skin-to-Skin Contact During Cesarean Surgery on Rate of Transfer of Newborns to NICU for Observation AUTHOR NAMES Schneider L.W. Crenshaw J.T. Gilder R.E. AUTHOR ADDRESSES (Schneider L.W.; Crenshaw J.T.; Gilder R.E.) SOURCE Nursing for women's health (2017) 21:1 (28-33). Date of Publication: 1 Feb 2017 ISSN 1751-486X (electronic) ABSTRACT We conducted an evidence-based practice project to determine if skin-to-skin contact immediately after cesarean birth influenced the rate of transfer of newborns to the NICU for observation. We analyzed data for 5 years (2011 through 2015) and compared the rates for the period before implementation of skin-to-skin contact with rates for the period after. The proportion of newborns transferred to the NICU for observation was significantly different and lower after implementing skin-to-skin contact immediately after cesarean birth (Pearson's χ2 = 32.004, df = 1, p < .001). These results add to the growing body of literature supporting immediate, uninterrupted skin-to-skin contact for all mother-newborn pairs, regardless of birth mode. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mother child relation organization and management psychology touch EMTREE MEDICAL INDEX TERMS adult cesarean section evidence based nursing female human neonatal intensive care unit newborn nursing pregnancy procedures retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28187837 (http://www.ncbi.nlm.nih.gov/pubmed/28187837) PUI L617079558 DOI 10.1016/j.nwh.2016.12.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.nwh.2016.12.008 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 61 TITLE Hospital transfer cost savings from triaging selected stroke patients directly to the comprehensive stroke centers (CSCs) courtesy of the mobile stroke treatment unit (MSTU) AUTHOR NAMES Zafar A. Udeh B. Reimer A. Ramanathan R.S. Vela-Duarte D. Taqui A. Wisco D. Winners S. Buletko A.B. Organek N. Hustey F. Hussain S. Uchino K. AUTHOR ADDRESSES (Zafar A.) UNM, Albuquerque, United States. (Udeh B.; Reimer A.; Ramanathan R.S.; Taqui A.; Wisco D.; Winners S.; Buletko A.B.; Organek N.; Hustey F.; Hussain S.; Uchino K.) Cleveland Clinic, Cleveland, United States. (Vela-Duarte D.) Univ of Colorado, Aurora, United States. CORRESPONDENCE ADDRESS A. Zafar, UNM, Albuquerque, United States. SOURCE Stroke (2017) 48 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME American Heart Association/American Stroke Association 2017 International Stroke Conference and State-of-the-Science Stroke Nursing Symposium CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2017-02-22 to 2017-02-24 ISSN 1524-4628 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The Mobile Stroke Treatment Unit (MSTU) is a novel onsite pre-hospital treatment team with all basic infra-structure to diagnose, emergently treat and hence timely triage acute ischemic and hemorrhagic stroke patients to either the primary stroke center (PSCs) or comprehensive stroke centers (CSCs). Recent evidence supports outcome benefits in favor of intra-arterial therapy (IAT) in large vessel strokes and transfers to neuro-critical care units for managing large strokes. This has resulted in a surge in transfers to CSCs summing additional transfer costs for patients not initially presenting to a CSC. This is the first ever study in the United States that utilizes a basic cost generation model to measure the economic benefits of MSTU triage directly to the CSCs by-passing PSCs, for the those patients requiring higher-level care. Method: Mobile Stroke Treatment Unit database was used to identify patients that stroke neurologists triaged to CSCs. These included all acute ICH, IAT candidates and severe strokes with ICU needs. We calculated the average costs of a typical primary stroke center emergency room visit and the cost of a critical care transport, generating a cost savings model. Result: Fifty two patients who were evaluated by stroke neurologists in the mobile stroke unit from July 2014 to October 2015 were adjudged candidates for comprehensive stroke centers. Twenty four (46%) of these were intra-cerebral hemorrhage (ICH) confirmed on portable head CT while the other 28 (54%) presented with major strokes with possible IA thrombectomy candidacy or anticipated Neuro ICU needs due to stroke severity. Eleven ICH and 13 ischemic stroke patients (46%) of the 52 patients by-passed PSC to be taken directly to comprehensive stroke centers with a potential of saving millions of dollars in costs and critical time. Conclusion: Even in a city with dense presence of comprehensive stroke centers, a large cohort of patients by-passed primary stroke centers with a potential of saving millions of dollars in costs and critical time. Future goals include evaluating for difference in outcome in this group of patients that bypassed PSC courtesy MSTU. Additionally, this needs to be replicated in other counties and cities before policy changes are proposed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain hemorrhage cost control emergency ward female male stroke patient EMTREE MEDICAL INDEX TERMS artery brain ischemia city data base disease model emergency health service head human major clinical study neurological intensive care unit neurologist stroke unit thrombectomy United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617465155 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 62 TITLE The Patient and Family Perioperative Experience During Transfer of Care: A Qualitative Inquiry AUTHOR NAMES Stutzman S.E. Olson D.M. Greilich P.E. Abdulkadir K. Rubin M.A. AUTHOR ADDRESSES (Stutzman S.E.; Olson D.M.; Greilich P.E.; Abdulkadir K.; Rubin M.A.) SOURCE AORN journal (2017) 105:2 (193-202). Date of Publication: 1 Feb 2017 ISSN 1878-0369 (electronic) ABSTRACT Patient transfers between the OR and intensive care unit are high-risk events. Previous studies regarding mechanisms to improve these transfers do not account for the perspectives of family members or patients. Using transfer-of-care reports from health care providers, we performed a qualitative study of patient and family member perspectives by transcribing, coding, and analyzing seven interviews using hermeneutic cycling, which revealed three main themes: communication, clinical interaction, and clinician demeanor. Participants reported that anxiety about the plan of care and its outcomes eased when they had more frequent communication with members of the clinical team, observed the team interacting with one another, and felt the clinicians' demeanors were confident. The results of this study showed that families perceived that clinicians who communicated the timing and frequency of protocols and procedures improved patient care. Clinician training on empathy, professionalism, and accessibility may increase patient and family satisfaction and decrease negative interactions between clinicians and patients and their family members. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) family health personnel attitude intensive care unit interpersonal communication operating room patient transport EMTREE MEDICAL INDEX TERMS anxiety human human relation prevention and control qualitative research LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28159078 (http://www.ncbi.nlm.nih.gov/pubmed/28159078) PUI L618871046 DOI 10.1016/j.aorn.2016.12.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.aorn.2016.12.006 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 63 TITLE Benefits of and untoward events during intrahospital transport of pediatric intensive care unit patients AUTHOR NAMES Harish M.M. Siddiqui S.S. Prabu Natesh R. Chaudhari H.K. Divatia J.V. Kulkarni A.P. AUTHOR ADDRESSES (Harish M.M.; Siddiqui S.S.; Prabu Natesh R.; Chaudhari H.K.; Kulkarni A.P., kaivalyaak@yahoo.co.in) Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India. (Divatia J.V.) Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India. CORRESPONDENCE ADDRESS A.P. Kulkarni, Department of Anaesthesia Critical Care and Pain, Division of Critical Care Medicine, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India. Email: kaivalyaak@yahoo.co.in SOURCE Indian Journal of Critical Care Medicine (2017) 21:1 (46-48). Date of Publication: 1 Jan 2017 ISSN 1998-359X (electronic) 0972-5229 BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. ABSTRACT Background and Aims: The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. Subjects and Methods: Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater), accompanying medical personnel, UEs, and benefits obtained during transport. Results: Among eighty pediatric patients, the median age was 8 years (range 2-17 years). During the transport, four (5%) patients required endotracheal intubation, three (3.75%) patients required intercostal drain placement, and six (7.5%) patients required cardiopulmonary resuscitation. Accidental removal of central venous catheter was reported in three (3.75%) patients, drain came out in four (5%) patients, and three (3.75%) patients had accidental extubation. Transport indirectly led to a change in antibiotic therapy in 24 (30%) patients and directly helped in change of therapy in the form of interventions in 20 (25%) patients. Conclusion: Critically ill children can be transported safely with adequate pretransport preparations, which may help in avoiding major UEs and benefit the patient by change in the therapy. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport pediatric intensive care unit risk risk benefit analysis untoward events EMTREE MEDICAL INDEX TERMS adolescent antibiotic therapy article cancer patient central venous catheter chest tube child clinical audit critically ill patient endotracheal intubation extubation female human major clinical study male medical personnel nuclear magnetic resonance imaging operating room patient safety radiology resuscitation x-ray computed tomography EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170067915 PUI L614185097 DOI 10.4103/0972-5229.198326 FULL TEXT LINK http://dx.doi.org/10.4103/0972-5229.198326 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 64 TITLE Pediatric Critical Care Transport as a Conduit to Terminal Extubation at Home: A Case Series AUTHOR NAMES Noje C. Bernier M.L. Costabile P.M. Klein B.L. Kudchadkar S.R. AUTHOR ADDRESSES (Noje C., cnicule1@jhmi.edu; Bernier M.L.; Kudchadkar S.R.) Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, United States. (Costabile P.M.) Department of Nursing, Johns Hopkins Hospital, Baltimore, United States. (Klein B.L.; Kudchadkar S.R.) Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, United States. SOURCE Pediatric Critical Care Medicine (2017) 18:1 (e4-e8). Date of Publication: 1 Jan 2017 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objectives: To present our single-center's experience with three palliative critical care transports home from the PICU for terminal extubation. Design: We performed a retrospective chart review of patients transported between January 1, 2012, and December 31, 2014. Setting: All cases were identified from our institutional pediatric transport database. Patients: Patients were terminally ill children unable to separate from mechanical ventilation in the PICU, who were transported home for terminal extubation and end-of-life care according to their families' wishes. Interventions: Patients underwent palliative care transport home for terminal extubation. Measurements and Main Results: The rate of palliative care transports home for terminal extubation during the study period was 2.6 per 100 deaths. The patients were 7 months, 6 years, and 18 years old and had complex chronic conditions. The transfer process was protocolized. The families were approached by the PICU staff during multidisciplinary goals-of-care meetings. Parental expectations were clarified, and home hospice care was arranged pretransfer. All transports were performed by our pediatric critical care transport team, and all terminal extubations were performed by physicians. All patients had unstable medical conditions and urgent needs for transport to comply with the families' wishes for withdrawal of life support and death at home. As such, all three cases presented similar logistic challenges, including establishing do-not-resuscitate status pretransport, having limited time to organize the transport, and coordinating home palliative care services with available community resources. Conclusions: Although a relatively infrequent practice in pediatric critical care, transport home for terminal extubation represents a feasible alternative for families seeking out-of-hospital end-of-life care for their critically ill technology-dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports to include patient screening tools, palliative care home discharge algorithms, transport protocols, and resource utilization and cost analyses. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extubation home care hospice care patient transport pediatric intensive care unit EMTREE MEDICAL INDEX TERMS acute lymphoblastic leukemia acute myeloid leukemia adult article artificial ventilation bone marrow transplantation cardiopulmonary arrest case report child chronic respiratory failure data base expectation extracorporeal oxygenation female gastrointestinal hemorrhage hemolytic anemia human hydrocephalus kidney failure male medical record review nasal cannula palliative therapy preschool child priority journal prostate cancer pulmonary hypertension respiratory failure retrospective study rhabdomyosarcoma septic shock spinal muscular atrophy terminally ill patient EMBASE CLASSIFICATIONS Cancer (16) Anesthesiology (24) Hematology (25) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160795369 MEDLINE PMID 27801708 (http://www.ncbi.nlm.nih.gov/pubmed/27801708) PUI L613085370 DOI 10.1097/PCC.0000000000000997 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000997 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 65 TITLE Improving handover between the transport team and neonatal intensive care unit staff in neonatal transports using the plan-do-study-act tool AUTHOR NAMES Kresch M.J. Christensen S. Kurtz M. Lubin J. AUTHOR ADDRESSES (Kresch M.J., mkresch@pennstatehealth.psu.edu) Department of Pediatrics, Division of Newborn Medicine, Penn State Health Children's Hospital, Hershey, United States. (Christensen S.; Kurtz M.; Lubin J.) Department of Emergency Medicine, Division of Prehospital and Transport Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, United States. CORRESPONDENCE ADDRESS M.J. Kresch, Department of Pediatrics, Division of Newborn Medicine, Penn State Health Children's Hospital, Hershey, United States. Email: mkresch@pennstatehealth.psu.edu SOURCE Journal of Neonatal-Perinatal Medicine (2017) 10:3 (301-306). Date of Publication: 2017 ISSN 1878-4429 (electronic) 1934-5798 BOOK PUBLISHER IOS Press, Nieuwe Hemweg 6B, Amsterdam, Netherlands. ABSTRACT OBJECTIVES: The aim was to achieve 100% effective handover from the critical care transport team to the neonatal intensive care unit (NICU) medical team. STUDY DESIGN: All patients transferred from referring hospitals by the critical care transport team to the Level IV NICU were included. Data for each infant was collected prospectively. The percentage of transported patients for which medical team and nursing handover occurredwas recorded.Aquality improvement projectwas launched using the Plan-Do-Study-Act (PDSA) tool. We implemented several processes including call from the transport team before arrival and the completion of a transfer of care form on arrival to the NICU. The process measures and the outcome measure of completion of handover were monitored. Run charts of process measures and the outcome measure were analyzed. RESULTS: Completion of medical handover increased from 95% (baseline) to 100% after 3 PDSA cycles and this has been maintained for 18 consecutive months. CONCLUSION: Medical handover from the critical care transport team to the NICU medical staff has been achieved and sustained for all neonatal transports. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical handover medical staff neonatal intensive care unit patient transport plan do study act tool EMTREE MEDICAL INDEX TERMS article emergency health service health care quality human infant intensive care medical record review nurse outcome assessment priority journal prospective study teamwork EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170736829 PUI L618859673 DOI 10.3233/NPM-16111 FULL TEXT LINK http://dx.doi.org/10.3233/NPM-16111 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 66 TITLE Quantitative Analysis of Estimated Burn Size Accuracy for Transfer Patients AUTHOR NAMES Armstrong J.R. Willand L. Gonzalez B. Sandhu J. Mosier M.J. AUTHOR ADDRESSES (Armstrong J.R., joe.r.armstrong@gmail.com; Willand L.) Loyola University Stritch School of Medicine, Maywood, United States. (Gonzalez B.; Sandhu J.) Clinical Research Office, Health Sciences Division, Loyola University Chicago, United States. (Mosier M.J.) Department of Surgery, Loyola University Medical Center, Maywood, United States. CORRESPONDENCE ADDRESS J.R. Armstrong, 2160 S 1st Ave., Maywood, United States. Email: joe.r.armstrong@gmail.com SOURCE Journal of Burn Care and Research (2017) 38:1 (e30-e35). Date of Publication: 1 Jan 2017 ISSN 1559-0488 (electronic) 1559-047X BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT The objective of this study was to quantify differences between estimated TBSA from referring hospitals vs calculated TBSA in the burn unit in regards to several variables. We conducted a retrospective review of 735 burn patients admitted over a 17-month period. Three hundred twenty-six patients fit the criteria of transfers with recorded %TBSA estimations from referring hospitals. Referring %TBSA was compared with actual %TBSA, and the difference was expressed as a percentage of actual %TBSA. This was then used to group referring estimations as underestimated (less than -25%), satisfactory (-25 to 25%), or overestimated (greater than 25%). A paired t-test was used to assess the paired differences for significance. Secondary variables were then assessed between groups. When assessing associations of these clinical measures, a one-way analysis of variance was used for continuous variables and Pearson's χ 2 test or Fisher's exact test was used. Of the 326 patients analyzed, 13 were underestimated, 63 were satisfactory, and 250 were overestimated. The ratio of overestimation to underestimation exceeded 19:1 and the ratio of overestimation to satisfactory estimation was nearly 4:1, with a statistically significant difference in referred %TBSA and actual %TBSA (P <.0001). Within the over and underestimated groups, there were significant differences between referred %TBSA and actual %TBSA (P <.0001). Larger burns were more accurately estimated (P <.0001). There are significant inaccuracies between referring hospital estimated %TBSA and actual %TBSA, which consistently and grossly skew toward overestimation. Inaccuracy in burn size estimation is systemic and can affect patient care and burn unit efficiency. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn patient quantitative analysis EMTREE MEDICAL INDEX TERMS analysis of variance body surface burn unit chi square test controlled study human major clinical study patient care quantitative study retrospective study Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170025568 PUI L614004510 DOI 10.1097/BCR.0000000000000460 FULL TEXT LINK http://dx.doi.org/10.1097/BCR.0000000000000460 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 67 TITLE The early natural history of sepsis: Symptoms and visits in the days leading up to sepsis hospitalization AUTHOR NAMES DeMerle K.M. Prescott H.C. Liu V. AUTHOR ADDRESSES (DeMerle K.M., kmgrady@med.umich.edu; Prescott H.C.) University of Michigan, Ann Arbor, United States. (Liu V.) Kaiser Permanente, Oakland, United States. CORRESPONDENCE ADDRESS K.M. DeMerle, University of Michigan, Ann Arbor, United States. Email: kmgrady@med.umich.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT Background: Sepsis is a leading cause of hospitalization and death. The CDC recently reported that 70% of sepsis patients have a healthcare visit in the month prior to sepsis hospitalization, but this was estimated indirectly based on patients' burden of comorbid illness. Little is known about the duration of infectious symptoms prior to sepsis hospitalization. However, it is likely that patients have prodromal infectious symptoms-and if identifiable, this might represent an untapped opportunity for prevention and intervention. Methods: We are reviewing 400 charts, a random sample of 811 community-acquired sepsis hospitalizations at University of Michigan (U-M) Health System (January 1 to December 31, 2014). Specifically, we are examining hospitalizations with a principal ICD-9-CM diagnosis of sepsis, severe sepsis or septic shock, excluding intra-hospital transfers and patients without evidence (or suspicion) of infection on hospital presentation. We are completing structured abstractions of ED and admission documentation and compiling data in REDCaps, a secure online reporting tool frequently used for clinical trials. We are collecting information on illness severity at presentation (SOFA score, suspected site of infection), duration of symptoms prior to presentation, and medical care sought and received prior to hospital presentation. Results: To date we have reviewed 197 of a planned 400 charts. 26 were excluded (7 with no suggestion of infection at hospital presentation and 18 intra-hospital transfers), leaving 172 community-acquired sepsis hospitalizations admitted directly to U-M. Of these 172 patients with community-acquired sepsis, 131 (76.2%) had sepsis present on admission (infection plus SOFA score (3)2). The most common organ failures were pulmonary (64.5%) and cardiovascular (60.4%). Suspected sites of infection at presentation were commonly respiratory (41.9%), gastrointestinal (28.5%) and urinary (35.5%). 159 (92.5%) patients reported prodromal symptoms. Fevers (44.8%), dyspnea (25.5%) and confusion (24.4%) were the most common symptoms immediately prior to hospital presentation. Of the 159 patients with prodromal symptoms, 77 (44.8%) patients sought treatment prior to hospitalization. Patients most commonly sought medical evaluation earlier on the day of admission, generally a telephone call to a physician (28, 16.3%) or a primary care physician visit (11, 6.4%). Of these 77 patients who sought evaluation prior to hospitalization, 43 (25%) received a treatment, 24(13.9%) were prescribed antibiotics, 16(9.3%) had cultures and/or labs drawn, and 51 (29.6%) were referred to the Emergency Department within 24 hours of physician contact. Conclusions: Over 90% of community-acquired sepsis hospitalizations have prodromal symptoms and about half seek medical evaluation prior to hospitalization. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) history hospitalization prodromal symptom septic shock EMTREE MEDICAL INDEX TERMS cardiovascular system clinical trial diagnosis doctor patient relation documentation drug therapy dyspnea emergency ward female fever gastrointestinal tract general practitioner human ICD-9-CM major clinical study male medical assessment Michigan random sample Sequential Organ Failure Assessment Score telephone university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617709971 DOI 10.1164/ajrccmconference.2017.C102 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccmconference.2017.C102 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 68 TITLE Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care AUTHOR NAMES Ramasubbu B. Stewart E. Spiritoso R. AUTHOR ADDRESSES (Ramasubbu B., ramasubb@tcd.ie; Stewart E.; Spiritoso R.) Department of Cardio-Thoracic Intensive Care Medicine and Surgery, St George’s Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS B. Ramasubbu, Cardio-Thoracic Intensive Care Unit, St George’s Hospital, Blackshaw Road, London, United Kingdom. Email: ramasubb@tcd.ie SOURCE Journal of the Intensive Care Society (2017) 18:1 (17-23). Date of Publication: 2017 ISSN 1751-1437 BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT Objective: To audit the quality and safety of the current doctor-to-doctor handover of patient information in our Cardiothoracic Intensive Care Unit. If deficient, to implement a validated handover tool to improve the quality of the handover process. Methods: In Cycle 1 we observed the verbal handover and reviewed the written handover information transferred for 50 consecutive patients in St George’s Hospital Cardiothoracic Intensive Care Unit. For each patient’s handover, we assessed whether each section of the Identification, Situation, Background, Assessment, Recommendations tool was used on a scale of 0–2. Zero if no information in that category was transferred, one if the information was partially transferred and two if all relevant information was transferred. Each patient’s handover received a score from 0 to 10 and thus, each cycle a total score of 0–500. Following the implementation of the Identification, Situation, Background, Assessment, Recommendations handover tool in our Intensive Care Unit in Cycle 2, we re-observed the handover process for another 50 consecutive patients hence, completing the audit cycle. Results: There was a significant difference between the total scores from Cycle 1 and 2 (263/500 versus 457/500, p < 0.001). The median handover score for Cycle 1 was 5/10 (interquartile range 4–6). The median handover score for Cycle 2 was 9/10 (interquartile range 9–10). Patient handover scores increased significantly between Cycle 1 and 2, U = 13.5, p < 0.001. Conclusions: The introduction of a standardised handover template (Identification, Situation, Background, Assessment, Recommendations tool) has improved the quality and safety of the doctor-to-doctor handover of patient information in our Intensive Care Unit. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit patient safety total quality management EMTREE MEDICAL INDEX TERMS clinical article clinical handover doctor patient relation human patient information LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170098722 PUI L614327223 DOI 10.1177/1751143716660982 FULL TEXT LINK http://dx.doi.org/10.1177/1751143716660982 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 69 TITLE Study of ICU patients transferred to a palliative care unit AUTHOR NAMES Conner A. Conner A.F. Earle B. Turrin D. AUTHOR ADDRESSES (Conner A., afc5bc@virginia.edu) North Shore University Hospital, Northwell Health, 300 Community Drive, Manhasset, United States. (Conner A.F.; Earle B.; Turrin D.) CORRESPONDENCE ADDRESS A. Conner, North Shore University Hospital, Northwell Health, 300 Community Drive, Manhasset, United States. Email: afc5bc@virginia.edu SOURCE Journal of Palliative Medicine (2017) 20:4 (A25). Date of Publication: 2017 CONFERENCE NAME Center to Advance Palliative Care National Seminar Practical Tools for Making Change, CAPC 2016 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-10-26 to 2016-10-29 ISSN 1557-7740 BOOK PUBLISHER Mary Ann Liebert Inc. ABSTRACT Description: Introduction: North Shore University Hospital (NSUH) has a 10-bed Palliative Care Unit (PCU) that admits over 500 patients annually for symptom management. 25% of these patients come from an Intensive Care Unit (ICU). The unit was designed to implement palliative symptom relief and hospice care for end of life patients including mechanically ventilated patients. Literature demonstrates the role of palliative care as an essential component of comprehensive medical care. In order to provide high quality care to ICU patient transfers, we wanted to better understand the intricacies of their hospital course. Method: A retrospective review was conducted for PCU transfers from April 1, 2016 - June 30, 2016 and specifically ICU transfers. All data was collected from Electronic Medical Records (EMRs). This data included patient demographics, hospital units, hospital length of stay (LOS), PCU LOS, admission to PCU consult time, and PCU consult to PCU admission time. Results: From April 1, 2016 - June 30, 2016, 130 patients were admitted to the PCU. Of these patients, 30 came from ICUs. For all 130 patients, the average hospital LOS ranged from 11.2- 15.4 days with an average PCU LOS ranging from 3.7-5.2 days. For ICU patients, hospital LOS range from 12.4-18.0 days while PCU LOS stay was 2.5-5.0 days. The average admission to PCU consult time for all patients was 4.4 days while for ICU patients it was 7.8 days. 61.5% of all PCU patients expired in the unit during this time period, 92.3% of the ICU patients expired. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female male palliative therapy EMTREE MEDICAL INDEX TERMS electronic medical record health care quality human intensive care unit length of stay major clinical study patient transport retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616394740 DOI 10.1089/jpm.2017.0051 FULL TEXT LINK http://dx.doi.org/10.1089/jpm.2017.0051 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 70 TITLE Late mobilization: In Hospital physical therapy after intensive care unit transfer AUTHOR NAMES Callahan L.P. Kelly A.P. Supinski G.S. AUTHOR ADDRESSES (Callahan L.P.; Kelly A.P.; Supinski G.S.) University of Kentucky, Lexington, United States. CORRESPONDENCE ADDRESS L.P. Callahan, University of Kentucky, Lexington, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Early mobilization (EM), a key component of care during critical illness is provided even in patients who require multiple pressors, high levels of mechanical ventilation/PEEP and/or dialysis. Recent clinical practice guidelines suggest EM implementation in order to improve outcomes. Since many patients who survive an episode of critical illness exhibit persistent physical disabilities for years, it seems reasonable that EM would be followed by aggressive physical therapy (PT) throughout hospitalization and following hospital discharge, with the goal to provide restoration of physical function and prevention of progressive debilitation. Objective: The present study examined the continuum of PT rehabilitation in patients transferred from an intensive care unit (ICU) to a general medicine (GM) service until hospital discharge. We tested the hypothesis that high levels of PT delivery for post-ICU patients continue throughout hospitalization. Methods: Data were extracted from the University of Kentucky Enterprise Data Warehouse (electronic health record and the diagnosis coding system). We examined patients who were transferred from an ICU to the GM service from January-August 2016. We also evaluated the number of PT sessions post-ICU patients received while on the GM floor service. Results: As indicated below, 543 (15%) of 3,609 GM hospital discharges from January-August 2016 were patients transferred to the floor after an ICU stay. Of these, 128 (23.6%) received PT while in the ICU and while on the floor. PT assessments averaged 2.8 ± 6.4 SD sessions per patient over an average of 13 days while on the GM service. Notably, a paucity of patients (1.5%, n=8) with an ICU stay were discharged from the GM service to a rehabilitation facility. Conclusions: While there is a strong emphasis on aggressive EM in the ICU with its obligatory resources and inherent risks, maintenance of PT in post-ICU patients after transfer to the floor is deficient, particularly during a time when PT may be much more feasible and safe. Moreover, many patients who likely suffer from significant post-ICU weakness and concomitant physical debilitation and frailty are not provided access to rehabilitation at hospital discharge. Additional investigation is warranted to delineate the short and long-term consequences of this absence of late mobilization. We speculate that more objective assessments of physical function at the time of ICU transfer as well as upon hospital discharge may provide guidance for targeted, patient-specific interventions that could improve recovery in this population. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit physiotherapy EMTREE MEDICAL INDEX TERMS clinical article data base diagnosis electronic health record female frailty general practice hospital discharge hospitalization human Kentucky male mobilization rehabilitation remission university weakness LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617713354 DOI 10.1164/ajrccm-conference.2017.A50 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccm-conference.2017.A50 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 71 TITLE Horizontal transfer of OXA-23-carbapenemase-producing Acinetobacter species in intensive care units at an academic complex hospital, Durban, KwaZulu-Natal, South Africa AUTHOR NAMES Swe-Han K.S. Pillay M. Schnugh D. Mlisana K.P. Baba K. Pillay M. AUTHOR ADDRESSES (Swe-Han K.S., dr.khine85@gmail.com; Pillay M.; Mlisana K.P.) Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa. (Swe-Han K.S., dr.khine85@gmail.com; Mlisana K.P.; Pillay M.) Medical Microbiology and Infection Control, School of Laboratory Medicine and Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. (Schnugh D.) Infection Control Services Laboratory, Department of Clinical Microbiology and Infectious Diseases, Witwatersrand Medical School, Johannesburg, South Africa. (Baba K.) Department of Medical Microbiology, National Health Laboratory Service, Universitas Academic Laboratory, University of the Free State, Bloemfontein, South Africa. CORRESPONDENCE ADDRESS K.S. Swe-Han, Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa. Email: dr.khine85@gmail.com SOURCE Southern African Journal of Epidemiology and Infection (2017) 32:4 (119-126). Date of Publication: 2017 ISSN 2220-1084 (electronic) 1015-8782 BOOK PUBLISHER Medpharm Publications, PO Box 14804, Lyttelton, Gauteng, South Africa. ABSTRACT Introduction: Carbapenemase production is an important mechanism of carbapenem resistance in Acinetobacter species. This study investigated the presence of the carbapenem-hydrolysing class D β–lactamase- encoding genes, bla(OXA-23) and bla(OXA-58), and their association with the spread of multidrug-resistant (MDR) Acinetobacter species in intensive care units at an academic hospital. Method: Forty-four MDR Acinetobacter species were confirmed using VITEK(®)2 and Epsilometer tests. The bla(OXA-23) and bla(OXA-58) genes were detected by polymerase chain reaction (PCR) in twenty-four selected isolates. The bla(OXA-23) amplicons were sequenced and compared to the GenBank database. Genotypic relatedness of isolates was determined by pulsed field gel electrophoresis (PFGE). Clinical and laboratory data were analysed. Results: Among the twenty-four isolates, eighteen were carbapenem resistant and six were sensitive. The bla(OXA-23) gene, but not bla(OXA-58), was detected in the eighteen resistant strains. The bla(OXA-23) amplicons showed 100% identity with the GenBank database of bla(OXA-23). The MICs of carbapenems against Acinetobacter species carrying the bla(OXA-23) gene were 8 to > 16 μg/ml. Genetic relatedness was evident among isolates of seven pairs from fourteen patients. Of these patients, twelve were in the same ICUs and two were adjacent to another ICU during the same hospitalisation period. Conclusion: The selected MDR Acinetobacter species carried the bla(OXA-23) gene responsible for resistance to carbapenems, while molecular and clinical data analysis suggested horizontal transmission in ICUs. In addition, the PFGE typing of a diverse collection of MDR Acinetobacter species clones showed that isolates were related to no more than two patients, suggesting that no outbreak had occurred. EMTREE DRUG INDEX TERMS carbapenem derivative EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter intensive care unit EMTREE MEDICAL INDEX TERMS amplicon article bacterial strain bacterium isolate clinical article controlled study epsilometer test gene hospital human minimum inhibitory concentration polymerase chain reaction pulsed field gel electrophoresis South Africa EMBASE CLASSIFICATIONS Anesthesiology (24) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170809928 PUI L619293618 DOI 10.1080/23120053.2017.1335482 FULL TEXT LINK http://dx.doi.org/10.1080/23120053.2017.1335482 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 72 TITLE 25(th) Critical Care Transport Medicine Conference AUTHOR NAMES Newman M. Petersen P. Good N. AUTHOR ADDRESSES (Newman M.; Petersen P.; Good N.) SOURCE Air Medical Journal (2017) 36:1 (24-26). Date of Publication: 1 Jan 2017 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS conference paper human medical education priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170048853 PUI L614093481 DOI 10.1016/j.amj.2016.11.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2016.11.001 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 73 TITLE Retrospective Review of Pediatric Transport: Where Do Our Patients Go After Transport? AUTHOR NAMES Krennerich E. Sitler C.G. Shah M. Lam F. Graf J. AUTHOR ADDRESSES (Krennerich E., emily.krennerich@gmail.com; Sitler C.G.; Lam F.; Graf J.) Department of Pediatric Critical Care, Texas Children's Hospital, Houston, TX (Krennerich E., emily.krennerich@gmail.com; Shah M.; Lam F.; Graf J.) Baylor College of Medicine, Houston, TX (Shah M.) Department of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, TX CORRESPONDENCE ADDRESS E. Krennerich, Department of Pediatric Critical Care, Texas Children's Hospital, Houston, TX Email: emily.krennerich@gmail.com SOURCE Air Medical Journal (2017). Date of Publication: 2017 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective: This review describes disposition of transported children and identifies contributing factors affecting optimal patient placement. The study describes timing and patient placement indicators in transport patients to identify areas of improvement, re-education, and training. Methods: A retrospective chart review for transports via our pediatric specialty transport team from January 1, 2012, to December 31, 2014, was performed. Patients were identified by the transport quality assurance performance improvement database, hospital electronic medical records, and transport medical records. Results: Three thousand two hundred fifty-six pediatric patient transports were reviewed. One hundred forty-three records were excluded. Of the remaining 3,113 patients, admission disposition was: 1,487 (47%) pediatric intensive care unit, 120 (4%) pediatric cardiovascular intensive care unit, 835 (27%) step-down critical care unit, 438 (14%) emergency department, 194 (6%) general floor, 29 (1%) neonatal intensive care unit, and 10 (< 1%) operating room. Of the 22% transported to a lower-acuity unit, several subsequently required critical care. Children transported for traumatic injuries had a shorter emergency department length of stay than medical patients. Conclusion: Our study validates the efficient use of pediatric specialty transport team resources. Many transported patients are critically ill, require specialized pediatric services, or require definitive pediatric emergency department care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female male retrospective study EMTREE MEDICAL INDEX TERMS child coronary care unit critically ill patient electronic medical record emergency ward human injury length of stay major clinical study medical record review neonatal intensive care unit newborn operating room patient transport pediatric intensive care unit quality control LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170609216 PUI L618025537 DOI 10.1016/j.amj.2017.06.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2017.06.006 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 74 TITLE Drip and ship versus direct to comprehensive stroke center AUTHOR NAMES Holodinsky J.K. Williamson T.S. Kamal N. Mayank D. Hill M.D. Goyal M. AUTHOR ADDRESSES (Holodinsky J.K.; Williamson T.S.; Hill M.D.) Department of Community Health Sciences, University of Calgary, Calgary, Canada. (Williamson T.S.) Alberta Children's Hospital Research Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada. (Kamal N.; Hill M.D.; Goyal M., mgoyal@ucalgary.ca) Departments of Clinical Neurosciences, University of Calgary, Calgary, Canada. (Hill M.D.; Goyal M., mgoyal@ucalgary.ca) Departments of Radiology, University of Calgary, Calgary, Canada. (Hill M.D.; Goyal M., mgoyal@ucalgary.ca) Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada. (Mayank D.) Division of Engineering Science, University of Toronto, Ontario, Canada. CORRESPONDENCE ADDRESS M. Goyal, Department of Radiology, Seaman Family MR Research Centre, Foothills Medical Centre, 1403 29th St NW, Calgary, Canada. Email: mgoyal@ucalgary.ca SOURCE Stroke (2017) 48:1 (233-238). Date of Publication: 1 Jan 2017 ISSN 1524-4628 (electronic) 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alteplase (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia (drug therapy, drug therapy) patient transport stroke unit EMTREE MEDICAL INDEX TERMS endovascular surgery human methodology note priority journal probability randomized controlled trial (topic) statistical model CAS REGISTRY NUMBERS alteplase (105857-23-6) EMBASE CLASSIFICATIONS Drug Literature Index (37) Internal Medicine (6) Neurology and Neurosurgery (8) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT02795962) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160885250 PUI L613535400 DOI 10.1161/STROKEAHA.116.014306 FULL TEXT LINK http://dx.doi.org/10.1161/STROKEAHA.116.014306 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 75 TITLE Implementation of a standardized handoff protocol for post-operative admissions to the surgical intensive care unit AUTHOR NAMES Mukhopadhyay D. Wiggins-Dohlvik K.C. MrDutt M.M. Hamaker J.S. Machen G.L. Davis M.L. Regner J.L. Smith R.W. Ciceri D.P. Shake J.G. AUTHOR ADDRESSES (Mukhopadhyay D., dhriti@utexas.edu; Wiggins-Dohlvik K.C.; MrDutt M.M.; Hamaker J.S.; Machen G.L.; Davis M.L.; Regner J.L.; Smith R.W.; Ciceri D.P.) Texas A and M University/Scott and White Hospital, 2401 S. 31st Street, Temple, TX, 76508, USA (Shake J.G.) University of Mississippi Medical Center, 2500 N State Street, Jackson, MS, 39216, USA CORRESPONDENCE ADDRESS D. Mukhopadhyay, Texas A and M University/Scott and White Hospital, 2401 S. 31st Street, Temple, TX, 76508, USA Email: dhriti@utexas.edu SOURCE American Journal of Surgery (2017). Date of Publication: 2017 ISSN 1879-1883 (electronic) 0002-9610 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background: The transfer of critically ill patients from the operating room (OR) to the surgical intensive care unit (SICU) involves handoffs between multiple providers. Incomplete handoffs lead to poor communication, a major contributor to sentinel events. Our aim was to determine whether handoff standardization led to improvements in caregiver involvement and communication. Methods: A prospective intervention study was designed to observe thirty one patient handoffs from OR to SICU for 49 critical parameters including caregiver presence, peri-operative details, and time required to complete key steps. Following a six month implementation period, thirty one handoffs were observed to determine improvement. Results: A significant improvement in presence of physician providers including intensivists and surgeons was observed (p = 0.0004 and p < 0.0001, respectively). Critical details were communicated more consistently, including procedure performed (p = 0.0048), complications (p < 0.0001), difficult airways (p < 0.0001), ventilator settings (p < 0.0001) and pressor requirements (p = 0.0134). Conversely, handoff duration did not increase significantly (p = 0.22). Conclusions: Implementation of a standardized protocol for handoffs between OR and SICU significantly improved caregiver involvement and reduced information omission without affecting provider time commitment. EMTREE DRUG INDEX TERMS hypertensive factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) operating room patient transport surgical intensive care unit EMTREE MEDICAL INDEX TERMS airway caregiver clinical article clinical handover complication controlled study doctor patient relation female human intensivist intervention study male standardization surgeon ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170593017 MEDLINE PMID 28823594 (http://www.ncbi.nlm.nih.gov/pubmed/28823594) PUI L617920852 DOI 10.1016/j.amjsurg.2017.08.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.amjsurg.2017.08.005 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 76 TITLE Intra hospital transport's complications: Incidence and risk factors AUTHOR NAMES Sedghiani I. Doghri H. Jendoubi A. Hamdi D. Cherif M.A. El Hechmi Y.Z. Zouheir J. AUTHOR ADDRESSES (Sedghiani I., sedghiani.ines@gmail.com; Jendoubi A.; Hamdi D.) Emergency and Intensive Care Department, Hôpital Habib Thameur, Tunis, Tunisia. (Doghri H.; Cherif M.A.; El Hechmi Y.Z.; Zouheir J.) Emergency and Intensive Care Department, Hopital Habib Thameur, Tunis, Tunisia. CORRESPONDENCE ADDRESS I. Sedghiani, Emergency and Intensive Care Department, Hôpital Habib Thameur, Tunis, Tunisia. Email: sedghiani.ines@gmail.com SOURCE Annals of Intensive Care (2017) 7:1 Supplement 1 (26). Date of Publication: 1 Jan 2017 CONFERENCE NAME French Intensive Care Society, International Congress - Reanimation 2017 CONFERENCE LOCATION Paris, France CONFERENCE DATE 2017-01-11 to 2017-01-13 ISSN 2110-5820 BOOK PUBLISHER Springer Verlag ABSTRACT Introduction Caring for patients during intra hospital transport (IHT) is a high-risk activity. Adverse events during transport are frequent and may have significant consequences for the patient. The aim of this study was to assess the incidence of complications occurring during the IHT and to analyze the causes of such complications. Patients and methods We prospectively describe IHT from the emergency department, realized from January 2016 to March 2016. Were included in the study IHT of compromised patients for whom critical care monitoring was needed and emergency physician is required. Clinical characteristics of patient's departure and technical equipments (mechanical ventilation, drugs) were noted. Complications were defined as follows: patient related problems (desaturation, haemodynamic instability, arrhythmia, extubation, acute change in mental status, death) and ventilator related problems (breakdown or defect of the material). Results During the inclusion period, 102 IHT were carried out. The IHT were realized for imaging procedure in 41 cases and for transferring patients to the intensive care unit in 24 cases and to the other wards in 37 cases. The median IHT duration was 15 min [10-30]. Twenty patients (19%) were mechanically ventilated. The majority of IHT (60%) were performed by the night shift emergency team. The incidence of complications was 44% (45 patients). Most events were related to haemodynamic instability in 25 cases, desaturation in 22 cases, agitation in 14 cases and cardiac arrest in 2 cases and one death. Therapeutic interventions were volume resuscitation in 13 cases, optimization of sedation in 12 cases, vasopressor managment in 12 patients and cardiopulmonary resuscitation in 3 cases. The occurrence of complications during transport was significantly increased in mechanically ventilated patients (p = 0.009), especially with inspiratory oxygen fraction >0.5 (p = 0.00), sedation before transport (p = 0.001), vasopressor requirement before transport (p = 0.03) and with the night shift team (p = 0.007). Sedation and mechanical ventilation were the independent risk factors of IHT complications. Conclusion This study confirms that the intrahospital transport of compromised patients leads to a significant number of complications. This finding emphasises the need of improving medical skills during IHT. EMTREE DRUG INDEX TERMS hypertensive factor oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward risk factor EMTREE MEDICAL INDEX TERMS agitation artificial ventilation clinical article complication death emergency physician extubation heart arrest heart arrhythmia hemodynamics human imaging intensive care unit mental health monitoring night resuscitation sedation skill ventilated patient CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614626277 DOI 10.1186/s13613-016-0223-8 FULL TEXT LINK http://dx.doi.org/10.1186/s13613-016-0223-8 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 77 TITLE Validation of the sepsis in obstetrics score: A model to predict intensive care unit transfer for sepsis in pregnancy AUTHOR NAMES Albright C.M. Has P. Rouse D.J. Hughes B.L. AUTHOR ADDRESSES (Albright C.M.) University of Washington, Seattle, United States. (Has P.; Rouse D.J.; Hughes B.L.) Women and Infants Hospital, Brown University, Providence, United States. CORRESPONDENCE ADDRESS C.M. Albright, University of Washington, Seattle, United States. SOURCE American Journal of Obstetrics and Gynecology (2017) 216:1 Supplement 1 (S407-S408). Date of Publication: 1 Jan 2017 CONFERENCE NAME 37th Annual Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2017-01-23 to 2017-01-28 ISSN 1097-6868 BOOK PUBLISHER Mosby Inc. ABSTRACT OBJECTIVE: To validate the Sepsis in Obstetrics Score (SOS), a pregnancy-specific sepsis scoring system. STUDY DESIGN: Women were included in this prospective validation study of the SOS if they presented to the emergency department meeting criteria for the systemic inflammatory response syndrome (SIRS), were suspected to have an infection, and were either pregnant or up to two weeks postpartum. The primary outcome was admission to the intensive care unit (ICU) for sepsis. The areas under the receiver operator characteristic curves for the SOS to predict ICU transfer between this validation cohort and the derivation cohort were compared to evaluate for an acceptable difference of 15%. Using the pre-determined cut-point of an SOS of 6, the test characteristics were evaluated in this cohort. RESULTS: Between March 2012 and May 2015, 1,250 women who were pregnant or within two weeks postpartum presented to the emergency department and met SIRS criteria. Of those, 425 (34%) had a clinical suspicion or diagnosis of infection: 14 patients (3.3%) were transferred to the ICU, and 45 (10.6%) to a telemetry unit. The SOS had an area under the receiver operator characteristic curve of 0.85 (95% CI 0.76-0.95) for prediction of ICU transfer for sepsis. This is within the 15% acceptable margin of the derivation cohort (Figure). An SOS cut-off of 6 had a sensitivity of 64%, a specificity of 88%, a positive predictive value of 15%, and a negative predictive value of 98.6% for ICU admission. After adjusting for age, BMI, and race/ethnicity, the OR for ICU transfer was 14.4 (95% CI, 4.0-52.1) and for ICU or telemetry unit transfer was 10.2 (95% CI, 5.2-20.1). By applying other validated scoring systems to our cohort of patients, each scoring system performed similarly well (Table). CONCLUSION: The SOS is the first scoring system derived and validated in a pregnant population and can predict ICU transfer for sepsis. Future studies should evaluate its incorporation into clinical practice in an attempt to more quickly recognize and treat sepsis in pregnancy. (Figure Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit model obstetrics pregnancy sepsis validation process EMTREE MEDICAL INDEX TERMS body mass clinical practice controlled study diagnosis diagnostic test accuracy study emergency ward ethnicity female human major clinical study prediction predictive value race scoring system telemetry LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614090794 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 78 TITLE International aircraft ECMO transportation: First French pediatric experience AUTHOR NAMES Rambaud J. Léger P.L. Porlier L. Larroquet M. Raffin H. Pierron C. Walti H. Carbajal R. AUTHOR ADDRESSES (Rambaud J., jerome.rambaud@aphp.fr; Léger P.L.; Porlier L.; Walti H.) Pediatric Intensive Care Unit, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. (Larroquet M.) Pediatric Surgery Department, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. (Raffin H.) Medic'air International, Bagnolet, France. (Pierron C.) Pediatric Intensive Care Unit, Kannerklinik, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg. (Carbajal R.) Pediatric Emergency Department, Armand-Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. CORRESPONDENCE ADDRESS J. Rambaud, Armand-Trousseau Hospital, 26 Avenue du Dr Arnold Netter, Paris, France. Email: jerome.rambaud@aphp.fr SOURCE Perfusion (United Kingdom) (2017) 32:3 (253-255). Date of Publication: 2017 ISSN 1477-111X (electronic) 0267-6591 BOOK PUBLISHER SAGE Publications Ltd, info@sagepub.co.uk ABSTRACT Refractory severe hemodynamic or respiratory failure may require extracorporeal membrane oxygenation (ECMO). Since some patients are too sick to be transported safely to a referral ECMO center on conventional transportation, mobile ECMO transport teams have been developed. The experiences of some ECMO transport teams have already been reported, including air and international transport. We report the first French pediatric international ECMO transport by aircraft. This case shows that a long distance intervention of the pediatric ECMO transport team is feasible, even in an international setting. Long distance ECMO transportations are widely carried out for adults, but remain rare in neonates and children. EMTREE DRUG INDEX TERMS dobutamine epinephrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport aircraft extracorporeal oxygenation EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome article artificial ventilation blood flow bronchiolitis case report electroencephalography female heart arrest hemodynamics human Human respiratory syncytial virus infant intensive care unit nuclear magnetic resonance imaging positive end expiratory pressure priority journal resuscitation CAS REGISTRY NUMBERS dobutamine (34368-04-2, 52663-81-7, 49745-95-1, 61661-06-1) epinephrine (51-43-4, 55-31-2, 6912-68-1) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Drug Literature Index (37) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170307743 MEDLINE PMID 27590633 (http://www.ncbi.nlm.nih.gov/pubmed/27590633) PUI L615749876 DOI 10.1177/0267659116667805 FULL TEXT LINK http://dx.doi.org/10.1177/0267659116667805 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 79 TITLE Improving Transfer Times for Acute Ischemic Stroke Patients to a Comprehensive Stroke Center AUTHOR NAMES Kodankandath T.V. Wright P. Power P.M. De Geronimo M. Libman R.B. Kwiatkowski T. Katz J.M. AUTHOR ADDRESSES (Kodankandath T.V.; Wright P.; Libman R.B.; Katz J.M., jkatz2@northwell.edu) Department of Neurology, North Shore University Hospital, Hofstra Northwell School of Medicine, Manhasset, United States. (Power P.M.) Department of Workforce Safety, Northwell Health, United States. (De Geronimo M.) Department of Informatics and Quality, Northwell Health, United States. (Kwiatkowski T.) Department of Emergency Medicine, Hofstra Northwell School of Medicine, United States. CORRESPONDENCE ADDRESS J.M. Katz, North Shore University Hospital, Department of Neurology, 300 Community Drive, 9 Tower, Manhasset, United States. Email: jkatz2@northwell.edu SOURCE Journal of Stroke and Cerebrovascular Diseases (2017) 26:1 (192-195). Date of Publication: 1 Jan 2017 ISSN 1532-8511 (electronic) 1052-3057 BOOK PUBLISHER W.B. Saunders ABSTRACT Background and Objective The transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Delays pose an obstacle to time-sensitive stroke treatments and, therefore, increase the likelihood of exclusion from endovascular stroke therapy. This study aims to evaluate the impact of the Stroke Rescue Program, with its goal of minimizing interfacility transfer delays and increasing the number of transport times completed within 60 minutes. Methods The Stroke Rescue Program was initiated to facilitate the rapid transfer of AIS patients from regional primary stroke centers (PSCs) to the network's CSC. The transfer process was divided into 3 time elements: transport 1 time (initial phone call from the PSC until emergency medical service [EMS] arrival at the PSC), emergency department (ED) time (EMS PSC arrival to PSC departure), and transport 2 time (PSC departure to CSC arrival). The total transport time target was set at less than 60 minutes. Protocols and procedures were implemented with a focus on decreasing the ED time. Results Comparing baseline (preimplementation) quarter (n = 21) to postproject quarter (1 year later, n = 31), the percent transported within 60 minutes increased from 62% to 81%. A statistically significant improvement was seen for both median ED time (23 minutes versus 14 minutes; U = 171, P < .01) and median total transport time (56 minutes versus 44 minutes; U = 199, P < .05). Conclusion Interfacility transfer protocols minimizing the time paramedics spend in a PSC ED can significantly reduce total transfer time to a comprehensive stroke center. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia patient transport time EMTREE MEDICAL INDEX TERMS article emergency health service emergency ward health impact assessment health program human outcome assessment priority journal stroke patient stroke unit EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160898394 MEDLINE PMID 27743926 (http://www.ncbi.nlm.nih.gov/pubmed/27743926) PUI L613586257 DOI 10.1016/j.jstrokecerebrovasdis.2016.09.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.008 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 80 TITLE Textual analysis of physician progress notes for patients transferred from the intensive care unit to hospital ward AUTHOR NAMES Brown K. Parsons Leigh J. Kamran H. Dodek P.M. Bagshaw S.M. Forster A.J. Turgeon A.F. Fowler R.A. Lamontagne F. Stelfox H.T. AUTHOR ADDRESSES (Brown K.; Kamran H.) Calgary, Canada. (Parsons Leigh J.) University of Calgary and Alberta Health Services, Calgary, Canada. (Dodek P.M.) University of British Columbia, Vancouver, Canada. (Bagshaw S.M.) University of Alberta, Edmonton, Canada. (Forster A.J.) University of Ottawa, Ottawa, Canada. (Turgeon A.F.) Université Laval, Québec, Canada. (Fowler R.A.) University of Toronto, Toronto, Canada. (Lamontagne F.) Universite de Sherbrooke, Sherbrooke, Canada. (Stelfox H.T., tstelfox@ucalgary.ca) University of Calgary, Calgary, Canada. CORRESPONDENCE ADDRESS H.T. Stelfox, University of Calgary, Calgary, Canada. Email: tstelfox@ucalgary.ca SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE Transfer of patients from the intensive care unit (ICU) to a hospital ward is a risky period in healthcare delivery that relies on multiple forms of communication. Information entered into the medical record by physicians is particularly important because it is a durable source of information in the context of frequently changing care teams. However, little is known about the structure and content of physician documentation in the medical record during transfers of care. We therefore sought to describe physician progress notes before, during, and after ICU to hospital ward transfer. METHODS We conducted a prospective multicenter cohort study of 451 adult patients who were transferred from an ICU to a hospital ward in 10 Canadian hospitals. Anonymized physician progress notes were collected from each patient's medical record for 10 consecutive calendar days: two days before ICU transfer, the day of transfer, and seven days' after transfer to the hospital ward. Quantitative and qualitative (open coding by two reviewers) analyses were used to identify and compare textual communication structure and content in ICU and ward physician notes. RESULTS A total of 447 patient medical records that included 7,201 progress notes (mean of 16 notes per patient [95% confidence interval 14.0-18.9]) were collected. Of these notes 96% [91%-100%] were handwritten and 86% of these [77%-97%] were legible. Of all notes, 93% [88%-98%] included a date, 51% [42%-61%] included a time, and 55% [42%-68%] included the identification of the writer. Notes written by ICU physicians were significantly longer than those written by ward physicians (mean number of lines of text 23.5 vs. 15.3, p<0.001). Qualitative analysis of a purposive sample (n=30) of records revealed several differences between ICU and ward physicians' notes. ICU physician notes followed a standardized structure, and focused on multiple patient issues whereas ward physician notes were mainly focused on issues that pertained to their specialty. The initial notes written by the accepting ward physicians followed a structured format similar to that of the ICU physicians and largely informed the structure and content of subsequent notes. However, over the course of the patients' ward stay, notes became progressively shorter and less structured. CONCLUSIONS We identified differences in the structure and content of ICU and ward physician progress notes, whereby there are important differences in how information is recorded. A standardized progress note template may facilitate communication across care settings and physician specialities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) doctor patient relation female intensive care unit male EMTREE MEDICAL INDEX TERMS clinical trial cohort analysis confidence interval controlled clinical trial controlled study human major clinical study medical record multicenter study purposive sample qualitative analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617710326 DOI 10.1164/ajrccmconference.2017.D22 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccmconference.2017.D22 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 81 TITLE Ward capacity strain: Defining a new construct based on ed boarding time and icu transfers AUTHOR NAMES Kohn R. Bayes B. Ratcliffe S.J. Halpern S.D. Kerlin M.P. AUTHOR ADDRESSES (Kohn R., rachel.kohn2@uphs.upenn.edu; Bayes B.; Ratcliffe S.J.; Halpern S.D.; Kerlin M.P.) University of Pennsylvania, Philadelphia, United States. CORRESPONDENCE ADDRESS R. Kohn, University of Pennsylvania, Philadelphia, United States. Email: rachel.kohn2@uphs.upenn.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Most ICU survivors are initially discharged to general hospital wards. Capacity strain on these wards could impact ICU survivors' care and outcomes in the way that ICU capacity strain impacts ICU patients. Therefore, we sought to define ward capacity strain and understand its potential role in ICU patient flow. Methods: This cross-sectional analysis of three Penn Medicine hospitals included all patients admitted to general wards 2014-2015. Candidate ward strain variables included daily measurements of: admissions, discharges, transports, census, severity of illness, total transfusions, proportion of patients seen by respiratory therapy and on telemetry monitoring, and mean total, intravenous, oral, and inhaled medications per patient. We examined two processes of care hypothesized to be altered by strain: ED boarding time (hours) and patient transfers to the ICU. All analyses were performed at the level of calendar day. Generalized estimating equations (GEE) were used for all analyses to account for clustering by ward. First, we evaluated associations of each candidate strain variable with each process of care in pairwise combinations, and retained strain variables with p<0.2 for further evaluation. We next evaluated correlations between remaining candidate strain variables in pairwise combinations and retained one per pair with strong correlation (equivalent of r>0.7). Finally, we built two multivariable GEE models, one for each process, using the retained candidate strain variables as independent variables. Results: The final dataset included 730 days with 89,677 patient encounters on 25 wards. Univariate analyses of candidate ward strain variables with processes of care resulted in retention of admissions, discharges, transports, census, severity of illness, and mean total and intravenous medications per patient for further analysis. Census, severity of illness, and mean total and intravenous medications had strong correlations in pairwise comparisons, and census was retained. Multivariable GEE regression of each remaining candidate strain variable with each process of care demonstrated that increased numbers of ward admissions were associated with increases in ED boarding time, increased number of ward discharges were associated with a small decrease in transfers to the ICU, and increased numbers of transports and higher census were associated with small increases in ICU transfers (Table). Conclusions: The novel construct of ward capacity strain is defined by ward admissions, discharges, transports, and census. Different factors are associated with different process measures, and differences in ICU transfers are small. Future directions include assessing ward strain's impact on ICU patient flow and outcomes among survivors of critical illness (Table presented). EMTREE MEDICAL INDEX TERMS critical illness cross-sectional study exposure female hospital human independent variable intravenous drug administration major clinical study male medicine monitoring patient transport respiratory care statistical model survivor telemetry univariate analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617710339 DOI 10.1164/ajrccmconference.2017.D22 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccmconference.2017.D22 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 82 TITLE Improving transfers from the intensive care unit to hospital ward: A multicenter qualitative study of barriers and facilitators to quality transfers AUTHOR NAMES De Grood C. Parsons Leigh J. Bagshaw S.M. Dodek P.M. Forster A.J. Fowler R.A. Boyd J. Stelfox H.T. AUTHOR ADDRESSES (De Grood C.; Boyd J.; Stelfox H.T., tstelfox@ucalgary.ca) University of Calgary, Calgary, Canada. (Parsons Leigh J.) University of Calgary and Alberta Health Services, Calgary, Canada. (Bagshaw S.M.) University of Alberta, Edmonton, Canada. (Dodek P.M.) University of British Columbia, Vancouver, Canada. (Forster A.J.) University of Ottawa, Ottawa, Canada. (Fowler R.A.) University of Toronto, Toronto, Canada. CORRESPONDENCE ADDRESS H.T. Stelfox, University of Calgary, Calgary, Canada. Email: tstelfox@ucalgary.ca SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE The transfer of patients from the intensive care unit (ICU) to a hospital ward is one of the most challenging, high risk, and inefficient transitions of care because the patients are sick and complex, the level of care changes from high-intensity to lower-intensity, and many different professionals are involved. However, little is known about the perspectives of providers and patients regarding barriers and facilitators associated with these transfers. METHODS We conducted a mixed methods prospective multicenter observational cohort study of 451 patients transferred from an ICU to a hospital ward in 10 Canadian hospitals. From this study cohort we purposively recruited one ICU provider, one ward provider, one patient, and one patient family member from each of the 8 English-speaking study sites (n=32 participants). Semi-structured telephone interviews were conducted to capture individual experiences and identify perceived barriers and facilitators associated with high quality transfers. Two investigators conducted qualitative content analysis of the transcribed interviews to identify themes and subthemes, which were iteratively refined with axial coding. RESULTS ICU and ward providers (physicians, nurses) described three overarching themes for barriers and facilitators: Capacity Strain/Availability of Resources, Communication, and Culture. Subthemes from ICU providers included: Continuity of Communication, ICU Follow-Up, Bed Availability, and Attending to Attending Communication; subthemes from ward providers included Timing of Transfer, Collegiality between Providers, Human Resources, and Patient Information at Transfer. Patients and their family members described similar barriers and facilitators as providers: Availability of Resources, Patient-Provider Communication and Provider Culture. However, subthemes differed from those given by providers: Staff Availability, Family Engagement, Provider Follow-Up, Ward Orientation, and Communication Aids. Ten recommendations to improve ICU transfers were suggested by stakeholders. The top recommendation across all study sites and stakeholder groups was to implement Standardized Communication Tools that streamline provider-provider and provider-patient communication during ICU to ward transfers (e.g., script for verbal handover & template for written handover). Participants from most study sites recommended development of Procedures to Manage Delays in Patient Transfer (e.g., scheduled communication updates). CONCLUSIONS We identified common barriers and facilitators associated with perceived high quality ICU-to-ward transfers. Recommendations to improve transfers include implementation of standardized multi-modal communication tools and procedures to optimize communication when there are delays in patient transfer. These barriers, facilitators, and recommendations can inform development of standardized protocols to improve the transfer of patients from the ICU to the hospital ward. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) controlled study intensive care unit qualitative research EMTREE MEDICAL INDEX TERMS clinical trial cohort analysis communication aid content analysis controlled clinical trial DNA transcription doctor nurse relation doctor patient relation family study female follow up human instrument validation major clinical study male multicenter study patient information patient transport speech structured interview LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617710359 DOI 10.1164/ajrccmconference.2017.D22 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccmconference.2017.D22 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 83 TITLE Physician handoffs at ICU-ward transfer: Communication failures and patient consequences AUTHOR NAMES Lyons P.G. Farnan J.M. Arora V. AUTHOR ADDRESSES (Lyons P.G., plyons@wustl.edu) Washington University in St. Louis School of Medicine, St. Louis, United States. (Farnan J.M.; Arora V.) University of Chicago, Chicago, United States. CORRESPONDENCE ADDRESS P.G. Lyons, Washington University in St. Louis School of Medicine, St. Louis, United States. Email: plyons@wustl.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Patient transfers from the intensive care unit (ICU) to the wards may be high-risk due to patient complexity and decreased monitoring intensity. We recently showed that physician handoff communication failures - including omitted and incorrect information - were related to adverse patient events or near-misses around the time of transfer. We aimed to characterize the information subject to communication failure and evaluate the burden of handoff failures in terms of patient consequences and physician workload. Methods: Between August 2015 and April 2016, all PGY-2 and PGY-3 internal medicine residents at the University of Chicago were recruited to complete a 31-item anonymous, paper-based, self-administered survey regarding the quality of written handoff notes and resident perceptions of patient care-related consequences of communication failures during ICU-ward handoffs. Residents were asked to estimate the frequency of omitted or incorrect information within transfer notes, with response options including “never,” “< 5 times per year,” “about 2 times per month,” “at least once per week,” and “almost every handoff.” Residents were also asked to recall adverse patient events or near-misses, and to estimate time spent addressing patient care issues resulting from missing or incorrect information, and the frequency with which they received handoffs on patients who were ultimately not transferred to their team. Results: Of 73 residents approached, 60 (82%) completed the survey. Information most frequently transmitted incorrectly included oxygen requirements, current antibiotics, current mental status, and hardware (Figure 1). Additionally, over 60% of respondents reported that at least twice per month notes omitted active subspecialty consultants, goals of care, venous thromboembolism prophylaxis, and information regarding healthcare decision makers. More than 40% of respondents were aware of missed critical results, medication errors, discharge delays, and patients lost in the hospital without an assigned care team resulting from incorrect or missing information. Finally, over 90% of respondents reported spending 15 minutes or more per patient repeating already-completed patient care tasks due to errors or omissions in handoffs. Conclusions: To our knowledge, this is the first survey of resident perceptions of ICU-ward patient handoffs. Respondents reported frequent errors of commission and omission of important information in transfer notes, were aware of numerous adverse patient events or near-misses related to these communication failures, and spent substantial time working to recover lost or incorrect information to avoid additional adverse outcomes. More work is needed to determine whether interventions targeted at more effective handoff communications can improve patient outcomes. (Figure presented). EMTREE DRUG INDEX TERMS antibiotic agent oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical handover doctor patient relation female male EMTREE MEDICAL INDEX TERMS adverse outcome clinical article clinical trial computer consultation human Illinois intensive care unit internal medicine medication error mental health perception prophylaxis recall resident treatment failure university venous thromboembolism workload CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617710372 DOI 10.1164/ajrccmconference.2017.D22 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccmconference.2017.D22 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 84 TITLE The challenge of ICU to floor transitions: A standardized transfer note improves documentation and resident satisfaction AUTHOR NAMES Kim B. Barmaimon G. Yudelevich E. Bambrick-Santoyo G. Basu A. Shapiro J. AUTHOR ADDRESSES (Kim B.; Barmaimon G.; Yudelevich E.; Bambrick-Santoyo G.; Basu A.; Shapiro J.) Mount Sinai St. Luke's West, New York, United States. CORRESPONDENCE ADDRESS B. Kim, Mount Sinai St. Luke's West, New York, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2017) 195. Date of Publication: 2017 CONFERENCE NAME American Thoracic Society International Conference, ATS 2017 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2017-05-19 to 2017-05-24 ISSN 1535-4970 BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE: Transitions of care require thorough transfer of information between providers. Resident work hour limitations, misuse of the electronic medical record (EMR), and the complexity of Intensive Care Unit (ICU) patients increase the risk of inadequate exchange of critical information, which can lead to adverse patient outcomes. We created a standardized transfer note (STN) in the EMR to improve exchange of information during ICU to medical floor transfers. METHODS: Mount Sinai St. Luke's-West ICUs are staffed by medical residents (PGY1-3), supervised by a fellow and an attending. During Phase 1 of our project, a housestaff survey was conducted to examine the current handoff process. Phase 2 consisted of reviewing 50 pre-intervention medical records to assess the inclusion of essential ICU information. In Phase 3, we created a STN to include essential domains of ICU care. Educational training sessions were held and the STN was implemented. In Phase 4, 57 post-intervention medical records were reviewed and the housestaff were re-surveyed. Chart review and survey results pre- and post-intervention were compared. RESULTS: Utilization of the STN was 100% for all transfers. Pre-intervention review revealed widespread deficits in documentation of essential information. Post-intervention, documentation improved for the following domains (Figure 1): mechanical ventilation 64% pre vs 86% post, current method of oxygenation 62% vs 82%, procedures 60% vs 82%, current IV access 50% vs 81%, transfusions 44% vs 79%, home medications continued 54% vs 82%, home medications held 38% vs 82%, relevant cultures 50% vs 86%, tests pending 64% vs 86%, goals of care 54% vs 74%, emergency contact information 62% vs 91%. The common practice of copy-paste was resolved by the design of the STN. Only 35% of the housestaff felt the pre-intervention transfer note was useful vs 64% post intervention. Overall, 86.7% of the housestaff felt the STN either moderately or significantly improved the handoff process and 92.7% felt that the STN led to an improvement in patient care and patient safety. CONCLUSION: Implementation of a standardized ICU transfer note led to substantial improvement in documentation of critical information, decreased redundancy and copy/pasting, and increased resident satisfaction with the handoff process. We believe that introduction of a STN optimizes documentation, facilitates more thorough transitions of care and may ultimately lead to improved patient care and safety. Transitions of care are challenging and require continued improvement; standardized documentation of critical information is just the first step. (Figure Presnted). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical record review resident satisfaction EMTREE MEDICAL INDEX TERMS artificial ventilation controlled clinical trial controlled study emergency female human human experiment intensive care unit male oxygenation patient care patient safety phase 1 clinical trial phase 2 clinical trial phase 3 clinical trial phase 4 clinical trial LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617704228 DOI 10.1164/ajrccm-conference.2017.A25 FULL TEXT LINK http://dx.doi.org/10.1164/ajrccm-conference.2017.A25 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 85 TITLE Intrahospital transport of ICU patients: Clinician perceptions and proposed solutions AUTHOR NAMES Lencioni A. Timothy K. Schell-Chaple H. Gross K. Shimabukuro D. Lipshutz A. Barchas D. AUTHOR ADDRESSES (Lencioni A.; Timothy K.; Schell-Chaple H.; Gross K.; Shimabukuro D.; Lipshutz A.; Barchas D.) CORRESPONDENCE ADDRESS A. Lencioni, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (379). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Intrahospital transport (IHT) of ICU patients occurs frequently due to need for diagnostic and interventional procedures. Adverse outcomes (airway, hemodynamic, metabolic, etc.) are associated with IHT of ICU patients. The aim of this project was to examine ICU clinician perceptions regarding the safety of IHT and to identify systems improvements to optimize safety during transport. Methods: We administered a 13-question survey to registered nurses (RNs) and respiratory therapists (RTs) in a 32-bed medical-surgical ICU at an academic medical center. Clinicians were surveyed on their perceptions of IHT safety, barriers to IHT safety, and on select interventions that may improve IHT safety. Results: The survey was completed by 103 clinicians (93 RNs, 10 RTs). Over three-quarters of RNs (77%) and half of RTs (50%) perceive overall IHT conditions as safe. Patient factors (e.g. instability) were reported as the most common safety concern by both RNs (78%) and RTs (80%). Lack of access to supplies, equipment and medications was the second most common safety concern among RNs (53%), while time constraints (50%) and lack of planning (50%) were the second most common safety concerns among RTs. Both RNs and RTs reported unfamiliarity with destination areas (54% RNs, 40% RTs) and staffing concerns (58% RNs, 80% RTs) as the most common challenges experienced during IHT. Over half of RNs (55%) did not feel confident they would receive adequate assistance if the patient's condition deteriorated. Respondents identified new interventions to optimize safety during IHT. The development of references with pertinent information about destination areas and a transport order set were commonly selected. Conclusions: Clinicians perceive overall IHT conditions as safe, but identified several factors that impede safety and emergency response. The design and implementation of standardized practice guidelines to minimize adverse events during IHT was recommended. Additional research is needed to further evaluate the safety barriers during IHT and identify system interventions to prevent harm during IHT of ICU patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) perception EMTREE MEDICAL INDEX TERMS consensus development emergency human human experiment intensive care unit prevention registered nurse respiratory therapist safety LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613520997 DOI 10.1097/01.ccm.0000509889.18395.64 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000509889.18395.64 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 86 TITLE Transport teams' documentation of interfacility transferred patients with aortic dissections AUTHOR NAMES Duncan R. Boualam B. Newton C. Rose M. Borja M. Bogne N. Robinson W. Tran Q. AUTHOR ADDRESSES (Duncan R.; Boualam B.; Newton C.; Rose M.; Borja M.; Bogne N.; Robinson W.; Tran Q.) CORRESPONDENCE ADDRESS R. Duncan, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (167). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Critically ill patients are often transferred between facilities for higher level of care, and documentations during transport ensure good patients' hands-off communication and care. The 2010 American Heart Association guideline for aortic dissection (AoD) recommends fast reduction of systolic blood pressure, heart rate (HR) and pain levels. Therefore, close monitoring of these patients during transport is important to provide appropriate treatment en route and upon arrival at accepting intensive care units (ICUs). There is no previous study about transportation teams' documentations (TTD) in this patient population. We hypothesized that 40% of transport team will not have documentation of vital signs or pain score upon arriving at referring facility (Arriving vital signs), at leaving (Departure vital signs) and en route (en route vital signs) to accepting ICUs. Methods: We performed a retrospective study of interfacility transferred patients for AoD, identified by ICD-9 billing codes of 441. XX, to a tertiary academic center between 01/01/2011 and 10/31/2013. Patients were excluded if a) not accompanied with transport teams' documents; b) intra-facility transfer. Results: Charts from 268 patients with AoD were reviewed. Eighty (80) intra-facility transferred patients were excluded. One-hundred-eighty (180) interfacility transferred patients' charts were analyzed, 100 charts (56%) were not accompanied with TTD. Among the remaining 80 patients, 55% did not have documentation of SBP, HR, 65% without pain score at arriving at referring facilities. At departure, 34% of TTD did not document SBP & HR, while 48% did not document pain score. Fifteen charts (19%) did not have documentation of re-evaluation during transportation. Conclusions: Transport teams' documentations are poor. Absence of documentations suggested no monitoring was provided in this group of critically ill patients during transport. Transport teams should be more thorough in documenting vital signs and pain levels of patients with AoD, not only to avoid medicolegal issues but also to provide high quality patient care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aortic dissection documentation EMTREE MEDICAL INDEX TERMS critically ill patient heart rate human ICD-9 intensive care unit major clinical study monitoring pain patient care retrospective study systolic blood pressure vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613521839 DOI 10.1097/01.ccm.0000509040.64685.b8 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000509040.64685.b8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 87 TITLE ICU, ED, OR, MED doctors' perceptions of teamwork and patient transfers: Evidence from HSOPS AUTHOR NAMES Lee S.-H. Dorman T. Pronovost P. Phan P. AUTHOR ADDRESSES (Lee S.-H.; Dorman T.; Pronovost P.; Phan P.) CORRESPONDENCE ADDRESS S.-H. Lee, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (347). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: ICU doctors transfer patients with ED, OR, and Medicine units. We sought to understand better the perceived differences between ICU, ED, Medicine, and OR doctors in communication, learning, and supervisory support practices may improve interunit patient transfers. Methods: Design was a cross-sectional study utilizing data from the 2010 AHRQ Hospital Survey on Patient Safety Culture (HSOPS) for Individuals. Responses from doctors in ICU (n=333), ED (n=719), Medicine (n=1130), and OR (n=904) at 885 U.S. hospitals were analyzed using t-tests and hierarchical regressions. Outcome measures included respondents' perceptions of the degree of interunit teamwork and quality of interunit transfers. Predictor variables consisted of 5-point Likert scale composites. Results: Compared to ICU, ED, Medicine and OR doctors have lower perceived teamwork quality (ICU=4.3; ED=4.02; Med=4.01; OR=3.92; p<.001), communications about error (ICU=3.65; ED=3.56; Med=3.52; OR=3.47; p<.05), learning (ICU=3.89; ED=3.66; Med=3.73; OR=3.68; p<.001), and supervisory support practices (ICU=3.9; ED=3.76; Med=3.74; OR=3.7; p<.05) but higher perceived quality of interunit transfers (ICU=2.82; ED=3.01; Med=2.99; OR=2.96; p<.05). Regressions show that the quality of interunit teamwork depends on management support for patient safety (ICU=.32; ED=.4; Med=.29; OR=.37; p<.01), staffing adequacy (ICU=.17; ED=.14; Med=.09; OR=.1; p<.01), and intra-unit teamwork quality (ICU=.11; ED=.12; Med=.13; OR=.17; p<.01). Quality of interunit transfer depends on interunit teamwork quality (ICU=.54; ED=.54; Med=.56; OR=.7; p<.01), which explains about 50% of interunit transfer quality (ICU=48%; ED=54%; Med=51%; OR=58%; p<.01). Conclusions: Interunit transfers can be improved with better interunit teamwork from support of management, staffing adequacy, and teamwork culture as well as better understanding and accommodation of the practices and constraints faced by other units. Interunit differences in perceived teamwork and transfer quality may limit quality improvement efforts. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport perception teamwork EMTREE MEDICAL INDEX TERMS clinical trial controlled clinical trial controlled study cross-sectional study doctor patient relation human learning Likert scale major clinical study medicine multicenter study patient safety predictor variable Student t test total quality management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613522976 DOI 10.1097/01.ccm.0000509761.70669.66 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000509761.70669.66 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 88 TITLE Seizure treatment in children transported to tertiary care: Recommendation adherence and outcomes AUTHOR NAMES Siefkes H.M. Holsti M. Morita D. Cook L.J. Bratton S. AUTHOR ADDRESSES (Siefkes H.M., hsiefkes@ucdavis.edu; Cook L.J.; Bratton S.) Divisions of Critical Care Medicine, University of Utah, Salt Lake City, United States. (Siefkes H.M., hsiefkes@ucdavis.edu) Division of Critical Care Medicine, Department of Pediatrics, University of California Davis, 2516 Stockton Blvd., Sacramento, United States. (Holsti M.) Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, United States. (Morita D.) Pediatric Neurology, Granger Medical Clinic, Riverton, United States. CORRESPONDENCE ADDRESS H.M. Siefkes, Division of Critical Care Medicine, Department of Pediatrics, University of California Davis, 2516 Stockton Blvd., Sacramento, United States. Email: hsiefkes@ucdavis.edu SOURCE Pediatrics (2016) 138:6 Article Number: e20161527. Date of Publication: 1 Dec 2016 ISSN 1098-4275 (electronic) 0031-4005 BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT BACKGROUND AND OBJECTIVES: Convulsive seizures account for 15% of pediatric air transports. We evaluated seizure treatment received in community hospital emergency departments among transported patients for adherence to recommended management. METHODS: This study was a retrospective cohort study of children transported for an acute seizure to a tertiary pediatric hospital from 2010 to 2013. Seizure treatment was evaluated for adherence to recommended management. The primary outcome was intubation. RESULTS: Among 126 events, 61% did not receive recommended acute treatment. The most common deviation from recommended care was administration of >2 benzodiazepine doses. Lack of adherence to recommended care was associated with a greater than twofold increased risk of intubation (relative risk 2.4; 95% confidence interval, 1.4-4.13) and 1.5-fold increased risk of admission to the ICU (relative risk 1.65; 95% confidence interval, 1.24-2.16). Duration of ventilation was commonly <24 hours (87%) for patients who did or did not receive recommended acute seizure care. Among events treated initially with a benzodiazepine, only 32% received a recommended weight-based dosage, and underdosing was most common. CONCLUSIONS: Adherence to evidence-based recommended acute seizure treatment during initial care of pediatric patients using medical air transportation was poor. Intubation was more common when patients did not receive recommended acute seizure care. Educational efforts with a sustained quality focus should be directed to increase adherence to appropriate pediatric seizure treatment of children in community emergency departments. EMTREE DRUG INDEX TERMS anticonvulsive agent (drug therapy) diazepam (drug dose, drug therapy, intravenous drug administration, rectal drug administration) fosphenytoin sodium (drug therapy) levetiracetam (drug therapy) lorazepam (drug dose, drug therapy, intramuscular drug administration, intravenous drug administration) midazolam (drug dose, drug therapy, intramuscular drug administration, intravenous drug administration) phenobarbital (drug therapy) phenytoin (drug therapy) valproic acid (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport protocol compliance seizure (drug therapy, drug therapy) tertiary care center EMTREE MEDICAL INDEX TERMS adolescent adult article body weight child cohort analysis emergency care evidence based medicine female health care hospital admission human infant intensive care unit intubation lung ventilation major clinical study male newborn outcome assessment pediatric hospital preschool child priority journal recommended drug dose retrospective study school child treatment duration Utah CAS REGISTRY NUMBERS diazepam (439-14-5) fosphenytoin sodium (92134-98-0) levetiracetam (102767-28-2) lorazepam (846-49-1) midazolam (59467-70-8) phenobarbital (50-06-6, 57-30-7, 8028-68-0) phenytoin (57-41-0, 630-93-3) valproic acid (1069-66-5, 99-66-1) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Epilepsy Abstracts (50) Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170023412 MEDLINE PMID 27940691 (http://www.ncbi.nlm.nih.gov/pubmed/27940691) PUI L613996971 DOI 10.1542/peds.2016-1527 FULL TEXT LINK http://dx.doi.org/10.1542/peds.2016-1527 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 89 TITLE Hemodynamic management of patients with aortic dissection in emergency departments prior to transfer AUTHOR NAMES Walker A. Henry A. Yi J. Tracy T. Qureshi M. Tucker L. Bonhag C. Tran Q. AUTHOR ADDRESSES (Walker A.; Henry A.; Yi J.; Tracy T.; Qureshi M.; Tucker L.; Bonhag C.; Tran Q.) CORRESPONDENCE ADDRESS A. Walker, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (153). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Acute Aortic Dissections (AoD) is a hypertensive emergency and associated with high morbidity and mortality. The 2010 American Heart Association (AHA) guidelines recommend reduction of systolic blood pressure (SBP) to <120mmHg, heart rate (HR) to <60 beats per minute, and pain control. Beta-blockers are the first line treatment for SBP and HR. From a previous study of 62 interfacility transferred patients, we hypothesized that up to 60% of non-hypotensive, non-bradycardic interfacility transferred patients will have SBP >121, HR > 61 at time of transfer. Fifty percent (50%) of the patients will have pain score ≥ 5/10. Methods: We performed a retrospective study of patients with diagnosis of aortic dissection, identified by ICD-9 codes of 441. XX, and transferred from referring EDs to a tertiary academic center between 01/01/2014 and 09/30/2015. Patients were excluded if a) not transferred from an ED; b) SBP≤89; c) HR≤59, d) no ED records available. Patient's vital signs and pain scores at time of presenting to EDs and at leaving EDs (Transfer Time) were compared. Results: Two-hundred-forty-eight (248) patients' charts were reviewed. One-hundred-forty-one (141) patients met one of the exclusion criteria and were excluded. One-hundred-seven (107) patients, who were admitted from 30 different EDs, were included in the analysis. Median [interquartile] of SBP, HR, pain score at triage were 150 [127-183], 79 [69-93], 7 [4-10] and at time of transfer were 134 [119-162], 79 [66-85], 3 [0-6], respectively. At time of transfer, 65% of patients had SBP≥121, 79% with HR≥61, 22% had pain score≥5. Fifty-four patients (51%) DID NOT receive any beta-blocker during their ED stays. Conclusions: Pain among patients with non-hypotensive, nonbradycardic Aortic Dissections were well controlled by Emergency Physicians. However, patients' SBP and HR were still not managed effectively according to AHA guidelines. Intensivists at accepting Intensive Care Units should be aware and actively involved in patients' hemodynamic management early and prior to transfer to improve patient care. EMTREE DRUG INDEX TERMS beta adrenergic receptor blocking agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aortic dissection emergency ward systolic blood pressure EMTREE MEDICAL INDEX TERMS blood pressure monitoring diagnosis emergency health service emergency physician heart rate human ICD-9 information processing intensive care unit intensivist major clinical study medical society pain practice guideline retrospective study vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613521107 DOI 10.1097/01.ccm.0000508986.30208.73 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000508986.30208.73 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 90 TITLE Unplanned device dislodgement: A quality metric in critical care transport AUTHOR NAMES Bigham M. Schwartz H. AUTHOR ADDRESSES (Bigham M.; Schwartz H.) CORRESPONDENCE ADDRESS M. Bigham, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (371). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Emergency Medical Services for Children emphasizes the value of “procedures and processes to prepare a child for safe interfacility transfer (securing airways, critical vascular access, etc.).” However, best practice measures to prevent unplanned therapeutic device dislodgement during interfacility transport do not exist. By comparing quality performance metrics among diverse institutional neonatal/pediatric/adult transport teams, programs excelling at specific measures will emerge, together with the detailed practices producing superior performance. Methods: Data are contained in the Ground and Air Medical qUality Transport (GAMUT) database. Unplanned device dislodgement (UDD) is defined as follows: NUMERATOR = The number of documented UDDs (may be more than 1 per transport) while under the care of the transport team of the following devices (IOs, IVs, UACs/UVCs, central venous lines, arterial lines, advanced airway, chest tubes, and tracheostomy tubes). This does not include IVs that infiltrate without obvious dislodgement. DENOMINATOR = Number of transport patient contacts during the calendar month. GAMUT data are reported using the REDCap database and quality metrics data from January 2014 - November 2015 were analyzed. Analyses included simple statistics and satisfaction of normality assumptions when determining confidence intervals for high and low-performing centers. Results: 89 transport programs supplied GAMUT data for > 6 consecutive months during the study period, and 49 programs submitted data specific to UDD. 68,322 patient contacts were noted, with only 19 programs (38.8%) providing a minimum 1,352 patient contacts (to satisfy normality). There were 250 (0.37%) UDD, with 10 insutitions performing better (<0.1% UDD) vs. 3 worse performing centers with 0.9% UDD. Conclusions: GAMUT QIC allows identification of better performing centers with lower UDD, using a large international database. Best practices from the high-performers can be learned and replicated to improve quality in CCT. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS airway arterial line central venous catheter chest tube confidence interval data base human major clinical study satisfaction statistics tracheostomy tube LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613522015 DOI 10.1097/01.ccm.0000509855.77817.a8 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000509855.77817.a8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 91 TITLE Characteristics of neonatal transports in California AUTHOR NAMES Akula V.P. Gould J.B. Kan P. Bollman L. Profit J. Lee H.C. AUTHOR ADDRESSES (Akula V.P., akulavishnupriya@gmail.com; Gould J.B.; Profit J.; Lee H.C.) Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Salter Packard Childreńs Hospital, 750 Welch Road, Suite 315, Palo Alto, United States. (Gould J.B.; Bollman L.) California Perinatal Transport System, Palo Alto, United States. (Gould J.B.; Kan P.; Bollman L.; Profit J.; Lee H.C.) California Perinatal Quality Care Collaborative, Palo Alto, United States. CORRESPONDENCE ADDRESS V.P. Akula, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Salter Packard Childreńs Hospital, 750 Welch Road, Suite 315, Palo Alto, United States. Email: akulavishnupriya@gmail.com SOURCE Journal of Perinatology (2016) 36:12 (1122-1127). Date of Publication: 1 Dec 2016 ISSN 1476-5543 (electronic) 0743-8346 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Objective:To describe the current scope of neonatal inter-facility transports.Study design:California databases were used to characterize infants transported in the first week after birth from 2009 to 2012.Results:Transport of the 22 550 neonates was classified as emergent 9383 (41.6%), urgent 8844 (39.2%), scheduled 2082 (9.2%) and other 85 (0.4%). In addition, 2152 (9.5%) were initiated for delivery attendance. Most transports originated from hospitals without a neonatal intensive care unit (68%), with the majority transferred to regional centers (66%). Compared with those born and cared for at the birth hospital, the odds of being transported were higher if the patient's mother was Hispanic, <20 years old, or had a previous C-section. An Apgar score <3 at 10 min of age, cardiac compressions in the delivery room, or major birth defect were also risk factors for neonatal transport.Conclusion:As many neonates receive transport within the first week after birth, there may be opportunities for quality improvement activities in this area. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neonatal transport patient transport EMTREE MEDICAL INDEX TERMS Apgar score article California congenital malformation (congenital disorder) delivery room female Hispanic hospital human male neonatal intensive care unit newborn prenatal care risk factor EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160706526 MEDLINE PMID 27684413 (http://www.ncbi.nlm.nih.gov/pubmed/27684413) PUI L612477304 DOI 10.1038/jp.2016.102 FULL TEXT LINK http://dx.doi.org/10.1038/jp.2016.102 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 92 TITLE Improving inpatient NICU staff utilization with an integrated consortium transport system AUTHOR NAMES Frakes M. Roumiantsev S. Farkas A. Gorman T. Prendergast M. Cohen J. AUTHOR ADDRESSES (Frakes M.; Roumiantsev S.; Farkas A.; Gorman T.; Prendergast M.; Cohen J.) CORRESPONDENCE ADDRESS M. Frakes, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (106). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Multiple national and international organizations have advanced recommendations for safe and efficient interfacility transport of neonatal patients. Three tertiary care newborn intensive care units serving different populations and partner facilities developed a partnership with an existing fully integrated, multi-modal critical care transport team within the bounds of these recommendations. Each center previously had separate out-of-hospital transport models, using a mix of their own NICU staff and various emergency medical services providers. We hypothesized utilization of existing transport resources would allow NICU staff to re-allocate nursing staff time to inpatient care. Methods: The three facilities were already served by an internationally-accredited, fullyintegrated, multi-modal nurse/paramedic critical care transport team with neonatal transport experience. Stakeholder meetings identified basic needs and key performance indicators for all parties, and multi-party analyses identified gaps and opportunities for improvement. The parties established logistical, educational, clinical, operational, and performance improvement structures to enable that team to become the primary provider for the participating tertiary NICUs. Records from the transport team communication center were queried for volume, completion, and time data. Results: In the first year, the team completed 85% of outbound transports from the three facilities that previously would have been completed using inpatient staff. The average time dedicated to the outbound transport (arrival-at-sending facility to arrival-at-receiving facility) was 82 minutes. The transport team does not return to the sending facility; we are satisfied that the measured first-half time is a reasonable estimate for the time spent on the return leg. With that, we identify 298 hours per institution that inpatient nurses were able to re-allocate from retro transports over the course of the year. Conclusions: Creation and utilization of a distinct transport system provides time benefit to inpatient staff resources. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient nursing staff EMTREE MEDICAL INDEX TERMS basic needs case report human information processing intensive care leg newborn LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613522448 DOI 10.1097/01.ccm.0000508797.42158.c0 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000508797.42158.c0 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 93 TITLE Effect of early ICU transfer in pediatric oncology patients with hypotension AUTHOR NAMES Wenger J. Villavicencio E. Watson R. Geyer R. Zimmerman J. Kroon L. Roberts J. AUTHOR ADDRESSES (Wenger J.; Villavicencio E.; Watson R.; Geyer R.; Zimmerman J.; Kroon L.; Roberts J.) CORRESPONDENCE ADDRESS J. Wenger, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (152). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Pediatric oncology patients frequently require fluid resuscitation for hypotension, which can be a sign of impending clinical deterioration. Our institution implemented a policy change to optimize outcomes for oncology patients by transferring these patients to the PICU earlier in the course of hemodynamic instability. After the policy change, all oncology patients with persistent signs of hemodynamic instability after 40 ml/kg of fluid required a rapid response team (RRT) activation. We hypothesized that RRT activation and early ICU transfer (EIT) would result in a decrease in time to normotension and/or amount of fluid resuscitation required. Methods: We compared oncology patients transferred to the PICU for hemodynamic instability before and after implementation of a policy change. Patients admitted to the bone marrow transplant service were excluded. The control (pre-EIT) population included oncology patients transferred to the PICU between March 2012-June 2014 (n=18). The EIT population included oncology patients transferred to the PICU after implementation of the policy, from July 2014-July 2015 (n=26). Time to normotension was defined as the time from mean arterial blood pressure (MAP) less than the 5th percentile for age to attainment of two consecutive blood pressures 15 minutes apart above the 5th percentile for age. Amount of fluid resuscitation was defined as the amount of fluid boluses from 24 hours prior to RRT activation until normotension was achieved. Results: There was a significantly decreased time to normotension after the policy change (pre-EIT=6.3 ± 4.5 hours, post- EIT=3.0 ± 2.2 hours; Wilcoxon Rank Sum Test p=0.006). There was no difference in the amount of fluid resuscitation needed to achieve normotension after the policy change (pre-EIT=59.3 ± 21.2 ml/kg, post-EIT=56.9 ± 24.9ml/kg; student T-test p=0.43). Conclusions: After implementation of a policy to more quickly identify oncology patients with persistent hemodynamic instability, there was a significantly decreased time to normotension, without a change in amount of fluid resuscitation. EMTREE DRUG INDEX TERMS endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood cancer hypotension EMTREE MEDICAL INDEX TERMS bone marrow transplantation cancer epidemiology clinical article controlled study fluid resuscitation human mean arterial pressure mental capacity rank sum test rapid response team Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613520798 DOI 10.1097/01.ccm.0000508982.43669.e9 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000508982.43669.e9 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 94 TITLE Tracheal intubation in critical care transport: Global consensus quality metric performance AUTHOR NAMES Bigham M. Schwartz H. Gothard M. Gothard M. Parrish P. AUTHOR ADDRESSES (Bigham M.; Schwartz H.; Gothard M.; Gothard M.; Parrish P.) CORRESPONDENCE ADDRESS M. Bigham, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (310). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Tracheal intubation (TI) is a life-saving critical care skill and failed TI attempts can harm patients. Critical care transport (CCT) teams function as the 1st point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical or trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI. We sought to describe TI amongst GAMUT participants. Methods: GAMUT database is a global, voluntary database for tracking consensus quality metric performance amongst CCT programs performing neonatal(neo), pediatric(ped), and adult(adlt) transports. The TI-specific quality metrics are 1st attempt TI success and definitive airway sans hypoxia/hypotension on 1st attempt (DASH1A). The 2015 GAMUT database was queried and analysis included patient age, program type, and intubation success. Analysis included simple statistics and Pearson chi-square with Bonferroni adjusted post-hoc z tests (significance=p<0.05). Results: 85,704 patient contacts were included [neo n(%)=12,664(14.8%), ped n(%)=28,992(33.8%), adlt n(%)=44,048(51.4%)] with 4,036(4.7%) TI attempts. 1st attempt TI success was lowest in neos [59.3%, 617 attempts], better in peds [81.7%, 519 attempts], and best in adlts [87%, 2900 attempts], p<0.001. Adult-focused CCT teams had higher overall 1st attempt TI success vs. non-adult teams (86.9% vs 63.5%, p<0.001) and higher ped 1st attempt TI success (86.5% vs. 75.3%, p<0.001). DASH1A rates were lower across all patient types [neo rate in %=51.9%, ped=74.3%, adlt=79.8%]. Stratification of performers (z±1.645) identified a single high-performing and 2 lowperforming CCT teams using weighted average for expected TI success vs. observed TI success based on patient population. Conclusions: TI is common in CCT, with higher rates of TI and DASH1A success in adult patients and adult-focused CCT teams. Identifying factors influencing TI success amongst high performers should influence best practice strategies for CCT TI. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consensus endotracheal intubation intensive care EMTREE MEDICAL INDEX TERMS adult airway child controlled study data base human hypotension hypoxia major clinical study newborn statistics stratification LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613522603 DOI 10.1097/01.ccm.0000509611.83430.d5 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000509611.83430.d5 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 95 TITLE The effectiveness of a pediatric expedited transfer team for critically ill children AUTHOR NAMES Bernier M. Vanderwagen S. Laura A. Foronda C. Jeffers J. AUTHOR ADDRESSES (Bernier M.; Vanderwagen S.; Laura A.; Foronda C.; Jeffers J.) CORRESPONDENCE ADDRESS M. Bernier, SOURCE Critical Care Medicine (2016) 44:12 Supplement 1 (344). Date of Publication: 1 Dec 2016 CONFERENCE NAME 46th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2016 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2017-01-21 to 2017-01-25 ISSN 1530-0293 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Handover of critically ill children is high-risk for harm with delayed hand off impacting time to definitive treatment. Our aim was to examine if a quality improvement initiative, the Pediatric Expedited Transfer (PET) team, decreased Pediatric Emergency Department (PED) length of stay (LOS) and time to Pediatric Intensive Care Unit (PICU) admission. Methods: We identified seven criteria activating the PET team: out-of-hospital arrest with return of spontaneous circulation, status epilepticus, complex cardiac history with unstable vital signs, intubation or new assisted ventilation, new Glasgow Coma Scale of <10, shock physiology requiring vasopressors, and high risk for acute decompensation per attending physician. PET team activation lead to a standardized tool driven bedside hand off within 10 minutes (min) between PED and PICU nurses and physicians. We implemented the PET team in 9/2015 and performed a retrospective pre/post intervention analysis on the first 6 months of pilot patients to determine if PED LOS and time to PICU admission were decreased. PET patients were matched to pre-intervention patients from 9/2014-2/2015 by admitting diagnosis, age, sex, and season. Results: Of 370 PED to PICU admissions during the pilot period, 45 activated the PET team. Compared with 90 matched pre intervention patients, PET patients had decreased PED LOS (257.9 min vs. 147.4 min, p<0.001) and decreased time to PICU arrival (99.7 min vs. 66.9 min, p=0.006). PET patients required more PICU respiratory and cardiovascular interventions (51.1% and 33.3%, respectively, and 17.8% of patients required both) in the first 24 hours compared with matched pre patients (41.1% respiratory, 26.7% cardiac, 12.2% both). Mortality was similar in both groups (3.4% pre and 4.4% post) as was PICU LOS (4.4 days pre and 5.9 post, p=0.21). Conclusions: Implementation of the PET team, including use of established patient criteria, an interdisciplinary standardized tool, and bedside handover, decreased PED LOS and accelerated PICU admission, suggesting earlier receipt of definitive care for critically ill children. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient EMTREE MEDICAL INDEX TERMS assisted ventilation child controlled study diagnosis doctor nurse relation emergency ward epileptic state Glasgow coma scale heart human instrument validation intubation length of stay major clinical study mortality pediatric intensive care unit physiology return of spontaneous circulation season total quality management vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613522165 DOI 10.1097/01.ccm.0000509749.30766.78 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000509749.30766.78 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 96 TITLE Prehospital Transport for Pediatric Trauma: A Comparison of Private Transport and Emergency Medical Services AUTHOR NAMES Lin Y.-C. Lee Y.T. Feng J.X.Y. Chiang L.W. Nah S.A. AUTHOR ADDRESSES (Lin Y.-C.) From the Department of Paediatric Surgery, KK Womenʼs and Childrenʼs Hospital, Singapore. (Lee Y.T.; Feng J.X.Y.; Chiang L.W.; Nah S.A.) CORRESPONDENCE ADDRESS Y.-C. Lin, From the Department of Paediatric Surgery, KK Womenʼs and Childrenʼs Hospital, Singapore. SOURCE Pediatric Emergency Care (2016). Date of Publication: 29 Nov 2016 ISSN 1535-1815 (electronic) 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT OBJECTIVES: We describe the demographics of pediatric patients with trauma transferred using private transport (PT) versus emergency medical services (EMS) and evaluate the potential impact on their treatment and outcome. METHODS: We accessed data from our national trauma registry, a prospectively collected database. Data were extracted on all patients with trauma admitted to our institution between January 2011 and June 2013, with injury severity score (ISS) higher than 8. We categorized unstable injuries as head injuries, spinal injuries, or proximal long bone fractures. Major trauma was defined as the presence of any of the following: ISS of 16 or higher, intensive care unit (ICU) admission or death. RESULTS: Ninety children were studied, including 27 major trauma and 66 unstable injuries; 69 patients (77%) used PT. Most patients with major trauma (17/27, 63%) and unstable injuries (50/66, 76%) used PT. Compared with EMS patients, PT patients were younger, smaller, took longer for emergency department physician review and stayed longer in the emergency department. Rates of ICU admission were similar in both groups, but length of stay in ICU and total hospital stay were shorter in the PT group despite similar proportions of major trauma and unstable injuries as well as median ISS. Each group had 1 mortality. CONCLUSIONS: Most children with major trauma and unstable injuries were brought by PT, risking deterioration en route. Nevertheless, this does not seem to translate to worse outcomes overall. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood injury emergency health service EMTREE MEDICAL INDEX TERMS child controlled study data base death deterioration emergency ward fracture head injury hospitalization human injury scale intensive care unit length of stay long bone major clinical study mortality physician register spine injury LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160884931 PUI L613534560 DOI 10.1097/PEC.0000000000000979 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0000000000000979 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 97 TITLE Benchmarking Pain Assessment Rate in Critical Care Transport AUTHOR NAMES Reichert R.J. Gothard M.D. Schwartz H.P. Bigham M.T. AUTHOR ADDRESSES (Reichert R.J.) Pediatric Resident, Akron Children's Hospital, Akron, United States. (Gothard M.D.) Statitician, BIOSTATS, Inc, East Canton, United States. (Schwartz H.P.) Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States. (Bigham M.T., mbigham@chmca.org) Akron Children's Hospital, Akron, United States. CORRESPONDENCE ADDRESS M.T. Bigham, Akron Children's Hospital, Akron, United States. Email: mbigham@chmca.org SOURCE Air Medical Journal (2016) 35:6 (344-347). Date of Publication: 1 Nov 2016 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT The purpose of this study is to determine the rate of pain assessment in pediatric neonatal critical care transport (PNCCT). The GAMUT database was interrogated for an 18-month period and excluded programs with less than 10% pediatric or neonatal patient contacts and less than 3 months of any metric data reporting during the study period. We hypothesized pain assessment during PNCCT is superior to prehospital pain assessment rates, although inferior to in-hospital rates. Sixty-two programs representing 104,445 patient contacts were analyzed. A total of 21,693 (20.8%) patients were reported to have a documented pain assessment. Subanalysis identified 17 of the 62 programs consistently reporting pain assessments. This group accounted for 24,599 patients and included 7,273 (29.6%) neonatal, 12,655 (51.5%) pediatric, and 4,664 (19.0%) adult patients. Among these programs, the benchmark rate of pain assessment was 90.0%. Our analysis shows a rate below emergency medical services and consistent with published hospital rates of pain assessment. Poor rates of tracking of this metric among participating programs was noted, suggesting an opportunity to investigate the barriers to documentation and reporting of pain assessments in PNCCT and a potential quality improvement initiative. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) benchmarking intensive care pain assessment patient transport EMTREE MEDICAL INDEX TERMS article controlled study data base emergency health service hospital human major clinical study priority journal total quality management EMBASE CLASSIFICATIONS Anesthesiology (24) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160872896 MEDLINE PMID 27894556 (http://www.ncbi.nlm.nih.gov/pubmed/27894556) PUI L613466625 DOI 10.1016/j.amj.2016.07.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2016.07.001 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 98 TITLE The relocation and road transfer of intensive care patients to a new hospital in Bristol: Our experiences AUTHOR NAMES Gough C. Grier S. AUTHOR ADDRESSES (Gough C.; Grier S.) Southmead Hospital, United Kingdom. CORRESPONDENCE ADDRESS C. Gough, Southmead Hospital, United Kingdom. SOURCE Journal of the Intensive Care Society (2016) 17:4 Supplement 1 (147). Date of Publication: 1 Nov 2016 CONFERENCE NAME Intensive Care Society State-of-the-Art Meeting, ICSSOA 2016 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2016-12-05 to 2016-12-07 ISSN 1751-1437 BOOK PUBLISHER SAGE Publications Inc. ABSTRACT In May 2014, North Bristol NHS Trust merged its two existing hospitals - Southmead and Frenchay - into a new, purpose-built building. The project involved the movement of 540 patients, many over a distance of several miles. It was one of the largest single patient transfer operations ever conducted in the United Kingdom. We describe the planning processes and transfer of 24 level two and three patients from two intensive care units into the new hospital. These transfers were performed successfully, without significant incident and under intense scrutiny from the Trust, patients and the media. In this, we also reflect upon our experiences of this process, which may be of benefit to those encountering a similar move in the future. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female intensive care unit male EMTREE MEDICAL INDEX TERMS doctor patient relation human major clinical study trust LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617401221 DOI 10.1177/1751143717708966 FULL TEXT LINK http://dx.doi.org/10.1177/1751143717708966 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 99 TITLE Characteristics and outcomes of critically ill children following emergency transport by a specialist paediatric transport team AUTHOR NAMES Hamrin T.H. Berner J. Eksborg S. Radell P.J. Fläring U. AUTHOR ADDRESSES (Hamrin T.H., tova.hannegard-hamrin@karolinska.se; Berner J.; Radell P.J.; Fläring U.) Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital Solna, Stockholm, Sweden. (Eksborg S.) Childhood Cancer Research Unit Q6:05, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital Solna, Stockholm, Sweden. CORRESPONDENCE ADDRESS T.H. Hamrin, Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital Solna, Stockholm, Sweden. Email: tova.hannegard-hamrin@karolinska.se SOURCE Acta Paediatrica, International Journal of Paediatrics (2016) 105:11 (1329-1334). Date of Publication: 1 Nov 2016 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com ABSTRACT Aim: We compared acute patients admitted to a single paediatric intensive care unit (PICU) following an emergency transfer by a specialist paediatric transport team and by other routes. Methods: This was a retrospective descriptive register-based study of consecutive admissions to a tertiary PICU in Sweden from 1 January 2008 to 31 December 2013. We compared the general characteristics of the cohorts, together with predicted death rates (PDR), PICU mortality, 30-day mortality, PICU length of stay (PICU LOS) and resource use. Results: Of the 3665 nonelective admissions, 221 patients received emergency transport from referring hospitals to the PICU by the specialist paediatric transport team. Their median age was lower (146 versus 482 days), PDR was higher (5.58% versus 1.39%), PICU LOS was longer (4.24 days versus 1.06 days), and they received more PICU-specific therapies. The standardised mortality ratio did not differ between the cohorts, and the PICU mortality was lower than predicted in both groups. The transport distance and mode of transport did not influence survival. Conclusion: Children admitted to the PICU following emergency transfers by the specialist paediatric transport team were younger, sicker, received more PICU-specific therapies and had longer PICU LOS than other acutely admitted critically ill patients. This indicates that these transfers were appropriate. EMTREE DRUG INDEX TERMS nitric oxide vasoactive agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical outcome critically ill patient emergency health service emergency transport patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation child extracorporeal oxygenation female hospital admission human infant length of stay major clinical study male medical specialist mortality rate pediatric intensive care unit priority journal renal replacement therapy retrospective study survival Sweden tertiary care center CAS REGISTRY NUMBERS nitric oxide (10102-43-9) EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160778445 MEDLINE PMID 27241071 (http://www.ncbi.nlm.nih.gov/pubmed/27241071) PUI L612950202 DOI 10.1111/apa.13492 FULL TEXT LINK http://dx.doi.org/10.1111/apa.13492 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 100 TITLE Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation AUTHOR NAMES Churpek M.M. Wendlandt B. Zadravecz F.J. Adhikari R. Winslow C. Edelson D.P. AUTHOR ADDRESSES (Churpek M.M., matthew.churpek@uchospitals.edu; Wendlandt B.; Zadravecz F.J.; Adhikari R.; Edelson D.P.) Department of Medicine, University of Chicago, Chicago, United States. (Winslow C.) Department of Medicine, NorthShore University HealthSystem, Evanston, United States. CORRESPONDENCE ADDRESS M.M. Churpek, Department of Medicine, University of Chicago, Chicago, United States. Email: matthew.churpek@uchospitals.edu SOURCE Journal of Hospital Medicine (2016) 11:11 (757-762). Date of Publication: 1 Nov 2016 ISSN 1553-5606 (electronic) 1553-5592 BOOK PUBLISHER John Wiley and Sons Inc., jhospitalmedicine@jjeditorial.com ABSTRACT BACKGROUND: Previous research investigating the impact of delayed intensive care unit (ICU) transfer on outcomes has utilized subjective criteria for defining critical illness. OBJECTIVE: To investigate the impact of delayed ICU transfer using the electronic Cardiac Arrest Risk Triage (eCART) score, a previously published early warning score, as an objective marker of critical illness. DESIGN: Observational cohort study. SETTING: Medical-surgical wards at 5 hospitals between November 2008 and January 2013. PATIENTS: Ward patients. INTERVENTION: None. MEASUREMENTS: eCART scores were calculated for all patients. The threshold with a specificity of 95% for ICU transfer (eCART ≥ 60) denoted critical illness. A logistic regression model adjusting for age, sex, and surgical status was used to calculate the association between time to ICU transfer from first critical eCART value and in-hospital mortality. RESULTS: A total of 3789 patients met the critical eCART threshold before ICU transfer, and the median time to ICU transfer was 5.4 hours. Delayed transfer (>6 hours) occurred in 46% of patients (n = 1734) and was associated with increased mortality compared to patients transferred early (33.2% vs 24.5%, P < 0.001). Each 1-hour increase in delay was associated with an adjusted 3% increase in odds of mortality (P < 0.001). In patients who survived to discharge, delayed transfer was associated with longer hospital length of stay (median 13 vs 11 days, P < 0.001). CONCLUSIONS: Delayed ICU transfer is associated with increased hospital length of stay and mortality. Use of an evidence-based early warning score, such as eCART, could lead to timely ICU transfer and reduced preventable death. Journal of Hospital Medicine 2016;11:757–762. © 2016 Society of Hospital Medicine. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article cohort analysis controlled study critical illness critically ill patient disease severity heart arrest human length of stay mortality multicenter study observational study priority journal scoring system EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160529852 MEDLINE PMID 27352032 (http://www.ncbi.nlm.nih.gov/pubmed/27352032) PUI L611267723 DOI 10.1002/jhm.2630 FULL TEXT LINK http://dx.doi.org/10.1002/jhm.2630 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 101 TITLE The relocation and road transfer of intensive care patients to a new hospital in Bristol: Our experiences AUTHOR NAMES Grier S. Gough C.J.R. Wrathall G.J. AUTHOR ADDRESSES (Grier S.; Gough C.J.R.; Wrathall G.J., Gareth.Wrathall@nbt.nhs.uk) North Bristol NHS Trust, Intensive Care Unit, Southmead Hospital, Bristol, United Kingdom. CORRESPONDENCE ADDRESS G.J. Wrathall, North Bristol NHS Trust, Intensive Care Unit, Southmead Hospital, Brunel Building, Southmead Road, Bristol, United Kingdom. Email: Gareth.Wrathall@nbt.nhs.uk SOURCE Journal of the Intensive Care Society (2016) 17:4 (326-331). Date of Publication: 1 Nov 2016 ISSN 1751-1437 BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT In May 2014, North Bristol NHS Trust merged its two existing hospitals – Southmead and Frenchay – into a new, purpose-built building. The project involved the movement of 540 patients, many over a distance of several miles. We describe the planning process and transfer of 24 level two and three patients from two intensive care units into the new hospital. These transfers were performed successfully, without significant incident and under intense scrutiny from the Trust, the patients and the media. In this paper, we reflect upon our experiences of this process, which may be of benefit to those encountering a similar move in the future. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient safety patient transport EMTREE MEDICAL INDEX TERMS doctor patient relation human major clinical study trust LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160781036 PUI L612957219 DOI 10.1177/1751143716644460 FULL TEXT LINK http://dx.doi.org/10.1177/1751143716644460 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 102 TITLE A consensus to determine the ideal critical care transfer bag AUTHOR NAMES Van Zwanenberg G. Dransfield M. Juneja R. AUTHOR ADDRESSES (Van Zwanenberg G., gezz.zwanenberg@nhs.net) North West London Critical Care Network, London, United Kingdom. (Dransfield M.) Imperial College NHS Healthcare Trust, London, United Kingdom. (Juneja R.) The Royal Marsden NHS Foundation Trust, London, United Kingdom. () CORRESPONDENCE ADDRESS G. Van Zwanenberg, North West London Critical Care Network, London, United Kingdom. Email: gezz.zwanenberg@nhs.net SOURCE Journal of the Intensive Care Society (2016) 17:4 (332-340). Date of Publication: 1 Nov 2016 ISSN 1751-1437 BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT Background: Familiarity with environment, processes and equipment reduces the risk inherently associated with critical care transfers. Therefore, the North West London Critical Care Network decided to create a standardised ideal transfer bag and contents to improve patient safety. Methods: A four-round modified Delphi survey developed a condensed and clinically tested content list. An expert panel then designed an ideal transfer bag based on agreed important principles. Results: Participants completed two rounds of an electronic survey. Round 3 comprised an expert clinical panel review, while round 4 tested the contents over 50 clinical transfers. The prototype bag’s design was adjusted after clinical use and feedback. Discussion: This project has introduced a standardised critical care transfer bag across our network. A similar technique could be used for other healthcare regions. Alternatively, the above critical care transfer bag could be adopted or adapted for regional use by clinicians. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consensus Delphi study intensive care patient safety patient transport EMTREE MEDICAL INDEX TERMS human human experiment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160781047 PUI L612957487 DOI 10.1177/1751143716658912 FULL TEXT LINK http://dx.doi.org/10.1177/1751143716658912 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 103 TITLE The development of an acute multidisciplinary team to enhance intensive care without borders AUTHOR NAMES Hunt R. AUTHOR ADDRESSES (Hunt R.) Derriford Hospital, United Kingdom. CORRESPONDENCE ADDRESS R. Hunt, Derriford Hospital, United Kingdom. SOURCE Journal of the Intensive Care Society (2016) 17:4 Supplement 1 (107-108). Date of Publication: 1 Nov 2016 CONFERENCE NAME Intensive Care Society State-of-the-Art Meeting, ICSSOA 2016 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2016-12-05 to 2016-12-07 ISSN 1751-1437 BOOK PUBLISHER SAGE Publications Inc. ABSTRACT The acute care team (ACT) is a multidisciplinary team working in a busy teaching hospital with a wealth of clinical skills and experience. The team was developed in 2011 through the combination of the acute and chronic pain teams, the vascular access team, the outreach team and the emergency resuscitation teams. Since 2014, the team have become responsible for the follow-up of patients on the trauma pathway and they assist with intrahospital transfers when needed. The team is available 24 h a day, 365 days a year, and is very active, averaging over 1000 patient interactions a month. They are invaluable in providing timely, safe, quality care to patients in the hospital. Testament to this is that the Care Quality Commission singled out the team in their most recent report, describing the ACT as outstanding. Emergency care of the unwell, deteriorating patient has become a particular feature of the team's workload since 2012. As seen in Table 1, the number of medical emergency calls has more than doubled, whereas the number of in hospital cardiac arrests has decreased significantly. The outcomes for patients having an in hospital cardiac arrest have also improved significantly. Survival over the last year has increased to 34% and we are now one of the leading hospitals in the country for survival after in hospital cardiac arrest. This aetiology of this improvement is multifactorial, though; during the same period the number of patients having a do not attempt resuscitation order in place decreased. The ACT is under appreciated, yet offers huge benefit to patients and provides invaluable assistance to the busy and very appreciative junior doctor workforce. The development of the doctor's assistant (DA) role has expanded the team over the last two years and there are now 19 DA's within the ACT. This expansion will mean we can provide the services of this outstanding team more effectively and so improve the quality of patient care within our hospital. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) resuscitation EMTREE MEDICAL INDEX TERMS averaging chronic pain emergency care female follow up heart arrest human injury jurisprudence major clinical study male patient transport skill teaching hospital vascular access workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617404325 DOI 10.1177/1751143717708966 FULL TEXT LINK http://dx.doi.org/10.1177/1751143717708966 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 104 TITLE Erratum to: Intrahospital transport of critically ill patients (Méd. Intensive Réa, 10.1007/s13546-016-1219-y) AUTHOR NAMES Brouard F. Muller G. Michel P. Ehrmann S. da Silva D. Kimmoun A. Hamzaoui O. Lacherade J.C. Audoin C. Boissier F. Hraiech S. Grimaldi D. Aissaoui N. AUTHOR ADDRESSES (Brouard F.) CH de Périgueux, service de réanimation polyvalente, 80 avenue Georges Pompidou, Périgueux cedex, France. (Muller G.) Service réanimation polyvalente, CHR d’Orléans, hôpital de la Source, Orléans, France. (Michel P.) Service de réanimation médicochirurgicale, CH René Dubos, Pontoise, France. (Ehrmann S.) Service de réanimation médicale polyvalente, CHRU de Tours, Tours, France. (da Silva D.) Service de réanimation médicale polyvalente, CH de Saint-Denis, hôpital Delafontaine, Saint-Denis, France. (Kimmoun A.) Service de réanimation médicale, CHU Nancy, hôpital Brabois adultes, Nancy, France. (Hamzaoui O.) Service de réanimation polyvalente, CHU Antoine Béclère, Clamart, France. (Lacherade J.C.) Service de réanimation polyvalente, CHD Les Oudairies, La Roche-sur-Yon, France. (Audoin C.) Service de réanimation polyvalente, clinique des Cèdres, Cornebarrieu, France. (Boissier F.) Service de réanimation médicale, CHU de Poitiers, Poitiers, France. (Hraiech S.) Service de réanimation médicale, CHU de Marseille-Hôpital Nord, Marseille, France. (Grimaldi D.) Services des soins intensifs, cliniques universitaires de Bruxelles, hôpital Érasme, Bruxelles, Belgium. (Aissaoui N., cerc@cerc.a6tole.fr) Service de réanimation médicale, CHU-hôpital européen Georges Pompidou, Paris, France. () CORRESPONDENCE ADDRESS N. Aissaoui, Service de réanimation médicale, CHU-hôpital européen Georges Pompidou, Paris, France. Email: cerc@cerc.a6tole.fr SOURCE Reanimation (2016) 25:6 (655). Date of Publication: 1 Nov 2016 ISSN 1951-6959 (electronic) 1624-0693 BOOK PUBLISHER Springer-Verlag France, 22, Rue de Palestro, Paris, France. york@springer-paris.fr EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French EMBASE ACCESSION NUMBER 20160835217 PUI L613201241 DOI 10.1007/s13546-016-1235-y FULL TEXT LINK http://dx.doi.org/10.1007/s13546-016-1235-y COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 105 TITLE Transfer of allogeneic stem cell transplant recipients to the intensive care unit: Guidelines from the Francophone society of marrow transplantation and cellular therapy (SFGM-TC) ORIGINAL (NON-ENGLISH) TITLE Transfert des patients allogreffés de cellules-souches hématopoïétiques en réanimation : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC) AUTHOR NAMES Moreau A.-S. Bourhis J.-H. Contentin N. Couturier M.-A. Delage J. Dumesnil C. Gandemer V. Hichri Y. Jost E. Platon L. Jourdain M. Pène F. Yakoub-Agha I. AUTHOR ADDRESSES (Moreau A.-S.; Jourdain M.) CHU, centre de réanimation, université de Lille 2, Inserm UII90, Lille, France. (Bourhis J.-H.) Institut Gustave-Roussy, service d'hématologie, 114, rue Édouard-Vaillant, Villejuif, France. (Contentin N.) Centre Henri-Becquerel, service d'hématologie, rue d'Amiens, Rouen, France. (Couturier M.-A.) CHU de Brest, hôpital Morvan, service d'hématologie stérile, 2, avenue Foch, Brest, France. (Delage J.) Département d'hématologie et de thérapie cellulaire, CHRU Montpellier-site Saint-Eloi, 80, avenue Augustin-Fliche, Montpellier, France. (Dumesnil C.) CHU de Rouen, service d'hémato-oncologie pédiatrique, 1, rue Germont, Rouen, France. (Gandemer V.) CHU Hôpital Sud, université Rennes 1, 2, rue Henri-le-Guilloux, Rennes, France. (Hichri Y.) CHU Montpellier, département d'hématologie clinique, Montpellier, France. (Jost E.) Hématologie/oncologie, Uniklinik RWTH Aachen, Aachen, Germany. (Platon L.) Réanimation médicale, CHU Lapeyronie, 345, rue du Muscadet, Montpellier, France. (Pène F.) Service de réanimation médicale, hôpital Cochin, AP–HP, université Paris Descartes, Paris, France. (Yakoub-Agha I., sfgm-tc-iya@live.fr) CHU de Lille, LIRIC Inserm U995, université Lille 2, Lille, France. CORRESPONDENCE ADDRESS I. Yakoub-Agha, CHU de Lille, LIRIC Inserm U995, université Lille 2, Lille, France. Email: sfgm-tc-iya@live.fr SOURCE Bulletin du Cancer (2016) 103:11 Supplement (S220-S228). Date of Publication: 1 Nov 2016 ISSN 1769-6917 (electronic) 0007-4551 BOOK PUBLISHER John Libbey Eurotext, 127, avenue de la Republique, Montrouge, France. ABSTRACT Transferring a patient undergoing an allogeneic stem cell transplantation to the intensive care unit (ICU) is always a challenging situation on a medical and psychological point of view for the patient and his relatives as well as for the medical staff. Despite the progress in hematology and intensive care during the last decade, the prognosis of these patients admitted to the ICU remains poor and mortality is around 50 %. The harmonization working party of the SFGM-TC assembled hematologists and intensive care specialist in order to improve conditions and modalities of the transfer of a patient after allogeneic stem cell transplantation to the ICU. We propose a structured medical form comprising all essential information necessary for optimal medical care on ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) allogeneic stem cell transplantation bone marrow graft recipient intensive care unit practice guideline transplantation EMTREE MEDICAL INDEX TERMS hematologist hematology human human experiment human tissue intensivist male medical care medical staff mortality prognosis relative LANGUAGE OF ARTICLE English, French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 20160879865 MEDLINE PMID 27816169 (http://www.ncbi.nlm.nih.gov/pubmed/27816169) PUI L613501840 DOI 10.1016/j.bulcan.2016.09.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.bulcan.2016.09.008 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 106 TITLE The capabilities and scope-of-practice requirements of advanced life support practitioners undertaking critical care transfers: A Delphi study AUTHOR NAMES Venter M. Stassen W. AUTHOR ADDRESSES (Venter M.; Stassen W., stassen88@gmail.com) Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa. CORRESPONDENCE ADDRESS W. Stassen, Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa. Email: stassen88@gmail.com SOURCE Southern African Journal of Critical Care (2016) 32:2 (58-61). Date of Publication: 1 Nov 2016 ISSN 1562-8264 BOOK PUBLISHER South African Medical Association, publishing@samedical.org ABSTRACT Background. Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics' training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Delphi study intensive care physician scope of practice EMTREE MEDICAL INDEX TERMS anesthesiology clinical article consensus emergency medicine human internal medicine postgraduate education skill South Africa LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160867611 PUI L613439789 DOI 10.7196/SAJCC.2016.v32i2.275 FULL TEXT LINK http://dx.doi.org/10.7196/SAJCC.2016.v32i2.275 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 107 TITLE Fly away with me AUTHOR NAMES McSharry B. AUTHOR ADDRESSES (McSharry B., BrentM@adhb.govt.nz) Starship Children's Health – Paediatric Intensive Care, Auckland, New Zealand. CORRESPONDENCE ADDRESS B. McSharry, Starship Children's Health – Paediatric Intensive Care, Auckland, New Zealand. Email: BrentM@adhb.govt.nz SOURCE Acta Paediatrica, International Journal of Paediatrics (2016) 105:11 (1336). Date of Publication: 1 Nov 2016 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport pediatric intensive care unit EMTREE MEDICAL INDEX TERMS childhood disease critical illness extubation human length of stay mortality note priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160778451 PUI L612950517 DOI 10.1111/apa.13530 FULL TEXT LINK http://dx.doi.org/10.1111/apa.13530 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 108 TITLE More than a bus ride: quality and outcomes of paediatric specialty transport AUTHOR NAMES Bigham M.T. AUTHOR ADDRESSES (Bigham M.T., mbigham@chmca.org) Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, United States. CORRESPONDENCE ADDRESS M.T. Bigham, Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, United States. Email: mbigham@chmca.org SOURCE Acta Paediatrica, International Journal of Paediatrics (2016) 105:11 (1335). Date of Publication: 1 Nov 2016 ISSN 1651-2227 (electronic) 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality patient transport pediatrics traffic and transport EMTREE MEDICAL INDEX TERMS Antiquity critically ill patient disease severity health care delivery hospital admission human length of stay mortality rate note outcome assessment pediatric intensive care unit priority journal respiratory failure standardized mortality ratio EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160778452 MEDLINE PMID 27444883 (http://www.ncbi.nlm.nih.gov/pubmed/27444883) PUI L612950522 DOI 10.1111/apa.13534 FULL TEXT LINK http://dx.doi.org/10.1111/apa.13534 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 109 TITLE Complications and benefits of intrahospital transport of adult Intensive Care Unit patients AUTHOR NAMES Sai Saran P.V. Azim A. AUTHOR ADDRESSES (Sai Saran P.V.; Azim A., draazim2002@gmail.com) Department of Critical Care Medicine, SGPGIMS, Lucknow, India. CORRESPONDENCE ADDRESS A. Azim, Department of Critical Care Medicine, SGPGIMS, Lucknow, India. Email: draazim2002@gmail.com SOURCE Indian Journal of Critical Care Medicine (2016) 20:10 (628-629). Date of Publication: 1 Oct 2016 ISSN 1998-359X (electronic) 0972-5229 BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS clinical evaluation human hyperventilation intensive care letter patient pneumothorax safety EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160799030 PUI L613097010 DOI 10.4103/0972-5229.192069 FULL TEXT LINK http://dx.doi.org/10.4103/0972-5229.192069 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 110 TITLE Frequency, Composition, and Predictors of In-Transit Critical Events during Pediatric Critical Care Transport∗ AUTHOR NAMES Singh J.M. Gunz A.C. Dhanani S. Aghari M. Macdonald R.D. AUTHOR ADDRESSES (Singh J.M.) Division of Critical Care Medicine, Department of Medicine, University Health Network, Toronto, Canada. (Singh J.M.) Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Canada. (Gunz A.C.) Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Canada. (Dhanani S.) Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada. (Dhanani S.) Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada. (Aghari M.; Macdonald R.D.) Ornge Transport Medicine, Mississauga, Canada. (Macdonald R.D.) Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada. SOURCE Pediatric Critical Care Medicine (2016) 17:10 (984-991). Date of Publication: 1 Oct 2016 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objectives: Transport of pediatric patients is common due to healthcare regionalization. We set out to determine the frequency of in-transit critical events during pediatric critical care transport and identify factors associated with these events. Design: Retrospective cohort study using administrative and clinical data. Setting: Single pediatric critical care transport provider in Ontario, Canada. Patients: All pediatric care transports between January 1, 2005, and December 31, 2010. Measurements and Main Results: The primary outcome was in-transit critical events, defined by an adaptation of a recent consensus definition. In-transit critical events occurred in 1,094 (12.3%) of 8,889 transports. Hypotension (3.6%), tachycardia (3.7%), and bradycardia (3.3%) were the most common critical events. Crews performed medical interventions in 194 transports (2.2%). The frequency and makeup of critical events varied across patient age groups. Age, pretransport mechanical ventilation, pretransport cardiovascular instability, transport duration, scene calls, and paramedic crew level were independently associated with increased risk of in-transit critical events in multivariate analysis. A Transport Pediatric Early Warning Score of 7 or greater predicted in-transit critical events with high specificity but low sensitivity (92.0% and 20.0%, respectively), but was not superior of the combination of pretransport mechanical ventilation and pretransport cardiovascular instability (sensitivity and specificity of 12.6% and 97.4%, respectively). Removal of early warning signs from the definition resulted in critical event rates comparable to those published in adults and improved predictive performance. Conclusions: Using new consensus definitions of transport-related critical events, we found critical events occurred in almost one in eight transports, and were strongly associated with pretransport cardiovascular instability. Transport Pediatric Early Warning Score was poorly predictive of in-transit critical events, and was not superior to the presence of pretransport mechanical ventilation and cardiovascular instability. Future prospective studies are required to elucidate the optimal matching of transport resources to patients, in particular those with both pretransport cardiovascular instability and mechanical ventilation. EMTREE DRUG INDEX TERMS adenosine atropine bicarbonate dopamine glucagon glucose hypertensive factor lidocaine naloxone noradrenalin phenylephrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness intensive care patient transport pediatrics EMTREE MEDICAL INDEX TERMS adolescent adult adverse outcome article artificial ventilation assisted ventilation bradycardia cardiovascular disease child cohort analysis endotracheal intubation female human hypotension infant major clinical study male manual emergency ventilator nasotracheal intubation newborn Ontario outcome assessment paramedical personnel patient safety preschool child priority journal retrospective study sensitivity and specificity sentinel event tachycardia thoracostomy tracheotomy CAS REGISTRY NUMBERS adenosine (58-61-7) atropine (51-55-8, 55-48-1) bicarbonate (144-55-8, 71-52-3) dopamine (51-61-6, 62-31-7) glucagon (11140-85-5, 62340-29-8, 9007-92-5) glucose (50-99-7, 84778-64-3) lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9) naloxone (357-08-4, 465-65-6) noradrenalin (1407-84-7, 51-41-2) phenylephrine (532-38-7, 59-42-7, 61-76-7) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Drug Literature Index (37) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160593799 MEDLINE PMID 27505717 (http://www.ncbi.nlm.nih.gov/pubmed/27505717) PUI L611645723 DOI 10.1097/PCC.0000000000000919 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000919 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 111 TITLE Critical Care Transport: How Perilous the Trip∗ AUTHOR NAMES Bigham M.T. Brilli R.J. AUTHOR ADDRESSES (Bigham M.T.) Department of Pediatrics, Akron Children's Hospital, Akron, United States. (Bigham M.T.) Department of Pediatrics, Northeast Ohio Medical University, Rootstown, United States. (Brilli R.J.) Department of Pediatrics Nationwide, Children's Hospital, Columbus, United States. (Brilli R.J.) Department of Pediatrics, Ohio State University, College of Medicine, Columbus, United States. SOURCE Pediatric Critical Care Medicine (2016) 17:10 (1008-1009). Date of Publication: 1 Oct 2016 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS abnormal laboratory result artificial ventilation childhood mortality critically ill patient disease severity editorial general condition deterioration hospital admission human laboratory test priority journal resuscitation risk assessment sentinel event EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160717102 PUI L612540803 DOI 10.1097/PCC.0000000000000927 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000927 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 112 TITLE Simulation-based training for pulmonary and critical care fellows in urgent endotracheal intubation: Does skill transfer to the clinical arena? AUTHOR NAMES Shah R. Makaryus M. Feldman M. Mayo-Malasky P. Narasimhan M. Mayo P. Singas E. AUTHOR ADDRESSES (Shah R.; Makaryus M.; Feldman M.; Mayo-Malasky P.; Narasimhan M.; Mayo P.; Singas E.) Northwell/North Shore and LIJ, New York, United States. CORRESPONDENCE ADDRESS R. Shah, Northwell/North Shore and LIJ, New York, United States. SOURCE Chest (2016) 150:4 Supplement 1 (636A). Date of Publication: 1 Oct 2016 CONFERENCE NAME CHEST 2016 CONFERENCE LOCATION Los Angeles, CA, United States CONFERENCE DATE 2016-10-22 to 2016-10-26 ISSN 1931-3543 BOOK PUBLISHER Elsevier B.V. ABSTRACT PURPOSE: Simulation-based training (SBT) for high-risk, low-frequency clinical events such as urgent endotracheal intubation (UEI) is a widely used training tool. Training effect is generally demonstrated by testing the learner on the simulator. We studied whether SBT for UEI performed by pulmonary/critical care medicine (PCCM) fellows transferred to real-life UEI. METHODS: In July of 2015, four first-year PCCM fellows attended 15 mandatory training sessions to develop skill at UEI. Each session included a short didactic discussion followed by SBT using a computerized patient simulator (CPS). Sessions emphasized task training, crew resource management (CRM) communication, mastery of a Do/Confirm 46-point checklist, standard crew assignments, and combined team tactics. The fellows executed multiple scenarios of increasing complexity and stress with one fellow assigned to be team leader while the others assumed the roles of crew members on a rotating basis. Each scenario was followed by a formal debriefing session. At the end of the entire training period, each fellow was tested on the CPS while wearing a body mounted video camera. The same video assessment was done on the fellow's first real patient UEI to evaluate if SBT translated to real-life patient encounter. Video recordings were scored by two independent investigators using a standardized score sheet. Forty of the 46 items on the checklist could be scored from the video recordings. RESULTS: Results of testing on the CPS for execution of the checklist ranged from 36/40 (90%) to 40/40 (100%). Results of testing on real-life patient UEI for execution of the checklist ranged from 37/40 (92.5%) to 39/40 (97.5%). Use of task training, CRM, and combined team tactics was excellent with the CPS and real-life UEI with all fellows. There was minimal inter-observer variability in scoring. CONCLUSIONS: SBT is an effective approach to train PCCM fellows in UEI. Video recording is a useful method to objectively assess the training effect of SBT for real-life patient UEI. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) endotracheal intubation intensive care lung skill EMTREE MEDICAL INDEX TERMS checklist crew member human human experiment leadership medicine resource management simulator stress videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613468004 DOI 10.1016/j.chest.2016.08.728 FULL TEXT LINK http://dx.doi.org/10.1016/j.chest.2016.08.728 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 113 TITLE Pneumothorax during transportation of patient on Ayres T-piece: A rare but lethal experience! AUTHOR NAMES Nikhar S. Gupta K. AUTHOR ADDRESSES (Nikhar S.) Department of Anaesthesia and Intensive Care, Nizam Institute of Medical Sciences, Hyderabad, India. (Gupta K., doc_krishan31@yahoo.co.in) Department of Anaesthesia and Intensive Care, GGS Medical College and Hospital, Medical Campus, Faridkot, India. CORRESPONDENCE ADDRESS K. Gupta, Department of Anaesthesia and Intensive Care, GGS Medical College and Hospital, Medical Campus, Faridkot, India. Email: doc_krishan31@yahoo.co.in SOURCE Saudi Journal of Anaesthesia (2016) 10:4 (490-491). Date of Publication: 1 Oct 2016 ISSN 0975-3125 (electronic) 1658-354X BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. EMTREE DRUG INDEX TERMS atropine (drug therapy) oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport patient transport device T piece tension pneumothorax (complication, diagnosis, therapy) EMTREE MEDICAL INDEX TERMS bradycardia (drug therapy) case report chest tube child endotracheal tube extubation general anesthesia human intensive care unit intermittent positive pressure ventilation intestine obstruction letter male manual ventilation needle oxygen saturation priority journal respiratory distress school child CAS REGISTRY NUMBERS atropine (51-55-8, 55-48-1) oxygen (7782-44-7) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160693952 PUI L612358178 DOI 10.4103/1658-354X.179124 FULL TEXT LINK http://dx.doi.org/10.4103/1658-354X.179124 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 114 TITLE Unfavorable Results After Free Tissue Transfer to Head and Neck: Lessons Learned at the University of Washington AUTHOR NAMES Houlton J.J. Bevans S.E. Futran N.D. AUTHOR ADDRESSES (Houlton J.J., jhoulton@uw.edu; Bevans S.E.; Futran N.D.) Department of Otolaryngology, University of Washington, 1959 Northeast Pacific Street, Box 356515, Seattle, United States. CORRESPONDENCE ADDRESS J.J. Houlton, Department of Otolaryngology, University of Washington, 1959 Northeast Pacific Street, Box 356515, Seattle, United States. Email: jhoulton@uw.edu SOURCE Clinics in Plastic Surgery (2016) 43:4 (683-693). Date of Publication: 1 Oct 2016 ISSN 1558-0504 (electronic) 0094-1298 BOOK PUBLISHER W.B. Saunders ABSTRACT This article discusses the lessons learned from nearly 2700 free tissue transfer procedures to reconstruct defects of the head and neck at the University of Washington. It discusses the authors’ perioperative management practices regarding perioperative tracheotomy tube placement, their method of postoperative flap monitoring, and their current protocol for use of postoperative antibiotics. It reports on the reconstructive preferences for 2 difficult defects that frequently result in unfavorable outcomes: the total glossectomy defect and the pharyngolaryngectomy defect. Key points for harvesting and insetting flaps, to maximize reconstructive outcomes, are provided. EMTREE DRUG INDEX TERMS antibiotic agent clindamycin levofloxacin sultamicillin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) free tissue graft head and neck surgery tissue flap treatment outcome EMTREE MEDICAL INDEX TERMS anterolateral thigh flap atrophy clinical practice Doppler flowmeter drug use esophagus resection fascia glossectomy hospitalization human intensive care unit intubation length of stay medical procedures morbidity needle stick technique patient monitoring percutaneous endoscopic gastrostomy perioperative period peripherally inserted central venous catheter postoperative care review surface area swallowing tracheotomy United States voice change CAS REGISTRY NUMBERS clindamycin (18323-44-9) levofloxacin (100986-85-4, 138199-71-0) sultamicillin (58694-35-2, 76497-13-7) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160845067 MEDLINE PMID 27601392 (http://www.ncbi.nlm.nih.gov/pubmed/27601392) PUI L613297618 DOI 10.1016/j.cps.2016.05.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2016.05.006 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 115 TITLE Identification and Cost of Potentially Avoidable Transfers to a Tertiary Care Neurosurgery Service: A Pilot Study AUTHOR NAMES Kuhn E.N. Warmus B.A. Davis M.C. Oster R.A. Guthrie B.L. AUTHOR ADDRESSES (Kuhn E.N., ekuhn@uabmc.edu; Warmus B.A.; Davis M.C.; Guthrie B.L.) Department of Neurological Surgery, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 Second Ave S, Birmingham, United States. (Warmus B.A.) Medical Scientist Training Program, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, United States. (Oster R.A.) Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, United States. CORRESPONDENCE ADDRESS E.N. Kuhn, Department of Neurological Surgery, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 Second Ave S, Birmingham, United States. Email: ekuhn@uabmc.edu SOURCE Neurosurgery (2016) 79:4 (541-548). Date of Publication: 1 Oct 2016 ISSN 1524-4040 (electronic) 0148-396X BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT BACKGROUND: Thousands of neurosurgical emergencies are transferred yearly to tertiary care facilities to assume a higher level of care. Several studies have examined how neurosurgical transfers influence patient outcomes, but characteristics of potentially avoidable transfers have yet to be investigated. OBJECTIVE: To identify whether potentially avoidable transfers represent a significant portion of transfers to a tertiary neurosurgical facility. METHODS: In this cohort study, we evaluated 916 neurosurgical patients transferred to a tertiary care facility over a 2-year period. Transfers were classified as potentially avoidable when no neurosurgical diagnostic test, intervention, or intensive monitoring was deemed necessary (n 180). The remaining transfers were classified as justifiable (n 736). The main outcomes and measures were age, sex, diagnosis, insurance status, intervention, distance of transfer, length of hospital and intensive care unit stay, mortality, discharge disposition, and cost. RESULTS: Nearly 20% of transfers were identified as being potentially avoidable. Although some of these patients had suffered devastating, irrecoverable neurological insults, many had innocuous conditions that did not require transfer to a higher level of care. Justifiable transfers tend to involve patients with nontraumatic intracranial hemorrhage and cranial neoplasm. Both groups were admitted to the intensive care unit at the same rate (approximately 70% of patients). Finally, the direct transportation cost of potentially avoidable transfers was $1.46 million over 2 years. CONCLUSION: This study identified the frequency and expense of potentially avoidable transfers. There is a need for closer examination of the clinical and financial implications of potentially avoidable transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care cost health care facility health service neurosurgery potentially avoidable transfer tertiary health care EMTREE MEDICAL INDEX TERMS adolescent adult aged article brain hemorrhage child cohort analysis diagnostic test female health insurance hospital cost hospital discharge hospitalization human intensive care unit intervention study length of stay major clinical study male outcome assessment pilot study priority journal tertiary care center EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160577300 MEDLINE PMID 27489167 (http://www.ncbi.nlm.nih.gov/pubmed/27489167) PUI L611548023 DOI 10.1227/NEU.0000000000001378 FULL TEXT LINK http://dx.doi.org/10.1227/NEU.0000000000001378 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 116 TITLE Preventing critical care transfers for antibiotic desensitization to improve patient and staff satisfaction AUTHOR NAMES Wesson S.J. Smith E. Egener N. AUTHOR ADDRESSES (Wesson S.J.; Smith E.; Egener N.) National Jewish Health, Saint Joseph Hospital, Denver, United States. CORRESPONDENCE ADDRESS S.J. Wesson, National Jewish Health, Saint Joseph Hospital, Denver, United States. SOURCE Pediatric Pulmonology (2016) 51 Supplement 45 (412). Date of Publication: 1 Oct 2016 CONFERENCE NAME 30th Annual North American Cystic Fibrosis Conference CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-10-27 to 2016-10-29 ISSN 1099-0496 BOOK PUBLISHER John Wiley and Sons Inc. ABSTRACT Background: Patients with cystic fibrosis (CF) receive many antibiotics throughout their lifetime to treat pulmonary infections. Over time, they can develop allergies to antibiotics that may be considered optimal for effective treatment. Patients with history of type-I hypersensitivity reaction to an antibiotic can be desensitized to that drug if clinically necessary. Desensitization induces a temporary immune-tolerant state, allowing for safe administration of the allergenic medication until scheduled doses are stopped. It is accomplished by administering increasing doses until the therapeutic dose is reached and tolerated. Due to risk for allergic reaction during this process, 1:1 nursing care is necessary. However, severe reactions are rare (Legere H, et al. J Cyst Fibros. 2009;8(6),418-24). CF patients are traditionally transferred to the intensive care unit (ICU) for this procedure and once completed, move back to the pulmonary unit (PU). This process was noted to cause delays in patient care, decreased patient and staff satisfaction, increased risk for handoff errors, and misuse of ICU resources. Purpose: The purpose of this project is to allow CF patients to remain on the PU for desensitization when clinically appropriate. With this process change, we aim to expand nursing skills, improve patient and staff satisfaction, maintain patient safety, and retain successful outcomes. Methods: In collaboration with PU hospitalists, a non-ICU protocol for antibiotic desensitization was developed. It includes an order to call rapid response for a severe reaction. Patients must have had a prior successful desensitization to the drug to desensitize on the PU. Staff nurses are trained by shadowing a desensitization in ICU and completing a skill check off with a competent nurse. A post-implementation survey of was utilized to evaluate the effects of this change on staff and patient satisfaction. Results from a staff satisfaction survey issued prior to the process change were utilized for comparison. Participating patients were interviewed. Outcomes of ICU vs PU desensitizations were reviewed for potential outcome differences. Outcomes: The process change took effect in March 2016. By the end of April 2016, four patients had been desensitized on the PU. One patient was desensitized in ICU per developed criteria. All five were successful with no moderate or severe reactions. All four patients desensitized on the PU had been desensitized in ICU on prior admissions. All participating patients had a positive response when asked their opinion about the process change. Seven PU nurses completed training. They report feeling nursing skills have been elevated. The staff felt this was a positive change in process for desensitizing. Nurse satisfaction survey response to the question “my job makes good use of my skills and abilities” went from 83% favorable to 100% favorable post-implementation. Conclusions: This project resolved many delay issues due to beds/ staff limitations, patient care transfers, and handoffs. Overall, the change has been a success demonstrated by consistent patient outcomes, positive patient response, and increased staff satisfaction. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) desensitization intensive care unit medical staff patient satisfaction EMTREE MEDICAL INDEX TERMS allergic reaction case report cyst cystic fibrosis drug resistance drug therapy error human lung infection nursing care nursing competence patient care patient safety prevention staff nurse LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612359225 DOI 10.1002/ppul.23576 FULL TEXT LINK http://dx.doi.org/10.1002/ppul.23576 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 117 TITLE Profile of Interfacility Emergency Department Transfers: Transferring Medical Providers and Reasons for Transfer AUTHOR NAMES Li J. Pryor S. Choi B. Rees C.A. Senthil M.V. Tsarouhas N. Myers S.R. Monuteaux M.C. Bachur R.G. AUTHOR ADDRESSES (Li J.) From the *Boston Childrenʼs Hospital, Harvard Medical School, Boston MA; †Seattle Childrenʼs Hospital, University of Washington School of Medicine, Seattle, WA; ‡Texas Childrenʼs Hospital, Baylor College of Medicine, Houston TX; and §The Childrenʼs Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. (Pryor S.; Choi B.; Rees C.A.; Senthil M.V.; Tsarouhas N.; Myers S.R.; Monuteaux M.C.; Bachur R.G.) CORRESPONDENCE ADDRESS J. Li, From the *Boston Childrenʼs Hospital, Harvard Medical School, Boston MA; †Seattle Childrenʼs Hospital, University of Washington School of Medicine, Seattle, WA; ‡Texas Childrenʼs Hospital, Baylor College of Medicine, Houston TX; and §The Childrenʼs Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. SOURCE Pediatric Emergency Care (2016). Date of Publication: 23 Sep 2016 ISSN 1535-1815 (electronic) 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT OBJECTIVES: The aim of this study was to determine the reasons for pediatric emergency department (ED) transfers and the professional characteristics of transferring providers. METHODS: We performed a multicenter, cross-sectional survey of ED medical providers transferring patients younger than 18 years to 1 of 4 tertiary care childrenʼs hospitals. Referring providers completed surveys detailing the primary reasons for transfer and their medical training. RESULTS: The survey data were collected for 25 months, during which 641 medical providers completed 890 surveys, with an overall response rate of 25%. Most pediatric patients were seen by physicians (89.4%) with predominantly general emergency medicine training (64.2%). The median age of patients seen was 5.6 years. The 3 most common diagnoses were closed extremity fracture (12.2%), appendicitis (11.6%), and pneumonia (3.7%). The 3 most common reasons for transfer were need for medical/surgical subspecialist consultation (62.6%), admission to the inpatient unit (17.1%), and admission to the intensive care unit (6.5%). When asked about the need for supportive pediatric services, referring providers ranked pediatric subspecialty and pediatric inpatient unit availability as the highest. CONCLUSIONS: Most pediatric interfacility ED transfers are referred by general emergency medicine physicians who often transfer for inpatient admission or subspecialty consultation. Understanding the needs of the community-based ED providers is an important step to forming more collaborative efforts for regionalized pediatric emergency care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward EMTREE MEDICAL INDEX TERMS appendicitis child clinical trial consultation controlled clinical trial controlled study diagnosis doctor patient relation emergency care emergency medicine human intensive care unit limb fracture major clinical study medical education multicenter study pediatrics pneumonia preschool child surgery tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160694824 PUI L612362886 DOI 10.1097/PEC.0000000000000848 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0000000000000848 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 118 TITLE Transfer delay from intensive care unit: Retrospective analytical study in an Indian tertiary care hospital AUTHOR NAMES Pattnaik S.K. Ray B. AUTHOR ADDRESSES (Pattnaik S.K.) Apollo Hospitals, Critical Care Unit, Bhubaneswar, India. (Ray B.) Apollo Hospitals, Bhubaneswar, India. CORRESPONDENCE ADDRESS S.K. Pattnaik, Apollo Hospitals, Critical Care Unit, Bhubaneswar, India. SOURCE Intensive Care Medicine Experimental (2016) 4 Supplement 1. Date of Publication: 1 Sep 2016 CONFERENCE NAME 29th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2016 CONFERENCE LOCATION Milan, Italy CONFERENCE DATE 2016-10-01 to 2016-10-05 ISSN 2197-425X BOOK PUBLISHER SpringerOpen ABSTRACT Introduction: There lies scarcity of Intensive Care Unit (ICU) beds in every tertiary care hospitals, and on top of it delayed transfer of patients from ICU to wards is further increasing the burdensome. Numerous factors affect in making delayed transfer, which in itself is a risk factor for patient related morbidity and mortality, especially the after hour transfers. Objectives: The aim of the study was to analyze the hours of transfer delay and their effect on readmission rates in the ICU. Methods: We conducted a retrospective study of patients transfer from our ICU to the wards over last one year (Jan-Dec'2015). Data collected from the ICU database by the secretarial staff during the study period and divided into following categories of transfer delays: 1) Less than 4 hrs 2) 4-8 hrs 3) 8-24 hrs 4) More than 24 hrs 5) After hour transfers (from 8 PM-8 AM) Results: There were 3362 patients admitted to our ICU during the study period of which 2475 patients were shifted to the wards. The average delay in shifting was around 6.5 hours (2-10.5 hrs). Delayed transfer of more than 8 hrs was found in 64 % patients and the percentage of after-hours transfer was 43 % of the total transfers. There were 16 readmissions into the ICU within 48 hrs of shift out among patients transferred in after hours as against 3 in patients transferred during routine hours. Conclusions: Prevalence of delayed discharge from ICU was significant, especially the after hour discharges, which has got an impact on readmission rate as well. Discharge delay should be considered as an important quality indicator for critically ill patients to decrease the morbidity and mortality in ICU patients. Further studies are warranted to identify factors associated with delayed discharge. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit tertiary care center EMTREE MEDICAL INDEX TERMS critically ill patient data base female hospital readmission human major clinical study male morbidity mortality prevalence retrospective study staff LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617992032 DOI 10.1186/s40635-016-0100-7 FULL TEXT LINK http://dx.doi.org/10.1186/s40635-016-0100-7 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 119 TITLE Consecutive lactate measurement in high risk oncohaematological patients as a tool for transfer to intensive care unit AUTHOR NAMES Judickas S. Serpytis M. Kezyte G. Urbanaviciute I. Gaizauskas E. AUTHOR ADDRESSES (Judickas S.; Serpytis M.; Gaizauskas E.) Clinics of Anaesthesiology and Intensive Care, Vilnius, Lithuania. (Kezyte G.; Urbanaviciute I.) Vilnius University, Vilnius, Lithuania. CORRESPONDENCE ADDRESS S. Judickas, Clinics of Anaesthesiology and Intensive Care, Vilnius, Lithuania. SOURCE Anesthesia and Analgesia (2016) 123:3 Supplement 2 (147). Date of Publication: 1 Sep 2016 CONFERENCE NAME 16th World Congress of Anaesthesiologists, WCA 2016 CONFERENCE LOCATION Hong Kong, Hong Kong CONFERENCE DATE 2016-08-28 to 2016-09-02 ISSN 1526-7598 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background & Objectives: Lactate elevation is strongly associated with morbidity and mortality in critically ill medical and surgical patients. Patients with oncohaematological (OH) malignancies are at a very high risk of developing severe infectious complications that need immediate recognition and prompt treatment. It is difficult to apply classical SIRS criteria for OH patients due to preexisting malignancy, chemotherapy and insufficiency of immune response [1]. Our aim was to evaluate the prognostic value of consecutive lactate measurements as an additive indicator of transfer of high risk OH patients to Intensive Care Unit (ICU). Materials & Methods: A retrospective study was conducted in Vilnius University Hospital Santariskiu Clinics during 1-year period from September 1, 2014 until August 31, 2015. During this period 88 patients were transferred from General Haematology Unit and Bone Marrow Transplantation Unit to ICU. A control group were patients treated during the same period of time in the same units but who did not require transfer to ICU. Data of lactate measurements on the day of transfer and up to 7 previous days were obtained with vital signs (heart beat, respiration rate, temperature, white blood cell count) from medical records. Study group was divided into survivors and non-survivors. Statistical Package for the Social Sciences (SPSS) was used for statistical analysis, using percentages to describe qualitative variables and means or medians to describe quantitative variables. Results: Overall analysis included 80 patients in study group and 190 patients in control group. ICU mortality in study group was 46,25% (43 patients survived). Transferred patients had significantly higher lactate level on transfer day compared to control group (2,13 (0,62- 17,78) vs. 1,57 (0,54-13,26), p=0,001). A day prior transfer lactate was measured in survivors group for 41,9% patients and in non-survivors for 43,2% of patients. Lactate level obtained in ICU after transfer was significantly higher in non-survivors group (2,5 (0,4-14,6) vs. 1,4 (0,4- 7,6), p=0,014). Non survivors group had significantly higher heart rate (116±26 vs. 105±22, p=0,04) and respiratory rate (25 (14-44) vs. 30 (20-43), p=0,013). Conclusion: A simple and inexpensive consecutive lactate level measurements can have additive value to vital signs monitoring identifying early deterioration of OH patients. Careful and frequent evaluation of OH patients and their dynamics is essential to identify those who will need more intensive treatment. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) lactic acid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit EMTREE MEDICAL INDEX TERMS bone marrow transplantation breathing rate control group controlled study deterioration heart beat heart rate hematology human leukocyte count major clinical study medical record monitoring mortality normal human retrospective study sociology statistical analysis survivor university hospital vital sign CAS REGISTRY NUMBERS lactic acid (113-21-3, 50-21-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612648553 DOI 10.1213/01.ane.0000492513.66329.01 FULL TEXT LINK http://dx.doi.org/10.1213/01.ane.0000492513.66329.01 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 120 TITLE 3D mapping of oxygen and CO(2) transport rates in the lung: a new imaging tool for use in lung surgery, intensive care and basic research AUTHOR NAMES Johansen T. Venegas J.G. AUTHOR ADDRESSES (Johansen T.) Department of Respiratory Diseases, Aarhus University Hospital, Aarhus, Denmark. (Venegas J.G., jvenegas@vqpet.mgh.harvard.edu) Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, United States. CORRESPONDENCE ADDRESS J.G. Venegas, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, United States. Email: jvenegas@vqpet.mgh.harvard.edu SOURCE Expert Review of Respiratory Medicine (2016) 10:9 (935-937). Date of Publication: 1 Sep 2016 ISSN 1747-6356 (electronic) 1747-6348 BOOK PUBLISHER Taylor and Francis Ltd, info@expert-reviews.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) carbon dioxide transport lung gas exchange oxygen transport three dimensional imaging EMTREE MEDICAL INDEX TERMS arterial gas arterial pH basic research blood gas tension capillary wall computer assisted tomography editorial forced expiratory volume human image segmentation lung diffusion capacity lung lobectomy oxygen consumption oxygen saturation EMBASE CLASSIFICATIONS Radiology (14) Physiology (2) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160521328 PUI L611216000 DOI 10.1080/17476348.2016.1206818 FULL TEXT LINK http://dx.doi.org/10.1080/17476348.2016.1206818 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 121 TITLE Neonatal transport characteristics ORIGINAL (NON-ENGLISH) TITLE La spécificité du transport néonatal AUTHOR NAMES Baleine J.F. Fournier-Favre P. Fabre A. AUTHOR ADDRESSES (Baleine J.F., jf-baleine@chu-montpellier.fr; Fournier-Favre P.; Fabre A.) Smur néonatal, CHU Montpellier, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier, France SOURCE Soins. Pediatrie, puericulture (2016) 37:292 (25-29). Date of Publication: 1 Sep 2016 ISSN 1259-4792 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) organization and management EMTREE MEDICAL INDEX TERMS emergency health service France human intensive care neonatal intensive care unit newborn patient transport LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English MEDLINE PMID 27664306 (http://www.ncbi.nlm.nih.gov/pubmed/27664306) PUI L616563530 DOI 10.1016/j.spp.2016.07.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.spp.2016.07.005 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 122 TITLE Perinatal outcomes after fresh versus frozen embryo transfers AUTHOR NAMES Chan S. Greenstein Y. Dasig D. Farah-Eways L. AUTHOR ADDRESSES (Chan S.) Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, United States. (Greenstein Y.) Obstetrics and Gynecology, Kaiser Permanente, Modesto, United States. (Dasig D.; Farah-Eways L.) Reproductive Endocrinology and Infertility, Kaiser Permanente Center for Reproductive Health, Fremont, United States. CORRESPONDENCE ADDRESS S. Chan, Obstetrics and Gynecology, Kaiser Permanente Medical Center, Santa Clara, United States. SOURCE Fertility and Sterility (2016) 106 Supplement 3 (e324-e325). Date of Publication: 1 Sep 2016 CONFERENCE NAME ASRM Scientific Congress and Expo Scaling New Heights in Reproductive Medicine, ASRM 2016 CONFERENCE LOCATION Salt Lake City, UT, United States CONFERENCE DATE 2016-10-15 to 2016-10-19 ISSN 1556-5653 BOOK PUBLISHER Elsevier Inc. ABSTRACT OBJECTIVE: To determine whether there is a difference in perinatal outcome when in vitro fertilization (IVF) with a fresh embryo transfer is compared to IVF using cryopreserved embryos. DESIGN: Retrospective cohort. MATERIALS AND METHODS: All fresh and frozen IVF cycles performed at an IVF center between Feb. 2006 and Aug. 2011 that resulted in a live birth were included in the study. Outcomes of interest included rates of gestational hypertension (GHTN), preeclampsia, small for gestational age (SGA), preterm delivery, gestational diabetes (GDM), and neonatal intensive care unit (NICU) admission. IVF data was obtained from the IVF program's SART database and outcome data was abstracted using ICD-9 codes from patient medical records. For patients with more than one birth during the study period, only the first delivery was included in the analysis. Chisquared analysis was used to analyze the differences in rates of the outcomes of interest between groups. RESULTS: A total of 669 live births following fresh transfer and 197 births following frozen transfer were analyzed. The groups were similar in terms of age, nulliparity, and rates of chronic hypertension. Multiple gestations were more common in pregnancies following fresh transfer than after frozen transfer (36.4% vs. 24.9%, p= 0.0025). Ethnic distribution of patients also varied between the groups (p = 0.0405). When including all gestations, there was a significantly higher rate of GHTN following frozen transfers when compared to fresh transfers (25.3% vs. 13.5%, p <0.0001). Among only singleton gestations, the rate of GHTN was still significantly higher following frozen transfer (27.0% vs 10.8%, p < 0.0001). The difference in the rate of preeclampsia was not as pronounced after frozen transfers vs fresh transfers (10.8% vs 6.1%, p = 0.0592). Rates of GDM, SGA, preterm delivery or NICU admission were similar for all gestations and singletons, and there were no significant differences in outcomes among only multiple gestations. CONCLUSIONS: Our data suggest that frozen embryo transfers were associated with a significantly higher rate of GHTN compared to fresh transfers. Patients should be counseled that pregnancies following frozen transfers may be at higher risk for developing hypertensive disorders of pregnancy. Additional risk factors should be identified to further stratify patients at greatest risk. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) embryo transfer EMTREE MEDICAL INDEX TERMS clinical article data base embryo ethnic difference female human ICD-9 live birth maternal hypertension medical record neonatal intensive care unit newborn nullipara preeclampsia pregnancy diabetes mellitus prematurity risk factor small for date infant LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612867505 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 123 TITLE Cross-sectional Survey of Canadian Pediatric Critical Care Transport AUTHOR NAMES Kawaguchi A. Gunz A. de Caen A. AUTHOR ADDRESSES (Kawaguchi A.) From the *Department of Pediatrics, Pediatric Critical Care Medicine, and †School of Public Health, University of Alberta, Edmonton, Alberta; and ‡Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. (Gunz A.; de Caen A.) CORRESPONDENCE ADDRESS A. Kawaguchi, From the *Department of Pediatrics, Pediatric Critical Care Medicine, and †School of Public Health, University of Alberta, Edmonton, Alberta; and ‡Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. SOURCE Pediatric Emergency Care (2016). Date of Publication: 20 Aug 2016 ISSN 1535-1815 (electronic) 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT OBJECTIVES: This study aimed to better understand the unique aspects of pediatric critical care transport programs across Canada by characterizing the current workforce of each transport program. METHODS: A cross-sectional questionnaire was sent to the 13 medical directors of Canadaʼs pediatric critical care transport teams, and to 2 nonhospital-affiliated transport services. If a childrenʼs hospital did not have a dedicated team for pediatric transport, the regional transport team providing this service was identified. RESULTS: Eight of the 13 pediatric intensive care units surveyed have unit-based pediatric transport teams. The median annual transport volume for the 8 hospital-based teams was 371 (range, 45–2300) with a total of 5686 patients being transported annually. Among patients transported by the 8 teams, 45% (2579 patients) were pediatric patients (older than 28 days and younger than 18 years) and 40% (1022 patients) of the pediatric patients were admitted to the pediatric intensive care units. Eighty-eight percent of the responding teams also transported neonates (older than 28 days), and 38% transported premature infants.A team composition of registered nurse–respiratory therapist–physician was used by 6/13 teams (75%); however, it accounted for only a small proportion of the transports for most of the teams (median, 2%; range, 2%–100%).The average transport time from dispatch (from team home site) to arrival at receiving facility was reported by 6 teams, and has a median of 195 minutes (range, 90–360 minutes). The median distance from home site to the farthest referral site in the catchment area was 700 km (range, 15–2500 km). CONCLUSIONS: This is the first Canadian nationwide study of pediatric critical care transport programs. It revealed a complexity and variability in transport team demographics, transport volume, team composition, and decision-making process. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit EMTREE MEDICAL INDEX TERMS administrative personnel Canada catchment child consensus development decision making human infant major clinical study newborn patient referral prematurity questionnaire LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160624309 PUI L611873485 DOI 10.1097/PEC.0000000000000853 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0000000000000853 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 124 TITLE Improvement in patient transfer process from the operating room to the PICU using a lean and six sigma-based quality improvement project AUTHOR NAMES Gleich S.J. Nemergut M.E. Stans A.A. Haile D.T. Feigal S.A. Heinrich A.L. Bosley C.L. Tripathi S. AUTHOR ADDRESSES (Gleich S.J., gleich.stephen@mayo.edu; Nemergut M.E.) Department of Pediatrics, Mayo Clinic, 200 1st St SW, Rochester, United States. (Gleich S.J., gleich.stephen@mayo.edu; Nemergut M.E.; Haile D.T.; Bosley C.L.) Department of Anesthesiology, Mayo Clinic, Rochester, United States. (Stans A.A.) Department of Orthopedics, Mayo Clinic, Rochester, United States. (Feigal S.A.; Heinrich A.L.) Department of Nursing, Mayo Clinic, Rochester, United States. (Tripathi S.) Department of Clinical Pediatrics, University of Illinois, College of Medicine, Peoria, United States. CORRESPONDENCE ADDRESS S.J. Gleich, Department of Pediatrics, Mayo Clinic, 200 1st St SW, Rochester, United States. Email: gleich.stephen@mayo.edu SOURCE Hospital Pediatrics (2016) 6:8 (483-489). Date of Publication: 1 Aug 2016 ISSN 2154-1671 (electronic) 2154-1663 BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT BACKGROUND AND OBJECTIVES: Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. METHODS: After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. RESULTS: With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers. CONCLUSIONS: By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) operating room patient transport EMTREE MEDICAL INDEX TERMS article clinical handover human interpersonal communication patient safety patient satisfaction spine fusion total quality management EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160578288 MEDLINE PMID 27471214 (http://www.ncbi.nlm.nih.gov/pubmed/27471214) PUI L611554753 DOI 10.1542/hpeds.2015-0232 FULL TEXT LINK http://dx.doi.org/10.1542/hpeds.2015-0232 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 125 TITLE Multi-task transfer learning for in-hospital-death prediction of ICU patients AUTHOR NAMES Karmakar C. Saha B. Palaniswami M. Venkatesh S. AUTHOR ADDRESSES (Karmakar C.; Saha B.; Palaniswami M.; Venkatesh S.) SOURCE Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference (2016) 2016 (3321-3324). Date of Publication: 1 Aug 2016 ISSN 1557-170X ABSTRACT Multi-Task Transfer Learning (MTTL) is an efficient approach for learning from inter-related tasks with small sample size and imbalanced class distribution. Since the intensive care unit (ICU) data set (publicly available in Physionet) has subjects from four different ICU types, we hypothesize that there is an underlying relatedness amongst various ICU types. Therefore, this study aims to explore MTTL model for in-hospital mortality prediction of ICU patients. We used single-task learning (STL) approach on the augmented data as well as individual ICU data and compared the performance with the proposed MTTL model. As a performance measurement metrics, we used sensitivity (Sens), positive predictivity (+Pred), and Score. MTTL with class balancing showed the best performance with score of 0.78, 0.73, o.52 and 0.63 for ICU type 1 (Coronary care unit), 2 (Cardiac surgery unit), 3 (Medical ICU) and 4 (Surgical ICU) respectively. In contrast the maximum score obtained using STL approach was 0.40 for ICU type 1 & 2. These results indicates that the performance of in-hospital mortality can be improved using ICU type information and by balancing the `non-survivor' class. The findings of the study may be useful for quantifying the quality of ICU care, managing ICU resources and selecting appropriate interventions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital mortality intensive care unit theoretical model EMTREE MEDICAL INDEX TERMS decision support system factual database human intensive care length of stay procedures LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28324982 (http://www.ncbi.nlm.nih.gov/pubmed/28324982) PUI L618064346 DOI 10.1109/EMBC.2016.7591438 FULL TEXT LINK http://dx.doi.org/10.1109/EMBC.2016.7591438 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 126 TITLE The association between prehospital transportation and clinical outcomes in patients with non–STEMI AUTHOR NAMES Kobayashi A. Misumida N. Kanei Y. AUTHOR ADDRESSES (Kobayashi A., akobayashi@chpnet.org; Misumida N.) Department of Internal Medicine, Mount Sinai Beth Israel, New York, United States. (Kanei Y.) Department of Cardiology, Mount Sinai Beth Israel, New York, United States. CORRESPONDENCE ADDRESS A. Kobayashi, Mount Sinai Beth Israel, Department of Internal Medicine, 1st Ave at 16th St, New York, United States. Email: akobayashi@chpnet.org SOURCE American Journal of Emergency Medicine (2016) 34:8 (1676-1677). Date of Publication: 1 Aug 2016 ISSN 1532-8171 (electronic) 0735-6757 BOOK PUBLISHER W.B. Saunders EMTREE DRUG INDEX TERMS troponin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical outcome non ST segment elevation myocardial infarction patient transport EMTREE MEDICAL INDEX TERMS electrocardiogram emergency health service heart catheterization heart infarction hospital admission hospital mortality human intensive care unit International Classification of Diseases letter priority journal retrospective study sepsis thorax pain EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160387013 MEDLINE PMID 27220865 (http://www.ncbi.nlm.nih.gov/pubmed/27220865) PUI L610457698 DOI 10.1016/j.ajem.2016.04.050 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajem.2016.04.050 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 127 TITLE Safe transport combined with prospective nursing intervention in intra-hospital transport of emergency critically ill patients AUTHOR NAMES Jiang X.-X. Wang J. Zhang W. Wang X.-J. Meng X.-H. AUTHOR ADDRESSES (Jiang X.-X.; Wang X.-J.) Department of Emergency, Liaocheng People’s Hospital, Liaocheng, China. (Wang J., wangjingwj1123@163.com; Meng X.-H.) Department of Neurology, Liaocheng People’s Hospital, Liaocheng, China. (Zhang W.) Department of Imaging, Liaocheng People’s Hospital, Liaocheng, China. CORRESPONDENCE ADDRESS J. Wang, Department of Neurology, Liaocheng People’s Hospital, Huashan Road, No. 45, Liaocheng, China. Email: wangjingwj1123@163.com SOURCE International Journal of Clinical and Experimental Medicine (2016) 9:7 (13166-13171). Date of Publication: 30 Jul 2016 ISSN 1940-5901 (electronic) BOOK PUBLISHER E-Century Publishing Corporation, 40 White Oaks Lane, Madison, United States. ABSTRACT Objective: We aimed to investigate the application values of safe transport combined with prospective nursing intervention in intra-hospital transport (IHT) of emergency critically ill patients. Methods: A sum of 546 critically ill patients receiving and curing in our hospital was randomly enrolled in our study, and divided into convention group and intervention group according to table of random number. Conventional nursing plan and safe transport combined with prospective nursing intervention were applied for comparing waiting time, transport time, nursing care, patient satisfaction, and monitoring items after transport between two groups. Results: Waiting time, transport time and accident rate in convention group were higher than that in intervention group, while, nursing score and patient satisfaction were found higher in intervention group. Higher scores were found in comparison of vital signs, stable condition after transport, nursing score, and management of respiratory tract and digestive tract in intervention group compared with those in convention group. Higher probabilities of unexpected events were observed in convention group comparing with intervention group. Besides, lower degree of satisfaction of receiving department, successful rescue and degree of satisfaction of patients were observed in convention group comparing with intervention group. Conclusion: Our study found that safe transport combined with prospective nursing intervention in intra-hospital transport of emergency critically ill patients presented very good application values in ensuring patients’ safety, reasonable arrangement of rescue time, avoiding unnecessary waste of time, improving patients’ satisfaction and ensuring the efficiency of the emergency treatment of patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient emergency treatment nursing care nursing intervention EMTREE MEDICAL INDEX TERMS accident controlled study digestive system human major clinical study monitoring patient satisfaction probability respiratory system safety vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160581389 PUI L611502201 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 128 TITLE Transition From Hospital to Home in Preterm Infants and Their Families AUTHOR NAMES Boykova M. AUTHOR ADDRESSES (Boykova M.) The Council of International Neonatal Nurses (COINN), Yardley, Pennsylvania SOURCE The Journal of perinatal & neonatal nursing (2016) 30:3 (270-272). Date of Publication: 1 Jul 2016 ISSN 1550-5073 (electronic) ABSTRACT When the day of discharge from a neonatal intensive care unit (NICU) comes for the parents of newborn infants, they are filled with long-awaited joy and happiness. They go home feeling as parents, away from scheduled routines of the hospital, monitor alarms, clinical rounds, numerous tests, and so on. What do we know about what happens after these little patients and their families leave the NICU? What happens from the point of leaving the hospital until when things get settled and life becomes perceived as normal? This article presents a short summary of research conducted with the vulnerable population of high-risk and preterm infants and their families postdischarge. Available evidence suggests that transition to home after hospital discharge, a phenomenon that many families experience, is challenging and requires attention from clinicians and researchers if we are to provide effective, efficient, and high-quality care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) infant care organization and management parent patient transport standards EMTREE MEDICAL INDEX TERMS education female hospital discharge human male needs assessment neonatal intensive care unit newborn prematurity procedures psychology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27465464 (http://www.ncbi.nlm.nih.gov/pubmed/27465464) PUI L617394702 DOI 10.1097/JPN.0000000000000198 FULL TEXT LINK http://dx.doi.org/10.1097/JPN.0000000000000198 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 129 TITLE Inter-hospital and intra-hospital patient transfer: Recent concepts AUTHOR NAMES Kulshrestha A. Singh J. AUTHOR ADDRESSES (Kulshrestha A., kulshi_20@rediffmail.com) Department of Anaesthesia and Intensive Care, Vardan Multispecialty Hospital, Garhi Sikrod, NH-58, Meerut Road, Ghaziabad, India. (Singh J.) Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. CORRESPONDENCE ADDRESS A. Kulshrestha, Villa No. 83, Villa Anandam, NH-58, Meerut Road, Ghaziabad, India. Email: kulshi_20@rediffmail.com SOURCE Indian Journal of Anaesthesia (2016) 60:7 (451-457). Date of Publication: 1 Jul 2016 ISSN 0019-5049 BOOK PUBLISHER Indian Society of Anaesthetists, Flat No 12/1A K Point, 68-BAPC Roy Road, Kolkata, India. ABSTRACT The intra- and inter-hospital patient transfer is an important aspect of patient care which is often undertaken to improve upon the existing management of the patient. It may involve transfer of patient within the same facility for any diagnostic procedure or transfer to another facility with more advanced care. The main aim in all such transfers is maintaining the continuity of medical care. As the transfer of sick patient may induce various physiological alterations which may adversely affect the prognosis of the patient, it should be initiated systematically and according to the evidence-based guidelines. The key elements of safe transfer involve decision to transfer and communication, pre-transfer stabilisation and preparation, choosing the appropriate mode of transfer, i.e., land transport or air transport, personnel accompanying the patient, equipment and monitoring required during the transfer, and finally, the documentation and handover of the patient at the receiving facility. These key elements should be followed in each transfer to prevent any adverse events which may severely affect the patient prognosis. The existing international guidelines are evidence based from various professional bodies in developed countries. However, in developing countries like India, with limited infrastructure, these guidelines can be modified accordingly. The most important aspect is implementation of these guidelines in Indian scenario with periodical quality assessments to improve the standard of care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consensus development doctor patient relation patient transport EMTREE MEDICAL INDEX TERMS developed country developing country diagnosis documentation health care quality human human experiment India monitoring patient care prevention prognosis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160518624 PUI L611204602 DOI 10.4103/0019-5049.186012 FULL TEXT LINK http://dx.doi.org/10.4103/0019-5049.186012 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 130 TITLE Cord Wraps Facilitate Patient Transfer AUTHOR NAMES Lambert D.H. AUTHOR ADDRESSES (Lambert D.H.) Department of Anesthesiology, Boston University School of Medicine, Boston, United States. CORRESPONDENCE ADDRESS D.H. Lambert, Department of Anesthesiology, Boston University School of Medicine, Boston, United States. SOURCE Anesthesia and Analgesia (2016) 123:1 (257). Date of Publication: 1 Jul 2016 ISSN 1526-7598 (electronic) 0003-2999 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cord wrap devices patient transport EMTREE MEDICAL INDEX TERMS human infection control intensive care unit letter priority journal EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160471142 MEDLINE PMID 27314701 (http://www.ncbi.nlm.nih.gov/pubmed/27314701) PUI L610934592 DOI 10.1213/ANE.0000000000001376 FULL TEXT LINK http://dx.doi.org/10.1213/ANE.0000000000001376 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 131 TITLE Intra-hospital transfer: Human error and safety concerns with improper setting up of a cylinder-based oxygen delivery system AUTHOR NAMES Deepak D. Kavitha J. Kiran S. Vidhu B. AUTHOR ADDRESSES (Deepak D., deepakdwivedi739@gmail.com; Kavitha J.; Kiran S.; Vidhu B.) Department of Anaesthesia and Critical Care, Institute of Naval Medicine, INHS ASVINI, Colaba, Mumbai, India. CORRESPONDENCE ADDRESS D. Deepak, Department of Anaesthesia and Critical Care, Institute of Naval Medicine, INHS ASVINI, Colaba, Mumbai, India. Email: deepakdwivedi739@gmail.com SOURCE Indian Journal of Anaesthesia (2016) 60:7 (519-520). Date of Publication: 1 Jul 2016 ISSN 0019-5049 BOOK PUBLISHER Indian Society of Anaesthetists, Flat No 12/1A K Point, 68-BAPC Roy Road, Kolkata, India. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cylinder based oxygen delivery system hospital management intra hospital transfer oxygen delivery device EMTREE MEDICAL INDEX TERMS barotrauma device failure human letter risk factor thoracotomy volutrauma EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160518638 PUI L611204886 DOI 10.4103/0019-5049.186015 FULL TEXT LINK http://dx.doi.org/10.4103/0019-5049.186015 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 132 TITLE Suspected large vessel occlusion: Should emergency medical services transport to the nearest primary stroke center or bypass to a comprehensive stroke center with endovascular capabilities? AUTHOR NAMES Southerland A.M. Johnston K.C. Molina C.A. Selim M.H. Kamal N. Goyal M. AUTHOR ADDRESSES (Southerland A.M.; Johnston K.C., kj4v@virginia.edu) Departments of Neurology, University of Virginia Health System, PO Box 800394, Charlottesville, United States. (Southerland A.M.; Johnston K.C., kj4v@virginia.edu) Departments of Public Health Sciences, University of Virginia Health System, Charlottesville, United States. (Molina C.A.) Department of Neurology, Hospital Vall d'Hebron-Barcelona, Barcelona, Spain. (Selim M.H.) Department of Neurology, Beth Israel Deaconess Medical Center, Boston, United States. (Kamal N.; Goyal M., mgoyal@ucalgary.ca) Departments of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Seaman Family MR Research Center, 1403 29th St NW, Calgary, Canada. (Goyal M., mgoyal@ucalgary.ca) Departments of Radiology, University of Calgary, Foothills Medical Centre, Calgary, Canada. CORRESPONDENCE ADDRESS M. Goyal, Departments of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Seaman Family MR Research Center, 1403 29th St NW, Calgary, Canada. Email: mgoyal@ucalgary.ca SOURCE Stroke (2016) 47:7 (1965-1967). Date of Publication: 1 Jul 2016 ISSN 1524-4628 (electronic) 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE DRUG INDEX TERMS tissue plasminogen activator (intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular accident comprehensive stroke center emergency health service endovascular surgery health center primary stroke center EMTREE MEDICAL INDEX TERMS article brain ischemia computer assisted tomography health care quality human National Institutes of Health Stroke Scale neuroimaging outcome assessment patient selection practice guideline priority journal randomized controlled trial (topic) stroke patient stroke unit telemedicine thrombectomy workflow CAS REGISTRY NUMBERS tissue plasminogen activator (105913-11-9) EMBASE CLASSIFICATIONS Radiology (14) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Internal Medicine (6) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160165606 PUI L608644781 DOI 10.1161/STROKEAHA.115.011149 FULL TEXT LINK http://dx.doi.org/10.1161/STROKEAHA.115.011149 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 133 TITLE Challenges and Resources for New Critical Care Transport Crewmembers: A Descriptive Exploratory Study AUTHOR NAMES Alfes C.M. Steiner S. Rutherford-Hemming T. AUTHOR ADDRESSES (Alfes C.M., cms11@case.edu) Learning Resource Skills and Simulation Center, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, United States. (Steiner S.) Dorothy Ebersbach Academic Center for Flight Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, United States. (Rutherford-Hemming T.) Ursuline College and Case Western Reserve University Schools of Nursing, Cleveland, United States. CORRESPONDENCE ADDRESS C.M. Alfes, Learning Resource Skills and Simulation Center, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, United States. Email: cms11@case.edu SOURCE Air Medical Journal (2016) 35:4 (212-215). Date of Publication: 1 Jul 2016 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective The purpose of this study was to identify the challenges new crewmembers experience in the critical care transport (CCT) environment and to determine the most valuable resources when acclimating to the transport environment. To date, no study has focused on the unique challenges nor the resources most effective in CCT training. Methods This descriptive exploratory study was conducted with a convenience survey sent to the 3 largest professional CCT organizations: the Association of Air Medical Services, the Air and Surface Transport Nurses Association, and the Association of Critical Care Transport. Results The study survey responses revealed that more education and training are needed. Novice crewmembers identified areas in safety, communication, environment, and crew resource management as particularly challenging. Responses also validate the need for more simulation training, especially for CCT of low-volume/high-risk patient populations. Conclusion Results of this survey provide valuable insight for improving training effectiveness of health care professionals transitioning to the CCT environment. More information regarding best practice on the frequency and timing of CCT simulation training should be collected, particularly for simulations completed in the transport environment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport crew member critical care transport intensive care resource management EMTREE MEDICAL INDEX TERMS article exploratory research health care personnel high risk patient human medical society nurse nurse practitioner physician priority journal respiratory therapist simulation training EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160406112 MEDLINE PMID 27393756 (http://www.ncbi.nlm.nih.gov/pubmed/27393756) PUI L610567524 DOI 10.1016/j.amj.2016.04.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2016.04.006 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 134 TITLE Impact of intrahospital transport (known as « Tertiaries ») performed by Angers’s Smur on the SAMU’s activity ORIGINAL (NON-ENGLISH) TITLE Impact sur l’activité du SAMU 49 des transports médicalisés internes (dits « tertiaires ») réalisés au CHU par le Smur d’Angers AUTHOR NAMES Hamdan D. Schotté T. Roy P.M. Soulié C. Courjault Y. Carneiro B. Templier F. AUTHOR ADDRESSES (Hamdan D., hamdandavid@yahoo.fr; Courjault Y.; Templier F.) département de médecine d’urgence, CHU Angers, Samu 49, 4 rue Larrey, Angers cedex 9, France. (Schotté T.; Soulié C.; Carneiro B.) département de médecine d’urgence, CHU Angers, 4 rue Larrey, Angers cedex 9, France. (Roy P.M.) département de médecine d’urgence, CHU Angers, université d’Angers, 4 rue Larrey, Angers cedex 9, France. CORRESPONDENCE ADDRESS D. Hamdan, département de médecine d’urgence, CHU Angers, Samu 49, 4 rue Larrey, Angers cedex 9, France. Email: hamdandavid@yahoo.fr SOURCE Annales Francaises de Medecine d'Urgence (2016) 6:4 (258-262). Date of Publication: 1 Jul 2016 ISSN 2108-6591 (electronic) 2108-6524 BOOK PUBLISHER Springer-Verlag France, 22, Rue de Palestro, Paris, France. york@springer-paris.fr ABSTRACT Aims: At Angers, ward hospital, the organization of an ambulance ride complicates the intra-hospital transport. If this transport has to be medicalised it is called “tertiary transport”, and has to be performed by a Smur team of SAMU 49. This causes adverse organizational events (AOE) and a diminution of regulation’s reinforcement at the 15 Center. The aim was to study the consequences of this organization on the frequency of AOE and the frequency of periods with no regulation’s reinforcement available. Procedure: A prospective observational study has been conducted during 120 days in which we identified the AOE and the period of time with no regulation’s reinforcement available. The AOE were: the deficiencies, the delays and the disengagements of a Smur team. We first compared the frequency of AOE between periods with and without tertiary transport. We then compared the frequency of periods with no regulation’s reinforcement available between periods with and without tertiary transport. Results: We identified 156 AOE. The difference of AOE’s frequencies were significative between periods with and without tertiary transport (p<0,05). The difference of frequencies of periods with no regulation’s reinforcement available were significative between periods with and without tertiary transport (p<0,05). Conclusion: The actual planning of tertiary transports by a Smur team has a negative impact on SAMU 49’s organization. Corrective measures have been implemented in October 2014 and a new evaluation is essential. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency care EMTREE MEDICAL INDEX TERMS human observational study reinforcement LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 20160626500 PUI L611827059 DOI 10.1007/s13341-016-0663-7 FULL TEXT LINK http://dx.doi.org/10.1007/s13341-016-0663-7 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 135 TITLE Work conditions, mental workload and patient care quality: A multisource study in the emergency department AUTHOR NAMES Weigl M. Müller A. Holland S. Wedel S. Woloshynowych M. AUTHOR ADDRESSES (Weigl M., matthias.weigl@med.lmu.de; Holland S.) Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University, Ziemssenstr. 1, Munich, Germany. (Müller A.) Institute for Occupational and Social Medicine, University of Düsseldorf, Düsseldorf, Germany. (Wedel S.) Fürstenfeldbruck Hospital, Fürstenfeldbruck, Germany. (Woloshynowych M.) Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London, United Kingdom. CORRESPONDENCE ADDRESS M. Weigl, Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Munich University, Ziemssenstr. 1, Munich, Germany. Email: matthias.weigl@med.lmu.de SOURCE BMJ Quality and Safety (2016) 25:7 (499-508). Date of Publication: 1 Jul 2016 ISSN 2044-5415 BOOK PUBLISHER BMJ Publishing Group, subscriptions@bmjgroup.com ABSTRACT Background Workflow interruptions, multitasking and workload demands are inherent to emergency departments (ED) work systems. Potential effects of ED providers' work on care quality and patient safety have, however, been rarely addressed. We aimed to investigate the prevalence and associations of ED staff's workflow interruptions, multitasking and workload with patient care quality outcomes. Methods We applied a mixed-methods design in a two-step procedure. First, we conducted a time-motion study to observe the rate of interruptions and multitasking activities. Second, during 20-day shifts we assessed ED staff's reports on workflow interruptions, multitasking activities and mental workload. Additionally, we assessed two care quality indicators with standardised questionnaires: first, ED patients' evaluations of perceived care quality; second, patient intrahospital transfers evaluated by ward staff. The study was conducted in a medium-sized community ED (16 600 annual visits). Results ED personnel's workflow was disrupted on average 5.63 times per hour. 30% of time was spent on multitasking activities. During 20 observations days, data were gathered from 76 ED professionals, 239 patients and 205 patient transfers. After aggregating daywise data and controlling for staffing levels, prospective associations revealed significant negative associations between ED personnel's mental workload and patients' perceived quality of care. Conversely, workflow interruptions were positively associated with patient-related information on discharge and overall quality of transfer. Conclusions Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward patient care workload EMTREE MEDICAL INDEX TERMS doctor patient relation human major clinical study motion patient transport prevalence questionnaire workflow LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160554441 MEDLINE PMID 26350066 (http://www.ncbi.nlm.nih.gov/pubmed/26350066) PUI L611385243 DOI 10.1136/bmjqs-2014-003744 FULL TEXT LINK http://dx.doi.org/10.1136/bmjqs-2014-003744 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 136 TITLE An evaluation of intra-hospital transport outcomes from tertiary neonatal intensive care unit AUTHOR NAMES Bastug O. Gunes T. Korkmaz L. Elmali F. Kucuk F. Ozturk M.A. Kurtoglu S. AUTHOR ADDRESSES (Bastug O., drosman76@hotmail.com; Gunes T.; Korkmaz L.; Ozturk M.A.; Kurtoglu S.) Department of Pediatrics, Division of Neonatology, Kayseri, Turkey. (Elmali F.) Department of Biostatistics and Medical Bioinformatics, Kayseri, Turkey. (Kucuk F.) Department of Nursing, Erciyes University Medical Faculty, Kayseri, Turkey. CORRESPONDENCE ADDRESS O. Bastug, Department of Neonatology, Erciyes University, School of Medicine, Talas C Kayseri, Turkey. Email: drosman76@hotmail.com SOURCE Journal of Maternal-Fetal and Neonatal Medicine (2016) 29:12 (1993-1998). Date of Publication: 17 Jun 2016 ISSN 1476-4954 (electronic) 1476-7058 BOOK PUBLISHER Taylor and Francis Ltd, healthcare.enquiries@informa.com ABSTRACT Introduction: Patient transport has more important side effects in patients in the newborn age group than in other age groups. This study was performed to evaluate the intra-hospital transport of infants in the neonatal intensive care unit(NICU). Methods: A total of 284 babies hospitalized in the neonatal unit and transported inside the hospital were divided into three groups based on their weights at the time of transport. Their places of transport and important changes in the vital functions of the newborn that might have been caused by transport were recorded with a view to understand the vital effects of intra-hospital transport on the newborn. Results: In our unit, the primary reasons for transport were determined to be echocardiography and radiology (26.4% and 25.7%, respectively). In our study, hyperglycemia and hypothermia were among the statistically most significant side effects associated with transport (p < 0.05). It was found that 19% and 27% of the patients had hyperglycemia and hypothermia, respectively. There was a significant difference in the blood sugar levels and the body temperature between pre- and post-transport (p < 0.05). There were no significant differences in the pH, blood gas CO(2), heart rate and breath rate values between pre- and post-transport (p > 0.05). As expected, the complication rate was higher in babies with low weight. Conclusions: Current weight is useful for assessing the risks of untoward outcomes associated with intra-hospital transport. Protecting patients from hypothermia during the time spent outside of the NICU would reduce the risk of complications. EMTREE DRUG INDEX TERMS glucose (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit intrahospital transport patient transport tertiary neonatal intensive care unit EMTREE MEDICAL INDEX TERMS article birth weight blood carbon dioxide tension body temperature breath rate clinical evaluation controlled study disease predisposition echocardiography female glucose blood level heart rate human hyperglycemia (complication) hypothermia (complication) male newborn pH priority journal radiology respiratory tract parameters risk assessment risk reduction CAS REGISTRY NUMBERS glucose (50-99-7, 84778-64-3) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015348448 MEDLINE PMID 26335382 (http://www.ncbi.nlm.nih.gov/pubmed/26335382) PUI L605878296 DOI 10.3109/14767058.2015.1072158 FULL TEXT LINK http://dx.doi.org/10.3109/14767058.2015.1072158 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 137 TITLE Universal surveillance versus targeted surveillance in reduction of HA-MRSA in endemic setting AUTHOR NAMES Yuen T.K. Gillian L.L.X. Ming T.Y. Hua S.J. Amin I.M. Lin L.M. AUTHOR ADDRESSES (Yuen T.K.; Gillian L.L.X.; Ming T.Y.; Hua S.J.; Amin I.M.) Singapore General Hospital, Singapore. (Lin L.M.) Department of Infection Control, Singapore General Hospital, Singapore. CORRESPONDENCE ADDRESS T.K. Yuen, Singapore General Hospital, Singapore. SOURCE American Journal of Infection Control (2016) 44:6 (S100). Date of Publication: 2 Jun 2016 CONFERENCE NAME 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology, APIC 2016 CONFERENCE LOCATION Charlotte, NC, United States CONFERENCE DATE 2016-06-11 to 2016-06-13 ISSN 1527-3296 BOOK PUBLISHER Mosby Inc. ABSTRACT BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in Singapore with about 50% of all Staphyloccus aureus isolates reported as MRSA. This study aims to determine the impact of universal MRSA screening in reducing healthcare-associated MRSA (HA-MRSA) in an acute tertiary care hospital. METHODS: From 2007, high risk patient groups were screened for MRSA on admission (previous history of MRSA, history of hospitalization (local or overseas) in past 6 months, inter-hospital or intra-hospital transfers, history of stay at long-term care facilities in past 6 months, end stage renal failure patient requiring dialysis and length of stay more than 7 days as an inpatient). This was changed to universal MRSA screening for all admissions from May 2014. Screening swabs taken from nasal, axillae and groins were put in enrichment broth before plating onto chromogenic agar at the Microbiology Laboratory. Nurse-led ordering system was also implemented to facilitate good compliance to screening. MRSA patients are identified on clinical management system and an orange sticker is placed at all documents and bedside to alert all staffs to practise Contact Precautions as well as cleaning of environment with sodium hypochlorite 1000 ppm. MRSA rates are displayed monthly on the Infection Control dashboard for all stakeholders to review. RESULTS: HA-MRSA rate is reduced from0.82 per 1000 patient days (June 13-April 14) to 0.68 per 1000 patient days following universal screening (May 14-August 15) [p: 0.015, paired t-test]. There was no significant reduction in HA-MRSA bacteraemia following universal screening [0.99 per 10,000 patient days (June 13-April 14) and 1.05 per 10,000 patient days (May 14 to August 15); p: 0.823, paired t-test]. CONCLUSIONS: Universal screening with combination of infection control practices significantly reduced HA-MRSA in the endemic setting. Reduction of HA-MRSA bacteremia may need decolonization measures to be included in the program. EMTREE DRUG INDEX TERMS agar hypochlorite sodium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) epidemiology infection control methicillin resistant Staphylococcus aureus EMTREE MEDICAL INDEX TERMS axilla dialysis end stage renal disease environment health care high risk patient hospital hospital patient hospitalization human inguinal region laboratory length of stay long term care methicillin resistant Staphylococcus aureus infection microbiology nurse patient screening Singapore Student t test tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72334455 DOI 10.1016/j.ajic.2016.04.134 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajic.2016.04.134 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 138 TITLE Mass gatherings: Experience and difficulties in elaborating an ebola virus disease outbreak response plan in a private hospital in Brazil AUTHOR NAMES De Miranda B.G. Cais D. Nunes J. Duarte L. Moura M.L. Costa A. AUTHOR ADDRESSES (De Miranda B.G.) Hospital Samaritano De São Paulo, Brazil. (Cais D.) Infection Control Team Leader, Hospital Samaritano, Brazil. (Nunes J.; Duarte L.; Moura M.L.; Costa A.) Infection Control Team, Hospital Samaritano, Brazil. CORRESPONDENCE ADDRESS B.G. De Miranda, Hospital Samaritano De São Paulo, Brazil. SOURCE American Journal of Infection Control (2016) 44:6 (S123-S124). Date of Publication: 2 Jun 2016 CONFERENCE NAME 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology, APIC 2016 CONFERENCE LOCATION Charlotte, NC, United States CONFERENCE DATE 2016-06-11 to 2016-06-13 ISSN 1527-3296 BOOK PUBLISHER Mosby Inc. ABSTRACT BACKGROUND: The 2014 Ebola Virus Disease (EVD) outbreak in West Africa raised high concern around the world due to its high lethality and contagiousness. Even with low risk of epidemic striking in Brazil, it was imperative to develop a response plan for management of suspected EVD cases, intending to minimize the occupational risks. We aimed to describe the main challenges on implementation of a response plan to EVD outbreak in a 300-bed private hospital in Brazil. METHODS: In August 2014, Infection Control Team (ICT) started internal discussions to implement a detailed plan for initial management of suspect EVD cases, including its correct identification, adequate use of personal protective equipment (PPE), intrahospital transport, sanity authorities notification and transport to referring hospital. Some adaptations from international guidelines recommendations to Brazilian reality were necessary. RESULTS: The plan implementation faced several difficulties: first, the guarantee of healthcare worker (HCW) security during the suspected case transport from reception area to the designated room, which required a 170-feet displacement without traffic on that route; second, the divergences between national and international recommendations about the sequence of putting in and taking off the PPE and its several steps required the presence of an ICT nurse besides the HCW during this process; third, training professionals in four shifts required six days of almost exclusive dedication by the ICT; fourth, there was a delay on acquisition of adequate PPE due to its high cost and low availability. CONCLUSIONS: Although there was no suspect EVD case in the institution, the elaboration of a response plan to the EVD outbreak resulted in a good experience for the service regarding the preparation for future mass gatherings. The involvement of the ICT as a supportive area was essential to improve the confidence of multi professional team on the first care of emergency epidemiologic situations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Brazil Ebolavirus epidemic epidemiology infection control private hospital virus infection EMTREE MEDICAL INDEX TERMS adaptation Africa Brazilian emergency health care personnel hospital human lethality nurse occupational hazard protective equipment receptive field risk traffic LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72334472 DOI 10.1016/j.ajic.2016.04.148 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajic.2016.04.148 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 139 TITLE The prognostic significance of the birmingham vasculitis activity score (BVAS) in patients with systemic vasculitis transferred to the intensive care unit (ICU) AUTHOR NAMES Biscetti F. Carbonella A. Parisi F. Cianci F. Bosello S.L. Tolusso B. Gremese E. Ferraccioli G. AUTHOR ADDRESSES (Biscetti F.; Carbonella A.; Parisi F.; Cianci F.; Bosello S.L.; Tolusso B.; Gremese E.; Ferraccioli G.) Rheumatology, Catholic University, School of Medicine, Rome, Italy. CORRESPONDENCE ADDRESS F. Biscetti, Rheumatology, Catholic University, School of Medicine, Rome, Italy. SOURCE Annals of the Rheumatic Diseases (2016) 75 Supplement 2 (1090). Date of Publication: 1 Jun 2016 CONFERENCE NAME Annual European Congress of Rheumatology of the European League Against Rheumatism, EULAR 2016 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2016-06-08 to 2016-06-11 ISSN 1468-2060 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background: 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) [1]. Birmingham Vasculitis Activity Score (BVAS) is the most widely used generic tool to quantify disease activity in systemic vasculitis. Acute Physiology And Chronic Health Evaluation (APACHE II) is a simple and accurate assessment scale of the severity of disease in critically ill patients newly admitted to ICU. Objectives: The aim of this study was to identify possible prognostic biomarkers for patients with vasculitis admitted to ICU. Methods: A retrospective study was carried out from 2004 to 2014 in patients with systemic vasculitis admitted to the Rheumatology division and transferred to ICU due to clinical worsening, with a length of stay beyond 24 hours. An additional group of patients admitted to ICU, and without history of systemic vasculitis, were used as a matched-control group. A total of 25 patients were included in the analysis. Results: 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 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 were significantly related to the mortality in ICU (p<0.01). Conclusions: BVAS appears to be an excellent tool for assessing ICU mortality risk of patients with systemic vasculitides 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. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit systemic vasculitis EMTREE MEDICAL INDEX TERMS APACHE clinical article control group controlled study critically ill patient human length of stay mortality risk retrospective study rheumatology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L612779318 DOI 10.1136/annrheumdis-2016-eular.3502 FULL TEXT LINK http://dx.doi.org/10.1136/annrheumdis-2016-eular.3502 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 140 TITLE Presentation and Management of Venomous Snakebites: Should All Patients Be Transferred to a Tertiary Referral Hospital? AUTHOR NAMES Irion V.H. Barnes J. Montgomery B.E. Suva L.J. Montgomery C.O. AUTHOR ADDRESSES (Irion V.H., virion919@yahoo.com) Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Barnes J.; Montgomery B.E.; Suva L.J.; Montgomery C.O.) SOURCE Journal of surgical orthopaedic advances (2016) 25:2 (69-73). Date of Publication: 1 Jun 2016 ISSN 1548-825X ABSTRACT Venomous snakebites may be difficult to manage because of the varied clinical presentations that may lead to uncertainty regarding the most appropriate medical and surgical management. Frequently, snakebite victims are referred from smaller rural hospitals to larger tertiary centers offering more specialized services and care. A retrospective chart review was performed using medical records from both adult and pediatric hospitals in a rural state over a 7-year period (January 2004 to January 2011) to investigate the utility of intensive care and specialized medical services offered at tertiary referral centers. The results demonstrated that presentation of venomous snakebites is the same in adults and children as well as the management. The results also demonstrated that the use of supportive care and antivenin alone was successful in the management of the vast majority of snakebites. Most snakebite victims recovered with nonsurgical care; thus surgical intervention is rarely warranted. These findings demonstrate that snakebite victims may not need referral to a tertiary center, if the primary local hospital has supportive care capacity and familiarity with antivenin usage. EMTREE DRUG INDEX TERMS venom antiserum (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Agkistrodon patient transport tertiary care center EMTREE MEDICAL INDEX TERMS adult age distribution animal child cohort analysis female hospital human intensive care unit lower limb male patient referral retrospective study season sex ratio snakebite (epidemiology, therapy) time to treatment United States upper limb LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27518288 (http://www.ncbi.nlm.nih.gov/pubmed/27518288) PUI L616046666 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 141 TITLE High-frequency percussive ventilation during neonatal transportation: A pilot study AUTHOR NAMES Colomb B. Kolev-Descamp K. Marie Petion A. Queudet L. Savajols E. Litzler-Renault S. Semama D. AUTHOR ADDRESSES (Colomb B., benoit.colomb@chu-dijon.fr; Litzler-Renault S.) Réanimation Pédiatrique Polyvalente, Chu Dijon, Dijon, France. (Kolev-Descamp K.) Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Bron, France. (Marie Petion A.; Queudet L.) Smur Pédiatrique, Chu Dijon, Dijon, France. (Savajols E.; Semama D.) Pédiatrie 2, Chu Dijon, Dijon, France. CORRESPONDENCE ADDRESS B. Colomb, Réanimation Pédiatrique Polyvalente, Chu Dijon, Dijon, France. Email: benoit.colomb@chu-dijon.fr SOURCE Annals of Intensive Care (2016) 6 SUPPL. 1. Date of Publication: June 2016 CONFERENCE NAME French Intensive Care Society, International Congress - Reanimation 2016 CONFERENCE LOCATION Paris, France CONFERENCE DATE 2016-01-13 to 2016-01-15 ISSN 2110-5820 BOOK PUBLISHER Springer Verlag ABSTRACT Introduction Neonatal respiratory distress syndrome (RDS) is a frequent medical condition encountered in preterm neonates. Outborn neonates with RDS may require mechanical ventilation (MV) and surfactant therapy before their transportation to the tertiary neonatal intensive care unit (NICU). High-frequency percussive ventilation (HFPV) has previously been used for management of RDS in neonates hospitalized in NICU. The aim of the present study was to assess the feasibility and safety of HFPV for the management of neonatal RDS during transportation. Patients and methods We performed a retrospective observational monocentric study from September 2008 to August 2011. All outborn neonates requiring invasive mechanical ventilation for RDS before their transportation were included. Neonates with severe malformations and those transported after 48 h of life were not included. When required, HFPV was provided by the Sinusoidal Bronchotron™ device (IMAPe®). For each infant, we recorded the mode of mechanical ventilation (conventional vs. HFPV), the evolution of SpO(2)/FiO(2) ratio, and maternal and neonatal characteristics. Our main outcome was SpO(2)/ FiO(2) ratio, 1 h after initiation of either conventional mechanical ventilation or HFPV (M60). The comparison was stratified by range of gestational age: <28, 28-31, 32-37, >37 weeks GA. In order to examine SpO(2)/FiO(2) ratio in relation to mode of ventilation, we defined potential confounding variables: baseline SpO(2)/FiO(2) ratio observed at the initiation of MV, obstetrical, maternal and neonatal characteristics. Categorical variables were compared using Chi square or Fisher's test as needed while continuous variables were compared using Student's t test. For main outcome, a multivariate analysis was performed using linear regression. p values <0.05 were considered statistically significant. Results Out of the 169 neonates included in the study, 57 received HFPV while 112 were placed on conventional mechanical ventilation (CMV). Univariate analysis for obstetrical, demographic and neonatal data showed no statistical difference between HFPV and CMV group whatever the gestational age, except for Apgar score at 1' and 5' which was significantly lower in the neonates aged 37 weeks or more and receiving HFPV. In 28-31 and 32-37 weeks subgroups, baseline SpO(2)/FiO(2) ratio was found significantly lower in infants receiving HFPV and this ratio remained lower after 1 h of ventilation. In the more mature infants, HFPV was associated with a higher increase in SpO(2)/FiO(2) ratio when compared to CMV, but this difference failed to reach statistical significance. After multivariate analysis, the main determinant for SpO(2)/FiO(2) ratio at M60 was the baseline value of this ratio. Noteworthy that complications usually associated with mechanical ventilation were not reported in this study. Discussion This observational study emphasizes the feasibility and safety of HFPV in neonatal transportation. The use of both HFPV and CMV resulted in favorable respiratory outcome. The significant initial lower values of SpO(2)/FiO(2) ratio in neonates between 28 and 37 weeks requiring HFPV may be explained by the retrospective design of the study. It is indeed reasonable to suspect that the more severe forms of RDS were immediately ventilated with HPFV. Conclusion To our knowledge, this is the first study to assess the feasibility and safety of HFPV during neonatal transportation. More studies are necessary to confirm these results and define the indications for HFPV. EMTREE DRUG INDEX TERMS surfactant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air conditioning intensive care pilot study resuscitation society traffic and transport EMTREE MEDICAL INDEX TERMS Apgar score artificial ventilation confounding variable congenital malformation devices Fisher exact test gestational age human infant intensive care unit linear regression analysis multivariate analysis neonatal respiratory distress syndrome newborn newborn intensive care observational study patient prematurity respiratory distress syndrome retrospective study safety statistical significance Student t test therapy univariate analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72342803 DOI 10.1186/s13613-016-0114-z FULL TEXT LINK http://dx.doi.org/10.1186/s13613-016-0114-z COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 142 TITLE Transportation of children on extracorporeal membrane oxygenation: 1-year experience of a tertiary referral center in the Paris region AUTHOR NAMES Rambaud J. Leger P.-L. Larroquet M. Amblard A. Lode N. Guilbert J. Jean S. Guellec I. Casadevall I. Kessous K. Walti H. Carbajal R. AUTHOR ADDRESSES (Rambaud J., jerome.rambaud@aphp.fr; Leger P.-L.; Amblard A.; Guilbert J.; Jean S.; Guellec I.; Walti H.; Carbajal R.) Réanimation Pédiatrique Et Néonatale, Hopital Pour Enfants Trousseau, Paris, France. (Larroquet M.) Chirugie Pédiatrique, Hopital Pour Enfants Trousseau, Paris, France. (Lode N.; Casadevall I.; Kessous K.) Smur Pédiatrique, Robert Debré, Paris, France. CORRESPONDENCE ADDRESS J. Rambaud, Réanimation Pédiatrique Et Néonatale, Hopital Pour Enfants Trousseau, Paris, France. Email: jerome.rambaud@aphp.fr SOURCE Annals of Intensive Care (2016) 6 SUPPL. 1. Date of Publication: June 2016 CONFERENCE NAME French Intensive Care Society, International Congress - Reanimation 2016 CONFERENCE LOCATION Paris, France CONFERENCE DATE 2016-01-13 to 2016-01-15 ISSN 2110-5820 BOOK PUBLISHER Springer Verlag ABSTRACT Introduction Extracorporeal membrane oxygenation (ECMO) is used as a rescue therapy in patients with severe and refractory respiratory and/or hemodynamic failure. Ideally, neonates or children candidates for ECMO support should be transferred to a referral ECMO center. However, sometimes patients are too ill to be safely moved with conventional ventilator support. In these situations, ECMO cannulation at the referring facility and transfer by a transport ECMO team is a potentially lifesaving intervention. With a 25-year experience on neonatal and pediatric ECMO, the pediatric intensive care unit and the pediatric surgery unit of the Armand-Trousseau Hospital in Paris developed in November 2014 a transport ECMO team. This mobile team has been developed in collaboration with the Robert Debré emergency transport unit and the Civil Security of Paris. We report the first-year experience of this mobile team. Patients and methods We retrospectively reviewed all neonatal and pediatric ECMO transports from November 2014 through September 2015. Reviewed data included referring facility, mode and duration of transport, type of ECMO, clinical severity score (PaO(2)/FiO(2), inotrope score) and laboratory tests (lactate, pH) before and after transport. Results Twenty-two requests for intervention of the mobile team were received. In 8 cases, the team intervention was not deemed necessary or exceeded status. In 14 cases, the mobile team travelled to the referring center. In one case the child was transported on conventional ventilation, and in 2 patients ECMO cannulation was not possible because of vascular problems. Eleven patients, including 4 neonates and 7 children, were transported on ECMO support. One patient was cannulated in our PICU and then transported to a pulmonary transplantation center. The median (range) run distance and round-trip duration were 117 km (4-392 km) and 8 h (2-13 h), respectively. Nine (81 %) transports were on venous-arterial ECMO and two (19 %) on venous-venous ECMO. Median (range) pre-ECMO cannulation pH, lactate, PaO(2)/FiO(2) and inotrope score were, respectively, 7.03 (6.67-7.27), 5.5 mmol/L (0.6-13.8 mmol/L), 36 (24-127) and 568 (50-890). Corresponding post-ECMO cannulation values were 7.33 (7.17-7.43), 2.8 mmol/L (1-12.6 mmol/L) and 60 (0 à 310). No adverse events during ECMO transport were noticed. Discussion This first-year experience suggests that the development of the first neonatal and pediatric mobile ECMO team in the north of France. This rapidly increased activity meets a significant need for ECMO support in children too critically ill to be moved on conventional therapy. The ECMO rapidly improved respiratory and hemodynamic parameters allowing transportation in good conditions to our ECMO center. It allows children hospitalized in non-ECMO centers to benefit from this rescue treatment. It contributes to improve the access to the continuity of health care in France. Conclusion Implantations and transportations of children on ECMO supports can be proposed to children with refractory respiratory or circulatory diseases and now accessible in a large perimeter around Paris region. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child extracorporeal oxygenation France human intensive care resuscitation society tertiary care center traffic and transport EMTREE MEDICAL INDEX TERMS air conditioning cannulation critically ill patient diseases emergency health care hemodynamic parameters hospital implantation intensive care unit laboratory test lung transplantation newborn patient pediatric surgery perimeter pH therapy ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72342810 DOI 10.1186/s13613-016-0114-z FULL TEXT LINK http://dx.doi.org/10.1186/s13613-016-0114-z COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 143 TITLE Impact of Telemedicine on Severity of Illness and Outcomes among Children Transferred from Referring Emergency Departments to a Children's Hospital PICU AUTHOR NAMES Dayal P. Hojman N.M. Kissee J.L. Evans J. Natale J.E. Huang Y. Litman R.L. Nesbitt T.S. Marcin J.P. AUTHOR ADDRESSES (Dayal P., pdayal@ucdavis.edu; Hojman N.M.; Kissee J.L.; Evans J.; Natale J.E.; Huang Y.; Litman R.L.; Nesbitt T.S.; Marcin J.P.) Department of Pediatrics, University of California, Davis Sacramento, United States. CORRESPONDENCE ADDRESS P. Dayal, Department of Pediatrics, University of California, Davis Sacramento, United States. Email: pdayal@ucdavis.edu SOURCE Pediatric Critical Care Medicine (2016) 17:6 (516-521). Date of Publication: 1 Jun 2016 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objectives: To compare the severity of illness and outcomes among children admitted to a children's hospital PICU from referring emergency departments with and without access to a pediatric critical care telemedicine program. Design: Retrospective cohort study. Setting: Tertiary academic children's hospital PICU. Patients: Pediatric patients admitted directly to the PICU from referring emergency departments between 2010 and 2014. Interventions: None. Measurements: Demographic factors, severity of illness, and clinical outcomes among children receiving care in emergency departments with and without access to pediatric telemedicine, as well as a subcohort of children admitted from emergency departments before and after the implementation of telemedicine. Main Results: Five hundred eighty-two patients from 15 emergency departments with telemedicine and 524 patients from 60 emergency departments without telemedicine were transferred and admitted to the PICU. Children admitted from emergency departments using telemedicine were younger (5.6 vs 6.9 yr; p< 0.001) and less sick (Pediatric Risk of Mortality III score, 3.2 vs 4.0; p < 0.05) at admission to the PICU compared with children admitted from emergency departments without telemedicine. Among transfers from emergency departments that established telemedicine programs during the study period, children arrived significantly less sick (mean Pediatric Risk of Mortality III scores, 1.2 units lower; p = 0.03) after the implementation of telemedicine (n = 43) than before the implementation of telemedicine (n = 95). The observed-to-expected mortality ratios of posttelemedicine, pretelemedicine, and no-telemedicine cohorts were 0.81 (95% CI, 0.53-1.09), 1.07 (95% CI, 0.53-1.60), and 1.02 (95% CI, 0.71-1.33), respectively. Conclusions: The implementation of a telemedicine program designed to assist in the care of seriously ill children receiving care in referring emergency departments was associated with lower illness severity at admission to the PICU. This study contributes to the body of evidence that pediatric critical care telemedicine programs assist referring emergency departments in the care of critically ill children and could result in improved clinical outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disease severity intensive care unit telemedicine EMTREE MEDICAL INDEX TERMS article child emergency ward human intensive care length of stay major clinical study mortality priority journal retrospective study EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160322868 MEDLINE PMID 27099972 (http://www.ncbi.nlm.nih.gov/pubmed/27099972) PUI L610067642 DOI 10.1097/PCC.0000000000000761 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000761 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 144 TITLE BMR-06 - Investigations about 2 cases of oxa-23, per-7 Acinetobacter baumannii outbreaks occurring in an intensive care unit before and after its relocation ORIGINAL (NON-ENGLISH) TITLE BMR-06 - Investigations autour de 2 épidémies à Acinetobacter baumannii oxa-23, per-7, survenues dans une unité de soins intensifs avant et après son déménagement AUTHOR NAMES Kadi A. Seytre D. Potron A. Saada N. Billard-Pomares T. Jacolot A. Van Der Meersch G. Picard B. Carbonnelle E. AUTHOR ADDRESSES (Kadi A.; Seytre D.; Saada N.; Billard-Pomares T.; Jacolot A.; Van Der Meersch G.; Picard B.; Carbonnelle E.) CHU Avicenne, Bobigny, France. (Potron A.) CHRU, Besançon, France. SOURCE Medecine et Maladies Infectieuses (2016) 46:4 (26). Date of Publication: 1 Jun 2016 ISSN 1769-6690 (electronic) 0399-077X BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter infection (epidemiology) epidemic intensive care unit EMTREE MEDICAL INDEX TERMS article EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English, French EMBASE ACCESSION NUMBER 20170046754 PUI L614068924 DOI 10.1016/S0399-077X(16)30315-8 FULL TEXT LINK http://dx.doi.org/10.1016/S0399-077X(16)30315-8 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 145 TITLE The critical care air transport experience Topical Collection on Pulmonology in Combat Medicine AUTHOR NAMES Crawley P.G. AUTHOR ADDRESSES (Crawley P.G., peter.crawley@us.af.mil) Pulmonary Department, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr, San Antonio, United States. CORRESPONDENCE ADDRESS P.G. Crawley, Pulmonary Department, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr, San Antonio, United States. Email: peter.crawley@us.af.mil SOURCE Current Pulmonology Reports (2016) 5:2 (77-85). Date of Publication: 1 Jun 2016 ISSN 2199-2428 (electronic) BOOK PUBLISHER Springer US ABSTRACT There have been over 8000 documented patients transported by US Air Force critical care air transport teams (CCATT) since the beginning of US military involvement in Iraq and Afghanistan (Ingalls et al. in JAMA 149:807-13, 2014). As part of the joint service, integrated and multi-tiered aeromedical evacuation system (AES), critically ill or injured service members are transported by CCATT on tactical (short range, within a theatre of operations) and strategic (long range, between theatres of operation) missions. Within the AE system, patients move through five echelons of care, beginning with care at the point of injury and culminating at major military medical centers in the United States. Patients with critical injuries sustained during support of Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) are first transported to Landstuhl Regional Medical Center (LRMC) in Germany where they are further stabilized for transport back to US facilities. Flight times between evacuation hospitals within the theatre of operations and LRMC can be as long as nine hours. During transport, CCATT monitor patients and continue ongoing resuscitation and treatment plans. Teams are equipped and prepared to intervene should emergent care be required. Critical patients transported to LRMC will often undergo further surgery and frequently require ICU level care with CCATT for transport from LRMC back to the USA. During the peak of conflicts in Iraq and Afghanistan, aeromedical evacuation of critical patients from the point of injury back to the US typically took 2-4 days (Dorlac et al. in J Trauma 66:S164-71, 2009). The paradigm of transporting "stabilizing" patients, even those with severe traumatic injuries over transcontinental distances and often just hours after initial damage control surgery, is supported by a 0.02 % en route mortality rate and a 98 % survival rate among individuals wounded in OIF/OEF that are transported back to LRMC (Ingalls et al. in JAMA 149:807-13, 2014). The long-range transport of critical patients in the austere environment of a military aircraft creates unique challenges for the transport team and is a vital part of the evolving globally mobile medical support apparatus. This article describes both the role of Air Force CCATT within the context of the integrated military AES and the CCATT mission experience in the deployed environment. The role of specialized transport teams and the expanding role of CCATT in a variety of noncombat operations will also be discussed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport experience intensive care EMTREE MEDICAL INDEX TERMS Afghanistan altitude article emergency health service flight human injury Iraq medical education military medicine oxygen consumption patient safety priority journal rescue personnel survival rate teamwork United States EMBASE CLASSIFICATIONS Occupational Health and Industrial Medicine (35) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170767297 PUI L619012459 DOI 10.1007/s13665-016-0148-6 FULL TEXT LINK http://dx.doi.org/10.1007/s13665-016-0148-6 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 146 TITLE Pediatric transport medicine and the dawn of the pediatric anesthesiology and critical care medicine subspecialty: An interview with pioneer Dr. Alvin Hackel AUTHOR NAMES Mai C.L. Ahmed Z. Maze A. Noorulla F. Yaster M. AUTHOR ADDRESSES (Mai C.L., cmai1@partners.org) Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, United States. (Mai C.L., cmai1@partners.org) Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, United States. (Ahmed Z.) Anesthesia Asociates of Ann Arbor, Wayne State University, Detroit, United States. (Maze A.) Valley Anesthesiology and Pain Consultants, Phoenix, United States. (Noorulla F.) Wayne State University School of Medicine, Detroit, United States. (Yaster M.) Departments of Anesthesiology, Critical Care Medicine and Pediatrics, Johns Hopkins University, Baltimore, United States. CORRESPONDENCE ADDRESS C.L. Mai, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, United States. Email: cmai1@partners.org SOURCE Paediatric Anaesthesia (2016) 26:5 (475-480). Date of Publication: 1 May 2016 ISSN 1460-9592 (electronic) 1155-5645 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com ABSTRACT Dr. Alvin 'Al' Hackel (1932-) Professor Emeritus of Anesthesiology, Perioperative and Pain Medicine, and Pediatrics at the Stanford University School of Medicine, has been an influential pioneer in shaping the scope and practice of pediatric anesthesia. His leadership helped to formally define the subspecialty of pediatric anesthesiology ('who is a pediatric anesthesiologist?') and the importance of specialization and regionalization of expertise in both patient transport and perioperative care. His enduring impact on pediatric anesthesia and critical care practice was recognized in 2006 by the American Academy of Pediatrics when it bestowed upon him the profession's highest lifetime achievement award, the Robert M. Smith Award. Of his many contributions, Dr. Hackel identifies his early involvement in the development of pediatric transport medicine as well as the subspecialty of pediatric anesthesiology as his defining contribution. Based on a series of interviews held with Dr. Hackel between 2009 and 2014, this article reviews the early development of transportation medicine and the remarkable career of a pioneering pediatric anesthesiologist. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesiology intensive care patient transport pediatric anesthesiology pediatric transport medicine pediatrics EMTREE MEDICAL INDEX TERMS accreditation achievement awards and prizes history human leadership medical practice medical society perioperative period practice guideline priority journal review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160237088 MEDLINE PMID 26992643 (http://www.ncbi.nlm.nih.gov/pubmed/26992643) PUI L609167184 DOI 10.1111/pan.12880 FULL TEXT LINK http://dx.doi.org/10.1111/pan.12880 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 147 TITLE The impact of transfer on pediatric trauma outcomes AUTHOR NAMES Locke T. Rekman J. Brennan M. Nasr A. AUTHOR ADDRESSES (Locke T., tlock016@uottawa.ca; Nasr A., anasr@cheo.on.ca) University of Ottawa Medical School, 451 Smyth Road, Ottawa, Canada. (Locke T., tlock016@uottawa.ca; Brennan M.; Nasr A., anasr@cheo.on.ca) Department of Pediatric Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Canada. (Rekman J., janellerekman@gmail.com) University of Ottawa, Division of General Surgery, Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Canada. (Nasr A., anasr@cheo.on.ca) Division Pediatric General Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Canada. CORRESPONDENCE ADDRESS A. Nasr, Division Pediatric General Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Canada. Email: anasr@cheo.on.ca SOURCE Journal of Pediatric Surgery (2016) 51:5 (843-847). Date of Publication: 1 May 2016 ISSN 1531-5037 (electronic) 0022-3468 BOOK PUBLISHER W.B. Saunders ABSTRACT Background Recently, concerns have been raised over delays that result from transferring patients to designated trauma centers. This study aimed to assess whether transfer status had an impact on pediatric trauma outcomes. Methods Using a local 1996-2014 pediatric trauma database containing 1541 patients, the following outcomes were tested: death, major complication, time to definitive treatment (TDT), hospital length of stay (LOS), and ICU length of stay (ICU LOS). Logistic, generalized linear, and Poisson regression models were used. Results Mortality and complication rates did not differ significantly between direct (mortality = 52/1000, complications = 54/1000) and transferred (mortality = 59/1000; complications = 67/1000) patients (mortality aRR: 1.17, 95% CI: 0.76-1.80, p = 0.48; complication aRR: 1.13, 95% CI: 0.75-1.70, p = 0.57). Transfer status was not a significant predictor of ICU LOS (p = 0.72). Transfer status was a significant predictor of time to definitive treatment (transfer x-= 17.4 h vs. direct x-= 2.6 h, p = 0.0035) and of LOS for severely injured patients (p = 0.005). The significant predictors of pediatric trauma mortality were: ISS, transport mode, age, and TDT, and of major complication were ISS and TDT. Conclusions Although transferred patients had longer time to specialized care, there were no significant differences in the mortality or complication rates between transferred and direct patients after adjusting for injury severity. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood injury outcome assessment patient transport EMTREE MEDICAL INDEX TERMS adolescent child conference paper death female hospitalization human infant intensive care unit length of stay male mortality predictor variable preschool child priority journal school child EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160169897 MEDLINE PMID 26932250 (http://www.ncbi.nlm.nih.gov/pubmed/26932250) PUI L608674272 DOI 10.1016/j.jpedsurg.2016.02.035 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpedsurg.2016.02.035 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 148 TITLE Factors associated with early death in burn transfer patients AUTHOR NAMES Savetamal A. Rotta S.A. AUTHOR ADDRESSES (Savetamal A.; Rotta S.A.) Bridgeport Hospital, Bridgeport, CT; Bridgeport Hospital, West Haven, CT CORRESPONDENCE ADDRESS A. Savetamal, SOURCE Journal of Burn Care and Research (2016) 37 SUPPL. 1 (S177). Date of Publication: May-June 2016 CONFERENCE NAME 48th Annual Meeting of the American Burn Association CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2016-05-03 to 2016-05-06 ISSN 1559-0488 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The creation of regional burn centers has streamlined patient care and dramatically improved morbidity and mortality after burn injury. However, there are some patients with such devastating injuries that death occurs within the first 48 hours of transfer. For these patients and their families, urgent transfer can intensify stress, create prognostic confusion, and increase the expense of an already unimaginable situation. After discussion with some of our referring hospitals, we sought to investigate which, if any, pre-hospital factors were associated with early death after transfer to our burn unit. Methods: A retrospective analysis of deaths in burn patients from September 2011 through September 2015 was undertaken. Patient data including age, TBSA, burn etiology, inhalation injury, CPR prior to burn unit arrival, patient co-morbidities, and length of stay in the burn unit prior to death were collected. Results: In total, 36 patient deaths were observed in the study time period, 16 of which occurred within 48 hours of admission. After applying Fisher's exact test to the early death and later death groups, significant associations were found between early death and pre burn unit CPR (p = 0.003) as well as inhalation injury (p=0.0448). Structure fire as the etiology of the burn was not a significant factor and patient comorbidities were quite varied and non-predictive. Age and TBSA, (after analysis with student's T test) were not found to be significant predictors of death within 48 hours of burn injury (p=0.23 and p= 0.45). Average age for the early death group was 54.07 years versus 63.18 years in the late death group; mean TBSA for the study population was 28.20% in the early death patients and 34.18% in the late death group. Conclusions: Patients transferred to our burn unit that died within 48 hours of admission were more likely to have received pre-transfer CPR and were more likely to have suffered an inhalation injury compared to patients that died later in their hospital course. Applicability of Research to Practice: Identifying burn patients that have a high likelihood of death within 48 hours of injury can help transferring and receiving facilities set expectations and convey prognostic information to family members prior to patient transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American death human patient EMTREE MEDICAL INDEX TERMS burn burn patient burn unit etiology fire Fisher exact test hospital inhalation injury length of stay morbidity mortality patient care patient coding patient transport population Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72281637 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 149 TITLE Are staff identification badges a vector for pathogen transfer AUTHOR NAMES Taylor D.E. Durkee P. James L. Madsen H. Fowler L. Gottschlich M.M. Warden G.D. Warner P. AUTHOR ADDRESSES (Taylor D.E.; Durkee P.; James L.; Madsen H.; Fowler L.; Gottschlich M.M.; Warden G.D.; Warner P.) Shriners Hospitals for Children, Cincinnati, United States. CORRESPONDENCE ADDRESS D.E. Taylor, Shriners Hospitals for Children, Cincinnati, United States. SOURCE Journal of Burn Care and Research (2016) 37 SUPPL. 1 (S180). Date of Publication: May-June 2016 CONFERENCE NAME 48th Annual Meeting of the American Burn Association CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2016-05-03 to 2016-05-06 ISSN 1559-0488 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Health Care Workers (HCW) are required to display identity badges. In addition to the identification (ID) badge, other cards are worn for quick reference and allow access to electronic health records. Badges are handled frequently, have potential for patient contact and could act as a vector for transmission of organisms. The purpose of this study was to determine if ID badges worn by HCW harbor potential bacterial pathogens that might contribute to pathogens identified in the burn unit. Methods: Microbiological samples of 100 badge components (ID, badge holder, smart card and other protocol badge cards) were obtained from a cross-section of clinical staff (n=31) at a pediatric hospital dedicated to treatment of burns, plastic and reconstructive conditions from February to September 2015. Components were cultured for bacterial growth using standard lab procedures, stratifying for nosocomial pathogens. Comparisons of positive cultures between ICU nurses and other clinical staff were made by χ2 tests and by Fisher's exact test when sample sizes were low. Results: Ten ICU nurses, 5 non-ICU nurses, 3 pharmacists, 3 radiology techs, 2 physicians, 2 respiratory therapists and 6 from other disciplines participated in this study. Fifty-seven (57%) of 100 samples were no growth, thirty-eight (38%) grew commensal skin flora and 5 (5%) had a potential pathogen identified (Enterobacter aerogenes, Enterobacter agglomerans, Pantoea agglomerans, and Staphylococcus aureus). There were no significant differences between ICU nurses and other patient care staff in the recovery of potential pathogens. Conclusions: Our study demonstrated a 5% incidence of potentially pathogenic contamination. This result adds to the growing data suggesting HCW clothing and equipment as potential vectors, albeit a small risk observed at our facility. It is not easy to establish the precise role that identity badges play in the transmission of pathogens to patients. Even when hand hygiene practices have been followed, badges are constantly touched, which may re-contaminate hands with pathogens. It is speculated that the practice of regular decontamination of ID cards may reduce the potential threat of bacterial transmission and improve patient safety. Applicability of Research to Practice: HCW need to be aware that identity cards may harbor potentially pathogenic bacteria, which place patients at risk for harmful infections. Enhanced awareness may also improve compliance to infection prevention practices already in place in the health care setting. (Table presented). EMTREE DRUG INDEX TERMS plastic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American pathogenesis EMTREE MEDICAL INDEX TERMS bacterial growth bacterial transmission bacterium burn unit clothing commensal contamination electronic medical record Enterobacter aerogenes Fisher exact test hand washing health care health care personnel human identity infection infection prevention nurse Pantoea agglomerans patient patient care patient safety pediatric hospital pharmacist physician procedures radiology respiratory therapist risk sample size skin flora smart card Staphylococcus aureus waste management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72281644 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 150 TITLE Hyperacute management-excluding clinical trial results: The race-direct (Rapid arterial occlusion evaluation for direct to endovascular treatment center transfer): A proposal for prehospital evaluation of acute stroke AUTHOR NAMES Rodriguez-Pardo J. Fuentes B. Alonso De Leciñana M. Ximénez-Carrillo A. Zapata-Wainberg G. Barriga F.J. Castillo L. Carneado J. Diaz-Guzmán J. Egido-Herrero J. De Felipe-Mimbrera A. Fernández-Ferro J.C. Garćia-Pastor A. Gil-Núñez A. Gómez-Escalonilla C. Guillan M. Masjuán-Vallejo J. Ortega-Casarrubios M.A. Vivancos-Mora J. Diez-Tejedor E. AUTHOR ADDRESSES (Rodriguez-Pardo J.; Fuentes B.; Alonso De Leciñana M.; Diez-Tejedor E.) UNIVERSITY HOSPITAL la PAZ, Neurology, Madrid, Spain. (Ximénez-Carrillo A.; Zapata-Wainberg G.; Vivancos-Mora J.) LA PRINCESA UNIVERSITY HOSPITAL, Neurology, Madrid, Spain. (Barriga F.J.; Castillo L.) FUNDACION ALCORCON UNIVERSITY HOSPITAL, Neurology, Alcorcón, Spain. (Carneado J.) PUERTA de HIERRO UNIVERSITY HOSPITAL, Neuroloǵia, Majadahonda, Spain. (Diaz-Guzmán J.; Ortega-Casarrubios M.A.) DOCE de OCTUBRE UNIVERSITY HOSPITAL, Neurology, Madrid, Spain. (Egido-Herrero J.; Gómez-Escalonilla C.) CLINICO SAN CARLOS UNIVERSITY HOSPITAL, Neurology, Madrid, Spain. (De Felipe-Mimbrera A.; Masjuán-Vallejo J.) RAMON y CAJAL UNIVERSITy HOSPITAL, Neurology, Madrid, Spain. (Fernández-Ferro J.C.; Guillan M.) REY JUAN CARLOS UNIVERSITY HOSPITAL, Neurology, Móstoles, Spain. (Garćia-Pastor A.; Gil-Núñez A.) GREGORIO MARANON UNIVERSITY HOSPITAL, Neurology, Madrid, Spain. CORRESPONDENCE ADDRESS J. Rodriguez-Pardo, UNIVERSITY HOSPITAL la PAZ, Neurology, Madrid, Spain. SOURCE European Stroke Journal (2016) 1:1 Supplement 1 (433). Date of Publication: 1 May 2016 CONFERENCE NAME 2nd European Stroke Organisation Conference, ESOC 2016 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2016-05-10 to 2016-05-12 ISSN 2396-9881 BOOK PUBLISHER SAGE Publications Ltd ABSTRACT Background: Several studies have shown better outcome and lower mortality in patients with large vessel occlusion undergoing Endovascular Treatment (ET) with stent retrievers versus medical treatment alone. However, ET requires a wide variety of specialized care, provided by Comprehensive Stroke Centers (CSC). It remains unclear whether selected patients with acute stroke should be directly transferred to the nearest CSC in order to avoid delay in ET Clinical scales such as RACE have been developed recently to predict large vessel occlusion, but were unable to rule out hemorrhagic stroke and their predictive value for ET was low. We propose new criteria to identify eligible patients for ET with higher accuracy. Methods: RACE-DIRECT criteria were defined based on a retrospective cohort of 317 patients admitted at the Stroke Unit of a CSC for over a year. Age, sex, RACE scale score and blood pressure (BP) were registered for analysis. Cut-off points with the highest association with ET were thereafter evaluated in a prospective cohort of 153 patients from 9 stroke centers comprising the Madrid Stroke Network. Results: Patients meeting RACE score> =5, Systolic BP <190mmHg and Age<=80 showed a significantly higher probability of undergoing ET (OR 33 [IC 95% 12-93]). This association was confirmed in the prospective cohort with 68% Sensitivity, 84% Specificity, 42% Positive and 94% Negative Predictive Values for ET, ruling out 83% hemor-rhagic strokes. 78% of secondly transferred patients met RACE-DIRECT criteria. Conclusions: RACE-DIRECT criteria can be useful to identify patients suitable for ET and develop a direct-to-CSC transfer system. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artery occlusion race stroke unit EMTREE MEDICAL INDEX TERMS blood pressure monitoring clinical trial controlled clinical trial controlled study diagnostic test accuracy study female human major clinical study male multicenter study predictive value probability systolic blood pressure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616988334 DOI 10.1177/2396987316642909 FULL TEXT LINK http://dx.doi.org/10.1177/2396987316642909 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 151 TITLE Quantitative analysis of estimated burn size accuracy for transfer patients AUTHOR NAMES Armstrong J.R. Willand L. Gonzalez B. Sandhu J. Mosier M.J. AUTHOR ADDRESSES (Armstrong J.R.; Willand L.; Gonzalez B.; Sandhu J.; Mosier M.J.) Loyola Stritch School of Medicine, Maywood, United States. CORRESPONDENCE ADDRESS J.R. Armstrong, Loyola Stritch School of Medicine, Maywood, United States. SOURCE Journal of Burn Care and Research (2016) 37 SUPPL. 1 (S259). Date of Publication: May-June 2016 CONFERENCE NAME 48th Annual Meeting of the American Burn Association CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2016-05-03 to 2016-05-06 ISSN 1559-0488 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Accurate burn size estimation (TBSA) is crucial for burn patients. However, there is a widespread and stark difference between TBSA reported by referring hospitals, and actual TBSA calculated at burn units. Methods: We conducted a retrospective review of 735 burn patients admitted over a 17-month period. Three hundred twenty-six patients fit the criteria of transfers with recorded TBSA estimations from referring hospitals. Referring TBSA was compared to actual TBSA, and the difference was expressed as a percentage of actual TBSA [(Referring TBSA-Loyola TBSA)/ Loyola TBSA]∗100. This was then used to group referring estimations as Underestimated (<-25%), Satisfactory (between -25 and 25%) or Overestimated (>25%). A paired T-Test was used to assess the paired differences for significance. Secondary variables were assessed between groups including mortality, length of stay, age, contiguity of burn, and referral volume. When assessing associations of these clinical measures by estimation status, a One-Way Anova was used for continuous variables and Pearson's Chi-Square Test or Fisher's Exact Test was used. Results: Of the 326 patients analyzed, 13 were underestimated, 63 were satisfactory, and 250 were overestimated. The ratio of overestimation to underestimation exceeded 19:1 and the ratio of overestimation to satisfactory estimation was nearly 4:1, with a statistically significant difference in referred TBSA and actual TBSA (p<0.0001). Within the over and underestimated groups, there were significant differences between referred TBSA and actual TBSA (p<0.0001). Larger burns were more accurately estimated (p<0.0001). There was no statistically significant link between contiguity of burn, age, or referral volume to accuracy of burn estimation. Conclusions: There are significant inaccuracies between referring hospital estimated TBSA and actual TBSA, that consistently and grossly skew towards overestimation. Inaccuracy in burn size estimation is systemic and can affect patient care and burn unit efficiency. Applicability of Research to Practice: Using this data, it should be possible to tailor existing education outreach programs to better target the weaker areas of estimation at referring hospitals, pushing the trend towards more satisfactory TBSA estimation. This targeted process could then result in increasing efficiency of patient treatment and improving patient care both before and after admission to the burn unit. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American human patient quantitative analysis EMTREE MEDICAL INDEX TERMS burn patient burn unit chi square test education Fisher exact test hospital length of stay mortality patient care Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72281801 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 152 TITLE The impact of resident holdover admissions on inpatient length of stay and risk of transfer to an intensive care unit AUTHOR NAMES Ashana D.C. Chan V.K. Vangala S. Bell D.S. AUTHOR ADDRESSES (Ashana D.C.; Chan V.K.; Vangala S.; Bell D.S.) UCLA, David Geffen School of Medicine, Los Angeles, United States. CORRESPONDENCE ADDRESS D.C. Ashana, UCLA, David Geffen School of Medicine, Los Angeles, United States. SOURCE Journal of General Internal Medicine (2016) 31:2 SUPPL. 1 (S424). Date of Publication: May 2016 CONFERENCE NAME 39th Annual Meeting of the Society of General Internal Medicine, SGIM 2016 CONFERENCE LOCATION Hollywood, FL, United States CONFERENCE DATE 2016-05-11 to 2016-05-14 ISSN 1525-1497 BOOK PUBLISHER Springer New York LLC ABSTRACT BACKGROUND: ACGME duty hour standards have led to the creation of novel staffing systems such as the “holdover” system, whereby residents admit patients at night and transfer care to daytime teams who provide longitudinal care. Despite growing literature describing differences between holdover and traditional staffing models, it remains unknown whether patient outcomes are ultimately affected. Thus, we conducted this study to investigate whether patients admitted by holdover teams at a large academic health center experience worse outcomes than those admitted by traditional teams that provide longitudinal care. In particular, we hypothesized that these patients would have a longer length of stay (LOS) and higher rate of transfer to the ICU within 72 h of admission. METHODS: We conducted a retrospective cohort study including patients admitted to the general internal medicine wards service at Ronald Reagan Medical Center at the University of California, Los Angeles from July 1, 2013 to June 6, 2015. Primary outcomes included LOS and transfer to an ICU within 72 h of admission. Secondary outcomes were any transfer to an ICU, inpatient mortality, discharge to home (versus discharge to post-acute care facility), and inpatient readmission within 30 days of discharge. RESULTS: Five thousand five hundred and eighteen patient encounters met criteria for inclusion. Of these, 64 % were admitted by the holdover team. LOS was significantly longer for holdover encounters, with a geometric mean LOS of 4.95 (4.78, 5.12) days for non-holdover patients and 5.18 (5.04, 5.31) days for holdover patients (p = 0.037). Rates of 72 h ICU transfer (OR 1.30, CI 0.58-2.93), any ICU transfer (OR 1.29, CI 0.78-2.14), inpatient mortality (OR 1.21, CI 0.27-5.37), home discharge (OR 1.27, CI 0.74-2.18), and 30-day hospital readmission (OR 0.97, CI 0.83-1.12) were not statistically different between study groups. CONCLUSIONS: The holdover system at our institution results in longer LOS, perhaps due to inefficiencies and delays in care delivery, but patient safety outcomes are not affected. Modest increases in LOS, when aggregated, can have a substantial impact on bed capacity, patient throughput, and hospital financial performance. Therefore, additional work to understand the drivers of this increase should be undertaken at hospitals that utilize a holdover staffing model. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient human intensive care unit internal medicine length of stay risk society EMTREE MEDICAL INDEX TERMS cohort analysis emergency care health center hospital hospital bed capacity hospital readmission model mortality night outpatient department patient patient safety United States university ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72288752 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 153 TITLE Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan AUTHOR NAMES Jones H.M. Zychowicz M.E. Champagne M. Thornlow D.K. AUTHOR ADDRESSES (Jones H.M.) Honey M. Jones, DNP, ACNP-BC, is an acute care nurse practitioner at Duke University Medical Center and the University of North Carolina at Chapel Hill. She also serves as clinical associate faculty for the MSN program at the Duke University School of Nursing. Her primary role is providing care for critically ill adults, and her clinical experience includes neurocritical care, cardiothoracic surgery, electrophysiology, and cardiac catheterization lab. She received her doctoral degree from Duke University, and her research interests include intrahospital transport of critically ill adults and neurocritical care practice issues. Michael E. Zychowicz, DNP, ANP, ONP, FAANP, is an associate professor and director of the MSN Program at DUSON. He is certified as both an adult nurse practitioner and an orthopedic nurse practitioner. His specialty is orthopedic nursing, with subspecialties in sports medicine, spine surgery, and general orthopedics. He received his doctoral degree from Case Western Reserve University. His research and clinical interests include occupational back injuries and the impact of health beliefs on return to work time. Mary Champagne, PhD, RN, FAAN, is Laurel Chadwick Distinguished Professor and dean emerita of DUSON. She has a secondary appointment as professor in the Department of Community and Family Medicine of the Duke University School of Medicine and is also a Senior Fellow of the Duke Center for the Study of Aging and Human Development. She received her doctoral degree from the University of Texas at Austin. Her research interests involve improving health in low-income seniors living locally in subsidized housing, quality and safety in the Duke Healthcare system, wound and ostomy care and quality of life of individuals with stomas, and the prevention of acute confusion in hospitalized elderly patients. Deirdre K. Thornlow, PhD, RN, CPHQ, is an assistant professor at DUSON, a John A. Hartford Foundation Claire M. Fagin Fellow, and a Senior Fell (Zychowicz M.E.; Champagne M.; Thornlow D.K.) SOURCE Dimensions of critical care nursing : DCCN (2016) 35:3 (133-146). Date of Publication: 1 May 2016 ISSN 1538-8646 (electronic) ABSTRACT OBJECTIVE: The aim of this study is to evaluate the implementation of a standardized evaluation plan for intrahospital transports to/from adult intensive care units.METHODS: Nurses at a level I trauma/academic center captured clinical data throughout transport. Outcome measures included compliance with the organization's transport policy and unexpected events.RESULTS: There were 502 transports audited. Most nurses were compliant with the policy, except for the stabilization process (n = 174, 34.7%). Forty-one transports (8.2%) had an unexpected event, and 11 of these transports (26.8%) were aborted. Most of the events were hemodynamic (12), sedation (11), respiratory (10), and gastrointestinal (5). Fewer events occurred with the transport team (P = .036) and among nurses with a bachelor of science in nursing or higher degree (P = .002). Events were higher among transporting nurses with only 0 to 2 years of intensive care unit experience (P = .002), "stabilized" transports (P = .022), and patients with higher Acute Physiology and Chronic Health Evaluation scores (P = .009).CONCLUSIONS: Health care organizations should have a policy that includes both transport and evaluation plans for intrahospital transport. Guidelines should be revised with specific criteria for the stabilization process and unexpected events. Revision should also have a standardized evaluation plan that includes an audit tool to measure incidence of unexpected events and a rapid change quality improvement method.BACKGROUND: Intrahospital transport of the critically ill adult carries inherent risks that can be manifested as unexpected events. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit critical illness organization and management patient care planning EMTREE MEDICAL INDEX TERMS emergency health service human intensive care nursing intensive care unit North Carolina patient transport statistics and numerical data university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27043399 (http://www.ncbi.nlm.nih.gov/pubmed/27043399) PUI L614915015 DOI 10.1097/DCC.0000000000000176 FULL TEXT LINK http://dx.doi.org/10.1097/DCC.0000000000000176 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 154 TITLE Transportation of children on extracorporeal membrane oxygenation: one-year experience of the first neonatal and paediatric mobile ECMO team in the north of France AUTHOR NAMES Rambaud J. Léger P.L. Larroquet M. Amblard A. Lodé N. Guilbert J. Jean S. Guellec I. Casadevall I. Kessous K. Walti H. Carbajal R. AUTHOR ADDRESSES (Rambaud J., jerome.rambaud@aphp.fr; Léger P.L.; Amblard A.; Guilbert J.; Jean S.; Guellec I.; Walti H.; Carbajal R.) Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, Paris, France. (Larroquet M.) Paediatric Surgery, Armand-Trousseau Hospital, APHP, UPMC University, Paris, France. (Lodé N.; Casadevall I.; Kessous K.) Emergency Transport Unit, Robert Debré Hospital, Paris, France. CORRESPONDENCE ADDRESS J. Rambaud, Paediatric Intensive Care Unit, Armand-Trousseau Hospital, APHP, UPMC University, 26 Avenue du Dr Arnold Netter, Paris, France. Email: jerome.rambaud@aphp.fr SOURCE Intensive Care Medicine (2016) 42:5 (940-941). Date of Publication: 1 May 2016 ISSN 1432-1238 (electronic) 0342-4642 BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extracorporeal oxygenation EMTREE MEDICAL INDEX TERMS blood flow velocity blood pump cannulation child health care access hemodynamic parameters high frequency ventilation human implantation intensive care unit letter lung hemodynamics lung transplantation oxygenator respiratory failure survival rate EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20151019355 MEDLINE PMID 26626061 (http://www.ncbi.nlm.nih.gov/pubmed/26626061) PUI L607221734 DOI 10.1007/s00134-015-4144-z FULL TEXT LINK http://dx.doi.org/10.1007/s00134-015-4144-z COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 155 TITLE A critical analysis of unplanned transfer to the ICU within 48 hours of admission from the ED AUTHOR NAMES Dahn C.M. Manasco T.A. Breaud A.H. Kim S. Nelson K.P. Moin O. Rumas N. Baker W. Mitchell P. Feldman J. AUTHOR ADDRESSES (Dahn C.M.; Manasco T.A.; Breaud A.H.; Kim S.; Nelson K.P.; Moin O.; Rumas N.; Baker W.; Mitchell P.; Feldman J.) Boston University, School of Medicine, Boston, United States. CORRESPONDENCE ADDRESS C.M. Dahn, Boston University, School of Medicine, Boston, United States. SOURCE Academic Emergency Medicine (2016) 23 SUPPL. 1 (S236). Date of Publication: May 2016 CONFERENCE NAME 2016 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2016 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2016-05-10 to 2016-05-13 ISSN 1553-2712 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Background: Unplanned intensive care unit (ICU) transfer (UIT) within 48 hours of ED admission increases morbidity and mortality. We hypothesized that many UITs do not have critical interventions (CrI) and that CrI is associated with worse outcomes. Objectives: Our objective was to characterize all UITs (including dying prior to ICU), the proportion with CrI, and the effect of having a CrI on length of stay (LOS) and mortality. Methods: Single center, retrospective cohort study of UITs within 48 hours from 6/1/2008 - 5/31/2013 at an urban, academic medical center. We queried the hospital clinical data warehouse and included those ≥ 18 years and without advanced directives (AD). We used a modified Delphi technique for developing a CrI list. Trained MD chart abstractors extracted data and met periodically to reach consensus. Data included demographics, comorbidities, reason for UIT, total LOS, CrI, and mortality. We calculated descriptive statistics with 95% confidence intervals. Blinded reviewers extracted a 10% random sample of charts and chance-corrected agreement (Cohen's Simple Kappa) was measured for key variables. Results: 837/179,787 (0.47%) non-ICU admissions from the ED had a UIT within 48 hours and 86 admitted patients died prior to ICU. We excluded: 23 AD, 117 post-operative transfers, 177 planned ICU transfers, and 4 with missing data. Of the 516 remaining, 65% (95% CI 61% - 69%) had a CrI. UIT reasons: 33 medical errors, 90 had disease processes not present on arrival, and 393 had clinical deterioration. Mortality was 10.5% (95% CI 8%-14%) and mean LOS was 258 hours (95% CI 233-283) for those with a CrI, while the mortality was 2.8% (95% CI 1%-6%) and mean LOS was 177 hours (95% CI 157-197) for those without a CrI. Therefore, mean LOS for those receiving CrI was, on average, 80.7 hours longer than for those receiving no CrI, with a margin of error of 32.0 hours. Cohen's Simple Kappa ranged from 0.81 and 0.84 for the exclusion and admission criteria variables, respectively, and 0.67 for the transfer category variable. Conclusion: We found UIT was rare over the study period, and those who received a CrI (65%) had increased morbidity and mortality. These results provide insight into our understanding of UITs within 48 hours to an ICU following ED admission as a measure of quality care and screening tool to detect adverse events. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine society EMTREE MEDICAL INDEX TERMS clinical study cohort analysis confidence interval consensus data base Delphi study deterioration hospital human intensive care unit length of stay medical error morbidity mortality patient questionnaire random sample screening statistics university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72281265 DOI 10.1111/acem.12974 FULL TEXT LINK http://dx.doi.org/10.1111/acem.12974 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 156 TITLE Patients transferred to an intensive care unit within seven days of stroke: Data from the ongoing tranexamic acid for hyperacute primary intracerebral haemorrhage (TICH-2) trial AUTHOR NAMES Sprigg N. Robson K. Appleton J. Bath P. AUTHOR ADDRESSES (Sprigg N.; Robson K.; Appleton J.; Bath P.) Division of Clinical Neuroscience, University of Nottingham, Stroke, Nottingham, United Kingdom. CORRESPONDENCE ADDRESS N. Sprigg, Division of Clinical Neuroscience, University of Nottingham, Stroke, Nottingham, United Kingdom. SOURCE European Stroke Journal (2016) 1:1 Supplement 1 (93-94). Date of Publication: 1 May 2016 CONFERENCE NAME 2nd European Stroke Organisation Conference, ESOC 2016 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2016-05-10 to 2016-05-12 ISSN 2396-9881 BOOK PUBLISHER SAGE Publications Ltd ABSTRACT Background: Intracerebral haemorrhage is a medical emergency and can lead to reduced consciousness. Some patients may require support in intensive care units (ICU). Methods: TICH-2 records whether participants have been transferred to ICU by day 7. Baseline characteristics and outcomes were compared between those that had been transferred and those that had not. Results: Of 1116 participants, at day 90, in TICH-2, 117 (10.5%) had been transferred to ICU. The percentage of patients going to ICU ranged from 2% to 100% across all centres, median [IQR] 14.3% [7.7%, 20%]. Patients going to ICU were younger, male and had more severe strokes with lower GCS. Over 40% patients who went to ICU were also transferred for surgery and almost 60% received invasive ventilation. Day 90 modified Rankin Scale, Barthel Index and Euroqol-5D were significantly worse for the people who were transferred (all p-values < 0.0001); however, 11.1% of people that went to ICU had a mRS of 2 or less and 16.2% were home alone or home with family/ carers at discharge. Deaths by day 90 were also signifi-cantly higher for those who had been transferred (p-value: 0.0005). Conclusions: The proportion of patients going to ICU varies widely across centres. Only half have ventilation. Those going to ICU were more likely to have more severe strokes and worse outcomes, but some patients survive and live independently. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tranexamic acid EMTREE DRUG INDEX TERMS endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain hemorrhage intensive care unit EMTREE MEDICAL INDEX TERMS artificial ventilation Barthel index clinical trial controlled study death family human information processing major clinical study male Rankin scale statistical significance surgery CAS REGISTRY NUMBERS tranexamic acid (1197-18-8, 701-54-2) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L617000435 DOI 10.1177/2396987316642909 FULL TEXT LINK http://dx.doi.org/10.1177/2396987316642909 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 157 TITLE Airway Management: A Structured Curriculum for Critical Care Transport Providers AUTHOR NAMES Kuszajewski M.L. O'Donnell J.M. Phrampus P.E. Robey W.C. Tuite P.K. AUTHOR ADDRESSES (Kuszajewski M.L., michele.kuszajewski@duke.edu) Duke University School of Nursing, Center for Nursing Discovery, Durham, United States. (O'Donnell J.M.) Department of Nurse Anesthesia, University of Pittsburgh School of Nursing, Pittsburgh, United States. (Phrampus P.E.) University of Pittsburgh School of Medicine, Pittsburgh, United States. (O'Donnell J.M.; Phrampus P.E.) Peter M. Winter Institute for Simulation, Education, Research (WISER), University of Pittsburgh, Pittsburgh, United States. (Robey W.C.) East Carolina University Brody School of Medicine, Clinical Simulation Program, Greenville, United States. (Tuite P.K.) University of Pittsburgh School of Nursing, Pittsburgh, United States. CORRESPONDENCE ADDRESS M.L. Kuszajewski, 8 Olde Union Court, Durham, United States. Email: michele.kuszajewski@duke.edu SOURCE Air Medical Journal (2016) 35:3 (138-142). Date of Publication: 1 May 2016 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective Airway assessment and management are vital skills for the critical care transport provider. Nurses and paramedics often enter a transport program with limited or no exposure to airway management. Many programs lack a structured curriculum to show skill competence. Optimal methods in the development of airway management competence and the frequency of training needed to maintain skills have not been clearly defined. Because of this lack of standardization, the actual level of competence in both new and experienced critical care transport providers is unknown. Methods A pretest, post-test repeated measures approach using an online curriculum combined with a deliberate practice model was used. Competence in airway management was measured using 3 evaluation points: static mannequin head, simulation scenario, and the live patient. Results A convenience sample of critical care transport providers participated (N = 9). Knowledge improvement was significant, with a higher percentage of participants scoring above 85% on the post-test compared with the pretest (P = .028). Mean scores in completion of the airway checklist pre- versus postintervention were significantly increased on all 3 evaluation points (P < .001 for all comparisons). Significant changes were noted in the response profile evaluating participants' confidence in their ability to verbalize indications for endotracheal intubation (P < .05). Conclusion The development of a standardized, blended learning curriculum combined with deliberate simulation practice and rigorous assessment showed improvements in multiple areas of airway assessment and management. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) curriculum health care personnel intensive care respiration control traffic and transport EMTREE MEDICAL INDEX TERMS article competence controlled study convenience sample endotracheal intubation human knowledge manikin online system pretest posttest design priority journal simulation EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160304084 MEDLINE PMID 27255875 (http://www.ncbi.nlm.nih.gov/pubmed/27255875) PUI L609922007 DOI 10.1016/j.amj.2015.12.013 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2015.12.013 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 158 TITLE When non-revascularized transfer patients come a-knocking at a stroke center AUTHOR NAMES Sands K. Albright K. Donnelly J. Jones B. Kaur M. Sisson A. Shiue H. Lyerly M. Gropen T. AUTHOR ADDRESSES (Sands K.; Albright K.; Donnelly J.; Jones B.; Kaur M.; Sisson A.; Shiue H.; Lyerly M.; Gropen T.) CORRESPONDENCE ADDRESS K. Sands, SOURCE Neurology (2016) 86:16 SUPPL. 1. Date of Publication: 5 Apr 2016 CONFERENCE NAME 68th American Academy of Neurology Annual Meeting, AAN 2016 CONFERENCE LOCATION Vancouver, BC, Canada CONFERENCE DATE 2016-04-15 to 2016-04-21 ISSN 0028-3878 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Objective: Compare patient characteristics, adverse events (AEs), and short term functional outcomes in patients directly presenting to and transferred into a comprehensive stroke center (CSC). Background: Guidelines recommend acute ischemic stroke (AIS) patients be transported rapidly to the closest certified stroke center (SC). The impact of SC care on transfer patients who do not receive acute revascularization therapy is not well understood. Design/Methods: Retrospective review of consecutive AIS patients at our CSC from March 2014-April 2015. We excluded patients who received tPA or endovascular therapy. Demographic and clinical data were collected. We compared AEs (hemorrhagic transformation [HT], DVT, PE, urinary tract infection [UTI], pneumonia [PNA], bacteremia) and poor short term functional outcome (modified Rankin scale score 36), among direct presenters and those transferred into our CSC. Results: Of 589 patients who did not receive revascularization therapy, 24.4[percnt] were transfers. Transfers were disproportionately white (76.4 vs 57.8[percnt], p<0.001), had higher median NIHSS (5 vs 4, p=0.028), were less often privately insured (40.1 vs 46.4[percnt]), and had less desirable ASPECTS scores on initial head CT (810; 22.9 vs 44.0, p<0.001). Transfers had higher odds of having AEs (crude OR 2.134, 95[percnt] 1.353-3.365). This association remained after adjusting for age, stroke severity, and admission glucose (OR 2.103, 95[percnt] CI 1.276-3.466.004). Transfers more frequently developed HT on repeat imaging (17.5 vs 7.0[percnt], p<0.001), clinical seizure during inpatient stay (4.9 vs 1.6[percnt], p=0.024), and PNA (7.6 vs 3.8[percnt], p=0.061). However, transfer status was not associated with poor short-term functional outcome (crude OR 1.453, 95[percnt] CI 0.986-2.141; adjusted OR 1.200, 95[percnt] CI 0.703-2.046). Conclusions: Despite having more severe strokes and higher frequency of adverse events, patients transferred into our CSC did not have worse short term functional outcomes. This highlights the importance of specialized inpatient care provided in NICUs and stroke units by experienced multidisciplinary teams. EMTREE DRUG INDEX TERMS glucose EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American cerebrovascular accident human neurology patient EMTREE MEDICAL INDEX TERMS bacteremia brain ischemia clinical study hospital patient imaging National Institutes of Health Stroke Scale pneumonia Rankin scale revascularization seizure stroke patient stroke unit therapy urinary tract infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72252309 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 159 TITLE Adverse events encountered during the intra-hospital transport of ICU patients AUTHOR NAMES Taggu A. Thomas J. Patil S. Arun M.V.P. AUTHOR ADDRESSES (Taggu A.; Thomas J.; Patil S.; Arun M.V.P.) St. Johns Medical College, Bangalore, India. CORRESPONDENCE ADDRESS A. Taggu, St. Johns Medical College, Bangalore, India. SOURCE Chest (2016) 149:4 SUPPL. 1 (A241). Date of Publication: 2016 CONFERENCE NAME CHEST World Congress 2016 Annual Meeting CONFERENCE LOCATION Shanghai, China CONFERENCE DATE 2016-04-15 to 2016-04-17 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT PURPOSE: To study the number and types of adverse events entered during intra-hospital transport of ICU patients. Interventions provided along with outcomes. METHODS: A prospective observational study of 438 intra-hospital ICU patients of our hospital transported for diagnostic purposes during May 2012 - june 2013. The escorting intensivist completed the profoma charting out the adverse events occuring during transport just after transport was over. RESULTS: A total of 438 patients were enrolled in the study for adverse events (AEs) during intra-hospital transfer of ICU patients. The overall AEs documented were 250 among 110 patients. Amongst the AEs encountered, the most common was miscellaneous causes (85.00%)] like SPO2 probe (45.6%) or rest were ECG lead displacement. Major events alarming the physician were drop in spo2 >5% observed in 26.4% patients, MAP (mean arterial pressure) variation >20% from baseline in 32% patients, altered mental status in 7%, and symptomatic arrhythmias in 2% patients. Among 110 (100%) patients with AEs, 5% patients with symptomatic adverse events had to be cancelled from the palnned transport. CONCLUSIONS: Adverse events are not uncommon during transport of ICU patients especially critically ill. Protocolised transport preferably escorted by intensivist as a part of dedicated transport team will be safer for these patients. CLINICAL IMPLICATIONS: AE's can be reduced when ICU patients are escorted by an intensivist along with dedicated transport team as per guidelines. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital human patient EMTREE MEDICAL INDEX TERMS critically ill patient diagnosis electrocardiogram heart arrhythmia intensivist mean arterial pressure mental health observational study physician LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72268096 DOI 10.1016/j.chest.2016.02.250 FULL TEXT LINK http://dx.doi.org/10.1016/j.chest.2016.02.250 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 160 TITLE Adverse events and near-misses relating to intensive care unit-ward transfer: A qualitative analysis of resident perceptions AUTHOR NAMES Lyons P.G. Arora V.M. Farnan J.M. AUTHOR ADDRESSES (Lyons P.G.; Arora V.M.; Farnan J.M.) University of Chicago, Chicago, United States. SOURCE Annals of the American Thoracic Society (2016) 13:4 (570-572). Date of Publication: 1 Apr 2016 ISSN 2325-6621 BOOK PUBLISHER American Thoracic Society, malexander@thoracic.org EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse outcome intensive care unit patient transport perception resident ward EMTREE MEDICAL INDEX TERMS hospital patient interpersonal communication letter patient monitoring qualitative analysis structured interview EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160709959 MEDLINE PMID 27058186 (http://www.ncbi.nlm.nih.gov/pubmed/27058186) PUI L612501166 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 161 TITLE Critical Care Resuscitation Unit: An Innovative Solution to Expedite Transfer of Patients with Time-Sensitive Critical Illness AUTHOR NAMES Scalea T.M. Rubinson L. Tran Q. Jones K.M. Rea J.H. Stein D.M. Bartlett S.T. O'Connor J.V. AUTHOR ADDRESSES (Scalea T.M., tscalea@umm.edu; Stein D.M.; Bartlett S.T.; O'Connor J.V.) Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, 22 S Greene St, Baltimore, United States. (Rubinson L.) Department of Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, United States. (Tran Q.; Jones K.M.; Rea J.H.) Department of Emergency Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, United States. CORRESPONDENCE ADDRESS T.M. Scalea, Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, 22 S Greene St, Baltimore, United States. Email: tscalea@umm.edu SOURCE Journal of the American College of Surgeons (2016) 222:4 (614-621). Date of Publication: 1 Apr 2016 ISSN 1879-1190 (electronic) 1072-7515 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background Time-sensitive, critical surgical illnesses require care at specialized centers. Trauma systems facilitate patient transport to designated trauma centers, but formal systems for nontraumatic critical illness do not exist. We created the critical care resuscitation unit to expedite transfers of adult critically ill patients with time-sensitive conditions to a quaternary academic medical center, hypothesizing that this would decrease time to transfer, increase transfer volume, and improve outcomes. Study Design Critical care transfers to the University of Maryland Medical Center during the first year of the critical care resuscitation unit (July 2013 to June 2014) were compared with a previous year (July 2011 to June 2012). Times from transfer request to arrival and operating room and hospital mortality were compared. Results There was a 64.5% increase in transfers with a 93.6% increase in critically ill surgical patients. For patients requiring operation, median time to arrival and operating room (118 vs 223 minutes and 1,113 vs 3,424 minutes, respectively; p < 0.001 for both) and median hospital length of stay (13 vs 17 days; p < 0.001) were reduced significantly. There was a nonsignificant trend toward lower mortality (14.6% vs 16.5%; p = 0.27). Conclusions The critical care resuscitation unit dramatically increased the volume of critically ill surgical patients. It decreased transfer times, increased volume, and, for those who required urgent operation, decreased time from initial referral to operating room. This benefit seems to be most marked in patients needing urgent operation. This might be a paradigm shift expediting the transfer of patients with time-sensitive critical illness to an appropriately resourced specialty center. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport time sensitive critical illness EMTREE MEDICAL INDEX TERMS comparative study conference paper emergency care emergency health service heart surgery human intensive care intensive care unit length of stay major clinical study mortality operating room outcome assessment priority journal resuscitation surgical patient EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160277280 MEDLINE PMID 26920992 (http://www.ncbi.nlm.nih.gov/pubmed/26920992) PUI L609629432 DOI 10.1016/j.jamcollsurg.2015.12.060 FULL TEXT LINK http://dx.doi.org/10.1016/j.jamcollsurg.2015.12.060 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 162 TITLE Atypical presentation and nosocomial spread-intensifying the MERS mystery and misery AUTHOR NAMES Fagbo S. Hakawi A.M. Mukahal M. Skakni L. Santos A. Garbati M. Alao K. AUTHOR ADDRESSES (Fagbo S.; Mukahal M.; Skakni L.; Santos A.; Garbati M.; Alao K.) King Fahad Medical City, Riyadh, Saudi Arabia. (Hakawi A.M.) KFMC, Riyadh, Saudi Arabia. CORRESPONDENCE ADDRESS S. Fagbo, King Fahad Medical City, Riyadh, Saudi Arabia. SOURCE International Journal of Infectious Diseases (2016) 45 SUPPL. 1 (209). Date of Publication: April 2016 CONFERENCE NAME 17th International Congress on Infectious Diseases CONFERENCE LOCATION Hyderabad, India CONFERENCE DATE 2016-03-02 to 2016-03-05 ISSN 1201-9712 BOOK PUBLISHER Elsevier ABSTRACT Background: Infection control measures to prevent nosocomial transmission of novel pathogens like the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) require strict adherence to guidelines. However, atypical presentations may mislead unwary Emergency Department (ED) physicians, thus posing challenges. Wepresent the investigation of a MERS case with atypical presentation at the King Fahad Medical City (KFMC) in Riyadh in the summer of 2015. Methods&Materials: The patient's charts and electronic health records covering her two ED visits and subsequent intensive care unit (ICU) admission were reviewed. Adhering to MOH protocols, health care workers (HCWs) exposed to the patient were monitored for possible nosocomial MERS CoV transmission. Results: The patient was a 77-year-old female with Diabetes Mellitus, Hypertension, chronic kidney disease and chronic myelocytic leukemia who presented twice at the ED, within 4 days. On her first visit, she was febrile (37.9°C), had abdominal pain and distension (ascites), nausea and vomiting. Four days earlier, she had visited her primary hospital, known to be experiencing a MERS outbreak at that time, for chemotherapy. Biochemical and microbiological testing of drained ascitic fluid were unremarkable. She was discharged the same day after spending 10 hours in the ED. Three days later, she returned to the ED with progressive abdominal distension, worsening fever (38.8°C) and deteriorating hepatic and renal function. She developed pulseless electrical activity (PEA) and asystole that required resuscitation for 19 minutes. She survived the arrest but clinically worsened and died 4 days in the ICU. Despite 6 intra-hospital transfers (5 prior to MERS CoV confirmation) during her second visit, none of the exposed HCWs (n = 60) developed MERS; included are those who performed high risk procedures (intubation and CPR) on her. However, epidemiological investigation suggests she infected a post-mastectomy patient that shared the waiting room with her while awaiting triage on her first ED visit. Both patients died. Conclusion: This case of an atypical MERS case with multiple exposures to several HCWs having varying levels of protection on multiple occasions led to only one nosocomial case thus further intensifying the mystery surrounding MERS CoV transmission. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) infection EMTREE MEDICAL INDEX TERMS abdominal distension abdominal pain ascites ascites fluid chemotherapy chronic kidney failure chronic myeloid leukemia city diabetes mellitus electric activity electronic medical record emergency health service emergency ward exposure female fever health care personnel heart arrest hospital human hypertension infection control intensive care unit intubation kidney function mastectomy Middle East respiratory syndrome coronavirus nausea and vomiting pathogenesis patient physician procedures protection resuscitation risk summer waiting room LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72245430 DOI 10.1016/j.ijid.2016.02.477 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijid.2016.02.477 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 163 TITLE Acquired 16s methyl transferase associated high level aminoglycoside resistance in Acinetobacter baumannii recovered from ICU patients from a tertiary referral hospital of northeast India AUTHOR NAMES Upadhyay S. Joshi S.R. Khryiem A.B. Bhattacharyya P. AUTHOR ADDRESSES (Upadhyay S.; Joshi S.R.) North Eastern Hill University, Shillong, India. (Khryiem A.B.; Bhattacharyya P.) NEIGRIHMS, Shillong, India. CORRESPONDENCE ADDRESS S. Upadhyay, North Eastern Hill University, Shillong, India. SOURCE International Journal of Infectious Diseases (2016) 45 SUPPL. 1 (46). Date of Publication: April 2016 CONFERENCE NAME 17th International Congress on Infectious Diseases CONFERENCE LOCATION Hyderabad, India CONFERENCE DATE 2016-03-02 to 2016-03-05 ISSN 1201-9712 BOOK PUBLISHER Elsevier ABSTRACT Background: Acinetobacter baumannii is an emerging pathogen associated with hospital acquired infections across the globe. In last one decade the therapeutic options against this pathogen became complicated due to acquisition of multidrug resistant trait. Aminoglycoside, which have been used successfully for treatment of hospital infection, is severely compromised as the acquired 16S rRNA methylases have emerged as an important mechanism of high-level resistance to aminoglycosides in clinical isolates of A.baumannii. Current investigation deals with the occurrence of acquired 16s methyl transferase genes associated with high-level aminoglycoside resistance (HLAR) in A. baumanni obtained from intensive care unit of a tertiary referral hospital in north-east India. Methods & Materials: We analysed a total of 164 multidrugresistant A. baumannii obtained from ICU patients admitted in a referral hospital of Shillong, north-east India, from April-September 2015. 16S rRNA methyl transferase genes; npmA, armA, rmtA, rmtB, rmtC and rmtD, were amplified by PCR among the isolates resistant to aminoglycosides by disk-diffusion method. To determine the HLAR [gentamicin and amikacin≥512μg/ml], MIC against gentamicin and amikacin was recorded. Horizontal transferability and plasmid stability were performed by conjugation and serial passage. Plasmid elimination was performed by treating the isolate with 10% SDS. Clonal dissemination/differentiation of the isolates was analysed by REP-PCR. Results: A total of 157 (95.7%) isolates were found to exhibit HLAR, among them carriage of acquired 16s methyl transferase was observed in 109 (69.4%) isolates. ArmA was found to be the predominant gene followed by rmtD and rmtA. All the gene types were horizontally transferable. The isolates retained the resistance genes from 89th to 95th consecutive serial passages. Plasmids were eliminated with a single treatment of SDS (4%). REP-PCR analysis indicated that 17 different haplotypes were responsible for infection. Conclusion: The current study underscores polyclonal spread of HLAR A. baumannii within ICU patients. The study has revealed the presence of different acquired 16s methyl transferase genes which is not being frequently reported from this geographical region. Further, the study could predict stability of these resistance determinants which is helpful in predicting a future treatment option and formulating infection control strategy in this region. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) aminoglycoside methyltransferase EMTREE DRUG INDEX TERMS amikacin gentamicin RNA 16S EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter baumannii human India infection patient tertiary care center EMTREE MEDICAL INDEX TERMS conjugation control strategy disk diffusion gene haplotype hospital hospital infection infection control intensive care unit minimum inhibitory concentration pathogenesis plasmid virus culture LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72245101 DOI 10.1016/j.ijid.2016.02.144 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijid.2016.02.144 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 164 TITLE Rates of ICU transfers after a scheduled night-shift interprofessional huddle AUTHOR NAMES Newman R.E. Bingler M.A. Bauer P.N. Lee B.R. Mann K.J. AUTHOR ADDRESSES (Newman R.E., renewman@cmh.edu; Mann K.J.) Department of Pediatrics, Sections of General Academic Pediatrics, Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, United States. (Bingler M.A.) Cardiology, Kansas City, United States. (Bauer P.N.) Critical Care Medicine, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospitals and Clinics, Kansas City, United States. (Lee B.R.) Center for Clinical Effectiveness, Quality Improvement, Children's Mercy Hospitals and Clinics, Kansas City, United States. CORRESPONDENCE ADDRESS R.E. Newman, Department of Pediatrics, Sections of General Academic Pediatrics, Children's Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, United States. Email: renewman@cmh.edu SOURCE Hospital Pediatrics (2016) 6:4 (234-242). Date of Publication: 1 Apr 2016 ISSN 2154-1671 (electronic) 2154-1663 BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT OBJECTIVES: To evaluate a scheduled interprofessional huddle among pediatric residents, nursing staff, and cardiologists on the number of high-risk transfers to the ICU. METHODS: A daily, night-shift huddle intervention was initiated between the in-house pediatric residents and nursing staff covering the cardiology ward patients with the at-home attending cardiologist. Retrospective cohort chart review identified high-risk transfers from the inpatient floor to the ICU over a 24-month period (eg, inotropic support, intubation, and/or respiratory support within 1 hour of ICU transfer). Satisfaction with the intervention and the impact of the intervention on team-based communication and resident education was collected using a retrospective pre-post survey. RESULTS: Ninety-three patients were identified as unscheduled transfers from the ward team to the ICU. Overall, 21 preintervention transfers were considered high risk, whereas only 8 patients were considered high risk after the intervention (P =.004). During the night shift, high risk transfers decreased from 8 of 17 (47%) to 3 of 21 patients (14%) (P =.03). Interprofessional communication improved with 12 of 14 nurses and 24 of 25 residents reporting effective communication after the intervention (P <.0001) compared with only 1 nurse and 15 residents reporting a positive experience before the intervention. Overall, all 3 provider groups stated an improved experience covering a high-risk cardiology patient population. CONCLUSIONS: Implementation of an interprofessional huddle may contribute to decreasing high-risk transfers to the ICU. Initiating a daily huddle was well received and allowed for open lines of communication across all provider groups. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) night EMTREE MEDICAL INDEX TERMS cardiology child controlled study doctor patient relation education human major clinical study resident satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160291554 MEDLINE PMID 26956424 (http://www.ncbi.nlm.nih.gov/pubmed/26956424) PUI L609721487 DOI 10.1542/hpeds.2015-0173 FULL TEXT LINK http://dx.doi.org/10.1542/hpeds.2015-0173 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 165 TITLE Universal acceptance of in-utero transfers between units within a regional Maternity and Newborn Network AUTHOR NAMES Poniatowska E. Jenkinson S. Moore R. Mulay A. AUTHOR ADDRESSES (Poniatowska E.; Jenkinson S.) Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. (Moore R.) Staffordshire, Shropshire and Black Country Newborn and Maternity Network, Stoke on Trent, United Kingdom. (Mulay A.) Walsall Healthcare NHS Trust, Walsall, United Kingdom. CORRESPONDENCE ADDRESS E. Poniatowska, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom. SOURCE BJOG: An International Journal of Obstetrics and Gynaecology (2016) 123 SUPPL. 1 (99-100). Date of Publication: April 2016 CONFERENCE NAME 18th Annual Conference of the British Maternal and Fetal Medicine Society, BMFMS 2016 CONFERENCE LOCATION Birmingham, United Kingdom CONFERENCE DATE 2016-04-21 to 2016-04-22 ISSN 1470-0328 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Introduction The project was designed to explore the concept of easing barriers to transfer and sharing of care for a small group of pregnancies between local maternity units with a local neonatal unit and neonatal intensive care unit. Methods All pregnancies that fulfilled the criteria of preterm prelabour rupture of membranes between 23(+0) and 28(+0) weeks were transferred into a unit containing a neonatal intensive care unit unconditionally, irrespective of barriers. If undelivered following their initial inpatient episode, outpatient care reverted to their unit of origin. However, if they required further admission they were able to self refer directly back to the neonatal intensive care unit. Results Over 6-month period, eight women fulfilled the project criteria, six were unconditionally accepted. Of those women, four were delivered in the accepting unit and two were transferred back to their unit of origin undelivered. Conclusion As the project progressed, barriers to transfer eased; the adapted pathway was felt to be the 'norm' and attitudes of staff to the project became more favourable. Although it was not necessary, it also allowed the project team to consider how the available cots in the network could be used to ensure unconditional acceptance of higher-risk cases to the neonatal intensive care unit in the future. As only a small number of cases were involved, consideration should be given to how a larger selection of cases could be transferred and accommodated. Potential financial implications should also be examined. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn society EMTREE MEDICAL INDEX TERMS female hospital patient human intensive care unit membrane newborn intensive care outpatient care pregnancy risk rupture LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72280651 DOI 10.1111/14710528.13988 FULL TEXT LINK http://dx.doi.org/10.1111/14710528.13988 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 166 TITLE Shaping the Flight Paramedic Program AUTHOR NAMES Davids N.B. AUTHOR ADDRESSES (Davids N.B.) Center for Prehospital Medicine, Army Medical Department Center and School, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas SOURCE U.S. Army Medical Department journal (2016) :2-16 (48-51). Date of Publication: 1 Apr 2016 ISSN 1946-1968 (electronic) ABSTRACT Over the past 14 years of conflict, the Department of Defense medical community has made significant strides in patient care. As the conflicts developed, many sources identified a critical gap in en route care, specifically the need for critical care trained personnel for point of injury and intrahospital transfers, as well as improved outcomes for patients who received care from critical care trained providers. As stopgap measures were implemented, the US Army instituted the Critical Care Flight Paramedic Program in order to meet this need of life saving critical care transport. Execution of both an institutional training model as well as a home station training option allows for increased numbers of personnel trained, as well as flexibility for National Guard and Army Reserve units to keep personnel in their area. The Critical Care Flight Paramedic Program's educational outcomes have been exceptional, with National Registry Paramedic pass rates well above the national average. As the program develops, recertification and sustainment of knowledge and skills will be challenges, and novel approaches and flexibility will become critical for continued success. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport education patient transport standards EMTREE MEDICAL INDEX TERMS human intensive care military medicine paramedical personnel procedures soldier United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27215866 (http://www.ncbi.nlm.nih.gov/pubmed/27215866) PUI L615930384 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 167 TITLE Preventable transfers in pediatric trauma: A 10-year experience at a level i pediatric trauma center AUTHOR NAMES Fenton S.J. Lee J.H. Stevens A.M. Kimbal K.C. Zhang C. Presson A.P. Metzger R.R. Scaife E.R. AUTHOR ADDRESSES (Fenton S.J., stephen.fenton@hsc.utah.edu; Lee J.H., justin.lee@hsc.utah.edu; Stevens A.M., austin.stevens@hsc.utah.edu; Metzger R.R., metzger2020@gmail.com; Scaife E.R., eric.scaife@hsc.utah.edu) Division of Pediatric Surgery, University of Utah School of Medicine, Primary, Children's Hospital, Salt Lake City, United States. (Kimbal K.C., kyle.kimbal@hsc.utah.edu) University of Utah School of Medicine, Salt Lake City, United States. (Zhang C., chong.zhang@hsc.utah.edu; Presson A.P., angela.presson@hsc.utah.edu) Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, United States. CORRESPONDENCE ADDRESS S.J. Fenton, Pediatric Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100 N. Mario Capecchi Drive, Salt Lake City, United States. Email: stephen.fenton@hsc.utah.edu SOURCE Journal of Pediatric Surgery (2016) 51:4 (645-648). Date of Publication: 1 Apr 2016 ISSN 1531-5037 (electronic) 0022-3468 BOOK PUBLISHER W.B. Saunders ABSTRACT Background Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center. Methods Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed. A PT was defined as a child who was discharged within 36 hours of arrival without surgical intervention or advanced imaging studies. Results During this period, 6380 children were transferred, with head injury being the most common injury. 61% had CT imaging performed before transfer. The mean age was 6.9 years, mean injury severity score (ISS) 10.4, and median transfer distance 37 miles. 27% of these transfers were classified as PT. Air transport was used in 15% at mean charge of $18,574. 29% were discharged from the emergency department. When compared, PTs were younger (6.0 vs. 7.2 years, p < 0.001), with lower median ISS (5 vs. 9, p < 0.001), shorter median LOS (15 vs. 43.6 hours, p < 0.001), and less PICU admissions (6% vs. 34%, p < 0.001). Conclusion A significant number of pediatric trauma transfers can be classified as preventable. Reducing preventable transfers could offer opportunities for improving value in a trauma care system. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood injury patient transport pediatric hospital preventable transfer EMTREE MEDICAL INDEX TERMS child computer assisted tomography conference paper emergency ward female head injury hospital admission hospital discharge human imaging injury scale intensive care unit major clinical study male priority journal retrospective study EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151060552 MEDLINE PMID 26520697 (http://www.ncbi.nlm.nih.gov/pubmed/26520697) PUI L607397157 DOI 10.1016/j.jpedsurg.2015.09.020 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpedsurg.2015.09.020 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 168 TITLE Early detection of multidrug resistant (MDR) Mycobacterium tuberculosis in a single tube with in-house designed fluorescence resonance energy transfer (FRET) probes using real-time PCR AUTHOR NAMES Chauhan D.S. Sharma R. Parashar D. Sharma P. Das R. Chahar M. Singh A.V. Singh P.K. Katoch K. Katoch V.M. AUTHOR ADDRESSES (Chauhan D.S.; Sharma R.; Parashar D.; Sharma P.; Das R.; Chahar M.; Singh A.V.; Singh P.K.; Katoch K.; Katoch V.M.) SOURCE Indian journal of experimental biology (2016) 54:4 (229-236). Date of Publication: 1 Apr 2016 ISSN 0019-5189 ABSTRACT Rapid and correct diagnosis is crucial for the management of multidrug resistance (MDR) in Mycobacterium tuberculosis (MTB). The present study aims at rapid diagnosis for identification of multidrug resistance tuberculosis (MDR-TB) using real-time PCR. FRET hybridization probes targeting most prominent four selected codons for rpoB526 and 531 and for katG314 and 315 genes were designed and evaluated on 143 clinical MTB isolates and paired sputa for rapid detection of MDR-TB. The results of real-time PCR were compared with gold standard L-J proportion method and further validated by DNA sequencing. Of the 143 MTB positive cultures, 85 and 58 isolates were found to be 'MDR' and 'pan susceptible', respectively by proportion L-J method. The sensitivity of real-time PCR for the detection of rifampicin (RIF) and isoniazid (INH) were 85.88 and 94.11%, respectively, and the specificity of method was found to be 98.27%. DNA sequencing of 31 MTB isolates having distinct melting temperature (Tm) as compared to the standard drug susceptible H37Rv strain showed 100% concordance with real-time PCR results. DNA sequencing revealed the mutations at Ser531Leu, His526Asp of rpoB gene and Ser315Thr, Thr314Pro of katG gene in RIF and INH resistance cases. This real-time PCR assay that targets limited number of loci in a selected range ensures direct and rapid detection of MDR-TB in Indian settings. However, future studies for revalidation as well as refinement are required to break the limitations of MDR-TB detection. EMTREE DRUG INDEX TERMS bacterial DNA isoniazid (pharmacology) rifampicin (pharmacology) tuberculostatic agent (pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS drug effects fluorescence resonance energy transfer genetics human isolation and purification microbial sensitivity test multidrug resistant tuberculosis (diagnosis) Mycobacterium tuberculosis real time polymerase chain reaction sensitivity and specificity CAS REGISTRY NUMBERS isoniazid (54-85-3, 62229-51-0, 65979-32-0) rifampicin (13292-46-1) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27295919 (http://www.ncbi.nlm.nih.gov/pubmed/27295919) PUI L613678866 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 169 TITLE Value of computed tomography of the chest in subjects with ARDS: A retrospective observational study AUTHOR NAMES Simon M. Braune S. Laqmani A. Metschke M. Berliner C. Kalsow M. Klose H. Kluge S. AUTHOR ADDRESSES (Simon M.; Braune S.; Metschke M.; Kalsow M.; Kluge S., s.kluge@uke.de) Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. (Laqmani A.; Berliner C.) Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. (Klose H.) Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. CORRESPONDENCE ADDRESS S. Kluge, Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, Germany. Email: s.kluge@uke.de SOURCE Respiratory Care (2016) 61:3 (316-323). Date of Publication: 1 Mar 2016 ISSN 1943-3654 (electronic) 0020-1324 BOOK PUBLISHER American Association for Respiratory Care ABSTRACT BACKGROUND: The value of computed tomography (CT) of the chest in the management of patients with ARDS is poorly defined. The aim of this study was to assess the clinical utility of thoracic CT scans in subjects with ARDS using the Berlin definition. METHODS: This was a retrospective, observational study in a university hospital ARDS center on all subjects with ARDS in whom a CT scan of the chest was performed immediately before or during an ICU stay between January 1, 2007 and June 30, 2013. RESULTS: During the study period, a total of 1,781 thoracic CT scans were performed, of which 204 cases met inclusion criteria. The most common pathologic findings of the lung parenchyma were consolidations (94.1% of cases) and ground glass opacities (85.3%). Furthermore, CT scans showed pleural effusions (80.4%), mediastinal lymphadenopathy (66.7%), signs of right ventricular strain and pulmonary hypertension (53.9%), pericardial effusion (37.3%), emphysema of the chest wall (12.3%), pneumothorax (11.8%), emphysema of the mediastinum (7.4%), and pulmonary embolism (2.5%). Results of CT scans led to changes in management in 26.5% of cases. Mortality was significantly increased in subjects with involvement of lung parenchyma of >80% (P =.004). Intrahospital transport was associated with critical incidents in 8.3% of cases. CONCLUSIONS: Systematic evaluation of thoracic CT scans yielded information useful for making a diagnosis, predicting prognosis, and recognizing concomitant disorders requiring therapeutic interventions. Results obtained from CT scans led to changes in management in 26.5% of cases. EMTREE DRUG INDEX TERMS glass EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adult respiratory distress syndrome computer assisted tomography observational study thorax EMTREE MEDICAL INDEX TERMS diagnosis Germany heart right ventricle human lung embolism lung parenchyma lymphadenopathy major clinical study mortality pericardial effusion pleura effusion pneumomediastinum pneumothorax prognosis pulmonary hypertension thorax wall university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160176678 MEDLINE PMID 26647453 (http://www.ncbi.nlm.nih.gov/pubmed/26647453) PUI L608718881 DOI 10.4187/respcare.04308 FULL TEXT LINK http://dx.doi.org/10.4187/respcare.04308 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 170 TITLE When non-revascularized transfer patients come A-knocking at a stroke center AUTHOR NAMES Sands K.A. Albright K.C. Donnelly J.P. Jones B.A. Kaur M. Sisson A. Shiue H. Lyerly M. Gropen T. AUTHOR ADDRESSES (Sands K.A.; Albright K.C.; Jones B.A.; Kaur M.; Sisson A.; Lyerly M.; Gropen T.) Neurology, Univ of Alabama at Birmingham, Birmingham, United States. (Donnelly J.P.) Epidemiology/Emergency Medicine/Div of Preventive Medicine, Univ of Alabama at Birmingham, Birmingham, United States. (Shiue H.) Hosp Pharmacy, Univ of Alabama at Birmingham, Birmingham, United States. CORRESPONDENCE ADDRESS K.A. Sands, Neurology, Univ of Alabama at Birmingham, Birmingham, United States. SOURCE Stroke (2016) 47 SUPPL. 1. Date of Publication: February 2016 CONFERENCE NAME American Heart Association/American Stroke Association 2016 International Stroke Conference and State-of-the-Science Stroke Nursing Symposium CONFERENCE LOCATION Los Angeles, CA, United States CONFERENCE DATE 2016-02-16 to 2016-02-19 ISSN 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: Guidelines recommend acute ischemic stroke (AIS) patients be transported rapidly to the closest certified stroke center (SC). The impact of SC care on transfer patients who do not receive acute revascularization therapy is not well understood. We sought to compare patient characteristics, adverse events (AEs), and short term functional outcomes in patients directly presenting to and transferred into a comprehensive stroke center (CSC). Methods: We conducted a retrospective review of consecutive AIS patients transferred to our CSC from March 2014-April 2015. We excluded patients who received tPA or endovascular therapy. Demographic and clinical data were collected. We compared AEs (hemorrhagic transformation [HT], DVT, PE, urinary tract infection [UTI], pneumonia [PNA], bacteremia) and poor short term functional outcome, as defined by modified Rankin scale (mRS) score 3-6, among patients directly admitted to our CSC and patients transferred to our CSC. Results: Of 589 patients who did not receive revascularization therapy, 24.4% were transfers. Transfers were disproportionately white (76.4 vs 57.8%, p<0.001), had higher median NIHSS (5 vs 4, p=0.028), were less often privately insured (40.1 vs 46.4%), and had less desirable ASPECTS scores on initial head CT (8-10; 22.9 vs 44.0, p<0.001). Transfers had higher odds of having AEs (crude OR 2.134, 95% 1.353-3.365). This association remained after adjusting for age, stroke severity, and admission glucose (OR 2.103, 95% CI 1.276-3.466.004). Transfers more frequently developed HT on repeat imaging (17.5 vs 7.0%, p<0.001), clinical seizure during inpatient stay (4.9 vs 1.6%, p=0.024), and PNA (7.6 vs 3.8%, p=0.061). However, transfer status was not associated with poor short-term functional outcome (crude OR 1.453, 95% CI 0.986-2.141; adjusted OR 1.200, 95% CI 0.703-2.046). Conclusion: Despite having more severe strokes and higher frequency of adverse events, patients transferred into our CSC for a higher level of care did not have worse short term functional outcomes. This highlights the importance of specialized inpatient care provided in NICUs and stroke units by experienced multidisciplinary teams. EMTREE DRUG INDEX TERMS glucose EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American cerebrovascular accident heart human nursing patient EMTREE MEDICAL INDEX TERMS bacteremia brain ischemia clinical study hospital patient imaging National Institutes of Health Stroke Scale pneumonia Rankin scale revascularization seizure stroke patient stroke unit therapy urinary tract infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72210741 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 171 TITLE National trends in transfer of patients with intracerebral hemorrhage to teaching hospitals AUTHOR NAMES Vahidy F. Albright K. Donnelly J.P. Shapshak A.H. Savitz S.I. AUTHOR ADDRESSES (Vahidy F.; Savitz S.I.) Neurology, UT-HSC, Houston, United States. (Albright K.; Shapshak A.H.) Neurology, Univ of Alabama, Birmingham, United States. (Donnelly J.P.) Emergency Medicine, Univ of Alabama, Birmingham, United States. CORRESPONDENCE ADDRESS F. Vahidy, Neurology, UT-HSC, Houston, United States. SOURCE Stroke (2016) 47 SUPPL. 1. Date of Publication: February 2016 CONFERENCE NAME American Heart Association/American Stroke Association 2016 International Stroke Conference and State-of-the-Science Stroke Nursing Symposium CONFERENCE LOCATION Los Angeles, CA, United States CONFERENCE DATE 2016-02-16 to 2016-02-19 ISSN 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The 2015 AHA guidelines for ICH management state that initial care of ICH patients should take place in an “ICU or a dedicated stroke unit with physician and nursing neuroscience acute care expertise”. This approach entails transferring ICH patients from community hospitals to centers with stroke expertise. Hypothesis: We explored national trends in transfer of ICH patients to teaching hospitals, and evaluated the differences in demographic, co-morbidity, resource utilization factors, and outcomes for transferred patients (TP) vs. directly admitted patients (DAP). Methods: From the National Inpatient Sample data for years 2006 to 2011, we identified patients with primary diagnosis of ICH (ICD-9 431). We assessed linear trends in the proportion of patients transferred over time using logistic regression. We constructed multivariate logistic regression models to explore the association of transfer status with inpatient mortality after controlling for significant factors. All analyses were performed using survey design variables, allowing us to report nationally-weighted estimates. Results: Our analysis subpopulation comprised of 232,009 patients, and 48,097 (20.7%, 95% CI: 17.8 - 23.9) were TP. There was a statistically significant increase in transfer over the 6 year period. (Figure 1). TP were younger, and were more likely to be white and have private insurance. The proportions of TP with hypertension, diabetes, congestive heart failure, and renal failure were also significantly smaller (Table 1). TP had lower adjusted odds of inpatient mortality as compared to DAP (Table 2). Conclusion: There is an increasing trend of transferring ICH patients to higher level of care. Care of transferred patients at specialized centers is associated with greater resource utilization and lower inpatient mortality. Evidence on optimal selection of patients benefiting from transfer, and long term functional outcomes are needed for policy planning. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American brain hemorrhage cerebrovascular accident heart human nursing patient teaching hospital EMTREE MEDICAL INDEX TERMS community hospital congestive heart failure diabetes mellitus diagnosis emergency care hospital patient hypertension hypothesis ICD-9 insurance kidney failure logistic regression analysis model morbidity mortality physician planning policy stroke unit LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72211140 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 172 TITLE Impact of Retrieval, Distance Traveled, and Referral Center on Outcomes in Unplanned Admissions to a National PICU AUTHOR NAMES Moynihan K. McSharry B. Reed P. Buckley D. AUTHOR ADDRESSES (Moynihan K.; McSharry B., BrentM@adhb.govt.nz; Buckley D.) Department of Paediatric Intensive Care, Starship Children's Hospital, 2 Park Road, Auckland Grafton, New Zealand. (Moynihan K.) Occupational and Aviation Medicine Unit, University of Otago, Dunedin, New Zealand. (Reed P.) Children's Research Centre, Starship Children's Hospital, Auckland, New Zealand. CORRESPONDENCE ADDRESS B. McSharry, Department of Paediatric Intensive Care, Starship Children's Hospital, 2 Park Road, Auckland Grafton, New Zealand. Email: BrentM@adhb.govt.nz SOURCE Pediatric Critical Care Medicine (2016) 17:2 (e34-e42). Date of Publication: 1 Feb 2016 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Objectives: Centralization of PICUs requires a transport system that delivers patient outcomes equivalent to that of the same institution admissions. Our aim was to evaluate how pediatric critical care retrieval, distance traveled, and referral center level of ICU support impact on outcomes in unplanned admissions. Design: Retrospective cohort study. Setting: The national PICU in New Zealand. Patients: A total of 5,609 (45% retrieved) unplanned pediatric admissions (< 15 yr) between January 1, 2004, and January 1, 2014. Interventions: None. Measurements and Main Results: Data analyzed included case-mix, source of admission, diagnostic category, Pediatric Index of Mortality score, PICU-specific resource use, distance traveled, transport duration, and referral hospital ICU level. Outcome measures were crude and risk-adjusted PICU mortality and PICU length of stay. Compared with nontransported admissions, retrieved children were younger, more frequently admitted outside normal working hours, had higher predicted mortality (median Pediatric Index of Mortality score, 4.7% vs 1.5%; p < 0.001) and PICU-specific resource use (respiratory support, vasoactive infusions, and renal replacement therapy). The transport cohort had greater crude mortality rates (8.6% vs 5.6%; p < 0.008) and a median of 29 hours longer PICU stay. There was no significant difference in risk-adjusted mortality between the cohorts (observed/expected mortality ratio for retrieved patients, 0.84 vs nontransported patients, 0.91; p = 0.73). Neither distance traveled (median, 135 km), transport duration (median, 4.4 hr), nor the level of ICU at the referral center had a significant effect on risk-adjusted PICU mortality in the retrieved cohort. Conclusions: Children retrieved to the national PICU in New Zealand have greater predicted mortality risk and PICU-specific resource use than nontransported patients. There is no significant difference in risk-adjusted mortality between retrieved and the same institution admissions. Critically ill pediatric patients can be transported long distances by specially trained and equipped transport teams, without an increase in risk-adjusted PICU mortality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital admission intensive care patient referral patient transport EMTREE MEDICAL INDEX TERMS article assisted ventilation child critically ill patient female hospitalization human intensive care unit major clinical study male mortality mortality rate New Zealand outcome assessment priority journal renal replacement therapy school child scoring system EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151042448 PUI L607321433 DOI 10.1097/PCC.0000000000000586 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000586 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 173 TITLE Embrace(TM) versus conventional care during transport of newborn > 15 0 0 grams : A randomized double blind controlled trial at tertiary care centre in Gujarat, India AUTHOR NAMES Morgaonkar V. Patel D. Nimbalkar A. Phatak A. Nimbalkar S. AUTHOR ADDRESSES (Morgaonkar V.; Patel D.; Nimbalkar S.) Pramukhswami Medical College, Department of Pediatrics, Karamsad, India. (Nimbalkar A.) Pramukhswami Medical College, Department of Physiology, Karamsad, India. (Phatak A.) Charutar Arogya Mandal, Central Research Services, Karamsad, India. CORRESPONDENCE ADDRESS V. Morgaonkar, Pramukhswami Medical College, Department of Pediatrics, Karamsad, India. SOURCE European Journal of Pediatrics (2016) 175:11 (1666). Date of Publication: 2016 CONFERENCE NAME 6th Congress of the European Academy of Paediatric Societies CONFERENCE LOCATION Geneva, Switzerland CONFERENCE DATE 2016-10-21 to 2016-10-25 ISSN 1432-1076 BOOK PUBLISHER Springer Verlag ABSTRACT Background and aims Neonates are prone to develop hypothermia during transport especially in resource poor settings. Embrace™ may be used to prevent neonatal hypothermia during transport. We decided to assess effectiveness of Embrace™ vs conventional care during transport from emergency department (ED) to Neonatal Intensive Care Unit (NICU). Methods All neonates weighing >1500 grams coming to ED were included. During stay in ED, neonates were placed in open warmers. Neonate was placed in Embrace™ or Warmed linen (Control) for transport to NICU. The embrace/linen was removed and neonate was placed on radiant warmer in the NICU. Temperature was recorded again (0 hour) and at 0.25, 0.5, 1, 2, 3, 6, 12 and 24 hours of the NICU stay. The distance travelled by every neonate from the ED to NICU was 700 meter. Results Socio-demographic, clinical variables were similar. Preterm were 7/20 (35%) in Embrace™, 5/20 (25%) in control. Females were 8/20 (40%)- embrace; 6/20 (30%) - control. Mean birth weight was 2.47 in embrace, 2.57 in control. Average age at admission is 3.35 days (embrace) 2.9(control). Average time for transport was 11.65 mins in embrace and 12.75 mins in control. From ED to NICU, the mean(SD) temperature difference in EMBRACE™ group was +0.03(0.71) (that is the temperature increased by +0.03 degree) whereas the same was -0.28(1.34) (that is the temperature dropped by 0.3 degrees on an average). However, this difference was not statistically significant (p=0.38). Conclusions Use of Embrace™ may be a cost effective way to maintain euthermia, especially for transport with longer duration. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Gujarat tertiary care center EMTREE MEDICAL INDEX TERMS birth weight clinical trial comparative effectiveness controlled clinical trial controlled study double blind procedure emergency ward female human neonatal intensive care unit newborn randomized controlled trial LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613885821 DOI 10.1007/s00431-016-2785-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00431-016-2785-8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 174 TITLE Serotonin Transporter Gene (SLC6A4) Methylation Associates With Neonatal Intensive Care Unit Stay and 3-Month-Old Temperament in Preterm Infants AUTHOR NAMES Montirosso R. Provenzi L. Fumagalli M. Sirgiovanni I. Giorda R. Pozzoli U. Beri S. Menozzi G. Tronick E. Morandi F. Mosca F. Borgatti R. AUTHOR ADDRESSES (Montirosso R.; Provenzi L.; Giorda R.; Pozzoli U.; Beri S.; Menozzi G.; Borgatti R.) IRCCS Eugenio Medea (Fumagalli M.; Sirgiovanni I.; Mosca F.) University of Milan (Tronick E.) University of Massachusetts and Division of Newborn Medicine (Morandi F.) Sacra Famiglia Hospital SOURCE Child development (2016) 87:1 (38-48). Date of Publication: 1 Jan 2016 ISSN 1467-8624 (electronic) ABSTRACT Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene (SLC6A4), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study examined a moderation model in which the exposure to NICU-related stress and SLC6A4 methylation moderated infant temperament at 3 months of age. SLC6A4 methylation at 20 CpG sites was quantified in preterm infants (N = 48) and full-term infants (N = 30) from Italian middle-class families. Results suggested that in preterm infants NICU-related stress might be associated with alterations of serotonergic tone as a consequence of SLC6A4 methylation, which in turn, might associate with temperamental difficulties assessed at 3 months of age. EMTREE DRUG INDEX TERMS serotonin transporter SLC6A4 protein, human EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) metabolism neonatal intensive care unit physiology EMTREE MEDICAL INDEX TERMS DNA methylation female follow up genetics human infant male mental stress newborn prematurity temperament LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26822441 (http://www.ncbi.nlm.nih.gov/pubmed/26822441) PUI L616263138 DOI 10.1111/cdev.12492 FULL TEXT LINK http://dx.doi.org/10.1111/cdev.12492 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 175 TITLE Vascularized tissue transfer in head and neck defects - Postoperative management without intensive care unit ORIGINAL (NON-ENGLISH) TITLE Vaskularisierter Gewebetransfer bei Kopf-Hals-Defekten - Postoperatives Management ohne Intensivstation AUTHOR NAMES Eichhorn K.W.G. Koscielny S. AUTHOR ADDRESSES (Eichhorn K.W.G., Klaus.Eichhorn@ukb.uni-bonn.de) Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Chirurgie Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, Bonn, Germany. (Koscielny S., sven.koscielny@med.uni-jena.de) Universitätsklinik und Poliklinik für, HNO-Heilkunde, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Lessingstr. 2, Jena, Germany. SOURCE Laryngo- Rhino- Otologie (2016) 95:8 (526-527). Date of Publication: 2016 ISSN 1438-8685 (electronic) 0935-8943 BOOK PUBLISHER Georg Thieme Verlag, kunden.service@thieme.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head and neck disease (surgery) intensive care unit postoperative care tissue transplantation vascular tissue EMTREE MEDICAL INDEX TERMS note priority journal EMBASE CLASSIFICATIONS Otorhinolaryngology (11) LANGUAGE OF ARTICLE English, German EMBASE ACCESSION NUMBER 20170411407 PUI L616602079 DOI 10.1055/s-0036-1585596 FULL TEXT LINK http://dx.doi.org/10.1055/s-0036-1585596 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 176 TITLE Association of hospital admission service structure with early transfer to critical care, hospital readmission, and length of stay AUTHOR NAMES Smith G.R. Ma M. Hansen L.O. Christensen N. O'Leary K.J. AUTHOR ADDRESSES (Smith G.R., gsmith2@nm.org; Hansen L.O.; Christensen N.; O'Leary K.J.) Division of Hospital MedicineFeinberg School of Medicine, Northwestern UniversityChicago, Illinois (Ma M.) Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern UniversityChicago, Illinois CORRESPONDENCE ADDRESS G.R. Smith, Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, 211 East Ontario Street, Suite 7-713, Chicago, IL 60611 Email: gsmith2@nm.org SOURCE Journal of Hospital Medicine (2016). Date of Publication: 2016 ISSN 1553-5606 (electronic) 1553-5592 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT BACKGROUND: Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE: To compare the effect of 2 hospitalist admission service models ("general" and "admitter-rounder") on patient disposition and length of stay. DESIGN: Retrospective observational cohort study with difference-in-difference analysis. SETTING: Large tertiary academic medical center in the United States. PARTICIPANTS: Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013. INTERVENTIONS: Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions. MEASUREMENTS: Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge. RESULTS: The change of hospitalist services to an admitter-rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference-in-difference P = 0.32 and P = 0.87, respectively). The admitter-rounder model was associated with decreased readmissions compared to the teaching service on difference-in-difference analysis (odds ratio difference: -0.21, P = 0.01). Adoption of the hospitalist admitter-rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P < 0.001). CONCLUSIONS: Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital admission hospital readmission intensive care length of stay EMTREE MEDICAL INDEX TERMS adoption cohort analysis controlled study emergency ward hospital medicine hospitalization human major clinical study model odds ratio teaching United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160319020 PUI L610052187 DOI 10.1002/jhm.2592 FULL TEXT LINK http://dx.doi.org/10.1002/jhm.2592 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 177 TITLE Time Trends and Predictors of Abnormal Postoperative Body Temperature in Infants Transported to the Intensive Care Unit AUTHOR NAMES Schroeck H. Lyden A.K. Benedict W.L. Ramachandran S.K. AUTHOR ADDRESSES (Schroeck H., hedwig.schroeck@hitchcock.org) Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, United States. (Lyden A.K., alyden@med.umich.edu; Benedict W.L., wlb@med.umich.edu) Department of Anesthesiology, University of Michigan Health System, 1500 E Medical Center Drive, Ann Arbor, United States. (Ramachandran S.K., rsatyak@med.umich.edu) Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, United States. CORRESPONDENCE ADDRESS H. Schroeck, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, United States. Email: hedwig.schroeck@hitchcock.org SOURCE Anesthesiology Research and Practice (2016) 2016 Article Number: 7318137. Date of Publication: 2016 ISSN 1687-6970 (electronic) 1687-6962 BOOK PUBLISHER Hindawi Publishing Corporation, 410 Park Avenue, 15th Floor, 287 pmb, New York, United States. ABSTRACT Background. Despite increasing adoption of active warming methods over the recent years, little is known about the effectiveness of these interventions on the occurrence of abnormal postoperative temperatures in sick infants. Methods. Preoperative and postoperative temperature readings, patient characteristics, and procedural factors of critically ill infants at a single institution were retrieved retrospectively from June 2006 until May 2014. The primary endpoints were the incidence and trend of postoperative hypothermia and hyperthermia on arrival at the intensive care units. Univariate and adjusted analyses were performed to identify factors independently associated with abnormal postoperative temperatures. Results. 2,350 cases were included. 82% were normothermic postoperatively, while hypothermia and hyperthermia each occurred in 9% of cases. During the study period, hypothermia decreased from 24% to 2% (p < 0.0001) while hyperthermia remained unchanged (13% in 2006, 8% in 2014, p = 0.357). Factors independently associated with hypothermia were higher ASA status (p = 0.02), lack of intraoperative convective warming (p < 0.001) and procedure date before 2010 (p < 0.001). Independent associations for postoperative hyperthermia included lower body weight (p = 0.01) and procedure date before 2010 (p < 0.001). Conclusions. We report an increase in postoperative normothermia rates in critically ill infants from 2006 until 2014. Careful monitoring to avoid overcorrection and hyperthermia is recommended. EMTREE DRUG INDEX TERMS anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) body temperature hyperthermia (complication, etiology) hypothermia (complication, etiology) postoperative complication (complication, etiology) time EMTREE MEDICAL INDEX TERMS article controlled study critically ill patient disease association female human infant intensive care unit major clinical study male patient transport temperature measurement thermostability trend study warming EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160746351 PUI L612706418 DOI 10.1155/2016/7318137 FULL TEXT LINK http://dx.doi.org/10.1155/2016/7318137 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 178 TITLE A multidisciplinary initiative to standardize intensive care to acute care transitions AUTHOR NAMES Halvorson S. Wheeler B. Willis M. Watters J. Eastman J. O'Donnell R. Merkel M. AUTHOR ADDRESSES (Halvorson S.; Wheeler B., wheelerb@ohsu.edu; Willis M.; Watters J.; Eastman J.; O'Donnell R.; Merkel M.) Division of Hospital Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, United States. (Watters J.) Department of Surgery, Oregon Health and Science University, 3303 SW Bond Ave, Portland, United States. (Merkel M.) Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, United States. CORRESPONDENCE ADDRESS B. Wheeler, Division of Hospital Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, United States. Email: wheelerb@ohsu.edu SOURCE International Journal for Quality in Health Care (2016) 28:5 (615-625). Date of Publication: 2016 ISSN 1464-3677 (electronic) 1353-4505 BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Quality issue: Transfers from intensive care units to acute care units represent a complex care transition for hospitalized patients. Within our institution, variation in transfer practices resulted in unpredictable processes in which patient safety concerns were raised. Initial assessment: Key stakeholders were engaged across the institution. Patient safety ('incident') reports and a staff survey identified safety concerns. Choice of a solution: Using lean methodology, current transfer processes were mapped for the four adult intensive care units and waste was identified. During a summit of key stakeholders an ideal transfer process was conceived and a structured handoff tool (checklist) was developed. A daily management system (DMS) was implemented to monitor adherence. Evaluation: The primary process outcome was adherence to the standardized workflow. Audits at 4, 8, and 12 months after implementation indicated that the checklist was used for 100% of transfers. Secondary outcomes included the percentage of transfers completed within a pre-specified time window of 120 minutes, provider notification of patient arrival on the acute care unit, and staff survey responses assessing adequacy of transfer communication. Lessons learned: Prior work has shown that structuring handoffs can improve patient safety, but the novelty of this project was addressing the transfer process in its entirety, across silos of care. Factors leading to the success of this project were the involvement of key stakeholders across the entire institution early in the project development phase, employment of lean methodology, and implementation of tools to guide workflow adherence and track causes of deviation from the workflow. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency care intensive care patient safety patient transport standardization EMTREE MEDICAL INDEX TERMS article checklist daily management system health care delivery health care management health care planning health survey hospital patient human intensive care unit interpersonal communication patient compliance trend study workflow EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170174337 MEDLINE PMID 27535085 (http://www.ncbi.nlm.nih.gov/pubmed/27535085) PUI L614698195 DOI 10.1093/intqhc/mzw076 FULL TEXT LINK http://dx.doi.org/10.1093/intqhc/mzw076 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 179 TITLE Rapid Response Team Calls and Unplanned Transfers to the Pediatric Intensive Care Unit in a Pediatric Hospital AUTHOR NAMES Humphreys S. Totapally B.R. AUTHOR ADDRESSES (Humphreys S.) Stacey Humphreys is a pediatric intensivist, Division of Critical Care Medicine, Palmetto Health Children's Hospital, Columbia, South Carolina. Balagangadhar R. Totapally is medical director of the pediatric intensive care unit, Division of Critical Care Medicine, Miami Children's Hospital, and a clinical professor of pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida (Totapally B.R.) Stacey Humphreys is a pediatric intensivist, Division of Critical Care Medicine, Palmetto Health Children's Hospital, Columbia, South Carolina. Balagangadhar R. Totapally is medical director of the pediatric intensive care unit, Division of Critical Care Medicine, Miami Children's Hospital, and a clinical professor of pediatrics, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. bala.totapally@mch.com SOURCE American journal of critical care : an official publication, American Association of Critical-Care Nurses (2016) 25:1 (e9-e13). Date of Publication: 1 Jan 2016 ISSN 1937-710X (electronic) ABSTRACT OBJECTIVE: To evaluate times and disposition of rapid response alerts and outcomes for children transferred from acute care to intensive care.METHODS: Deidentified data on demographics, time and disposition of the child after activation of a rapid response, time of transfer to intensive care, and patient outcomes were reviewed retrospectively. Data for rapid-response patients on time of activation of the response and unplanned transfers to the intensive care unit were compared with data on other patients admitted to the unit.RESULTS: Of 542 rapid responses activated, 321 (59.2%) were called during the daytime. Out of all rapid response activations, 323 children (59.6%) were transferred to intensive care, 164 (30.3%) remained on the general unit, and 19 (3.5%) required resuscitation. More children were transferred to intensive care after rapid response alerts (P = .048) during the daytime (66%) than at night (59%). During the same period, 1313 patients were transferred to intensive care from acute care units. Age, sex, risk of mortality, length of stay, and mortality rate did not differ according to the time of transfer. Mortality among unplanned transfers (3.8%) was significantly higher (P < .001) than among other intensive care patients (1.4%).CONCLUSION: Only 25% of transfers from acute care units to the intensive care unit occurred after activation of a rapid response team. Most rapid responses were called during daytime hours. Mortality was significantly higher among unplanned transfers from acute care than among other intensive care admissions.BACKGROUND: Variability in disposition of children according to the time of rapid response calls is unknown. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) statistics and numerical data EMTREE MEDICAL INDEX TERMS child hospital hospital mortality human patient transport pediatric intensive care unit rapid response team resuscitation retrospective study time factor treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26724305 (http://www.ncbi.nlm.nih.gov/pubmed/26724305) PUI L612305048 DOI 10.4037/ajcc2016329 FULL TEXT LINK http://dx.doi.org/10.4037/ajcc2016329 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 180 TITLE Facilitating a child's transfer from ICU to the medium care: A proposal for change AUTHOR NAMES Verwijs-Van Den Heuvel I. Cochius-Den Otter S. Van Dijk M. AUTHOR ADDRESSES (Verwijs-Van Den Heuvel I.; Cochius-Den Otter S.; Van Dijk M.) Erasmus MC-Sophia Children's Hospital, Intensive Care, Department of Pediatric Surgery- Erasmus MC, Sophia Children's Hospital, Rotterdam, Netherlands. CORRESPONDENCE ADDRESS I. Verwijs-Van Den Heuvel, Erasmus MC-Sophia Children's Hospital, Intensive Care, Department of Pediatric Surgery- Erasmus MC, Sophia Children's Hospital, Rotterdam, Netherlands. SOURCE European Journal of Pediatrics (2016) 175:11 (1808). Date of Publication: 2016 CONFERENCE NAME 6th Congress of the European Academy of Paediatric Societies CONFERENCE LOCATION Geneva, Switzerland CONFERENCE DATE 2016-10-21 to 2016-10-25 ISSN 1432-1076 BOOK PUBLISHER Springer Verlag ABSTRACT Background and aims We regularly survey parents' opinions about the care provided to their child and themselves in our PICU two weeks after discharge. It appears that discharge often comes too sudden and is not well communicated beforehand. We therefore introduced a bundle of interventions to facilitate this transfer. The aim of this study is to summarize the first results since the introduction in 2015. Methods The bundle for patients with a length of stay of 5 days or more includes the following elements: 1. Give parents a tour around the medium care early on 2. Ask parents to write their own hand-over report 3. Take away the monitor devices as soon as safe 4. Visit the parents and child the following day at the medium care We implemented these interventions first in one of our 4 units and recorded when the elements were indeed executed. Results In 2015, 132 admissions in this unit were 5 days or longer. In 74 admissions (56.1%) the child was transferred to a medium care unit in our hospital, the other children to another PICU unit (22.0%) ,another hospital (13.6%), home (4.5%) or died (3.8%). In 30 cases (40.5%) an ICU nurse visited the parents and child in the medium care. Parents appreciated this and many told that the transfer was quite overwhelming. In 8 cases parents wrote their own hand-over report primarily explaining the child's daily routines. Conclusions Implementation of our transfer bundle was far from optimal. However considering the impact on parents we need to develop new guidelines to guarantee better compliance. EMTREE MEDICAL INDEX TERMS child clinical article consensus development controlled study hospital human length of stay nurse LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613885470 DOI 10.1007/s00431-016-2785-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00431-016-2785-8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 181 TITLE Pediatric specialty transport teams are not associated with decreased 48-hour pediatric intensive care unit mortality: A propensity analysis of the VPS, LLC database AUTHOR NAMES Meyer M.T. Mikhailov T.A. Kuhn E.M. Collins M.M. Scanlon M.C. AUTHOR ADDRESSES (Meyer M.T., mtmeyer@mcw.edu; Mikhailov T.A.; Scanlon M.C.) Medical College of Wisconsin, Division of Pediatric Critical Care Medicine, MS 681, 9000 West Wisconsin Avenue, Milwaukee, United States. (Kuhn E.M.) Children's Hospital of Wisconsin, Milwaukee, United States. (Collins M.M.) Curative Care Network, Inc, Milwaukee, United States. CORRESPONDENCE ADDRESS M.T. Meyer, Medical College of Wisconsin, Division of Pediatric Critical Care Medicine, MS 681, 9000 West Wisconsin Avenue, Milwaukee, United States. Email: mtmeyer@mcw.edu SOURCE Air Medical Journal (2016) 35:2 (73-78). Date of Publication: 2016 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective The purpose of this study was to determine if pediatric specialty pediatric team (SPT) interfacility-transported children from community emergency departments to a pediatric intensive care unit (PICU) have improved 48-hour mortality. Methods This is a multicenter, historic cohort analysis of the VPS, LLC PICU clinical database (VPS, LLC, Los Angeles, CA) for all PICU directly admitted pediatric patients ≤ 18 years of age from January 1, 2007, to March 31, 2009. Categoric variables were analyzed by the chi-square and Mann-Whitney tests for non-normally distributed continuous variables. The propensity score was determined by multiple logistic regression analysis. Nearest neighbor matching developed emergency medical services SPT pairs by similar propensity score. Multiple regression analyses of the matched pairs determined the association of SPT with 48-hour PICU mortality. P values <.05 were considered significant. Results This study included 3,795 PICU discharges from 12 hospitals. SPT-transported children were more severely ill, younger in age, and more likely to have a respiratory diagnosis (P <.0001). Unadjusted 48-hour PICU mortality was statistically significantly higher for SPT transports (2.04% vs. 0.070%, P =.0028). Multiple regressions adjusted for propensity score, illness severity, and PICU site showed no significant difference in 48-hour PICU mortality. Conclusion No significant difference in adjusted 48-hour PICU mortality for children transported by transport team type was discovered. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit EMTREE MEDICAL INDEX TERMS article child disease severity female human length of stay major clinical study male mortality patient transport priority journal propensity score race EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160471084 PUI L610934407 DOI 10.1016/j.amj.2015.12.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2015.12.003 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 182 TITLE A quality improvement project to decrease emergency department and medical intensive care unit transfer times AUTHOR NAMES Cohen R.I. Kennedy H. Amitrano B. Dillon M. Guigui S. Kanner A. AUTHOR ADDRESSES (Cohen R.I.; Guigui S.) Department of Medicine, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, United States. (Kennedy H.; Amitrano B.; Dillon M.; Kanner A.) Department of Nursing, The Long Island Jewish Medical Center, The Hofstra-North Shore LIJ School of Medicine, New Hyde Park, United States. CORRESPONDENCE ADDRESS R.I. Cohen, The Division of Pulmonary, Critical Care and Sleep Medicine, The North Shore-LIJ Health System, The Hofstra-NSLIJ School of Medicine, New Hyde Park, United States. SOURCE Journal of Critical Care (2015) 30:6 (1331-1337) Article Number: 51895. Date of Publication: 1 Dec 2015 ISSN 1557-8615 (electronic) 0883-9441 BOOK PUBLISHER W.B. Saunders ABSTRACT Objective: To reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU). Design: A prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center. Interventions: A team of frontline health care professional including ED, MICU, and supporting services using the clinical microsystems approach mapped out existing practice patterns, determined causes for delays, and used the Plan-Do-Study-Act to test changes.Measurements and Main Results. The team identified multiple issues that contributed to delays. These included poor coordination between transport services, respiratory therapy, and nursing in transferring patients from the ED as well delays in identification and transfer of stable MICU patients. These interventions reduced transfer time from 4.2 (3.4-5.7) hours to 2.2 (1.4-3.1) hours (median [interquartile range]; P < .001). Hospital length of stay decreased from 9.9 ± 9 to 8.3 ± 7 days (. P < .03). Conclusion: A team made up of frontline health care professionals using a structured quality improvement process and implementing multifaceted, multistage interventions, reduced transfer delays, and length of stay. Added benefits included engagement among members of the 2 microsystems and a more cohesive approach to patient care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward intensive care unit patient transport total quality management EMTREE MEDICAL INDEX TERMS article cooperation health care personnel health care quality human length of stay observational study patient care patient referral EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015369103 MEDLINE PMID 26365001 (http://www.ncbi.nlm.nih.gov/pubmed/26365001) PUI L605986960 DOI 10.1016/j.jcrc.2015.07.017 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcrc.2015.07.017 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 183 TITLE Acute cold and exercise training up-regulate similar aspects of fatty acid transport and catabolism in house sparrows (Passer domesticus) AUTHOR NAMES Zhang Y. Carter T. Eyster K. Swanson D.L. AUTHOR ADDRESSES (Zhang Y., yufeng.zhang@usd.edu; Carter T.; Swanson D.L.) Department of Biology, University of South Dakota, Vermillion, SD 57069, USA (Eyster K.) Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, Vermillion, SD 57105, USA SOURCE The Journal of experimental biology (2015) 218 (3885-3893). Date of Publication: 1 Dec 2015 ISSN 1477-9145 (electronic) ABSTRACT Summit maximum thermoregulatory metabolic rate (Msum) and maximum exercise metabolic rate (MMR) both increase in response to acute cold or exercise training in birds. Because lipids are the main fuel supporting both thermogenesis and exercise in birds, adjustments to lipid transport and catabolic capacities may support elevated energy demands from cold and exercise training. To examine a potential mechanistic role for lipid transport and catabolism in organismal cross-training effects (exercise effects on both exercise and thermogenesis, and vice versa), we measured enzyme activities and mRNA and protein expression in pectoralis muscle for several key steps of lipid transport and catabolism pathways in house sparrows (Passer domesticus) during acute exercise and cold training. Both training protocols elevated pectoralis protein levels of fatty acid translocase (FAT/CD36), cytosolic fatty acid-binding protein, and citrate synthase (CS) activity. However, mRNA expression of FAT/CD36 and both mRNA and protein expression of plasma membrane fatty acid-binding protein did not change for either training group. CS activities in supracoracoideus, leg and heart, and carnitine palmitoyl transferase (CPT) and β-hydroxyacyl CoA-dehydrogenase activities in all muscles did not vary significantly with either training protocol. Both Msum and MMR were significantly positively correlated with CPT and CS activities. These data suggest that up-regulation of trans-sarcolemmal and intramyocyte lipid transport capacities and cellular metabolic intensities, along with previously documented increases in body and pectoralis muscle masses and pectoralis myostatin (a muscle growth inhibitor) levels, are common mechanisms underlying the training effects of both exercise and shivering in birds. EMTREE DRUG INDEX TERMS fatty acid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) physiology EMTREE MEDICAL INDEX TERMS adaptation animal animal experiment basal metabolic rate cardiac muscle cold energy metabolism gene expression lipid metabolism metabolism skeletal muscle sparrow thermogenesis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26486368 (http://www.ncbi.nlm.nih.gov/pubmed/26486368) PUI L616636264 DOI 10.1242/jeb.126128 FULL TEXT LINK http://dx.doi.org/10.1242/jeb.126128 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 184 TITLE A critical analysis of unplanned transfer to the icu within 48 hours of admission from the ED AUTHOR NAMES Dahn C. Manasco A. Breaud A.H. Kim S. Moin O. Rumas N. Baker W. Feldman J. AUTHOR ADDRESSES (Dahn C.; Manasco A.; Breaud A.H.; Kim S.; Moin O.; Rumas N.; Baker W.; Feldman J.) CORRESPONDENCE ADDRESS C. Dahn, SOURCE Critical Care Medicine (2015) 43:12 SUPPL. 1 (190-191). Date of Publication: December 2015 CONFERENCE NAME 45th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2015 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-02-20 to 2016-02-24 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Patients who experience unplanned ICU transfer (UIT), within 48 hr of admission from the Emergency Department (ED), have a higher mortality and increased LOS than directly admitted ICU patients. The study purpose was to describe reasons for all UIT, proportion of critical interventions (CrI) performed within 48 hr, length of stay (LOS) and mortality. Methods: Single center, retrospective cohort study of ED patients admitted to a non-ICU bed and had a UIT within 48 hr from 2008 - 2013 at an urban academic medical center. We excluded those under 18 and those with 'do not resuscitate' (DNR) and 'do not intubate' (DNI) on admission. Trained investigators abstracted: demographics, comorbidities, time and reason for UIT, total LOS, CrI's, and mortality. We used a modified Delphi process to determine CrI. We calculated descriptive statistics with 95%CI for all outcomes. Results: A total of 837/512,525 (0.17%) non-ICU admissions from the ED had a UIT within 48 hr and 86 admitted patients died prior to transfer. We excluded: 23 DNR/DNI, 117 post-operative transfers, 177 planned ICU transfers, and 4 with missing data. Of the 516 patients remaining, 65% (95% CI 61%-69%) received a CrI and transfer reasons included: 33 medical errors, 90 disease processes not clearly present on arrival, and 393 deterioration of presenting symptoms. In patients who received a CrI, the mortality rate was 10.5% (95% CI 8%-14%) and mean LOS was 258 hr (95% CI 233-283). Those without a CrI had a mortality rate of 2.8% (95% CI 1%-6%) and mean LOS was 177 hr (95% CI 157-197). Conclusions: We found UIT (or death prior to UIT) is a rare event and only 65% of UIT's, or died prior to UIT, had a CrI. Although UIT is used as a screening tool for quality of care, this measure does not include patients who die prior to UIT or differentiate those who do not have a CrI performed from those patients who have a CrI. Further research should determine whether post-hoc analysis of UIT affects ED triage practices and the need to prospectively test and develop validated tools to reduce UIT. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS cohort analysis death Delphi study deterioration emergency health service emergency ward human learning length of stay medical error mortality patient post hoc analysis screening statistics university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72102277 DOI 10.1097/01.ccm.0000474585.42889.79 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000474585.42889.79 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 185 TITLE Postresuscitation Care and Pretransport Stabilization of Newborns Using the Principles of STABLE Transport AUTHOR NAMES Bellini S. AUTHOR ADDRESSES (Bellini S.) SOURCE Nursing for women's health (2015/2016) 19:6 (533-536). Date of Publication: 1 Dec 2015 ISSN 1751-486X (electronic) ABSTRACT The practice of perinatal regionalization is designed to ensure that newborns are born in facilities with a care level designation that is consistent with expected pregnancy outcomes. Regionalization practices have resulted in lower neonatal mortality and morbidity rates. However, despite regionalization efforts, approximately 10 percent of newborns will require some level assistance with breathing, and a few (<1 percent) will require resuscitation in the birthing room. After resuscitation, many of these newborns require acute transport to a different facility. This column provides an overview of principles from the STABLE Program, which guides clinicians in providing postresuscitation care and pretransport stabilization for compromised newborns. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) education nursing organization and management EMTREE MEDICAL INDEX TERMS female human in service training male neonatal intensive care unit newborn newborn nursing patient care patient transport prematurity program evaluation resuscitation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26682660 (http://www.ncbi.nlm.nih.gov/pubmed/26682660) PUI L614452005 DOI 10.1111/1751-486X.12248 FULL TEXT LINK http://dx.doi.org/10.1111/1751-486X.12248 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 186 TITLE THE PRINCIPLES OF ORGANIZATION AND TREATMENT FOR SORTING OF WOUNDED PERSONS WITH A COMBAT SURGICAL TRAUMA OF EXTREMITIES ON THE IV LEVEL OF THE MEDICAL CARE PROVISION AUTHOR NAMES Korohl S.O. Zherdev I.I. Domanskiy A.M. AUTHOR ADDRESSES (Korohl S.O.; Zherdev I.I.; Domanskiy A.M.) SOURCE Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny (2015) :12 (48-50). Date of Publication: 1 Dec 2015 ISSN 0023-2130 ABSTRACT Experience of medical sorting of 434 injured persons with a gun-shot woundings of extremities in 2014-2015 yrs is adduced. The principles of organization and treatment for medical sorting of wounded persons were elaborated. Prognostic intrahospital, diagnostic and evacuation--transport sorting was introduced in wounded persons in the IV level hospital, concerning severity of traumatic shock and prognosis of their survival. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) organization and management EMTREE MEDICAL INDEX TERMS emergency health service gunshot injury (diagnosis, surgery) human injuries injury scale limb mortality pathology prognosis survival traumatic shock (diagnosis, surgery) LANGUAGE OF ARTICLE Ukrainian LANGUAGE OF SUMMARY English MEDLINE PMID 27025033 (http://www.ncbi.nlm.nih.gov/pubmed/27025033) PUI L609751205 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 187 TITLE Response to "Where do we go from here? A small-scale observation of transfer results from chronic to skilled ventilator facilities" AUTHOR NAMES Brandão da Silva N. AUTHOR ADDRESSES (Brandão da Silva N., nbrandao@portoweb.com.br) Department of Internal Medicine, Universidade Federal das Ciências da Saúde de Porto Alegre, Rua Dr Vale 651 ap 902, Porto Alegre, Brazil. CORRESPONDENCE ADDRESS N. Brandão da Silva, Department of Internal Medicine, Universidade Federal das Ciências da Saúde de Porto Alegre, Rua Dr Vale 651 ap 902, Porto Alegre, Brazil. Email: nbrandao@portoweb.com.br SOURCE Journal of Critical Care (2015) 30:6 (1404) Article Number: 51917. Date of Publication: 1 Dec 2015 ISSN 1557-8615 (electronic) 0883-9441 BOOK PUBLISHER W.B. Saunders EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mechanical ventilator patient transport EMTREE MEDICAL INDEX TERMS artificial ventilation comorbidity cost effectiveness analysis critical illness disease severity elderly care hospitalization human intensive care unit length of stay letter outcome assessment prognosis quality of life risk assessment risk factor scoring system EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015396938 MEDLINE PMID 26395923 (http://www.ncbi.nlm.nih.gov/pubmed/26395923) PUI L606118275 DOI 10.1016/j.jcrc.2015.08.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcrc.2015.08.005 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 188 TITLE A pilot study to evaluate the effect of peep during transport to the ICU following cardiac surgery AUTHOR NAMES Dempsey A. Legault R. Mehl J. Steyn J. Hatton K. AUTHOR ADDRESSES (Dempsey A.; Legault R.; Mehl J.; Steyn J.; Hatton K.) CORRESPONDENCE ADDRESS A. Dempsey, SOURCE Critical Care Medicine (2015) 43:12 SUPPL. 1 (28). Date of Publication: December 2015 CONFERENCE NAME 45th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2015 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-02-20 to 2016-02-24 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: We hypothesized that the use of PEEP during transport from the operating room to the ICU after cardiac surgery will decrease lung derecruitment. The primary objectives of this pilot study were 1) to assess the feasibility of performing a randomized controlled trial (RCT) to study PEEP during transport in this patient population, 2) to assess the impact on the change in PaO2/Fi02 ratio (P/F) and the time to extubation, and 3) if a favorable trend was noted, to predict the number of patients that would be needed to power a future and larger trial. Methods: This was a single-center, blinded, randomized, controlled pilot study performed in 30 patients. Patients were randomized prior to surgery to one of three groups to receive 0, 5, or 10 cm H2O of PEEP during transport. All OR and ICU clinicians were blinded to the PEEP valve setting. Intraoperative, transport, and postoperative ventilation was standardized according to the ARDSnet protocol. The delta P/F of each patient was defined as the difference in P/F immediately before and shortly after transport from the OR to the ICU, based on ABG results. Results: No patients experienced significant hemodynamic instability during transport. With the exception of gender, there were no statistically significant differences in multiple baseline patient and procedure characteristics. There was a non-statistically significant trend toward increased mean delta P/F with PEEP compared to no PEEP. The trend toward increased P/F was greatest with PEEP=10. In addition, there was also a non-statistically significant trend toward decreased time to extubation with PEEP compared to no PEEP. Conclusions: The results of this pilot study demonstrate that the methodology was feasible for a future RCT to study PEEP during transport in this population. In addition, we were able to calculate group sample size for a future trial using a two-tailed sample size calculation. According to our data, we will need to enroll at least 132 patients in a future study to detect a statistically significant difference when comparing 0 and 10 cm H2O of PEEP. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart surgery intensive care pilot study society EMTREE MEDICAL INDEX TERMS air conditioning extubation gender human learning lung methodology operating room patient population positive end expiratory pressure procedures randomized controlled trial randomized controlled trial (topic) sample size surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72101627 DOI 10.1097/01.ccm.0000473935.75901.6d FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000473935.75901.6d COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 189 TITLE Predictors of rapid unplanned transfer to the PICU following admission from the ED AUTHOR NAMES McMahon K. Del Grippo E. DePiero A. AUTHOR ADDRESSES (McMahon K.; Del Grippo E.; DePiero A.) CORRESPONDENCE ADDRESS K. McMahon, SOURCE Critical Care Medicine (2015) 43:12 SUPPL. 1 (201). Date of Publication: December 2015 CONFERENCE NAME 45th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2015 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-02-20 to 2016-02-24 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Admitting a patient from the emergency department (ED) to a general unit who then quickly requires transfer to an ICU generates stress and safety concerns. Our study sought to identify predictors at the time of admission of patients likely to require rapid transfer. We evaluated vital signs, Pediatric Early Warning Scores (PEWS), ED length of stay, time from last ED vitals to admission and degree of respiratory support at admission. Methods: We retrospectively reviewed patients requiring transfer to the ICU within 10 hr of admission from the ED at a pediatric tertiary care center from 3/09 to 10/13. These 73 case patients were then matched by age and diagnosis with 73 control patients who never required ICU admission. PEWS and vital signs were compared prior to ED departure, on admission to the floor and, for cases, at time of ICU transfer. ED lengths of stay, respiratory support and timing of last vitals were also recorded. Results: The ED PEWS for case patients were higher than those for controls (median 2 vs 0, p=0.03). PEWS on admission remained higher for cases (median 3 vs 1). At ICU transfer, PEWS for cases increased to a median of 4. No significant differences in ED or admission vital signs were found between groups. ED length of stay was slightly shorter for cases than controls (p=0.05), but time from last set of vitals to admission did not differ. Case patients were more likely to require high flow oxygen at admission. Conclusions: Patients requiring ICU transfer within hr of admission had higher PEWS than control patients at all time points, and PEWS increased from the ED to admission and time of ICU transfer, but remained only a median of 4. We did not identify any specific vital sign predictors, but case patients were more likely to require high flow oxygen at admission emphasizing that respiratory distress was the most likely reason for transfer. Shorter ED length of stay was noted for case patients demonstrating that perhaps longer observation would help determine disposition. Patient disposition remains a challenge with clinical judgement paramount. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS assisted ventilation decision making diagnosis emergency ward human learning length of stay patient respiratory distress safety tertiary care center vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72102318 DOI 10.1097/01.ccm.0000474626.02093.a3 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000474626.02093.a3 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 190 TITLE Time out for sign out: Improved transfer of care from the operating room to the ICU AUTHOR NAMES Prasad A. Cios T. Dziedzina C. Staub-Juergens W. Prasad S.R. Singbartl K. AUTHOR ADDRESSES (Prasad A.; Cios T.; Dziedzina C.; Staub-Juergens W.; Prasad S.R.; Singbartl K.) CORRESPONDENCE ADDRESS A. Prasad, SOURCE Critical Care Medicine (2015) 43:12 SUPPL. 1 (212). Date of Publication: December 2015 CONFERENCE NAME 45th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2015 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-02-20 to 2016-02-24 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Healthcare professionals strive to provide safe care, yet an estimated 98,000 Americans die each year due to errors. Error rates as high as 37% in ICUs occur during exchanges between nurses and physicians. A quality project was initiated to improve the hand-off process from the OR team to the ICU team following cardiac operating room (OR) cases. Methods: The OR and ICU teams identified key components of a hand-off process. As a result “Time Out for Sign Out” was created. Phase 1-planning- the OR nurse calls the ICU when the patient is off bypass and when sternal wires are being inserted. Phase 2- gathering- the OR nurse calls the ICU nurse when the patient is being transferred to the ICU bed to prepare for arrival. Phase 3-handoff- is our structured sign-out process from the OR team to the ICU team and the transferring of care. The process was trialed for 3 mo. A pre and post survey was collected using a Likert scale of 1-7 to assess the perception of the new hand-off process. The questions assessed quality of information, comfort and environment, efficiency, and the overall relevance. Results: In all 4 areas, significant improvements were seen with the new, standardized process. The new sign-out process rating increased from 4.2 ± 1.6 to 5.7 ± 0.9 (p=0.004) for information, from 3.8 ± 1.8 to 5.9 ± 0.7 (p<0.001) for comfort, from 3.8 ± 1.8 to 5.6 ± 1.1 (p<0.0001) for efficiency, and from 3.9 ± 1.9 to 6.0 ± 0.9 (p=0.0001) for relevance. Linear regression analysis demonstrated nurses with less than 4 yr of experience felt that the non-standardized process needed improvement compared to nurses with 5+ yr (1-2 year, p=0.003; 2-3 yr p=0.029; 3-4 yr p=0.015). Conclusions: A standardized signout process significantly improved satisfaction with the transfer of information given from the OR team to the ICU team. Initial apprehension by experienced anesthesia providers was observed, but younger ICU staff prefer a standardized sign-out. This new structured process holds promise for a better handoff of patient care with improved communication between OR and ICU providers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care operating room society EMTREE MEDICAL INDEX TERMS American anesthesia comfort environment health care personnel human interpersonal communication learning Likert scale linear regression analysis nurse patient patient care physician planning satisfaction sternal wire LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72102363 DOI 10.1097/01.ccm.0000474671.23178.65 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000474671.23178.65 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 191 TITLE Outcomes of patients transferred to respiratory care unit (RCU) on tracheotomy ventilation: A 4 year experience AUTHOR NAMES Nisar S. Baluwala A. Elliott M.W. Ghosh D. AUTHOR ADDRESSES (Nisar S.; Baluwala A.; Elliott M.W.; Ghosh D.) St. James University Hospital, Leeds, United Kingdom. CORRESPONDENCE ADDRESS S. Nisar, St. James University Hospital, Leeds, United Kingdom. SOURCE Thorax (2015) 70 SUPPL. 3 (A96). Date of Publication: December 2015 CONFERENCE NAME British Thoracic Society Winter Meeting 2015 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2015-12-02 to 2015-12-04 ISSN 0040-6376 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background RCU in Leeds admits patients who had tracheostomy in ICU as part of acute admission and are slow to wean from ventilation. We looked at the long-term outcomes of attempted weaning from ventilator support in terms of survival and level of support at discharge. We also looked at length of stay (LOS), underlying diagnosis and comorbidities. Methods Thirty one patients admitted to RCU as a step-down from ICU between October 2011 and July 2014 were included. Patients were identified using database and data was collected from electronic records and inpatient notes. Patients were excluded if they had tracheostomy inserted on a previous admission. Results The demographics, length of stay on RCU and primary diagnosis leading to respiratory failure and intubation are described in Table 1. All except one patient had significant other comorbidities including muscular dystrophies, MND, COPD, IHD, etc. The average number of days spent in ICU after tracheostomy prior to step-down was 19+/-15. Eight (26%) patients died in hospital. Seventeen patients (55%) were discharged without any ventilatory support after decanulation, 3 required overnight NIV and 3 were discharged with tracheostomy ventilation. At 12 months post-discharge 16 (52%) patients were dead; 11 (35%) were not on any ventilatory support; 3 were continuing to be ventilated via tracheostomy, 1 remained on NIV. Discussion and conclusion Patients coming for weaning from trachy-ventilation represent a complex group with diverse aetiology and have multiple comorbidities. Their stay in a high dependency area is unpredictable and the LOS varies considerably. While a third of patients remained successfully weaned at one year they carry a high in-hospital and 1 year mortality. LOS is influenced by the complexity of discharge planning often including patients from outside our catchment area. Our RCU like many others are not staffed to look after more than 2 trachy-ventilated patients at any one time which combined with prolonged stay slows down patient flow form ICU. This highlights the need for dedicated units for weaning with a team that is able to look after complex needs in hospital and coordinate complex discharges. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air conditioning human intensive care unit patient society tracheotomy winter EMTREE MEDICAL INDEX TERMS catchment data base diagnosis etiology hospital hospital discharge hospital patient intubation length of stay mortality muscular dystrophy respiratory failure survival tracheostomy ventilated patient ventilator weaning LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72199623 DOI 10.1136/thoraxjnl-2015-207770.178 FULL TEXT LINK http://dx.doi.org/10.1136/thoraxjnl-2015-207770.178 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 192 TITLE Shock index as a predictor of icu transfer in patients admitted to the medical ward with sepsis AUTHOR NAMES Biney I. Amin R. Mehari A. AUTHOR ADDRESSES (Biney I.; Amin R.; Mehari A.) CORRESPONDENCE ADDRESS I. Biney, SOURCE Critical Care Medicine (2015) 43:12 SUPPL. 1 (262-263). Date of Publication: December 2015 CONFERENCE NAME 45th Critical Care Congress of the Society of Critical Care Medicine, SCCM 2015 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2016-02-20 to 2016-02-24 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Sepsis constitutes a significant health care burden in the United States. A significant number of patients with sepsis are admitted to a non-Intensive care unit (ICU) setting. Delayed ICU consults and transfers have been associated with adverse events when critically ill patients are not promptly identified. The Shock Index (SI) has been shown to predict disease escalation in patients presenting to the emergency room with sepsis. The purpose of this study was to determine whether the SI can be used to help identify patients admitted to the medical ward who might require a higher level of care. Methods: This was a retrospective study of patients admitted to the medical ward with sepsis between April 2013 and December 2014. The shock index was calculated for each set of vitals recorded from time of admission till ICU transfer or hospital discharge using a 7 day cut-off. A sustained SI elevation (SSIE) was defined as an SI of 0.8 or more for at least 50% of the time. Results: A total of 206 patients were identified with 50.5% being male and 87% being African American. The mean age was 56.4 ± 15.8. Sixty-eight (32.8%) patients had a SSIE and there were 44 ICU transfers. For the ICU transfers, the average length of stay on the floor was 3.8 days. Hospital mortality was 4.8%. The rate of ICU transfer was higher in patients with a SSIE compared to patients without a SSIE (47.8% vs 8.0%; p<0.001). A SSIE was also associated with rapid response activation (19.1% vs 2.2%; p<0.001) and hyperlactatemia (38.2% vs 21.1%; p=0.031). Patients with a SSIE had a higher mean number of organ failures (2.97 ± 2.4 vs 1.65 ± 1.6; p<0.001), hospital length of stay (13.6 ± 11.2 vs 8.6 ± 6.35, p<0.001) and had a higher mortality (10.1% vs 2.1%, p=0.012) compared to patients without a SSIE. Conclusions: A SSIE was associated with higher rates of ICU transfers and worse patient outcomes. The SI is a simple measure that may help identify patients with sepsis in a non-ICU setting at risk of deterioration and guide clinicians to institute early aggressive interventions when necessary. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient sepsis shock society ward EMTREE MEDICAL INDEX TERMS African American critically ill patient deterioration emergency ward health care hospital hospital discharge hyperlactatemia intensive care unit learning length of stay male mortality retrospective study risk United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72102563 DOI 10.1097/01.ccm.0000474874.57925.3e FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000474874.57925.3e COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 193 TITLE Unplanned ICU Transfers from Inpatient Units: Examining the Prevalence and Preventability of Adverse Events Associated with ICU Transfer in Pediatrics AUTHOR NAMES Miles A.H. Spaeder M.C. Stockwell D.C. AUTHOR ADDRESSES (Miles A.H., amiles8@jhmi.edu) Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, United States. (Spaeder M.C.; Stockwell D.C.) Division of Critical Care Medicine, Children's National Health System, Washington, United States. CORRESPONDENCE ADDRESS A.H. Miles, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Bloomberg Children's Center, 1800 Orleans Street Suite 6321, Baltimore, United States. Email: amiles8@jhmi.edu SOURCE Journal of Pediatric Intensive Care (2015) 5:1 (21-27). Date of Publication: 30 Nov 2015 ISSN 2146-4626 (electronic) 2146-4618 BOOK PUBLISHER Georg Thieme Verlag, kunden.service@thieme.de ABSTRACT Background: Adverse events have been associated with unplanned intensive care unit (ICU) transfers in adults. Objective: To examine trends in unplanned ICU transfers in pediatrics resulting from adverse events. Design, Setting, Patients: Retrospective observational study of pediatric and cardiac ICU transfers from acute care units during a 2-year period in a tertiary care children's hospital. Methods: Transfers were identified via electronic health record query and investigated for adverse events. Predefined adverse events included ICU transfers within 12 hours of admission to an acute care unit, readmissions to an ICU within 24 hours, and cardiopulmonary arrest on an acute care unit. Other adverse events examined were not predefined. Adverse events were evaluated for preventability and categorized by type, diagnosis, time of day and weekday versus weekend occurrence, and level of associated patient harm. Results: There were 1,008 ICU transfers during the study period; 67% were unplanned. Of the unplanned transfers, 32% were attributed to adverse events, 35% of which were preventable. Unplanned transfers associated with a high rate of preventable adverse events included readmission to an ICU within 24 hours (58%, p = 0.002) and ICU transfer within 12 hours of acute care admission (34%). Conclusions: We observed a high rate of preventable adverse events associated with unplanned pediatric ICU transfers, many of which were due to inappropriate triage. Readmission to an ICU within 24 hours of transfer to an acute care unit was significantly associated with preventability. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward patient harm patient transport pediatric intensive care unit pediatric ward EMTREE MEDICAL INDEX TERMS adolescent article cardiopulmonary arrest child coronary care unit electronic health record emergency care female hospital patient hospital readmission human infant major clinical study male observational study preschool child priority journal retrospective study school child EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160942013 PUI L613851679 DOI 10.1055/s-0035-1568150 FULL TEXT LINK http://dx.doi.org/10.1055/s-0035-1568150 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 194 TITLE Direct transfer of long-stay ICU patients to a nursing-home rehabilitation unit: focus on functional dependency AUTHOR NAMES Vossenberg-Postma S.R. Sikkema Y.T. Drogt-Bilaseschi I. Bruins-Lange N.A. de Jager C.M. van Maaren T. van der Pol V. Boerma E.C. AUTHOR ADDRESSES (Vossenberg-Postma S.R.; van Maaren T.; van der Pol V.) Elderly Care Medicine, Zorggroep Noorderbreedte, Leeuwarden, Netherlands. (Sikkema Y.T.) Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, Netherlands. (Drogt-Bilaseschi I.; Bruins-Lange N.A.; de Jager C.M.; Boerma E.C., e.boerma@chello.nl) Department of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, Leeuwarden, Netherlands. CORRESPONDENCE ADDRESS E.C. Boerma, Department of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, Leeuwarden, Netherlands. Email: e.boerma@chello.nl SOURCE Intensive Care Medicine (2015) 41:11 (2031-2032). Date of Publication: 29 Nov 2015 ISSN 1432-1238 (electronic) 0342-4642 BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit length of stay nursing home patient transport rehabilitation center EMTREE MEDICAL INDEX TERMS disability hospital patient hospital readmission hospitalization human letter ward EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015326812 MEDLINE PMID 26306720 (http://www.ncbi.nlm.nih.gov/pubmed/26306720) PUI L605775189 DOI 10.1007/s00134-015-4029-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-015-4029-1 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 195 TITLE Critical Care Transport: How Do We Measure Up? AUTHOR NAMES Oberender F. AUTHOR ADDRESSES (Oberender F.) Paediatric Intensive Care, Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia. CORRESPONDENCE ADDRESS F. Oberender, Paediatric Intensive Care, Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia. SOURCE Pediatric Critical Care Medicine (2015) 16:8 (775-776). Date of Publication: 11 Nov 2015 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS anesthesiology clinical decision making critically ill patient editorial emergency medicine endotracheal intubation funding health care personnel management health care policy health care quality human medical education mortality newborn intensive care priority journal resuscitation EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015425144 MEDLINE PMID 26427809 (http://www.ncbi.nlm.nih.gov/pubmed/26427809) PUI L606281509 DOI 10.1097/PCC.0000000000000478 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000478 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 196 TITLE Parental presence at cardiac intensive care unit bedside transfer rounds reduces parental anxiety: Results of a randomized controlled trial AUTHOR NAMES Anand V. Williams E. Elgendi M. Meakins L. Cunningham C. McCrady H. Tawfiq G. Devlin N. Shine K. Larsen B. Rebeyka I. Adatia I. AUTHOR ADDRESSES (Anand V.; Williams E.; Shine K.; Larsen B.; Adatia I.) Pediatrics, Univ of Alberta, Edmonton, Canada. (Elgendi M.) Computer Sciences, Univ of Alberta, Edmonton, Canada. (Meakins L.; Cunningham C.; McCrady H.; Devlin N.) Pediatrics, Stollery Children's Hosp, Edmonton, Canada. (Tawfiq G.) Pharmacy, Stollery Children's Hosp, Edmonton, Canada. (Rebeyka I.) Cardiac Surgery, Univ of Alberta, Edmonton, Canada. CORRESPONDENCE ADDRESS V. Anand, Pediatrics, Univ of Alberta, Edmonton, Canada. SOURCE Circulation (2015) 132 SUPPL. 3. Date of Publication: 10 Nov 2015 CONFERENCE NAME American Heart Association's 2015 Scientific Sessions and Resuscitation Science Symposium CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2015-11-07 to 2015-11-11 ISSN 0009-7322 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The transfer of children from the pediatric cardiac intensive care unit (PCICU) to the ward is a time of great anxiety for the parents of children and medical vulnerability for children who are receiving complex therapies. Hypothesis: We assessed the hypothesis that parental presence at bedside transfer rounds would reduce parental anxiety and improve patient safety following transfer of children from PCICU to the ward. Methods: We undertook a randomized controlled trial of children discharged from the PCICU to the ward. Consenting parents were randomized to be absent (control group) or present (intervention group) at multidisciplinary face to face bedside transfer rounds. The primary outcome measure was parental stress measured by the validated Spielberger's State -Trait Anxiety Inventory (STAI) pre and post transfer. Secondary outcome measures included unplanned readmission to the PCICU, medication errors and emergency calls to the ward. We excluded patients being transferred between intensive care units. Results: We enrolled 230 subjects (control group n=93, intervention group n=91, failed to complete study n= 46). The 2 groups were matched with respect to gender (male 46% control vs 54% intervention), age (median age control 1.9 yrs (range 0.02 to 16.3) vs intervention 0.9 (0.02 to 17), parental age 32 yrs (18-64) vs 33 (20-60), parental years of schooling 15.5 years ( 7-26) vs 15 (9-24), presence of medical co-morbidities (33% each group). There was significantly greater reduction in trait (p=0.004, state (p=0.01) and total anxiety (p=0.0012) pre and post transfer in the intervention group vs the control group. There were no differences in minor medication errors (36 vs 33), unplanned PCICU re-admissions (11 vs 12) and emergency ward calls(7 vs 8) Conclusions: Parental presence at face to face multidisciplinary transfer rounds from the PCICU is associated with reduced parental anxiety without change in medication errors, readmission rates or emergency calls to the ward. Reduced parental anxiety may improve parental satisfaction with their child's care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety human intensive care intensive care unit medical society patient care pediatric cardiology randomized controlled trial resuscitation EMTREE MEDICAL INDEX TERMS child child care control group emergency emergency ward gender hospital readmission hypothesis male medication error morbidity parent parental age parental stress patient patient safety satisfaction school State Trait Anxiety Inventory therapy ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72181275 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 197 TITLE Risk of mishaps during intrahospital transport of critically ill patients ORIGINAL (NON-ENGLISH) TITLE Risque d’incidents lors des transports intra hospitaliers des patients de réanimation AUTHOR NAMES Hajjej Z. Gharsallah H. Boussaidi I. Daiki M. Labbene I. Ferjani M. AUTHOR ADDRESSES (Hajjej Z.; Gharsallah H.; Boussaidi I.; Daiki M.; Labbene I.; Ferjani M.) Department of Critical Care Medicine and Anesthesiology Military Hospital of Tunis, Université Tunis Elmana, Tunisia. SOURCE Tunisie Medicale (2015) 93:11 (708-713). Date of Publication: 1 Nov 2015 ISSN 0041-4131 BOOK PUBLISHER Maison du Medicine, tunisie.medicale@planet.tn ABSTRACT Background: Mishaps are common during transport and may havemajor impacts on patients.Aims: The main objectives of our study are: first to determine theincidence of complications during intra hospital transports (IHT) ofcritically ill patients, and second, to determine their risk factors.Methods: All intra hospital transports for diagnostic and therapeuticpurposes of patients consecutively admitted in an 18-bed medicalsurgical intensive care unit in an university hospital, have beenstudied prospectively during a period of six months (September 1st2012 to February 28th 2013).Results: Of 184 transports observed (164 patients), 85 (462%) wereassociated with mishaps. Eighty two mishaps were patient-related(445%).Oxygen desaturation (30 cases), agitation (24 cases) andhemodynamic instability (15 cases) were predominantly. One case ofcardiac arrest and 3 cases of accidental extubation were occurredduring IHT. Seventy three systems-based mishaps were noted(396%). Emergency transports, mechanical ventilation and positiveend-expiratory pressure (PEEP) ≥ 6 cmH2O were independent riskfactors for a higher rate of mishaps. In our study, complications did notstatistically increase ventilator-associated pneumonia.Conclusion: This study confirms that IHT of critically-ill patients stillinvolves considerable risks and mishaps incidence remains high. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) accident patient transport EMTREE MEDICAL INDEX TERMS agitation article artificial ventilation critically ill patient heart arrest human intensive care unit major clinical study oxygen desaturation positive end expiratory pressure risk factor EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 20160055263 PUI L607813574 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 198 TITLE A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa AUTHOR NAMES Royal C. McKerrow N.H. AUTHOR ADDRESSES (Royal C., candiceroyal@gmail.com; McKerrow N.H.) Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. (McKerrow N.H.) Department of Health, KwaZulu-Natal, South Africa. CORRESPONDENCE ADDRESS C. Royal, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. Email: candiceroyal@gmail.com SOURCE SAJCH South African Journal of Child Health (2015) 9:4 (112-118). Date of Publication: 1 Nov 2015 ISSN 1994-3032 BOOK PUBLISHER Health and Medical Publishing Group ABSTRACT Background. Obtaining care for an acutely ill child in specialised paediatric services relies on referral from lower-level facilities. In South Africa, it is common practice for acutely ill children to be transported far distances by non-specialist teams with limited equipment, knowledge and skills. Objectives. To describe the transfer of these children and to determine whether they deteriorate from the time of referral to the time of arrival at a tertiary centre. Furthermore, we sought to identify modifiable factors that might improve outcomes during resuscitation and transfer. Methods. The study was a retrospective review of emergency referrals of children aged 1 month - 12 years to Grey’s Hospital paediatric ward or paediatric intensive care unit (PICU), from lower-level facilities in KwaZulu-Natal between January and June 2012. In conjunction with an assessment by the receiving clinician at Grey’s Hospital, Triage Early Warning Signs (TEWS) scores were obtained during telephonic referral and compared with the TEWS score on arrival in order to determine if a deterioration had occurred. Results. A total of 57 PICU referrals and 79 ward referrals were analysed. The mortality rate prior to transportation was 8.8%. Mean transfer distance was 131 km and mean transfer time 9 hours. Advanced life support teams undertook transportation in 76.7% of PICU and 25% of ward transfers and few adverse events were reported in transfer logs. However, 31.5% of PICU and 11.3% of ward referrals required immediate resuscitation on arrival. When the TEWS scoring system was applied 78.5% of PICU and 30.4% of ward referrals fell into the ‘very urgent’ and ‘emergency’ categories. Conclusion. Pretransport and in-transit care failed to stabilise children and this may reflect lack of skill of attending healthcare workers, transport delays or illness progression. Interventions to improve resuscitation and transfer are needed, and the use of retrieval teams should be investigated. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient referral tertiary health care EMTREE MEDICAL INDEX TERMS age distribution article controlled study diarrhea female gastrointestinal disease human infant intensive care unit major clinical study male mortality neurologic disease patient transport pediatric advanced life support pneumonia resuscitation retrospective study scoring system seizure South Africa EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015517690 MEDLINE PMID 25796080 (http://www.ncbi.nlm.nih.gov/pubmed/25796080) PUI L606936610 DOI 10.7196/SAJCH.2015.v9i4.913 FULL TEXT LINK http://dx.doi.org/10.7196/SAJCH.2015.v9i4.913 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 199 TITLE Risk factors for postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients AUTHOR NAMES Melamed R. Boland L. Normington J. Prenevost R. Hur L. Maynard L. McNaughton M. Huguelet J. AUTHOR ADDRESSES (Melamed R.; Boland L.; Normington J.; Prenevost R.; Hur L.; Maynard L.; McNaughton M.; Huguelet J.) Allina Health, Minneapolis, United States. CORRESPONDENCE ADDRESS R. Melamed, Allina Health, Minneapolis, United States. SOURCE Chest (2015) 148:4 MEETING ABSTRACT. Date of Publication: October 2015 CONFERENCE NAME CHEST 2015 CONFERENCE LOCATION Montreal, QC, Canada CONFERENCE DATE 2015-10-24 to 2015-10-28 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT Purpose: To describe patient characteristics, care factors, and outcomes in orthopedic surgery patients who developed postoperative respiratory failure (RF) requiring transfer to the intensive care unit (ICU) and in control patients who did not develop this complication. Methods: A retrospective frequency-matched case control study was conducted among orthopedic surgery patients treated at a single tertiary care facility between 2010 and 2013. Cases were all patients who underwent elective or semi-elective orthopedic surgery (knee, hip, shoulder, or spine) and developed postoperative RF necessitating transfer to the ICU (n=51). Controls (n=153) were randomly selected from among similar orthopedic surgery patients and frequency matched to cases by gender, age, and surgical procedure. Patient and care factors, length of stay, mortality, and cost of care were examined in the two groups. Results: The mean age of patients was 66 years, 65% were female, and the majority underwent knee (37%) or non-cervical spine (41%) procedures. Transfer to the ICU occurred within 48 hours of surgery in 73% of the cases, and 9 (18%) required mechanical ventilation. Body-mass index was similar in cases and controls, but cases had a higher prevalence of chronic obstructive pulmonary disease (COPD; 22% vs 3%, p<0.0001) and obstructive sleep apnea (OSA; 35% vs 11%, p<0.001) than controls. Postoperatively, cases were more likely to have received patient-controlled analgesia (PCA; 51% vs 31%, p=0.01) and had more intravenous morphine equivalents during the first 24 postoperative hours than controls (median 110 mg vs 73 mg, p=0.006). Cases had longer hospitalizations (9 days versus 3 days) and higher in-hospital mortality (6% vs 0%) than controls. The average cost of hospitalization was significantly higher in cases ($46,456) than controls Conclusions: Acute RF after elective orthopedic surgery is a highly significant complication associated with extended hospitalization, increased mortality and higher cost of care. Risk factors may include preexisting COPD and OSA, use of PCA, and larger doses of opioid analgesics in the initial 24-hr postoperative period. Clinical Implications: Development of hospital protocols that include risk factor assessment as well as enhanced monitoring and a cautious approach to opioid use in patients deemed high-risk may reduce the frequency and cost of this complication. EMTREE DRUG INDEX TERMS morphine narcotic analgesic agent opiate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care unit orthopedic surgery respiratory failure risk factor surgical patient EMTREE MEDICAL INDEX TERMS artificial ventilation body mass case control study cervical spine chronic obstructive lung disease female gender hip hospital hospitalization knee length of stay monitoring mortality patient patient controlled analgesia postoperative period prevalence procedures risk shoulder sleep disordered breathing spine surgery surgical technique tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72120199 DOI 10.1378/chest.2228884 FULL TEXT LINK http://dx.doi.org/10.1378/chest.2228884 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 200 TITLE Measuring intangibles: Defining predictors of non-technical skills in critical care Air transport team trainees AUTHOR NAMES Jernigan P.L. Wallace M.C. Novak C. Gerlach T. Pritts T.A. Davis B.R. AUTHOR ADDRESSES (Jernigan P.L.; Wallace M.C.; Novak C.; Gerlach T.; Pritts T.A.; Davis B.R.) University of Cincinnati, Cincinnati, OH; University of Cincinnati Institute of Military Medicine, Cincinnati, OH CORRESPONDENCE ADDRESS P.L. Jernigan, SOURCE Journal of the American College of Surgeons (2015) 221:4 SUPPL. 1 (S53). Date of Publication: October 2015 CONFERENCE NAME 101st Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2015-10-04 to 2015-10-08 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: Critical Care Air Transport Teams (CCATTs) are an essential component of the United States Air Force aeromedical evacuation paradigm. Previous work by our group demonstrated that task saturation frequently occurs in simulated CCATT training missions and is associated with worse performance in non-technical skills. This study was conducted to evaluate predictors of performance in non-technical skills. METHODS: Sixteen CCATTs were assessed during simulated training missions. Biographical data were gathered from participant surveys. Teams were assessed during critical events to determine the presence or absence of task saturation. Non-technical skills were scored using a validated tool assessing 8 domains of performance. Cortisol levels were measured at baseline and pre- and post-simulation. RESULTS: A total of 69 crisis events were identified, and task saturation was observed in 42% of these events. There was an inverse correlation between team performance score and task saturation during the simulations (odds ratio 0.5, 95% CI, 0.32-0.80, p<0.01). In a multivariate analysis, daily ICU experience (p<0.03) and previous deployment experience (p<0.04) correlated with higher performance scores; previous participation in the training course and in simulated missions did not. Average pre-simulation cortisol levels increased significantly from baseline (p=0.0002), suggesting appropriate suspension of disbelief during simulations. Of note, cortisol levels did not correlate with performance scores or biographical data. CONCLUSIONS: Task saturation is associated with worse performance in non-technical skills. Previous real world experience correlates with better non-technical skills, while simulated experience does not. Further studies are needed to develop more effective strategies for training non-technical skills. EMTREE DRUG INDEX TERMS hydrocortisone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American college human intensive care skill student surgeon EMTREE MEDICAL INDEX TERMS air force multivariate analysis risk simulation training United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72170094 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 201 TITLE Clinical consideration of surveillance cultures for out-born neonates transferred to NICU AUTHOR NAMES Lee S. Cho H.J. AUTHOR ADDRESSES (Lee S.; Cho H.J.) Wonkwang University, School of Medicine and Hospital, Iksan (Neonatal Intensive Care Center), South Korea. CORRESPONDENCE ADDRESS S. Lee, Wonkwang University, School of Medicine and Hospital, Iksan (Neonatal Intensive Care Center), South Korea. SOURCE Journal of Perinatal Medicine (2015) 43 SUPPL. 1. Date of Publication: October 2015 CONFERENCE NAME 12th World Congress of Perinatal Medicine 2015 CONFERENCE LOCATION Madrid, Spain CONFERENCE DATE 2015-11-03 to 2015-11-06 ISSN 0300-5577 BOOK PUBLISHER Walter de Gruyter GmbH ABSTRACT Objective: To identify trends in bacterial organisms and antimicrobial susceptibilities for transmission by out-born neonates, it is important to perform surveillance cultures. The aim of this study was to investigate major organisms and any other clinical factors through surveillance cultures of out-born neonates who transferred to NICU. Methods: This study is a retrospective collected data among 189 out-born neonates admitted to NICU from Mar. 1, 2012, to Feb. 31, 2014. Surveillance cultures were obtained routinely from both nasal and axillary region and inoculated CHROM agar™ MRSA immediately. Bacterial culture identification and antibiotic susceptibility were using Vitek II ID-GPI card. Results: The most prevalent organisms isolated from the nasal surveillance cultures were MRSA and CoNS (each 17 cases vs. 11 cases); both vancomycin and rifampin were susceptible. Only 1 case of S. epidermidis has same result in blood and surveillance culture. Demographic, clinical and healthcare related parameters according to surveillance culture results were compared, but no obvious association was apparent on above parameters. Nevertheless, positive surveillance culture group showed lower birth weight and longer duration until transferred to NICU. Conclusion: In our surveillance culture study showed that MRSA and CoNS were the most common organisms in out-born neonates; both were penicillin & oxacillin resistant on antibiotic susceptibility testing. Although there is no statistical meaning, positive surveillance culture group showed relatively lower birth weight and longer duration from birth to NICU arrival. These findings contributed to obtain a reliable policy of the transmission in NICU. EMTREE DRUG INDEX TERMS agar oxacillin penicillin derivative rifampicin vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn perinatal care EMTREE MEDICAL INDEX TERMS antibiotic sensitivity bacterium culture birth weight blood health care methicillin resistant Staphylococcus aureus parameters policy Staphylococcus epidermidis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72185360 DOI 10.1515/jpm-2015-2003 FULL TEXT LINK http://dx.doi.org/10.1515/jpm-2015-2003 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 202 TITLE Clinical uncertainty, near-misses, and adverse events relating to physician handoffs during intensive care unit-ward transfer: A qualitative analysis AUTHOR NAMES Lyons P.G. Farnan J.M. Arora V.M. AUTHOR ADDRESSES (Lyons P.G.; Farnan J.M.; Arora V.M.) University of Chicago Medicine, Chicago, United States. CORRESPONDENCE ADDRESS P.G. Lyons, University of Chicago Medicine, Chicago, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2015) 191 MeetingAbstracts. Date of Publication: 2015 CONFERENCE NAME American Thoracic Society International Conference, ATS 2015 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2015-05-15 to 2015-05-20 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Patients are vulnerable during care transitions, and significant research has linked discontinuity in care transitions to adverse patient outcomes. Despite focus on improving inpatient handoff quality, little is known about physician communication when patients transfer from the ICU to the wards. This study aims to describe resident handoff behaviors during ICU-ward transfer and identify near-miss and adverse patient events secondary to uncertainty related to these handoffs. Methods: All residents completing inpatient general medicine, oncology, and cardiology rotations between October 2013 and January 2014 were invited to participate. Consenting residents were privately interviewed using critical incident technique to elicit near-miss and adverse events due to ineffective handoffs of patients transferring from the ICU to the wards. Interviews were audio recorded and transcribed for analysis. A member of the research team coded transcripts using the constant comparative method, with no a priori hypotheses, to generate initial categories. A second member of the research team independently reviewed 15% of the transcripts to ensure coder agreement and reliability. Patient outcomes identified in the narrative examples were evaluated to identify critical events. Results: 68 residents were approached and 29 (43%) were interviewed. Residents reported spending an average of 8 minutes per patient per handoff. 24 residents (83%) reported receiving at least one handoff in-person, and 13 residents (45%) reported receiving at least one telephone handoff. 19 residents (66%) reported 27 adverse events or near-misses experienced by patients due to communication failures from a poor ICU-ward handoff. Three major domains of communication failure emerged (Table 1): missing information (16), incorrect information (10), and unclear responsibility for the patient peri-handoff (1). A representative narrative comment for the domain of “incorrect information” in a handoff for a patient transferring from the cardiac ICU: “we had been [incorrectly] told [the electrophysiology consultants] wanted to keep holding [prophylactic anticoagulation] she ended up developing PEs and subsequently died.” In total, 4 incidents involved patient death or life-threatening adverse events, and another 6 were near-misses with life-threatening potential, such as failure to alert the receiving resident to a patient's active disseminated intravascular coagulation. Conclusions: Residents report spending little time on ICU-ward handoffs, and commonly encounter adverse events or near-misses due to handoff communication failures. Our results highlight the ubiquity of miscommunication and the risk of medical error when patients transfer from the ICU to the wards. Interventions to improve ICU-ward communication are needed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American clinical handover human intensive care unit qualitative analysis society ward EMTREE MEDICAL INDEX TERMS anticoagulation cardiology constant comparative method consultation death disseminated intravascular clotting electrophysiology general practice hospital patient hypothesis interpersonal communication interview medical error narrative oncology patient physician reliability responsibility risk telephone LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72048876 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 203 TITLE Clinical implications and biases involved in inter-icu transfers AUTHOR NAMES Nadig N.R. Goodwin A.J. Simpson A. Simpson K.N. Ford D.W. AUTHOR ADDRESSES (Nadig N.R., nadig@musc.edu; Goodwin A.J.; Simpson A.; Simpson K.N.; Ford D.W.) Medical University of South Carolina, Charleston, United States. CORRESPONDENCE ADDRESS N.R. Nadig, Medical University of South Carolina, Charleston, United States. Email: nadig@musc.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2015) 191 MeetingAbstracts. Date of Publication: 2015 CONFERENCE NAME American Thoracic Society International Conference, ATS 2015 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2015-05-15 to 2015-05-20 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale- Patients with ventilator-dependent respiratory failure (VDRF) represent a population that is severely ill with high risk of morbidity and mortality. Prior investigation has shown that patients with VDRF have improved outcomes when treated at high volume centers sparking debate over whether regionalized care is needed, which in theory involves inter-ICU transfers. However, other studies report that transferred critically ill patients have worse outcomes compared to patients who do not undergo transfer. Thus, there are conflicting views about clinical implications of inter-ICU transfer. In order to address this, we propose to characterize the clinical impact and inherent biases involved in inter-ICU transfers among patients with VDRF and compare it to a group that is not transferred. Methods- We devised a retrospective cohort study utilizing the Healthcare Cost and Utilization Project (HCUP) state inpatient database (SID) and identified patients with ICD-9 codes of respiratory failure and mechanical ventilation from Florida during the calendar year 2012. Inter-ICU transfers were defined as readmission within 24 hours to another hospital. The transfers and the non-transfers were compared for final analysis. Our primary outcome was in-hospital mortality and secondary outcomes included hospital length of stay and discharge destination. Results- We identified 55,631 admissions with VDRF diagnosis to Florida ICU's in 2012 to 48,252 unique patients. 4% or 1,831 of these patients were transferred to another ICU. Of the transferred patients 1,325 (72%) had individual record identifiers that enabled us to analyze them. Transfers were younger, more likely to be male, Hispanic, and have Medicare or commercial insurance. Inaddition, the transfers had lower mortality (16.1% vs 28.4%), but longer length of stay (15.8 vs. 14.9) days, and were more likely to be discharged to home (23.3% vs. 19.8%). In multivariable models controlling for age, sex, race and insurance status, the risk of death in the hospital for transfers was about half of the risk observed for non-transfers Conclusions- This is an observational study of current practices and crude mortality associated with inter-ICU transfers. It also helps us identify the patterns of inherent biases of transfers in the current system. Transferred patients with VDRF are more likely to be insured compared to non-transfers. Transferred patients also have lower mortality than non-transferred patients. However, the limitations include lack of robust measures to control for illness severity which will need to be evaluated in future studies. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American society EMTREE MEDICAL INDEX TERMS artificial ventilation cohort analysis critically ill patient data base death diagnosis disease severity health care cost Hispanic hospital hospital patient hospital readmission human ICD-9 insurance length of stay male medicare model morbidity mortality observational study patient population respiratory failure risk United States ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72051514 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 204 TITLE Pre- and intra-transport neonatal care oxygen saturation hypoxemia among referred neonate in a tertiary hospital in Nigeria AUTHOR NAMES Abdulraheem M.A. Orimadegun A.E. Tongo O. AUTHOR ADDRESSES (Abdulraheem M.A., ojomuhy@yahoo.com) Nagasaki University, Nagasaki, Japan. (Orimadegun A.E.) University of Ibadan, Ibadan, Nigeria. (Tongo O.) University College Hospital, Ibadan, Nigeria. CORRESPONDENCE ADDRESS M.A. Abdulraheem, Nagasaki University, Nagasaki, Japan. Email: ojomuhy@yahoo.com SOURCE American Journal of Respiratory and Critical Care Medicine (2015) 191 MeetingAbstracts. Date of Publication: 2015 CONFERENCE NAME American Thoracic Society International Conference, ATS 2015 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2015-05-15 to 2015-05-20 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Background: Large proportion of babies in Nigeria are delivered at home or primary health care centers and many get referred to secondary or tertiary health care level. Poorly organized transport practices often make the condition of most of these referred neonates on arrival at neonatal intensive care unit worse. Though hypoxaemia relating to respiratory and non-respiratory causes is potential morbidity attributable to quality of care received during neonatal transportation, its magnitude and related consequences have not been studied in Nigeria. Methods: In this study, we prospectively recruited 382 neonates referred to the University College Hospital (UCH), Ibadan Nigeria. A structured form was used to record events pre-transport, intra-transport and at presentation in UCH. Oxygen saturation measured using pulse oximeter (Massimo® Rad 5 Pulse Oximeter, made in U.S.A) Demographic and clinical features were recorded. Hypoxemia was defined as hemoglobin saturation of less than 90%. Also, temperature, random plasma glucose, serum bicarbonate and the weight of the babies were measured. Descriptive and Chi-square statistics were used in data analyses with level of significance set at p = 0.05. Logistic regression was used to determine predictors of hypoxemia and outcome in 48-hour of admission. Results: Study participants included 58.6% male and 41.2% female of which 67.1% were term, 31.4% preterm and 1.5% post term. Eighty-two percent were transported from hospitals/maternity centres while 17.9% were from home. Less than 25% received the expected pre-transport care for each item in STABLE program and this care was continued intra-transport in <20%. Only 3 (0.2%) were transported in an incubator. Morbidity detected at presentation included: hypoxemia (66.2%), hypothermia (29.8%), hypoglycaemia (17.7%), metabolic acidosis (36.1%) and apnoea (9.4%). At presentation, hypoxemia was associated with failure to administer oxygen (OR = 3.44; 95% CI = 1.92, 6.16) while acidosis (OR = 2.07; 95% CI = 1.23, 3.47) and apnoea (OR = 4.16; 95% CI = 1.26, 21.65) were significantly associated with failure to feed after adjusting for gestational age and other variables (Table 2). However, these variables did not influence occurrence of hypoxemia in the first 48 hours of admission. Conclusion: Quality transport facilities are not available in most referring centres, poor pre- transport care negatively influenced oxygen saturation. There is the need for health care providers at primary facilities to recognise the importance of pre-transport stabilisation for referred neonates. Policy makers need to urgently regulate perinatal care and make policies regarding the transfer of sick neonates. EMTREE DRUG INDEX TERMS hemoglobin oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American hypoxemia newborn newborn care Nigeria oxygen saturation society tertiary care center EMTREE MEDICAL INDEX TERMS acidosis apnea baby bicarbonate blood level clinical feature college data analysis female gestational age glucose blood level health care personnel hospital human hypoglycemia hypothermia incubator intensive care unit logistic regression analysis male metabolic acidosis morbidity newborn intensive care perinatal care policy primary health care pulse oximeter statistics temperature tertiary health care traffic and transport university weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72049701 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 205 TITLE Analysis of clinical characteristics, rationale, and management of critically ill obstetric patients transferred to ICU AUTHOR NAMES Yousuf N. Shaikh S.N. Soomro A. Baloch R. AUTHOR ADDRESSES (Yousuf N., nymemon66@gmail.com; Shaikh S.N.; Baloch R.) Department of OB/GY, SMBBMU, Larkana, Pakistan. (Soomro A.) Department of Anaesthesia and ICU, CMC, SMBBMU, Larkana, Pakistan. CORRESPONDENCE ADDRESS N. Yousuf, Department of OB/GY, SMBBMU, Larkana, Pakistan. SOURCE Journal of the Pakistan Medical Association (2015) 65:9 (959-962). Date of Publication: 1 Sep 2015 ISSN 0030-9982 BOOK PUBLISHER Pakistan Medical Association ABSTRACT Objective: To evaluate the clinical and demographic characteristics, rationale for transfer of critically ill obstetric patients to intensive care unit and their management therein. Methods: The observational retrospective case series study was conducted at Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan, and comprised critically ill female patients transferred to intensive care unit from the department of Obstetrics and Gynaecology between August 2011 and June 2013. The data was collected on pre-designed proforma which included demographic characteristics of patients, their symptomatology and initial diagnosis, intervention in the department, continuing or subsequent complications/reasons for admission to intensive care unit, management and stay there and, finally, outcome. Data was analysed using SPSS 21. Results: The mean age of 150 patients in the study was 30.3±5.047years,mean parity was 2.49±2.207.The most common condition affecting women and leading to their transfer to intensive care was eclampsia/pre-eclampsia in 80(53.33%) followed by bleeding disorders in 25(16.65%) and septic shock in 24(16%). The mean stay in intensive care was 4.47±2.53 days, and 38(25.3%) patients required ventilator support, while 112(74.7%) were managed with oxygen and inotropic support. The overallmaternalmortality rate was 41(27.3%), which included 19(16.9%) patients managed without ventilator, and 22 (57.8%) managed with ventilator (p<0.05). Conclusion: Hypertensive and bleeding disorders were the main reasons for transfer of obstetric patients to intensive care unit, and maternal mortality was high among patients treated on ventilator support. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical feature intensive care unit obstetric patient EMTREE MEDICAL INDEX TERMS abdominal hysterectomy adolescent adult amenorrhea antepartum hemorrhage article artificial ventilation bleeding disorder cesarean section distress syndrome dyspnea female hospitalization human hypertension hypovolemic shock laparotomy lung edema major clinical study mortality outcome assessment peritonitis preeclampsia retrospective study sepsis septic shock vagina bleeding vagina discharge EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015337006 MEDLINE PMID 26338741 (http://www.ncbi.nlm.nih.gov/pubmed/26338741) PUI L605821800 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 206 TITLE Resuscitation During Critical Care Transportation in Afghanistan AUTHOR NAMES Tobin J.M. Nordmann G.R. Kuncir E.J. AUTHOR ADDRESSES (Tobin J.M.; Nordmann G.R.; Kuncir E.J.) SOURCE Journal of special operations medicine : a peer reviewed journal for SOF medical professionals (2015) 15:3 (72-75). Date of Publication: 1 Sep 2015 ISSN 1553-9768 ABSTRACT OBJECTIVE: These data describe the critical care procedures performed on, and the resuscitation markers of, critically wounded personnel in Afghanistan following point of injury (POI) transports and intratheater transports. Providing this information may help inform discussion on the design of critical care transportation platforms for future conflicts.METHODS: The Department of Defense Trauma Registry (DoDTR) was queried for descriptive data on combat casualties with Injury Severity Score (ISS) greater than 15 who were transported in Operation Enduring Freedom (OEF) from 1 January 2010 to 31 December 2010. Both POI transportation events and interfacility transportation events were reviewed. Base deficit (BD) was evaluated as a maker of resuscitation, and international normalized ratio (INR) was evaluated as a measure of coagulopathy.RESULTS: There were 1198 transportation events that occurred during the study period--634 (53%) transports from the POI and 564 (47%) intratheater transports. Critical care interventions were performed during 147 (12.3%) transportation events, including intubation, cricothyrotomy, double-lumen endotracheal tube placement, needle or tube thoracostomy, central venous access placement, and cardiopulmonary resuscitation. The mean BD on arrival in the emergency department was -5.4 mEq/L for POI transports and 0.68 mEq/L intratheater transports (ρ<.001). The mean INR on arrival in the emergency department was 1.48 for POI transports and 1.21 for intratheater transports (ρ<.001).CONCLUSIONS: Critical care interventions were needed frequently during evacuation of severely injured personnel. Furthermore, many troops arrived acidotic and coagulopathic following initial transport from POI. Together, these data suggest that a platform capable of damage control resuscitation and critical care interventions may be warranted on longer transports of more critically injured patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) soldier statistics and numerical data EMTREE MEDICAL INDEX TERMS acidosis adolescent adult battle injury (therapy) blood blood clotting disorder blood gas analysis central venous catheterization decompression surgery endotracheal intubation human injury scale intensive care international normalized ratio middle aged patient transport register resuscitation thorax drainage United States utilization war young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26360357 (http://www.ncbi.nlm.nih.gov/pubmed/26360357) PUI L611005734 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 207 TITLE Single embryo transfer of frozen-thawed embryos is associated with increased maternal complications AUTHOR NAMES Shavit T. Oron G. Tulandi T. Son W. Holzer H. Buckett W. AUTHOR ADDRESSES (Shavit T.) McGill University, MUHC Reproductive Center, Montreal, Canada. (Oron G.; Son W.; Holzer H.) Department of Obstetrics and Gynecology, McGill University, Montreal, Canada. (Tulandi T.; Buckett W.) McGill University, Montreal, Canada. CORRESPONDENCE ADDRESS T. Shavit, McGill University, MUHC Reproductive Center, Montreal, Canada. SOURCE Fertility and Sterility (2015) 104:3 SUPPL. 1 (e196). Date of Publication: September 2015 CONFERENCE NAME 71st Annual Meeting of the American Society for Reproductive Medicine, ASRM 2015 CONFERENCE LOCATION Baltimore, MD, United States CONFERENCE DATE 2015-10-17 to 2015-10-21 ISSN 0015-0282 BOOK PUBLISHER Elsevier Inc. ABSTRACT OBJECTIVE: Cryopreservation of embryos allows transfer of a single embryo (SET) and storage of supernumerary embryos maximizing the cumulative pregnancy rates. It has been reported that IVF conceived singletons are prone to pregnancy complications including low birth weight (LBW), preterm deliveries (PTD) and small for gestational age (SGA). The purpose of our study was to compare the pregnancy outcome in singletons born after fresh or frozen-thawed single blastocyst transfer (SBT). DESIGN: A single center retrospective cohort study, a reproductive unit of a tertiary university health center. MATERIALS AND METHODS: We compared singleton live births resulting from transfer of fresh or frozen-thawed single blastocyst embryo (SBT). The primary outcomes were perinatal outcomes including SGA, LBW, very LBW, PTD, early PTD, large for gestational age (LGA), hospitalization at the neonatal intensive care unit, respiratory and gastrointestinal complications and congenitalmal formations. Maternal complications included preeclampsia, placenta previa, placental abruption, gestational diabetes mellitus (GDM) and chorioamnionitis. Adjustment for confounding factors was done. RESULTS: We studied 1886 fresh-SBT and 1200 FET-SBT cycles. SBT of fresh embryo resulted in a clinical pregnancy rate of 52.2% and live birth rate of 31.3% per embryo transfer (ET). These were significantly higher than 34.4% clinical pregnancy rate and 13.7% live birth rate per ET in the FET group (p<0.001). Demographic characteristics of the mothers were comparable. The birth weight of neonate in the fresh embryo transfer group was lower compared to those in the FET (3281±595 grams vs. 3381±756 grams P=0.003). Mothers in the FET group had a higher rate of cesarean sections. Neonates in the frozen embryo transfer had increase risk to be LGA. Mothers in the FET had higher risk to develop preeclampsia (5.59% vs. 2.09% p=0.036) and GDM (4.97% vs. 1.57% p=0.02). The incidence of group maternal complication was higher in the frozen blastocyst transfer (14.29% vs. 8.17% p=0.03) whereas group neonatal complications were comparable. CONCLUSIONS: FET of a single blastocyst is associated with a higher rate of maternal complications. Singleton pregnancies achieved after FETSBT should be considered high risk pregnancies. Further studies are needed to assess the impact of freezing and thawing of embryos on maternal safety during pregnancy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American embryo embryo transfer reproduction society EMTREE MEDICAL INDEX TERMS birth rate birth weight blastocyst cesarean section chorioamnionitis cohort analysis cryopreservation demography female freezing health center high risk pregnancy hospitalization human intensive care unit large for gestational age live birth low birth weight mother newborn newborn intensive care placenta previa preeclampsia pregnancy pregnancy complication pregnancy diabetes mellitus pregnancy outcome pregnancy rate premature labor risk safety small for date infant storage thawing university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72025621 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 208 TITLE Intubation in Pediatric/Neonatal Critical Care Transport: National Performance AUTHOR NAMES Bigelow A.M. Gothard M.D. Schwartz H.P. Bigham M.T. AUTHOR ADDRESSES (Bigelow A.M.; Gothard M.D.; Schwartz H.P.; Bigham M.T.) SOURCE Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors (2015) 19:3 (351-357). Date of Publication: 1 Jul 2015 ISSN 1545-0066 (electronic) ABSTRACT OBJECTIVE: Respiratory interventions are a priority in pediatric and neonatal critical care transport (PNCCT). A recent Delphi study identified intubation performance as an important PNCCT quality metric, though data are insufficient. The objective of the study is to determine multi-center rates of first attempt intubation success in pediatric/neonatal transport and identify practice processes associated with higher performing centers.METHODS: Retrospective chart review where data was collected from the 9 participating centers over a 6-month period from January-June 2013. Data describing intubation training and practices were gathered using SurveyMonkey® (Palo Alto, CA). Data were tabulated in Microsoft Excel (Redmond, WA) and analyzed using descriptive statistics. Through the determination of 1(st) intubation success rate across multiple pediatric/neonatal critical care transport programs, we hypothesized that the features of higher and lower performing centers can be identified to inform practice.RESULTS: 9 of 14 invited institutions participated. The median (IQR) 6-month transport volume for neonates(neo) was 289(35-646) and pediatric (ped) 510(122-831). On average, 7%(+/-3.0) of neo and 1.6%(+/-0.7) of ped transport patients required intubation. Individual centers had their initial success rate calculated and a 95% confidence interval was determined for those centers satisfying the np > 5 and n(1-p) > 5 sample size requirement for normality assumption of proportions. Since the overall success rate was 64%, it was determined that n = 14 initial intubation attempts would be the minimum number needed per center in order to fulfill the sample size requirement for normality assumption. Centers whose 95% confidence interval did not contain the initial overall success rate were identified.CONCLUSION: This represents the first multi-center neo/ped intubation dataset in PNCCT. First attempt intubation success lags behind reported anesthesia intubation rates but parallels pediatric emergency department intubation success rates. Training and operational processes are variable in PNCCT, though top performing teams require live-patient intubation success to achieve initial intubation competency.BACKGROUND: There are nearly 200,000 US infants/children transported annually for specialty care and there are no published best practices in transport intubation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport standards EMTREE MEDICAL INDEX TERMS clinical audit clinical trial endotracheal intubation human multicenter study newborn retrospective study United States utilization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25664667 (http://www.ncbi.nlm.nih.gov/pubmed/25664667) PUI L609310568 DOI 10.3109/10903127.2014.980481 FULL TEXT LINK http://dx.doi.org/10.3109/10903127.2014.980481 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 209 TITLE Evaluation of effects of pneumatic tube transport on ROTEM® analyses ORIGINAL (NON-ENGLISH) TITLE Evaluatie van analytische variatie en het effect van buizenpost transport op ROTEM® analyses AUTHOR NAMES Rotteveel-De Groot D.M. Frenzel T. Noorland J. Kulk J. Loof A.H. Van Pampus E.C.M. Van Zwam M. Oosting J.D. AUTHOR ADDRESSES (Rotteveel-De Groot D.M., dorien.rotteveel-degroot@radboudumc.nl; Noorland J.; Kulk J.; Loof A.H.; Van Pampus E.C.M.; Van Zwam M.; Oosting J.D.) Radboudumc, Afdeling Laboratoriumgeneeskunde, Onderdeel LKC, Postbus 9101, Nijmegen, Netherlands. (Frenzel T.) Afdeling Intensive Care, Nijmegen, Netherlands. CORRESPONDENCE ADDRESS D.M. Rotteveel-De Groot, Radboudumc, Afdeling Laboratoriumgeneeskunde, Onderdeel LKC, Postbus 9101, Nijmegen, Netherlands. SOURCE Nederlands Tijdschrift voor Klinische Chemie en Laboratoriumgeneeskunde (2015) 40:3 (201-204). Date of Publication: 1 Jul 2015 ISSN 1570-8306 BOOK PUBLISHER Nederlandse Vereniging voor Klinische Chemie, buro@nvkc.nl ABSTRACT Rotational tromboelastometry (ROTEM®) can be used for monitoring of the blood coagulation status of patients in emergency situations. For a rapid analysis the blood samples can be transported to the central laboratory in our hospital via a pneumatic tube system. This study has been performed to determine the analytical variation of the ROTEM® parameters INTEM, EXTEM, FIBTEM and HEPTEM, and to evaluate possible effects of pneumatic tube transport on ROTEM® parameters in blood samples of cardiothoracic surgery patients of the Intensive Care Unit. Our results show that the ROTEM parameters used in a newly defined ROTEM based protocol for hemostatic therapy (EXTEM CT, EXTEM A10 and FIBTEM A10) have a within-run and between-run analytical variation of less than 5% with the exception of EXTEM CT (maximum of 8%), which is in accordance with the manufacturer's specifications. Following pneumatic tube transport, these parameters have a bias of less than 5%. In conclusion, the pneumatic tube system in our hospital can be used to transport blood samples to the central laboratory for ROTEM® analyses. In the future, this provides the possibility for various other departments in our hospital to include ROTEM® analyses in their treatment protocols. Future studies will have to elucidate whether such treatment protocol will be beneficial. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) pneumatic tool pneumatic tube transport thromboelastograph tube EMTREE MEDICAL INDEX TERMS article blood sampling clinical evaluation hemostasis human intensive care unit surgical patient thorax surgery DEVICE TRADE NAMES ROTEM EMBASE CLASSIFICATIONS Hematology (25) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE Dutch LANGUAGE OF SUMMARY English, Dutch EMBASE ACCESSION NUMBER 2015292782 PUI L605595112 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 210 TITLE Apgar Score at 5 Minutes Is Associated with Mortality in Extremely Preterm Infants even after Transfer to an All Referral NICU AUTHOR NAMES Bartman T. Bapat R. Martin E.M. Shepherd E.G. Nelin L.D. Reber K.M. AUTHOR ADDRESSES (Bartman T.; Bapat R.; Shepherd E.G.; Nelin L.D., Leif.Nelin@nationwidechildrens.org; Reber K.M.) Division of Neonatology, Department of Pediatrics, Ohio State University, Columbusa, United States. (Bapat R.; Martin E.M.; Shepherd E.G.; Nelin L.D., Leif.Nelin@nationwidechildrens.org; Reber K.M.) Small Baby Program, Nationwide Children's Hospital, Columbusa, United States. (Nelin L.D., Leif.Nelin@nationwidechildrens.org) Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbusa, United States. CORRESPONDENCE ADDRESS L.D. Nelin, Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, 575 Children's Crossroads, Columbusa, United States. Email: Leif.Nelin@nationwidechildrens.org SOURCE American Journal of Perinatology (2015) 32:13 (1268-1272). Date of Publication: 9 Jun 2015 ISSN 1098-8785 (electronic) 0735-1631 BOOK PUBLISHER Thieme Medical Publishers, Inc., custserv@thieme.com ABSTRACT Objective The Apgar score has been shown to have utility in predicting mortality in the extremely preterm infant in delivery hospital populations, where most mortality occurs within 12 hours of birth. We tested the hypothesis that the 5 minute Apgar score would remain associated with mortality in extremely preterm infants after transfer from the delivery hospital to an all referral neonatal intensive care unit at an average age of 10 days. Study Design A retrospective analysis of 454 infants born at < 27 weeks gestation. Results The median Apgar score was 3 at 1 minute (interquartile range [IQR] 2-6) and 6 at 5 minutes (IQR 4-7). The Apgar score increased from 1 to 5 minutes by 2.0 ± 1.7 (p < 0.001). In logistic regression modeling, an Apgar score of < 5 at 5 minutes was associated with an increased mortality (odds ratio 1.76 [95% confidence interval 1.06-2.94], p < 0.05), but not morbidities. Conclusion Infants born at < 27 weeks gestation admitted to an all referral children's hospital at a mean age of 10 days with a 5 minute Apgar < 5 are at an increased risk of mortality. Our findings continue to support the importance of the Apgar score given at delivery even in the extremely preterm infant referred to a nondelivery children's hospital. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Apgar score newborn mortality prematurity EMTREE MEDICAL INDEX TERMS age distribution article association gestational age human infant intermittent positive pressure ventilation major clinical study newborn intensive care obstetric delivery patient referral patient transport priority journal retrospective study risk factor EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015123014 MEDLINE PMID 26058370 (http://www.ncbi.nlm.nih.gov/pubmed/26058370) PUI L604837709 DOI 10.1055/s-0035-1554803 FULL TEXT LINK http://dx.doi.org/10.1055/s-0035-1554803 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 211 TITLE Nurse knowledge of intrahospital transport AUTHOR NAMES Shields J. Overstreet M. Krau S.D. AUTHOR ADDRESSES (Shields J., john.shields@mtsa.edu) Cardiac Anesthesia Division, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA; Middle Tennessee School of Anesthesia, 315 Hospital Drive, Madison, TN 37115, USA. Electronic address: (Overstreet M.) Center for Clinical Simulation, Middle Tennessee School of Anesthesia, Madison, TN 37115, USA; Vanderbilt School of Nursing, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA (Krau S.D.) Vanderbilt School of Nursing, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA SOURCE The Nursing clinics of North America (2015) 50:2 (293-314). Date of Publication: 1 Jun 2015 ISSN 1558-1357 (electronic) ABSTRACT Preventable adverse events and other medical errors occur to hundreds of thousands of Americans every year. The financial burden of these preventable events is estimated to be $29 billion. According to the World Health Organization, reducing medical errors has become an international concern. Protecting patients from harm is a primary responsibility of all nurses regardless of whether the nurse works in the intensive care unit or operating room. Adherence to policies to maintain patient safety can be discerned once the level of knowledge of these policies among nurses is determined. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) knowledge nursing staff patient transport EMTREE MEDICAL INDEX TERMS clinical handover human medical error practice guideline prevention and control United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25999072 (http://www.ncbi.nlm.nih.gov/pubmed/25999072) PUI L605433151 DOI 10.1016/j.cnur.2015.03.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.cnur.2015.03.005 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 212 TITLE The effect of initiation of strict embryo transfer limits on neonatal complications with in-vitro fertilization (IVF) AUTHOR NAMES Shaulov T. Belisle S. Dahan M.H. AUTHOR ADDRESSES (Shaulov T.) McGill University, Obstetrics and Gynecology, Montreal, Canada. (Belisle S.) Université De Montreal, Obstetrics and Gynecology, Montreal, Canada. (Dahan M.H.) McGill University, Reproductive Services, Montreal, Canada. CORRESPONDENCE ADDRESS T. Shaulov, McGill University, Obstetrics and Gynecology, Montreal, Canada. SOURCE Human Reproduction (2015) 30 SUPPL. 1 (i363). Date of Publication: June 2015 CONFERENCE NAME 31st Annual Meeting of the European Society of Human Reproduction and Embryology, ESHRE 2015 CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2015-06-14 to 2015-06-17 ISSN 0268-1161 BOOK PUBLISHER Oxford University Press ABSTRACT Study question: What is the effect of the initiation of a government funded in-vitro fertilization (IVF) program with strict limits on numbers of embryos which can be transferred on neonatal complication rates and incidence? Summary answer: This first North American publicly funded IVF program has decreased the multiple birth rates related to IVF. However, the absolute numbers of IVF babies born prematurely or requiring admission have slightly increased. Also, the average admission cost per IVF baby has seen a substantial increase. What is known already: Multiple pregnancies carry with them risks to both mothers and fetuses. Several international jurisdictions have demonstrated that publicly funded fertility programs with a single embryo transfer (SET) policy decrease multiple pregnancy rates. Also, IVF pregnancies are generally associated with higher rates of complications than spontaneous pregnancies, attributed partially to multiples. In August 2010, Quebec started funding of IVF with SET, with a goal of decreasing neonatal complications and their costs. Study design, size, duration: This a retrospective study. Data compares outcomes of all IVF cycles performed in Quebec from the 2009 to 2010 (last complete pre-coverage) to 2012-2013 (first complete post-coverage) fiscal years. This study is based on 168 602 spontaneous and IVF deliveries. In 2009-2010, 906 women conceived with IVF, while in 2012-2013, 1746 conceived. Participants/materials, setting, methods: Data was extracted from two reports by the Health and Welfare Commissioner as well as the Ministry of Health and Social Services published in June 2014 and October 2013, respectively. This data was collected from all assisted reproduction centers in Quebec providing IVF services. Data was compared using chi-squared tests. Main results and the role of chance: The number of babies born from IVF increased 63% from 2009-2010 to 2012-2013 (1057-1723). Multiple pregnancy rates decreased from 24.06% in 2009-2010 to 9.45% in 2012-2013 (p < 0.0001). The proportions of IVF babies that were the result of multiple births, were premature, or required intensive-care unit (ICU) admission, decreased by 55% (p < 0.0001), 35.5% (p < 0.0001), and 37% (p < 0.0001), respectively, from 2009-2010 to 2012-2013. These changes in absolute numbers were a decrease from 407 to 297, an increase from 313 to 329 and an increase from 199 to 204 babies, respectively. The average ICU admission costs for a baby conceived through IVF and spontaneously was $19,990 and $14,563 in 2009-2010, respectively, and $28,418 and $17,155 in 2011-2012, respectively. Limitations, reason for caution: Retrospective data concerning IVF cycles and clinical outcomes was gathered from several sources. However this is a robust study on data collected from more than 160,000 women who underwent conceptions either spontaneously or through IVF. Wider implications of the findings: Publicly funded IVF programs substantially decrease multiple pregnancy rates. However, due to substantially increased usage, neonatal complications increase. Interestingly, the cost per IVF neonatal-ICU admission skyrocketed when the cost of caring for multiples was reduced. This suggests that the singleton IVF pregnancies which require neonatal-ICU care are much sicker than IVF twins which end up in the ICU. Further research should be directed into decreasing the rate of ICU admissions for singleton IVF conceptions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) embryo transfer embryology European human in vitro fertilization reproduction society EMTREE MEDICAL INDEX TERMS baby birth rate Canada embryo female fertility fetus funding government health intensive care unit mother multiple pregnancy North American parthenogenesis policy pregnancy pregnancy rate retrospective study risk social work study design twins welfare LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72005918 DOI 10.1093/humrep/30.Supplement-1.1 FULL TEXT LINK http://dx.doi.org/10.1093/humrep/30.Supplement-1.1 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 213 TITLE Mortality in children with respiratory failure transported using high-frequency oscillatory ventilation AUTHOR NAMES Jones P. Dauger S. Leger P.-L. Kessous K. Casadevall I. Maury I. Mazeron P. Lodé N. AUTHOR ADDRESSES (Jones P., sejjprj@live.ucl.ac.uk; Kessous K.; Casadevall I.; Maury I.; Mazeron P.; Lodé N.) SMUR Pédiatrique, Hôpital Robert Debré, Assistance publique–Hôpitaux de Paris (AP-HP), 48 Bd Sérurier, Paris, France. (Jones P., sejjprj@live.ucl.ac.uk; Dauger S.) Réanimation Pédiatrique (PICU), Hôpital Robert Debré, AP-HP, 48 Bd Sérurier, Paris, France. (Jones P., sejjprj@live.ucl.ac.uk) Respiratory, Critical Care and Anaesthesia Group, University College London (UCL) Institute of Child Health, 30 Guilford Street, London, United Kingdom. (Leger P.-L.) Réanimation Pédiatrique (PICU), Hôpital Robert Trousseau, AP-HP, 26 avenue du Dr Arnold Netter, Paris, France. CORRESPONDENCE ADDRESS P. Jones, Respiratory, Critical Care and Anaesthesia Group, University College London (UCL) Institute of Child Health, 30 Guilford Street, London, United Kingdom. SOURCE Intensive Care Medicine (2015) 41:7 (1363-1364). Date of Publication: 14 May 2015 ISSN 1432-1238 (electronic) 0342-4642 BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assisted ventilation highthe frequency oscillatory ventilation mortality patient transport respiratory failure (therapy) EMTREE MEDICAL INDEX TERMS airway pressure blood oxygen tension child diaphragm hernia diastolic blood pressure extracorporeal membrane oxygenation device heart rate hemodynamics human intensive care unit letter respiratory function survivor systolic blood pressure EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015053967 MEDLINE PMID 25971382 (http://www.ncbi.nlm.nih.gov/pubmed/25971382) PUI L604433887 DOI 10.1007/s00134-015-3808-z FULL TEXT LINK http://dx.doi.org/10.1007/s00134-015-3808-z COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 214 TITLE A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients AUTHOR NAMES Brunsveld-Reinders A.H. Arbous M.S. Kuiper S.G. de Jonge E. AUTHOR ADDRESSES (Brunsveld-Reinders A.H., A.H.Brunsveld-Reinders@lumc.nl; Arbous M.S., marbous@lumc.nl; Kuiper S.G., sgkuiper89@gmail.com; de Jonge E., E.de_Jonge@lumc.nl) Leiden University Medical Center, Department of Intensive Care, Albinusdreef 2, PO Box 9600, RC Leiden, Netherlands. CORRESPONDENCE ADDRESS A.H. Brunsveld-Reinders, Leiden University Medical Center, Department of Intensive Care, Albinusdreef 2, PO Box 9600, RC Leiden, Netherlands. SOURCE Critical Care (2015) 19:1 Article Number: 214. Date of Publication: 7 May 2015 ISSN 1466-609X (electronic) 1364-8535 BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Introduction: Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients. Method: A three-step approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this approach a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested. Results: Eleven existing guidelines and five checklists were found. Only one checklist covered all three phases: pre-, during- and post-transport. Recommendations and checklist items mostly focused on the pre-transport phase. Documented incidents most frequently related to patient physiology and equipment malfunction and occurred most often during transport. Discussing the incidents with ICU physicians and ICU nurses resulted in important recommendations such as the introduction of a standard checklist and improved communication with the other departments. This approach resulted in a generally applicable checklist, adaptable for local circumstances. Feedback from nurses using the checklist were positive, the fill in time was 4.5 minutes per phase. Conclusion: A comprehensive way to develop an intra-hospital checklist for safe transport of ICU patients to another department is described. This resulted in a checklist which is a framework to guide physicians and nurses through intra-hospital transports and provides a continuity of care to enhance patient safety. Other hospitals can customize this checklist to their own situation using the methods proposed in this paper. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient safety patient transport practice guideline EMTREE MEDICAL INDEX TERMS article communication protocol health care system hospital equipment human intensive care unit interview nurse patient assessment patient care physician priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015056775 PUI L604437965 DOI 10.1186/s13054-015-0938-1 FULL TEXT LINK http://dx.doi.org/10.1186/s13054-015-0938-1 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 215 TITLE A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients AUTHOR NAMES Brunsveld-Reinders A.H. Arbous M.S. Kuiper S.G. de Jonge E. AUTHOR ADDRESSES (Brunsveld-Reinders A.H., A.H.Brunsveld-Reinders@lumc.nl; Arbous M.S., marbous@lumc.nl; Kuiper S.G., sgkuiper89@gmail.com) Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300, RC, Leiden, the Netherlands (de Jonge E.) Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300, RC, Leiden, the Netherlands. E.de_Jonge@lumc.nl SOURCE Critical care (London, England) (2015) 19 (214). Date of Publication: 7 May 2015 ISSN 1466-609X (electronic) ABSTRACT INTRODUCTION: Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients.METHOD: A three-step approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this approach a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested.RESULTS: Eleven existing guidelines and five checklists were found. Only one checklist covered all three phases: pre-, during- and post-transport. Recommendations and checklist items mostly focused on the pre-transport phase. Documented incidents most frequently related to patient physiology and equipment malfunction and occurred most often during transport. Discussing the incidents with ICU physicians and ICU nurses resulted in important recommendations such as the introduction of a standard checklist and improved communication with the other departments. This approach resulted in a generally applicable checklist, adaptable for local circumstances. Feedback from nurses using the checklist were positive, the fill in time was 4.5 minutes per phase.CONCLUSION: A comprehensive way to develop an intra-hospital checklist for safe transport of ICU patients to another department is described. This resulted in a checklist which is a framework to guide physicians and nurses through intra-hospital transports and provides a continuity of care to enhance patient safety. Other hospitals can customize this checklist to their own situation using the methods proposed in this paper. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) standards EMTREE MEDICAL INDEX TERMS checklist critical illness (therapy) human intensive care unit patient safety patient transport procedures LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25947327 (http://www.ncbi.nlm.nih.gov/pubmed/25947327) PUI L615646210 DOI 10.1186/s13054-015-0938-1 FULL TEXT LINK http://dx.doi.org/10.1186/s13054-015-0938-1 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 216 TITLE A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically ill patients AUTHOR NAMES Brunsveld-Reinders A.H. Arbous M.S. Kuiper S.G. de Jonge E. AUTHOR ADDRESSES (Brunsveld-Reinders A.H., A.H.Brunsveld-Reinders@lumc.nl; Arbous M.S., marbous@lumc.nl; Kuiper S.G., sgkuiper89@gmail.com; de Jonge E., E.de_Jonge@lumc.nl) Leiden University Medical Center, Department of Intensive Care, Albinusdreef 2, PO Box 9600, Leiden, RC, 2300 the Netherlands CORRESPONDENCE ADDRESS A.H. Brunsveld-Reinders, Leiden University Medical Center, Department of Intensive Care, Albinusdreef 2, PO Box 9600, Leiden, RC, 2300 the Netherlands SOURCE Critical Care (2015). Date of Publication: 7 May 2015 ISSN 1466-609X (electronic) 1364-8535 BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Introduction: Transport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients. Method: A three-step approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this approach a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested. Results: Eleven existing guidelines and five checklists were found. Only one checklist covered all three phases: pre-, during- and post-transport. Recommendations and checklist items mostly focused on the pre-transport phase. Documented incidents most frequently related to patient physiology and equipment malfunction and occurred most often during transport. Discussing the incidents with ICU physicians and ICU nurses resulted in important recommendations such as the introduction of a standard checklist and improved communication with the other departments. This approach resulted in a generally applicable checklist, adaptable for local circumstances. Feedback from nurses using the checklist were positive, the fill in time was 4.5 minutes per phase. Conclusion: A comprehensive way to develop an intra-hospital checklist for safe transport of ICU patients to another department is described. This resulted in a checklist which is a framework to guide physicians and nurses through intra-hospital transports and provides a continuity of care to enhance patient safety. Other hospitals can customize this checklist to their own situation using the methods proposed in this paper. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) checklist critically ill patient hospital human safety EMTREE MEDICAL INDEX TERMS data base diagnosis feedback system intensive care intensive care unit interpersonal communication interview nurse patient patient care patient safety physician physiology procedures LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015056297 PUI L604444437 DOI 10.1186/s13054-015-0938-1 FULL TEXT LINK http://dx.doi.org/10.1186/s13054-015-0938-1 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 217 TITLE Association between Hospital Volume and Within-Hospital Intensive Care Unit Transfer for Sickle Cell Disease in Children's Hospitals AUTHOR NAMES Raphael J.L. Richardson T. Hall M. Oyeku S.O. Bundy D.G. Kalpatthi R.V. Shah S.S. Ellison A.M. AUTHOR ADDRESSES (Raphael J.L., Raphael@bcm.edu) Department of Pediatrics, Baylor College of Medicine, Houston, TX (Richardson T.; Hall M.) Children's Hospital Association, Overland Park, KS (Oyeku S.O.) Department of Pediatrics, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (Bundy D.G.) Department of Pediatrics, Medical University of South Carolina, Charleston, SC (Kalpatthi R.V.) Department of Pediatrics, The Children's Mercy Hospital and Clinics, Kansas City, MO (Shah S.S.) Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Ellison A.M.) Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA CORRESPONDENCE ADDRESS J.L. Raphael, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Suite D.1540.00, 6701 Fannin St, Houston, TX 77030 Email: Raphael@bcm.edu SOURCE Journal of Pediatrics (2015). Date of Publication: 6 Apr 2015 ISSN 1097-6833 (electronic) 0022-3476 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective: To assess the relationship between hospital volume and intensive care unit (ICU) transfer among hospitalized children with sickle cell disease (SCD). Study design: We conducted a retrospective cohort study of 83 477 SCD-related hospitalizations at children's hospitals (2009-2012) using the Pediatric Health Information System database. Hospital-level all-cause and SCD-specific volumes were dichotomized (low vs high). Outcomes were within-hospital ICU transfer (primary) and length of stay (LOS) total (secondary). Multivariable logistic/linear regressions assessed the association of hospital volumes with ICU transfer and LOS. Results: Of 83 477 eligible hospitalizations, 1741 (2.1%) involving 1432 unique children were complicated by ICU transfer. High SCD-specific volume (OR 0.77, 95% CI 0.64-0.91) was associated with lower odds of ICU transfer while high all-cause hospital volume was not (OR 0.87, 95% CI 0.73-1.04). A statistically significant interaction was found between all-cause and SCD-specific volumes. When results were stratified according to all-cause volume, high SCD-specific volume was associated with lower odds of ICU transfer at low all-cause volume (OR 0.46, 95% CI 0.38-0.55). High hospital volumes, both all-cause (OR 0.94, 95% CI 0.92-0.97) and SCD-specific (OR 0.86, 95% CI 0.84-0.88), were associated with shorter LOS. Conclusions: Children's hospitals vary substantially in their transfer of children with SCD to the ICU according to hospital volumes. Understanding the practices used by different institutions may help explain the variability in ICU transfer among hospitals caring for children with SCD. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care unit sickle cell anemia EMTREE MEDICAL INDEX TERMS child cohort analysis controlled study data base doctor patient relation hospitalization human length of stay linear regression analysis major clinical study medical information system study design LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151064273 MEDLINE PMID 26470686 (http://www.ncbi.nlm.nih.gov/pubmed/26470686) PUI L607411162 DOI 10.1016/j.jpeds.2015.09.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpeds.2015.09.007 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 218 TITLE Improving the safety of icu to floor transfers-“ticket to ride” AUTHOR NAMES Siddiqi F. Jones M. Axon R.N. AUTHOR ADDRESSES (Siddiqi F.; Axon R.N.) Charleston VAMC, Charleston, United States. (Siddiqi F.; Jones M.; Axon R.N.) MUSC, Charleston, United States. CORRESPONDENCE ADDRESS F. Siddiqi, Charleston VAMC, Charleston, United States. SOURCE Journal of General Internal Medicine (2015) 30 SUPPL. 2 (S541). Date of Publication: April 2015 CONFERENCE NAME 38th Annual Meeting of the Society of General Internal Medicine CONFERENCE LOCATION Toronto, ON, Canada CONFERENCE DATE 2015-04-22 to 2015-04-25 ISSN 0884-8734 BOOK PUBLISHER Springer New York LLC ABSTRACT STATEMENT OF PROBLEMOR QUESTION (ONE SENTENCE): Facilities with 'closed' intensive care units (ICU) often experience delays in bed availability spanning work shifts which complicate communication and can result in missed patient handoffs. OBJECTIVES OF PROGRAM/INTERVENTION (NO MORE THAN THREE OBJECTIVES): 1. Prevent delays in floor team notification when patients are transferred from the ICU (i.e. missed handoffs). 2. Reduce delays in initiating ICU transfer orders. 3. Prevent transfer of medically unstable patients from ICU. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): Patient handoffs have been the subject of increased study in recent years. Nevertheless, handoff quality often remains poor; a recent systematic review found a 13 % information error rate. Additionally, handoffs are ineffective when they are simply not performed. Transfer of patients from the ICU to ward is less well studied, but these handoffs are arguably more important given patient complexity. In response to a series of near-miss episodes where ICU patients were transferred from our ICU without proper handoffs, we sought to improve facility performance. A multi-stakeholder team of physicians, nurses, and clerical personnel mapped transfer/handoff processes and analyzed performance gaps. Our Internal Medicine program already had a well-established handoffs curriculum/system in place, but a critical area of delay was identified between the time of initial bed request and the actual time of bed assignment and patient transfer. In some cases, this delay was over 12 h and spanned multiple work shifts. There were also instances of delayed initiation of transfer orders with the potential for missed medications or treatments. We devised a simple checklist, called the “Ticket to Ride” (TtR), which forces a face-to-face, standardized interaction between the transferring and accepting physicians and other team members at the time of bed assignment. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVE METRICS WHICH WILL BE USED TO EVALUATE PROGRAM/ INTERVENTION): We performed intermittent audits of TtR forms to track implementation. We also reviewed charts of consecutive ICU transfer patients comparing 3 months pre-intervention (n=71) to 3months post (n=80). Mean times (inminutes) were examined using Students t test, and proportions were compared using Pearson chi square. FINDINGS TODATE (IT ISNOT SUFFICIENT TOSTATE FINDINGSWILL BE DISCUSSED): We observed no further episodes of 'missed handoffs' after TtR implementation. Post implementation, the proportion of accept notes written before transfer increased significantly (41 vs. 22 %, p=0.01). Among transfer notes written after ICU transfer, mean time to first accept was not significantly changed (113 vs. 103 min, p= 0.53). Only 2 patients required ICU readmission pre-implementation, and none postimplementation. Finally, we observed a significantly lower proportion of in-hospital deaths among ICU transfers (5 vs. 15 %, p=0.03) post-implementation. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY?): 1. Use of a standardized checklist requiring signatures is a simple, seemingly effective means for prompting providers to complete patient handoffs at the time of ICU transfer. 2. Early accept note completion improved post implementation indicating more prompt ward team evaluations. 3. Observed differences in mortality after implementation are intriguing and may be the subject of future study. Nevertheless, we do not interpret these results as causal as it relates to the TtR without analysis of a larger sample with adjustment for potential confounders. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) internal medicine safety society EMTREE MEDICAL INDEX TERMS checklist clinical audit clinical handover death drug therapy hospital hospital patient hospital readmission human intensive care unit interpersonal communication mortality nurse office worker patient patient transport physician student Student t test systematic review ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71878619 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 219 TITLE From clinical trials to bedside: Evaluating the transfer of scientific insights to the “real-world” stroke care in Germany by comparison of nation-wide administrative data AUTHOR NAMES Krogias C. Bartig D. Kitzrow M. Weber R. Eyding J. AUTHOR ADDRESSES (Krogias C.) Neurology St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany. (Bartig D.) Drg Market, Osnabrück, Germany. (Kitzrow M.) Neurology Bergmannsheil, Ruhr University Bochum, Bochum, Germany. (Weber R.) Neurology, Alfried-Krupp-Krankenhaus, Essen, Germany. (Eyding J.) Neurology Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany. CORRESPONDENCE ADDRESS C. Krogias, Neurology St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany. SOURCE International Journal of Stroke (2015) 10 SUPPL. 2 (118). Date of Publication: April 2015 CONFERENCE NAME European Stroke Organisation Annual Conference 2015 CONFERENCE LOCATION Glasgow, United Kingdom CONFERENCE DATE 2015-04-17 to 2015-04-19 ISSN 1747-4930 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Promising advances in stroke medicine have been reported recently regarding specialized stroke unit (SU) care, expansion of the time window of iv thrombolysis (IVT), mechanical thrombectomy (MT), and decompressive hemicraniectomy (DHC) for malignant brain infarction. It remains unclear to what extent new evidence of therapeutic procedures is transferred to the “real-world” of everyday hospital care. Methods: We analyzed epidemiologic and procedural therapeutic trends of hospitalized acute stroke patients in Germany by the comparison of administrative hospital data of the years 2008 (n = 219,359) and 2012 (n = 239,394). Results: Proportion of specialized SU care rose from 43.4% to 56.9%. Rate of IVT increased from 5.6% to 10.2%. 32% of IVT therapies in 2012 were performed in patients over 80 years. Number of MT increased exponentially from 298 to 3906 procedures. Number of DHC did not increase significantly (2008 = 636; 2011 = 796). Conclusions: A strong momentum in transferring scientific insights to the “real-world” stroke care in Germany was documented. Increase of IVT therapy is largely due to the increase of off-label treatment. Almost every 46 th patient <80 years was treated by MT in 2012. Despite proven benefits in selected patients, utilization of DHC remained almost stable. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular accident clinical trial (topic) European Germany organization EMTREE MEDICAL INDEX TERMS blood clot lysis brain infarction hospital hospital care human mechanical thrombectomy patient procedures stroke patient stroke unit therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72034005 DOI 10.1111/ijs.12479 FULL TEXT LINK http://dx.doi.org/10.1111/ijs.12479 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 220 TITLE Are our patients safe during in-hospital transport AUTHOR NAMES Meenakshisundaram C. Malakkla N.N. Dandachi D. Gopalakrishnan V.P. Ganipisetti V.M. AUTHOR ADDRESSES (Meenakshisundaram C.; Malakkla N.N.; Dandachi D.; Gopalakrishnan V.P.) Saint Francis Hospital, Evanston, United States. (Ganipisetti V.M.) Presence Saint Francis, Evanston, United States. CORRESPONDENCE ADDRESS C. Meenakshisundaram, Saint Francis Hospital, Evanston, United States. SOURCE Journal of General Internal Medicine (2015) 30 SUPPL. 2 (S365-S366). Date of Publication: April 2015 CONFERENCE NAME 38th Annual Meeting of the Society of General Internal Medicine CONFERENCE LOCATION Toronto, ON, Canada CONFERENCE DATE 2015-04-22 to 2015-04-25 ISSN 0884-8734 BOOK PUBLISHER Springer New York LLC ABSTRACT LEARNING OBJECTIVE #1: Importance of administering incremental doses of sedatives in high risk individuals who are prone to develop respiratory depression. LEARNING OBJECTIVE #2: To emphasize the importance of essential monitoring during in-hospital transport of patients. Discuss the basic strategies to decrease the adverse events and ensure safe transport. CASE: Fifty-two year old obese AA female was brought by her sister to ED as she sounded confused and her speech was slurring over phone. Her past medical history included hypertension, DM, HLD, Sleep apnea and hypothyroidism. Her medications were metformin, amlodipine, Lisinopril, metoprolol, synthroid and fluoxetine. Vitals revealed tachycardia and SpO2 of 91 %. On physical examination she appeared confused, agitated, had slurring speech but no significant neurological deficit. Basic labs were significant for leukocytosis, blood glucose of 685 mg/dl, ABG showed severe respiratory and metabolic acidosis, negative serum and urine acetone. She received ativan for agitation and placed on BiPAP support. She was given fluid boluses and started on insulin infusion. During CT imaging of brain as she remained agitated she received additional doses of ativan. Then she was transferred to ICU with only cardiac monitor. On arrival to ICU, she was found to have shallow respirations and saturated 60% with BiPAP. She had massive emesis twice during intubation and was started on mechanical ventilatory support. Next day her CXR showed increasing infiltrates in both lung fields and her oxygen requirements were also increasing. ARDS protocol was initiated. Over the next few days she also developed AKI and eventually became oliguric. She also needed Hemodialysis for few weeks. Her TSH was elevated (30 mIU/ml) and started on IV levothyroxine. She was successfully extubated and her renal function returned to baseline in about a week. As she was deconditioned by the complicated hospital stay of 48 days she was discharged to sub-acute rehabilitation facility. DISCUSSION: Our patient had a prolonged and complicated hospital stay that was not related to her presenting complaints but due to insufficient monitoring during imaging that was least necessary and during transport to intensive care unit after multiple doses of benzodiazepine which is well known to cause respiratory depression. The intra-hospital transport of patients is often performed by unlicensed hospital personnel who encounter patient condition changes that require immediate intervention. Risk reduction strategies include development of an intra-hospital transport team, hand off communication using a specific tool including written information facilitating clear communication before, during and immediately following transport from the patient care unit to the destination point and back. Also the transport personnels should have robust educational and competency program including CPR certification to ensure safe patient transport. All hospitals should develop a transport team model with clear outline of specific responsibilities for each team member. Every patient should be assessed for the basic level of monitoring needed, the required equipment and the expected level of intervention if there is any change in patient condition. Intra-hospital transport exposes patients to potential periods of instability and increases the risk for complications, morbidity and mortality. Physicians must evaluate the risk benefit ratio of each transport, the need of urgency of diagnostic imaging or the therapeutic procedures, and accurate information exchange will decrease the number of adverse events. EMTREE DRUG INDEX TERMS acetone amlodipine benzodiazepine fluoxetine levothyroxine levothyroxine sodium lisinopril lorazepam metformin metoprolol sedative agent thyrotropin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital human internal medicine patient society EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome agitation brain certification diagnostic imaging drug therapy female glucose blood level hemodialysis hospital patient hospital personnel hospitalization hypertension hypothyroidism imaging insulin infusion intensive care unit interpersonal communication intubation kidney function leukocytosis liquid lung medical history metabolic acidosis model monitoring morbidity mortality multiple drug dose oxygen consumption patient care patient transport personnel physical examination physician procedures rehabilitation respiration depression responsibility risk risk reduction serum sleep disordered breathing speech tachycardia urine vomiting LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71878174 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 221 TITLE Transferring patient care: patterns of synchronous bidisciplinary communication between physicians and nurses during handoffs in a critical care unit AUTHOR NAMES McMullan A. Parush A. Momtahan K. AUTHOR ADDRESSES (McMullan A.; Parush A.; Momtahan K.) SOURCE Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses (2015) 30:2 (92-104). Date of Publication: 1 Apr 2015 ISSN 1532-8473 (electronic) ABSTRACT PURPOSE: The transfer of patient care from one health care worker to another involves communication in high-pressure contexts that are often vulnerable to error. This research project captured current practices for handoffs during the critical care stage of surgical recovery in a hospital setting. The objective was to characterize information flow during transfer and identify patterns of communication between nurses and physicians.CONCLUSIONS: Findings reflect positive and constructive patterns of communication during handoffs in the observed hospital unit.DESIGN AND METHODS: Observations were used to document communication exchanges. The data were analyzed qualitatively according to the types of information exchanged and verbal behavior types.FINDINGS: Reporting and questions were the most common verbal behaviors, and retrospective medical information was the focus of information exchange. The communication was highly interactive when discussing patient status and future care plans. Nurses proactively asked questions to capture a large proportion of the information they needed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) standards EMTREE MEDICAL INDEX TERMS doctor nurse relation human intensive care interdisciplinary communication patient care patient transport public relations questionnaire retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25813295 (http://www.ncbi.nlm.nih.gov/pubmed/25813295) PUI L616371854 DOI 10.1016/j.jopan.2014.05.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.jopan.2014.05.009 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 222 TITLE Transporting neonates to the NICU: A comparative study AUTHOR NAMES Rosin M. Ehrlich L. Margaret B. AUTHOR ADDRESSES (Rosin M.; Ehrlich L.; Margaret B.) Department of Neonatology, Centenary Hospital for Women and Children, Australia. (Margaret B.) Australian Catholic University, Australia. CORRESPONDENCE ADDRESS M. Rosin, Department of Neonatology, Centenary Hospital for Women and Children, Australia. SOURCE Journal of Paediatrics and Child Health (2015) 51 SUPPL. 1 (52). Date of Publication: April 2015 CONFERENCE NAME 19th Annual Meeting of the Perinatal Society of Australia and New Zealand, PSANZ 2015 CONFERENCE LOCATION Melbourne, VIC, Australia CONFERENCE DATE 2015-04-19 to 2015-04-22 ISSN 1034-4810 BOOK PUBLISHER Blackwell Publishing ABSTRACT Background: It is important during the transfer of a neonate to the Neonatal Intensive Care Unit (NICU) the neonate's physiological status is maintained within normal limits. At the Canberra NICU a variety of transport vehicles (TV) are used to transport neonates to the NICU. In 2014 we trialled the General Electric Shuttle (GES) to transport neonates to the NICU, hypothesising the shuttle wouldn't have any significant effect on the physiological state of neonates. Method: A prospective comparative study comparing the physiological state of the neonates transported via the GES and other TV was undertaken over three weeks. Data included: Gestation (GA), Birthweight (BW), and vital signs (VS) on admission (OA) and for four hours post transfer (PT). Data were analysed using one way ANOVA on SPSS version 20. Significance = p < 0.05 Results: Study numbers = GES (12) and TV(15). There was no significant (ns) difference in weeks GA (34.0 ± 2.6, 33.5 ± 4.4, p = 0.723 respectively) or BW (2335 ± 681, 1948 ± 864 grams, p = 0.229 respectively) when comparing the two groups. Study results demonstrated a higher diastolic mean blood pressure in the shuttle group (36 ± 8, 25 ±8 p< 0.05) but otherwise no ns between the two groups OA: Temperature (37.9 c ± 0.54, 37.0 c ± 0.58 c, p = 0.946 respectively) Heart Rate (152 ± 20, 156 ± 14, p = 0.588 respectively) Respiratory Rate (54 ± 9, 52 ± 6, p = 0.583 respectively) or the four hours PT. Conclusion: This study has shown the GES is a safe method to transport neonates with the added benefit of not having to relocate the neonate on arrival at the NICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia and New Zealand comparative study newborn society EMTREE MEDICAL INDEX TERMS analysis of variance birth weight breathing rate data analysis software heart rate intensive care unit mean arterial pressure newborn intensive care pregnancy temperature vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71873911 DOI 10.1111/jpc.12884-3 FULL TEXT LINK http://dx.doi.org/10.1111/jpc.12884-3 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 223 TITLE Development of an in-house TomoTherapy transfer plan check AUTHOR NAMES Nundlall N. Clifford C. Tudor S. Natarajan K. AUTHOR ADDRESSES (Nundlall N.; Natarajan K.) University Hospital Birmingham NHS Foundation Trust, CCISS Radiotherapy Physics, Birmingham, United Kingdom. (Clifford C.; Tudor S.) University Hospital Birmingham NHS Foundation Trust, Radiotherapy Physics, Birmingham, United Kingdom. CORRESPONDENCE ADDRESS N. Nundlall, University Hospital Birmingham NHS Foundation Trust, CCISS Radiotherapy Physics, Birmingham, United Kingdom. SOURCE Radiotherapy and Oncology (2015) 115 SUPPL. 1 (S902-S903). Date of Publication: April 2015 CONFERENCE NAME 3 ESTRO Forum CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2015-04-24 to 2015-04-28 ISSN 0167-8140 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Purpose/Objective: At the UHB Radiotherapy department we have two TomoTherapy HD units. The QA procedure for patients being treated on TomoTherapy (Tomo) is that a patient specific delivery QA (DQA) must be carried out prior to the patient beginning treatment, using out Delta4 phantom. For Category 1 patients, a secondary DQA must be carried out (known as a transfer plan), so there is one plan for each of the two rooms in case of a treatment delivery unit breakdown. The Tomo HD units have dynamic jaws functionality (known as TomoEDGE) which speeds up the delivery time thus enabling us to increase patient throughput. More throughput means more time required on the machines to carry out DQA. The aim of this project is to reduce the workload of patient specific QA on transfer plans. The solution should be auditable, safe, secure, maintainable, not impact on already deployed clinical software and present the required results in a presentable format to attach to patient records in our Oncology Management System (OMS), MOSAIQ. Materials and Methods: The two DICOM Tomo RT plan files were validated and interpreted using dcm4chee library and private Tomo DICOM tags compared using standard Java libraries. A web application was created using the robust infrastructure of Enterprise Java Beans (EJB) to allow the user to load the two plans for comparison. The sinogram from the two plans were compared against each other by taking into account the latency differences between the machines. As TomoEDGE functionality is used, the jaw positions for each projection were also compared. The results of the comparison are displayed in the Graphical User Interface (GUI) as a table and graph. The entire program suite was developed using Netbeans. Results: A robust and maintainable solution has been put in place through a web application without interfering with any software medical devices. The table of values that have been compared against tolerances can be attached as a PDF document to the patient records in the OMS. The graphical user aspects of the application have been tested with the automated testing package, Selenium. This enables future modifications in the program to have the vast majority of its user interface checked without user intervention. The developed application had its business logic tested using JUnit4 with 23 representative datasets. This program has the capability of reducing the time it takes to carry out patient specific QA by removing the need to deliver the transfer plan on the second machine, which takes 40 minutes for the first patient and 20 minutes for subsequent patients. Conclusions: An application has been developed that meet the overarching requirements of such medical software. It is a reliable independent check on transfer plans. It has reduced the need to carry out transfer plan checks on the second TomoTherapy machine. It will be running in parallel with the QA procedure of checking patient transfer plans and then eventually integrated into the QA workflow. EMTREE DRUG INDEX TERMS selenium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) tomotherapy EMTREE MEDICAL INDEX TERMS bean commercial phenomena computer interface digital imaging and communications in medicine human jaw latent period library machine medical device medical record oncology outpatient patient patient transport phantom procedures radiotherapy software velocity workflow workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71962185 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 224 TITLE Pediatric critical care transport as a conduit to palliative care: A case series and literature review AUTHOR NAMES Bernier M. Noje C. Costabile P. Klein B. Kudchadkar S. AUTHOR ADDRESSES (Bernier M.; Noje C.; Kudchadkar S.) Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, United States. (Costabile P.) Pediatric Nursing, Johns Hopkins Hospital, Baltimore, United States. (Klein B.) Pediatrics, Johns Hopkins Hospital, Baltimore, United States. CORRESPONDENCE ADDRESS M. Bernier, Department of Anesthesia and Critical Care, Johns Hopkins Hospital, Baltimore, United States. SOURCE Journal of Investigative Medicine (2015) 63:3 (585-586). Date of Publication: March 2015 CONFERENCE NAME American Federation for Medical Research Eastern Regional Meeting, AFMR 2015 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2015-04-16 to 2015-04-16 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: To present a series of three successful pediatric palliative critical care transports from the Intensive Care Unit (ICU) of a tertiary care facility to home and to provide an overview of the existing literature on both pediatric and adult palliative critical care transports. Methods Used: Cases were identified from the Johns Hopkins Hospital Pediatric Transport database and the literature review was based on the National Library of Medicine PubMed search from 1975 to present. All three cases were terminally ill pediatric patients unable to separate from lifesustaining medical devices in the ICU who were transported home for terminal extubation and end of life care according to their families' wishes. Review of transport and palliative care literature focusing on the end of life transport process from ICU to home was then undertaken. All pediatric and adult studies (case reports, case series and review articles) were included. Summary of Results: All three cases presented similar logistical challenges due to the patients' unstable medical condition and urgent need for transport to facilitate the families' wishes for withdrawal of care and death at home. These included the need to clarify resuscitation status pre-transport and the limited time to organize the transport (mode of transport and team composition), as well as to coordinate home palliative care with the existent resources in the community. The literature review identified a very limited number of case reports (1 in neonates, 2 in children and 8 in the adult aging population) which shared our logistical challenges. Conclusions: Palliative critical care transports pose a unique set of challenges in both pediatric and adult populations. Limited data exist in the literature surrounding this field. These data in combination with our recent pediatric experience support the need for further research and formal program development for end of life critical care transports. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American case study intensive care medical research palliative therapy EMTREE MEDICAL INDEX TERMS adult aging case report child community data base death extubation hospital human intensive care unit laryngeal mask library medical device Medline newborn non implantable urine incontinence electrical stimulator patient population program development resuscitation rigid telescope terminal care terminally ill patient tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71820620 DOI 10.1097/JIM.0000000000000173 FULL TEXT LINK http://dx.doi.org/10.1097/JIM.0000000000000173 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 225 TITLE Goal directed intraoperative therapy for head and neck microvascular free tissue transfer AUTHOR NAMES Hand W.R. Stoll W.D. McEvoy M.D. AUTHOR ADDRESSES (Hand W.R.; Stoll W.D.) Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, United States. (McEvoy M.D.) Anesthesiology, Vanderbilt University, Nashville, United States. CORRESPONDENCE ADDRESS W.R. Hand, Anesthesiology and Perioperative Medicine, Medical University of South Carolina, Charleston, United States. SOURCE Anesthesia and Analgesia (2015) 120:3 SUPPL. 1 (S317). Date of Publication: March 2015 CONFERENCE NAME 2015 Annual Meeting of the International Anesthesia Research Society, IARS 2015 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2012-03-21 to 2012-03-24 ISSN 0003-2999 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT INTRODUCTION: Patients receiving free flap of the head and neck, historically, large volumes of fluid have been administered to maintain hemodynamic stability. This practice is due to an anecdotal belief that vasoactive medications should be avoided due to microvascular anastomoses. However, recent evidence suggests vasopressors are commonly used and have minimal affect on human flap outcomes. In intermediate to high-risk surgeries, utilizing Goal Directed Therapy (GDT) has been associated with improved patient outcomes. Our study aims to show an intraoperative GDT protocol decreases intensive care unit (ICU) length of stay (LOS) for patients receiving a free tissue transfer reconstruction of the head and neck. METHOD: 94 patients scheduled for a primary resection of the head and neck with resultant free flap reconstruction were enrolled following inclusion/exclusion criteria and randomized into treatment or control protocols. Treatment group therapy followed a specific algorithm (Figure 1) utilizing real-time values from arterial waveform analysis. These values included blood pressure, stroke volume variation, cardiac index, and systemic vascular resistance. Control group patients' therapy was limited to judicious administration of fluids to maintain blood pressure within 20% of baseline. Our primary endpoint was ICU length of stay (LOS) with secondary endpoints included: flap failure, medical complications, and total fluid administration. RESULTS: 94 patients were enrolled between April 2013 and August 2014. The groups were similar in terms of age, race, gender, type of flap, ASA classification, BMI, and smoking status. The ICU length of stay was significantly shorter in the treatment group (32.2h vs 57.3h, p=0.025). The total hospital length of stay was shorter, but did not reach statistical significance (180.0h vs 258.4h, p=0.101). The incidence of major surgical morbidity was higher in the control group for all categories, though none reached statistical significance: flap failure (4.25% vs 6.38%), flap death (4.25% vs 8.51%) or need for reoperation (8.51% vs 17.02%), Patients in both groups received similar total volumes of fluid (5887 vs 6318mL, p=0.462). CONCLUSION: Our results indicate patients treated with arterial waveform-derived GDT had a decreased ICU LOS. This is a reasonable proxy for several clinical events including adequate spontaneous ventilation, hemodynamic stability, flap viability, and return of cognitive function. Many GDT patients required vasoactive medication administration without a measurable increase in flap failure or death. (Table Presented). EMTREE DRUG INDEX TERMS hypertensive factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia free tissue graft neck society therapy EMTREE MEDICAL INDEX TERMS algorithm anastomosis blood pressure breathing cardiac index classification cognition control group death drug therapy gender graft failure group therapy heart stroke volume hospital human intensive care unit length of stay liquid morbidity patient reoperation risk smoking statistical significance surgery systemic vascular resistance waveform LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72149151 DOI 10.1213/01.ane.0000470325.07465.0f FULL TEXT LINK http://dx.doi.org/10.1213/01.ane.0000470325.07465.0f COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 226 TITLE Audit of intra-hospital inpatient transfers to the respiratory high dependency unit at the princess alexandra hospital during 2013 AUTHOR NAMES Baird T. Hukins C. Murphy M. AUTHOR ADDRESSES (Baird T.; Hukins C.; Murphy M.) Princess Alexandra Hospital, Australia. CORRESPONDENCE ADDRESS T. Baird, Princess Alexandra Hospital, Australia. SOURCE Respirology (2015) 20 SUPPL. 2 (133). Date of Publication: March 2015 CONFERENCE NAME 2015 Annual Scientific Meetings of the Thoracic Society of Australia and New Zealand and the Australian and New Zealand Society of Respiratory Science, TSANZSRS 2015 CONFERENCE LOCATION Gold Coast, QLD, Australia CONFERENCE DATE 2015-03-27 to 2015-04-01 ISSN 1323-7799 BOOK PUBLISHER Blackwell Publishing ABSTRACT Aim: The PA Respiratory High Dependency Unit (RHDU) manages high acuity respiratory patients. Although the majority of patients admitted to the RHDU come through the Emergency Department (ED), a number of patients require intra-hospital transfer from other treating teams. The aim was to compare this cohort of patients to those admitted directly from ED to determine whether there were differences in clinical features, management and outcomes. Methods: Retrospective audit of patients admitted to the RHDU as intrahospital transfers from non-respiratory treating teams during 2013. Outcomes were compared to patients admitted to the RHDU directly from ED during the same period. Results: 34 patients required intra-hospital transfer, 26 (76%) from medical teams. The mean ± SD age was 64 ± 13.71 years. 12 patients (35%) had a respiratory diagnosis on hospital admission; 10 of these (29%) met criteria for admission under Respiratory Medicine and 4 (11%) met criteria for RHDU admission at initial presentation. 22 patients (69%) were originally admitted though the ED outside of standard working hours. 19 patients (56%) spent < 72 hours on the ward prior to RHDU transfer. Compared to direct RHDU admissions, intra-hospital transfer patients were more likely to have a higher acuity score (TISS 16 (IQR 14-18) vs 14 (IQR 12-15), p < 0.001), die in RHDU (9% vs 0%, p = 0.008), or die in hospital (24% vs 3.6%, p < 0.05). There was a trend toward higher rates of respiratory failure (88.2% vs 70.3%, p = 0.06). There was no difference in age, NIV requirement or RHDU length of stay. Conclusion: Compared to patients admitted directly to the RHDU, those undergoing intra-hospital transfer have worse outcomes. A significant number of patients that met criteria for admission under Respiratory Medicine were admitted inappropriately under other teams, often outside of standard working hours. Stricter adherence to current Respiratory Medicine admission criteria may improve outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia and New Zealand Australian clinical audit hospital hospital patient human New Zealand society EMTREE MEDICAL INDEX TERMS clinical feature diagnosis emergency ward hospital admission length of stay patient patient transport respiratory failure ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71870941 DOI 10.1111/resp.12495 FULL TEXT LINK http://dx.doi.org/10.1111/resp.12495 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 227 TITLE “Patient-safety during the PICU transfer” AUTHOR NAMES Trigoso E. Dolz C. Riera V. Alberola E. Almodovar A. AUTHOR ADDRESSES (Trigoso E.; Dolz C.; Riera V.; Alberola E.; Almodovar A.) Hospital U y P LA FE, Agencia Valenciana de Salud, Ribarroja del Turia, Spain. CORRESPONDENCE ADDRESS E. Trigoso, Hospital U y P LA FE, Agencia Valenciana de Salud, Ribarroja del Turia, Spain. SOURCE Bone Marrow Transplantation (2015) 50 SUPPL. 1 (S515-S516). Date of Publication: March 2015 CONFERENCE NAME 41st Annual Meeting of the European Society for Blood and Marrow Transplantation, EBMT 2015 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2015-03-22 to 2015-03-25 ISSN 0268-3369 BOOK PUBLISHER Nature Publishing Group ABSTRACT Introduction: Background: “It is generally agreed that patient's safety can be defined as freedom for a patient from unnecessary or potential harm associated with health care” ∗ Through the process and, due to the intensity of the therapy, BMT is still associated with a variety of complications that may require admission to paediatric intensive care. The average of HSCT children admitted in PICU varies between 10% and 20%, although peaks of 44% have been reported. The main causes were: Severe sepsis, fluid overload, and respiratory distress. Paediatric Transplants Unit from Hospital Universitario y Politécnico “La Fe” carries out an average of 25 HSCT a year autologus, alogeneics (related and undreleated donors) and haplo. ∗ and the average of patients who need to be transfer to PICU is similar to other Centers. Objectives: - To increase the transplanted patient's safety during the transfer from the HSCT ward to the PICU, by systematizing information, developing a continuity of care report and following a checklist in order to increase the quality and effectiveness of information transfer. - To avoid the mistakes in the information transfers getting an efficient communication among health care professionals. - Work team between both Units in order to assure the continuity of the care and, therefore, this team work is vital during all the transplant process. Method: METODOLOGY - Bibliography review in order to know the scientific evidence about this topic. - We have also valued our daily professional experience. - Periodic meetings among nurses from both units have been established. - The Project aim is to elaborate a standardized operating procedure with the information required in order to guarantee the patient's safety during that process. It has been developed based in the Human Needs Model from Virginia Henderson and the IDEAS techniques. Conclusion: COMMENTS: Regarding the continuity of the cares and the patient-safety periodically, we think that working parties among intensivists physicians and nurses, hemato-oncologist nurses and physicians as well as others health care professional, are of vital importance and should be mandatory. EMTREE DRUG INDEX TERMS iron EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood bone marrow European human patient safety society transplantation EMTREE MEDICAL INDEX TERMS checklist child donor error health care health care personnel hospital human needs hypervolemia intensive care intensivist interpersonal communication model nurse oncologist patient patient care physician procedures publication respiratory distress sepsis teamwork therapy United States ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71830633 DOI 10.1038/bmt.2015.32 FULL TEXT LINK http://dx.doi.org/10.1038/bmt.2015.32 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 228 TITLE Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery AUTHOR NAMES Vergales J. Addison N. Vendittelli A. Nicholson E. Carver D.J. Stemland C. Hoke T. Gangemi J. AUTHOR ADDRESSES (Vergales J., jvergales@virginia.edu; Addison N.; Vendittelli A.; Nicholson E.; Carver D.J.; Stemland C.; Hoke T.; Gangemi J.) University of Virginia Health System, Charlottesville, VA SOURCE American journal of medical quality : the official journal of the American College of Medical Quality (2015) 30:2 (119-125). Date of Publication: 1 Mar 2015 ISSN 1555-824X (electronic) ABSTRACT The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) interpersonal communication pediatric intensive care unit standards thorax surgery total quality management EMTREE MEDICAL INDEX TERMS checklist clinical handover human patient care patient transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24443318 (http://www.ncbi.nlm.nih.gov/pubmed/24443318) PUI L615080815 DOI 10.1177/1062860613518419 FULL TEXT LINK http://dx.doi.org/10.1177/1062860613518419 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 229 TITLE Transferring the critically ill patient: Are we there yet? AUTHOR NAMES Droogh J.M. Smit M. Absalom A.R. Ligtenberg J.J.M. Zijlstra J.G. AUTHOR ADDRESSES (Droogh J.M., j.m.droogh@umcg.nl; Smit M., m.smit@umcg.nl; Zijlstra J.G., j.g.zijlstra@umcg.nl) University Medical Center Groningen, University of Groningen, Department of Critical Care, Research Program for Critical Care, Anesthesiology, Per-operative and Emergency medicine (CAPE), Hanzeplein 1, Groningen, Netherlands. (Absalom A.R., a.r.absalom@umcg.nl) University Medical Center Groningen, University of Groningen, Department of Anesthesiology, Research Program for Critical Care, Anesthesiology, Per-operative and Emergency medicine (CAPE), Hanzeplein 1, Groningen, Netherlands. (Ligtenberg J.J.M., j.j.m.ligtenberg@umcg.nl) University Medical Center Groningen, University of Groningen, Emergency Department, Research Program for Critical Care, Anesthesiology, Per-operative and Emergency medicine (CAPE), Hanzeplein 1, Groningen, Netherlands. CORRESPONDENCE ADDRESS J.M. Droogh, University Medical Center Groningen, University of Groningen, Department of Critical Care, Research Program for Critical Care, Anesthesiology, Per-operative and Emergency medicine (CAPE), Hanzeplein 1, Groningen, Netherlands. SOURCE Critical Care (2015) 19:1 Article Number: 62. Date of Publication: 20 Feb 2015 ISSN 1466-609X (electronic) 1364-8535 BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT During the past few decades the numbers of ICUs and beds has increased significantly, but so too has the demand for intensive care. Currently large, and increasing, numbers of critically ill patients require transfer between critical care units. Inter-unit transfer poses significant risks to critically ill patients, particularly those requiring multiple organ support. While the safety and quality of inter-unit and hospital transfers appear to have improved over the years, the effectiveness of specific measures to improve safety have not been confirmed by randomized controlled trials. It is generally accepted that critically ill patients should be transferred by specialized retrieval teams, but the composition, training and assessment of these teams is still a matter of debate. Since it is likely that the numbers and complexity of these transfers will increase in the near future, further studies are warranted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS clinical effectiveness health care quality human intensive care intensive care unit intermethod comparison legal aspect patient care patient safety priority journal randomized controlled trial (topic) review risk factor total quality management EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015810755 MEDLINE PMID 25887575 (http://www.ncbi.nlm.nih.gov/pubmed/25887575) PUI L602649276 DOI 10.1186/s13054-015-0749-4 FULL TEXT LINK http://dx.doi.org/10.1186/s13054-015-0749-4 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 230 TITLE Posterior spinal postsurgical infection: Infection, obesity and transferring to ICU as independent risk factors AUTHOR NAMES Na S. Xu T. Guo H.-L. Sheng W.-B. AUTHOR ADDRESSES (Na S.; Xu T.; Guo H.-L.; Sheng W.-B.) Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. CORRESPONDENCE ADDRESS W.-B. Sheng, Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. SOURCE Chinese Journal of Tissue Engineering Research (2015) 19:7 (1127-1132). Date of Publication: 12 Feb 2015 ISSN 1673-8225 BOOK PUBLISHER Journal of Clinical Rehabilitative Tissue Engineering Research, lei_0415@hotmail.com ABSTRACT BACKGROUND: With the application of new screw-rod system, fusion cage and minimally invasive techniques, the amount of spinal surgeries becomes gradually increasing, along with expanded surgical scope and increased surgical difficulty. Meanwhile, postoperative infection rate is also increasing. Postoperative infections after spinal surgery often lead to increased length of stay and hospital costs, and cause neurological deterioration, and even death. OBJECTIVE: To investigate the risk factors and treatment strategies of posterior spinal postoperative infections. METHODS: A retrospective analysis including 857 cases of posterior spinal surgery from September 2012 to September 2013 in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University was performed. These patients were divided into infection (n=34) and non-infection (n=823) groups. We compared the preoperative, intraoperative, postoperative factors affecting postoperative infection in the two groups, and summarized the therapeutic strategies by analyzing the treatment methods and therapeutic effects. RESULTS AND CONCLUSION: The infection rate after posterior spinal surgery was 3.97% (34/857). There were significantly differences between the two groups in terms of muscle strength ≤ 3 level, preoperative immune dysfunction, acute or chronic infection, obesity, preoperative and postoperative incontinence or catheterization time ≥ 3 days, operative time ≥180 minutes, intraoperative bleeding, allogeneic bone grafting, standard use of antibiotics, postsurgical transferring to ICU, the number of drainage pipes, and the time of indwelling drainage tube (P<0.05), while other variables showed no statistical significance. Logistic regression analysis showed that acute or chronic infections, obesity (bone mass index>30 kg/m(2)), transfering to ICU after surgery were independent risk factors for posterior spinal postoperative infections. In addition, individual treatment is preferred for different patients with posterior spinal postoperative infections. It is even more important to choose the appropriate treatment. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care obesity postoperative infection (drug therapy, drug therapy) risk factor surgical infection (drug therapy, drug therapy) EMTREE MEDICAL INDEX TERMS antibiotic therapy article bone transplantation catheterization controlled study human incontinence infection rate muscle strength operation duration operative blood loss retrospective study spine surgery therapy effect EMBASE CLASSIFICATIONS Orthopedic Surgery (33) Drug Literature Index (37) LANGUAGE OF ARTICLE Chinese LANGUAGE OF SUMMARY English, Chinese EMBASE ACCESSION NUMBER 2015399610 PUI L606127199 DOI 10.3969/j.issn.2095-4344.2015.07.026 FULL TEXT LINK http://dx.doi.org/10.3969/j.issn.2095-4344.2015.07.026 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 231 TITLE Helicopter versus ground emergency medical services for the transportation of traumatically injured children AUTHOR NAMES Stewart C.L. Metzger R.R. Pyle L. Darmofal J. Scaife E. Moulton S.L. AUTHOR ADDRESSES (Stewart C.L., Camille.Stewart@ucdenver.edu; Moulton S.L., Steven.Moulton@childrenscolorado.org) University of Colorado School of Medicine, Department of Surgery, 12631 E. 17th Ave, Aurora, United States. (Stewart C.L., Camille.Stewart@ucdenver.edu; Moulton S.L., Steven.Moulton@childrenscolorado.org) Children's Hospital Colorado, Division of Pediatric Surgery, 13123 E. 16th Ave, Aurora, United States. (Metzger R.R., metzger2020@gmail.com; Scaife E., Eric.Scaife@imail2.org) Primary Children's Hospital, Division of Pediatric Surgery, 100 N Mario Capecchi Dr, Salt Lake City, United States. (Pyle L., Laura.Pyle@ucdenver.edu) University of Colorado School of Medicine, Department of Pediatrics, 13001 E. 17th Place, Aurora, United States. (Darmofal J., Joe.Darmofal@childrenscolorado.org) Children's Hospital Colorado, Department of Transport and EMS Outreach and Education, 13123 E. 16th Ave, Aurora, United States. CORRESPONDENCE ADDRESS C.L. Stewart, University of Colorado School of Medicine, Department of Surgery, 12631 E. 17th Ave, Aurora, United States. SOURCE Journal of Pediatric Surgery (2015) 50:2 (347-352). Date of Publication: 1 Feb 2015 ISSN 1531-5037 (electronic) 0022-3468 BOOK PUBLISHER W.B. Saunders ABSTRACT Background Helicopter emergency medical services (HEMS) are a common mode of transportation for pediatric trauma patients. We hypothesized that HEMS improve outcomes for traumatically injured children compared to ground emergency medical services (GEMS). Methods We queried trauma registries of two level 1 pediatric trauma centers for children 0-17 years, treated from 2003 to 2013, transported by HEMS or GEMS, with known transport starting location and outcome. A geocoding service estimated travel distance and time. Multivariate regression analyses were performed to adjust for injury severity variables and travel distance/time. Results We identified 14,405 traumatically injured children; 3870 (26.9%) transported by HEMS and 10,535 (73.1%) transported by GEMS. Transport type was not significantly associated with survival, ICU length of stay, or discharge disposition. Transport by GEMS was associated with a 68.6%-53.1% decrease in hospital length of stay, depending on adjustment for distance/time. Results were similar for children with severe injuries, and with propensity score matched cohorts. Of note, 862/3850 (22.3%) of HEMS transports had an ISS < 10 and hospitalization < 1 day. Conclusions HEMS do not independently improve outcomes for traumatically injured children, and 22.3% of children transported by HEMS are not significantly injured. These factors should be considered when requesting HEMS for transport of traumatically injured children. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport childhood injury emergency health service helicopter EMTREE MEDICAL INDEX TERMS adolescent article blunt trauma child comparative study female hospital discharge hospitalization human infant injury severity intensive care unit length of stay major clinical study male newborn priority journal register survival time travel EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015751563 MEDLINE PMID 25638635 (http://www.ncbi.nlm.nih.gov/pubmed/25638635) PUI L602303696 DOI 10.1016/j.jpedsurg.2014.09.040 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpedsurg.2014.09.040 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 232 TITLE Scheduling pick-up and delivery jobs in a hospital to level ergonomic stress AUTHOR NAMES Elmbach A.F. Boysen N. Briskorn D. Mothes S. AUTHOR ADDRESSES (Elmbach A.F.; Mothes S.) Friedrich-Schiller-Universität Jena, Lehrstuhl für Management Science, Jena, Germany. (Boysen N., nils.boysen@uni-jena.de) Friedrich-Schiller-Universität Jena, Lehrstuhl für Operations Management, Jena, Germany. (Briskorn D.) Bergische Universität Wuppertal, Professur für BWL, insbesondere Produktion und Logistik, Wuppertal, Germany. CORRESPONDENCE ADDRESS N. Boysen, Friedrich-Schiller-Universität Jena, Lehrstuhl für Operations Management, Jena, Germany. SOURCE IIE Transactions on Healthcare Systems Engineering (2015) 5:1 (42-53). Date of Publication: 2 Jan 2015 ISSN 1948-8319 (electronic) 1948-8300 BOOK PUBLISHER Taylor and Francis Inc., 325 Chestnut St, Suite 800, Philadelphia, United States. ABSTRACT During a typical stay in a hospital patients visit multiple wards to receive therapy and other treatment, so that a large number of intra-hospital transportation jobs are to be accomplished each day. Transporting patients in wheelchairs or beds causes ergonomic stress for the workforce, which depends, for instance, on the conveyance vehicle, the tour length, and the patient’s weight; excessive ergonomic strain, in turn, increases the risk of musculoskeletal disorders. This article presents the case of a large-size state-owned German hospital, where ergonomic aspects are to be integrated into the scheduling of patient transports. We formalize the resulting scheduling problem, settle computational complexity, provide exact and heuristic solution procedures, and investigate managerial aspects in a comprehensive computational study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ergonomic stress health care management patient scheduling stress EMTREE MEDICAL INDEX TERMS algorithm article bed body weight decision making health care personnel hospital hospitalization human manager musculoskeletal disease patient transport priority journal procedures wheelchair workflow EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015837901 PUI L603096619 DOI 10.1080/19488300.2014.996837 FULL TEXT LINK http://dx.doi.org/10.1080/19488300.2014.996837 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 233 TITLE Quality metrics in neonatal and pediatric critical care transport: A national delphi project AUTHOR NAMES Schwartz H.P. Bigham M.T. Schoettker P.J. Meyer K. Trautman M.S. Insoft R.M. AUTHOR ADDRESSES (Schwartz H.P.) Division of Emergency Medicine, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, United States. (Bigham M.T.) Division of Critical Care Medicine, Department of Pediatrics, Northeast Ohio Medical University, Akron, United States. (Schoettker P.J.) James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, United States. (Meyer K.) Division of Critical Care Medicine, Department of Pediatrics, Miami Children's Hospital, Miami, United States. (Trautman M.S.) Division of Neonatology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States. (Insoft R.M.) Department of Pediatrics, Brown University Alpert School of Medicine, Providence, United States. SOURCE Pediatric Critical Care Medicine (2015) 16:8 (711-717). Date of Publication: 11 Nov 2015 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, LRorders@phl.lrpub.com ABSTRACT Objectives: The transport of neonatal and pediatric patients to tertiary care facilities for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. In 2011, pediatric transport teams in Ohio met to identify quality indicators permitting comparisons among programs. However, no set of national consensus quality metrics exists for benchmarking transport teams. The aim of this project was to achieve national consensus on appropriate neonatal and pediatric transport quality metrics. Design: Modified Delphi technique. Setting: The first round of consensus determination was via electronic mail survey, followed by rounds of consensus determination in-person at the American Academy of Pediatrics Section on Transport Medicine's 2012 Quality Metrics Summit. Subjects: All attendees of the American Academy of Pediatrics Section on Transport Medicine Quality Metrics Summit, conducted on October 21-23, 2012, in New Orleans, LA, were eligible to participate. Measurements and Main Results: Candidate quality metrics were identified through literature review and those metrics currently tracked by participating programs. Participants were asked in a series of rounds to identify "very important" quality metrics for transport. It was determined a priori that consensus on a metric's importance was achieved when at least 70% of respondents were in agreement. This is consistent with other Delphi studies. Eighty-two candidate metrics were considered initially. Ultimately, 12 metrics achieved consensus as "very important" to transport. These include metrics related to airway management, team mobilization time, patient and crew injuries, and adverse patient care events. Definitions were assigned to the 12 metrics to facilitate uniform data tracking among programs. Conclusions: The authors succeeded in achieving consensus among a diverse group of national transport experts on 12 core neonatal and pediatric transport quality metrics. We propose that transport teams across the country use these metrics to benchmark and guide their quality improvement activities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article consensus Delphi study human mobilization patient care priority journal quality control respiration control tertiary care center total quality management EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015425134 MEDLINE PMID 26181297 (http://www.ncbi.nlm.nih.gov/pubmed/26181297) PUI L606281411 DOI 10.1097/PCC.0000000000000477 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000477 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 234 TITLE Rate of preventable early unplanned intensive care unit transfer for direct admissions and emergency department admissions AUTHOR NAMES Reese J. Deakyne S.J. Blanchard A. Bajaj L. AUTHOR ADDRESSES (Reese J., jennifer.reese@childrenscolorado.org) Section of Hospital Medicine, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, United States. (Deakyne S.J.) Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, United States. (Blanchard A.) Research Informatics, Children's Hospital Colorado, Aurora, United States. (Bajaj L.) New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, United States. CORRESPONDENCE ADDRESS J. Reese, Section of Hospital Medicine, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, United States. SOURCE Hospital Pediatrics (2015) 5:1 (27-34). Date of Publication: 1 Jan 2015 ISSN 2154-1671 (electronic) 2154-1663 BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT BACKGROUND AND OBJECTIVE: Appropriate patient placement at the time of admission to avoid unplanned transfers to the ICU and codes outside of the ICU is an important safety goal for many institutions. The objective of this study was to determine if the overall rate of unplanned ICU transfers within 12 hours of admission to the inpatient medical/surgical unit was higher for direct admissions compared with emergency department (ED) admissions.METHODS: This was a retrospective cohort study of all unplanned ICU transfers within 12 hours of admission to an inpatient unit at a tertiary care children's hospital from January 2010 to December 2012. Proportions of preventable unplanned transfers from the ED and from direct admission were calculated and compared.RESULTS: Over the study period, there were a total of 46 998 admissions; 279 unplanned ICU transfers occurred during the study period of which 101 (36%) were preventable. Preventable unplanned transfers from each portal of entry were calculated and compared with the total number of admissions from those portals. The portals of entry evaluated included admissions from our internal ED versus all outside facility transfers. The rates of early unplanned transfer (per 1000 admissions) by portal of entry were 3.50 for direct admissions and 3.18 for ED. There was no difference between direct admissions and ED admissions resulting in preventable unplanned transfers to the ICU (P = .64).CONCLUSIONS: Rates of unplanned ICU transfers within 12 hours of admission to an inpatient unit are not higher for direct admissions compared with ED admissions. Further studies are required to determine clinical risk factors associated with unplanned ICU transfer after admission, thus allowing for more accurate initial patient placement. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward hospital admission intensive care unit patient transport EMTREE MEDICAL INDEX TERMS anaphylaxis article breath holding child clinical assessment cohort analysis comorbidity controlled study female hospital management hospital patient human major clinical study male medical error medical history practice guideline preschool child retrospective study tertiary health care EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015651156 MEDLINE PMID 25554756 (http://www.ncbi.nlm.nih.gov/pubmed/25554756) PUI L601136890 DOI 10.1542/hpeds.2013-0102 FULL TEXT LINK http://dx.doi.org/10.1542/hpeds.2013-0102 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 235 TITLE Prospective cohort study protocol to describe the transfer of patients from intensive care units to hospital wards AUTHOR NAMES Buchner D.L. Bagshaw S.M. Dodek P. Forster A.J. Fowler R.A. Lamontagne F. Turgeon A.F. Potestio M. Stelfox H.T. AUTHOR ADDRESSES (Buchner D.L.) Faculty of Medicine, University of Calgary, Calgary, Canada. (Bagshaw S.M.) Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. (Dodek P.) Division of Critical Care Medicine, Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. (Forster A.J.) Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Canada. (Fowler R.A.) Department of Medicine, Department of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Canada. (Lamontagne F.) Centre de Recherche du CHU de Sherbrooke, Universite de Sherbrooke, Sherbrooke, Canada. (Turgeon A.F.) Department of Anesthesiology and Critical Care Medicine, CHU de Quebec Research Center, Quebec City, Canada. (Potestio M.) Critical Care Strategic Clinical Network, Alberta Health Services, Calgary, Canada. (Stelfox H.T., tstelfox@ucalgary.ca) Department of Critical Care Medicine, University of Calgary, Calgary, Canada. CORRESPONDENCE ADDRESS H.T. Stelfox, Department of Critical Care Medicine, University of Calgary, Calgary, Canada. Email: tstelfox@ucalgary.ca SOURCE BMJ Open (2015) 5:7 Article Number: e007913. Date of Publication: 2015 ISSN 2044-6055 (electronic) BOOK PUBLISHER BMJ Publishing Group, subscriptions@bmjgroup.com ABSTRACT Introduction: The transfer of patient care between the intensive care unit (ICU) and the hospital ward is associated with increased risk of medical error and adverse events. This study will describe patient transfer from ICU to hospital ward by documenting (1) patient, family and provider experiences related to ICU transfer, (2) communication between stakeholders involved in ICU transfer, (3) adverse events that follow ICU transfer and (4) opportunities to improve ICU to hospital ward transfer. Methods: This is a mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. We will recruit 50 patients at each site (n=500) who are transferred from ICU to hospital ward, and distribute surveys to enrolled patients, family members, and healthcare providers (ICU and ward physicians and nurses) after patient transfer. A random sample of 6 consenting study participants (patients, family members, healthcare providers) from each study site (n=60) will be offered an opportunity to participate in interviews to further describe stakeholders' experience with ICU to hospital ward transfer. We will abstract information from patient health records to identify clinical data and use of transfer tools, and identify adverse events that are related to the transfer. Ethics and Dissemination: Research ethics board approval has been obtained at the coordinating study centre (UofC REB13-0021) and 5 study sites (UofA Pro00050646; UBC-PHC H14-01667; Sunnybrook 336-2014; QCH 14-07; Sherbrooke 14-172). Dissemination of the findings will provide a comprehensive description of transfer from ICU to hospital ward in Canada including the uptake of validated or local transfer tools, a conceptual framework of the experiences and needs of stakeholders in the ICU transfer process, a summary of adverse events experienced by patients after transfer from ICU to hospital ward, and opportunities to guide quality improvement efforts. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport ward EMTREE MEDICAL INDEX TERMS article Canada conceptual framework family health care personnel human interpersonal communication major clinical study medical error total quality management EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015203526 MEDLINE PMID 26155820 (http://www.ncbi.nlm.nih.gov/pubmed/26155820) PUI L605214819 DOI 10.1136/bmjopen-2015-007913 FULL TEXT LINK http://dx.doi.org/10.1136/bmjopen-2015-007913 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 236 TITLE Study of the condition and problems of the newborn infants before and during transportation to mofid children's hospital NICU AUTHOR NAMES Kazemian M. Hossein Fakhraee S. Afjeh A. Kosari K. AUTHOR ADDRESSES (Kazemian M.; Afjeh A.) Neonatologist, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (Hossein Fakhraee S.) MD-FAAP, Neonatologist, Shahid Beheshti University of Medical Sciences, Tehran, Iran. (Kosari K., koroshkosari@yahoo.com) Neonatologist, AJA University of Medical Sciences, Tehran, Iran. CORRESPONDENCE ADDRESS K. Kosari, Neonatologist, AJA University of Medical Sciences, Tehran, Iran. SOURCE Biosciences Biotechnology Research Asia (2015) 12:2 (1303-1309). Date of Publication: 1 Aug 2015 ISSN 0973-1245 BOOK PUBLISHER Oriental Scientific Publishing Company ABSTRACT Transportation of unstable newborn to well equiped NICU is very important in managing such patients. So investigation the condition of transportation is very important for revealing the probable problem. The aim of this study is to investigate the condition and problems of the newborn infants before and during transportation to Mofid children's Hospital NICU as a one of major referal center in Iran. This is a cross sectional study conducted in Sep 2010 to Sep 2011. In this period all newborn transported to NICU ot Mofid hospital were enrolled. For each newborn a questionnaire consisting of question about demographic, condition of transportation, time of transportation, drugs and other treatment measurs were filled. Totally 211 patients were enrolled. In 58(27.5%), 123 (58.5%), and 41 (19.4)% a MD, a nurse or a technician respectively accompanied the newborn in transportation. In 52(24.6%) cases had tracheal tube and In 159 (75.4) cases did not have it. In 167(70.1%) were stable were reached to NICU. In 11 (5.2) cases were hypothermic. In 31 (14.7%) cases were cyanotic. There were no significant relation between person of transporter with stability of newborn. Unstable newborn were transported by physician more than nurses and technicians. In stable group more people passed the newborn CPR workshops but this difference was not significant statistically. In spite of progress in transportation condition recently, better specialized training for newborn transportation can improve transportation yet. It is necessary to register transportation data more precisely. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS anesthesiology Apgar score article central venous catheter cross-sectional study diaphragm hernia dystrophy endotracheal tube esophagus atresia female human Iran male medical education newborn care nurse physician prematurity private hospital respiratory dystrophy resuscitation EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015334478 PUI L605813334 DOI 10.13005/bbra/1785 FULL TEXT LINK http://dx.doi.org/10.13005/bbra/1785 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 237 TITLE Impact of Video Laryngoscopy on Advanced Airway Management by Critical Care Transport Paramedics and Nurses Using the CMAC Pocket Monitor AUTHOR NAMES Boehringer B. Choate M. Hurwitz S. Tilney P.V.R. Judge T. AUTHOR ADDRESSES (Boehringer B., bradboehringer@gmail.com; Choate M., choatemi@gmail.com; Tilney P.V.R., tilneype@cmhc.org; Judge T., tjudge@emhs.org) LifeFlight of Maine, 13 Main Street, Camden, United States. (Boehringer B., bradboehringer@gmail.com) Laurea University of Applied Sciences, Uudenmaankatu 22, Hyvinkää, Finland. (Hurwitz S., hurwitz@hms.harvard.edu) Brigham and Women's Biostatistics Center, 5 Francis Street, Boston, United States. CORRESPONDENCE ADDRESS B. Boehringer, LifeFlight of Maine, 13 Main Street, Camden, United States. SOURCE BioMed Research International (2015) 2015 Article Number: 821302. Date of Publication: 2015 ISSN 2314-6141 (electronic) 2314-6133 BOOK PUBLISHER Hindawi Publishing Corporation, 410 Park Avenue, 15th Floor, 287 pmb, New York, United States. ABSTRACT Accurate endotracheal intubation for patients in extremis or at risk of physiologic decompensation is the gold standard for emergency medicine. Field intubation is a complex process and time to intubation, number of attempts, and hypoxia have all been shown to correlate with increases in morbidity and mortality. Expanding laryngoscope technology which incorporates active video, in addition to direct laryngoscopy, offers providers improved and varied tools to employ in management of the advanced airway. Over a nine-year period a helicopter emergency medical services team, comprised of a flight paramedic and flight nurse, intended to intubate 790 patients. Comparative data analysis was performed and demonstrated that the introduction of the CMAC video laryngoscope improved nearly every measure of success in airway management. Overall intubation success increased from 94.9% to 99.0%, first pass success rates increased from 75.4% to 94.9%, combined first and second pass success rates increased from 89.2% to 97.4%, and mean number of intubation attempts decreased from 1.33 to 1.08. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cmac pocket monitor video laryngoscope intensive care patient transport respiration control videolaryngoscope EMTREE MEDICAL INDEX TERMS adult airplane crew article child comparative study data analysis emergency health service emergency medicine endotracheal intubation female gold standard human hypoxia infant laryngoscopy major clinical study male medical record review morbidity mortality nurse patient care retrospective study risk factor total quality management DEVICE TRADE NAMES Video Laryngoscope Karl Storz DEVICE MANUFACTURERS Karl Storz EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015173625 MEDLINE PMID 26167501 (http://www.ncbi.nlm.nih.gov/pubmed/26167501) PUI L605026536 DOI 10.1155/2015/821302 FULL TEXT LINK http://dx.doi.org/10.1155/2015/821302 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 238 TITLE Clinical outcomes of septic patients according to the elapsed time before transfer to the intensive care unit AUTHOR NAMES Gonçalves Dias A. Ribeiro Dos Santos E. Faria Moura D. Takao Lopes C. Murata Murakami B. AUTHOR ADDRESSES (Gonçalves Dias A.; Ribeiro Dos Santos E.; Faria Moura D.; Murata Murakami B.) Hospital Israelita Albert Einstein, São Paulo, Brazil. (Takao Lopes C.) Universidade Federal de São Paulo, São Paulo, Brazil. CORRESPONDENCE ADDRESS B. Murata Murakami, Hospital Israelita Albert Einstein, São Paulo, Brazil. SOURCE Intensive Care Medicine Experimental (2015) 3 Supplement 1 Article Number: A229. Date of Publication: 2015 ISSN 2197-425X (electronic) BOOK PUBLISHER SpringerOpen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport sepsis EMTREE MEDICAL INDEX TERMS clinical article death descriptive research human note outcome assessment priority journal rapid response team retrospective study EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160639940 PUI L611852530 DOI 10.1186/2197-425X-3-S1-A229 FULL TEXT LINK http://dx.doi.org/10.1186/2197-425X-3-S1-A229 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 239 TITLE A two-site survey of clinicians to identify practices and preferences of intensive care unit transfers to general medical wards AUTHOR NAMES Detsky M.E. Ailon J. Weinerman A.S. Amaral A.C. Bell C.M. AUTHOR ADDRESSES (Detsky M.E., mdetsky@mtsinai.on.ca; Ailon J., ailonj@smh.ca; Weinerman A.S., weinerman@sunnybrook.ca; Amaral A.C., andrecarlos.amaral@sunnybrook.ca; Bell C.M., cbell@mtsinai.on.ca) Faculty of Medicine, University of Toronto, Toronto, Canada. (Bell C.M., cbell@mtsinai.on.ca) Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. (Detsky M.E., mdetsky@mtsinai.on.ca; Ailon J., ailonj@smh.ca; Weinerman A.S., weinerman@sunnybrook.ca; Amaral A.C., andrecarlos.amaral@sunnybrook.ca; Bell C.M., cbell@mtsinai.on.ca) Department of Medicine, University of Toronto, Toronto, Canada. (Detsky M.E., mdetsky@mtsinai.on.ca; Bell C.M., cbell@mtsinai.on.ca) Department of Medicine, Mount Sinai Hospital, Toronto, Canada. (Amaral A.C., andrecarlos.amaral@sunnybrook.ca) Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. (Detsky M.E., mdetsky@mtsinai.on.ca) Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States. (Detsky M.E., mdetsky@mtsinai.on.ca) Leonard Davis Institute, University of Pennsylvania, Philadelphia, United States. (Ailon J., ailonj@smh.ca) Department of Medicine, St Michael's Hospital, Toronto, Canada. (Weinerman A.S., weinerman@sunnybrook.ca) Department of Medicine, Sunnybrook Health Sciences Center, Toronto, Canada. CORRESPONDENCE ADDRESS M.E. Detsky, Mount Sinai Hospital 600 University Ave, Suite 433, Toronto, Canada. SOURCE Journal of Critical Care (2015) 30:2 (358-362). Date of Publication: 1 Apr 2015 ISSN 1557-8615 (electronic) 0883-9441 BOOK PUBLISHER W.B. Saunders ABSTRACT Introduction: The transfer of patients from the intensive care unit (ICU) to the general medical ward is high risk for adverse events and health care provider dissatisfaction. We aimed to identify perceived practices, and what information is important to communicate during an ICU transfer. Methods: This study used a self-administered questionnaire that surveyed physicians in 2 different hospitals. These physicians provide care in either the ICU or the general medical ward. Responses were evaluated with Likert scales and frequencies. Results: A total of 121 physicians (54% response rate) completed the survey. Current practice most often includes written chart and telephone communication. Most providers (63.3%) believed that the current process is inadequate. Surprises are common (79% of respondents); and reported adverse events include medication errors (60.4%), aspiration (49.5%), and decreased level of consciousness requiring intervention (44.6%). The use of an ICU transfer tool is one potential mechanism of improving this process of care, and providers reported several items that may be useful. Conclusion: Providers reported the current process of transferring patients from the ICU to the general medical ward as inadequate. We highlight data that physicians feel is important to communicate at the time of transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) general medical ward intensive care unit medical practice patient transport ward EMTREE MEDICAL INDEX TERMS article aspiration consciousness level critically ill patient death hospital discharge human hypercapnia hypotension hypoxia interpersonal communication intervention study Likert scale medical education medication error outpatient questionnaire respiratory failure seizure self administration test EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014959718 MEDLINE PMID 25499415 (http://www.ncbi.nlm.nih.gov/pubmed/25499415) PUI L600731498 DOI 10.1016/j.jcrc.2014.10.026 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcrc.2014.10.026 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 240 TITLE A national survey exploring views and experience of health professionals about transferring patients from critical care home to die AUTHOR NAMES Darlington A.-S.E. Long-Sutehall T. Richardson A. Coombs M.A. AUTHOR ADDRESSES (Darlington A.-S.E., a.darlington@soton.ac.uk; Long-Sutehall T.; Richardson A.; Coombs M.A.) Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom. (Coombs M.A.) Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand. CORRESPONDENCE ADDRESS A.-S.E. Darlington, Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom. SOURCE Palliative Medicine (2015) 29:4 (363-370). Date of Publication: 25 Apr 2015 ISSN 1477-030X (electronic) 0269-2163 BOOK PUBLISHER SAGE Publications Ltd, info@sagepub.co.uk ABSTRACT Background: Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals' (HCP) experience and views. Objectives: To examine (1) HCPs' experience of transferring patients home to die from critical care, (2) HCPs' views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. Design: A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. Setting/participants: Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. Results: In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home to die (88.8%). Patients identified by respondents as unsuitable for transfer included unstable patients (61.8%), intubated and ventilated patients (68.5%) and patients receiving inotropes (65.7%). There were statistically significant differences in views between those with and without experience and between doctors and nurses. Nurses and those with experience tended to have more positive views. Conclusion: While transferring patients home to die is supported in critical care, its frequency in practice remains low. Patient stability and level of intervention are important factors in decision-making in this area. Views held about this practice are influenced by previous experience and the professional role held. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient health care personnel patient transport terminal care EMTREE MEDICAL INDEX TERMS article human intensive care unit major clinical study nurse patient identification United Kingdom ventilated patient EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015866956 MEDLINE PMID 25656087 (http://www.ncbi.nlm.nih.gov/pubmed/25656087) PUI L603444783 DOI 10.1177/0269216315570407 FULL TEXT LINK http://dx.doi.org/10.1177/0269216315570407 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 241 TITLE Maternal colonization with group B streptococcus is associated with an increased rate of infants transferred to the neonatal intensive care unit AUTHOR NAMES Brigtsen A.K. Jacobsen A.F. Dedi L. Melby K.K. Fugelseth D. Whitelaw A. AUTHOR ADDRESSES (Brigtsen A.K., a.k.brigtsen@medisin.uio.no; Jacobsen A.F.; Melby K.K.; Fugelseth D.; Whitelaw A.) Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Oslo, Norway. (Brigtsen A.K., a.k.brigtsen@medisin.uio.no; Fugelseth D.) Department of Neonatal Intensive Care, Oslo University Hospital Ullevaal, Oslo, Norway. (Jacobsen A.F.) Department of Obstetrics and Gynaecology, Oslo University Hospital Ullevaal, Oslo, Norway. (Dedi L.; Melby K.K.) Department of Microbiology, Oslo University Hospital Ullevaal, Oslo, Norway. CORRESPONDENCE ADDRESS A.K. Brigtsen, Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, Oslo, Norway. SOURCE Neonatology (2015) 108:3 (157-163). Date of Publication: 18 Sep 2015 ISSN 1661-7819 (electronic) 1661-7800 BOOK PUBLISHER S. Karger AG ABSTRACT Background:Streptococcus agalactiae (group B Streptococcus, GBS) is the most common cause of early neonatal infection, but restricting the diagnosis to culture-positive infants may underestimate the burden of GBS disease. Our objective was to determine whether maternal GBS colonization was associated with an increased risk of transfer of term infants to the neonatal intensive care unit (NICU) and, if so, to estimate the incidence of probable early-onset GBS disease. Methods: We conducted a prospective cohort study of 1,694 term infants whose mothers had vaginal-rectal swabs collected at delivery. Data collected on each mother and infant included demographics, clinical findings and laboratory investigations. The medical staff were unaware of the maternal GBS colonization status. Results: A total of 26% of the mothers were colonized. Infants born to colonized mothers did not differ from infants born to non-colonized mothers with respect to birth weight or Apgar score. Altogether, 30 (1.8%) of the term infants were transferred to the NICU. Only 1 infant born to a colonized mother had culture-positive early-onset GBS disease. Infants born to colonized mothers were more than 3 times as likely to be transferred to the NICU compared to infants of non-colonized mothers (3.6 vs. 1.1%; OR 3.4, 95% CI 1.6-6.9, p = 0.001); 5 infants of colonized mothers had probable GBS disease with tachypnoea and raised C-reactive protein (3.0/1,000 live term births). Conclusions: Maternal GBS colonization is associated with increased risk of transfer to the NICU in term infants. The burden of neonatal GBS disease may be greater than indicated by the number of culture-positive cases. EMTREE DRUG INDEX TERMS C reactive protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial colonization group B streptococcal infection (etiology) maternal colonization newborn intensive care Streptococcus agalactiae EMTREE MEDICAL INDEX TERMS adult Apgar score article bacterium culture birth weight cohort analysis female gestational age human incidence laboratory diagnosis major clinical study male newborn newborn infection (etiology) Norway onset age outcome assessment priority journal prospective study rectal swab risk assessment tachypnea term birth vagina smear CAS REGISTRY NUMBERS C reactive protein (9007-41-4) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015456033 MEDLINE PMID 26182960 (http://www.ncbi.nlm.nih.gov/pubmed/26182960) PUI L606512392 DOI 10.1159/000434716 FULL TEXT LINK http://dx.doi.org/10.1159/000434716 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 242 TITLE Outcomes of preterm neonates transferred between tertiary perinatal centers AUTHOR NAMES Longhini F. Jourdain G. Ammar F. Mokthari M. Boithias C. Romain O. Letamendia E. Tissieres P. Chabernaud J.L. De Luca D. AUTHOR ADDRESSES (Longhini F.; Jourdain G.; Ammar F.; Romain O.; Letamendia E.; Chabernaud J.L.; De Luca D.) Division of Pediatrics and Neonatal Critical Care, FAME Department, South Paris University Hospitals, Paris, France. (Longhini F.) Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy. (Mokthari M.; Boithias C.; Tissieres P.) Division of Paediatric Critical Care and Neonatal Medicine, FAME Department, South Paris University Hospitals, Paris, France. SOURCE Pediatric Critical Care Medicine (2015) 16:8 (733-738). Date of Publication: 11 Nov 2015 ISSN 1947-3893 (electronic) 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, LRorders@phl.lrpub.com ABSTRACT Objective: To verify if preterm neonates transferred between tertiary referral centers have worse outcomes than matched untransferred infants. Design: Cohort study with a historically matched control group. Setting: Two tertiary-level neonatal ICUs. Patients: Seventy-five neonates per group. Interventions: Transfer between tertiary-level neonatal ICUs carried out by a fully equipped transportation team. Measurements and Main Results: We measured in-hospital mortality, frequency of intraventricular hemorrhage greater than 2nd grade, periventricular leukomalacia, necrotizing enterocolitis greater than or equal to grade 2, bronchopulmonary dysplasia, composite outcomes (in-hospital mortality/bronchopulmonary dysplasia, in-hospital mortality/intraventricular hemorrhage 2nd grade, and bronchopulmonary dysplasia/periventricular leukomalacia/intraventricular hemorrhage 2nd grade), length of neonatal ICU stay, weight at discharge, and time spent on ventilatory support. Seventy-five similar (except for antenatal steroids administration) neonates were enrolled in each cohort. Cohorts did not differ in mortality, bronchopulmonary dysplasia, intraventricular hemorrhage greater than 2nd grade, periventricular leukomalacia, necrotizing enterocolitis greater than or equal to grade 2, any composite outcomes, neonatal ICU stay, weight at discharge, and duration of respiratory support. Results were unchanged adjusting for antenatal steroids. Conclusions: Neonatal transfer between tertiary-level centers does not impact on clinical outcomes, if performed under optimal conditions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport prematurity (epidemiology) tertiary care center EMTREE MEDICAL INDEX TERMS anemia Apgar score article assisted ventilation birth weight body weight brain hemorrhage cohort analysis controlled study encephalomalacia female gestational age hospital discharge human hypoglycemia hypotension hypothermia intensive care unit lung dysplasia major clinical study male necrotizing enterocolitis neutropenia newborn newborn intensive care newborn morbidity newborn mortality outcome assessment perinatal care priority journal respiratory distress syndrome thrombocytopenia treatment duration EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015425137 MEDLINE PMID 26132742 (http://www.ncbi.nlm.nih.gov/pubmed/26132742) PUI L606281427 DOI 10.1097/PCC.0000000000000482 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000482 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 243 TITLE Early transfer of cases from emergency (ER) to ICU (≤1 hour) - Does it really make a big difference in outcome? An analysis AUTHOR NAMES Kar A. Datta A. Ahmed A. AUTHOR ADDRESSES (Kar A.; Datta A.; Ahmed A.) Medica Superspecialty Hospital, Medica Institute of Critical Care (MICC), Kolkata, India. CORRESPONDENCE ADDRESS A. Kar, Medica Superspecialty Hospital, Medica Institute of Critical Care (MICC), Kolkata, India. SOURCE Intensive Care Medicine Experimental (2015) 3 Supplement 1 Article Number: A363. Date of Publication: 2015 ISSN 2197-425X (electronic) BOOK PUBLISHER SpringerOpen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward intensive care turnaround time EMTREE MEDICAL INDEX TERMS APACHE controlled study human mortality mortality rate note priority journal tertiary care center EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160632693 PUI L611852679 DOI 10.1186/2197-425X-3-S1-A363 FULL TEXT LINK http://dx.doi.org/10.1186/2197-425X-3-S1-A363 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 244 TITLE Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality AUTHOR NAMES Chang A.S. Berry A. Jones L.J. Sivasangari S. AUTHOR ADDRESSES (Chang A.S.; Berry A.; Jones L.J.; Sivasangari S.) Department of Neonatology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore, 229899 SOURCE The Cochrane database of systematic reviews (2015) 10 (CD007485). Date of Publication: 2015 ISSN 1469-493X (electronic) ABSTRACT BACKGROUND: Maternal antenatal transfers provide better neonatal outcomes. However, there will inevitably be some infants who require acute transport to a neonatal intensive care unit (NICU). Because of this, many institutions develop services to provide neonatal transport by specially trained health personnel. However, few studies report on relevant clinical outcomes in infants requiring transport to NICU.OBJECTIVES: To determine the effects of specialist transport teams compared with non-specialist transport teams on the risk of neonatal mortality and morbidity among high-risk newborn infants requiring transport to neonatal intensive care.SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE (1966 to 31 July 2015), EMBASE (1980 to 31 July 2015), CINAHL (1982 to 31 July 2015), conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.STUDY DESIGN: randomised, quasi-randomised or cluster randomised controlled trials.POPULATION: neonates requiring transport to a neonatal intensive care unit.INTERVENTION: transport by a specialist team compared to a non-specialist team.OUTCOMES: any of the following outcomes - death; adverse events during transport leading to respiratory compromise; and condition on admission to the neonatal intensive care unit.DATA COLLECTION AND ANALYSIS: The methodological quality of the trials was assessed using the information provided in the studies and by personal communication with the author. Data on relevant outcomes were extracted and the effect size estimated and reported as risk ratio (RR), risk difference (RD), number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) and mean difference (MD) for continuous outcomes. Data from cluster randomised trials were not combined for analysis.MAIN RESULTS: One trial met the inclusion criteria of this review but was considered ineligible owing to serious bias in the reporting of the results.AUTHORS' CONCLUSIONS: There is no reliable evidence from randomised trials to support or refute the effects of specialist neonatal transport teams for neonatal retrieval on infant morbidity and mortality. Cluster randomised trial study designs may be best suited to provide us with answers on effectiveness and clinical outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care organization and management specialization EMTREE MEDICAL INDEX TERMS human infant infant mortality newborn patient care patient transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26508087 (http://www.ncbi.nlm.nih.gov/pubmed/26508087) PUI L611484528 DOI 10.1002/14651858.CD007485.pub2 FULL TEXT LINK http://dx.doi.org/10.1002/14651858.CD007485.pub2 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 245 TITLE Improving quality of data extractions for the computation of patient-days and admissions AUTHOR NAMES Fortin É. Gonzales M. Fontela P.S. Platt R.W. Buckeridge D.L. Quach C. AUTHOR ADDRESSES (Fortin É.; Platt R.W.; Buckeridge D.L.; Quach C., caroline.quach@mcgill.ca) Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada. (Fortin É.; Quach C., caroline.quach@mcgill.ca) Direction des Risques Biologiques et de la Santé Au Travail, Institut National de Santé Publique du Québec, Québec and Montréal, Canada. (Gonzales M.; Fontela P.S.; Quach C., caroline.quach@mcgill.ca) Department of Pediatrics, Montréal Children's Hospital, McGill University, Montréal, Canada. CORRESPONDENCE ADDRESS C. Quach, Montreal Children's Hospital of the MUHC, C1242 - 2300 Tupper St, Montreal, Canada. SOURCE American Journal of Infection Control (2015) 43:2 (174-176). Date of Publication: 1 Feb 2015 ISSN 1527-3296 (electronic) 0196-6553 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT We describe how admissions/discharges/transfers datasets were carefully reviewed for the computation of patient days and admissions used to monitor resistance and antimicrobial use in 9 intensive care units. A visual inspection of datasets and comparisons with other data sources improved accuracy, completeness, and consistency of computations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) data extraction hospital admission hospital discharge patient transport EMTREE MEDICAL INDEX TERMS antimicrobial therapy article human intensive care unit EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014616983 MEDLINE PMID 25530553 (http://www.ncbi.nlm.nih.gov/pubmed/25530553) PUI L601001444 DOI 10.1016/j.ajic.2014.10.024 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajic.2014.10.024 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 246 TITLE Critical Care Transport Training: New Strides in Simulating the Austere Environment AUTHOR NAMES Alfes C.M. Steiner S.L. Manacci C.F. AUTHOR ADDRESSES (Alfes C.M.) Learning Resource Center, Frances Payne Bolton School of Nursing, Case Western Reserve University in Cleveland, United States. (Steiner S.L.; Manacci C.F.) Dorothy Ebersbach Academic Center for Flight Nursing, Frances Payne Bolton School of Nursing, Case Reserve Western University, United States. SOURCE Air Medical Journal (2015) 34:4 (186-187). Date of Publication: 1 Jul 2015 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT The air medical transport arena requires the practitioner to develop clinical and diagnostic reasoning abilities to manage the dynamic needs of the patient in unstructured, uncertain, and often unforgiving environments. High-fidelity simulation can be instrumental in training interprofessional flight teams to improve competency through quality and safe patient care during medical transport that may otherwise take years to learn because of the inconsistency in real-world experiences. Because of the suboptimal circumstantial conditions inherent to critical care transport, a helicopter simulator designed to discretely replicate the phases of flight and train teams in air medical transport scenarios has been developed at the Dorothy Ebersbach Academic Center for Flight Nursing at the Frances Payne Bolton School of Nursing in Cleveland, OH. The goal is to prepare interdisciplinary critical care transport flight teams in collaborative practice, research, and leadership through measurable and highly structured learning activities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care training EMTREE MEDICAL INDEX TERMS article feedback system flight nursing helicopter human leadership medical education patient care patient safety priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015225702 MEDLINE PMID 26206542 (http://www.ncbi.nlm.nih.gov/pubmed/26206542) PUI L605364563 DOI 10.1016/j.amj.2015.03.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2015.03.006 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 247 TITLE Mishaps during intrahospital transport of patients from emergency department - A mixed bag of patients AUTHOR NAMES Taggu A. Murthy S. Krishna B. Varma M.K.M. AUTHOR ADDRESSES (Taggu A.; Krishna B.) St. Johns Medical College Hospital, Critical Care Medicine, Bangalore, India. (Murthy S.; Varma M.K.M.) St. Johns Medical College Hospital, Emergency Medicine, Bangalore, India. CORRESPONDENCE ADDRESS A. Taggu, St. Johns Medical College Hospital, Critical Care Medicine, Bangalore, India. SOURCE Intensive Care Medicine Experimental (2015) 3 Supplement 1 Article Number: A69. Date of Publication: 2015 ISSN 2197-425X (electronic) BOOK PUBLISHER SpringerOpen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward patient transport EMTREE MEDICAL INDEX TERMS arterial line device failure electrocardiography lead displacement health care availability human hypoglycemia hypotension infusion interruption intensive care major clinical study medical error note observational study oxygen desaturation oxygen saturation probe displacement oxygen therapy power cord tangle priority journal prospective study resuscitation EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160639363 PUI L611853036 DOI 10.1186/2197-425X-3-S1-A69 FULL TEXT LINK http://dx.doi.org/10.1186/2197-425X-3-S1-A69 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 248 TITLE Evaluation of effects of pneumatic tube transport on ROTEM® analyses AUTHOR NAMES Rotteveel-De Groot D. Frenzel T. Noorland J. Kulk J. Van Zwam M. Oosting J. AUTHOR ADDRESSES (Rotteveel-De Groot D., Dorien.Rotteveel-deGroot@radboudumc.nl; Noorland J.; Kulk J.; Van Zwam M.; Oosting J.) Department of Laboratory Medicine, Radboud UMC, Nijmegen, Netherlands. (Frenzel T.) Department of Intensive Care, Radboud UMC, Nijmegen, Netherlands. CORRESPONDENCE ADDRESS D. Rotteveel-De Groot, Department of Laboratory Medicine, Radboud UMC, Nijmegen, Netherlands. Email: Dorien.Rotteveel-deGroot@radboudumc.nl SOURCE Clinical Chemistry and Laboratory Medicine (2015) 53:4 (eA16-eA17). Date of Publication: Marh 2015 CONFERENCE NAME 3rd EFLM-BD European Conference on Preanalytical Phase CONFERENCE LOCATION Porto, Portugal CONFERENCE DATE 2015-03-20 to 2015-03-21 ISSN 1434-6621 BOOK PUBLISHER Walter de Gruyter GmbH ABSTRACT Background: Rotational tromboelastometry (ROTEM®) can be used for quick monitoring of the blood coagulation status of patients in emergency situations. For a rapid analysis the blood samples can be transported to the central laboratory in our hospital via a pneumatic tube system. This study has been performed to evaluate possible effects of pneumatic tube transport on several ROTEM® parameters in blood samples of cardiothoracic surgery patients of the Intensive Care Unit. Materials and methods: Blood samples of 30 patients were transported to the central laboratory either by pneumatic tube system or by walking. All samples were used for ROTEM® INTEM, EXTEM, FIBTEM and HEPTEM analyses. Results: Our results show that the ROTEM parameters that are included in the in house protocol for hemostatic therapy (EXTEM CT, EXTEM A10 and FIBTEM A10) have a bias of less than 5%. The measured within-run and between-run analytical variation of these parameters was less than 5% with the exception of EXTEM CT (maximum of 8%), which is in accordance with the manufacturer's specifications. Conclusions: In conclusion, the pneumatic tube system in our hospital can be used to transport blood samples to the central laboratory for ROTEM® analyses. In the future, this provides the opportunity for various other departments in our hospital to include ROTEM® analyses in their treatment protocols. EMTREE DRUG INDEX TERMS hemostatic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) European thromboelastograph tube EMTREE MEDICAL INDEX TERMS blood clotting blood sampling emergency hospital human intensive care unit laboratory monitoring parameters patient surgical patient therapy thorax surgery walking LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71915294 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 249 TITLE A cost-effectiveness analysis of maternal transfer for spontaneous preterm labor at 24 weeks AUTHOR NAMES Jansen S. Savitsky L. Caughey A. AUTHOR ADDRESSES (Jansen S.; Savitsky L.; Caughey A.) Oregon Health and Science University, Portland, United States. CORRESPONDENCE ADDRESS S. Jansen, Oregon Health and Science University, Portland, United States. SOURCE American Journal of Obstetrics and Gynecology (2015) 212:1 SUPPL. 1 (S347). Date of Publication: January 2015 CONFERENCE NAME 35th Annual Meeting of the Society for Maternal-Fetal Medicine: The Pregnancy Meeting CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2015-02-02 to 2015-02-07 ISSN 0002-9378 BOOK PUBLISHER Mosby Inc. ABSTRACT OBJECTIVE: There has been extensive research documenting the decrease in mortality at high volume NICU vs. low volume NICU in early preterm neonates. This study evaluates the cost-effectiveness of transferring women presenting with spontaneous preterm labor at 24 weeks gestational age. STUDY DESIGN: A decision-analytic model was built using TreeAge 2014 software. Probabilities and costs were derived from the literature. Outcomes were compared with regards to transferring women presenting with spontaneous preterm labor to tertiary care hospitals or delivering at low-volume centers. Outcomes compared included: delivery at 24 weeks with mild, moderate, severe, or no neurodevelopmental delay (NDD), as well as delivery at 37 weeks. A cost effectiveness threshold was set at $100,000 per quality adjusted life year (QALY). Univariate sensitivity analyses were used to vary model inputs to investigate the impact of interventions with varying effectiveness. RESULTS: From the model there is demonstrated benefit to transferring women before delivery. Given the differing rates of mortality at high volume vs. low volume neonatal intensive care units for preterm neonates, there was a theoretical 5,000 QALYs saved by transferring women prior to delivery (Table 1). Overall there was an incremental cost-effectiveness ratio of $50.3 per QALY. Sensitivity analysis showed that by decreasing the probability of delivery from 66% to 30%, there was still benefit to maternal transfer to a tertiary care facility prior to delivery. CONCLUSION: This model shows that it is cost-effective to transfer women presenting with spontaneous preterm labor at 24 weeks to tertiary care facilities for delivery. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost effectiveness analysis pregnancy premature labor society EMTREE MEDICAL INDEX TERMS female gestational age human intensive care unit model mortality newborn newborn intensive care prematurity quality adjusted life year sensitivity analysis software tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71743161 DOI 10.1016/j.ajog.2014.10.918 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajog.2014.10.918 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 250 TITLE A standard handoff improves cardiac surgical patient transfer: operating room to intensive care unit AUTHOR NAMES Dixon J.L. Stagg H.W. Wehbe-Janek H. Jo C. Culp W.C. Shake J.G. AUTHOR ADDRESSES (Dixon J.L.; Stagg H.W.; Wehbe-Janek H.; Jo C.; Culp W.C.; Shake J.G.) SOURCE Journal for healthcare quality : official publication of the National Association for Healthcare Quality (2015) 37:1 (22-32). Date of Publication: 1 Jan 2015 ISSN 1945-1474 (electronic) ABSTRACT BACKGROUND: Patient handoffs are high-risk times associated with sentinel events. Effective handoff processes may enhance patient safety and team member communication. This study assesses the impact of a standardized protocol for handoffs from the cardiac surgery operating room to intensive care unit (ICU).METHODS: Using a prospective pre-post study design, a formalized handoff process was developed including critical handoff elements and a standardized handoff procedure, script, and checklist. Data were collected from 60 handoff observations (30 pre and 30 post), evaluating 52 unique parameters, and survey of providers on perspectives of the handoff process. Results were compared by chi-square test, two sample t-test, or nonparametric Mann-Whitney test. Statistical significance was defined as P ≤ .05.RESULTS: Provider's perspectives showed improved satisfaction with the standardized handoff process through improved responses in 19 of 22 survey items (P < .001). Median time until ventilator connection, ICU monitor transfer, first cardiac index, and chest radiograph were reduced after implementation. Completion of handoff process components also improved after implementation for 36 of 47 nontime parameters.CONCLUSIONS: A standard checklist-driven handoff process can dramatically improve key data transmission and reduce time of critical patient care steps during the high-risk period of patient handoff in a cardiac surgical ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart surgery organization and management standards EMTREE MEDICAL INDEX TERMS checklist clinical handover hospital personnel human information dissemination intensive care unit operating room patient safety patient transport prospective study questionnaire LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26042374 (http://www.ncbi.nlm.nih.gov/pubmed/26042374) PUI L615678841 DOI 10.1097/01.JHQ.0000460123.91061.b3 FULL TEXT LINK http://dx.doi.org/10.1097/01.JHQ.0000460123.91061.b3 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 251 TITLE Diagnostic yield and safety of CT scans in ICU AUTHOR NAMES Aliaga M. Forel J.-M. De Bourmont S. Jung B. Thomas G. Mahul M. Bisbal M. Nougaret S. Hraiech S. Roch A. Chaumoitre K. Jaber S. Gainnier M. Papazian L. AUTHOR ADDRESSES (Aliaga M., marinealiaga@hotmail.com; Forel J.-M.; Thomas G.; Hraiech S.; Roch A.; Papazian L.) Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, Marseille, France. (Forel J.-M.; Thomas G.; Hraiech S.; Roch A.; Papazian L.) Faculté de Médecine, Aix-Marseille Université, URMITE UMR CNRS 7278, Marseille, France. (De Bourmont S.; Bisbal M.; Gainnier M.) Réanimation des Urgences Médicales, Assistance Publique-Hôpitaux de Marseille, Hôpital la Timone, Marseille, France. (Jung B.; Mahul M.; Jaber S.) Départ d’Anesthésie-Réanimation B (DAR B), Réanimation et Transplantation, CHU de Montpellier, Hôpital Saint-Eloi, Montpellier, France. (Nougaret S.) Départ d’Imagerie Abdominale, CHU de Montpellier, Hôpital Saint-Eloi, Montpellier, France. (Chaumoitre K.) Département d’Imagerie Médicale, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France. CORRESPONDENCE ADDRESS M. Aliaga, Réanimation des Détresses Respiratoires et des Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, Marseille, France. SOURCE Intensive Care Medicine (2015) 41:3 (436-443). Date of Publication: 2015 ISSN 1432-1238 (electronic) 0342-4642 BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Purpose: Critically ill patients often require CT scans. Adverse events (AE) can occur during intra-hospital transport (IHT). The aim of this prospective study was to determine the diagnostic and therapeutic yield and the safety of CT scans in ICU patients.Methods: All ICU patients having a CT scan for diagnostic purposes were eligible. Diagnostic yield was evaluated by the agreement (full, partial or disagreement) between the physician main diagnostic hypothesis before the CT scan and the diagnosis established after the CT scan. Therapeutic yield was assessed by therapeutic changes after the CT scan. The safety was determined by the AE rate during IHT.Results: A total of 533 CT scans were performed on 359 patients in three teaching hospital ICUs. The diagnostic yield of CT scan showed 40.7 % of full agreement, 5.6 % of partial agreement and 53.7 % of disagreement with the main diagnostic hypothesis formulated before the CT scan. The CT-scan brought new elements to the diagnosis in 22.9 % of the cases. There was 54.4 % of therapeutic change after CT scan, while 22.3 % of AE occurred during IHT, including 6.7 % of life-threatening events. AE occurred more frequently in the first 48 h after ICU admission, in the most severely ill patients (higher SAPS II at admission), and when there was a large amount of equipment required for transport.Conclusions: The CT scan as a diagnostic procedure invalidated a diagnostic hypothesis and led to a therapeutic change in more than half of the cases. EMTREE DRUG INDEX TERMS iodinated contrast medium (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) computer assisted tomography critically ill patient diagnostic value intensive care patient safety EMTREE MEDICAL INDEX TERMS adverse outcome article atelectasis (diagnosis) bleeding (diagnosis) brain disease (diagnosis) contrast induced nephropathy (side effect) controlled study diagnostic test accuracy study heart arrest (complication) human infection (diagnosis) major clinical study malignant neoplasm (diagnosis) mortality observational study patient transport pleura effusion (diagnosis) prospective study risk benefit analysis teaching hospital venous thromboembolism (diagnosis) EMBASE CLASSIFICATIONS Radiology (14) Anesthesiology (24) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014979796 MEDLINE PMID 25518950 (http://www.ncbi.nlm.nih.gov/pubmed/25518950) PUI L600867635 DOI 10.1007/s00134-014-3592-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-014-3592-1 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 252 TITLE Efficiency of hematocrit, lymphocyte, C-reactive protein and transferrin levels in predicting mortality in intensive care unit patients ORIGINAL (NON-ENGLISH) TITLE Yoğun bakım hastalarında hematokrit, lenfosit, C-reaktif protein ve transferrin düzeylerinin mortalite tahmininde etkinliği AUTHOR NAMES Palabiyik O. Isik Y. Cegin M.B. Goktas U. Kati I. AUTHOR ADDRESSES (Palabiyik O., mdpalabiyikonur@yahoo.com) Sakarya University Training and Research Hospital, Department of Anesthesiology and Reanimation, Turkey. (Isik Y.) Izmir Katip Celebi University, Department of Anesthesiology and Reanimation, Izmir, Turkey. (Cegin M.B.; Goktas U.) Yuzuncu Yil University, Department of Anesthesiology and Reanimation, Van, Turkey. (Kati I.) Gazi University, Department of Anesthesiology and Reanimation, Ankara, Turkey. CORRESPONDENCE ADDRESS O. Palabiyik, Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi, Merkez Kampüsü Anesteziyoloji, , Turkey. SOURCE European Journal of General Medicine (2015) 12:3 (222-226). Date of Publication: 16 Sep 2015 ISSN 1304-3889 BOOK PUBLISHER TIP ARASTIRMALARI DERNEGI, journal@ejgm.org ABSTRACT The effectiveness of many physiological parameters and laboratory tests was investigated in predicting mortality. In this study, we investigated hematocrit, C-reactive protein, transferrin and total lymphocyte count along with Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scores of patients who were hospitalized in the intensive care unit. The data were retrospectively analyzed from hospital information management system, doctors' records and nurse observing forms. The mortality rate was 42.6%. The Acute Physiology and Chronic Health Evaluation II scores were significantly higher in cases with mortality compared to those without mortality. The admission and discharge Glasgow Coma Scores were significantly lower in patients who showed mortality compared with patients without mortality. Admission and discharge hematocrit and transferrin values were significantly lower in cases with mortality compared to those without mortality. Discharge C-reactive protein values were significantly higher in cases with mortality compared to those without mortality. Discharge total lymphocyte count values were significantly lower in cases with mortality compared to those without mortality. Consequently, we believe that hematocrit and transferrin values at the time of admission to the intensive care unit and total lymphocyte count and C-reactive protein at the time of discharge from the intensive care unit can be effective in predicting mortality. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) C reactive protein protein transferrin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hematocrit human intensive care unit lymphocyte lymphocyte count mortality patient EMTREE MEDICAL INDEX TERMS APACHE coma hospital information system laboratory test nurse parameters physician LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Turkish EMBASE ACCESSION NUMBER 2015377864 PUI L606022959 DOI 10.15197/sabad.1.12.47 FULL TEXT LINK http://dx.doi.org/10.15197/sabad.1.12.47 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 253 TITLE Air medical transport system vasanthi pinto anuja abayadeera AUTHOR NAMES Pinto V. Abayadeera A. AUTHOR ADDRESSES (Pinto V.; Abayadeera A.) SOURCE Sri Lankan Journal of Anaesthesiology (2015) 23:2 (47-49). Date of Publication: 2015 ISSN 1391-8834 BOOK PUBLISHER College of Anaesthesiologists of Sri Lanka, 44/5A, Gnanartha Pradeepaya,Mawatha,, Colombo, Sri Lanka. anujaa@sltnet.lk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport emergency health service EMTREE MEDICAL INDEX TERMS article coronary care unit health care delivery health care personnel human intensive care medical decision making nursing care patient care patient transport rapid response team respiratory care Sri Lanka EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015226613 PUI L605368520 DOI 10.4038/slja.v23i2.8098 FULL TEXT LINK http://dx.doi.org/10.4038/slja.v23i2.8098 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 254 TITLE 23rd Critical Care Transport Medicine Conference Preview AUTHOR NAMES Newman M. Petersen P. Good N. AUTHOR ADDRESSES (Newman M.; Petersen P.; Good N.) SOURCE Air Medical Journal (2015) 34:1 (26-28). Date of Publication: 1 Jan 2015 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS certification clinical research conference paper headache human hypotension medical education patient care priority journal ultrasound EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160086462 PUI L607895498 DOI 10.1016/j.amj.2014.10.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2014.10.010 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 255 TITLE Natural caesarean delivery ORIGINAL (NON-ENGLISH) TITLE La césarienne naturelle AUTHOR NAMES Benhamou D. AUTHOR ADDRESSES (Benhamou D., dan.benhamou@bct.aphp.fr) Groupe Hospitalier, Université Paris-Sud, Département d'Anesthésie-réanimation, 78, rue du Général-Leclerc, Le Kremlin-Bicêtre cedex, France. CORRESPONDENCE ADDRESS D. Benhamou, Groupe Hospitalier, Université Paris-Sud, Département d'Anesthésie-réanimation, 78, rue du Général-Leclerc, Le Kremlin-Bicêtre cedex, France. SOURCE Anesthesie et Reanimation (2015) 1:4 (313-317). Date of Publication: 2015 ISSN 2352-5819 (electronic) 2352-5800 BOOK PUBLISHER Elsevier Masson s.r.l. ABSTRACT Although the use of postoperative enhanced recovery after caesarean delivery is still incompletely implemented in France today, the concept of natural caesarean delivery is a logical addition in a patient-centred outcome vision of care. The anaesthetist may be seen as playing a minor role in this new step, but his (her) positive and proactive attitude will facilitate implementation. Components of this new concept are really innovative. In the preoperative period, detailed information (aided by written or electronic/video material) and patient's adherence to the process are required. The patient may enter the operating room in a standing position and walking, simplifying intra-hospital transportation and creating an ambiance of reducing invasiveness. In the operating room, while medical care maintains a high degree of safety, monitoring (EKG electrodes, oxygen saturation probe and blood pressure cuff) is positioned differently to facilitate mother-infant contact at birth. The father's presence is highly encouraged. At the time of birth, drapes are lowered (not necessary if transparent drapes are used) and allow parents to directly visualise neonate delivery. The obstetrician only accompanies birth without any traction by placing his (her) hands in the neonate axillas, delivery occurring under the influence of spontaneous uterine contractions which start after uterine incision. Duration of surgery is only slightly altered. Skin-to-skin contact is immediately started and maintained as long as possible. Facilitation in early mother (and father) relationship with the neonate is a well established of skin-to-skin contact, as well as the safety of this approach. The natural caesarean delivery concept is a really innovative approach of care for both healthcare professionals and parents. Implementing such a concept requires both validations by the obstetrical team and appropriate information to the parents in order to alleviate any concern they may have. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cesarean section EMTREE MEDICAL INDEX TERMS anesthesist France health care personnel human kangaroo care medical care mother child relation patient care patient compliance patient transport preoperative period review EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2015072870 PUI L604531056 DOI 10.1016/j.anrea.2015.04.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.anrea.2015.04.002 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 256 TITLE The lethargic diabetic: Cerebral edema in pediatric patients in diabetic ketoacidosis AUTHOR NAMES Gee S.W. AUTHOR ADDRESSES (Gee S.W., Samantha.Gee@nationwidechildrens.org) Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, United States. CORRESPONDENCE ADDRESS S.W. Gee, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, United States. SOURCE Air Medical Journal (2015) 34:2 (109-112). Date of Publication: 2015 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Diabetic ketoacidosis (DKA) is the leading cause of hospitalizations for pediatric patients with diabetes mellitus. The most severe complication of DKA is cerebral edema that may lead to brain herniation. We present a case report that highlights the subclinical presentation of DKA-related cerebral edema in a pediatric patient and review the acute care management of suspected cerebral edema during transport. Diabetes mellitus is a health care problem that has been coined an "epidemic." The estimated incidence of diabetes in the United States is 24.3 per 100,000 children per year; this approximates to 15,000 children being newly diagnosed annually. The observation that children younger than 12 months of age are being diagnosed with new-onset diabetes is also alarming because diabetes is a chronic disease into adulthood and currently is the seventh leading cause of death in the US.1 There are 2 distinct classifications of diabetes. Type 1 diabetes describes those patients who are inherently insulin deficient and must rely on lipolysis for fuel needs during times of stress. Most patients with type 1 diabetes present during childhood. Type 2 diabetes is characterized by variable degrees of peripheral insulin resistance, but these patients have inadequate cellular glucose uptake during times of stress. Patients with type 2 diabetes classically present later in life although the problem of youth obesity has been associated with earlier diagnoses during adolescence. The most serious complication of diabetes is diabetic ketoacidosis (DKA). In children with diabetes, DKA is the leading cause of hospitalizations, morbidity, and mortality.2,3 A single episode of DKA can place a pediatric patient at risk for developing cerebral edema with subsequent brain herniation. The occurrence of cerebral edema is rare, approximately 0.5% to 1% of all pediatric DKA cases. However, there is an estimated 40% to 90% mortality from DKA-related cerebral edema.2-6 Risk factors for cerebral edema include first presentation, younger age, aggressive fluid administration, administration of sodium bicarbonate or bolus insulin doses, and precipitous drops in blood glucose (> 100 mg/dL/h). Additional metabolic abnormalities at presentation, namely an elevated blood urea nitrogen and low partial pressure of arterial CO2, are also considered to be risk factors.7,8 Medical management can be lifesaving when initiated at the time of presentation and during transport. We present a case of a 4-year-old patient with previously diagnosed type 1 diabetes who presented at a local emergency department (ED) with severe DKA. The management of this child's acidosis was complicated by the clinical presentation of cerebral edema, which was later confirmed by computed tomographic imaging of the brain upon arrival at our institution. The goal is to encourage a high index of suspicion for the presence of cerebral edema and to provide clinicians a review of the management strategies for cerebral edema during the transport process. EMTREE DRUG INDEX TERMS bicarbonate (endogenous compound) creatinine (endogenous compound) glucose (endogenous compound) infusion fluid (intravenous drug administration) insulin (drug therapy) mannitol (intravenous drug administration) sodium (endogenous compound) sodium chloride (intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain edema (complication) diabetic ketoacidosis (drug therapy, drug therapy) emergency care patient transport EMTREE MEDICAL INDEX TERMS acid base balance article bicarbonate blood level case report child computer assisted tomography creatinine blood level drug dose reduction dyspnea fluid resuscitation fluid therapy glucose blood level gray matter helicopter human insulin dependent diabetes mellitus intensive care intensive care unit male pH preschool child priority journal sodium blood level urea nitrogen blood level vomiting white matter CAS REGISTRY NUMBERS bicarbonate (144-55-8, 71-52-3) creatinine (19230-81-0, 60-27-5) glucose (50-99-7, 84778-64-3) insulin (9004-10-8) mannitol (69-65-8, 87-78-5) sodium (7440-23-5) sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Drug Literature Index (37) Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015159369 MEDLINE PMID 25733118 (http://www.ncbi.nlm.nih.gov/pubmed/25733118) PUI L605006448 DOI 10.1016/j.amj.2014.10.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2014.10.009 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 257 TITLE Doctors' and nurses' views and experience of transferring patients from critical care home to die: A qualitative exploratory study AUTHOR NAMES Coombs M. Long-Sutehall T. Darlington A.-S. Richardson A. AUTHOR ADDRESSES (Coombs M.) Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand. (Coombs M.; Long-Sutehall T., T.Long@soton.ac.uk; Darlington A.-S.; Richardson A.) Faculty of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom. CORRESPONDENCE ADDRESS T. Long-Sutehall, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, United Kingdom. SOURCE Palliative Medicine (2015) 29:4 (354-362). Date of Publication: 25 Apr 2015 ISSN 1477-030X (electronic) 0269-2163 BOOK PUBLISHER SAGE Publications Ltd, info@sagepub.co.uk ABSTRACT Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) dying homebound patient intensive care nurse attitude personal experience physician attitude EMTREE MEDICAL INDEX TERMS article critically ill patient general practitioner human information processing palliative therapy qualitative research terminal care EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015866953 MEDLINE PMID 25519147 (http://www.ncbi.nlm.nih.gov/pubmed/25519147) PUI L603444748 DOI 10.1177/0269216314560208 FULL TEXT LINK http://dx.doi.org/10.1177/0269216314560208 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 258 TITLE A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy AUTHOR NAMES Akula V.P. Joe P. Thusu K. Davis A.S. Tamaresis J.S. Kim S. Shimotake T.K. Butler S. Honold J. Kuzniewicz M. DeSandre G. Bennett M. Gould J. Wallenstein M.B. Van Meurs K. AUTHOR ADDRESSES (Akula V.P.; Gould J.; Wallenstein M.B.; Van Meurs K.) Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, United States. (Joe P.) Division of Neonatology, Children's Hospital and Research Center, Oakland, United States. (Thusu K.) Division of Neonatology, Children's Hospital Central California, Madera, United States. (Davis A.S.) Pediatrix Medical Group, San Jose, United States. (Tamaresis J.S.) Department of Pediatrics, Stanford University School of Medicine, Palo Alto, United States. (Kim S.) Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, United States. (Shimotake T.K.) Division of Neonatology, University of California San Francisco (UCSF) Medical Center, San Francisco, United States. (Butler S.) Division of Neonatology, Sutter Medical Center, Sacramento, United States. (Honold J.) Division of Neonatology, Rady Children's Hospital, San Diego, United States. (Kuzniewicz M.) Division of Neonatology, Kaiser Permanente, Oakland, United States. (DeSandre G.) Division of Neonatology, Santa Clara Valley Medical Center, San Jose, United States. (Bennett M.; Gould J.) California Perinatal Quality Care Collaborative (CPQCC), Palo Alto, United States. SOURCE Journal of Pediatrics (2015) 166:4 (856-861.e2). Date of Publication: 2015 ISSN 1097-6833 (electronic) 0022-3476 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective To determine if temperature regulation is improved during neonatal transport using a servo-regulated cooling device when compared with standard practice. Study design We performed a multicenter, randomized, nonmasked clinical trial in newborns with neonatal encephalopathy cooled during transport to 9 neonatal intensive care units in California. Newborns who met institutional criteria for therapeutic hypothermia were randomly assigned to receive cooling according to usual center practices vs device servo-regulated cooling. The primary outcome was the percentage of temperatures in target range (33°-34°C) during transport. Secondary outcomes included percentage of newborns reaching target temperature any time during transport, time to target temperature, and percentage of newborns in target range 1 hour after cooling initiation. Results One hundred newborns were enrolled: 49 to control arm and 51 to device arm. Baseline demographics did not differ with the exception of cord pH. For each subject, the percentage of temperatures in the target range was calculated. Infants cooled using the device had a higher percentage of temperatures in target range compared with control infants (median 73% [IQR 17-88] vs 0% [IQR 0-52], P < .001). More subjects reached target temperature during transport using the servo-regulated device (80% vs 49%, P <.001), and in a shorter time period (44 ± 31 minutes vs 63 ± 37 minutes, P = .04). Device-cooled infants reached target temperature by 1 hour with greater frequency than control infants (71% vs 20%, P < .001). Conclusions Cooling using a servo-regulated device provides more predictable temperature management during neonatal transport than does usual care for outborn newborns with neonatal encephalopathy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain disease induced hypothermia neonatal encephalopathy newborn disease patient transport EMTREE MEDICAL INDEX TERMS adult article artificial ventilation assisted ventilation controlled study extracorporeal oxygenation female human intensive care unit intention to treat analysis male multicenter study newborn newborn mortality priority journal rectal temperature thermoregulation time to treatment EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015753369 MEDLINE PMID 25684087 (http://www.ncbi.nlm.nih.gov/pubmed/25684087) PUI L602311277 DOI 10.1016/j.jpeds.2014.12.061 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpeds.2014.12.061 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 259 TITLE Post operative complications in a dedicated elective orthopaedic hospital: Transfers requiring specialist critical care support AUTHOR NAMES Dawson P. Daly A. Lui D. Butler J.S. Cashman J. AUTHOR ADDRESSES (Dawson P., peterhughdawson@gmail.com; Daly A.; Lui D.; Butler J.S.; Cashman J.) Department of Trauma and Orthopaedics, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. CORRESPONDENCE ADDRESS P. Dawson, Department of Trauma and Orthopaedics, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland. SOURCE Irish Medical Journal (2015) 108:5. Date of Publication: 1 May 2015 ISSN 0332-3102 (electronic) 0332-3102 BOOK PUBLISHER Irish Medical Association ABSTRACT We aim to report our experience with out of hospital transfers for postoperative complications in a stand-alone elective orthopaedic hospital. We aim to describe the cohort of patients transferred, the rate of transfer and assess the risk factors for transfer. Patients were identified who were transferred out of the hospital to another acute hospital for management of non-routine medical problems. Patient data was collected relating to age, BMI, ASA, type of surgery, nature of the complication, timing and the outcome of transfer. In 2012, 2,853 inpatient surgical procedures were carried out, 51 patients (1.8%) developed a postoperative complication that required out of hospital transfer. Mean age of patients transferred was 67 (12-86) years, mean age of the overall case mix 58 years (0-96) (p=0.01). 37.7% of the overall case mix of surgeries was made up of primary hip and knee arthroplasty procedures, these patients made up 63.7% of patients transferred out (p=0.001). Mean BMI recorded was 31.7 (22-48) compared to the mean BMI of the total arthroplasty case mix of 28.8 (20-44) (p=0.02). 59% of all patients at our institution were ASA category II or III. 76% of patients transferred were ASA category II or III (p=0.005). We can conclude that patients requiring transfer are typically older. Arthroplasty patients are more likely to require transfer than patients undergoing other orthopaedic procedures. Among the arthroplasty cohort transferred patients will typically have a higher BMI than average. Patients with ASA category II or III make up nearly three quarters of those patients transferred. The mean age of patients transferred is typically older by 9 years. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care orthopedics postoperative complication EMTREE MEDICAL INDEX TERMS adolescent adult aged article body mass child follow up hip arthroplasty human knee arthroplasty major clinical study medical record review middle aged patient transport retrospective study risk factor treatment outcome very elderly EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Orthopedic Surgery (33) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015050741 MEDLINE PMID 26062246 (http://www.ncbi.nlm.nih.gov/pubmed/26062246) PUI L604420165 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 260 TITLE Critical care nurses' experiences of helicopter transfers AUTHOR NAMES Senften J. Engström Å. AUTHOR ADDRESSES (Senften J.) J Senften, RN, CCN, MSc, Critical Care Nurse, Intensive Care Unit, Gällivare Hospital, Gällivare, Sweden (Engström Å.) SOURCE Nursing in critical care (2015) 20:1 (25-33). Date of Publication: 1 Jan 2015 ISSN 1478-5153 (electronic) ABSTRACT BACKGROUND: Intensive care is conducted in intensive care units (ICUs), and also during the transportation of critically ill people.AIM: The aim of the study was to describe critical care nurses' (CCNs) experiences of nursing critically ill patients during helicopter transport.PARTICIPANTS: Seven CCNs, five women and two men participated in this study.DESIGN: Seven participants from two centres in Sweden were recruited. The design uses an inductive, qualitative approach with data collected by means of qualitative interviews with seven CCNs.METHODS: The interviews were transcribed verbatim and subjected to qualitative thematic content analysis.RESULTS: The analysis resulted in one theme which is safe nursing care, but sometimes feeling afraid and six categories as follows: experiencing the care environment as an ICU with limited space; a loud environment complicates communication; planning and checking to minimize risks; experience and good co-operation; facing the dilemma of allowing relatives to accompany the patient or not; feeling the patient's and their own fear.CONCLUSION: CCNs plan for the transportation and control of patients to improve patient safety, but can sometimes feel afraid. Good co-operation is necessary.RELEVANCE TO CLINICAL PRACTICE: The possibilities for CCNs to provide effective nursing care in helicopters are good, although in some cases limited by the environmental conditions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical competence organization and management procedures EMTREE MEDICAL INDEX TERMS air medical transport critical illness female human intensive care intensive care nursing intensive care unit interview male nursing patient transport qualitative research Sweden LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24238003 (http://www.ncbi.nlm.nih.gov/pubmed/24238003) PUI L615282077 DOI 10.1111/nicc.12063 FULL TEXT LINK http://dx.doi.org/10.1111/nicc.12063 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 261 TITLE Acinetobacter Baumannii: Trends in antimicrobial resistance after relocation of an intensive care unit in Tunisia AUTHOR NAMES Koubaji S. Kamoun S. Ben Souissi A. Haddad F. Ben Aicha Y. Mebazaa M.S. AUTHOR ADDRESSES (Koubaji S.; Kamoun S.; Ben Souissi A.; Haddad F.; Ben Aicha Y.; Mebazaa M.S.) Mongi Slim University Hospital La Marsa, Anesthesiology and ICU Department, Sidi Daoued, Tunisia. CORRESPONDENCE ADDRESS S. Koubaji, Mongi Slim University Hospital La Marsa, Anesthesiology and ICU Department, Sidi Daoued, Tunisia. SOURCE Intensive Care Medicine Experimental (2015) 3 Supplement 1 Article Number: A135. Date of Publication: 2015 ISSN 2197-425X (electronic) BOOK PUBLISHER SpringerOpen EMTREE DRUG INDEX TERMS amikacin carbapenem colistin (drug combination) fosfomycin imipenem (drug combination) quinolone rifampicin (drug combination) tigecycline (drug combination) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter infection (drug resistance) antibiotic resistance EMTREE MEDICAL INDEX TERMS antibiotic sensitivity antibiotic therapy assisted ventilation catheterization hospital hygiene hospital infection human intensive care unit major clinical study mortality rate note prevalence priority journal retrospective study risk factor septic shock treatment outcome Tunisia CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) carbapenem (83200-96-8) colistin (1066-17-7, 1264-72-8) fosfomycin (23155-02-4) imipenem (64221-86-9) rifampicin (13292-46-1) tigecycline (220620-09-7) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160632857 PUI L611852415 DOI 10.1186/2197-425X-3-S1-A135 FULL TEXT LINK http://dx.doi.org/10.1186/2197-425X-3-S1-A135 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 262 TITLE Outcome is associated with type of neurologic disease during specialized transport of children AUTHOR NAMES Newmyer R. Kuch B. Fink E. Kochanek P. Orr R. AUTHOR ADDRESSES (Newmyer R.) Children's Hospital of Pittsburgh of UPMC, Pittsburgh, United States. (Kuch B.; Fink E.; Orr R.) Children's Hospital of Pittsburgh, Pittsburgh, United States. (Kochanek P.) Safar Center for Resuscitation Research, Pittsburgh, United States. CORRESPONDENCE ADDRESS R. Newmyer, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1498). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Children with neurologic disease represent ∼20% of interfacility transports by our pediatric transport team but few data exist that describe outcomes. We aim to compare the neurocritical care provided and outcomes of children on transport by type of neurologic disease. Methods: Children ages 1 mo-21 y requiring interfacility transport by our team during 1997-2013 (n=1,991) were grouped by neurologic disease: seizure (1, n=1,404), infection (2, n=243), anatomic abnormality (3, n=154), anoxia (4, n=106), and stroke (5, n=84). Epochs began in 1997, 2003, and 2008. Multivariate regressions were created for intensive care unit (ICU) admission and hospital mortality using pediatric risk of mortality (PRISM) score, and patient and transport variables. Results: Overall, 37% children were comatose (initial GCS<9), 37% were intubated, 51% required ICU admission, and 5.6% died. Group 4 were most frequently in coma (93% with initial Glasgow Coma Scale < 9) (p<0.05). More children in Groups 3 and 4 were admitted to the ICU (82% and 75%) and died (16% and 76%) (p<0.05). Interventions were performed in 35% overall including peripheral venous access (PIV) (10%), antiseizure medication (6%), intubation (6%), and intracranial hypertension treatment (2%). Group 4 required vasoactive medications most frequently (47%) and had most adverse events compared to the other diseases (28% vs. 6% overall) (p<0.05). Older age, higher PRISM, more recent epoch, intubation, fluid bolus, antiepileptics, and longer transport time were associated with ICU admission (p<0.05). Placement of a PIV, higher PRISM, oldest epoch, and vasoactive medications were associated with mortality while Group 1 and longer bedside time were associated with survival (p<0.05). Conclusions: Children requiring interfacility transport require specialized neurocritical care that varies by disease and severity. Our long term objective is to use these findings to inform quality improvement of treatment protocols that optimize outcomes. EMTREE DRUG INDEX TERMS recombinant erythropoietin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child human intensive care neurologic disease EMTREE MEDICAL INDEX TERMS anoxia cerebrovascular accident coma diseases drug therapy Glasgow coma scale infection intensive care unit intracranial hypertension intubation learning liquid mortality patient risk seizure survival total quality management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71707283 DOI 10.1097/01.ccm.0000458073.17365.3f FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000458073.17365.3f COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 263 TITLE Predicting PICU admission and team composition from transport risk assessment in pediatrics score AUTHOR NAMES Esperanza M. Darcy J. Keizer C. Schneider J. AUTHOR ADDRESSES (Keizer C.) (Esperanza M.; Darcy J.; Schneider J.) Cohen Children's Medical Center, New Hyde Park, United States. CORRESPONDENCE ADDRESS M. Esperanza, Cohen Children's Medical Center, New Hyde Park, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1382). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Emergency room providers are uncomfortable with the triage and care of pediatric patients. The accurate and timely disposition of pediatric transports rely on the accuracy of their assessments. The use of a scoring system may facilitate timely and appropriate decision making by medical control. We hypothesize that the Transport Risk Assessment in Pediatrics Score (TRAP) at the time of transport intake may be utilized to predict the admission location, transport team composition, and required urgency of response. Methods: A retrospective chart review was performed on patients transported into a tertiary children's hospital from May to July 2013. Patient demographics, clinical information, and transport data were collected. Using the data provided at the time of referral, the TRAP scores were calculated by the investigators. Results were analyzed using Mood's Median Test and logistic regression analysis. Results: A total of 388 transports were analyzed. Median age is 8 years (interquartile range [IQR] 3, 13). 61% (n=235) were males. The referring diagnoses are as follows: gastrointestinal (26%), neurologic (18%), trauma-related (17%) and respiratory (11%). Overall median TRAP score is 1 (IQR 0,2). The TRAP scores by receiving location were statistically significant, with those requiring critical care higher than those less severely ill; (PICU-3 [IQR 1,5]; Medical Floor-1 [IQR 0,2]; ED-1[IQR 0,2] (p value < 0.001). The TRAP scores by team composition were also statistically significantly higher for those with a full team including an ICU physician and nurse; EMS-0[IQR 0,2]; EMS/RN-1.5[IQR 1,3]; EMS/RN/MD/RT 6 [IQR 3,7] (p value < 0.001). The TRAP scores by transport category (emergent -3 [IQR 1,7]; urgent -2 [IQR 0.2]; non-emergent -2 [IQR 0,2]) were not statistically significant (p value = 0.087). Regression analysis of TRAP scores and likelihood of PICU admission had a p value of 0.000 and an R-squared adjusted value of 17.1%. Conclusions: The TRAP score at the time of the intake can predict the likelihood to require ICU admission and the use of an advanced practice transport team. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care pediatrics risk assessment EMTREE MEDICAL INDEX TERMS decision making diagnosis emergency health service emergency ward human injury learning logistic regression analysis male median test medical record review mood non implantable urine incontinence electrical stimulator nurse patient pediatric hospital physician regression analysis scoring system statistical significance LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71706799 DOI 10.1097/01.ccm.0000457589.31339.5b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000457589.31339.5b COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 264 TITLE Improved oxygenation after critical care transport in patients with hypoxemic respiratory failure AUTHOR NAMES Wilcox S. Saia M. Waden H. Gates J. McGahn S. Cocchi M. Genthon A. Richards J. AUTHOR ADDRESSES (Saia M.) (Wilcox S.) Massachusetts General Hospital, Boston, United States. (Waden H.) Grafton, United States. (Gates J.) Brigham and Women's Hospital, Brookline, United States. (McGahn S.) Boston MedFlight, Bedford, United States. (Cocchi M.; Richards J.) Beth Israel Deaconess Medical Center, Boston, United States. (Genthon A.) Brigham and Women's Hospital, Boston, United States. CORRESPONDENCE ADDRESS S. Wilcox, Massachusetts General Hospital, Boston, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1532-A1533). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Critically ill patients, especially hypoxemic patients, have a high rate of deterioration in vital signs when transported. Although the benefits of transporting patients with respiratory failure to ECMO centers are known, little is known about the risk attributable to transport. We designed this physiologic retrospective study to measure the rate and magnitude of changes in oxygenation that occur during and after a transport by a critical care transport team for patients with severe hypoxemic respiratory failure. Methods: We analyzed oxygenation data for patients with severe hypoxemic respiratory failure with a FiO2 > 50%, transported from referring hospitals to tertiary care hospitals from October 2009 to May 2011. The primary outcome was the change in PaO2/FiO2 ratio from the sending to the receiving hospital. We also compared the PaO2 and SpO2 before and after transport. We compared initial SpO2 measurements with the lowest SpO2 en route. A subgroup analysis of patients from each division of oxygenation, 100-90%, 89-80%, and < 80%, prior to transport, to determine the incidence of desaturation in each group. Results: We identified 161 charts for review. The primary outcome, the mean change in PaO2/FiO2 ratio from the sending to the receiving hospital, was an increase of 22.56mmHg [CI 8.56 - 36.54, p= 0.012]. The mean change in PaO2 was an increase in 29.93mmHg [CI 14.71 - 39.14, p= 0.0004]. The mean SpO2 was not significantly increased at 0.69% [CI -0.38 - 1.76, p= 0.92]. Despite the improvement in the PaO2/ FiO2 ratio and the stable saturation on arrival at the tertiary hospitals, 35.8% of patients experienced a desaturation event in transport, and 11.9% had a critical desaturation. Patients with initial saturations of < 80% were the only group to show a decrease in PaO2 on arrival, while all other groups had an increase in PaO2. Conclusions: In this cohort of critically ill patients with severe hypoxemic respiratory failure, PaO2/FiO2 ratios and PaO2 ratios increased after transport by a CCT team, despite 35% of patients having a desaturation episode in transit. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care oxygenation patient respiratory failure EMTREE MEDICAL INDEX TERMS critically ill patient deterioration fatty acid desaturation hospital learning retrospective study risk tertiary care center vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71707423 DOI 10.1097/01.ccm.0000458213.66197.6e FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000458213.66197.6e COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 265 TITLE Outcomes of delayed rrt activation in patients transferring to the ICU AUTHOR NAMES Barwise A. Thongprayoon C. Herasevich V. Pickering B. Gajic O. Jensen J. AUTHOR ADDRESSES (Barwise A.; Thongprayoon C.; Herasevich V.; Jensen J.) Mayo Clinic, Rochester, United States. (Pickering B.) Mayo Clinic - College of Medicine, Rochester, United States. (Gajic O.) Mayo Graduate School of Medicine(Rochester), Rochester, United States. CORRESPONDENCE ADDRESS A. Barwise, Mayo Clinic, Rochester, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1417). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: The Rapid Response Team (RRT) was designed to reduce serious adverse events such as cardiac arrest on the floor by activating a “critical care team” to the bedside of the deteriorating patient. To date there has been mixed evidence about the effectiveness of rapid response teams in decreasing patient mortality and in reducing adverse outcomes. To be most effective, the RRT should be activated early in the course of physiological deterioration. This study examines the effect of delay on RRT activation on hospital mortality and morbidity. It was hypothesized that delay in RRT activation would result in worse patient outcomes. Methods: A retrospective cohort study of all the Rapid Response Team (RRT) activations taking place between January 2012 and December 2012 was performed in a tertiary academic center. The subjects were patients admitted to the ICU following a RRT activation. Data was compared between those patients who had a timely RRT activation (60 minutes), after adjustment for patient characteristics using multivariate Cox proportional regression analysis. The primary outcome was 30-Day mortality after RRT activation. The secondary outcomes were hospital and ICU length of stay, mechanical ventilator and vasopressor use in ICU. Results: Of 1120 patients who required ICU admission after RRT call, 698 (62%) had >60 minute delay in RRT activation. Patients who experienced delay in RRT activation after meeting physiologic RRT criteria had increased mortality (adjusted hazard ratio 1.5 (95% 1.05-2.2): p=0.02. Mortality was positively correlated with increased time in hours from first abnormal vital sign to RRT activation (adjusted Hazards Ratio 1.03) (95% 1.01-1.04): p=0.001. Patients with delayed activation had increased ICU length of stay, p=0.004, increased ventilator use, p= 0.04 and vasopressor use, p < 0.001. Conclusions:Delayed RRT activation occurred frequently and was independently associated with increased mortality and ICU resource utilization. EMTREE DRUG INDEX TERMS hypertensive factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient EMTREE MEDICAL INDEX TERMS adverse outcome cohort analysis deterioration hazard hazard ratio heart arrest hospital learning length of stay mechanical ventilator morbidity mortality rapid response team regression analysis ventilator vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71706940 DOI 10.1097/01.ccm.0000457730.99332.4f FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000457730.99332.4f COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 266 TITLE Comparing the monitoring of patients transferred from a critical care unit to hospital wards at after-hours with day transfers: an exploratory, prospective cohort study AUTHOR NAMES Wood S.D. Coster S. Norman I. AUTHOR ADDRESSES (Wood S.D.; Coster S.; Norman I.) Cardiff University Hospital Trust, UK SOURCE Journal of advanced nursing (2014) 70:12 (2757-2766). Date of Publication: 1 Dec 2014 ISSN 1365-2648 (electronic) ABSTRACT AIMS: To investigate possible factors related to patient monitoring to explain the higher mortality rates associated with after-hours transfers compared with daytime transfers from critical care units to the wards.BACKGROUND: International research suggests that patients transferred from critical care units after-hours have a higher mortality rate than transfers during daytime, although the reasons remain unknown.DESIGN: A prospective exploratory study.METHODS: Twenty-nine patients transferred from a UK critical care unit to a ward within the same hospital after-hours for 10 weeks beginning April 2009 were compared with 29 transfers during daytime hours matched on potentially confounding characteristics. UK Critical Care Unit transfer guidelines have remained unchanged since data collection. Outcomes were as follows: (i) frequency of nursing observations; (ii) time periods from transfer to first medical review; (iii) time period from transfer to first clinical observations; (iv) frequency of transfer to an inappropriate ward; (v) delayed transfers from Critical Care Unit to ward.RESULTS: Using Wilcoxon's Rank test (two tail) to compare paired data from the matched groups, observations were recorded significantly less frequently within the first 12 hours for after-hours transfers. Time from transfer to first clinical observations was significantly longer for after-hour transfer patients. The delay from when the patient was ready for ward care and actual transfer was also longer for the after-hours transfer group.CONCLUSIONS: Surveillance differences, including time to the first set of observations and frequency of observations in the first 12 hours, are potential factors that may explain the differential mortality associated with after-hours transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mortality statistics and numerical data EMTREE MEDICAL INDEX TERMS adolescent adult aged cohort analysis comparative study female health care delivery human intensive care intensive care unit male middle aged patient transport physiologic monitoring prospective study time United Kingdom very elderly LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24702103 (http://www.ncbi.nlm.nih.gov/pubmed/24702103) PUI L609225299 DOI 10.1111/jan.12410 FULL TEXT LINK http://dx.doi.org/10.1111/jan.12410 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 267 TITLE Shock index to assess outcomes on pediatric interfacility transport AUTHOR NAMES Jennings R. Felmet K. Carcillo J. Orr R. Kuch B. Fink E. AUTHOR ADDRESSES (Jennings R.) University of Pittsburgh School of Medicine, Pittsburgh, United States. (Felmet K.; Carcillo J.; Orr R.; Kuch B.; Fink E.) Children's Hospital of Pittsburgh, Pittsburgh, United States. CORRESPONDENCE ADDRESS R. Jennings, University of Pittsburgh School of Medicine, Pittsburgh, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1384). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Shock Index (SI), the ratio of heart rate to systolic blood pressure, is useful in assessing prehospital mortality risk and guiding interventions in adults. Increased SI was associated with mortality among children with sepsis in intensive care units (ICU). In children, adherence to treatment guidelines decreased SI and improved outcomes prior to interfacility transport, but the effect of transport interventions is unknown. Methods: We reviewed the Children's Hospital of Pittsburgh (CHP) transport database of children aged 1 mo - 21 y transported to CHP from another facility with at least 2 sets of vital signs recorded. Subjects were divided into 4 age groups: group 1 (< 1 y), group 2 (1-3 y), group 3 (4-11 y), and group 4 (≥ 12 y). Suspected sepsis was defined based on referring facility classification and diagnosed sepsis was defined based on discharge diagnosis. The primary outcomes, ICU admission and survival, were evaluated with multivariate logistic regression analysis to determine associated variables. Results:We studied 3,519 children (56% male, age 75 ± 65 mos). Overall, 1,819 (52%) were admitted to an ICU, 1,572 (45%) had suspected sepsis, and 493 (14%) had diagnosed sepsis. Initial transport SI decreased with age: group 1: 1.45 ± 0.42 (mean ± standard deviation), group 2: 1.36 ± 0.32, group 3: 1.20 ± 0.34, group 4: 1.00 ± 0.32 (p<0.001). Change in initial and final transport SI was not associated with survival (p=0.647). Increased initial SI, age > 1 y, suspected and confirmed sepsis, and longer transport times were independently associated with ICU admission while increased initial SI and longer transport times were associated with mortality (p<0.05). Conclusions:Increased initial SI may be a good indicator for need for ICU resources and in identifying children at increased risk of mortality requiring interfacility transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care shock EMTREE MEDICAL INDEX TERMS adult child classification data base diagnosis groups by age heart rate human intensive care unit learning male mortality multivariate logistic regression analysis patient compliance pediatric hospital risk sepsis survival systolic blood pressure vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71706807 DOI 10.1097/01.ccm.0000457597.54209.1d FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000457597.54209.1d COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 268 TITLE STRESS (subjective transfer risk evaluation severity score) accurately predicts ICU readmission AUTHOR NAMES Pisa M. Collins T. Saucier J. Holena D. Sicoutris C. Reilly P. Kohl B. Martin N. AUTHOR ADDRESSES (Pisa M.; Collins T.; Saucier J.; Holena D.; Sicoutris C.; Reilly P.; Martin N.) Hospital of The University of Pennsylvania, Philadelphia, United States. (Kohl B.) University of Pennsylvania, Philadelphia, United States. CORRESPONDENCE ADDRESS M. Pisa, Hospital of The University of Pennsylvania, Philadelphia, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1553). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Re-admission to an ICU is associated with increased morbidity & mortality. Effectively designing a tool that accurately identifies patients at high risk for readmission can aid in the design of subsequent directed interventions. We hypothesize that practitioners in a surgical ICU using the Subjective Transfer Risk Evaluation Severity Score (STRESS) can accurately identify high risk patients. Subsequent directed interventions can be optimized by assessing outcomes of the STRESS stratification. Methods: STRESS was implemented at our large, urban, university-based medical center in October 2013. The discharging ICU Nurse Practitioner assigned a risk of adverse event on a subjective 3 point scale (low, intermediate, and high) to all patients at ICU discharge. All subsequent ICU re-admissions were noted. The correlation of readmission with initial STRESS was measured. Further, STRESS was used to stratify timing of a post-ICU discharge follow-up by the critical care team. Efficacy of the timing of follow-up was measured by noting the temporal relationship between ICU readmission and follow-up visit. Results: During the initial 9 months of STRESS implementation, there were 1396 discharges from the ICU; these included 443, 527, 222, and 204 patients for STRESS of low, intermediate, and high, and no score, respectively. No scores included transfers to other institutions, deaths, discharges home, and transfers to a non-surgical service. There were 54 re-admissions, with rates of 2.7, 4.7, and 7.7% for STRESS low, intermediate, and high, respectively, p<0.01. Four of the 17 high STRESS re-admissions were re-admitted prior to the follow-up visit. Conclusions: STRESS accurately predicts the potential for ICU readmission. This finding should be used to more efficiently direct post ICU interventions to optimize outcomes in high risk patients. Timing of follow-up visits should be adjusted based on these findings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital readmission human intensive care risk EMTREE MEDICAL INDEX TERMS death follow up high risk patient learning morbidity mortality nurse practitioner patient physician stratification surgery university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71707510 DOI 10.1097/01.ccm.0000458300.77731.43 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000458300.77731.43 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 269 TITLE Medical readiness for transfer does not predict actual picu length of stay AUTHOR NAMES Ambati S.R. Brandwein A. Bredin G. Cohn M. Falco J. Hong J. Sweberg T. Schneider J. AUTHOR ADDRESSES (Ambati S.R.; Cohn M.; Hong J.; Sweberg T.) Cohen Children's Medical Center of New York, New Hyde Park, United States. (Brandwein A.) Cohen Children's Medical Center of New York, New York, United States. (Bredin G.) Hospital for Sick Children, Toronto, Canada. (Falco J.) Mercy Children's Hospital and Clinics, Des Moines, United States. (Schneider J.) Cohen's Children's Medical Center, Hyde Park, United States. CORRESPONDENCE ADDRESS S.R. Ambati, Cohen Children's Medical Center of New York, New Hyde Park, United States. SOURCE Critical Care Medicine (2014) 42:12 SUPPL. 1 (A1569). Date of Publication: December 2014 CONFERENCE NAME Critical Care Congress 2015 CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2015-01-17 to 2015-01-21 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Learning Objectives: Delays in patient transfer from the Pediatric Intensive Care Unit (PICU) can result in significant health care costs. PICU services are expensive and delayed discharges affect the efficiency of the PICU team. The purpose of our study was to determine if there are any significant delays in transferring patients out of the PICU. We hypothesized that there would be a significant difference between the medical length of stay (MLOS) and the actual LOS (ALOS) for patient hospitalized in the PICU. Methods: This was a single-center, prospective, observational study of all children admitted to the PICU over a 4 month period. For each patient we recorded the time of admission and discharge from the PICU. Additionally, we documented the time of medical discharge (when the PICU team determined that the patient no longer needed ICU care). We then calculated the MLOS and the ALOS for each patient. Final disposition was recorded as floor, home or extended care facility. Results: A total of 400 patients were included. Patients were classified into subgroups based upon diagnostic category. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Median MLOS was significantly shorter than ALOS (1.82 vs 2.55 days, p<0.001). Neurosurgical patients had a shorter MLOS-ALOS gap when compared to the rest of the patients (0.2 vs 0.3 days, p=0.048), and general surgical patients had a larger gap (0.77 vs 0.3, p=0.038). Patients transferred to the floor had a longer gap than those patients discharged directly to home (0.31 vs 0.23 days, p=0.015). Conclusions: Our results suggest that delays in patient transfer from the PICU are substantial. The reasons are likely multifactorial ranging from issues such as hospital bed availability to medical insurance approval. This gap in discharge time can potentially result in increasing hospital costs and patient morbidity. Further studies should be aimed at evaluating possible mechanisms to improve patient throughput in the PICU and thus minimizing delays in discharge. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care length of stay EMTREE MEDICAL INDEX TERMS child diagnosis health care cost health insurance hospital bed hospital cost hospital patient human intensive care unit Kruskal Wallis test learning morbidity neurosurgery nursing home observational study patient patient transport surgical patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71707576 DOI 10.1097/01.ccm.0000458366.35973.36 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000458366.35973.36 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 270 TITLE Parents' experience of the transition with their child from a pediatric intensive care unit (PICU) to the hospital ward: searching for comfort across transitions AUTHOR NAMES Berube K.M. Fothergill-Bourbonnais F. Thomas M. Moreau D. AUTHOR ADDRESSES (Berube K.M., kristyn.berube@gmail.com) MacEwan University, Edmonton, AB, Canada (Fothergill-Bourbonnais F.; Moreau D.) University of Ottawa, Ottawa, ON, Canada (Thomas M.) Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada SOURCE Journal of pediatric nursing (2014) 29:6 (586-595). Date of Publication: 1 Nov 2014 ISSN 1532-8449 (electronic) ABSTRACT Parents of children in pediatric intensive care units (PICUs) have many needs and stressors, but research has yet to examine their experience of their child's transfer from PICU to the hospital ward. Ten parents were interviewed following transfer from PICU to a hospital ward at a children's hospital in Canada. Parents' experience involved a search for comfort through transitions. The themes were: 'being a parent with a critically ill child is exhausting', 'being kept in the know', 'feeling supported by others', and 'being transferred'. Findings from this study can help nurses and health professionals working with parents during transitions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport pediatric intensive care unit psychology EMTREE MEDICAL INDEX TERMS adolescent child female human infant male parent preschool child LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25023951 (http://www.ncbi.nlm.nih.gov/pubmed/25023951) PUI L615278074 DOI 10.1016/j.pedn.2014.06.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.pedn.2014.06.001 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 271 TITLE Predictors of intensive care unit (ICU) transfer in hospitalized patients with decompensated cirrhosis AUTHOR NAMES Valentin T. Forde K. Hao D. Reddy K.R. Bahirwani R. AUTHOR ADDRESSES (Valentin T.) Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, United States. (Forde K.; Hao D.; Reddy K.R.; Bahirwani R.) Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, United States. CORRESPONDENCE ADDRESS T. Valentin, Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, United States. SOURCE American Journal of Gastroenterology (2014) 109 SUPPL. 2 (S170). Date of Publication: October 2014 CONFERENCE NAME 79th Annual Scientific Meeting of the American College of Gastroenterology CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2014-10-17 to 2014-10-22 ISSN 0002-9270 BOOK PUBLISHER Nature Publishing Group ABSTRACT Introduction: Patients with end-stage liver disease frequently require intensive care for management of the acute complications of their disease, and the use of emergent life-sustaining interventions such as endotracheal intubation can negatively impact liver transplant candidacy. Understanding that mortality rates are extremely high in critically ill patients with cirrhosis, the aim of this study is to determine predictors of early ICU transfer in order to identify potentially preventable decompensations in patients with advanced liver disease. Methods: Retrospective cohort study of 142 patients with cirrhosis admitted to the Hospital of the University of Pennsylvania and subsequently transferred to the intensive care unit from a medicine floor between January 2007 and March 2012. Logistic regression was performed to determine predictors of ICU transfer within 5 days of the hospital admission date. Results: The median age of our population was 60 years old; 58% were male and 65% were white. Median BMI was 28 kg/m2. Median length of hospital stay was 15 days with 66% of patients transferred to the ICU by hospital day 5. Median MELD scores on the day of admission, and at 72, 48, and 24 hours prior to ICU transfer were 24, 27, 29, and 30, respectively. The median MELD score on the day of ICU transfer was 29. Thirty-seven percent were listed for liver transplant. Six percent of patients had bacteremia, 15% had a documented urinary tract infection, 24% had findings suspicious for pneumonia on chest radiograph, and 11% had spontaneous bacterial peritonitis (SBP). Fifteen percent had a prior history of SBP and only 48% were on appropriate antibiotic prophylaxis. The median serum creatinine on admission was 1.7 mg/dL. Hepatorenal syndrome (HRS) was diagnosed or suspected in 25% of patients, and 29% of the 142 included patients received intravenous albumin. Of those who received intravenous albumin, 47% had HRS. Sixty percent of patients requiring ICU transfer within 5 days of admission had acute kidney injury (AKI). Mean arterial blood pressure and SIRS criteria were not predictive of early ICU transfer in our study. Interestingly, a rise in serum creatinine was associated with a lower incidence of ICU transfer within 5 days of hospital admission (OR 0.72, 95% CI 0.55-0.96). Conclusion: Over half of patients with end-stage liver disease transferred to the ICU had AKI. However a rising creatinine was found to be protective against ICU transfer within 5 days of hospital admission. We hypothesize that increasing awareness of acute kidney injury as a harbinger of poor outcomes in cirrhosis and early aggressive interventions including intravenous albumin administration and cessation of diuretics curtailed the ICU trajectory of these patients. EMTREE DRUG INDEX TERMS albumin creatinine diuretic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American college decompensated liver cirrhosis gastroenterology hospital patient human intensive care unit EMTREE MEDICAL INDEX TERMS acute kidney failure antibiotic prophylaxis bacteremia bacterial peritonitis cohort analysis creatinine blood level critically ill patient end stage liver disease endotracheal intubation hepatorenal syndrome hospital hospital admission hospitalization intensive care liver cirrhosis liver disease liver graft logistic regression analysis male mean arterial pressure mortality patient pneumonia population thorax radiography United States university urinary tract infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71749506 DOI 10.1038/ajg.2014.277 FULL TEXT LINK http://dx.doi.org/10.1038/ajg.2014.277 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 272 TITLE Assessing mortality in the medical intensive care unit of interfacility transferred MICU patients AUTHOR NAMES Patel N. Damaghi N. Stephen M. AUTHOR ADDRESSES (Patel N.; Damaghi N.; Stephen M.) Drexel University, School of Medicine, Philadelphia, United States. CORRESPONDENCE ADDRESS N. Patel, Drexel University, School of Medicine, Philadelphia, United States. SOURCE Chest (2014) 146:4 MEETING ABSTRACT. Date of Publication: October 2014 CONFERENCE NAME CHEST 2014 CONFERENCE LOCATION Austin, TX, United States CONFERENCE DATE 2014-10-25 to 2014-10-30 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT PURPOSE: The purpose of this study was to asses outcomes in patients in an academic MICU that were transferred from an outside hospital MICU. Transferring a patient to a tertiary care MICU is costly and the risks of the transfer may outweigh the benefits. This study assessed mortality of transferred patients. Furthermore, it assesses if patients have met their primary purpose post transfer, whether it was an improvement in their condition, or if the patients received an organ transplantation (Liver/ kidney). METHODS: A retrospective single center study of inter-facility MICU transferred patients within the last year (1/8/2013 to 1/1/2014) was performed. Each patient's records were examined over the course of their ICU stay. Gathered data included APACHE score, demographics, medical condition, and outcomes of their illness RESULTS: The over-all mortality of 48 patients transferred was 39% (19/48) with an average ICU stay of nine days. Sixteen of the 48 patients transferred were due to liver transplant evaluations. Ten out of 16 liver patients died in the hospital or in the ICU with a mortality of 63%. One patient received a liver during their hospital course. The rest of the patients either died, were removed from transplant list, or transferred to hospice care. Mortality rate was 42% of the hepatology patients transferred for specific interventions (banding, TACE, or NAC protocol). Lowest mortality rate were from patients transferred due to respiratory failure (29%) and status epilepticus (16.7%). There were no significant changes in vitals post transfer within 48 hours. CONCLUSIONS: The highest mortality was seen among liver failure patients transferred specifically for a transplant evaluation. Patients with Non-cirrhotic/acute hepatitis, respiratory failure, and status epilepticus had more noticeable better outcomes. CLINICAL IMPLICATIONS: Many patients admitted to the MICU in community hospitals may not have the proper resources or specialized care needed to treat such complicated medical conditions. There are many studies that have recommended structured guidelines for optimal inter-facility transfer of critically ill patients but few have assessed clinical outcomes post transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care unit mortality patient EMTREE MEDICAL INDEX TERMS APACHE community hospital critically ill patient diseases donkey epileptic state hepatitis hospice care hospital kidney liver liver failure liver graft medical record organ transplantation respiratory failure risk tertiary health care transplantation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71780646 DOI 10.1378/chest.1991775 FULL TEXT LINK http://dx.doi.org/10.1378/chest.1991775 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 273 TITLE In-flight blood administration is not associated with pre-flight hemoglobin levels in patients evacuated out of combat by U.S. Air force critical care air transport teams AUTHOR NAMES Mora A. Ervin A. Ganem V. Bebarta V. AUTHOR ADDRESSES (Mora A.; Ervin A.; Ganem V.; Bebarta V.) 59th MDW/ST-USAISR, Fort Sam Houston, United States. CORRESPONDENCE ADDRESS A. Mora, 59th MDW/ST-USAISR, Fort Sam Houston, United States. SOURCE Annals of Emergency Medicine (2014) 64:4 SUPPL. 1 (S70). Date of Publication: October 2014 CONFERENCE NAME American College of Emergency Physicians, ACEP 2014 Research Forum CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-10-27 to 2014-10-28 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: Traumatically injured troops suffer blood loss that often requires blood transfusions. These patients are frequently evacuated via Critical Care Air Transport Teams (CCATT) to hospitals that can provide a higher level of specialized care. There is limited research that describes the use of blood products during flight. Current guidelines recommend a hemoglobin (Hgb) ≥ 9-10 g/dL prior to airevacuation for CCATT. Previously we reported long-term patient outcomes with a Hgb >8 g/dL were similar to a Hgb ≤8 g/dL. Our objective was to compare the inflight adverse clinical events of patients who received blood transfusion during flight with a pre-flight Hgb >8 g/dL versus ≤8 g/dL. Methods: We conducted an IRB-approved retrospective review of CCATT medical records. In-flight hemodynamics, lab values, procedures, vital signs, administration of blood to include units transfused, and incidence of pre-defined adverse events were recorded. Patients were grouped based on a pre-flight Hgb>8 g/dL versus ≤8 g/dL. Adverse clinical events were compared between groups. Patients who have a hemoglobin ≤8 g/dL or received blood products are more likely to have higher acuity of injury; thus, we performed an analysis on a subset of patients (blast-related injuries only) to equalize injuries between groups and adjust for covariates. ANOVAs and Kruskal-Wallis were used for continuous data and chi-square or Fisher's exact tests were performed as appropriate (P values) in this interim analysis. Logistic regressions were conducted to evaluate associations between pre-flight hemoglobin levels, in-flight blood administration, and en route patient status. Results: Of 531 abstracted patients, 368 had a pre-flight Hgb>8 g/dL and 46 had a Hgb≤8 g/dL (others had no Hgb recorded). Demographics were similar. Primary injury was blast-related (68%),17% penetrating, and 9% blunt-related injuries. Hgb >8 g/dL and ≤8 g/dL groups were similar in percent of ventilated patients, lab values, vital signs, and rates of in-flight adverse events (to include coagulopathy, and bleeding). Hgb >8 g/dL group was more likely to have MAP in normal range than ≤8 g/dL (84% versus 67%, P=.01). Patients who received blood were more likely to have clinically significant changes in temperature measures (P=.02), MAP values (P=.0005), and hemodynamics (P<.0001) in both Hgb >8 g/dL and ≤8 g/dL groups. Likewise, in the subset analysis of patients with blast-related injuries only (n=285), patients that received blood inflight were associated with adverse temperature measures (P=.007), poor MAP values (P<.001), and significant changes in hemodynamics (P<.0001) regardless of pre-flight Hgb values. Patients with a pre-flight Hgb >8 g/dL who received blood products were more likely to have clinically significant changes in respiratory (P=.04), abnormal CBC values (P<.0001), and to receive paralytics in-flight (P=.03). Those with a pre-flight Hgb>8 g/dL who did not receive blood in-flight were more likely to be ventilated (P=.03). Conclusion: In combat-injured patients evacuated by CCATT, in-flight adverse events were similar between low and high Hgb groups. Patients who were transfused blood during flight were likely to have adverse hemodynamics regardless of pre-flight hemoglobin levels. EMTREE DRUG INDEX TERMS hemoglobin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air force blood college emergency physician flight hemoglobin blood level human intensive care patient United States EMTREE MEDICAL INDEX TERMS bleeding blood clotting disorder blood transfusion chronic patient Fisher exact test hemodynamics hospital implantable cardioverter defibrillator injury logistic regression analysis medical record procedures spinal spacer statistical significance temperature ventilated patient vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71668116 DOI 10.1016/j.annemergmed.2014.07.219 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2014.07.219 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 274 TITLE Therapeutic hypothermia on transport: providing safe and effective cooling therapy as the link between birth hospital and the neonatal intensive care unit AUTHOR NAMES Schierholz E. AUTHOR ADDRESSES (Schierholz E.) Rady Children's Hospital San Diego, California SOURCE Advances in neonatal care : official journal of the National Association of Neonatal Nurses (2014) 14 Supplement 5 (S24-S31). Date of Publication: 1 Oct 2014 ISSN 1536-0911 (electronic) ABSTRACT Therapeutic hypothermia as a neuroprotective strategy in neonates is an established standard of care for infants with hypoxic-ischemic encephalopathy (HIE) in tertiary care neonatal intensive care units (NICUs). To maximize the neuroprotective effect in infants with HIE, hypothermia is initiated as soon as possible after birth. Many infants who would benefit from therapeutic hypothermia are not born at centers that have intensive care units or offer therapeutic hypothermia and are thus transported to a tertiary care center with a NICU, offering specialty services of therapeutic hypothermia and pediatric neurology. The neonatal transport team plays a significant role in the management of these critically ill infants. Clinical research provides data for safe and effective management of these infants during therapeutic hypothermia in the NICU; however, there are no evidence-based clinical guidelines for management before and during transport. The establishment of evidence-based guidelines for cooling before and during transport will facilitate early recognition of infants who would benefit from therapeutic hypothermia therapy, and decrease delay in initiation of therapy. Careful assessment, monitoring, and intervention by the transport team are critical to provide appropriate care and ensure safe transport of these infants. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS human hypoxic ischemic encephalopathy (therapy) induced hypothermia newborn newborn intensive care patient transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25136751 (http://www.ncbi.nlm.nih.gov/pubmed/25136751) PUI L604356578 DOI 10.1097/ANC.0000000000000121 FULL TEXT LINK http://dx.doi.org/10.1097/ANC.0000000000000121 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 275 TITLE Role of the anaesthetic team in paediatric critical care transfers in the North West of UK AUTHOR NAMES Sefton G. Puppala N.K. Phatak R. Campbell N. AUTHOR ADDRESSES (Sefton G.) Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. (Puppala N.K.; Campbell N.) Anaesthesia, Countess of Chester Hospital NHS Foundation Trust, Chester, United Kingdom. (Phatak R.) Paediatric Intensive Care, North West and North Wales Paediatric Transport Service, Warrington, United Kingdom. CORRESPONDENCE ADDRESS G. Sefton, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. SOURCE Archives of Disease in Childhood (2014) 99 SUPPL. 2 (A338). Date of Publication: October 2014 CONFERENCE NAME 5th Congress of the European Academy of Paediatric Societies, EAPS 2014 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2014-10-17 to 2014-10-21 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background and aims Critically ill children in the UK are stabilised in the district general hospitals (DGH) and transferred to tertiary paediatric intensive care units (PICU). The North West and North Wales Paediatric transport Service (NWTS) is a specialist paediatric retrieval service, which transports sick children and also provides expert advice to DGH staff. However, in the DGHs, anaesthetic teams (AT) provide the initial resuscitation and undertake the time-critical transfers. Countess of Chester hospital (COCH) is one of the 29 DGHs in the north-west. The aim of this project was to review the role of AT in resuscitation, stabilisation and transfer of critically ill children from COCH to PICUs. Methods Retrospective review of patient notes, NWTS- transport documentation and discharge summaries of the patients at tertiary PICUs over 2.5 years between November 2010 to August 2013. Results Of the 43 transfers from COCH 11 transfers were undertaken by AT. Major proportion of interventions were performed by the AT and the NWTS stabilisation time at COCH was similar to that in the rest of the DGHs. (See Table and Figure). Conclusions Anaesthetic teams at DGH play a significant role in the resuscitation, stabilisation and transfer of critically ill children. Effective communication with the transport service and shared protocols enhance the performance of the DGH staff. (Table Presented). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care organization United Kingdom EMTREE MEDICAL INDEX TERMS child critically ill patient documentation general hospital hospital human information retrieval intensive care unit interpersonal communication medical specialist patient resuscitation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71667182 DOI 10.1136/archdischild-2014-307384.938 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2014-307384.938 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 276 TITLE A pre-operative screening program for obstructive sleep apnea decreases the transfers to the ICU and hospital costs in elective hip and knee arthoplasty AUTHOR NAMES Freeman K. Enfield K. Truwit J.D. Suratt P. Brown C.D. AUTHOR ADDRESSES (Freeman K., cb5am@virginia.edu; Enfield K.; Truwit J.D.; Suratt P.; Brown C.D.) University of Virginia, Charlottesville, United States. CORRESPONDENCE ADDRESS K. Freeman, University of Virginia, Charlottesville, United States. Email: cb5am@virginia.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2014) 189 MeetingAbstracts. Date of Publication: 2014 CONFERENCE NAME American Thoracic Society International Conference, ATS 2014 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2014-05-16 to 2014-05-21 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE Obstructive sleep apnea (OSA) has been shown to be associated with an increase in postoperative complications and is an independent risk factor for increased morbidity and mortality. However, limited data exists regarding whether treating OSA reduces a patient's perioperative risk. We hypothesized that improved preoperative diagnosis and treatment of OSA would be associated with a decreased incidence of certain perioperative complications, decreased length of stay, and decreased hospital cost. METHODS On April 1, 2010, the UVA Orthopedics clinic began screening patients scheduled for elective surgery with a modified STOP-BANG questionnaire (1/2 rather than 1 point for male gender and for older than 55), and individuals with a score > 3 were recommended to be evaluated by polysomnography prior to surgery. We identified patients > 18 years old who had undergone knee or hip arthroplasty using the UVA Clinical Database Repository from 10/1/09 - 9/30/10. Charts were reviewed for comorbidities, polysomnography results, and perioperative complications. In addition, hospital length of stay and cost were recorded for each patient. Differences between the groups were compared by Fisher's exact test or Mann-Whitney U test. P-values of less than 0.05 were considered statistically significant. RESULTS During the period of interest, 418 patients had 439 encounters. Sixty eight patients were excluded due to a pre-existing OSA, hypoxemia, or incomplete records. There were 199 encounters in the control period and 167 encounters in the intervention period. Baseline demographics were similar between the two groups. In the control period 65% of patients had a STOP-BANG performed. Of those, 32% had a score > 3 and 11% were referred for polysomnography. In the intervention period, 79% of patients had a STOP-BANG performed. Of those, 34% had a score of > 3, and 57% were referred for polysomnography. The control group had significantly more transfers to the ICU than the intervention group ( 7 vs. 0, p< 0.017). The control group also had higher median hospital costs than the intervention group ($23,905 vs. $17,782, p <0.001). The median hospital length of stay was 3 days for both groups, and there was no difference in other perioperative complications (table 1). CONCLUSIONS Preoperative screening for OSA decreased hospital cost and ICU transfers although there were no differences in perioperative complications. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American hip hospital cost knee screening sleep disordered breathing society EMTREE MEDICAL INDEX TERMS control group data base diagnosis elective surgery Fisher exact test gender hip arthroplasty hospital human hypoxemia length of stay male morbidity mortality orthopedics patient peroperative complication polysomnography postoperative complication questionnaire rank sum test risk risk factor statistical significance surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72047607 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 277 TITLE Trauma patients evacuated by critical care air transport teams out of the combat zones (2007-2013): A preliminary descriptive report AUTHOR NAMES Mora A. Ervin A. Ganem V. Bebarta N. AUTHOR ADDRESSES (Mora A.; Ervin A.; Ganem V.; Bebarta N.) 59th MDW/ST-USAISR, Fort Sam Houston, United States. CORRESPONDENCE ADDRESS A. Mora, 59th MDW/ST-USAISR, Fort Sam Houston, United States. SOURCE Annals of Emergency Medicine (2014) 64:4 SUPPL. 1 (S41). Date of Publication: October 2014 CONFERENCE NAME American College of Emergency Physicians, ACEP 2014 Research Forum CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-10-27 to 2014-10-28 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: In the combat setting, casualties sustain injuries that can be severe and require specialized treatment not readily available at the point of injury. Critical Care Air Transport Teams (CCATT) evacuate severely injured and critically ill patients to higher levels of care. Limited data has been reported about the care provided to this population en route or procedures performed by CCATT providers. Further, no study has described the clinical status of these patients. Our objective is to in-flight events and procedures that occur during the transport of combat-wounded patients being evacuated by CCATT, and to provide evidence for new clinical practice guidelines and validation of existing guidelines. Methods: We conducted an IRB-approved retrospective review of CCATT medical records of patients with traumatic injuries transported out of the combat setting to Landstuhl Regional Medical Center (LRMC) between 2007 and 2013. Along with sending facility location we collected patient demographics, injury description, in-flight vital signs, hemodynamics, laboratory values, medications, blood products administered, and procedures performed en route. Clinical adverse events were pre-defined such as clinically significant respiratory changes, hemodynamics check, hemostasis, and neurologic events were recorded. Percentages and frequencies were reported along with mean ± SD in this interim analysis. Results: Five hundred thirty-one flight medical records have been reviewed to date. Most aeromedical transports were from Bagram (64%) or Balad (22%). Mean age was 27 ± 7 years and 98% males. The majority were US military (87%) and sustained combat-related injuries (88%). A portion of CCATT transports (8%) sustained >20% TBSA burn or inhalation injury. Medications administered were 94% IV analgesia, 62% sedatives, 13% vasopressors (n=13 started in-flight), 4% oral opioids, and 4% paralytics. Patients were on PCA (23%), epidurals (9%), received ketamine (4%), or ketamine/propofol (1%). In addition to IV maintenance fluids, 27% received fluid boluses and 15% blood products (mean units of red cells, 2; plasma, 2; and platelets, 1). Three percent received 3% NaCl, while 57% were mechanically ventilated, 6% had a tracheostomy, and 89% had chest tubes. Mean FiO2 was 40%. The mean lowest heart rate was 88±20, beats per minute (bpm) and highest 105±20 bpm. The mean lowest systolic blood pressure was 111±16 mmHg and highest 135±19 mmHg. The mean lowest mean arterial pressure (MAP) was 74±10 and highest 88±12. About 3% had a hypoxic episode and 1% had a bleeding event en route. Predefined major clinical events were rare or did not occur-neurologic event (n=29); medication reaction (n=1), cardiac event (n=0), and transfusion reaction (n=0). Conclusion: The majority of trauma patients transported by CCATT from the combat setting were ventilated, received analgesics, and had additional fluids or blood products administered in-flight. In spite of the severity of injuries, CCATT patients had stable hemodynamic values and rarely experienced adverse clinical events. EMTREE DRUG INDEX TERMS analgesic agent hypertensive factor ketamine nitrogen 13 sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) college emergency physician human injury intensive care patient EMTREE MEDICAL INDEX TERMS accident air medical transport analgesia army bleeding blood blood transfusion reaction chest tube critically ill patient drug therapy epidural drug administration erythrocyte flight heart rate hemodynamics hemostasis inhalation injury severity laboratory liquid male mean arterial pressure medical record plasma population practice guideline procedures systolic blood pressure thrombocyte tracheostomy vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71668038 DOI 10.1016/j.annemergmed.2014.07.140 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2014.07.140 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 278 TITLE Mortality after transfer to medical ICU with and without a proceeding rapid response or cardiac arrest Code AUTHOR NAMES Eshak D.S.A. Tibb A.S. AUTHOR ADDRESSES (Eshak D.S.A.; Tibb A.S.) Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, United States. CORRESPONDENCE ADDRESS D.S.A. Eshak, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2014) 189 MeetingAbstracts. Date of Publication: 2014 CONFERENCE NAME American Thoracic Society International Conference, ATS 2014 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2014-05-16 to 2014-05-21 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Introduction Medical intensive care unit (MICU) patients may be directly admitted from the emergency room (ER), or can transfer into MICU after admission to a general medicine floor. MICU transfer can occur after a scheduled critical care consult, or after a Rapid Response Team (RRT) activation or Cardiac Arrest Code (CAC). Presuming optimal triage into MICU, it is hypothesized that there is no mortality difference (on that admission) between patients directly admitted to MICU versus those who transfer into MICU, regardless of RRT or CAC activation prior to MICU transfer. Methods This study was conducted at Jacobi Medical Center, a municipal teaching hospital in the Bronx, NY with a 12-bed MICU and >400 total beds. Decisions to admit or transfer to MICU are finalized by a critical care attending or fellow. The RRT/CAC team is composed entirely of internal medicine housestaff. Any hospital staff can trigger RRT/CAC activation. A retrospective analysis was performed by reviewing the EMR of all patients admitted or transferred into MICU over one year (07/01/2011-06/30/2012). Exclusion criteria included patients transferred to or from an outside institution, or from another intensive care unit. Results There were 528 total admissions to MICU, including 100 transfers. Among the 100 transfers, 44 patients underwent an RRT or CAC prior to transfer. There was no significant difference between overall MICU mortality (18.56%), mortality of patients directly admitted to MICU (17.99%), and mortality of patients transferred to MICU (21.00%). Patients with a Rapid Response proceeding MICU transfer had significantly greater mortality versus patients directly admitted to MICU (30.00% vs. 17.99%, Odds Ratio 2.1273, 95% CI 1.0770 to 4.2017, p value = 0.0297). Among transfers to MICU, patients who had a Rapid Response or CAC proceeding their transfer had a significantly greater mortality versus patients who transferred directly to MICU without an RRT/CAC (31.82% vs. 12.50%, Odds Ratio = 3.2667, 95% CI 1.1842 to 9.0115, p value = 0.022). Conclusions In this center, patients who transfer to MICU following a Rapid Response have higher mortality than patients admitted directly to MICU. This compels further study to determine why this population is at risk for worse outcome. Possibilities include: (1.) Higher severity of illness among the patients who underwent RRT, (2.) Sub-optimal triage in the ER, (3.) Sub-optimal evaluation on the medicine floor, (4.) Sup-optimal effectiveness of the RRT. There may be a potential role for improved education of frontline providers. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American heart arrest mortality society EMTREE MEDICAL INDEX TERMS diseases education emergency health service emergency ward general practice hospital personnel human intensive care intensive care unit internal medicine patient population rapid response team risk statistical significance teaching hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72042325 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 279 TITLE En route use of opioids, ketamine, and epidural analgesia to treat pain in awake patients transported out of combat zones by us air force critical care air transport teams AUTHOR NAMES Mora A. Ervin A. Ganem V. Bebarta V. AUTHOR ADDRESSES (Mora A.; Ervin A.; Ganem V.; Bebarta V.) 59th MDW/ST-USAISR, Fort Sam Houston, United States. CORRESPONDENCE ADDRESS A. Mora, 59th MDW/ST-USAISR, Fort Sam Houston, United States. SOURCE Annals of Emergency Medicine (2014) 64:4 SUPPL. 1 (S130). Date of Publication: October 2014 CONFERENCE NAME American College of Emergency Physicians, ACEP 2014 Research Forum CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-10-27 to 2014-10-28 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: Critical Care Air Transport Teams (CCATT) transport critically injured patients with acute pain. Methods such as epidural and regional anesthetics, and ketamine are used alone or in combination with parenteral opioids. Limited data has been reported about analgesic administration en route, and no study has reported analgesic use and in-flight adverse events for CCATT. Our objective was to describe analgesic use and adverse events on CCATT for non-intubated, awake, critically injured trauma patients during evacuation from a combat setting. Methods: We conducted an IRB-approved, retrospective review of CCATT medical records. Inclusion criteria were non-intubated critically injured trauma patients who were evacuated out of combat zones between 2007 and 2012 and received analgesics in-flight.Data collected included demographics, injury type, analgesics and anesthetics administered. Analgesic doses were compared using morphine equivalence. Pre-defined clinical adverse events such as clinically significant respiratory changes, hemodynamic variations, and worsening pain were recorded. In additional analysis, patients were grouped based on analgesics to include combinations of ketamine and opioid (Ket+O) versus epidural/regional anesthetic (Anst+O) and opioid versus opioid only (O). For this interimstatistical analysis we compared the incidence with chi-square or Fisher's exact tests where appropriate. Wilcoxon test was used for non-parametric variables. A P<.05 was considered significant. Results: Of the 531 patients evaluated, 193 were non-intubated and included in this interim analysis. Mean age was 26 (SD±5) years, 97% male, with 68% blast related trauma, 20% penetrating, 10% blunt, and 2% sustained burns and inhalation injuries. Eighty-four percent of patients received one type of parenteral analgesia and 16% received a combination of two or more. Common opioids were morphine (51%), hydromorphone (41%), and fentanyl (14%). Mean morphine equivalent dose per hour was 6.3 mg (SD±8.8). 61% had a PCA and 10% received oral opioids. Three percent received ketamine (n=6), 22% had an epidural (n=42), and 7% a regional block (n=13). Twelve percent received a combination of IV opioid and epidural therapy. Hypoxia occurred in 3% of patients, hypocarbia in 12%, and hypercarbia in 10%. There was a significant change in FiO2 for 5%. Patients with morphine are more likely to have a change in systolic blood pressure (9% versus 2%; P=.04) as compared to those who did not receive morphine. In additional analysis, Ket+O patients received less morphine equivalent dose (P=.01) in comparison to Anst+O or O (0.7±0 mg, 5±8.7 mg, 7±6.5 mg, respectively). Incidence of other respiratory and hemodynamic events were similar between IV opioids, ketamine, epidural, and regional anesthetic block. In addition, the occurrences of clinical adverse events were similar between Ket+O, Anst+O, and O. Conclusion: Most awake combat injured patients transported by CCATT received IV analgesics in-flight and half of these received morphine. Twenty-two percent of patients had an epidural. Patients that received morphine were more likely to develop hypotension. Hypoxia was rarely experienced by patients in spite of critical injuries, limited oxygenation support, and analgesics. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) ketamine EMTREE DRUG INDEX TERMS analgesic agent anesthetic agent fentanyl hydromorphone morphine nitrogen 13 opiate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air force college emergency physician epidural anesthesia human intensive care pain patient EMTREE MEDICAL INDEX TERMS analgesia epidural drug administration Fisher exact test flight hypercapnia hypocapnia hypotension hypoxia inhalation injury male medical record oxygenation rank sum test systolic blood pressure therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71668286 DOI 10.1016/j.annemergmed.2014.07.393 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2014.07.393 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 280 TITLE Tertiary care transfer experience: One month of emergency department transfers AUTHOR NAMES Black K.P. Ko P.Y. Grant W.D. AUTHOR ADDRESSES (Black K.P.; Ko P.Y.; Grant W.D.) SUNY Upstate Medical University, Evans Mills, United States. CORRESPONDENCE ADDRESS K.P. Black, SUNY Upstate Medical University, Evans Mills, United States. SOURCE Annals of Emergency Medicine (2014) 64:4 SUPPL. 1 (S134-S135). Date of Publication: October 2014 CONFERENCE NAME American College of Emergency Physicians, ACEP 2014 Research Forum CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2014-10-27 to 2014-10-28 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: Transfers to tertiary care emergency department (ED) centers provide beneficial effects to patient care due to the increased availability of medical specialists and services. Are there characteristics which help determine the appropriateness of these transfers? The objective of this study was to describe the nature of outside facility transfers to a tertiary care center ED. Methods: The charts of all hospital transfers to a tertiary care ED during August 2013 were examined. The orders and diagnosis of the transferring emergency physician were extracted from the electronic medical record. The orders and diagnosis of the emergency physician at the tertiary care center were also extracted. Results: There were 296 patients transferred from 30 different facilities (60.5% male, mean age 36.5 years, SD 27.2 years, 95% CI 33.4 to 39.6 years, range 3 months to 99 years). The primary diagnosis was related to injury or trauma for 167 patients (58.4%). The primary diagnosis was in a specialty surgical field 65.6% of the time (orthopedics 25.7%, Otolaryngology 17.6, trauma surgery 11.8% and neurosurgery 10.5%), with general surgery 7.4%, neurology 5.7%, general medicine 4.1%, and gastroenterology 3.4%. At the outside EDs, each patient had an average of 7.1 orders, 3.8 of which were labs and 2.2 radiographs. The tertiary care emergency physician had an average of 4.7 orders, 1.9 labs, 1.1 radiographs and 1.1 consults. The vast majority of tertiary ED repeated tests were on patients from three outside facilities (28.4% of patients). Within this group there were 17 patients with repeated complete blood count (CBC), 12 with repeated basic metabolic panel (BMPs) and 6 with repeated electrocardiogram (EKG). There were 10 patients with repeated radiographs. Overall there was an average of 1.0 repeated tests per patient, 0.79 labs and 0.14 radiographs. In only 20 cases (6.7%) there was mention of the outside ED directly consulting a specialist at the accepting tertiary center, who advised ED to ED transfer. Thirty patients did not receive specialist consults in the ED of which 19 were discharged (13 to follow-up with PCP and 6 to followup with a specialist). The tertiary care emergency physician significantly disagreed with the referring diagnosis in 28 cases (9.8%). The patients' dispositions were: floor 39.5%, discharged with specialist follow-up 29.4%, discharged with primary care physician (PCP) follow-up 11.8%, intensive care unit 8.8%, Operating room 5.4%, step-down unit 4.3%, with one patient going to interventional Radiology and one leaving against medical advice. Conclusion: The majority of patients in this study required surgical specialty care due to injuries. However, several cases may not have benefitted from transfer, as they neither required specialist care nor admission, as well as select cases that were “over-called” by the referring physician. Only for a small proportion of cases did the outside ED attempt to consult a specialist before transferring. Better communication and cooperation with outside referring EDs is needed to assure the most appropriate care for all patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) college emergency physician emergency ward human tertiary health care EMTREE MEDICAL INDEX TERMS blood cell count diagnosis electrocardiogram electronic medical record follow up gastroenterology general practice general practitioner general surgery hospital injury intensive care unit interpersonal communication interventional radiology male medical specialist neurology neurosurgery operating room orthopedics otorhinolaryngology patient patient care physician surgery tertiary care center traumatology X ray film LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71668296 DOI 10.1016/j.annemergmed.2014.07.403 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2014.07.403 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 281 TITLE In-house validation and technology transfer of the GARD assay for prediction of sensitizing compounds AUTHOR NAMES Forreryd A. Johansson H. Rydnert F. -Sofie Albrekt A. Borrebaeck C. Lindstedt M. AUTHOR ADDRESSES (Forreryd A.; Johansson H.; Rydnert F.; -Sofie Albrekt A.; Borrebaeck C.; Lindstedt M.) Department of Immunotechnology, Lund, Sweden. CORRESPONDENCE ADDRESS A. Forreryd, Department of Immunotechnology, Lund, Sweden. SOURCE Toxicology Letters (2014) 229 SUPPL. 1 (S135-S136). Date of Publication: 10 Sep 2014 CONFERENCE NAME 50th Congress of the European Societies of Toxicology, EUROTOX 2014 CONFERENCE LOCATION Edinburgh, United Kingdom CONFERENCE DATE 2014-09-07 to 2014-09-10 ISSN 0378-4274 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Background: Allergic contact dermatitis is caused by an adverse immune response towards chemical haptens. The disease affects a significant proportion of the population, leading to a substantial economic burden for society. New legislations on the registration and use of chemicals within cosmetic industry require development of high-throughput, in vitro assays for the prediction of sensitization, to replace current animal-based experiments. Methods: We have developed a cell-based assay for prediction of sensitizing chemicals, called Genomic Allergen Rapid Detection, GARD. Analyzing the transcriptome of the MUTZ-3 cell line after 24 h stimulation, using well characterized skin sensitizing chemicals and controls, we identified a genomic biomarker signature with potent discriminatory ability. To further adapt the assay to high-throughput screening mode, we evaluated the performance of three non-array based platforms using a restricted set of probes from the biomarker signature. Results: Prediction accuracy of the assay was assessed in three separate in-house, validation studies, and is thus far 89%. Results from the evaluation of platforms mimicked previous data from genome wide transcriptome analysis in terms of reproducibility while alternative platforms proved to be superior in terms of cost efficiency, sample throughput and simplified protocols. Conclusions: GARD was demonstrated to have potent ability to predict sensitization. Changing the technical platform for gene expression analysis, we retained robustness and discriminatory power of GARD and at the same time simplified assay procedures, reduced assay cost and increased sample throughput. This provided a step towards formal validation and adaptation of the assay for industrial screening of potential sensitizers. EMTREE DRUG INDEX TERMS allergen biological marker hapten transcriptome EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assay organization prediction technology toxicology EMTREE MEDICAL INDEX TERMS adaptation cell line cosmetic industry gene expression genome high throughput screening immune response implantable cardioverter defibrillator in vitro study law population procedures registration reproducibility screening sensitization skin allergy skin sensitization society stimulation validation study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71631300 DOI 10.1016/j.toxlet.2014.06.479 FULL TEXT LINK http://dx.doi.org/10.1016/j.toxlet.2014.06.479 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 282 TITLE Investigation into standards of discharge summary completeness on patient transfer from the intensive care unit (ICU) to the general ward AUTHOR NAMES Skorko A. Sivasubramaniam G. Kakar V. Hopkins P. AUTHOR ADDRESSES (Skorko A.) Guy's and St Thomas' Hospital, Department of Anaesthetics, London, United Kingdom. (Sivasubramaniam G.; Kakar V.; Hopkins P.) King's College Hospital, Intensive Care Unit, London, United Kingdom. CORRESPONDENCE ADDRESS A. Skorko, Guy's and St Thomas' Hospital, Department of Anaesthetics, London, United Kingdom. SOURCE Intensive Care Medicine (2014) 40:1 SUPPL. 1 (S39). Date of Publication: September 2014 CONFERENCE NAME 27th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2014 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2014-09-27 to 2014-10-01 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Discharge from the Intensive Care Unit (ICU) is a period fraught with potential risks and good handover is a vital tool in minimising this. To this end, In 2007 the National Institute for Clinical Excellence (NICE) published guidelines outlining the information that should be handed over when a patient leaves the ICU1. This states that there should be a formal structured handover of care from ICU to ward staff on the parts of both the medical and nursing staff, which should be supported by written plans. The handover should include: a summary of the ICU stay including diagnosis and treatment, a monitoring and investigation plan, a plan for ongoing treatment, current drugs and therapies, a nutrition plan, infection status, agreed limitations of treatment, physical and rehabilitation needs, psychological and emotional needs and communication/language needs. There is no nationally standardised discharge protocol in the UK. In our tertiary centre ICU once a decision to discharge is made an ICU doctor telephones the accepting team to verbally handover the patient. A discharge proforma is completed electronically and uploaded to the patient's electronic notes. The nursing staff fill in a paper proforma which they file in the paper hospital notes and use to handover face-to-face on transfer to the ward. In order to assess our unit's adherence to the NICE standards we audited the completeness of the summaries produced by doctors and nurses for every patient discharged from the ICU. We excluded patients who were transferred out of the hospital, to another ICU or who died. A 4 week audit period in February 2013 captured 106 discharges (100 % of eligible discharges). The results were presented to the department at a training meeting. A re-audit occurred in June 2013 and 110 discharges were audited (100 % of eligible discharges). Comparison of each data field in the initial audit and re-audit periods are presented in table 1. In summary, the standard of paperwork completeness did not meet those set out by NICE. Although the vast majority of patients had written documentation, very few were verbally handed over by medical staff. Additionally, the holistic aspects of patient care such as psychological, emotional and communication needs were very poorly documented. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care intensive care unit patient transport society ward EMTREE MEDICAL INDEX TERMS clinical audit diagnosis documentation hospital implantable cardioverter defibrillator infection interpersonal communication medical staff monitoring nurse nursing staff nutrition patient patient care physician plant leaf rehabilitation risk telephone Tertiary (period) therapy United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71629976 DOI 10.1007/s00134-013-3451-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-3451-5 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 283 TITLE An analysis of the reasons for transfer of patients from general ward to high dependency/intensive care unit within 24 hours of admission from the emergency department AUTHOR NAMES Sooi W.X. Chiu L.Q. AUTHOR ADDRESSES (Sooi W.X.) National University of Singapore, Singapore, Singapore. (Chiu L.Q.) Tan Tock Seng Hospital, Singapore, Singapore. CORRESPONDENCE ADDRESS W.X. Sooi, National University of Singapore, Singapore, Singapore. SOURCE Annals of the Academy of Medicine Singapore (2014) 43:9 SUPPL. 1 (S165). Date of Publication: September 2014 CONFERENCE NAME Singapore Health and Biomedical Congress, SHBC 2014 CONFERENCE LOCATION Singapore, Singapore CONFERENCE DATE 2014-09-26 to 2014-09-27 ISSN 0304-4602 BOOK PUBLISHER Academy of Medicine Singapore ABSTRACT Background & Hypothesis: The emergency department (ED) is the first recipient of most admitted patients in a hospital. Errors involving ED triage, management and disposition have adverse patient outcomes. Studies have shown that unplanned transfers from general ward (GW) to high dependency (HD)/intensive care units (ICU) are associated with increased morbidity and mortality. Primary aims are to determine the number of unplanned transfers among ED patients from GW to HD/ICU within 24 hours of admission and the mortality rate of such patients. The secondary aim is to evaluate the reasons for these unplanned transfers. Methods: We conducted a retrospective review of ED admission summaries and inpatient discharge summaries from October 2013 to March 2014. Information collected included demographics, admitting and final diagnosis, time to transfer, reason(s) for transfer and outcome. Data was analysed by SPSS v19. Results: There were 23,401 patients admitted from ED to GW with 326 (1.39%) unplanned transfers to HD/ICU within 24 hours of admission. The mortality rate was 11.0%. The most frequent diagnoses were acute coronary syndrome (15.0%) and pneumonia (14.1%). The top reasons for transfer were disease progression (27.6%) and postoperative monitoring (27.6%). Other reasons included admission to HD for monitoring (10.4%), HD/ICU requested but denied by inpatient team (7.1%), development of new unrelated problem(s) (5.0%) and misinterpretation of investigations (4.8%). Discussion & Conclusion: There is a low rate and mortality of unplanned transfers to HD/ICU. Qualitative analyses of cases should be done to guide and improve current ED protocols in order to decrease morbidity, mortality and healthcare costs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward health human patient Singapore ward EMTREE MEDICAL INDEX TERMS acute coronary syndrome data analysis software diagnosis disease course emergency health service health care cost hospital hospital patient hypothesis intensive care unit monitoring morbidity mortality pneumonia qualitative analysis recipient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71796420 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 284 TITLE Re-location of a critical care unit-specific challenges and patient outcomes AUTHOR NAMES O'Leary R.A. O'Loughlin C. Marsh B. AUTHOR ADDRESSES (O'Leary R.A.; O'Loughlin C.; Marsh B.) Mater Misericordiae University Hospital, Intensive Care Medicine, Dublin, Ireland. CORRESPONDENCE ADDRESS R.A. O'Leary, Mater Misericordiae University Hospital, Intensive Care Medicine, Dublin, Ireland. SOURCE Intensive Care Medicine (2014) 40:1 SUPPL. 1 (S79). Date of Publication: September 2014 CONFERENCE NAME 27th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2014 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2014-09-27 to 2014-10-01 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Intrahospital transport (IHT) of critically ill patients is associated with increased morbidity. Overall complication rates are as high as 70 %. Re-location of critical care units is associated with mass transfer of critically ill patients. OBJECTIVES. The aim of our study was to describe the process of relocating our intensive care unit (ICU) and assess impact on patient outcomes. METHODS. In February 2014 our ICU relocated to a facility in a new building. The estimated transfer time was 17 min, including transit in 2 lifts. Preparations prior to transfer included staff orientation and provision of extra portering, nursing and medical engineering staff. A rest station was provided on the transfer route in case of patient instability or equipment failure. Data was collected on 21 patients. Transfer times and complications associated with transport were recorded prospectively. We followed patients until hospital discharge and collected details of their critical care course, including adverse events. RESULTS. 21 patients were transferred over a 7 h period. 71.4 % of patients were ventilated (15/21), 33 % of patients required inotropes (7/21) and 1 patient required extracorporeal life support (ECLS). 2 consultant intensivists managed patients in the old ICU and 2 consultant intensivists received care in the new ICU. A dedicated transport team of 6 non-consultant hospital doctors with anaesthesia and intensive care medicine training managed all patient transfers. Average transfer time was 11 min 14 s, 2 transfers required interruption for equipment failure and 1 transfer was delayed by lift malfunction. No patient suffered significant haemodynamic or respiratory deterioration during or after transfer. There was no statistically significant increase in mortality and 30-day mortality was 14.3 % (3/21 patients). CONCLUSIONS. IHT in critically ill patients has an associated morbidity. Our experience shows that this can be minimised with planning and adequately skilled personnel. We propose that IHT with a high level of organisation allows necessary interventions, such as radiology, to proceed in a timely manner with minimal risk and avoids patient risks associated with delay. EMTREE DRUG INDEX TERMS inotropic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient society EMTREE MEDICAL INDEX TERMS anesthesia biomedical engineering consultation critically ill patient deterioration device failure hospital discharge hospital physician intensive care unit intensivist morbidity mortality nursing patient risk patient transport personnel planning radiology risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71630115 DOI 10.1007/s00134-013-3451-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-3451-5 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 285 TITLE In-house validation and technology transfer of the GARD assay for prediction of sensitising compounds AUTHOR NAMES Forreryd A. Johansson H. Rydnert F. Albrekt A.S. Borrebaeck C.A.K. Lindstedt M. AUTHOR ADDRESSES (Forreryd A.; Johansson H.; Rydnert F.; Albrekt A.S.; Borrebaeck C.A.K.; Lindstedt M.) Department of Immunotechnology, Lund University, Lund, Sweden. CORRESPONDENCE ADDRESS A. Forreryd, Department of Immunotechnology, Lund University, Lund, Sweden. SOURCE Allergy: European Journal of Allergy and Clinical Immunology (2014) 69 SUPPL. 99 (43). Date of Publication: September 2014 CONFERENCE NAME 33rd Congress of the European Academy of Allergy and Clinical Immunology CONFERENCE LOCATION Copenhagen, Denmark CONFERENCE DATE 2014-06-07 to 2014-06-11 ISSN 0105-4538 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Allergic contact dermatitis is caused by an adverse immune response towards chemical haptens. The disease affects a significant proportion of the population, with increasing incidences, which leads to a substantial economic burden for society. New legislations on the registration and use of chemicals within chemical and cosmetic industries require development of alternative, high-throughput, in vitro assays for the prediction of sensitisation, to replace current animal-based experiments. Method: We have developed a human cellbased assay for the prediction of sensitising chemicals, called Genomic Allergen Rapid Detection, GARD. By analyzing the transcriptome of the MUTZ-3 cell line after 24 h stimulation, using well characterised skin sensitising chemicals (N = 20) and controls (N = 20), we have identified a genomic biomarker signature with potent discriminatory ability. In order to further adapt the assay to a high-throughput screening mode, we evaluated the performance of three nonarray based platforms using a restricted set of probes from the biomarker signature. Results: The prediction accuracy of the assay has been assessed in three separate in-house, partially blinded, validation studies (N = 37), and is thus far 89%. Results from the evaluation of platforms mimicked previous data from genome wide transcriptome analysis in terms of reproducibility and robustness while alternative platforms proved to be superior in terms of cost efficiency, increased sample throughput and simplified protocols. Conclusion: The GARD assay was demonstrated to have potent ability to predict sensitisation. By changing the technical platform for gene expression analysis, we could retain the robustness and discriminatory power of GARD and at the same time simplify assay procedures, reduce assay cost and increase sample throughput providing a first step towards formal validation and adaption of the assay for industrial screening of potential sensitisers. EMTREE DRUG INDEX TERMS allergen biological marker hapten transcriptome EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) allergy assay clinical immunology prediction technology EMTREE MEDICAL INDEX TERMS cell line cosmetic industry gene expression genome high throughput screening human immune response implantable cardioverter defibrillator in vitro study law population procedures registration reproducibility screening skin skin allergy society stimulation validation study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71612431 DOI 10.1111/all.12491 FULL TEXT LINK http://dx.doi.org/10.1111/all.12491 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 286 TITLE An audit of the accuracy of drug prescription information on transfer letters from the paediatric intensive care unit AUTHOR NAMES Kokoskova A. Fletcher P. AUTHOR ADDRESSES (Kokoskova A.; Fletcher P.) St Mary's Hospital, Imperial College Healthcare NHS Trust, United Kingdom. CORRESPONDENCE ADDRESS A. Kokoskova, St Mary's Hospital, Imperial College Healthcare NHS Trust, United Kingdom. SOURCE Archives of Disease in Childhood (2014) 99:8 (e3). Date of Publication: August 2014 CONFERENCE NAME 19th Annual Conference of the Neonatal and Paediatric Pharmacists Group, NPPG 2013 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2013-11-08 to 2013-11-10 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Aim To audit the accuracy of prescribing following transfer from a Paediatric Intensive Care Unit using electronic prescribing. Methods Historical data: Transfer from PICU letters sent to both external Trusts and wards within the same hospital were randomly selected pre and post the electronic prescribing system upgrade ( July 2012) and compared with the final prescription screen of the inpatient electronic prescription record (EPR). Current data: For patients transferred to a ward of the same hospital between 17 December 2012 and 28th January 2013, the first handwritten drug chart after transfer from PICU was also reviewed for accuracy in comparison to the PICU EPR. Audit standard: 100% of patients transferred from PICU have correct transfer from PICU letters with regard to prescribed medicines. 100% of patients transferred from PICU to a ward within the hospital have correct transfer from PICU letters and correct first inpatient drug chart. Results Data were collected for 16 patients pre-upgrade: 6 had correct transfer letters, 10 (63%) had errors. Among the 85 drugs prescribed, there were 12 errors involving 12 drugs (14% of drugs). After the July 2012 upgrade 14 patients were analysed, 10 had correct transfer letters, 4 (29%) had errors. Of the 80 drugs prescribed there were 8 errors (10% of drugs documented in the letters were wrong). Data were collected for 13 patients transferred to wards within the hospital; 9 (69%) had correct transfer letters and a correct first inpatient drug chart. Two patients had errors on their transfer letter and first drug chart, and two had errors on the transfer letter but the drug chart was correct (due to ward pharmacist intervention). There were 6 errors in total for these 4 patients. Errors included incorrect gentamicin and vancomycin doses and incorrect information about whether patients still required morphine, azithromycin and ceftriaxone. Following this audit a meeting was held with senior PICU consultants. The EPR software company have been contacted to improve the automated transfer letter system. Meanwhile the automated transfer letter has been modified to exclude drugs and junior doctors are requested to input this data manually. The signing consultant is reminded to check the prescription section carefully to prevent errors. Discussions are ongoing for nurses to be part of the checking process. Conclusion Transfer letters are not being thoroughly checked before being sent with the patient on transfer from PICU. Some errors were due to a system failure where dose changes were not pulled across to the transfer letter. This did not resolve after the July 2012 upgrade. Errors appear to have reduced over the data collection period however this is anecdotally due to a raised awareness of the system failures and some junior doctors writing their own drug list rather than relying on the system to generate it. In order to meet expected standards of 100% correct information on transfer letters much closer attention must be paid to final accuracy checks. EMTREE DRUG INDEX TERMS azithromycin ceftriaxone gentamicin morphine vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit human intensive care unit pharmacist prescription EMTREE MEDICAL INDEX TERMS consultation electron spin resonance electronic prescribing hospital hospital patient implantable cardioverter defibrillator information processing nurse patient physician software ward writing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71562149 DOI 10.1136/archdischild-2014-306798.22 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2014-306798.22 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 287 TITLE Effective teamwork and communication mitigate task saturation in simulated critical care air transport team missions AUTHOR NAMES Davis B. Welch K. Walsh-Hart S. Hanseman D. Petro M. Gerlach T. Dorlac W. Collins J. Pritts T. AUTHOR ADDRESSES (Davis B.) Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267 (Welch K.) Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267 (Walsh-Hart S.) United States Air Force Center for Sustainment of Trauma and Readiness Skills, 234 Goodman Avenue, Cincinnati, OH 45213 (Hanseman D.) Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267 (Petro M.) United States Air Force Center for Sustainment of Trauma and Readiness Skills, 234 Goodman Avenue, Cincinnati, OH 45213 (Gerlach T.) United States Air Force Center for Sustainment of Trauma and Readiness Skills, 234 Goodman Avenue, Cincinnati, OH 45213 (Dorlac W.) Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267 (Collins J.) Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267 (Pritts T.) Department of Surgery and Institute for Military Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH 45267 SOURCE Military medicine (2014) 179:8 Supplement (19-23). Date of Publication: 1 Aug 2014 ISSN 1930-613X (electronic) ABSTRACT BACKGROUND: Critical Care Air Transport Teams (CCATTs) are a critical component of the United States Air Force evacuation paradigm. This study was conducted to assess the incidence of task saturation in simulated CCATT missions and to determine if there are predictable performance domains.METHODS: Sixteen CCATTs were studied over a 6-month period. Performance was scored using a tool assessing eight domains of performance. Teams were also assessed during critical events to determine the presence or absence of task saturation and its impact on patient care.RESULTS: Sixteen simulated missions were reviewed and 45 crisis events identified. Task saturation was present in 22/45 (49%) of crisis events. Scoring demonstrated that task saturation was associated with poor performance in teamwork (odds ratio [OR] = 1.96), communication (OR = 2.08), and mutual performance monitoring (OR = 1.9), but not maintenance of guidelines, task management, procedural skill, and equipment management. We analyzed the effect of task saturation on adverse patient outcomes during crisis events. Adverse outcomes occurred more often when teams were task saturated as compared to non-task-saturated teams (91% vs. 23%; RR 4.1, p < 0.0001).CONCLUSIONS: Task saturation is observed in simulated CCATT missions. Nontechnical skills correlate with task saturation. Task saturation is associated with worsening physiologic derangements in simulated patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport cooperation interpersonal communication patient care soldier EMTREE MEDICAL INDEX TERMS group process human intensive care patient safety simulation training task performance United States workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25102544 (http://www.ncbi.nlm.nih.gov/pubmed/25102544) PUI L612093149 DOI 10.7205/MILMED-D-13-00240 FULL TEXT LINK http://dx.doi.org/10.7205/MILMED-D-13-00240 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 288 TITLE Improved outcomes of transported neonates in Beijing: the impact of strategic changes in perinatal and regional neonatal transport network services AUTHOR NAMES Kong X.-Y. Liu X.-X. Hong X.-Y. Liu J. Li Q.-P. Feng Z.-C. AUTHOR ADDRESSES (Kong X.-Y.; Hong X.-Y.; Liu J.; Li Q.-P.; Feng Z.-C., zhjfengzc@126.com) Newborn Care Center, Bayi Children’s Hospital, the Military General Hospital of Beijing, the People’s Liberation Army, Beijing, China. (Liu X.-X.) Department of Pediatrics, Hospital of Binzhou Medical University, Binzhou, Shandong, China. (Feng Z.-C., zhjfengzc@126.com) Bayi Children’s Hospital, the Military General Hospital of Beijing, the People’s Liberation Army, 5 Nanmen Chang, Dongcheng District, Beijing, China. CORRESPONDENCE ADDRESS Z.-C. Feng, Bayi Children’s Hospital, the Military General Hospital of Beijing, the People’s Liberation Army, 5 Nanmen Chang, Dongcheng District, Beijing, China. SOURCE World Journal of Pediatrics (2014) 10:3 (251-255). Date of Publication: 1 Aug 2014 ISSN 1867-0687 (electronic) 1708-8569 BOOK PUBLISHER Institute of Pediatrics of Zhejiang University, wjpch@zju.edu.cn ABSTRACT Background: Infants born outside perinatal centers may have compromised outcomes due to the transfer speed and efficiency to an appropriate tertiary center. This study aimed to evaluate the impact of regional coordinated changes in perinatal supports and retrieval services on the outcome of transported neonates in Beijing, China.Methods: Information about transported newborns between phase 1 (July 1, 2004 to June 30, 2006) and phase 2 (July 1, 2007 to June 30, 2009) was collected. The strategic changes during phase 2 included standardized neonatal transport procedures, skilled attendants, a perinatal consulting service, and preferential admission of transported neonates to the intensive care unit of the tertiary care center. Data from phase 2 (after-strategic changes) were compared with those of phase 1 (the period of pre-strategic changes) after a 12-month washout period, especially regarding the reduction in mortality and selected morbidity.Results: There was a large increase in the number of transported infants in phase 2 compared with phase 1 (2797 vs. 567 patients). The average monthly rate of increase of transported infants was 383.3% (from 24 infants per month to 116 infants per month). The mortality rate of transported neonates reduced significantly from phase 1 to phase 2 (5.11% vs. 2.82%; P=0.005), particularly for preterm infants (8.47% vs. 4.34%; P=0.006). In addition, transported neonates during phase 2 had significantly decreased morbidities.Conclusions: Regional coordinated strategies optimizing the perinatal services and transport of outborn sick and preterm infants to tertiary care centers improved survival outcomes considerably. These findings have vital implications for health outcomes and resource planning. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health service newborn care patient transport perinatal care EMTREE MEDICAL INDEX TERMS adult Apgar score article female high risk infant human intensive care unit major clinical study male newborn newborn morbidity newborn mortality prematurity survival rate tertiary care center EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015881213 MEDLINE PMID 25124977 (http://www.ncbi.nlm.nih.gov/pubmed/25124977) PUI L603481650 DOI 10.1007/s12519-014-0501-1 FULL TEXT LINK http://dx.doi.org/10.1007/s12519-014-0501-1 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 289 TITLE A population-based evaluation of severity and mortality among transferred patients with acute pancreatitis AUTHOR NAMES Anand G. Hutfless S.M. Akshintala V.S. Khashab M.A. Lennon A.M. Makary M.A. Hirose K. Andersen D.K. Kalloo A.N. Singh V.K. AUTHOR ADDRESSES (Anand G.; Hutfless S.M.; Akshintala V.S.; Khashab M.A.; Lennon A.M.; Makary M.A.; Hirose K.; Andersen D.K.; Kalloo A.N.; Singh V.K.) CORRESPONDENCE ADDRESS G. Anand, SOURCE Pancreas (2014). Date of Publication: 23 Jul 2014 ISSN 0885-3177 1536-4828 (electronic) BOOK PUBLISHER Lippincott Williams & Wilkins. ABSTRACT OBJECTIVES: This study aimed to compare severity of acute pancreatitis (AP) and mortality rates between transferred and nontransferred patients and to determine the factors that influence the decision to transfer. METHODS: A retrospective analysis coding a statewide administrative database in Maryland was conducted. Severity was defined by presence of organ failure (OF), need for intensive care unit (ICU), mechanical ventilation (MV), or hemodialysis. RESULTS: There were 71,035 discharges for AP, with 1657 (2.3%) patient transfers. Transferred patients had more multisystem OF (5.6% vs 1.2%), need for ICU (22.8% vs 4.3%), MV (13.1% vs 1.4%), hemodialysis (4.2% vs 2.7%), and higher mortality (6.1% vs 1.1%) compared with nontransferred patients (P < 0.0001). After adjusting for disease severity, mortality was similar between the transferred patients and the nontransferred patients (OR, 1.37; 95% confidence interval, 0.96-1.97). Younger (OR, 0.99), African American (OR, 0.55), and uninsured (OR, 0.46) patients were less likely to be transferred, whereas patients with multisystem OF (OR, 3.5), need for ICU (OR, 2.3), or MV (OR, 2.1) were more likely to be transferred (P < 0.0001). CONCLUSIONS: Transferred patients with AP have more severe disease and higher overall mortality. Mortality is similar after adjusting for disease severity. Disease severity, insurance status, race, and age all influence the decision to transfer patients with AP. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute pancreatitis human mortality patient population EMTREE MEDICAL INDEX TERMS African American artificial ventilation confidence interval data base disease severity hemodialysis insurance intensive care unit medically uninsured patient transport United States LANGUAGE OF ARTICLE English PUI L53256249 DOI 10.1097/MPA.0000000000000179 FULL TEXT LINK http://dx.doi.org/10.1097/MPA.0000000000000179 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 290 TITLE Parents' experiences of their premature infants' transportation from a university hospital NICU to the NICU at two local hospitals AUTHOR NAMES Granrud M.D. Ludvigsen E. Andershed B. AUTHOR ADDRESSES (Granrud M.D.) Department of Nursing, Hedmark University College, Elverum, Norway; Neonatal Intensive Care Unit, Innlandet Hospital Trust, Norway (Ludvigsen E.) Neonatal Intensive Care Unit, Innlandet Hospital Trust, Norway (Andershed B., birgitta.andershed@hig.no) Department of Nursing, Gjøvik University College, Norway, and Department of Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden. Electronic address: SOURCE Journal of pediatric nursing (2014) 29:4 (e11-e18). Date of Publication: 1 Jul 2014 ISSN 1532-8449 (electronic) ABSTRACT The aim of this study was to describe how the parents of premature infants experience the transportation of their baby from the neonatal intensive care unit at a university hospital (NICU-U) to such a unit at a local hospital (NICU-L). This descriptive qualitative study comprises interviews with nine sets of parents and two mothers. The qualitative content analysis resulted in one theme: living in uncertainty about whether the baby will survive, and three categories: being distanced from the baby; fearing that something would happen to the baby during transportation; and experiencing closeness to the baby. The results also revealed that the parents experienced developmental, situational and health-illness transitions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) community hospital newborn intensive care organization and management prematurity psychology university hospital EMTREE MEDICAL INDEX TERMS adaptive behavior child parent relation comparative study evaluation study female human interview male mental stress newborn parent patient transport qualitative research Sweden LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24582644 (http://www.ncbi.nlm.nih.gov/pubmed/24582644) PUI L611478307 DOI 10.1016/j.pedn.2014.01.014 FULL TEXT LINK http://dx.doi.org/10.1016/j.pedn.2014.01.014 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 291 TITLE Automatic protective ventilation using the ARDSNet protocol with the additional monitoring of electrical impedance tomography AUTHOR NAMES Pomprapa A. Schwaiberger D. Pickerodt P. Tjarks O. Lachmann B. Leonhardt S. AUTHOR ADDRESSES (Pomprapa A., pomprapa@hia.rwth-aachen.de; Leonhardt S., leonhardt@hia.rwth-aachen.de) Philips Chair of Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, Aachen, Germany. (Schwaiberger D., David.Schwaiberger@charite.de; Pickerodt P., Philipp.Pickerodt@charite.de; Tjarks O., Onno.Tjarks@charite.de; Lachmann B., burkhard.lachmann@gmail.com) Department of Anesthesiology and Intensive Care Medicine, Campus Charite´ Mitte and Campus Virchow-Klinikum, Charite´ - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin, Germany. CORRESPONDENCE ADDRESS A. Pomprapa, Philips Chair of Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, Aachen, Germany. SOURCE Critical Care (2014) 18:3 Article Number: R128. Date of Publication: 23 Jun 2014 ISSN 1466-609X (electronic) 1364-8535 BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Introduction: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy. We therefore developed a prototype for closed-loop ventilation using acute respiratory distress syndrome network (ARDSNet) protocol, called autoARDSNet.Methods: A protocol-driven ventilation using goal-oriented structural programming was implemented and used for 4 hours in seven pigs with lavage-induced acute respiratory distress syndrome (ARDS). Oxygenation, plateau pressure and pH goals were controlled during the automatic ventilation therapy using autoARDSNet. Monitoring included standard respiratory, arterial blood gas analysis and electrical impedance tomography (EIT) images. After 2-hour automatic ventilation, a disconnection of the animal from the ventilator was carried out for 10 seconds, simulating a frequent clinical scenario for routine clinical care or intra-hospital transport.Results: This pilot study of seven pigs showed stable and robust response for oxygenation, plateau pressure and pH value using the automated system. A 10-second disconnection at the patient-ventilator interface caused impaired oxygenation and severe acidosis. However, the automated protocol-driven ventilation was able to solve these problems. Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.Conclusions: We implemented an automatic ventilation therapy using ARDSNet protocol with seven pigs. All positive outcomes were obtained by the closed-loop ventilation therapy, which can offer a continuous standard protocol-driven algorithm to ARDS subjects. EMTREE DRUG INDEX TERMS carbon dioxide EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adult respiratory distress syndrome (therapy) artificial ventilation computer assisted impedance tomography EMTREE MEDICAL INDEX TERMS acidosis alkalosis animal experiment arterial carbon dioxide tension arterial gas arterial oxygen saturation arterial oxygen tension article atelectasis female mechanical ventilator nonhuman oxygenation pH pig pilot study positive end expiratory pressure thoracic cavity CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014701247 PUI L600011330 DOI 10.1186/cc13937 FULL TEXT LINK http://dx.doi.org/10.1186/cc13937 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 292 TITLE Automatic protective ventilation using the ARDSNet protocol with the additional monitoring of electrical impedance tomography AUTHOR NAMES Pomprapa A. Schwaiberger D. Pickerodt P. Tjarks O. Lachmann B. Leonhardt S. AUTHOR ADDRESSES (Pomprapa A., pomprapa@hia.rwth-aachen.de; Leonhardt S., leonhardt@hia.rwth-aachen.de) Philips Chair of Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, Aachen 52074, Germany. (Schwaiberger D., David.Schwaiberger@charite.de; Pickerodt P., Philipp.Pickerodt@charite.de; Tjarks O., Onno.Tjarks@charite.de; Lachmann B., burkhard.lachmann@gmail.com) Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, Berlin 13353, Germany. CORRESPONDENCE ADDRESS A. Pomprapa, Philips Chair of Medical Information Technology, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, Aachen 52074, Germany. Email: pomprapa@hia.rwth-aachen.de SOURCE Critical Care (2014) 18:3 Article Number: R128. Date of Publication: 23 Jun 2014 ISSN 1466-609X (electronic) 1364-8535 ABSTRACT Introduction: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy. We therefore developed a prototype for closed-loop ventilation using acute respiratory distress syndrome network (ARDSNet) protocol, called autoARDSNet.Methods: A protocol-driven ventilation using goal-oriented structural programming was implemented and used for 4 hours in seven pigs with lavage-induced acute respiratory distress syndrome (ARDS). Oxygenation, plateau pressure and pH goals were controlled during the automatic ventilation therapy using autoARDSNet. Monitoring included standard respiratory, arterial blood gas analysis and electrical impedance tomography (EIT) images. After 2-hour automatic ventilation, a disconnection of the animal from the ventilator was carried out for 10 seconds, simulating a frequent clinical scenario for routine clinical care or intra-hospital transport.Results: This pilot study of seven pigs showed stable and robust response for oxygenation, plateau pressure and pH value using the automated system. A 10-second disconnection at the patient-ventilator interface caused impaired oxygenation and severe acidosis. However, the automated protocol-driven ventilation was able to solve these problems. Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.Conclusions: We implemented an automatic ventilation therapy using ARDSNet protocol with seven pigs. All positive outcomes were obtained by the closed-loop ventilation therapy, which can offer a continuous standard protocol-driven algorithm to ARDS subjects. © 2014 Pomprapa et al. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adult respiratory distress syndrome (therapy) artificial ventilation automatic ventilation automation computer assisted impedance tomography EMTREE MEDICAL INDEX TERMS animal experiment animal model arterial gas arterial oxygen saturation article capnometer capnometry controlled study female mechanical ventilator monitoring nonhuman oxygenation patient monitor pH pig pilot study pneumothorax (complication) priority journal pulse oximetry spectrophotometer standard DEVICE TRADE NAMES CeVOX , GermanyPulsion CO2SMO+ , GermanyPhilips Respironics GOE-MF II , GermanyDrager KPCMCIA-12AI-C , United Stateskeithley instruments PCMDA12B , United Statessuperlogics Sirecust , GermanySiemens DEVICE MANUFACTURERS (Germany)Drager (Germany)Philips Respironics (Germany)Pulsion (Germany)Siemens (United States)keithley instruments (United States)superlogics EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014518414 PUI L53202325 DOI 10.1186/cc13937 FULL TEXT LINK http://dx.doi.org/10.1186/cc13937 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 293 TITLE Is it always reasonable to transfer babies with necrotizing enterocolitis to neonatal surgical units? AUTHOR NAMES Molnar E. Fukari-Irvine E. King C. Kawa B. Ratnavel N. AUTHOR ADDRESSES (Molnar E.; Fukari-Irvine E.; King C.; Kawa B.; Ratnavel N.) Neonatal Transfer Service, London, United Kingdom. CORRESPONDENCE ADDRESS E. Molnar, Neonatal Transfer Service, London, United Kingdom. SOURCE Journal of Maternal-Fetal and Neonatal Medicine (2014) 27 SUPPL. 1 (239). Date of Publication: June 2014 CONFERENCE NAME 24th European Congress of Perinatal Medicine CONFERENCE LOCATION Florence, Italy CONFERENCE DATE 2014-06-04 to 2014-06-07 ISSN 1476-7058 BOOK PUBLISHER Informa Healthcare ABSTRACT Brief Introduction: Necrotising Enterocolitis (NEC) is the most common gastrointestinal emergency and a major cause of morbidity and mortality in preterm infants. Based on severity of the disease, treatment can involve a medical approach or surgical intervention. Whilst babies requiring medical treatment can be managed in a nonsurgical neonatal intensive care unit (NICU), patients that require surgery need to be transferred to a tertiary surgical NICU. In recent years, the sense that an increasing number of patients transferred to surgical centres had no clear surgical indication has arisen. In addition neonatal surgical bed capacity is under constant strain. Materials & Methods: Our aim was to quantify the number of babies referred for NEC who were transferred directly to neonatal surgical units in London and to see what proportion of these had a clear need for surgery and proceeded to have surgical intervention. The Neonatal Transfer Service (NTS) provides neonatal transfers across London. In this observational retrospective study, we collected data from 66 babies who were transferred with the diagnosis or suspicion of necrotising enterocolitis between July 2012 and June 2013. We recorded if the receiving hospital was a tertiary level medical NICU or a tertiary surgical unit, the clinical and abdominal X-ray findings in the referring hospital, the transport events, whether the baby needed surgical treatment and the mortality. We also compared the referral patterns between 2 epochs; July 2012-June 2013 versus January 2011-December 2011. Clinical Cases or Summary Results: All babies (100%) with suspected NEC were transferred to tertiary surgical NICUs. 31/66 (47%) did not require surgical intervention and were successfully managed with medical treatment only. 35/66 (53%) underwent surgery in the receiving hospital. Conclusions: We have noted a high number of transfers into surgical units of infants with confirmed or suspected NEC that had no indication for surgery at the time of referral or transfer and did not go on to have surgery. Our results suggest that referral patterns could be modified to optimize surgical cot usage. In recent years clinicians have started referring patients with NEC who may not necessarily have indications for surgery into surgical units for joint medical and surgical oversight. However surgical bed pressure has increased as a consequence. Depending on careful clinical assessment and review of the abdominal X-ray, a more informed decision can be made as to whether an infant with suspected NEC needs to be transferred to a tertiary medical or surgical unit. Guidelines on indication for transfer in surgical patients could be effective in avoiding unnecessary transports to surgical centres. EMTREE DRUG INDEX TERMS recombinant erythropoietin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) baby necrotizing enterocolitis perinatal care EMTREE MEDICAL INDEX TERMS abdominal radiography clinical assessment diagnosis emergency enterocolitis hospital hospital bed capacity human infant intensive care unit morbidity mortality newborn intensive care patient prematurity retrospective study surgery surgical patient therapy United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71505022 DOI 10.3109/14767058.2014.924236 FULL TEXT LINK http://dx.doi.org/10.3109/14767058.2014.924236 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 294 TITLE Transferring critically ill patients home to die: Scoping the potential population AUTHOR NAMES Darlington A.-S. Long-Sutehall T. Richardson A. Coombs M. AUTHOR ADDRESSES (Darlington A.-S.; Long-Sutehall T.; Richardson A.; Coombs M.) University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom. (Coombs M.) Victoria University, Wellington, New Zealand. CORRESPONDENCE ADDRESS A.-S. Darlington, University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom. SOURCE Palliative Medicine (2014) 28:6 (570). Date of Publication: June 2014 CONFERENCE NAME 8th World Research Congress of the European Association for Palliative Care, EAPC 2014 CONFERENCE LOCATION Lleida, Spain CONFERENCE DATE 2014-06-05 to 2014-06-07 ISSN 0269-2163 BOOK PUBLISHER SAGE Publications Ltd ABSTRACT Aims: Transfer home to die from critical care is rare, despite policy supporting the implementation of patient choice regarding preferred place of care at end of life. A retrospective 12-month audit of patients, who died in critical care, was undertaken to determine the size and profile of the population who could potentially, if they wished, be transferred home to die. Methods: A cohort of patients from ten critical care areas (Intensive Care Units (ICU) and High Dependency Units (HDU)) from 2 hospitals in England who died in 2011 was investigated. A proforma was developed, collecting data on physiological (e.g sudden death, clinical stability) and care variables (e.g. intense manual handling, high gastrointestinal losses). Results: From an original sample of patients (n=7844) 422 were decedents. The majority of the deceased were judged as being unsuitable for transfer home due to: sudden death (14.7%), clinical instability (53.3%) or requiring complex care (8.3%). 100 (23.7%) patients were identified as potentially eligible for transfer: 53% of patients were conscious, and 20% were ventilated via an endotracheal tube. The majority of patients had been diagnosed with respiratory (41%), neurological (19%) or cardiac disease (19%). The mean time between discussion about withdrawal of treatment with family and time of death was 36.4 hours. Patients judged eligible for transfer were statistically significantly more likely to be treated in HDU than ITU compared to patients who were excluded (Chi2=19.80, p=0.00) and had less intensive nursing care needs. Conclusions: This is the first study to establish the potential size and profile of patients who might possibly be suitable for transfer home to die from critical care. Although patient and family wishes were not ascertained, the data gives an indication of the potential population for transfer. For those patients who express a wish to be transferred home mechanisms need to be in place to facilitate this practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient human palliative therapy population EMTREE MEDICAL INDEX TERMS book clinical audit endotracheal tube heart disease hospital intensive care intensive care unit nursing care patient policy sudden death time of death United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71484246 DOI 10.1177/0269216314532748 FULL TEXT LINK http://dx.doi.org/10.1177/0269216314532748 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 295 TITLE Direct admission to a pacing centre of patients who present urgently for pacing: Retrospective modelling study of feasibility, potential savings and indicators of suitability for direct transfer AUTHOR NAMES Dewhurst M. Di Marco L. McComb J. AUTHOR ADDRESSES (Dewhurst M.; McComb J.) Freeman Hospital, United Kingdom. (Di Marco L.) INSIGNIO Institute for In silico Medicine, United Kingdom. CORRESPONDENCE ADDRESS M. Dewhurst, Freeman Hospital, United Kingdom. SOURCE Heart (2014) 100 SUPPL. 3. Date of Publication: June 2014 CONFERENCE NAME British Cardiovascular Society Annual Conference 2014 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2014-06-02 to 2014-06-04 ISSN 1355-6037 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Introduction Patients with symptoms consistent with bradycardia suggesting the need for permanent pacing who present to the emergency department in our city are admitted to a coronary care unit in one hospital and then transferred to a pacing centre in another. We investigated the potential for direct admission to our regional pacing centre and indicators of suitability. Methods We undertook a retrospective observational study of patients who were referred urgently for pacing from one referring hospital to a pacing centre within the same city. Hospital records were reviewed for 138 consecutive patients over a 3 year period from April 2009-12 to determine indicators for suitability for direct admission to the pacing centre (based on symptoms, initial electrocardiogram and comorbidities). We also estimated potential hospital bed day savings, and in hospital complications that might have been avoided if the patient had been admitted directly to the pacing centre, and paced within 24 h. Results 134/138 patients had sufficient data for analysis. The indication for pacing was AV block (AVB) in 60%, atrial fibrillation (AF) in 23%, sinus node disease (SND) in 16% and carotid hypersensitivity in 1. 87 patients had bradycardia <50 bpm on presentation; 75 (86%) were suitable for direct admission; 12 had co-morbidities, the majority either injury or infection, precluding early pacing, and the pacing indication was not immediately obvious in 3. 45 had a HR >50 bpm; 7 (16%) were suitable for direct admission, 5 had co-morbidity and in 33 diagnosis was not obvious. The heart rate at presentation was unknown in 6; 1 was suitable for direct admission, 1 had an infection and the diagnosis was not obvious in 4. Overall, 60% were considered suitable for direct admission from an emergency department to a pacing centre. Had these patients been admitted directly, 4.2 bed days per patient could have been saved, in addition to avoiding 4 temporary pacing wire placements and a bradycardia-related VT arrest. Predictors of suitability for direct transfer are shown in Tables 1 and 2. Significant indicators of suitability for direct transfer to a pacing centre Odds ratios of heart rate <47 bpm and high grade AV block on presenting ECG predicting The predictive ability of the clinical variables used according to multivariable linear regression analysis was 91.7%. Conclusions The indication for pacing is obvious at presentation in the majority of patients who undergo non elective pacing. Triage to a pacing centre should be possible at presentation to an emergency department, using criteria including initial heart rate (≤50 bpm), high grade AVB and lack of co-morbidity, particularly infection or trauma, requiring urgent management in two thirds of patients. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human model patient society EMTREE MEDICAL INDEX TERMS atrial fibrillation atrioventricular block bradycardia carotid artery city coronary care unit diagnosis electrocardiogram emergency health service emergency ward heart rate hospital hospital bed hypersensitivity infection injury linear regression analysis medical record morbidity non implantable urine incontinence electrical stimulator observational study risk sinus node disease LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71560965 DOI 10.1136/heartjnl-2014-306118.25 FULL TEXT LINK http://dx.doi.org/10.1136/heartjnl-2014-306118.25 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 296 TITLE Has the implementation of network antenatal referral pathways decreased ex-utero transfers of the extreme preterm infant? AUTHOR NAMES Kumar R. Philpott A. AUTHOR ADDRESSES (Kumar R.; Philpott A.) West Midlands Neonatal Transfer Service, West Midlands, United Kingdom. CORRESPONDENCE ADDRESS R. Kumar, West Midlands Neonatal Transfer Service, West Midlands, United Kingdom. SOURCE Archives of Disease in Childhood: Fetal and Neonatal Edition (2014) 99 SUPPL. 1 (A69-A70). Date of Publication: June 2014 CONFERENCE NAME Perinatal Medicine 2014 CONFERENCE LOCATION Harrogate, United Kingdom CONFERENCE DATE 2014-06-09 to 2014-06-11 ISSN 1359-2998 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background The West Midlands Neonatal Transfer Service (WMNTS) is commissioned to transfer babies between designated neonatal intensive care (NICU), local neonatal (LNU) and special care units (SCU) in two neighbouring operational delivery networks (ODNs). The DoH Toolkit (2009) recommended that extreme preterm babies of less than 27 weeks gestation should not be delivered in LNUs or SCUs unless there are extenuating circumstances. This recommendation had been in place in the region since 2007. Aims •To report on transfer activity of extremely preterm infants (<27 weeks gestation) since implementation of antenatal care pathways •To compare ex-utero transfers between networks. Data Collection: Retrospective data analysis of WMNTS Excel© database (2009-2013) by a single investigator Results There has been no significant decrease in the number of extreme preterm infants transferred by WMNTS from LNUs and SCUs over the 5 year period (Figure 1). Analysing by ODNs we report a decrease in ex-utero transfer in ODN 1 compared with ODN 2 over the study period (Figure 2). (Figure presented) Conclusion In the study period there is no overall decrease in ex-utero referrals numbers. However, there is a difference in the change of referral rates between the two networks and further work is necessary to understand this. Possible hypotheses include lack of maternity and obstetric capacity in NICUs, lack of understanding of referral patterns, and different rates of antenatal complications, preventing in-utero transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human infant perinatal care prematurity EMTREE MEDICAL INDEX TERMS baby data analysis data base hypothesis information processing intensive care unit newborn intensive care pregnancy prenatal care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71561371 DOI 10.1136/archdischild-2014-306576.199 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2014-306576.199 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 297 TITLE Intrafacility transportation of patients with acute brain injury AUTHOR NAMES Tu H. AUTHOR ADDRESSES (Tu H., hsinfentu@yahoo.com) Questions or comments about this article may be directed to Hsinfen Tu, RN MSN MSN-Ed, at . She is a Staff Nurse at the Neurotrauma Intensive Care Unit, Hartford Hospital, and Clinical Instructor at Capital Community College, Hartford, CT SOURCE The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses (2014) 46:3 (E12-E16). Date of Publication: 1 Jun 2014 ISSN 1945-2810 (electronic) ABSTRACT Patients with acute brain injury (ABI) frequently require diagnostic and therapeutic procedures in the areas located outside of the intensive care unit. Transports can be risky for critically ill patients with ABI. Secondary brain injury can occur during the transport from causes such as ischemia, hypotension, hypoxia, hypercapnia, and cerebral edema. Preparation and implementation of preventive procedures including pretransport assessment, monitoring during transport, and posttransport examination and documentation for transports of patients with ABI deem to be necessary. The purpose of this article is to review the typical risks associated with the transports of the patients with ABI out of the intensive care unit and to propose the strategies that can be used to minimize the risks of secondary brain injury. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) standards EMTREE MEDICAL INDEX TERMS brain injury (therapy) critical illness human intensive care unit neuroscience nursing nursing organization and management patient transport risk assessment risk management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24796477 (http://www.ncbi.nlm.nih.gov/pubmed/24796477) PUI L601988756 DOI 10.1097/JNN.0000000000000055 FULL TEXT LINK http://dx.doi.org/10.1097/JNN.0000000000000055 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 298 TITLE Exploration of transfer anxiety of patients transferred from a hyper acute stroke unit to a stroke ward: A pilot study of participants following the London Stroke Care Pathway AUTHOR NAMES Brooke J.M. Lusher J. AUTHOR ADDRESSES (Brooke J.M.) University of Greenwich, London, United Kingdom. (Lusher J.) London Metropolitan University, London, United Kingdom. CORRESPONDENCE ADDRESS J.M. Brooke, University of Greenwich, London, United Kingdom. SOURCE Cerebrovascular Diseases (2014) 37 Supplement 1 (315). Date of Publication: 1 May 2014 CONFERENCE NAME 23th European Stroke Conference CONFERENCE LOCATION Nice, France CONFERENCE DATE 2014-05-06 to 2014-05-09 ISSN 1421-9786 BOOK PUBLISHER S. Karger AG ABSTRACT Background The psychological and physical problems experienced by patients and their family members on transferring from a critical care setting to a general ward have been well defined and termed 'transfer anxiety'. Interventions to reduce transfer anxiety have been successfully implemented for patients and their family members. Currently there is no data available on transfer anxiety for patients following transfer from a hyper acute stroke unit to a stroke ward. This study set out to explore this issue. Methods Data were collected from a purposive pilot sample (n=6) from a London stroke ward. Semi-structured interviews were carried out to determine stroke survivors' experience of transfer from a hyper acute stroke unit to a stroke ward. The interview schedule was based on published literature and revised by a stroke patient and a clinical nurse specialist. Interviews were conducted during October-December 2012. Participants were interviewed within 48 hours of admission to a stroke ward. Data were analysed using Interpretative Phenomenological Analysis. Results: Two participants reported receiving explicit information from doctors on the reason for their transfer to the stroke ward; the remaining participants reported receiving no information. All participants had cognitively explored their transfer to understand the process. Four emergent themes from IPA included; attachment to staff on the hyper acute stroke unit, lack of empowerment regarding the transfer process, need for physiotherapy as a form of acceptance of transfer and isolation from staff following transfer. Discussion: Elements of transfer anxiety were identified, including emotional attachment to and then isolation from the nurses. This study suggests transfer anxiety may differ from patients being transfer from a critical care setting because of the need for and extensive completion of physiotherapy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety England pilot study stroke patient stroke unit EMTREE MEDICAL INDEX TERMS clinical article clinical nurse specialist doctor patient relation emotional attachment empowerment human physiotherapy semi structured interview survivor LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614325868 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 299 TITLE Criteria for transfer to tertiary trauma centers: Validation phase based on the severity of cases treated in tertiary centers AUTHOR NAMES Le Sage N. Lavoie A. Moore L. Verreault R. Emond M. AUTHOR ADDRESSES (Le Sage N.; Lavoie A.; Moore L.; Verreault R.; Emond M.) Université Laval, Québec, Canada. CORRESPONDENCE ADDRESS N. Le Sage, Université Laval, Québec, Canada. SOURCE Canadian Journal of Emergency Medicine (2014) 16 SUPPL. 1 (S21). Date of Publication: May 2014 CONFERENCE NAME 2014 CAEP/ACMU CONFERENCE LOCATION Ottawa, ON, Canada CONFERENCE DATE 2014-05-31 to 2014-06-04 ISSN 1481-8035 BOOK PUBLISHER Decker Publishing ABSTRACT Introduction: Recently, a consensus on the indications for transfer to a tertiary trauma center was obtained from 83 experts representing four disciplines (emergency medicine, surgery, neurosurgery and intensive care) who are involved within the integrated trauma system. This study aims to statistically validate these indications for patient transfer. Methods: Each criteria was converted into a consensus indicator in order to enable a statistical validation using a trauma registry. The study population consisted of all patients in the registry who were directly transported to a tertiary care center between 1998 and 2008. We compared the rate of intrahospital death, admission to intensive care unit and intrahospital complications in patients responding to either of the criteria over those not meeting the criteria. Results: Data from 27 480 major trauma patients were analyzed. The risk of death, ICU admission and severe complications [CI 95%] of patients responding to either of the criteria of consensus is higher than that of patients with no criteria (respectively RR = 6.1 [5.5-6.7], 3.9 [3.8-4.1] and 2.8 [2.6-2.9]). Each individual criteria significantly increases the risk of death (p < 0.001) with the exception of spinal injury, an entity that is most often a single trauma not putting the patient's life in danger. Conclusion: These results suggest that the criteria are valid injury severity indicators and that these patients require a higher level of care. However, they also need to be validated on the ability of transfer to improve the prognosis of these patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service injury EMTREE MEDICAL INDEX TERMS consensus death emergency medicine human injury severity intensive care intensive care unit neurosurgery patient patient transport population prognosis register risk spine injury surgery tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71929674 DOI 10.1017/S1481803500003171 FULL TEXT LINK http://dx.doi.org/10.1017/S1481803500003171 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 300 TITLE Criteria for transfer to tertiary trauma centers: validation phase based on the severity of cases treated in tertiary centers AUTHOR NAMES Sage N. L. Lavoie A. Moore L. Verreault R. Emond M. AUTHOR ADDRESSES (Sage N. L.; Lavoie A.; Moore L.; Verreault R.; Emond M.) Université Laval, Québec, Canada. SOURCE Canadian Journal of Emergency Medicine (2014) 16 Suppl1 (S21). Date of Publication: May 2014 CONFERENCE NAME 2014 CAEP/ACMU Scientific Abstracts, CAEP 2014 CONFERENCE LOCATION Ottawa, ON, Canada CONFERENCE DATE 2014-05-31 to 2014-06-04 ISSN 1481-8035 1481-8043 (electronic) ABSTRACT Introduction: Recently, a consensus on the indications for transfer to a tertiary trauma center was obtained from 83 experts representing four disciplines (emergency medicine, surgery, neurosurgery and intensive care) who are involved within the integrated trauma system. This study aims to statistically validate these indications for patient transfer. Methods: Each criteria was converted into a consensus indicator in order to enable a statistical validation using a trauma registry. The study population consisted of all patients in the registry who were directly transported to a tertiary care center between 1998 and 2008. We compared the rate of intrahospital death, admission to intensive care unit and intrahospital complications in patients responding to either of the criteria over those not meeting the criteria. Results: Data from 27 480 major trauma patients were analyzed. The risk of death, ICU admission and severe complications [CI 95%] of patients responding to either of the criteria of consensus is higher than that of patients with no criteria (respectively RR = 6.1 [5.5-6.7], 3.9 [3.8-4.1] and 2.8 [2.6-2.9]). Each individual criteria significantly increases the risk of death (p < 0.001) with the exception of spinal injury, an entity that is most often a single trauma not putting the patient’s life in danger. Conclusion: These results suggest that the criteria are valid injury severity indicators and that these patients require a higher level of care. However, they also need to be validated on the ability of transfer to improve the prognosis of these patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service EMTREE MEDICAL INDEX TERMS consensus death emergency medicine human injury injury severity intensive care intensive care unit neurosurgery patient patient transport population prognosis register risk spine injury surgery tertiary care center LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L75006827 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 301 TITLE The utility of tracking patients transferred within 24 hours of admission from a hospital ward to an intensive care unit as a marker for emergency department quality of care AUTHOR NAMES Solano J.J. Anderson P. Wolfe R.E. Dubosh N. Edlow J. Grossman S. AUTHOR ADDRESSES (Solano J.J.; Anderson P.; Wolfe R.E.; Dubosh N.; Edlow J.; Grossman S.) Beth Israel Deaconess Medical Center, Boston, United States. CORRESPONDENCE ADDRESS J.J. Solano, Beth Israel Deaconess Medical Center, Boston, United States. SOURCE Academic Emergency Medicine (2014) 21:5 SUPPL. 1 (S288-S289). Date of Publication: May 2014 CONFERENCE NAME 2014 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2014 CONFERENCE LOCATION Dallas, TX, United States CONFERENCE DATE 2014-05-13 to 2014-05-17 ISSN 1069-6563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Prior studies suggest 4% of hospitalized patients suffer adverse events of which 60% are preventable. However, metrics of error and adverse events are lacking. Markers, such as 72-hour returns to the ED resulting in admission, have shown error rates ranging from 0.2 to 4%, with 0.4 to 1% resulting in changes in outcome. Unplanned transfer to the ICU has been implicated as a possible source of preventable error, with an error rate of up to 19%. Objectives: To investigate the utility of tracking patients transferred to the ICU <24 hours after admission from the ED as a marker of preventable errors and adverse events. Methods: From 11/11-3/13, we prospectively collected data for all patients presenting to an urban, tertiary care academic ED (annual volume of 57,000 patients) using an automated electronic tracking system to identify ED patients who were admitted to a hospital ward and then transferred to the ICU within 24 hours. Cases were randomly assigned to physicians not involved with the patients' care for review. We designed a structured tool with an eight-point Likert scale to determine presence of error and adverse events. If a reviewer felt that a possible error and adverse event resulted in the need for intervention, additional treatment, or caused patient harm, a 20-member QA committee of ED physicians and nurses met to determine definitively whether an error and adverse event had occurred. Results: Of 29,925 ward admissions, 325 (1%) patients were subsequently transferred to the ICU within 24 hours of ED presentation. The mean age of these patients was 64 and 50.5% were male; (18%) were then referred to the QA committee for review. Total rate of adverse events regardless of whether or not an error occurred was 4.3%, 14/325 (95% CI 2.09% to 6.51%). Preventable error on the part of the ED was 3.7%, 12/325 (95% CI 1.65 to 5.75%) and associated with an ED-triggered adverse event in 1.8%, 6/325 (95% CI 0.35% to 3.25%). Remaining preventable errors were considered to be “near misses.” Conclusion: Tracking patients admitted to the hospital from the ED who are transferred to the ICU <24 hours after admission may be a valuable marker for adverse events and preventable errors in the ED. Additional studies may better understand the lower rates of error found in our study and differentiate types of clinical error which put patients most at risk for transfer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine emergency ward human intensive care unit patient society ward EMTREE MEDICAL INDEX TERMS hospital hospital patient Likert scale male nurse patient harm physician risk tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71470004 DOI 10.1111/acem.12365 FULL TEXT LINK http://dx.doi.org/10.1111/acem.12365 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 302 TITLE Validation of the children's hospital early warning scoring system for identifying hospitalized children at risk for arrest or ICU transfer AUTHOR NAMES McLellan M. Gauvreau K. Connor J.A. AUTHOR ADDRESSES (McLellan M.; Gauvreau K.; Connor J.A.) Cardiovascular Program, Boston Children's Hospital, Boston, United States. CORRESPONDENCE ADDRESS M. McLellan, Cardiovascular Program, Boston Children's Hospital, Boston, United States. SOURCE Pediatric Critical Care Medicine (2014) 15:4 SUPPL. 1 (30). Date of Publication: May 2014 CONFERENCE NAME 7th World Congress on Pediatric Intensive and Critical Care, PICC 2014 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2014-05-04 to 2014-05-07 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and aims: Most inpatient pediatric arrests are preventable through early recognition/treatment of deterioration. Early warning scoring systems provide early identification of at risk children. The CHEWS system was developed, implemented and validated at a single academic pediatric hospital. Nurses assess patients' CHEWS scores during vital signs. Based upon score, an algorithm directs: routine care (score 0-2), increased assessment/intervention (3-4), or ICU consult/transfer (≥5). Aims: To validate the Children's Hospital Early Warning Score (CHEWS) tool and algorithm for identifying hospitalized children at risk for cardiopulmonary arrest or ICU transfer. Methods: A retrospective chart review was performed on a patient cohort admitted to inpatient units over 12 months who experienced arrest / unplanned ICU transfer (n=360) and a randomly selected comparison sample (n=776). Documented CHEWS scores and abstracted Brighton Pediatric Early Warning Scores (PEWS) were used to calculate sensitivity, specificity, negative and positive predictive values and area under the receiver operating characteristic curves (ROC) to measure discrimination. IRB approval was obtained. Results: The ROC for CHEWS was 0.902 compared to PEWS 0.798. The mean lead time prior to event was 3.8 hours for CHEWS versus 0.6 hours for PEWS (p < 0.001). CHEWS algorithm sensitivity was 97.8 (for score ≥2), 84.2 (≥4) and 75.6 (≥5) versus PEWS of 82.8 (≥2), 54.4 (≥4), and 38.9 (≥5). CHEWS specificity was 52.5 (≥2), 80.9 (≥4), and 88.5 (≥5) versus PEWS of 63.7 (≥ 2), 85.3 (≥4) and 93.9 (≥5). Conclusions: The CHEWS system demonstrated higher discrimination, higher sensitivity and longer lead time than PEWS for identifying hospitalized children at risk for arrest or unplanned ICU transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospitalized child human intensive care pediatric hospital risk scoring system EMTREE MEDICAL INDEX TERMS algorithm cardiopulmonary arrest child deterioration hospital patient medical record review nurse patient predictive value receiver operating characteristic vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71625928 DOI 10.1097/01.pcc.0000448836.27923.e3 FULL TEXT LINK http://dx.doi.org/10.1097/01.pcc.0000448836.27923.e3 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 303 TITLE Specialized pediatric critical care vs rapid EMS transport of trauma patients AUTHOR NAMES Garlick J. Melguizo-Castro M. Keen P. Nick T. Stroud M. AUTHOR ADDRESSES (Garlick J.; Melguizo-Castro M.; Keen P.; Nick T.; Stroud M.) Critical Care, Arkansas Childrens Hospital, Little Rock, United States. CORRESPONDENCE ADDRESS J. Garlick, Critical Care, Arkansas Childrens Hospital, Little Rock, United States. SOURCE Pediatric Critical Care Medicine (2014) 15:4 SUPPL. 1 (175-176). Date of Publication: May 2014 CONFERENCE NAME 7th World Congress on Pediatric Intensive and Critical Care, PICC 2014 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2014-05-04 to 2014-05-07 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and aims: The use of specialized pediatric transport teams has been shown to reduce adverse events and lower mortality rates in children with medical illness. Rapid transport of trauma patients requiring surgical intervention to tertiary care centers is intuitive; however, the specialized care provided by pediatric transport teams may be beneficial in subsets of trauma patients. Aims: Improved care during transport may be more advantageous than rapid transport in pediatric trauma patients not requiring immediate surgical intervention. Methods: Data was collected on all pediatric trauma patients transported between January2007-December2011 to Arkansas Children's Hospital (ACH). Demographic data, vital signs, mortality scores, required interventions, and injury-severity scores (ISS) were compared between patients transported by a specialized pediatric team at ACH and state EMS services. Results: Univariate analysis showed that trauma patients transported by a specialized team had shorter Length of Stay (LOS), shorter ED LOS, and a higher probability of survival. Multivariate analysis, adjusting for age and ISS, revealed a significantly different ED LOS with patients transported by EMS teams spending an average of 0.67 (95% CI 0.65-0.68) hours longer in the ED. Conclusions: Trauma patients transported by a specialized team spent significantly less time in the ED prior to admission [2.5h(3.2 } 3.9) vs 2.3h(2.6 } 2.2) P<0.001], Improved care during transport, resulting in enhanced resuscitation, may decrease time spent in the ED, thus expediting appropriate ongoing care and rationing ED resources. Future evaluations will determine if differences exist in subsets of trauma patients and if the number of interventions during transport differs among specialized pediatric teams versus EMS teams. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human injury intensive care patient EMTREE MEDICAL INDEX TERMS child childhood injury diseases injury scale length of stay mortality multivariate analysis pediatric hospital resuscitation surgery survival tertiary care center United States univariate analysis vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71626602 DOI 10.1097/01.pcc.0000449510.15567.6e FULL TEXT LINK http://dx.doi.org/10.1097/01.pcc.0000449510.15567.6e COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 304 TITLE Characteristics and disposition of children who undergo intraosseous placement before transport AUTHOR NAMES Reuter-Rice K. AUTHOR ADDRESSES (Reuter-Rice K.) Nursing Medicine Dept. of Pediatrics, Duke University, Durham, United States. CORRESPONDENCE ADDRESS K. Reuter-Rice, Nursing Medicine Dept. of Pediatrics, Duke University, Durham, United States. SOURCE Pediatric Critical Care Medicine (2014) 15:4 SUPPL. 1 (186). Date of Publication: May 2014 CONFERENCE NAME 7th World Congress on Pediatric Intensive and Critical Care, PICC 2014 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2014-05-04 to 2014-05-07 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and aims: The use of intraosseous (IO) needles as an access for resuscitation in pediatric advance life support has led to more pediatric patients being transported with IO needles in place. It would be reasonable to expect that the disposition of these patients would be admission to the intensive care unit, but to date there have been no studies to support this supposition. Aims: To determine the characteristics and disposition of children following IO needle placement referred for transport from an outlying facility. Methods: A retrospective review of the transport database from 1993-2009 of pediatric patients who had an IO as a part of their care. The IRB waived the need for consent. Results: 143 children were transported to a level 1 trauma tertiary care children's hospital from 25 referral facilities. Patients were 65% male and 35% female with a mean age of 1.20 years (range 0.01-13 years). All had IO's placed placed by pre-hospital providers, the referral facility, or the transport team. Of the 143 patients transported, 53% were placed for no intravenous access and 34% were placed for no perfusing rhythm. Most common reason for admission to the hospital was combined system failure with 79% of patients admitted to the pediatric intensive care. Of those hospitalized, 58% were discharged home. Conclusions: IO placement is a life-saving measure with most IOs placed by referring facilities prior to transport and few reported complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child human intensive care EMTREE MEDICAL INDEX TERMS aspiration needle data base female hospital injury intensive care unit male needle patient pediatric hospital resuscitation rhythm tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71626652 DOI 10.1097/01.pcc.0000449560.90017.56 FULL TEXT LINK http://dx.doi.org/10.1097/01.pcc.0000449560.90017.56 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 305 TITLE Usage of osmotherapy during paediatric critical care transport AUTHOR NAMES Clarke A. Lutman D. Ramnarayan P. AUTHOR ADDRESSES (Clarke A.; Lutman D.; Ramnarayan P.) Childrens Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS A. Clarke, Childrens Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. SOURCE Pediatric Critical Care Medicine (2014) 15:4 SUPPL. 1 (72). Date of Publication: May 2014 CONFERENCE NAME 7th World Congress on Pediatric Intensive and Critical Care, PICC 2014 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2014-05-04 to 2014-05-07 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and aims: Administration of high osmolarity solutions (hypertonic saline (HS) or mannitol) is one of a number of interventions to treat raised intracranial pressure. These are commonly used in an intensive care environment with intracranial monitoring to assess response, but this is rarely available in a retrieval setting. Aims: We report the usage of hyperosmotic solutions by a dedicated critical care transport team in the UK. Methods: Retrospective audit of all patients who received either hypertonic saline or mannitol for treatment of raised intracranial pressure. The local audit department approved data collection. Results: Between April 2009 and June 2013, 168 patients received 235 doses of osmotherapy. The mean age and weight was 5.8 yrs (range 1 day-16yrs) and 23.0kg (2.4-70kg). Common diagnoses were meningoencephalitis, traumatic brain injury (TBI) and diabetic ketoacidosis (DKA) (27%, 22% and 12% of doses respectively). Different agents are preferred with different diagnoses, and there appear to have been temporal changes in use over the last 4 years (figure). In patients requiring multiple doses, both agents are initially used equally, but hypertonic saline is preferred for subsequent doses (Mannitol vs HS: 1st dose 51% vs 49%, 2nd dose 18% vs 81%, 3rd dose 31% vs 69%). Conclusions: This audit describes use of osmotherapy in an exclusively retrieval setting in the UK. In TBI, HS is the preferred agent, practice having changed in 2010. In meningoencephalitis and DKA, although there may have been preferences previously, most currently both agents are used equally. There were no adverse incidents associated with osmotherapy in this audit. EMTREE DRUG INDEX TERMS mannitol sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS clinical audit diabetic ketoacidosis diagnosis environment human information processing intracranial pressure meningoencephalitis monitoring multiple drug dose osmolarity patient traumatic brain injury United Kingdom weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71626123 DOI 10.1097/01.pcc.0000449031.74556.01 FULL TEXT LINK http://dx.doi.org/10.1097/01.pcc.0000449031.74556.01 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 306 TITLE Neonatal pain and COMT RS4680 genotype in relation to serotonin transporter (SLC6A4) promoter methylation in very preterm children at school age AUTHOR NAMES Chau C.M.Y. Ranger M. Devlin A. Oberlander T.F. Grunau R.E. AUTHOR ADDRESSES (Chau C.M.Y.; Ranger M.; Oberlander T.F.; Grunau R.E.) Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, Canada. (Ranger M.; Devlin A.; Oberlander T.F.; Grunau R.E.) Pediatrics, University of British Columbia, Vancouver, Canada. (Devlin A.) Diabetes, Nutrition and Metabolism, Child and Family Research Institute, Vancouver, Canada. CORRESPONDENCE ADDRESS C.M.Y. Chau, Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, Canada. SOURCE Pain Research and Management (2014) 19:3 (e67-e68). Date of Publication: May-June 2014 CONFERENCE NAME 35th Annual Scientific Meeting of the Canadian Pain Society CONFERENCE LOCATION Quebec City, QC, Canada CONFERENCE DATE 2014-05-20 to 2014-05-23 ISSN 1203-6765 BOOK PUBLISHER Pulsus Group Inc. ABSTRACT AIM: Children born very preterm are exposed to repeated neonatal procedural pain-related stress during Hospitalization in the neonatal intensive care unit (NICU). The COMT rs4680 genotype is involved with pain sensitivity, and early life stress is implicated in altered methylation level of the serotonin transporter. We examined: (1) whether methylation of serotonin transporter (SLC6A4) promoter differs between very preterm children and full-term controls at school age, (2) relationships with child behavior problems, and (3) the extent of COMT rs4680 genotypes modulated the association between neonatal pain exposure and SLC6A4 methylation at seven years in the very preterm children. METHODS: Participants comprised n=111 children, 61 born very preterm (24 to 32 weeks gestation), and 50 control children born full-term, all seen at mean age 7.8 years (SD 0.65 years). SLC6A4 and COMT rs4680 were genotyped from saliva DNA. SLC6A4 methylation was quantified by bisulfite pyrosequencing. Generalized linear modeling was used to examine associations between the COMT genotypes, neonatal pain exposure (adjusted for medical confounders), SLC6A4 methylation, and child behavioral problems. RESULTS: Very preterm children had higher methylation at 7 of 10 CpG sites in the SLC6A4 promoter compared to full-terms at age seven years. Greater neonatal pain (adjusted for medical confounders) was associated with higher Total child behavior problem score on the Child Behavior Checklist (CBCL) questionnaire (adjusted for concurrent stressors and 5HTTLPR genotype) (P=0.035). Higher CBCL total problem was associated with greater SLC6A4 methylation in very preterm children (P=0.01). In COMT Met/Met children, greater neonatal pain (adjusted for medical confounders) was associated with reduced methylation of SLC6A4 promoter (P=0.001). CONCLUSIONS: We demonstrated a complex relationship between early exposure to highly stressful environmental events that induce repeated pain, child genotype reflecting pain sensitivity, and epigenetic modifications in children born during a critically sensitive developmental period. These findings provide evidence that both genetic predisposition and early environment need to be considered in understanding susceptibility for developing behavioral problems in this vulnerable population. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) serotonin transporter EMTREE DRUG INDEX TERMS bisulfite DNA EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child genotype human methylation pain prematurity promoter region school society EMTREE MEDICAL INDEX TERMS behavior disorder child behavior Child Behavior Checklist early life stress environment exposure female genetic predisposition hospitalization intensive care unit model newborn intensive care nociception pregnancy pyrosequencing questionnaire saliva vulnerable population LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71607057 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 307 TITLE Remote paediatric critical care transport consultations: A review AUTHOR NAMES Tijssen J. Parshuram C. AUTHOR ADDRESSES (Tijssen J.) Paediatric Critical Care Medicine, Children's Hospital London, Health Sciences Centre, London, Canada. (Parshuram C.) Critical Care Medicine, Hospital for Sick Children, Toronto, Canada. CORRESPONDENCE ADDRESS J. Tijssen, Paediatric Critical Care Medicine, Children's Hospital London, Health Sciences Centre, London, Canada. SOURCE Pediatric Critical Care Medicine (2014) 15:4 SUPPL. 1 (218-219). Date of Publication: May 2014 CONFERENCE NAME 7th World Congress on Pediatric Intensive and Critical Care, PICC 2014 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2014-05-04 to 2014-05-07 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and aims: Formal evaluation of our provincial critical care telephone consultation system has not been performed. Aims: To describe the process of providing advice, the content of the advice, and the planned disposition for patients for which calls were placed to the ICU at Toronto's Hospital for Sick Children. Methods: We retrospectively reviewed 100 consecutive consultations in January 2012 and December 2011. Descriptive analyses (SAS v9.3) were performed for patient demographic data, time of day and duration of consultations, interruptions, clinical information discussed, and advice provided to describe the individual impact of timing, primary system, and planned disposition on the duration of calls, interruptions, and information discussed. Results: Patients with a mean (SD) age of 3.1 (4.6) years were from 30 hospitals, a mean (SD) of 62.2 (102.8) km away. Half of calls were made during the day. The median (IQR) duration of consultations was 15 (11-21) minutes. The primary problem system was respiratory in 42. Interruptions occurred in 94% of calls. Recommendations were made in more than 75% of consultations and 55 patients had a planned disposition to the ICU. The number of interruptions, time to disposition decision, and the total duration of calls were not associated with planned disposition and the primary system involved. Duration of calls during the night were shorter (p<0.001) but the number of interruptions was unchanged. Conclusions: The content, flow and duration of calls, and disposition decision were not affected by the patient's problem system or ICU admission plan. This demonstrates a consistent service despite many consulting physicians. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) consultation intensive care EMTREE MEDICAL INDEX TERMS child hospital human night patient physician teleconsultation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71626807 DOI 10.1097/01.pcc.0000449715.59042.84 FULL TEXT LINK http://dx.doi.org/10.1097/01.pcc.0000449715.59042.84 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 308 TITLE Frequency and reasons of “Futile” interhospital transfer for endovascular recanalization treatment in acute ischemic stroke. The madrid stroke network AUTHOR NAMES Fuentes B. Alonso De Leciñana M. Ximenez-Carrillo A. Martínez-Sánchez P. Cruz-Culebras A. Zapata G. Ruiz-Ares G. García-Pastor A. Gil-Nuñez A. Vivancos J. Masjuan J. Diez-Tejedor E. AUTHOR ADDRESSES (Fuentes B.; Martínez-Sánchez P.; Ruiz-Ares G.; Diez-Tejedor E.) La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain. (Alonso De Leciñana M.; Cruz-Culebras A.; Masjuan J.) Ramón y Cajal University Hospital, IRYCIS Reasearch Institute, Madrid, Spain. (Ximenez-Carrillo A.; Zapata G.; Vivancos J.) La Princesa University Hospital, IIS-Princesa Research Institute, Madrid, Spain. (García-Pastor A.; Gil-Nuñez A.) Gregorio Marañón University Hospital, IiSGM Health Research Institute, Madrid, Spain. CORRESPONDENCE ADDRESS B. Fuentes, La Paz University Hospital, IdiPAZ Health Research Institute, Madrid, Spain. SOURCE Cerebrovascular Diseases (2014) 37 Supplement 1 (98). Date of Publication: 1 May 2014 CONFERENCE NAME 23th European Stroke Conference CONFERENCE LOCATION Nice, France CONFERENCE DATE 2014-05-06 to 2014-05-09 ISSN 1421-9786 BOOK PUBLISHER S. Karger AG ABSTRACT Objectives: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke (IS) and the small number of patients eligible to that treatment justifies the development of Stroke Center networks with interhospital transfers. But it is possible that this approach generate “futile” transfers generating unnecessary costs. Our aim is to analyze the frequency of this fact, the reasons for rejection for ERT and to identify the possible associated factors. Methods: We analyzed a prospective registry of ERT from a Stroke Network integrated by three hospitals with a common stroke treatment protocol and a weekly rotatory shift with interhospital transference to the on-call center for ERT in those patients in whom this therapy is indicated. We analyzed: demographic data, vascular risk factors, stroke severity, frequency of prior intravenous thrombolysis, time from stroke onset and reasons for rejection. Results: ERT protocol was activated in 199 patients, receiving ERT 129 (64.8%). 120 (60.3%) patients required hospital transfer, of which 50 (41%) were not followed by ERT (futile transfer). There were no differences in age, vascular risk factors, times from stroke onset or times of interhospital transfer, baseline NIHSS, baseline ASPECTS or rates of prior intravenous thrombolysis compared transferred patients treated with ERT. Reasons for rejection were: clinical improvement or arterial recanalization (42%), findings in neuroimaging (ASPECTS <7 or no mismatch; 38%), clinical deterioration (9%), delay in shipment (2%), and revocation of consent (1%). There were no complications during intrahospital transfer. Conclusions: 40% of shipments for ERT are “futile”. None of the baseline patient characteristics predict this fact, being arterial recanalization and findings in neuroimaging test done in the hospital receiving the main reasons for ERT rejection. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia recanalization EMTREE MEDICAL INDEX TERMS artery blood clot lysis call center cardiovascular risk clinical protocol clinical trial controlled clinical trial controlled study demography deterioration hospital human major clinical study multicenter study National Institutes of Health Stroke Scale neuroimaging patient transport register revascularization transference LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614325636 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 309 TITLE To transfer or not transfer-the ethical and resources implications for transferring infants with a high risk of early death AUTHOR NAMES William Ibrahim T.M. Broster S. Kelsall W. AUTHOR ADDRESSES (William Ibrahim T.M.) Neonatal Intensive Care Unit and Acute Neonatal Transport Service, Cambridge University, Hospitals NHS Foundation Trust, Cambridge, United Kingdom. (Broster S.) Acute Neonatal Transport Service, Cambridge University, Hospitals NHS Foundation Trust, Cambridge, United Kingdom. (Kelsall W.) Neonatal Intensive Care Unit, Cambridge University, Hospitals NHS Foundation Trust, Cambridge, United Kingdom. CORRESPONDENCE ADDRESS T.M. William Ibrahim, Neonatal Intensive Care Unit and Acute Neonatal Transport Service, Cambridge University, Hospitals NHS Foundation Trust, Cambridge, United Kingdom. SOURCE Archives of Disease in Childhood (2014) 99 SUPPL. 1 (A54). Date of Publication: April 2014 CONFERENCE NAME Annual Conference of the Royal College of Paediatrics and Child Health, RCPCH 2014 CONFERENCE LOCATION Birmingham, United Kingdom CONFERENCE DATE 2014-04-08 to 2014-04-10 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background Over the last decade neonatal transport services (TS) have developed significantly as networks have been established. The responsibility of the TS is to transfer sick neonates for specialist care usually to level III units for medical or surgical treatment.1 Medical and nursing expertise in network units varies, with staff on neonatal tertiary intensive care units managing neonatal deaths more frequently. This study aims to review deaths across a single network particularly considering cases that were referred for transfer. Methods A retrospective review of neonatal deaths and the infants referred to the TS between January 2011 and December 2012. Data was collected from the network SEND and TS databases. Results Over 2 years there were approximately 150,000 live births in the network, with 1445 (1%) infants referred as an emergency for neonatal TS. There were 219 deaths with an overall mortality rate of 1.46 deaths per 1000 live births. The gestational age of babies who died was median 28 (range 23-41) weeks and birth weight 900 (400-3500) gram. Of these 219 babies 107 (49%) were referred for neonatal transfer. Of the referrals, 73 (68%) transfers were completed with 14 (19%) of these babies dying within 24 h, 13 (18%) dying between 24 - 48 h and 46 (63%) dying more than 48 h after transfer. Of the 34 cases that were not transferred 15 (44%) died before the TS was despatched, 18 (53%) were deemed too sick to transfer by the TS after arrival in the referring unit and 1 (3%) transfer was declined by the parents. Conclusion The study demonstrates that careful communication between TS and local consultants has avoided the unnecessary transfer of a small number of neonates in whom it was felt that death was inevitable. A small but significant number of transferred infants die within 24 h of transfer. It could be argued that these babies should not have been moved. However the reasons for transfer may be more complicated: with parents wanting everything possible done or local clinicians wanting to work with specialist centres in managing all aspects of care including a neonatal death. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health college death infant pediatrics risk EMTREE MEDICAL INDEX TERMS baby birth weight consultation data base emergency gestational age human intensive care unit interpersonal communication live birth medical specialist mortality newborn newborn death nursing expertise parent responsibility surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71566126 DOI 10.1136/archdischild-2014-306237.128 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2014-306237.128 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 310 TITLE Virulence and transferability of resistance determinants in a novel klebsiella pneumoniae sequence type 1137 in China AUTHOR NAMES Liu Y. Li X.-Y. Wan L.-G. Jiang W.-Y. Yang J.-H. Li F.-Q. AUTHOR ADDRESSES (Liu Y., ly13767160474@sina.com; Wan L.-G.) Department of Bacteriology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong Wai Zheng Jie No. 17, Nanchang 330006, China. (Li X.-Y.; Jiang W.-Y.; Yang J.-H.; Li F.-Q.) Department of Clinical Microbiology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou Medical College, Wenzhou, China. CORRESPONDENCE ADDRESS Y. Liu, Department of Bacteriology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong Wai Zheng Jie No. 17, Nanchang 330006, China. Email: ly13767160474@sina.com SOURCE Microbial Drug Resistance (2014) 20:2 (150-155). Date of Publication: 1 Apr 2014 ISSN 1931-8448 (electronic) 1076-6294 BOOK PUBLISHER Mary Ann Liebert Inc., info@liebertpub.com ABSTRACT A study was designed to characterize three carbapenemase-producing Klebsiella pneumoniae isolated from pediatric patients in China. Molecular characterization was done using polymerase chain reaction and sequencing for bla(VIM), bla(NDM), bla(IMP), bla(KPC), bla(CTX-Ms), bla(OXAs), bla(TEMs), and bla (SHV); plasmid-mediated quinolone resistance determinants; aminoglycoside resistance determinants; multilocus sequencing typing; plasmid replicon typing; addiction; and virulence factors. Kp32 belonged to the newly described sequence type 1137, were positive for aac(6′)-Ib-suzhou, qnrA1, qnrB4, qnrS1, aac(6′)-Ib, rmtB, armA, bla(SHV-12), bla (CTX-M-15), bla(KPC-2), and bla(IMP-4); contained IncA/C plasmids that tested positive for K1 capsular antigens, the ccdAB (coupled cell division locus) addiction system and the wabG, ureA, rmpA, magA, allS, fimH, and the aerobactin virulence factors. However, the others belonged to clone ST11, and were positive for aac(6′)-Ib-cr, qnrB4, bla (CTX-M-14), bla(SHV-11), aac(6′)-Ib, rmtB, and bla (KPC-2); contained IncFIA plasmids that tested positive for K2 capsular antigens, the vagCD addiction system and the uge, wabG, ureA, kfuBC, rpmA, and fimH virulence factors. ST1137 had more virulence factors than the comparative strains ST11. The bla(KPC-2) gene was located on the IncFIA and IncA/C replicon groups of plasmids. An analysis of the genetic environment of bla (KPC-2) gene has demonstrated that the bla(KPC-2) gene was always associated with one of the Tn4401 isoforms (a or b). Our study suggested that K. pneumoniae carbapenemases being found in virulent K. pneumoniae should be emphasized, as this will eventually become a global health threat. © 2014, Mary Ann Liebert, Inc. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carbapenemase EMTREE DRUG INDEX TERMS aerobactin amikacin aminoglycoside amoxicillin plus clavulanic acid aztreonam (drug therapy) beta lactamase cefoxitin ceftazidime ceftriaxone ciprofloxacin cotrimoxazole ertapenem etimicin (drug therapy) gentamicin imipenem meropenem (drug therapy) piperacillin plus tazobactam quinolone tobramycin virulence factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance bacterial gene bacterial virulence gene sequence Klebsiella pneumoniae Klebsiella pneumoniae sequence type 1137 EMTREE MEDICAL INDEX TERMS abdominal pain allele antibiotic sensitivity antibiotic therapy article bacteremia bacterial strain bacterium culture bacterium detection bacterium identification bacterium isolation blood culture burn unit case report central venous catheter child child hospitalization childhood disease (drug therapy) China communicable disease (drug therapy) emergency ward epsilometer test fever gene duplication gene locus hospital admission hospital infection hospitalization human indwelling catheter intensive care unit inverted repeat length of stay male mechanical ventilator minimum inhibitory concentration multilocus sequence typing nonhuman outcome assessment plasmid polymerase chain reaction preschool child priority journal pulsed field gel electrophoresis replicon restriction fragment length polymorphism sepsis (drug therapy) urinary tract infection urine culture CAS REGISTRY NUMBERS aerobactin (26198-65-2) amikacin (37517-28-5, 39831-55-5) amoxicillin plus clavulanic acid (74469-00-4, 79198-29-1) aztreonam (78110-38-0) beta lactamase (9073-60-3) cefoxitin (33564-30-6, 35607-66-0) ceftazidime (72558-82-8) ceftriaxone (73384-59-5, 74578-69-1) ciprofloxacin (85721-33-1) cotrimoxazole (8064-90-2) ertapenem (153773-82-1, 153832-38-3, 153832-46-3) etimicin (172450-93-0, 59711-96-5) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) imipenem (64221-86-9) meropenem (96036-03-2) tobramycin (32986-56-4) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Urology and Nephrology (28) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014210004 MEDLINE PMID 24236613 (http://www.ncbi.nlm.nih.gov/pubmed/24236613) PUI L372686260 DOI 10.1089/mdr.2013.0107 FULL TEXT LINK http://dx.doi.org/10.1089/mdr.2013.0107 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 311 TITLE Infections with resistant bacteria in hospitalized cirrhotic patients cause longer hospital stay and frequent ICU transfer AUTHOR NAMES Çelik G. Köksal R. Bedir F. Ata G. Özer M. Sancar S. Kilic¸ S. Özdoʇan O.C. AUTHOR ADDRESSES (Çelik G.; Bedir F.; Ata G.; Özer M.; Sancar S.; Kilic¸ S.) Marmara University, Medical School, Istanbul, Turkey. (Köksal R.; Özdoʇan O.C., osmanozdogan@yahoo.com) Gastroenterology and Hepatology, Marmara University, Medical School, Istanbul, Turkey. CORRESPONDENCE ADDRESS G. Çelik, Marmara University, Medical School, Istanbul, Turkey. SOURCE Journal of Hepatology (2014) 60:1 SUPPL. 1 (S216). Date of Publication: April 2014 CONFERENCE NAME 49th Annual Meeting of the European Association for the Study of the Liver, International Liver Congress 2014 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2014-04-09 to 2014-04-13 ISSN 0168-8278 BOOK PUBLISHER Elsevier ABSTRACT Background and Aims: The aim of this present study is to evaluate the bacterial resistance profiles and their effects on clinical situations and hospitalization duration in hospitalized cirrhotic patients. Methods: A total of 114 cirrhotic patients hospitalized in our unit between 2012 and 2013 were recruited from our Database. Demographic, clinical, laboratory data and culture results and resistance profiles, mortalities and hospitalization durations were included into the evaluation. Results: Forty-nine out of 114 (43.9%) patients were female, median age 58, main etiologies were HBV, HCV, alcohol and, cryptogenic. Forty-eight hospitalizations were related to infections inwhich 15 (31%) were “health-care related”, 21 (43%) were hospital-acquired infections. Thirty-six of 167 (21%)cultures were positive inwhich 18 cultures (50%) were resistant to at least two antibiotic groups. Main infection sides for the resistant bacteria were urinary (44%), blood (17%), sputum (11%), ascitic fluid (11%), and catheter (6%). Logistic regression analysis showed that male gender and oral nonabsorbable antibiotic prophylaxis have positive, and daily use of lactulose have negative impact on the development of the bacterial resistance (p < 0.05). Patients with resistance infections had more frequent signs of systemic inflammatory response, transfer to ICU and prolonged hospital stay when compared the patients without having resistant infections (p < 0.05). There was no mortality difference between the patients who have resistant or non-resistant bacterial infections. Conclusions: In our series of hospitalized cirrhotic patients, infections with resistant bacteria found to be half of the positive cultures which is associated with the extended duration of hospitalization and frequent transfer to intensive care unit. Daily lactulose usage seems to decrease the resistant bacterial infections. EMTREE DRUG INDEX TERMS alcohol antibiotic agent lactulose EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterium hospitalization human infection liver patient EMTREE MEDICAL INDEX TERMS antibiotic prophylaxis antibiotic resistance ascites fluid bacterial infection blood catheter clinical laboratory data base etiology female gender health care hospital infection resistance inflammation intensive care unit logistic regression analysis male mortality sputum LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71443983 DOI 10.1016/S0168-8278(14)60605-X FULL TEXT LINK http://dx.doi.org/10.1016/S0168-8278(14)60605-X COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 312 TITLE Comparison of three different timeframes for pediatric index of mortality data collection in transported intensive care admissions* AUTHOR NAMES Rahiman S. Sadasivam K. Ridout D.A. Tasker R.C. Ramnarayan P. AUTHOR ADDRESSES (Rahiman S.; Sadasivam K.) Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom. (Ridout D.A.) Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom. (Tasker R.C.) Departments of Neurology and Anaesthesia (Pediatrics), Boston Children's Hospital and Harvard Medical School, Boston, MA, United States. (Ramnarayan P., p.ramnarayan@gosh.nhs.uk) Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom. SOURCE Pediatric Critical Care Medicine (2014) 15:3 (e120-e127). Date of Publication: March 2014 ISSN 1529-7535 1947-3893 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT OBJECTIVE:: To identify the most appropriate timeframe for Pediatric Index of Mortality-2 data collection in patients transported to PICUs by specialist teams. DESIGN:: Retrospective cohort study. SETTING:: A regional PICU transport team in London, United Kingdom. PATIENTS:: Children admitted for intensive care to a tertiary children's hospital PICU following transport by a PICU transport team between January 1, 2007, and December 31, 2008. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Data on case mix and outcome from children transferred to the tertiary PICU during the study period were analyzed. The "standard" timeframe used in calculating Pediatric Index of Mortality-2 was compared with Pediatric Index of Mortality-2 calculated using data from two other 1-hour timeframes (during "retrieval" and during "admission"). A total of 759 transported admissions were studied. Eighty-three children died (mortality rate, 10.9%). Data were missing in up to 42.7% of admissions for some Pediatric Index of Mortality-2 variables from transport. However, missing data persisted even after the first hour of PICU admission in most cases. There was significant improvement in some physiological variables following transport (p < 0.01), but Pediatric Index of Mortality-2 did not change significantly. Pediatric Index of Mortality-2 from all three timeframes exhibited good discrimination (area under the receiver-operating characteristic curve ≥ 0.77). Calibration across deciles of mortality risk was poor for the "admission" Pediatric Index of Mortality-2 (Hosmer-Lemeshow goodness-of-fit test p = 0.04) but good for the other two calculated Pediatric Index of Mortality-2 models (p > 0.20). CONCLUSIONS:: The findings of our single-center study do not support the need for different timeframes for Pediatric Index of Mortality-2 data collection in transported and direct PICU admissions. Uniformity in scoring procedure may simplify data collection and improve data quality. © 2014 by the Society of critical care medicine. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assessment of humans intensive care pediatric index of mortality 2 EMTREE MEDICAL INDEX TERMS article child female hospital admission human information processing major clinical study male mortality preschool child priority journal United Kingdom EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014191488 MEDLINE PMID 24395001 (http://www.ncbi.nlm.nih.gov/pubmed/24395001) PUI L52947317 DOI 10.1097/PCC.0000000000000058 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0000000000000058 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 313 TITLE Improving alcohol withdrawal outcomes in acute care AUTHOR NAMES Melson J. Kane M. Mooney R. Mcwilliams J. Horton T. AUTHOR ADDRESSES (Melson J.) Nurse Practitioner in the Stepdown Unit at Christiana Care Health System in Wilmington, DE. jmelson@christianacare.org (Kane M.) Medicine Outcomes Coordinator in the Performance Improvement Department at Christiana Care Health System in Newark, DE. mikane@christianacare.org (Mooney R.) Research Facilitator for the Christiana Care Health System in Newark, DE. rmooney@christianacare.org (Mcwilliams J.) Nurse Practitioner with the Healthstar Physicians of Hot Springs, AR. polonius47@gmail.com (Horton T.) Chief of the Division of Addiction Medicine for the Christiana Care Health System in Newark, DE. thorton@christianacare.org SOURCE The Permanente journal (2014) 18:2 (e141-e145). Date of Publication: 1 Mar 2014 ISSN 1552-5775 (electronic) ABSTRACT CONTEXT: Excessive alcohol consumption is the nation's third leading cause of preventable deaths. If untreated, 6% of alcohol-dependent patients experience alcohol withdrawal, with up to 10% of those experiencing delirium tremens (DT), when they stop drinking. Without routine screening, patients often experience DT without warning.OBJECTIVE: Reduce the incidence of alcohol withdrawal advancing to DT, restraint use, and transfers to the intensive care unit (ICU) in patients with DT.DESIGN: In October 2009, the alcohol withdrawal team instituted a care management guideline used by all disciplines, which included tools for screening, assessment, and symptom management. Data were obtained from existing datasets for three quarters before and four quarters after implementation. Follow-up data were analyzed and showed a great deal of variability in transfers to the ICU and restraint use. Percentage of patients who developed DT showed a downward trend.MAIN OUTCOME MEASURES: Incidence of alcohol withdrawal advancing to DT and, in patients with DT, restraint use and transfers to the ICU.RESULTS: Initial data revealed a decrease in percentage of patients with alcohol withdrawal who experienced DT (16.4%-12.9%). In patients with DT, restraint use decreased (60.4%-44.4%) and transfers to the ICU decreased (21.6%-15%). Follow-up data indicated a continued downward trend in patients with DT. Changes were not statistically significant. Restraint use and ICU transfers maintained postimplementation levels initially but returned to preimplementation levels by third quarter 2012.CONCLUSION: Early identification of patients for potential alcohol withdrawal followed by a standardized treatment protocol using symptom-triggered dosing improved alcohol withdrawal management and outcomes. EMTREE DRUG INDEX TERMS alcohol (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) exercise intensive care unit patient transport standards EMTREE MEDICAL INDEX TERMS alcoholic delirium (prevention, therapy) alcoholism clinical protocol follow up human intensive care mass screening treatment outcome withdrawal syndrome (therapy) CAS REGISTRY NUMBERS alcohol (64-17-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24867561 (http://www.ncbi.nlm.nih.gov/pubmed/24867561) PUI L604689008 DOI 10.7812/TPP/13-099 FULL TEXT LINK http://dx.doi.org/10.7812/TPP/13-099 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 314 TITLE Centralisation of paediatric intensive care and a 24-hour retrieval service. AUTHOR NAMES Roussak P. AUTHOR ADDRESSES (Roussak P.) Staff Nurse, Rays of Sunshine Ward, Kings College Hospital, London. CORRESPONDENCE ADDRESS P. Roussak, Staff Nurse, Rays of Sunshine Ward, Kings College Hospital, London. SOURCE British journal of nursing (Mark Allen Publishing) (2014) 23:1 (25-29). Date of Publication: 2014 Jan 9-22 ISSN 0966-0461 ABSTRACT This article aims to analyse the effects of the centralisation of paediatric intensive care (PIC) and the requirement for a 24-hour retrieval service, as outlined in Standards for the Care of Critically Ill Children (Paediatric Intensive Care Society, 2010). It affects staff at district general hospitals (DGHs) and has an impact on the critically ill children who present there. Although the centralisation of PIC has shown better outcomes, there have been concerns that, coupled with relocation of elective surgery to tertiary centres, it has resulted in the deskilling of staff in DGHs. The introduction of more paediatric high-dependency care units in DGHs is presented as a solution to the increased burden on the retrieval service and the deskilling of staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article clinical competence United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 24406493 (http://www.ncbi.nlm.nih.gov/pubmed/24406493) PUI L372466242 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 315 TITLE Arterial blood pressure changes induced by acceleration during mobile intensive care unit patient transport are not patient related: Beware of misinterpretation AUTHOR NAMES Droogh J.M. Reinke L. Snel G.J. Mouthaan B. Struys M.M.R.F. Ligtenberg J.J.M. Keus F. Zijlstra J.G. AUTHOR ADDRESSES (Droogh J.M., j.m.droogh@umcg.nl; Reinke L.; Keus F.; Zijlstra J.G.) Department of Critical Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, Netherlands. (Reinke L.; Snel G.J.; Mouthaan B.) Technical Medicine, University of Twente, Drienerlolaan 5, 7500 AE Enschede, Netherlands. (Struys M.M.R.F.) Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, Netherlands. (Ligtenberg J.J.M.) Emergency Department, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, Netherlands. CORRESPONDENCE ADDRESS J.M. Droogh, Department of Critical Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, Netherlands. Email: j.m.droogh@umcg.nl SOURCE Intensive Care Medicine (2014) 40:3 (460-461). Date of Publication: 2014 ISSN 1432-1238 (electronic) 0342-4642 BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) arterial pressure intensive care unit mobile intensive care unit patient transport EMTREE MEDICAL INDEX TERMS acceleration blood pressure transducer critically ill patient deceleration human letter mean arterial pressure EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014280165 PUI L52953508 DOI 10.1007/s00134-013-3195-2 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-3195-2 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 316 TITLE Critical care paramedics - A missing component for safe interfacility transport in the United States AUTHOR NAMES Kupas D.F. Wang H.E. AUTHOR ADDRESSES (Kupas D.F., dkupas@geisinger.edu) Department of Emergency Medicine, Geisinger Health System, Danville, PA, United States. (Wang H.E.) Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States. CORRESPONDENCE ADDRESS D.F. Kupas, Department of Emergency Medicine, Geisinger Health System, Danville, PA, United States. Email: dkupas@geisinger.edu SOURCE Annals of Emergency Medicine (2014) 64:1 (17-18). Date of Publication: July 2014 ISSN 1097-6760 (electronic) 0196-0644 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care facility intensive care paramedical personnel patient transport EMTREE MEDICAL INDEX TERMS critically ill patient emergency health service health care system health insurance human note priority journal United States EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014422892 MEDLINE PMID 24721717 (http://www.ncbi.nlm.nih.gov/pubmed/24721717) PUI L53092890 DOI 10.1016/j.annemergmed.2014.03.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2014.03.010 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 317 TITLE Developing and evaluating a machine learning based algorithm to predict the need of pediatric intensive care unit transfer for newly hospitalized children AUTHOR NAMES Zhai H. Brady P. Li Q. Lingren T. Ni Y. Wheeler D.S. Solti I. AUTHOR ADDRESSES (Zhai H.; Li Q.; Lingren T.; Ni Y.; Solti I., imre.solti@cchmc.org) Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. (Brady P.) Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. (Wheeler D.S.) Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. (Brady P.; Solti I., imre.solti@cchmc.org) James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. CORRESPONDENCE ADDRESS I. Solti, Cincinnati Children's Hospital Medical Center, Division of Biomedical Informatics, 3333 Burnet Avenue, MLC 7024, Cincinnati, OH 45229-3039, United States. Email: imre.solti@cchmc.org SOURCE Resuscitation (2014) 85:8 (1065-1071). Date of Publication: August 2014 ISSN 1873-1570 (electronic) 0300-9572 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Background: Early warning scores (EWS) are designed to identify early clinical deterioration by combining physiologic and/or laboratory measures to generate a quantified score. Current EWS leverage only a small fraction of Electronic Health Record (EHR) content. The planned widespread implementation of EHRs brings the promise of abundant data resources for prediction purposes. The three specific aims of our research are: (1) to develop an EHR-based automated algorithm to predict the need for Pediatric Intensive Care Unit (PICU) transfer in the first 24. h of admission; (2) to evaluate the performance of the new algorithm on a held-out test data set; and (3) to compare the effectiveness of the new algorithm's with those of two published Pediatric Early Warning Scores (PEWS). Methods: The cases were comprised of 526 encounters with 24-h Pediatric Intensive Care Unit (PICU) transfer. In addition to the cases, we randomly selected 6772 control encounters from 62516 inpatient admissions that were never transferred to the PICU. We used 29 variables in a logistic regression and compared our algorithm against two published PEWS on a held-out test data set. Results: The logistic regression algorithm achieved 0.849 (95% CI 0.753-0.945) sensitivity, 0.859 (95% CI 0.850-0.868) specificity and 0.912 (95% CI 0.905-0.919) area under the curve (AUC) in the test set. Our algorithm's AUC was significantly higher, by 11.8 and 22.6% in the test set, than two published PEWS. Conclusion: The novel algorithm achieved higher sensitivity, specificity, and AUC than the two PEWS reported in the literature. © 2014 The Authors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health needs human needs intensive care unit machine learning patient transport EMTREE MEDICAL INDEX TERMS algorithm article automation child childhood disease clinical assessment tool controlled study electronic medical record hospital admission hospital patient human major clinical study newborn pediatric early warning score preschool child priority journal retrospective study school child sensitivity and specificity EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014450290 MEDLINE PMID 24813568 (http://www.ncbi.nlm.nih.gov/pubmed/24813568) PUI L53143177 DOI 10.1016/j.resuscitation.2014.04.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.resuscitation.2014.04.009 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 318 TITLE Analysis of serum γ-glutamyl transferase levels in neonatal intensive care unit patients AUTHOR NAMES Hirfanoglu I.M. Unal S. Onal E.E. Beken S. Turkyilmaz C. Pasaoglu H. Koc E. Ergenekon E. Atalay Y. AUTHOR ADDRESSES (Hirfanoglu I.M., imhirfanoglu@yahoo.com; Unal S.; Onal E.E.; Beken S.; Turkyilmaz C.; Koc E.; Ergenekon E.; Atalay Y.) Department of Pediatrics, Division of Neonatology, Gazi University Medical School, Turgutreis cad. Serefli sok. no: 4/4, Mebusevleri, Ankara 06500, Turkey. (Pasaoglu H.) Department of Biochemistry, Gazi University Medical School, Ankara, Turkey. CORRESPONDENCE ADDRESS I.M. Hirfanoglu, Department of Pediatrics, Division of Neonatology, Gazi University Medical School, Turgutreis cad. Serefli sok. no: 4/4, Mebusevleri, Ankara 06500, Turkey. Email: imhirfanoglu@yahoo.com SOURCE Journal of Pediatric Gastroenterology and Nutrition (2014) 58:1 (99-101). Date of Publication: January 2014 ISSN 0277-2116 1536-4801 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Objectives: Gamma-glutamyl transferase (GGT) is commonly measured in newborn infants as a sensitive liver function test; however, reference ranges are mostly based on early studies, including relatively small number of patients. The aim of this study was to emphasise recently changed GGT values because of changed newborns profile admitted to neonatal intensive care units (NICUs) and establish new cross-sectional reference ranges for the serum GGT levels in a cohort of neonates between 26 and 42 weeks' gestational age in 1 centre. METHODS: From January 1, 2010 to December 31, 2012, liver function tests including serum GGT measurements were performed in 705 newborns who were admitted to NICUs because of different aetiologies at Gazi University School of Medicine Hospital, Ankara, Turkey. Infants with Apgar score <8 at the fifth minute, any metabolic or liver disease, cholestasis, congenital infection, culture-proven sepsis, elevated serum aminotransferases, and who were treated with phenobarbital were excluded. Clinical and laboratory data of 583 neonates were analysed retrospectively. GGT was measured by enzymatic method using the Abbott Architect C16000 autoanalyser. Mean, 2.5th, and 97.5th percentiles were used to express the reference range data. RESULTS: Four hundred sixty-one GGT values of 200 preterm infants and 501 GGT values of 383 term infants during the first 28 days after birth were analysed. Serum GGT levels of preterm infants in the first 7 days and between 8 and 28 days after delivery were (mean±standard deviation; 141.81±88.56 U/L and 131.17±85.53 U/L) similar to term infants (139.90±86.46 U/L and 144.56±86.51 U/L), respectively (P=0.649 and P=0.087). Serum GGT levels were found to be significantly higher in male infants (no need of query) (145.98±93.68 U/L) than female infants (132.18±78.97 U/L) (P=0.035), and infants born vaginally (152.24±90.71 U/L) also had higher serum GGT activity than those born by caesarean section (135.38±85.37 U/L) (P=0.005). CONCLUSIONS: A new reference range for serum GGT levels that is higher than previous reference values can identify neonates with truly abnormal results and prevent unnecessary interventions. © 2013 by European Society for Pediatric Gastroenterology,Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) gamma glutamyltransferase (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) gamma glutamyl transferase blood level liver function test newborn intensive care EMTREE MEDICAL INDEX TERMS article cesarean section female gestational age human major clinical study male newborn prematurity priority journal reference value CAS REGISTRY NUMBERS gamma glutamyltransferase (85876-02-4) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014071337 MEDLINE PMID 23969532 (http://www.ncbi.nlm.nih.gov/pubmed/23969532) PUI L52741981 DOI 10.1097/MPG.0b013e3182a907f2 FULL TEXT LINK http://dx.doi.org/10.1097/MPG.0b013e3182a907f2 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 319 TITLE 22nd critical care transport medicine conference AUTHOR NAMES Newman M. Petersen P. Wojdyla K. AUTHOR ADDRESSES (Newman M.) International Association of Flight and Critical Care Paramedics, United States. (Petersen P.) Air Medical Physician Association, United States. (Wojdyla K.) Air and Surface Transport Nurses Association, United States. CORRESPONDENCE ADDRESS International Association of Flight and Critical Care Paramedics, United States. SOURCE Air Medical Journal (2014) 33:1 (22-24). Date of Publication: January-February 2014 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care EMTREE MEDICAL INDEX TERMS conference paper critically ill patient emergency care human priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014009621 PUI L372038935 DOI 10.1016/j.amj.2013.11.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2013.11.003 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 320 TITLE Patient safety and prevention of unexpected events occurring during the intra-hospital transport of critically ill ICU patients AUTHOR NAMES Shweta K. Kumar S. AUTHOR ADDRESSES (Shweta K.) Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), New Delhi, India. (Kumar S.) Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India. SOURCE Indian Journal of Critical Care Medicine (2014) 18:9 (636). Date of Publication: 1 Sep 2014 ISSN 1998-359X (electronic) 0972-5229 BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient hospital human patient patient safety prevention LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014795722 PUI L600028601 DOI 10.4103/0972-5229.140156 FULL TEXT LINK http://dx.doi.org/10.4103/0972-5229.140156 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 321 TITLE Erratum to Antimicrobial stewardship in patients recently transferred to a ward from the ICU (Rev Esp Quimioter, (2014), 27, 1 (46-50)) ORIGINAL (NON-ENGLISH) TITLE Erratum to Asesoramiento antibiótico en pacientes tras estancia en cuidados intensivos (Rev Esp Quimioter, (2014), 27, 1 (46-50)) AUTHOR NAMES Ramos A. Benitez-Gutierrez L. Asensio A. Ruiz-Antorán B. Folguera C. Sanchez-Romero I. Muñez E. AUTHOR ADDRESSES (Ramos A., aramos220@gmail.com; Benitez-Gutierrez L.; Muñez E.) Department of Internal Medicine (Infectious Disease Unit), Hospital Universitario Puerta de Hierro, Majadahonda. Madrid, Spain. (Asensio A.) Department of Preventive Medicine, Hospital Universitario Puerta de Hierro, Majadahonda. Madrid, Spain. (Ruiz-Antorán B.) Department of Pharmacology, Hospital Universitario Puerta de Hierro, Majadahonda. Madrid, Spain. (Folguera C.) Department of Pharmacy, Hospital Universitario Puerta de Hierro, Majadahonda. Madrid, Spain. (Sanchez-Romero I.) Department of Microbiology, Hospital Universitario Puerta de Hierro, Majadahonda. Madrid, Spain. CORRESPONDENCE ADDRESS A. Ramos, Department of Internal Medicine (Infectious Diseases Unit), Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Maestro Rodrigo no 2, 28222 Majadahonda. Madrid, Spain. Email: aramos220@gmail.com SOURCE Revista Espanola de Quimioterapia (2014) 27:2 (134-139). Date of Publication: 2014 ISSN 0214-3429 BOOK PUBLISHER Sociedad Espanola de Quiminoterapia, luisalou@med.ucm.es ABSTRACT This paper is a corrigendum to the previously published paper: "Antimicrobial stewardship in patients recently transferred to a ward from the ICU" [Rev Esp Quimioter. 2014 Mar;27(1):46-50.] This corrigendum was prepared in order to correct some erroneous comments included in the discussion section. First, it should be pointed out that there could have been several suitable options for treating many infections and that, therefore, the word "inadequate" was not the most appropriate in this situation. In addition, some comments about the interpretation of microbiological results made by ICU physicians have been removed from the first article because this variable was not included in the study. Finally, another change made to the discussion was to clarify the ICU physicians' alleged low level of compliance with advice given by infectious disease specialists. This has been suggested in previous studies it cannot be substantiated when analyzing the results of the study. Purpose. Inappropriate use of antibiotics is an important health problem that is related to increasing bacterial resistance. Despite its relevance, many health institutions assign very limited resources to improving prescribing practices. An antimicrobial stewardship programme (APS) centred on patients discharged from the ICU could efficiently undertake this task. Methods. During this six month study the main activity was performing a programmed review of antimicrobial prescriptions in patients transferred to the ward from the ICU. In the case of amendable antimicrobial treatment, a recommendation was included in the medical record. Results. A total of 437 antimicrobial prescriptions for 286 patients were revised during a six month period and a total of 271 prescriptions (62%) in 183 patients were considered to be amendable. In most of these cases, treatment could have been reduced taking into consideration each patient's clinical improvement and their location in a hospital area with a lower risk of infection due to resistant bacteria. The most common advice was antimicrobial withdrawal (64%), antimicrobial change (20%) and switching to oral route (12%). Proposed recommendations were addressed in 212 cases (78%). There was no significant difference in adherence with respect to the type of recommendation (p=0.417). There was a 5% lower use of antibiotics during the year the study was conducted compared to the previous one. Conclusions. ASPs centred on patients discharged from the ICU may be an efficient strategy to ameliorate antimicrobial use in hospitals. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English, Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2014445097 PUI L373435951 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 322 TITLE [Hemodynamics, oxygen transport and perioperative intensive care evaluation in newborns with surgical pathology]. AUTHOR NAMES Kurochkin M.I. Davydova A.H. Chemerys I.O. AUTHOR ADDRESSES (Kurochkin M.I.; Davydova A.H.; Chemerys I.O.) CORRESPONDENCE ADDRESS M.I. Kurochkin, SOURCE Likars'ka sprava / Ministerstvo okhorony zdorov'ia Ukraïny (2014) :1-2 (45-50). Date of Publication: 2014 Jan-Feb ISSN 1019-5297 ABSTRACT The aim of the work was to develop criteria of perioperative intensive therapy efficiency in surgical neonates by hemodynamic, acid--base status, oxygen transport and pulmonary hydration studying and evaluating. The study of hemodynamics, oxygen transport, pulmonary hydration was performed in 69 infants with surgical pathology. In 36 children neuroaxial central blockades were used on the background of general anesthesia. The criteria of preoperative preparation effectiveness--balanced oxygen regime--3-3.5 units; positive central venous pressure--3-4 sm w. c.; hourly urine output of at least 1 ml/(kg x h); transthoracic impedance is not less than 19 ohms (prevention of pulmonary edema). In group I hemodynamic variations were minimal compared with infants of the II groups that is associated with better analgesic effect of caudal-epidural blockades. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) digestive system malformation (surgery) hemodynamics oxygen consumption perioperative period physiologic monitoring EMTREE MEDICAL INDEX TERMS article blood devices epidural anesthesia general anesthesia heart function test human impedance cardiography lung function test methodology newborn physiology signal processing CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE Ukrainian MEDLINE PMID 24908959 (http://www.ncbi.nlm.nih.gov/pubmed/24908959) PUI L373619269 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 323 TITLE Automatic protective ventilation using the ARDSNet protocol with the additional monitoring of electrical impedance tomography AUTHOR NAMES Pomprapa A. Schwaiberger D. Pickerodt P. Tjarks O. Lachmann B. Leonhardt S. AUTHOR ADDRESSES (Pomprapa A.; Schwaiberger D.; Pickerodt P.; Tjarks O.; Lachmann B.; Leonhardt S.) SOURCE Critical care (London, England) (2014) 18:3 (R128). Date of Publication: 2014 ISSN 1466-609X (electronic) ABSTRACT INTRODUCTION: Automatic ventilation for patients with respiratory failure aims at reducing mortality and can minimize the workload of clinical staff, offer standardized continuous care, and ultimately save the overall cost of therapy. We therefore developed a prototype for closed-loop ventilation using acute respiratory distress syndrome network (ARDSNet) protocol, called autoARDSNet.METHODS: A protocol-driven ventilation using goal-oriented structural programming was implemented and used for 4 hours in seven pigs with lavage-induced acute respiratory distress syndrome (ARDS). Oxygenation, plateau pressure and pH goals were controlled during the automatic ventilation therapy using autoARDSNet. Monitoring included standard respiratory, arterial blood gas analysis and electrical impedance tomography (EIT) images. After 2-hour automatic ventilation, a disconnection of the animal from the ventilator was carried out for 10 seconds, simulating a frequent clinical scenario for routine clinical care or intra-hospital transport.RESULTS: This pilot study of seven pigs showed stable and robust response for oxygenation, plateau pressure and pH value using the automated system. A 10-second disconnection at the patient-ventilator interface caused impaired oxygenation and severe acidosis. However, the automated protocol-driven ventilation was able to solve these problems. Additionally, regional ventilation was monitored by EIT for the evaluation of ventilation in real-time at bedside with one prominent case of pneumothorax.CONCLUSIONS: We implemented an automatic ventilation therapy using ARDSNet protocol with seven pigs. All positive outcomes were obtained by the closed-loop ventilation therapy, which can offer a continuous standard protocol-driven algorithm to ARDS subjects. EMTREE DRUG INDEX TERMS carbon dioxide oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome (therapy) animal blood female impedance lung ventilation male pathophysiology pH physiologic monitoring pig pilot study positive end expiratory pressure tidal volume tomography CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) oxygen (7782-44-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24957974 (http://www.ncbi.nlm.nih.gov/pubmed/24957974) PUI L604409028 DOI 10.1186/cc13937 FULL TEXT LINK http://dx.doi.org/10.1186/cc13937 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 324 TITLE Failure to wake up AUTHOR NAMES James P. Mehrotra P. Sperry D. AUTHOR ADDRESSES (James P.; Mehrotra P.; Sperry D.) Nottingham,University Hospitals NUS Trust, United Kingdom. CORRESPONDENCE ADDRESS P. James, Nottingham,University Hospitals NUS Trust, United Kingdom. SOURCE Journal of the Intensive Care Society (2014) 15:1 SUPPL. 1 (S21). Date of Publication: January 2014 CONFERENCE NAME State of the Art 2013 Meeting CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2013-12-16 to 2013-12-18 ISSN 1751-1437 BOOK PUBLISHER Stansted News Ltd ABSTRACT Sedation facilitates ventilatory support in critically ill patients. Patients occasionally fail to wake appropriately following cessation of sedation. Where failure to wake is prolonged computed tomography of the head (CTH) is frequently undertaken to exclude intracranial pathology. Published yields from CTH are between 37% and 57%1,2 but anecdotal feeling was that the yield was low within our unit. Inherent risks of Intra hospital transfer3 and radiation dose are associated with this practice. Our aim was to evaluate the local incidence of CTH for failure to wake against published data and look for factors associated with new pathology on CTH. Using the picture archiving and communication system (PACS) (IMPAX 6.5.2.657 Agfa healthcare) we retrieved every CTH on ICU patients for two years commencing on 1st January 2011. Each request was reviewed and scans performed for “failure to wake” were included in the data analysis. Reports were scrutinised and compared to previous scans, looking for new or evolving abnormalities. We also collected demographic data, reason for admission, admitting team, duration off sedation, renal function, the presence of neurological deficit on examination and seizure activity. A total of 35 scans were performed for failure to wake; 17 (48%) of the CT scans were positive for new pathology, nine out of 17 (52%) were positive if the patient admission was for intracerebral pathology. Six of 14 (42%) patients admitted under neurosurgery had positive scans. Median time from cessation of sedation to scan was 30.7 hours, positive scans 26.43 hours and negative scans 38.61 hours. Neurological deficit was documented in 48%. Seven patients (41%) with positive scans had document deficit as did 44% of the negative scans (sensitivity of 0.47 (95% confidence intervals 0.22-0.73) and specificity of 0.5 (95%, 0.33-0.69), positive predictive value (PPV) of 0.47). Seizure activity preceded scans in four patients, three had new pathology. Patients with new neurology and seizure always had new pathology. This study was conducted as it was believed that CTH was not picking up many significant abnormalities when the indication was early failure to wake. Our yield for new pathology from CTH was high at 48% and contradicted this belief. It was found to be in line with high yields in published data. CTH abnormalities were almost as high in non- Neurosurgical patients as those with previous intracranial pathology. Neurological deficit did not predict the presence of new pathology well but seizure activity alone or combined with neurological deficit significantly increased the likelihood of a positive CTH. Quality and documentation of pre-CTH neurological examination needs improvement. Recommendations: • CT of the head should continue to be used as an investigation where there is clinical concern that the patient is not waking after cessation of sedation • Neurological examination should be completed and documented prior to CT head request • Evidence of seizure and of seizure and neurological deficit on examination should prompt urgent CT scan • Prospective review of this cohort of patients to assess the impact of CT on immediate and long-term care. EMTREE MEDICAL INDEX TERMS computer assisted tomography confidence interval critically ill patient data analysis documentation examination health care hospital hospital admission human intracerebral drug administration kidney function long term care neurologic examination neurology neurosurgery non implantable urine incontinence electrical stimulator pathology patient picture archiving and communication system predictive value radiation dose risk sedation seizure wakefulness LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71773088 DOI 10.1177/17511437140151S105 FULL TEXT LINK http://dx.doi.org/10.1177/17511437140151S105 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 325 TITLE Interface hospital discharge: Active transfer of information on in-house productions to public pharmacies ORIGINAL (NON-ENGLISH) TITLE Aktive Weitergabe von Informationen zu Eigenherstellungen an öffentliche Apotheken AUTHOR NAMES Ober M. Rosenhagen M. Sauer S. Hoppe-Tichy T. AUTHOR ADDRESSES (Ober M., michael.ober@med.uni-heidelberg.de; Rosenhagen M.; Sauer S.; Hoppe-Tichy T.) Universität, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany. SOURCE Krankenhauspharmazie (2014) 35:6 (243-244). Date of Publication: June 2014 ISSN 0173-7597 BOOK PUBLISHER Deutscher Apotheker Verlag, Birkenwaldstr.44,, Stuttgart, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital discharge information system pharmacy EMTREE MEDICAL INDEX TERMS article EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY German EMBASE ACCESSION NUMBER 2014444039 PUI L373431530 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 326 TITLE Clostridium difficile: Transferring C. difficile spores causes an infection that leads to 14,000 deaths annually in the U.S. AUTHOR NAMES Barzoloski-O'Connor B. AUTHOR ADDRESSES (Barzoloski-O'Connor B.) Howard County General Hospital, Columbia, MD, United States. CORRESPONDENCE ADDRESS B. Barzoloski-O'Connor, Howard County General Hospital, Columbia, MD, United States. SOURCE Nursing Critical Care (2014) 9:4 (30-34). Date of Publication: July 2014 ISSN 1558-447X EMTREE DRUG INDEX TERMS alcohol antibiotic agent (drug therapy) antidiarrheal agent cefotaxime (drug therapy) exotoxin (endogenous compound) gatifloxacin (drug therapy) intestine contraction stimulating agent levofloxacin (drug therapy) metronidazole (drug therapy, intravenous drug administration, oral drug administration) moxifloxacin (drug therapy) piperacillin plus tazobactam (drug therapy) probiotic agent (adverse drug reaction, drug therapy) proton pump inhibitor quinoline derived antiinfective agent vancomycin (drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Clostridium difficile infection (drug therapy, diagnosis, drug therapy, epidemiology, etiology) prevalence EMTREE MEDICAL INDEX TERMS abdominal pain acute kidney failure age antibiotic resistance article bacterial colonization bacterial transmission biological therapy colon perforation contamination critically ill patient dehydration diarrhea differential diagnosis disease severity disease transmission drug contraindication drug efficacy electrolyte disturbance fecal bacteriotherapy feces culture fever fungemia (side effect) glove hand washing hospital infection (prevention) hospitalization human hypoalbuminemia infection risk intensive care intensive care unit leukocytosis mortality muscle cramp nonhuman Peptoclostridium difficile polymerase chain reaction prescription priority journal protective clothing pseudomembranous colitis rectum hemorrhage recurrent disease risk factor Saccharomyces boulardii safety sanitation sepsis symptomatology systemic inflammatory response syndrome toxic megacolon treatment duration CAS REGISTRY NUMBERS alcohol (64-17-5) cefotaxime (63527-52-6, 64485-93-4) gatifloxacin (112811-59-3, 180200-66-2) levofloxacin (100986-85-4, 138199-71-0) metronidazole (39322-38-8, 443-48-1) moxifloxacin (151096-09-2) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Drug Literature Index (37) Adverse Reactions Titles (38) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014542137 PUI L373756680 DOI 10.1097/01.CCN.0000451020.07574.3c FULL TEXT LINK http://dx.doi.org/10.1097/01.CCN.0000451020.07574.3c COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 327 TITLE The effect of unit-based simulation on nurses' identification of deteriorating patients AUTHOR NAMES Disher J. Burgum A. Desai A. Fallon C. Hart P.L. Aduddell K. AUTHOR ADDRESSES (Disher J.; Burgum A.; Desai A.; Fallon C.; Hart P.L.; Aduddell K.) Jocelyn Disher, MSN RN, is Nurse Educator for Preventive Cardiology, Saint Joseph's Hospital, Atlanta, Georgia. Angela Burgum, RN, is Critical Care Float Nurse specializing in Cardiovascular ICU, Saint Joseph's Hospital, Atlanta, Georgia. Anisha Desai, BSN, RN, is Unit Nurse Educator for a Cardiovascular Step-down unit, Saint Joseph's Hospital, Atlanta, Georgia. Cynthia Fallon, BSN, RN, ONC, is Shift Nurse Manager for Outpatient Infusion, Saint Joseph's Hospital, Atlanta, Georgia. Patricia L. Hart, PhD, RN, is Assistant Professor of Nursing at Kennesaw State University, Georgia. Kathie Aduddell, EdD, RN, is Associate Professor of Nursing at Kennesaw State University, Georgia SOURCE Journal for nurses in professional development (2014) 30:1 (21-28). Date of Publication: 1 Jan 2014 ISSN 2169-981X (electronic) ABSTRACT Patients are admitted to healthcare organizations with multiple, complex conditions that can lead to acute deterioration events. It is imperative that nurses are adequately trained to recognize and respond appropriately to these events to ensure positive patient outcomes. The purpose of this pilot research study was to examine the effects of a unit-based, high-fidelity simulation initiative on cardiovascular step-down unit registered nurses' identification and management of deteriorating patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) audiovisual equipment nursing nursing assessment pathophysiology patient transport rapid response team EMTREE MEDICAL INDEX TERMS chronic obstructive lung disease clinical competence disease course human intensive care unit pilot study questionnaire respiratory failure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24045408 (http://www.ncbi.nlm.nih.gov/pubmed/24045408) PUI L605239057 DOI 10.1097/NND.0b013e31829e6c83 FULL TEXT LINK http://dx.doi.org/10.1097/NND.0b013e31829e6c83 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 328 TITLE Transporting critically ill children AUTHOR NAMES Fortune P.-M. Parkins K. Playfor S. AUTHOR ADDRESSES (Fortune P.-M.; Playfor S.) Royal Manchester Children's Hospital, Manchester, UK (Parkins K.) Newton House, Birchwood Park, Warrington, UK SOURCE Anaesthesia and Intensive Care Medicine (2014). Date of Publication: 2014 ISSN 1878-7584 (electronic) 1472-0299 BOOK PUBLISHER Elsevier Ltd ABSTRACT Increasing centralization of paediatric intensive care services and a reduction in the numbers of children cared for in adult intensive care units over the last 15-20 years has led to an increase in the numbers of critically ill children being transferred between clinical centres throughout the UK. Eighty percent of these retrievals are conducted by a specialist paediatric intensive care unit (PICU) team, 13% by a specialist non-PICU team, and only 7% by an ad-hoc, non-specialist team. Various pressures have made it increasingly difficult for PICUs to facilitate the timely retrieval of critically ill children whilst maintaining the quality of care being provided to patients already under their care. This situation has led to the development of regional, stand-alone transport teams throughout the UK over the last 5-10 years. A typical example of such a team is the North West & North Wales Paediatric Transport Service (NWTS). Utilizing the highly structured approaches advocated by the Paediatric and Neonatal Safe Transfer and Retrieval (PaNSTaR) and the Adult STaR courses; focussing on the SCRUMP (Shared assessment, Clinical isolation, Resource limitations, Unfamiliar equipment, Movement and Safety and Physiology) and the ACCEPT (Assessment, Control, Communication, Evaluation, Preparation/Packaging, Transportation) approach, regional transport teams have delivered significant measurable benefits in terms of patient outcomes and experiences when compared to previous models of service delivery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child critically ill patient human intensive care pediatrics EMTREE MEDICAL INDEX TERMS adult centralization health care delivery intensive care unit interpersonal communication medical specialist model movement (physiology) patient physiology safety traffic and transport United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015760121 PUI L602403317 DOI 10.1016/j.mpaic.2014.09.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.mpaic.2014.09.001 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 329 TITLE Toxic epidermal necrolysis and early transfer to a regional burn unit: Is it time to reevaluate what we teach? AUTHOR NAMES Kaffenberger B.H. Rosenbach M. AUTHOR ADDRESSES (Kaffenberger B.H.) Dermatology, Ohio State University College of Medicine, Columbus, OH, United States. (Rosenbach M., misha.rosenbach@uphs.upenn.edu) Dermatology, University of Pennsylvania Hospital, Philadelphia, PA, United States. CORRESPONDENCE ADDRESS M. Rosenbach, Perelman Center for Advanced Medicine, South Pavilion, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States. Email: misha.rosenbach@uphs.upenn.edu SOURCE Journal of the American Academy of Dermatology (2014) 71:1 (195-196). Date of Publication: July 2014 ISSN 1097-6787 (electronic) 0190-9622 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE DRUG INDEX TERMS antibiotic agent corticosteroid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn unit patient transport toxic epidermal necrolysis EMTREE MEDICAL INDEX TERMS antibiotic prophylaxis antibiotic therapy corticosteroid therapy human letter priority journal EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014426038 MEDLINE PMID 24947692 (http://www.ncbi.nlm.nih.gov/pubmed/24947692) PUI L373372945 DOI 10.1016/j.jaad.2013.12.048 FULL TEXT LINK http://dx.doi.org/10.1016/j.jaad.2013.12.048 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 330 TITLE Risk of incident mental health conditions among critical care air transport team members AUTHOR NAMES Tvaryanas A.P. Maupin G.M. AUTHOR ADDRESSES (Tvaryanas A.P., anthony.tvaryanas@wpafb.af.mil; Maupin G.M.) 711th Human Performance Wing, Wright-Patterson Air Force Base, OH, United States. CORRESPONDENCE ADDRESS A.P. Tvaryanas, 711th Human Performance Wing, 2510 5 th St., Bldg 840, Wright-Patterson AFB, OH 45433-7913, United States. Email: anthony.tvaryanas@wpafb.af.mil SOURCE Aviation Space and Environmental Medicine (2014) 85:1 (30-38). Date of Publication: January 2014 ISSN 0095-6562 BOOK PUBLISHER Aerospace Medical Association, 320 S. Henry Street, Alexandria, United States. ABSTRACT Background: This study investigated whether Critical Care Air Transport Team (CCATT) members are at increased risk for incident post-deployment mental health conditions. Methods: We conducted a retrospective cohort study of 604 U.S. Air Force medical personnel without preexisting mental health conditions who had at least one deployment as a CCATT member during 2003-2012 as compared to a control group of 604 medical personnel, frequency matched based on job role, with at least one deployment during the same period, but without CCATT experience. Electronic health record data were used to ascertain the diagnosis of a mental health condition. Results: The incidence of post-deployment mental health conditions was 2.1 per 1000 mo for the CCATT group versus 2.2 per 1000 mo for the control group. The six most frequent diagnoses were the same in both groups: adjustment reaction not including posttraumatic stress disorder (PTSD), anxiety, major depressive disorder, specific disorders of sleep of nonorganic origin, PTSD, and depressive disorder not elsewhere classified. Women were at marginally increased risk and nurses and technicians were at twice the risk of physicians. The distribution of the time interval from end of the most recent deployment to diagnosis of incident mental health condition was positively skewed with a median greater than 6 mo. Conclusions: CCATT members were at no increased risk for incident post-deployment mental health conditions as compared to non-CCATT medical service members. Nearly two-thirds of incident post-deployment mental health conditions were diagnosed outside the standard 6-mo medical surveillance period, a finding warranting further study. © by the Aerospace Medical Association, Alexandria, VA. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aviation health care personnel mental disease (diagnosis, epidemiology) soldier EMTREE MEDICAL INDEX TERMS adolescent adult article female human incidence male middle aged psychological aspect risk sex difference United States (epidemiology) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24479256 (http://www.ncbi.nlm.nih.gov/pubmed/24479256) PUI L370560510 DOI 10.3357/ASEM.3782.2014 FULL TEXT LINK http://dx.doi.org/10.3357/ASEM.3782.2014 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 331 TITLE Should mechanical ventilation care be centralized and should we thus transfer all ventilated patients to high volume units? Take a breath first AUTHOR NAMES Schultz M.J. Spronk P.E. AUTHOR ADDRESSES (Schultz M.J., marcus.j.schultz@gmail.com; Spronk P.E.) Department of Intensive Care C3-415, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. (Schultz M.J., marcus.j.schultz@gmail.com) Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. (Spronk P.E.) Department of Intensive Care, Gelre Hospitals, Apeldoorn, Netherlands. CORRESPONDENCE ADDRESS M.J. Schultz, Department of Intensive Care C3-415, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Email: marcus.j.schultz@gmail.com SOURCE Intensive Care Medicine (2014) 40:3 (453-455). Date of Publication: 2014 ISSN 1432-1238 (electronic) 0342-4642 BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation hospital management intensive care unit EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome blood transfusion fluid resuscitation human intensive care length of stay mortality patient transport review sedation ventilated patient EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014280177 PUI L52994807 DOI 10.1007/s00134-014-3216-9 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-014-3216-9 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 332 TITLE Have a safe journey AUTHOR NAMES Sampath S. AUTHOR ADDRESSES (Sampath S., sriram.sampath123@gmail.com) Department of Critical Care Medicine, St John's Medical College and Hospital, Bangalore - 560 034, India. CORRESPONDENCE ADDRESS S. Sampath, Department of Critical Care Medicine, St John's Medical College and Hospital, Bangalore - 560 034, India. Email: sriram.sampath123@gmail.com SOURCE Indian Journal of Critical Care Medicine (2014) 18:6 (343-344). Date of Publication: June 2014 ISSN 1998-359X (electronic) 0972-5229 BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit medical education patient transport EMTREE MEDICAL INDEX TERMS editorial human incident report India intensive care interpersonal communication mortality residency education ventilated patient ventilator associated pneumonia EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014406993 PUI L373310273 DOI 10.4103/0972-5229.133865 FULL TEXT LINK http://dx.doi.org/10.4103/0972-5229.133865 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 333 TITLE Interventions employed to improve intrahospital handover: A systematic review AUTHOR NAMES Robertson E.R. Morgan L. Bird S. Catchpole K. McCulloch P. AUTHOR ADDRESSES (Robertson E.R., eleanor.robertson@nds.ox.ac.uk; Morgan L.; McCulloch P.) Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom. (Bird S.) University of Oxford Medical School, John Radcliffe Hospital, Oxford, United Kingdom. (Catchpole K.) Department of Surgery, Cedars- Sinai Medical Center, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS E.R. Robertson, Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, Oxfordshire OX3 9DU, United Kingdom. Email: eleanor.robertson@nds.ox.ac.uk SOURCE BMJ Quality and Safety (2014) 23:7 (600-607). Date of Publication: July 2014 ISSN 2044-5415 BOOK PUBLISHER BMJ Publishing Group, subscriptions@bmjgroup.com ABSTRACT Background: Modern medical care requires numerous patient handovers/handoffs. Handover error is recognised as a potential hazard in patient care, and the information error rate has been estimated at 13%. While accurate, reliable handover is essential to high quality care, uncertainty exists as to how intrahospital handover can be improved. This systematic review aims to evaluate the effectiveness of interventions aimed at improving the quality and/or safety of the intrahospital handover process. Methods: We searched for articles on handover improvement interventions in EMBASE, MEDLINE, HMIC and CINAHL between January 2002 and July 2012. We considered studies of: staff knowledge and skills, staff behavioural change, process change or patient outcomes. Results: 631 potentially relevant papers were identified from which 29 papers were selected for inclusion (two randomised controlled trials and 27 uncontrolled studies). Most studies addressed shift-change handover and used a median of three outcome measures, but there was no outcome measure common to all. Poor study design and inconsistent reporting methods made it difficult to reach definite conclusions. Information transfer was improved in most relevant studies, while clinical outcome improvement was reported in only two of 10 studies. No difference was noted in the likelihood of success across four types of intervention. Conclusions: The current literature does not confirm that any methodology reliably improves the outcomes of clinical handover, although information transfer may be increased. Better study designs and consistency of the terminology used to describe handover and its improvement are urgently required. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical handover health care quality patient safety EMTREE MEDICAL INDEX TERMS behavior change data base human knowledge outcome assessment randomized controlled trial (topic) review skill study design systematic review total quality management EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014409970 MEDLINE PMID 24811239 (http://www.ncbi.nlm.nih.gov/pubmed/24811239) PUI L373319075 DOI 10.1136/bmjqs-2013-002309 FULL TEXT LINK http://dx.doi.org/10.1136/bmjqs-2013-002309 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 334 TITLE Evacuation of the ICU: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement AUTHOR NAMES King M.A. Niven A.S. Beninati W. Fang R. Einav S. Rubinson L. Kissoon N. Devereaux A.V. Christian M.D. Grissom C.K. AUTHOR ADDRESSES (King M.A., maryking@uw.edu) University of Washington, Harborview Medical Center, Seattle, United States. (Niven A.S.) Madigan Army Medical Center, Uniformed Services University of Health Sciences, Tacoma, United States. (Beninati W.) Intermountain Tele-Critical Care, University of Utah School of Medicine, Salt Lake City, United States. (Fang R.) University of Maryland Medical Center, Baltimore, United States. (Einav S.) Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel. (Rubinson L.) R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, United States. (Kissoon N.) BC Children's Hospital, Sunny Hill Health Centre, University of British Columbia, Vancouver, Canada. (Devereaux A.V.) Sharp Hospital, Coronado, United States. (Christian M.D.) Royal Canadian Medical Service, Canadian Armed Forces, Mount Sinai Hospital, Toronto, Canada. (Grissom C.K.) Intermountain Medical Center, University of Utah, Salt Lake City, United States. (King M.A., maryking@uw.edu) Pediatric Trauma Intensive Care Unit, Harborview Medical Center, 325 9th Ave, Box 359774, Seattle, United States. () CORRESPONDENCE ADDRESS M.A. King, Pediatric Trauma Intensive Care Unit, Harborview Medical Center, 325 9th Ave, Box 359774, Seattle, United States. SOURCE Chest (2014) 146 Supplement 4 (e44S-e60S). Date of Publication: 1 Oct 2014 ISSN 1931-3543 (electronic) 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT 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 active preparation, participation, communication, and leadership by critical care providers. Critical care providers have a professional obligation to become better educated, prepared, and engaged with the processes of ICU evacuation to provide a safe continuum of critical care during a disaster. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster emergency care intensive care intensive care unit pandemic patient transport EMTREE MEDICAL INDEX TERMS article cooperation critically ill patient evidence based medicine government health care personnel health care quality human interpersonal communication leadership medical decision making medical literature patient information public health simulation strategic planning EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014876686 MEDLINE PMID 25144509 (http://www.ncbi.nlm.nih.gov/pubmed/25144509) PUI L600342635 DOI 10.1378/chest.14-0735 FULL TEXT LINK http://dx.doi.org/10.1378/chest.14-0735 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 335 TITLE Correlation between bacterial pathogens transfer in healthcare workers and patients: A study from paediatric ICU and nursery of a tertiary care hospital AUTHOR NAMES Lavanya J. Jais M. Rakshit P. Kumar V. Dutta R. Gupta R.K. AUTHOR ADDRESSES (Lavanya J.; Jais M.; Dutta R.) Department of Microbiology, Lady Hardinge Medical College, New Delhi-110001, India. (Kumar V.) Department of Paediatrics, Kalawati Saran Children Hospital, New Delhi-110001, India. (Rakshit P.; Gupta R.K., rkgupta08@gmail.com) Central Research Institute, Kasauli- 173204. H.P, India. CORRESPONDENCE ADDRESS R.K. Gupta, Central Research Institute, Kasauli- 173204. H.P, India. Email: rkgupta08@gmail.com SOURCE Journal of Microbial and Biochemical Technology (2014) 6:1 (035-037). Date of Publication: January 2014 ISSN 1948-5948 (electronic) BOOK PUBLISHER OMICS Publishing Group, 5716 Corsa Ave., Suite 110,, Westlake, Los Angeles,, United States. ABSTRACT Background: Cross transmission of microorganisms by the hands of healthcare workers is the main route of spread of health care associated infections (HCAI) as they provide essential services to the patients. HCAI has increased the morbidity and mortality of hospitalized patients especially the ones admitted in Paediatric ICU and nursery. Objectives: The present study was undertaken to isolate bacteria from hands of resident doctors and nursing staff from Paediatric ICU and nursery and to correlate them with the patients sample isolates from same Paediatric ICU and Nursery during the same time period. Material and Methods: Fingertips of subjects were directly stabbed on MacConkey agar and Blood agar plates. Antibiogram of isolated pathogens was also determined by standard methods. Observations: Hands of 60% healthcare workers were culture positive. Predominant isolate were Coagulase negative Staphylococcus spp. (73.3%), followed by Staphylococcus aureus (10%), Enterococcus and Acinetobacter spp. (each 6.6%). Methicillin resistant Staphylococcus aureus (50%) were also observed. Conclusion: Implementation and improving the compliance to hand hygiene may result in order to reduce cross infection from health care workers to patients. © 2014 Lavanya J, et al. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care personnel intensive care unit nursery tertiary care center EMTREE MEDICAL INDEX TERMS Acinetobacter article bacterial strain bacterial transmission bacterium identification bacterium isolate bacterium isolation clinical practice coagulase negative Staphylococcus correlation analysis Enterococcus hand washing human methicillin resistant Staphylococcus aureus patient care Staphylococcus aureus EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014069118 PUI L372200390 DOI 10.4172/1948-5948.1000118 FULL TEXT LINK http://dx.doi.org/10.4172/1948-5948.1000118 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 336 TITLE 2014 critical care transport workplace and salary survey AUTHOR NAMES Greene M.J. AUTHOR ADDRESSES (Greene M.J., mgreene@fitchassoc.com) Fitch and Associ. LLC, Platte City, United States. CORRESPONDENCE ADDRESS M.J. Greene, Fitch and Associ. LLC, Platte City, United States. SOURCE Air Medical Journal (2014) 33:6 (257-264). Date of Publication: 1 Nov 2014 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT This 2014 survey polled critical care transport industry leaders, programs, and caregivers about workplace and salary information. Beyond descriptive information and salary data, the article details specific experience, education, and scope of practice within the critical care transport industry. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport critical care transport intensive care salary workplace EMTREE MEDICAL INDEX TERMS employment health care industry health care policy health care system human medical care medical education medical practice medical service medical society review scope of practice EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Occupational Health and Industrial Medicine (35) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014946374 MEDLINE PMID 25441517 (http://www.ncbi.nlm.nih.gov/pubmed/25441517) PUI L600663446 DOI 10.1016/j.amj.2014.09.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2014.09.008 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 337 TITLE Traumatic brain injury: Initial resuscitation and transfer AUTHOR NAMES John R. Appleby I. AUTHOR ADDRESSES (John R.; Appleby I.) National Hospital for Neurology and Neurosurgery, London, United Kingdom. SOURCE Anaesthesia and Intensive Care Medicine (2014) 15:4 (161-163). Date of Publication: April 2014 ISSN 1878-7584 (electronic) 1472-0299 BOOK PUBLISHER Elsevier BV ABSTRACT Traumatic brain injury (TBI) is common and carries a high morbidity and mortality. Initial management of the traumatic brain injury patient is directed toward preventing and limiting secondary brain injury while facilitating rapid transport to an appropriate facility capable of providing definitive neurocritical care. During resuscitation of the TBI patient, management is directed at correcting and maintaining mean arterial pressure (MAP), blood glucose, PaO(2) and PaCO(2) within their normal ranges. After the initial resuscitation, management is directed at limiting secondary damage to the brain that occurs in response to inflammatory changes, expanding haematomas, cellular swelling, seizures, and systemic complications such as haemodynamic or pulmonary changes, fever and pain. The transport of critically ill brain injured patients carries inherent risks. Although both intrahospital and interhospital transport must comply with regulations, patient safety is enhanced during transport by establishing an organised, efficient process supported by appropriate equipment and personnel. This review examines the evidence base for the initial resuscitation and transfer of head-injured patients. © 2014 Published by Elsevier Ltd. EMTREE DRUG INDEX TERMS metaraminol noradrenalin vitamin K group EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) resuscitation traumatic brain injury (disease management) EMTREE MEDICAL INDEX TERMS air conditioning analgesia anesthesia article brain injury brain perfusion cell swelling cervical spine computer assisted tomography critically ill patient fever glucose blood level hematoma human hypothermia mean arterial pressure pain patient referral patient safety patient transport priority journal prophylaxis radiology department respiration control seizure CAS REGISTRY NUMBERS metaraminol (33402-03-8, 54-49-9) noradrenalin (1407-84-7, 51-41-2) vitamin K group (12001-79-5) EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014243778 PUI L372781206 DOI 10.1016/j.mpaic.2014.01.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.mpaic.2014.01.010 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 338 TITLE AMPA's mission: Advancing air & ground critical care transport medicine AUTHOR NAMES Hinckley W. AUTHOR ADDRESSES (Hinckley W.) CORRESPONDENCE ADDRESS W. Hinckley, SOURCE Air Medical Journal (2014) 33:3 (102-103). Date of Publication: May-June 2014 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport medical society EMTREE MEDICAL INDEX TERMS critically ill patient human medical education medical research note occupational safety patient safety priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014298866 PUI L372982251 DOI 10.1016/j.amj.2014.03.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2014.03.006 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 339 TITLE Feasibility of using the predisposition, insult/infection, physiological response, and organ dysfunction concept of sepsis to predict the risk of deterioration and unplanned intensive care unit transfer after emergency department admission AUTHOR NAMES Tsai J.C.H. Weng S.-J. Huang C.-Y. Yen D.H.T. Chen H.-L. AUTHOR ADDRESSES (Tsai J.C.H., erdr2181@gmail.com; Chen H.-L.) Department of Emergency Medicine, Cheng-Ching General Hospital, Taichung, Taiwan. (Tsai J.C.H., erdr2181@gmail.com; Weng S.-J.) Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan. (Tsai J.C.H., erdr2181@gmail.com) Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan. (Huang C.-Y.) Program of Health Administration, Tunghai University, Taichung, Taiwan. (Yen D.H.T.) Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan. CORRESPONDENCE ADDRESS J.C.H. Tsai, Department of Emergency Medicine, China Medical University Hospital, 2, Yu-Der Road, Taichung 404, Taiwan. Email: erdr2181@gmail.com SOURCE Journal of the Chinese Medical Association (2014) 77:3 (133-141). Date of Publication: March 2014 ISSN 1728-7731 (electronic) 1726-4901 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Recognizing patients at risk for deterioration and in need of critical care after emergency department (ED) admission may prevent unplanned intensive care unit (ICU) transfers and decrease the number of deaths in the hospital. The objective of this research was to study if the predisposition, insult, response, and organ dysfunction (PIRO) concept of sepsis can be used to predict the risk of unplanned ICU transfer after ED admission. Methods: The ICU transfer group included 313 patients with unplanned transfer to the ICU within 48 hours of ED admission, and the control (non-transfer) group included 736 randomly sampled patients who were not transferred to the ICU. Two-thirds of the total 1049 patients in this study were randomly assigned to a derivation group, which was used to develop the PIRO model, and the remaining patients were assigned to a validation group. Results: Independent predictors of deterioration within 48 hours after ED admission were identified by the PIRO concept. PIRO scores were higher in the ICU transfer group than in the non-transfer group, both in the derivation group [median (mean±SD), 5 (5.7±3.7) vs. 2 (2.5±2.5); p<0.001], and in the validation group [median (mean±SD), 6 (6.0±3.4) vs. 2 (2.4±2.6); p<0.001]. The proportion of ICU transfer patients with a PIRO score of 0-3, 4-6, 7-9, and ≥10 was 14.1%, 46.5%, 57.3%, and 83.8% in the derivation group (p<0.001) and 12.8%, 37.3%, 68.2%, and 70.0% in the validation group (p<0.001), respectively. The proportion of inpatient mortality in patients with a PIRO score of 0-3, 4-6, 7-9, and ≥10 was 2.6%, 10.1%, 23.2%, and 45.9% in the derivation group (p<0.001) and 3.3%, 12.0%, 18.2%, and 20.5% in the validation group (p<0.001), respectively. Conclusion: The PIRO concept of sepsis may be used in undifferentiated medical ED patients as a prediction system for unplanned ICU transfer after admission. © 2014 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) conceptual framework emergency ward hospital admission intensive care unit predisposition insult response and organ dysfunction concept sepsis EMTREE MEDICAL INDEX TERMS adolescent adult aged article body temperature breathing rate controlled study feasibility study female general condition deterioration heart rate hematologic disease human hypotension kidney dysfunction leukocyte count liver dysfunction major clinical study male metabolic disorder middle aged observational study patient transport prediction randomized controlled trial respiratory failure risk assessment very elderly young adult EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014148397 MEDLINE PMID 24495529 (http://www.ncbi.nlm.nih.gov/pubmed/24495529) PUI L52987225 DOI 10.1016/j.jcma.2013.12.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcma.2013.12.001 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 340 TITLE PEWS score predicts the need for PICU transfer and critical care interventions AUTHOR NAMES Hopkins M. Rowan C. Rigby M. Tori A. AUTHOR ADDRESSES (Hopkins M.) Indiana University, Riley Hospital for Children, Indiapoilis, United States. (Rowan C.; Rigby M.; Tori A.) Riley Hospital for Children, Indianapolis, United States. CORRESPONDENCE ADDRESS M. Hopkins, Indiana University, Riley Hospital for Children, Indiapoilis, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A168). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The 7-component pediatric early warning system (PEWS) score was developed as an objective means by which children at risk for clinical deterioration can be identified sooner. It is largely objective and easily integrated into the electronic medical record. However, this system has not been formally evaluated in additional institutions. Methods: To determine if the peak PEWS score at a large tertiary care pediatric center is a reliable predictor for PICU transfer and critical care interventions, a retrospective chart review was conducted. We identified 288 code blue or rapid response team (RRT) events that occurred between January 1, 2012 and December 31, 2012. We then compared the PEWS scores for those patients requiring PICU transfer with those who remained on the general ward. Additionally, we compared PEWS scores for those patients requiring critical care interventions with those who did not, regardless of transfer status. Results: A preliminary analysis was conducted for 113 events, as data collection is ongoing and will be complete by October 2013. Of all events, 58.4% required transfer to the PICU. The mean PEWS score was significantly higher for those patients requiring ICU transfer (9.95 [5.30] vs. 5.87 [3.90], p<0.0001). Of those requiring PICU transfer, 93.6% needed critical care interventions. A peak PEWS score of >7 within 12 hours of RRT or code blue event has PPV of 0.875 for requiring critical care interventions. Of those requiring PICU transfer for respiratory instability, 91.8% required respiratory support (32.7% required high-flow nasal cannula, 10.2% required continuous albuterol nebulization and 49.0% required positive pressure ventilation). Of those with hemodynamic instability, 90% required cardiovascular support. Conclusions: The modified 7-component PEWS score is a reliable predictor of both the need for transfer to ICU and the need for critical care interventions. EMTREE DRUG INDEX TERMS salbutamol EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS assisted ventilation child deterioration electronic medical record human information processing medical record review nasal cannula nebulization patient pediatric hospital positive end expiratory pressure rapid response team risk tertiary health care ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533862 DOI 10.1097/01.ccm.0000439922.90559.23 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439922.90559.23 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 341 TITLE Improving efficacy and safety of pediatric intensive care unit patient transfers AUTHOR NAMES Patel B. Miller K. Salas A. AUTHOR ADDRESSES (Patel B.) Drexel University College of Medicine, Dept. of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, United States. (Patel B.) Children's Hospital at Montefiore, Bronx, United States. (Miller K.; Salas A.) St. Christopher's Hospital for Children, Philadelphia, United States. CORRESPONDENCE ADDRESS B. Patel, Drexel University College of Medicine, Dept. of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A25). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Patient transfers from the Pediatric ICU were largely inefficient, which can compromise patient safety. After the PICU team decided that the patient was stable for transfer to the regular floor, it would take several hours to days for the bed assignment to the floor. This provided the floor teams with inaccurate sign out and orders on the patient as plan of care might have changed at the actual time of transfer. While awaiting bed placement, patients might have been discharged home from the PICU which was not relayed to floor teams and these patients were continued to be counted in the floor team census. The aim of this study is to decrease the time lapse between the notification of PICU transfer to the floor to actual arrival of the patient to the floor to 120 minutes within one year. Methods: Initially, pre-intervention data was collected for 3 months to determine the length of time for PICU patient transfer to the regular floor. Data was collected by retrospective review of admission list by noting the time PICU resident called the admitting resident and time of the first vital sign recorded on the regular floor. Intervention was conducted in a multidisciplinary team approach by creating a hospital wide policy to only notify the admitting resident about the PICU transfer after the patient already has a bed assignment on the regular floor. After the implementation of the intervention, post-intervention data was collected for 4 months in the similar fashion to the collection of the pre intervention data. Data was analyzed via control charts. Results: The average length of time for PICU transfers pre-intervention was 11.5 hours and post-intervention was 1.88 hours (113 minutes). There was a 9.62 hour reduction in the length of time for PICU transfers postinterventional. Pre-interventional, there were 8 discharges from the PICU prior to transfer; whereas, there were 0 discharges noted post-interventional. The C-charts showed sustained and improving decrease in length of time lapse for transfers over time after the intervention. Conclusions: We conclude that the aim statement was achieved; the average length of time of PICU transfer was under 120 minutes in less than one year. The efficiency of the PICU transfer also improved over time after the intervention implementation as involved team players had increased familiarity and acceptance of the new hospital policy. Accurate and timely sign out of the patient to the floor team with better understanding of the management leads to improvement in resident satisfaction and stress reduction as well as enhancement of patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care intensive care unit patient transport safety society EMTREE MEDICAL INDEX TERMS hospital hospital policy patient patient safety policy population research satisfaction vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533313 DOI 10.1097/01.ccm.0000439273.18488.33 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439273.18488.33 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 342 TITLE Intubation in pediatric/neonatal critical care transport: A national benchmark AUTHOR NAMES Bigham M. Bigelow A. Schwartz H. Gothard M. AUTHOR ADDRESSES (Bigham M.; Bigelow A.) Akron Children's Hospital, Akron, United States. (Schwartz H.) Cincinnati Children'S Hospital, Cincinnati, United States. (Gothard M.) BIOSTATS, East Canton, United States. CORRESPONDENCE ADDRESS M. Bigham, Akron Children's Hospital, Akron, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A96). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Nearly 200,000 US infants/children are transported annually for specialty care. Respiratory interventions are a priority in pediatric and neonatal critical care transport(PNCCT). A recent Delphi study identified intubation performance as an important PNCCT quality metric, though data are insufficient. Establishing performance benchmarks around transport intubation is necessary and permits evaluation of intubation practices that result in higher performance. Methods: This multi-center study seeks to determine 1st attempt intubation success and describe intubation practices in PNCCT. Data from participating centers regarding infants/children intubated by the PNCCT team were tracked over a 6-month period (Jan-June 2013). Data describing intubation training and practices were gathered using SurveyMonkey® (Palo Alto, CA). Data were tabulated in Microsoft Excel (Redmond, WA) and analyzed using descriptive statistics and ANOVA. Results: 8 of 14 invited institutions participated. The median(IQR) 6-month transport volume for neonates(neo) was 217.5(178-397) and pediatric(ped) 510.5(179-608). On average, 6.9%(±2.6) of neo and 1.7%(±0.8) of ped transport patients required intubation. The mean(±SD) 1st intubation attempt success rate in neo was 67.9%(±18.7) and in ped 60.6%(±32.1). Respiratory therapists(RT) were the primary intubator at 63% of programs. Initial intubation competency requires live intubations at 88% of programs. For ongoing intubation competency, 63% of programs require live intubations while all programs incorporate simulated intubations. The top-performing transport team with neo (88%) and ped (100%) 1st attempt intubation success requires successful live-patient intubations for initial competency and reports primary intubation responsibilities shared amongst nurse and RT. Conclusions: This represents the first multi-center neo/ped intubation dataset in PNCCT. First attempt intubation success lags behind reported anesthesia intubation rates but parallels pediatric emergency department intubation success rates. Training and operational processes are variable in PNCCT, though top performing teams require livepatient intubation success to achieve initial intubation competency. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care intubation society EMTREE MEDICAL INDEX TERMS analysis of variance anesthesia Delphi study emergency ward human implantable cardioverter defibrillator multicenter study newborn nurse patient respiratory therapist responsibility statistics LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533585 DOI 10.1097/01.ccm.0000439545.87244.b3 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439545.87244.b3 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 343 TITLE Prediction of intensive care unit transfer or death in emergency department patients with suspected AUTHOR NAMES Jessen M.K. Mackenhauer J. Hvass A.M. Ødorf K. Skibsted S. Kirkegaard H. AUTHOR ADDRESSES (Jessen M.K.; Mackenhauer J.; Ødorf K.; Skibsted S.; Kirkegaard H.) Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. (Hvass A.M.) Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark. (Ødorf K.; Skibsted S.) Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, United States. CORRESPONDENCE ADDRESS M.K. Jessen, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A262). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: A challenge faced by emergency physicians is determining which patients with suspected infection will deteriorate. The purpose of this study is to compare patients with suspected infection who die or are transferred to an ICU within 48 hours to those remaining at primary wards, and creating a prediction model of ICU transfer or death. Methods: A retrospective case-control study. Inclusion criteria were: 1) age >18 years and 2) having a blood culture drawn upon admission to the ED at Aarhus University Hospital, Jan 1st to Dec 31st 2011. Patients were grouped by in-hospital course within the first 48 hours. Cases were defined as the composite endpoint of death or ICU-transfer within 48 hours of admission. Controls were defined as those not meeting the composite endpoint. Matching was performed 1:3, where possible, by age and admission month. Laboratory results, type of antibiotics and clinical data from within the first 4 hours of admission were collected. We constructed a model predicting death or transfer to ICU within 2 days using backward, stepwise logistic regression. Fractional polynomial-transformations were performed. In order to evaluate the quality of the model we measured its sensitivity, specificity, Positive Predictive Value and Negative Predictive Value as well as its ability to discriminate cases from non-cases by estimating the area under the ROC-curve. Results: 1578 patients had a blood culture drawn in the ED. Overall in-hospital mortality was 9%. 140 cases were matched to 401 controls. Independent predictors of ICU-transfer or death included respiratory rate, temperature and number of failing organs. A prediction model containing these independent predictors had a good predictive accuracy with an area under the curve of 0.89 (95% CI 0.8403- 0.9296). Sensitivity was 63%, specificity 93 %, positive predictive value 72% and negative predictive value 90%. Conclusions: Readily available clinical and laboratory variables at arrival in the ED can aid in the prediction of the outcome within two days of admission. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) death emergency ward human intensive care intensive care unit patient prediction society EMTREE MEDICAL INDEX TERMS area under the curve blood culture breathing rate case control study clinical study emergency physician hospital infection laboratory logistic regression analysis model mortality predictive value receiver operating characteristic temperature university hospital ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71534219 DOI 10.1097/01.ccm.0000440279.77880.4d FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000440279.77880.4d COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 344 TITLE Predicto rs and outco mes of unplanned transfers to the PICU among children with respirato ry distress AUTHOR NAMES Collins C. Daley S. Goodman D. AUTHOR ADDRESSES (Collins C.) Seattle Children's Hospital and Medical Center, Seattle, United States. (Daley S.) Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, United States. (Goodman D.) Ann and Robert H Lurie Children's Hospital, Chicago, United States. CORRESPONDENCE ADDRESS C. Collins, Seattle Children's Hospital and Medical Center, Seattle, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A134-A135). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Transfers from the ward to the Intensive Care Unit (ICU) may delay therapy and are disruptive to patient care. Studies in adults show that patients who have unplanned transfers to the ICU have worse outcomes compared to those directly admitted to the ICU. Studies in adult patients have identified predictors for unplanned ICU transfers. There is a paucity of data in pediatric patients regarding predictors of unplanned transfers or outcomes of patients with unplanned transfers. Methods: A retrospective case-control chart review from January 2010 through January 2012 was performed. Patients admitted or discharged with a single-system respiratory disease were included. Cases were those patients admitted to the ward and transferred to the ICU within 24 hours. Controls were matched on age and date of admission. Patients directly admitted to the ICU were compared to cases and controls. Results: 51 cases, 95 controls, and 71 ICU admissions were reviewed. Demographics were similar between the groups. Differences in respiratory rate, heart rate, and temperature were not significant between cases and controls. Oxygen saturation was lower for cases than controls (93% vs. 95%, p = .0019) and similar between cases and direct ICU admissions (93% vs. 92%, p = .4204). Cases required an intermediate amount of oxygen compared to controls and direct ICU admissions (FiO2 mean 0.27 vs. 0.23 vs. 0.49 respectively, p<.0001). Cases had longer hospitalizations compared to controls and direct ICU admissions respectively (6.1 days vs. 1.8 days vs. 3.9 days respectively, p < .0001). Cases were intubated more than direct ICU admissions (14% vs. 3%, p = 0.0337). There was no statistically significant difference in rates of Non-Invasive Positive Pressure Ventilation (NIPPV) between cases and direct ICU admissions (24% vs. 13%, p = .0579). Conclusions: Patients with respiratory distress requiring unplanned transfer have lower saturations upon arrival to the ED compared to patients who do not require transfer and similar saturations compared to patients directly admitted to the ICU. Respiratory rate, heart rate, and temperature do not discriminate between those who require transfer and those who do not. Patients who require unplanned transfers have longer hospitalizations and require intubation more often than patients directly admitted to the ICU. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child human intensive care society EMTREE MEDICAL INDEX TERMS adult breathing rate heart rate hospitalization intensive care unit intubation medical record review oxygen saturation patient patient care positive end expiratory pressure respiratory distress respiratory tract disease temperature therapy ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533733 DOI 10.1097/01.ccm.0000439793.73556.a2 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439793.73556.a2 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 345 TITLE Classification of inpatient adverse dru g reactions leading to intensive care unit transfer AUTHOR NAMES Sejnowski C. Saber S. AUTHOR ADDRESSES (Sejnowski C.; Saber S.) UPMC Hamot, Erie, United States. CORRESPONDENCE ADDRESS C. Sejnowski, UPMC Hamot, Erie, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A136-A137). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Research has shown that there is an incidence of adverse drug reactions in 10-13% of all hospitalized patients. There are no published studies that review adverse drug reactions that lead to intensive care unit transfer. Methods: This study was approved by the Institutional Review Board. All patients transferred to one of the three intensive care units from November 2012 through February 2013 were reviewed retrospectively using the electronic medical record and paper charts. Patients were included in the study if an adverse drug reaction occurred causing transfer to an ICU from a non-ICU inpatient unit. Patients were excluded if admitted to the ICU from the emergency department, directly admitted from another facility or doctor's office, or directly admitted from the operating room (OR) or post-anesthesia care unit (PACU). Probability, preventability, severity, type, and cause of the adverse drug reaction were evaluated. Logistic regression was used to determine factors associated with preventability. Data was evaluated for patterns among ICU admissions caused by adverse drug reactions. Results: A total of 315 patients were reviewed that were transferred to the ICU during the study period, and twenty patients met the inclusion criteria. Of the twenty patients included in the study, 35% (7 patients) were female and 45% (9 patients) had no known drug allergies. Three adverse drug reactions were deemed preventable. The results of this study suggest that female gender may be a predictor of preventable ADRs, but the sample size is too small to make any conclusions. Opioids alone and anticoagulants caused 45% of the ADRs leading to ICU admission. Conclusions: Although it is difficult to make generalized suggestions for improvement due to the small sample size, one problem area was the use of benzodiazepines and opioids within a short time frame in two cases. Further studies looking at risk factors for preventable adverse drug reactions leading to ICU admission are needed. EMTREE DRUG INDEX TERMS anticoagulant agent benzodiazepine derivative EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) classification hospital patient human intensive care intensive care unit society EMTREE MEDICAL INDEX TERMS adverse drug reaction drug hypersensitivity electronic medical record emergency ward female gender institutional review logistic regression analysis operating room patient physician recovery room risk factor sample size LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533741 DOI 10.1097/01.ccm.0000439801.88803.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439801.88803.88 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 346 TITLE A novel policy to assure safe inter-hospital ICU to ICU transport: A review of the literature AUTHOR NAMES Pakula A. Gannon J. Mundy L. Berns K. Stoltenberg A. Ballinger B. AUTHOR ADDRESSES (Pakula A.; Gannon J.; Mundy L.; Berns K.; Stoltenberg A.; Ballinger B.) Mayo Clinic, Rochester, United States. CORRESPONDENCE ADDRESS A. Pakula, Mayo Clinic, Rochester, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A149). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Transfer of patients from quaternary centers will increase in frequency as care becomes increasingly regionalized and resources concentrated. These patients can convalesce in their home institutions' ICU. We performed a literature review on Interhospital transport from ICU to ICU of critically ill patients. However, the majority of literature addresses intrahospital transports for procedures. Also, it describes only incidence of adverse events and risk factors for complication. There is paucity of data on policies to assure safe interhospital ICU transport. A transport policy coordinated with a multidisciplinary transport team (MTT) is indicated. Methods: A PubMed search was performed and keywords included “interhospital transport”, “critically ill patients”, “ICU transfers”, and “transport policy”. All information and recommendations were considered and our own institution's process was evaluated before establishing a policy. Results: Adverse events have been reported to occur from 30-70% of transports. These include changes in vital signs, respiratory status, increased vasopressor need, oxygen support and interventions. At our institution we created a policy to guide future interhospital transport. Elements include: 1) primary service determines ICU patient medically safe for transfer 2) physician will request Transport Team Meeting be arranged. Team includes the primary physician, members of nursing staff: Clinical Nurse Specialist (CNS) and most recent nurses caring for patient, social worker/discharge planner, transport/flight team manager and transport respiratory therapist 3) transport elements to be determined include level of care, mode of transport required to meet patient's medical needs, equipment resources and personnel expertise set needed. Also included is summary of patient's hospitalization 4) recommendations for these needs determined at the MTT meeting will be placed in the EMR, using a newly created template document which can be readily accessed for review 5) a referral will be submitted to our hospital transfer and communication center who will use this information to secure a transport provider who has all of these resources. Conclusions: Transparent policies can be created across all institutional ICUs for safe transport of critically ill patients. As a result of this literature review we found that there is data expressing the need for these policies but the policies themselves scarcely exist. To our knowledge this is the first description of an institutional policy for inter-hospital ICU to ICU transport of patents. EMTREE DRUG INDEX TERMS hypertensive factor oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care policy society EMTREE MEDICAL INDEX TERMS clinical nurse specialist critically ill patient hospitalization human interpersonal communication manager Medline nurse nursing staff patent patient personnel physician procedures respiratory therapist risk factor vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533789 DOI 10.1097/01.ccm.0000439849.82896.de FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439849.82896.de COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 347 TITLE Utility of surveillance cultures for antimicrobial resistant organisms in infants transferred to the neonatal intensive care unit AUTHOR NAMES Macnow T. O'Toole D. DeLaMora P. Murray M. Rivera K. Whittier S. Ross B. Jenkins S. Saiman L. Duchon J. AUTHOR ADDRESSES (Macnow T.; O'Toole D.; Rivera K.; Saiman L.; Duchon J., jmd2116@columbia.edu) Department of Pediatrics, Columbia University Medical Center, 3959 Broadway, New York, NY 10032, United States. (DeLaMora P.) Department of Pediatrics, Cornell University, New York, NY, United States. (Murray M.) Columbia University School of Nursing, Columbia University Medical Center, New York, NY, United States. (Whittier S.) Department of Pathology, Columbia University Medical Center, New York, NY, United States. (Whittier S.) Department of Clinical Microbiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, United States. (Ross B.; Saiman L.) Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, United States. (Jenkins S.) Department of Pathology, Weill Cornell Medical Center, New York, NY, United States. (Jenkins S.) Department of Clinical Microbiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States. CORRESPONDENCE ADDRESS J. Duchon, Department of Pediatrics, Columbia University Medical Center, 3959 Broadway, New York, NY 10032, United States. Email: jmd2116@columbia.edu SOURCE Pediatric Infectious Disease Journal (2013) 32:12 (e443-e450). Date of Publication: 2013 ISSN 0891-3668 1532-0987 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Background: Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits and costs of different strategies have not been fully evaluated. Methods: We conducted a retrospective study in 2 level III NICUs from 2004 to 2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods. Risk factors, selected outcomes and laboratory costs associated with ARO colonization were assessed. Results: Among 1751 infants studied, the rate of colonization for methicillin-resistant S. aureus, vancomycin-resistant enterococci and antibioticresistant gram-negative rods was 3%, 1.7% and 1%, respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at.7 days of life had 5.8 increased odds of ARO colonization compared with infants <7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection and duration of hospitalization compared with those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425. Conclusions: The rate of colonization with AROs at transfer was low particularly in infants <7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants. © 2013 Lippincott Williams &Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistant organism bacterium bacterium culture infant disease newborn intensive care EMTREE MEDICAL INDEX TERMS article bacterial colonization bacterial infection birth weight congenital heart disease female gastrointestinal disease gestational age Gram negative bacterium health care cost human infant infant mortality length of stay major clinical study male methicillin resistant Staphylococcus aureus patient transport priority journal retrospective study risk factor vancomycin resistant Enterococcus EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014013661 MEDLINE PMID 23811747 (http://www.ncbi.nlm.nih.gov/pubmed/23811747) PUI L52653196 DOI 10.1097/INF.0b013e3182a1d77f FULL TEXT LINK http://dx.doi.org/10.1097/INF.0b013e3182a1d77f COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 348 TITLE Use of simulation/checklist to improve safety during intra-hospital transport of the critically ill AUTHOR NAMES Bangar M. Durst M. Venegas-Borsellino C. Eisen L. Lizano D. Dudaie R. Carlese A. Shiloh A. AUTHOR ADDRESSES (Lizano D.) (Bangar M.; Durst M.; Venegas-Borsellino C.; Eisen L.; Dudaie R.) Montefiore Medical Center, Bronx, United States. (Carlese A.) Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States. (Shiloh A.) Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, United States. CORRESPONDENCE ADDRESS M. Bangar, Montefiore Medical Center, Bronx, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A2). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Intra-hospital transport of critically ill patients is often necessary for patient care. However, such transport also puts patients at risk for adverse events. Some arise from preventable sources such as human error and poor communication. Safe intra-hospital transport depends on the anticipation of complications and appropriate handling complications when they arise. Methods: After Institutional Review Board approval, an observational, prospective, before-after study design was used on 23 PAs in the Critical Care Medicine environment. Each PA completed a total of 6 simulated scenarios using a HFS (SimMan - Laerdal). During each case the group was evaluated on a 20-point performance checklist including transport-specific items including: understanding principles of safe transport, knowing physiologic effects of transport, knowing transport equipment, planning for potential transport problems, using pre-transport checklist, identifying patient needs during transfer, assuming leadership role during transfer, providing handover. After the first 2 cases the PAs were given a training session and a pre-transport safety checklist was introduced. Then the PAs participated in 2 more cases for penetrating education and finally they participated in 2 more cases evaluated and scored as post-training cases. Scores between pre and post training cases were compared. Analysis was performed using STATA/IC 11.2. Results: The overall clinical performance comparing a pre vs. post training combined score improved from 61.9%+17% to 96.45%+8% (delta +34.55%, p<0.01). The knowledge required for a level 1 transport (stable condition) improved from 65.6%+14% to 98.7%+11% (+33.1% p=0.12); and for a level 2 or 3 transport (critical condition) from 61.3%+22% to 100%+0% (delta +38.6% p<0.01). The core competences with the most significant improvement were: understanding the benefit of pre-transfer check lists in clinical practice (+83%), using a structured approach for assessment of critically ill patients prior to transfer (+50%), identifying potential patient needs prior to and during transfer (+50%), and providing a clear and precise structured handover to the receiving unit (+100%). Conclusions: Complications related to the transport of critically ill patients can potentially be avoided with proper pre-transport preparation and training to handle adverse events. The implementation of a pre-transport safety checklist and simulation training are valuable educational tools for preparing PAs to oversee the intra-hospital transport of critically ill patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient hospital human intensive care safety society EMTREE MEDICAL INDEX TERMS checklist clinical practice competence CPR manikin education environment error institutional review interpersonal communication leadership patient patient care planning risk simulation study design LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533232 DOI 10.1097/01.ccm.0000439192.75425.bb FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439192.75425.bb COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 349 TITLE Implementation of a structured information transfer checklist improves postoperative data transfer after congenital cardiac surgery AUTHOR NAMES Karakaya A. Moerman A.T. Peperstraete H. François K. Wouters P.F. De Hert S.G. AUTHOR ADDRESSES (Karakaya A.; Moerman A.T., annelies.moerman@UGent.be; Wouters P.F.; De Hert S.G.) Department of Anaesthesiology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. (Peperstraete H.) Department of Intensive Care, Ghent University Hospital, Gent, Belgium. (François K.) Department of Cardiac Surgery, Ghent University Hospital, Gent, Belgium. CORRESPONDENCE ADDRESS A.T. Moerman, Department of Anaesthesiology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium. Email: annelies.moerman@UGent.be SOURCE European Journal of Anaesthesiology (2013) 30:12 (764-769). Date of Publication: December 2013 ISSN 0265-0215 1365-2346 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 250 Waterloo Road, London, United Kingdom. ABSTRACT BACKGROUND During one hospital stay, a patient can be cared for by five different units. With patient transfer from one unit to another, it is of prime importance to convey a complete picture of the patient's situation to minimise the risk of medical errors and to provide optimal patient care. OBJECTIVE(S) This study was designed to test the hypothesis that the implementation of a standardised checklist used during verbal patient handover could improve postoperative data transfer after congenital cardiac surgery. DESIGN Prospective, pre/postinterventional clinical study. SETTING Cardiac centre of a university hospital. PATIENTS Forty-eight patients younger than 16 years undergoing heart surgery. INTERVENTIONS A standardised checklist was developed containing all data that, according to the investigators, should be communicated during the handover of a paediatric cardiac surgery patient from the operating room to the ICU. MAIN OUTCOME MEASURES Data transfer during the postoperative handover before and after implementation of the checklist was evaluated. Duration of handover, number of interruptions, number of irrelevant data and number of confusing pieces of information were noted. Assessment of the handover process by ICU medical and nursing staff was quantified. RESULTS After implementation of the information transfer checklist, the overall data transfer increased from 48 to 73% (P<0.001). The duration of data transfer decreased from a median (range) of 6 (2 to 16) to 4 min (2 to 19) (P=0.04). The overall handover assessment by the intensive care nursing staff improved significantly after implementation of the checklist. CONCLUSION Implementation of an information transfer checklist in postoperative paediatric cardiac surgery patients resulted in a more complete transfer of information, with a decrease in the handover duration. © 2013 Copyright European Society of Anaesthesiology. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart disease (congenital disorder, surgery) medical information system EMTREE MEDICAL INDEX TERMS article checklist child clinical article clinical handover female human intensive care unit male medical error medical staff nursing staff operating room patient care patient transport postoperative period surgical patient EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013745271 MEDLINE PMID 23736091 (http://www.ncbi.nlm.nih.gov/pubmed/23736091) PUI L370339210 DOI 10.1097/EJA.0b013e328361d3bb FULL TEXT LINK http://dx.doi.org/10.1097/EJA.0b013e328361d3bb COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 350 TITLE Specialized pediatric critical care vs rapid EMS transport of trauma patients AUTHOR NAMES Garlick J. Melguizo-Castro M. Keen P. Nick T. Stroud M. AUTHOR ADDRESSES (Garlick J.) University of Arkansas for Medical Sciences, Little Rock, United States. (Melguizo-Castro M.; Keen P.; Nick T.) Arkansas Childrens Hospital, Little Rock, United States. (Stroud M.) University of Arkansas For Medical Sciences, Arkansas Children's Hospital, Little Rock, United States. CORRESPONDENCE ADDRESS J. Garlick, University of Arkansas for Medical Sciences, Little Rock, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A58-A59). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Purpose: The purpose of this study was to determine if differences exist between care provided by specialized pediatric transport teams and EMS services with respect to trauma patient outcomes. The use of specialized pediatric transport teams has been shown to reduce adverse events and lower mortality rates in children with medical illness. No studies have evaluated if a difference exists in pediatric trauma patients. The Golden Hour concept has emphasized expeditious transport of trauma patients by EMS Services. Rapid transport of trauma patients requiring surgical intervention to tertiary care centers is intuitive; however, the specialized care provided by pediatric transport teams may be beneficial in subsets of trauma patients. Improved care during transport may be more advantageous than rapid transport in pediatric trauma patients not requiring immediate surgical intervention. Methods: Retrospective data was collected on all pediatric trauma patients transported between (Jan 2007 - Dec 2011) to Arkansas Children's Hosptial (ACH), the only tertiary care children's hospital in the state. Demographic information, initial vital signs, predicted mortality scores, interventions performed by the transport teams, mechanism of injury, and injury severity scores (ISS) were collected and compared between patients transported by a specialized pediatric transport team at ACH and state EMS services. Final disposition, Emergency Department (ED) length of stay (LOS), hospital LOS, and time to the operating room (OR) were compared between group. Demographic characteristics and baseline clinical variables were assessed with two sample t-tests for continuous variables (with appropriate log transformations of the skewed variables) and Pearson test for categorical variables. Multivariate linear models using ordinary least squares was used to assess whether the differences in LOS between EMS and specialized teams remained significant after adjusting for age, gender, race and ISS. Results: There were significant differences between specialized transport team and EMS groups for demographic variables; in particular median age of the specialized team group was lower; [EMS team 10.4y (9.6 ± 5.6) vs. Specialized team 6.2y (7.4 ± 5.8) median (mean ± SD)] and ISS scores were lower in the specialized transport group. For outcome variables, un-adjusted differences in ED disposition were different, LOS was shorter, ED LOS was shorter, and the probability of survival was higher in patients transported by a specialized pediatric team. Multivariate analysis, adjusting for age and ISS revealed a significantly different ED LOS with patients transported by EMS teams spending an average of 0.67 (95% CI 0.65 to 0.68) hours longer in the ED. Conclusions: The age difference between groups was expected as specialized teams are more often called upon to transport younger patients. The difference in ED LOS [EMS Team 2.5 (3.2 ± 3.9) vs Specialized Team 2.3h (2.6 ± 2.2) P<0.001] suggests that improved care provided by specialized pediatric teams may result in enhanced resuscitation during transport, decreasing time spent in the ED. In turn, patients are transferred to ICUs or ORs more quickly, thus expediting appropriate ongoing care and rationing ED resources more efficiently. Future evaluations will determine if differences exist in subsets of trauma patients and if the number of interventions during transport differs among specialized pediatric teams versus EMS teams. Specialized pediatric transport teams may provide better care and shorten ED LOS in trauma patients transported to tertiary care children's hospitals. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human injury intensive care patient society EMTREE MEDICAL INDEX TERMS child childhood injury demography diseases emergency ward gender hospital injury scale length of stay mortality multivariate analysis operating room outcome variable pediatric hospital regression analysis resuscitation statistical model Student t test surgery survival tertiary care center tertiary health care United States vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533443 DOI 10.1097/01.ccm.0000439403.36902.cb FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439403.36902.cb COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 351 TITLE Televisitation: virtual transportation of family to the bedside in an acute care setting. AUTHOR NAMES Nicholas B. AUTHOR ADDRESSES (Nicholas B.) Thunder Bay Regional Health Sciences Centre in Ontario, Canada. CORRESPONDENCE ADDRESS B. Nicholas, Thunder Bay Regional Health Sciences Centre in Ontario, Canada. Email: nicholab@tbh.net SOURCE The Permanente journal (2013) 17:1 (50-52). Date of Publication: 2013 Winter ISSN 1552-5775 (electronic) ABSTRACT Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. This innovation in the Telemedicine Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) in Ontario, Canada, embraces the concept of patient- and family-centered care and has been identified as a leading practice by Accreditation Canada. The need to find creative ways to link patients to their family and friend supports hundreds of miles away was identified more than ten years ago. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. TBRHSC's patient- and family-centered model of care focuses on connecting patients with their families. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient videoconferencing EMTREE MEDICAL INDEX TERMS article Canada economics human human relation organization and management patient satisfaction LANGUAGE OF ARTICLE English MEDLINE PMID 23596369 (http://www.ncbi.nlm.nih.gov/pubmed/23596369) PUI L369862065 DOI 10.7812/TPP/12-013 FULL TEXT LINK http://dx.doi.org/10.7812/TPP/12-013 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 352 TITLE Intrahospital transport of patients with severe lung disease ORIGINAL (NON-ENGLISH) TITLE Transporte intrahospitalario del paciente con enfermedad pulmonar grave AUTHOR NAMES Portela Ortiz J.M. Delgadillo Arauz C. AUTHOR ADDRESSES (Portela Ortiz J.M.) HospitaL Ángeles Pedregal, Mexico. (Delgadillo Arauz C.) HospitaL Ángeles Pedregal, Universidad La Salle, Mexico. CORRESPONDENCE ADDRESS HospitaL Ángeles Pedregal, Mexico. SOURCE Revista Mexicana de Anestesiologia (2013) 36:SUPPL.1 (S23-S27). Date of Publication: 2013 ISSN 0185-1012 BOOK PUBLISHER Colegio Mexicano de Anestesiologia A.C., CP 03810, Mexico D.F., Mexico. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) lung disease patient transport EMTREE MEDICAL INDEX TERMS human note EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English, Spanish EMBASE ACCESSION NUMBER 2014008821 PUI L372036641 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 353 TITLE Interfacility specialized transport care of children with neurologic disease AUTHOR NAMES Newmyer R. Kuch B. Fink E. AUTHOR ADDRESSES (Newmyer R.) Children's Hospital of Pittsburgh of UPMC, Pittsburgh, United States. (Kuch B.; Fink E.) Children's Hospital of Pittsburgh, Pittsburgh, United States. CORRESPONDENCE ADDRESS R. Newmyer, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A171). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Neurologic diagnoses (ND), in particular traumatic brain injury, account for significant morbidity and mortality in hospitalized children. Data on interfacility transport of patients with non-traumatic ND are lacking. The purposed of the study is to describe interfacility transport of children with and without ND by a specialized pediatric transport team. The long term objective is to use findings to inform treatment protocols and improve patient outcomes. Methods: Patients aged 1 month to 21 years that underwent interfacility transport by a non-trauma pediatric critical care transport team between October 1997 and February 2013 were studied from a prospectively collected database. Patients were categorized as having ND versus other diagnosis (OD) using data at hospital discharge. Groups were compared using Mann-Whitney U test. Univariate analysis identified variables that predict survival and a multivariate regression model was used to determine association with survival. Results: 12,855 patients met inclusion criteria. 2,155 with a ND, and 10,730 with OD. Children with ND were older (36m (IQR 83) vs 20 m (IQR 70)), had a higher median pre-hospital PRISM (6 (IQR 10) vs 0 (IQR 4)), a lower median GCS (10 (IQR 8) vs 14 (IQR 3)). In transport, children with ND had longer scene time in minutes (25 (IQR 22) vs 18 (IQR15)), were more likely to receive IV access (91 vs 80% (OR=2.6 [2.2-3.1])), interosseous access (5.2 vs 2.1% (OR=2.5 [2.0-3.2])) or intubation (36.3 vs 18.5% (OR 2.5 [2.3-2.8])), and were more likely to be admitted to the intensive care unit (ICU) (47.9 vs 36.7 % (OR 1.7 [1.5-1.8])) compared with children with OD. Children with ND had longer ICU and hospital length of stay and were more likely to die in the hospital (6.5 vs 4.4% (OR=1.5 [1.2-1.8])) than children with OD (all p<0.001). After accounting for variables that predicted survival in univariate analyses (PRISM, GCS, intubation status), a multivariate regression model showed that ND is associated with worse survival (negative coefficient) while transport time and mode of transport were not related to survival. The most frequent ND were seizure (66%), infection (11.5%) and anatomic abnormality (8.5%). Conclusions: In a population of children with non-traumatic ND, children with ND received more critical care interventions in transport, used more hospital resources and had worse outcomes than children with OD. Future directions include identifying interventions that may improve prehospital care and outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child human intensive care neurologic disease society EMTREE MEDICAL INDEX TERMS data base diagnosis emergency care hospital hospital discharge hospitalized child infection injury intensive care unit intubation length of stay model morbidity mortality patient population prism rank sum test seizure survival traumatic brain injury univariate analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533874 DOI 10.1097/01.ccm.0000439934.45710.d0 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439934.45710.d0 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 354 TITLE Use of an ICU discharge checklist results in an increased transfer to rehabilitation facilities AUTHOR NAMES Chirumamilla N. Schmidt U. Lemovitz A. Johnson D. Ryan C. Dunn P. Lee J. AUTHOR ADDRESSES (Chirumamilla N.; Schmidt U.; Lemovitz A.; Ryan C.; Dunn P.; Lee J.) Massachusetts General Hospital, Boston, United States. (Johnson D.) University of Nebraska Medical Center, Omaha, United States. CORRESPONDENCE ADDRESS N. Chirumamilla, Massachusetts General Hospital, Boston, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A23). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: We have previously reported that 22% of patients in a surgical ICU experience non-medical transfer delays from the ICU. The average delay to transfer for the patients in the study was 1.5 days. Checklists have been shown to improve care coordination in numerous clinical settings. Methods: We introduced checklists for patients in a 20 bed surgical ICU who were medically cleared for transfer to the floor for longer than 24 hours. These checklists were used by intensivists, nurses, case management, social workers, physical therapists and nutritionists to create a multi disciplinary approach to the patient's discharge planning. We compared the six months of data after implementation of the checklist to the baseline data from our previously published dataset. Proportions were analyzed by chi-square and length-of-stay by log-rank time analysis. Results: Out of the 1204 admissions in the ICU from Jan 1, 2013 to June 30, 2013 there were 69 discharge checklists used for 52 patients. During the study period the rate of transfer of patients from the ICU directly to rehabilitation facilities increased from 5.0 per 100 (8 patients in 160 discharges) admissions to 28.8 per 100 (15 patients for 52 discharges) admissions (p<0.001, ChiSquare=23.1). Median LOS in the ICU before and after introduction of the checklists remained at 3 days (p=0.37). The median Hospital LOS before introducing the checklists was 9 days compared to 8 days following the use of the checklists (p=0.88). Conclusions: Implementation of checklists resulted in more patients being discharged to rehabilitation facilities directly, but did not affect ICU nor hospital length of stay. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) checklist intensive care rehabilitation society EMTREE MEDICAL INDEX TERMS case management dietitian hospital hospital discharge human intensivist length of stay nurse patient physiotherapist social worker LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533306 DOI 10.1097/01.ccm.0000439266.03241.46 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439266.03241.46 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 355 TITLE Successful pediatric intubations by non-physicians in a children's critical care transport team AUTHOR NAMES Dugan M. Leong T. Petrillo-Albarano T. AUTHOR ADDRESSES (Dugan M.) Emory University, School of Medicine, Atlanta, United States. (Leong T.) Emory School of Public Health, Atlanta, United States. (Petrillo-Albarano T.) Children's Healthcare of Atlanta, Atlanta, United States. CORRESPONDENCE ADDRESS M. Dugan, Emory University, School of Medicine, Atlanta, United States. SOURCE Critical Care Medicine (2013) 41:12 SUPPL. 1 (A34). Date of Publication: December 2013 CONFERENCE NAME 43rd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-01-09 to 2014-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Prior research on physician and non-physician endotracheal intubation (ETI) of pediatric patients demonstrates highly variable success rates. To assess the performance of a single children's critical care transport team (CCT), we analyzed data from 2.5 years of pediatric ETI encounters. Methods: A retrospective review encompassed pediatric ETI encounters from 127 patient charts from the rotorcraft and ground emergency CCT of a large quaternary referral children's hospital with an average of greater than 5000 patient transports annually. Pediatric patients were cared for by the CCT between January 1, 2011, and July 31, 2013. We included all patients between 1 day and 20 years of age in our analysis, without exclusion. A single ETI attempt was defined by the insertion of a laryngoscope. We characterized first-attempt intubation success and overall intubation success with descriptive statistics and calculated 95% confidence intervals. Results: For our cohort, demographics indicated a mean patient age of 3.68 years (median age = 0.8 years, SD = 5.3 years), mean patient weight of 17.9kg (median weight = 8.5kg, SD = 23.9kg), and 60.6% of patients were male. For pediatric ETIs performed, overall success of pediatric ETI was confirmed in 125/127 patients (98.4%, 95% CI 93.9%-99.7%). First-attempt success over 2.5 years of patient encounters was 70.6% (95% CI 63.2%-77.1%). Both failures of ETI were managed successfully with a laryngeal mask airway (LMA) device. Operator inexperience was not a consistent feature in the two ETI failures. Patients successfully intubated on a first attempt were significantly older than patients requiring multiple attempts (p=.049, two sample t test). For the 89 successful first attempt intubations, average age was 4.2 yrs in contrast with an average of 2.4 yrs for the patients who required multiple attempts. Patient weight was not significantly different between patients who required a single attempt versus multiple attempts (p=.391), nor did success rates vary by patient sex (p=1.0; Fisher's exact test). Conclusions: Pediatric ETI performed by an experienced children's CCT is a safe and successful procedure. Failures can be expertly managed with extra-glottic devices, such as the LMA. Younger patient age is associated with higher likelihood of initial intubation failure and may require multiple attempts for successful definitive airway placement. Further evaluation may be used to further characterize the likelihood of first-attempt success based on patient demographics and diagnosis, in addition to providing a risk profile for those patients less likely to be amenable to first-attempt success. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child human intensive care intubation physician society EMTREE MEDICAL INDEX TERMS airway confidence interval devices diagnosis emergency endotracheal intubation Fisher exact test laryngeal mask laryngoscope male patient patient transport pediatric hospital procedures risk soft contact lens statistics Student t test weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71533347 DOI 10.1097/01.ccm.0000439307.31880.52 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000439307.31880.52 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 356 TITLE Evaluation of ventilators used during transport of critically Ill patients: A bench study AUTHOR NAMES Boussen S. Gainnier M. Michelet P. AUTHOR ADDRESSES (Boussen S., michelsalah.boussen@ap-hm.fr; Gainnier M.; Michelet P.) Réanimation des Urgences et Médicale, Hôpital de la Timone, Marseille, France. CORRESPONDENCE ADDRESS S. Boussen, Réanimation des Urgences et Médicale, Hôpital de la Timone, 254 Rue Saint Pierre, Marseille, 13005, France. Email: michelsalah.boussen@ap-hm.fr SOURCE Respiratory Care (2013) 58:11 (1911-1922). Date of Publication: 1 Nov 2013 ISSN 0020-1324 1943-3654 (electronic) BOOK PUBLISHER American Association for Respiratory Care, 9425 N. MacArthur Blvd. Suite 100, Irving, United States. ABSTRACT Objective: To evaluate the most recent transport ventilators' operational performance regarding volume delivery in controlled mode, trigger function, and the quality of pressurization in pressure support mode. Methods: Eight recent transport ventilators were included in a bench study in order to evaluate their accuracy to deliver a set tidal volume under normal resistance and compliance conditions, ARDS conditions, and obstructive conditions. The performance of the triggering system was assessed by the measure of the decrease in pressure and the time delay required to open the inspiratory valve. The quality of pressurization was obtained by computing the integral of the pressure-time curve for the first 300 ms and 500 ms after the onset of inspiration. Results: For the targeted tidal volumes of 300, 500, and 800 mL the errors ranged from -3% to 48%, -7% to 18%, and -5% to 25% in the normal conditions, -4% to 27%, -2% to 35%, and -3% to 35% in the ARDS conditions, and -4% to 53%, -6% to 30%, and -30% to 28% in the obstructive conditions. In pressure support mode the pressure drop range was 0.4 -1.7 cm H(2)O, the trigger delay range was 68-198 ms, and the pressurization performance (percent of ideal pressurization, as measured by pressure-time product at 300 ms and 500 ms) ranges were -9% to 44% at 300 ms and 6%-66% at 500 ms (P <.01). Conclusions: There were important differences in the performance of the tested ventilators. The most recent turbine ventilators outperformed the pneumatic ventilators. The best performers among the turbine ventilators proved comparable to modern ICU ventilators. © 2013 Daedalus Enterprises. EMTREE DRUG INDEX TERMS Medumat Transport WM28400 unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport ventilator EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome (therapy) article comparative study controlled study electric battery gas powered ventilator human inhalation intensive care unit measurement accuracy medical parameters obstructive airway disease (therapy) positive end expiratory pressure pressure time product tidal volume trigger delay time turbine ventilator DRUG TRADE NAMES Medumat Transport WM28400 , GermanyWeinmann Medical Technology DRUG MANUFACTURERS (Germany)Weinmann Medical Technology DEVICE TRADE NAMES Carina , GermanyDrager Elisee 350 , United StatesResMed Hamilton C1 , United Stateshamilton medical Hamilton T1 , United Stateshamilton medical Monnal T60 , FranceAir Liquide Medical System Osiris 3 , FranceAir Liquide Medical System Oxylog 3000+ , GermanyDrager DEVICE MANUFACTURERS (France)Air Liquide Medical System (Germany)Drager (United States)hamilton medical (United States)ResMed EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013674176 MEDLINE PMID 23592785 (http://www.ncbi.nlm.nih.gov/pubmed/23592785) PUI L370104884 DOI 10.4187/respcare.02144 FULL TEXT LINK http://dx.doi.org/10.4187/respcare.02144 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 357 TITLE Predictors of transfer to rehabilitation for trauma patients admitted to a level 1 trauma centre - A model derivation and internal validation study AUTHOR NAMES Dinh M. Bein K.J. Byrne C. Nair I. Petchell J. Gabbe B. Ivers R. AUTHOR ADDRESSES (Dinh M., dinh.mm@gmail.com; Bein K.J., kendallbein@tpg.com.au; Byrne C., chrisbyrne@hotmail.com) Emergency Department, Royal Prince Alfred Hospital, Australia. (Dinh M., dinh.mm@gmail.com) Department of Trauma Services, Royal Prince Alfred Hospital, Australia. (Byrne C., chrisbyrne@hotmail.com; Petchell J., jfpetchell@aapt.net.au) Division of Surgery, Royal Prince Alfred Hospital, Australia. (Nair I., Indu.Nair@sswahs.nsw.gov.au) Rehabilitation Medicine, Royal Prince Alfred Hospital, Australia. (Gabbe B., belinda.gabbe@monash.edu) Department of Epidemiology and Preventive Medicine, Monash University, Australia. (Ivers R., rivers@georgeinstitute.org.au) Injury Division, George Institute for Global Health, Australia. CORRESPONDENCE ADDRESS M. Dinh, Department of Trauma Services, Royal Prince Alfred Hospital, Australia. Email: dinh.mm@gmail.com SOURCE Injury (2013) 44:11 (1551-1555). Date of Publication: November 2013 ISSN 0020-1383 1879-0267 (electronic) BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Objective: Determine the predictors of transfer to rehabilitation in a cohort of trauma patients and derive a risk score based clinical prediction tool to identify such patients during the acute phase of injury management. Methods: Trauma registry data at a single level one trauma centre were obtained for all patients aged between 15 and 65 years admitted due to injury between 2007 and 2011. Multivariable logistic regression with stepwise selection was performed to derive a prediction model for transfer to rehabilitation. The model was tested on a validation dataset using receiver operator characteristic analyses and bootstrap cross validation on the entire dataset. A clinical prediction risk score was developed based on the final model. Results: There were 4900 patients included in the study. Variables found to be the strongest predictors of rehabilitation after logistic regression with stepwise selection were pelvic injuries (OR 12.6 95% CI 6.2, 25.2 p < 0.001), need for intensive care unit admission (OR 7.2 95% CI 4.2, 12.3 p < 0.001) and neurosurgical operation (OR 10.5 95% CI 4.7, 23.1 p < 0.001). After bootstrap cross validation the mean AUC was 0.86 (95% CI 0.84, 0.89). The model had a sensitivity of 89% and specificity of 64%. Conclusion: Intensive unit admission, neurosurgical operation, pelvic injuries and other lower limb injuries were the most important predictors of the need for rehabilitation after trauma. The prediction model has good overall sensitivity, discrimination and could be further validated for use in clinical practice. © 2013 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) injury rehabilitation care EMTREE MEDICAL INDEX TERMS adolescent adult aged area under the curve arm injury article female hospital admission human intensive care unit leg injury major clinical study male neurosurgery pelvis injury prediction priority journal sensitivity and specificity validation study EMBASE CLASSIFICATIONS Orthopedic Surgery (33) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013637382 MEDLINE PMID 23669140 (http://www.ncbi.nlm.nih.gov/pubmed/23669140) PUI L52577965 DOI 10.1016/j.injury.2013.04.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.injury.2013.04.005 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 358 TITLE Multidisciplinary Decision Making Needed for Patient Transfers AUTHOR NAMES Baggs J. AUTHOR ADDRESSES (Baggs J.) CORRESPONDENCE ADDRESS J. Baggs, SOURCE American Journal of Critical Care (2013) 22:6 (464). Date of Publication: 1 Nov 2013 ISSN 1062-3264 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit length of stay mortality patient transport EMTREE MEDICAL INDEX TERMS female human letter male organization and management statistics LANGUAGE OF ARTICLE English MEDLINE PMID 24186812 (http://www.ncbi.nlm.nih.gov/pubmed/24186812) PUI L1370362532 DOI 10.4037/ajcc2013116 FULL TEXT LINK http://dx.doi.org/10.4037/ajcc2013116 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 359 TITLE Response AUTHOR NAMES Garland A. AUTHOR ADDRESSES (Garland A.) CORRESPONDENCE ADDRESS A. Garland, SOURCE American Journal of Critical Care (2013) 22:6 (464). Date of Publication: 1 Nov 2013 ISSN 1062-3264 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit length of stay mortality patient transport EMTREE MEDICAL INDEX TERMS female human letter male organization and management statistics LANGUAGE OF ARTICLE English MEDLINE PMID 24186813 (http://www.ncbi.nlm.nih.gov/pubmed/24186813) PUI L1370362533 DOI 10.4037/ajcc2013593 FULL TEXT LINK http://dx.doi.org/10.4037/ajcc2013593 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 360 TITLE Treat and transfer: Efficacy and safety of the telestroke approach in Salzburg, Austria AUTHOR NAMES Deak I. Mutzenbach J.S. Johansson T. Trinka E. Sellner J. AUTHOR ADDRESSES (Deak I.; Mutzenbach J.S.; Johansson T.; Trinka E.; Sellner J.) Department of Neurology, Christian-Doppler Klinik, Paracelsus Medical University, Salzburg, Austria. CORRESPONDENCE ADDRESS I. Deak, Department of Neurology, Christian-Doppler Klinik, Paracelsus Medical University, Salzburg, Austria. SOURCE Journal of the Neurological Sciences (2013) 333 SUPPL. 1 (e258). Date of Publication: 15 Oct 2013 CONFERENCE NAME 21st World Congress of Neurology CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2013-09-21 to 2013-09-26 ISSN 0022-510X BOOK PUBLISHER Elsevier ABSTRACT Background: Five hospitals without 24 h neurology coverage in the Austrian state of Salzburg are connected to a stroke hub via videoconferencing. Prompt transfer to the comprehensive stroke center (20-129 km distance) is carried out after administration of recombinant tissue plasminogen activator (rt-PA). Objective: To assess efficacy and safety of teleconference-assisted thrombolysis for acute ischemic stroke and instant transfer to the stroke center. Patients and methods: Retrospective chart review of patients treated with acute ischemic stroke from 2006-2009. Inclusion criteria: rt-PA administration within 4.5 h from symptom onset, age ≥18 years. Exclusion criteria: arrival at the stroke center beyond 24 h from symptom onset, initial NIHSS >25, and previous stroke. The measures for efficacy were mortality, NIHSS and mRS at 3-month follow-up. Results: Forty-seven patients were moved to the stroke center after rt-PA treatment. The control group consisted of 304 patients who received rt-PA directly at the stroke center. Mean time till admission to the stroke unit was 231 and 108 min, respectively (P < 0.001). Patient demographics, NIHSS on admission and door-to-needle time did not differ between the groups. No transfer-related complications were reported. The rate of complications during stroke unit care did differ between the groups. There were no differences in the outcome measures. Conclusion: This study confirms that the efficacy of telemedicineassisted systemic thrombolysis is comparable to in-house administration at a comprehensive stroke center. Importantly, rapid patient relocation was safe and provides the added benefit of care at a stroke unit and interdisciplinary management in case of complications. EMTREE DRUG INDEX TERMS alteplase EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Austria neurology safety EMTREE MEDICAL INDEX TERMS blood clot lysis brain ischemia cerebrovascular accident control group follow up hospital human medical record review mortality National Institutes of Health Stroke Scale needle onset age patient stroke unit teleconference videoconferencing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71188563 DOI 10.1016/j.jns.2013.07.992 FULL TEXT LINK http://dx.doi.org/10.1016/j.jns.2013.07.992 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 361 TITLE Severe neurological impairment and problematic emergency recourses: The construction of a non-transferable patient AUTHOR NAMES Le Fort M. Ville I. Perrouin-Verbe B. AUTHOR ADDRESSES (Le Fort M., marc.lefort@chu-nantes.fr; Perrouin-Verbe B.) Service de Médecine Physique et de Réadaptation Neurologique, CHU de Nantes, 85, rue Saint-Jacques, Nantes cedex 01, France. (Ville I.) École des Hautes-Études en Sciences Sociales, Cermes 3, France. CORRESPONDENCE ADDRESS M. Le Fort, Service de Médecine Physique et de Réadaptation Neurologique, CHU de Nantes, 85, rue Saint-Jacques, Nantes cedex 01, France. Email: marc.lefort@chu-nantes.fr SOURCE Annals of Physical and Rehabilitation Medicine (2013) 56 SUPPL. 1 (e269). Date of Publication: October 2013 CONFERENCE NAME 28e Congres de Medecine Physique et de Readaptation CONFERENCE LOCATION Reims, France CONFERENCE DATE 2013-10-17 to 2013-10-19 ISSN 1877-0657 BOOK PUBLISHER Elsevier Masson SAS ABSTRACT Objective.- The ministerial circular of June 2004, the 18th, described the «good conditions» of a multidisciplinary organization for neuro-traumatic healthcare networks. Difficulties for an upstream return in case of acute complication during a stay in a PRM department constituted the basis of this study. Some patients' transfers from PRM were not executed in a convenient way. The aim of this study was to determine the causes of these problematic transfers. Patients and method.- Six severe handicap cases with a history of problematic upstream transfer during an hospitalisation in the neurological PRM department of Nantes' University Hospital (F) between 2006 and 2012: semi-structured interviews, first of the six patients and of their closer family circle, secondly of 16 acute healthcare professionals (emergency medical service and transport, respiratory intensive care unit, resuscitation departments). Analysis with the support of literature in social sciences and humanities. Results.- Several explanations of transfer difficulties, structural (notably a lack of beds in the upstream units) or linked to the confidence from the acute healthcare departments (anticipation of various «risks» at the PRM department level: turning back of the patient, tracheotomy and future dependency towards an artificial breathing apparatus, the question of active treatments limitation or cessation). A third level of explanation directly related to the patients' functional status: an a priori unfavourable opinion in case of cognitive impairment, especially for born-native pathologies, multiple sclerosis or brain injury in case of lack of perceived improvement since the admission in the PRM department. Discussion.- Two essential findings appeared: a misunderstanding of the professional practice between PRM and acute healthcare units, in spite of common practices, and an imperfect perception of the patients' future by the upstream departments practitioners. A kind of disabled patient who could be transferred with difficulty was especially constructed in case of cognitive impairment within precisely defined pathologies. The final goal of our «action sociology» study is to make clearer the daily medical practices within the framework of emergency transfers of severely impaired patients in order to promote a renewed fluidity within our healthcare networks. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adaptation disability emergency health care hospital organization human patient EMTREE MEDICAL INDEX TERMS brain injury breathing circuit cognitive defect disabled person emergency health service functional status health care personnel humanities intensive care unit medical practice multiple sclerosis pathology physician professional practice resuscitation risk semi structured interview sociology tracheotomy university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71224923 DOI 10.1016/j.rehab.2013.07.698 FULL TEXT LINK http://dx.doi.org/10.1016/j.rehab.2013.07.698 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 362 TITLE Clinical information transfer and data capture in the acute myocardial infarction pathway: An observational study AUTHOR NAMES Kesavan S. Kelay T. Collins R.E. Cox B. Bello F. Kneebone R.L. Sevdalis N. AUTHOR ADDRESSES (Kesavan S.; Kelay T.; Collins R.E.; Bello F.; Kneebone R.L.; Sevdalis N., n.sevdalis@imperial.ac.uk) Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, Norfolk Place, London, W2 1PG, United Kingdom. (Cox B.) Business School, Imperial College London, London, United Kingdom. CORRESPONDENCE ADDRESS N. Sevdalis, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital Campus, Norfolk Place, London, W2 1PG, United Kingdom. Email: n.sevdalis@imperial.ac.uk SOURCE Journal of Evaluation in Clinical Practice (2013) 19:5 (805-811). Date of Publication: October 2013 ISSN 1356-1294 1365-2753 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Rationale, aims and objectives Acute myocardial infarctions (MIs) or heart attacks are the result of a complete or an incomplete occlusion of the lumen of the coronary artery with a thrombus. Prompt diagnosis and early coronary intervention results in maximum myocardial salvage, hence time to treat is of the essence. Adequate, accurate and complete information is vital during the early stages of admission of an MI patient and can impact significantly on the quality and safety of patient care. This study aimed to record how clinical information between different clinical teams during the journey of a patient in the MI care pathway is captured and to review the flow of information within this care pathway. Method A prospective, descriptive, structured observational study to assess (i) current clinical information systems (CIS) utilization and (ii) real-time information availability within an acute cardiac care setting was carried out. Completeness and availability of patient information capture across four key stages of the MI care pathway were assessed prospectively. Results Thirteen separate information systems were utilized during the four phases of the MI pathway. Observations revealed fragmented CIS utilization, with users accessing an average of six systems to gain a complete set of patient information. Data capture was found to vary between each pathway stage and in both patient cohort risk groupings. The highest level of information completeness (100%) was observed only in the discharge stage of the MI care pathway. The lowest level of information completeness (58%) was observed in the admission stage. Conclusion The study highlights fragmentation, CIS duplication, and discrepancies in the current clinical information capture and data transfer across the MI care pathway in an acute cardiac care setting. The development of an integrated and user-friendly electronic data capture and transfer system would reduce duplication and would facilitate efficient and complete information provision at the point of care. © 2012 John Wiley & Sons Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute heart infarction EMTREE MEDICAL INDEX TERMS article clinical article coronary care unit female high risk patient human information system male medical information system observational study patient information priority journal prospective study EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013624273 MEDLINE PMID 22587539 (http://www.ncbi.nlm.nih.gov/pubmed/22587539) PUI L52017406 DOI 10.1111/j.1365-2753.2012.01853.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2753.2012.01853.x COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 363 TITLE Bouncing back with SWIFT (Stability and Workload Index for Transfer Score): Is It applicable to ICUs in urban America? AUTHOR NAMES Vaquera K. Newcomb R. Amaransingham R. Ma Y. Wilhoite S. Girod C. Ruggiero R. AUTHOR ADDRESSES (Vaquera K.; Newcomb R.; Amaransingham R.; Ma Y.; Wilhoite S.; Girod C.; Ruggiero R.) UT Southwestern Medical Center, Dallas, United States. CORRESPONDENCE ADDRESS K. Vaquera, UT Southwestern Medical Center, Dallas, United States. SOURCE Chest (2013) 144:4 MEETING ABSTRACT. Date of Publication: October 2013 CONFERENCE NAME CHEST 2013 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2013-10-26 to 2013-10-31 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT PURPOSE: Over the past few decades, the number of patients surviving critical illness has improved. However, ICU readmission rates have remained unchanged. The armamentarium has been relatively empty regarding discharge criteria from the ICU for physicians. In 2008, investigators from the Mayo Clinic developed and validated a new protocol scoring system -The Stability and Workload Index for Transfer (SWIFT) score. A standardized prediction tool is an ideal premise to optimize patient outcomes. The SWIFT scoring system has value in that it is the first predictive tool for intensive care readmission. Is this scoring system to applicable to their ICU? The purpose of this study is to assess the validity of the SWIFT Scoring System at an ICU in an urban public hospital. METHODS: This is a retrospective observational cohort study comprising the medical intensive care units at Parkland Hospital. The cohort for this study consists of consecutive patients discharged alive from the medical ICUs at Parkland Hospital from June 1, 2010 to May 31, 2011. The primary outcome variables paralleled the SWIFT study, measuring unplanned ICU readmission or unexpected death within 7 days of ICU discharge. The performance of the SWIFT Score was assessed amongst our cohort for its accuracy in predicting ICU readmissions. RESULTS: Our cohort included 2,054 patients admitted to the medical ICU at Parkland Hospital over 1 year. Patients were excluded for ICU stay <24hrs or planned admissions (499), those discharged home or transferred to another hospital/ICU within 7 days (358), those discharged to comfort care (14) and those who died during their ICU stay (141). 1,042 patients were discharged alive and evaluated as our baseline patient population. Fifty-two patients (5%) were readmitted to an ICU at our institution and six (0.5%) patients died unexpectedly within 7 days; the combined readmission and unexpected death rate was 5.5%. The sensitivity of the SWIFT score for predicting ICU readmissions was 0.21 and specificity was 0.83. This compares with original data showing sensitivity of 0.56 and specificity of 0.83. CONCLUSIONS: While the specificity of the SWIFT score remained robust in our study, the sensitivity was lacking at predicting ICU readmission. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Western Hemisphere workload EMTREE MEDICAL INDEX TERMS cohort analysis comfort critical illness death hospital hospital readmission human intensive care intensive care unit mortality outcome variable patient physician population prediction public hospital scoring system validity LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71269487 DOI 10.1378/chest.1704419 FULL TEXT LINK http://dx.doi.org/10.1378/chest.1704419 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 364 TITLE Discussants AUTHOR NAMES Inabnet W.B. Sheetz K.H. AUTHOR ADDRESSES (Inabnet W.B.) (Sheetz K.H.) SOURCE Annals of Surgery (2013) 258:4 (618). Date of Publication: October 2013 ISSN 0003-4932 1528-1140 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport tertiary health care EMTREE MEDICAL INDEX TERMS emergency care falling intensive care unit medical information mortality note outcome assessment priority journal statistics survival United States university hospital EMBASE CLASSIFICATIONS Surgery (9) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013596306 PUI L369865197 DOI 10.1097/SLA.0b013e3182a5021d FULL TEXT LINK http://dx.doi.org/10.1097/SLA.0b013e3182a5021d COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 365 TITLE Functional analysis of choline transporter in glioma cells: Effect of propofol on cell proliferation and choline uptake AUTHOR NAMES Taguchi C. Ishida Y. Hara N. Ogihara Y. Uchino H. Inazu M. AUTHOR ADDRESSES (Taguchi C.; Ishida Y.; Hara N.; Ogihara Y.; Uchino H.) Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan. (Inazu M.) Institute of Medical Science, Tokyo Medical University, Tokyo, Japan. CORRESPONDENCE ADDRESS C. Taguchi, Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan. SOURCE Journal of Neurosurgical Anesthesiology (2013) 25:4 (512). Date of Publication: October 2013 CONFERENCE NAME 17th Annual Meeting of the Japanese Society of Neuroanesthesia and Critical Care, JSNACC 2013 CONFERENCE LOCATION Tokyo, Japan CONFERENCE DATE 2013-04-12 to 2013-04-13 ISSN 0898-4921 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Propofol is a sedative and anesthetic drug commonly used for induction and intravenous maintenance in the operating room, for short-term procedural sedation, and for long-term sedation in the intensive care unit. Interestingly, previous studies suggest that propofol has neuroprotective effects or neurotoxicity. Although, there are some studies that revealed propofol at clinically relevant concentrations promoted the proliferation of cancer cells. However, the mechanisms involved in its cell proliferation remain unclear. Choline is essential for the synthesis of the major membrane phospholipid phosphatidylcholine and the neurotransmitter acetylcholine. Elevated levels of choline and upregulated choline kinase activity have been detected in cancer cells. However, the uptake system for choline and the functional expression of choline transporters are unknown. We examined the molecular and functional characterization of choline uptake in the glioma cell line A-172, and effect of propofol at clinically relevant concentrations on cell proliferation and choline uptake. Choline uptake was Na+-independent, and mediated by 2 transport systems. Choline uptake was inhibited by the choline analogue hemicholinium-3, and decreased by acidification of the extracellular medium. In addition, A-172 cells mainly express mRNA and protein for choline transporter-like protein 1 (CTL1) and CTL2, but not expressed high-affinity choline transporter 1 and organic cation transporters. Propofol at clinically relevant concentrations increased choline uptake and cell proliferation. These data indicated that CTL1 and CTL2 are functionally expressed in A-172 cells and is responsible for choline uptake, and this choline transport system uses a directed H+ gradient as a driving force. Propofol is considered to stimulate cell proliferation by enhancing the choline uptake through the CTL2 and CTL1. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) choline propofol EMTREE DRUG INDEX TERMS acetylcholine anesthetic agent choline kinase hemicholinium 3 membrane phospholipid messenger RNA neurotransmitter organic cation transporter phosphatidylcholine protein sedative agent synapsin I EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia cell proliferation choline uptake glioma cell intensive care Japanese (people) society EMTREE MEDICAL INDEX TERMS acidification cancer cell cell line intensive care unit neurotoxicity operating room sedation synthesis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71215410 DOI 10.1097/ANA.0b013e3182a4d750 FULL TEXT LINK http://dx.doi.org/10.1097/ANA.0b013e3182a4d750 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 366 TITLE Factors affecting the threshold transfer of sick parturients to higher levels of care AUTHOR NAMES James A. Endacott R. Stenhouse E. AUTHOR ADDRESSES (James A.; Endacott R.; Stenhouse E.) Plymouth University, School of Nursing and Midwifery, Plymouth, United Kingdom. (Endacott R.) Monash University, School of Nursing and Midwifery, Melbourne, Australia. CORRESPONDENCE ADDRESS A. James, Plymouth University, School of Nursing and Midwifery, Plymouth, United Kingdom. SOURCE Intensive Care Medicine (2013) 39 SUPPL. 2 (S227). Date of Publication: October 2013 CONFERENCE NAME 26th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2013 CONFERENCE LOCATION Paris, France CONFERENCE DATE 2013-10-05 to 2013-10-09 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Introduction. Current maternal mortality rate directly or indirectly due to pregnancy in the United Kingdom currently stands at 11.39 per 100,000 maternities (CMACE, 2011) and suboptimal care is frequently identified as a contributing factor in these deaths. The appropriate and timely escalation of care for maternity patients is vital in order to ensure they receive the appropriate level of care and have safe clinical outcomes (CMACE, 2011). This may include the need for maternity high dependency care (MHDC), transfer to an intensive care unit (ICU) or other specialist unit. The thresholds at which transfers to higher levels of care happen appear variable (Maternal Critical Care Working Group, 2011). OBJECTIVES. The aim of the research was to determine what constitutes high dependency care in the maternity unit setting. Research questions: 1. How do clinicians define MHDC? 2. Is there any difference in the definition of MHDC between professional groups? 3. Does the size and type of hospital/ maternity unit influence the definition of MHDC? METHODS. A three-round Delphi study was used to seek consensus across experts currently involved either directly/indirectly in the provision of/transfer to MHDC. Participants were drawn from seven maternity units in the UK, birth rates ranging from 1,700 to 5,000. Sixty-seven doctors and midwives completed all 3 rounds. Responses to a question about what constitutes MHDC (Round 1) were grouped into themes and participants rated agreement on a 5 point Likert scale (Round 2). Statements that didn't achieve consensus were presented again in Round 3, and participants were also asked if they were familiar with the UK Intensive Care Society levels of care. RESULTS. Four themes were identified in R1 (conditions, vigilance, interventions and service delivery), common across anaesthetists, obstetricians and midwives. However, midwives were more likely than doctors to request ICU admission for continuous ECG monitoring (63.3 vs. 36.4 %) and arterial line monitoring (73.5 vs. 53.1 %). Smaller maternity units were less likely to provide MHDC and had a more liberal policy of transferring women to ICU. Qualitative comments indicated that a lack of necessary equipment, facilities and skilled midwifery staff were contributing factors. The extent of familiarity with the ICS levels of care (14.3-57.1 % familiarity) tended to correspond with the size of Unit (1,700-4,500 birth rate). CONCLUSIONS. Whilst it may be seen as accountable and safe practice, this 'early' escalation of care to intensive care or HDC has workload implications for ICUs and may also impact on the bonding process between the mother and her baby. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS alertness anesthesist arterial line baby birth rate consensus death Delphi study electrocardiogram electrocardiography monitoring female health care delivery human intensive care unit Likert scale maternal mortality medical specialist midwife monitoring mortality mother obstetric patient obstetrician physician policy pregnancy United Kingdom workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71446003 DOI 10.1007/s00134-013-3095-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-3095-5 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 367 TITLE Evacuation of critically ill combat patients by military critical care air transport teams with a restricted transfusion approach is safe and may have higher return to duty rates AUTHOR NAMES Bebarta V.S. Mora A. Ervin A. AUTHOR ADDRESSES (Bebarta V.S.; Mora A.; Ervin A.) Air Force Enroute Care Research Center, San Antonio Military Medical Center, San Antonio, TX; Air Force Enroute Care Research Center, San Antonio, TX CORRESPONDENCE ADDRESS V.S. Bebarta, SOURCE Annals of Emergency Medicine (2013) 62:4 SUPPL. 1 (S30). Date of Publication: October 2013 CONFERENCE NAME American College of Emergency Physicians, ACEP Research Forum 2013 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2013-10-14 to 2013-10-15 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: Military Critical Care Transport Teams (CCATT) rapidly evacuate critically ill and injured patients out of theater for tertiary care and treatment. Teams are led by a critical care physician (emergency physician commonly), nurse, and respiratory technician. Current guidelines require a hemoglobin (Hgb) of >= 9 g/dl to evacuate. Studies in civilian critical care hospitals have reported fewer adverse events with a lower hemoglobin. Our objective was to compare short term and 30-day patient outcomes for CCATT patients evacuated out of theater with a Hgb <= 8 g/dl to those with >8 g/dl. Methods: We conducted an IRB-approved, retrospective medical record review of all traumatically injured patients evacuated from Theater by CCATT between March 2007 and December 2011. We recorded demographics, injury descriptions, vital signs, and labs and obtained outcome data including predefined complications, procedures, and mortality/hospital discharge status at 30 days. Patients were separated into pre-flight Hgb≤8.0 g/dl (L-Hgb) vs. >8.0 g/dl (H-Hgb). Continuous data were analyzed using Student's t-tests or Wilcoxon tests when appropriate and reported as mean ± SD. Chi-square or fisher's exact tests were performed as appropriate. Stepwise, multifactorial regression models were employed to assess associations between demographics, injury, and outcomes. Statistical significance was set at p<0.05. Results: Of 1257 enrolled, 219 had a pre-flight Hgb≤8.0 (L-Hgb) and 1033 Hgb>8.0 (H-Hgb). Groups were similar in age and gender proportions. Injury Severity Score (ISS, 24 SD ± 12.6) were similar and the L-Hgb group had more blast injuries (76% vs. 68%, p=0.01). Pre-flight vital signs and Post-flight vital signs and lab values were similar. In regression model analysis no associations were identified between pre-flight hemoglobin levels and adverse outcomes including pneumonia, kidney injury, ARDS, sepsis, DVT/PE, MI, mechanical ventilation, hemodialysis, or transfusions. Mortality and discharge status at 30 days were similar. We also compared a pre-flight Hgb ≤7 g/dl versus >7 g/dl (n=45 vs 1212), and the higher Hgb group had a greater incidence of patients at 30 days receiving in-patient care (79% vs 90%, p=0.04). The group with Hgb ≤ 7 g/dl had more subjects discharged home or returning to duty (21% vs. 10%, p=0.04). In addition there was a non-significant increase incidence of infection in those with Hgb >7.0 g/dl (11% vs 23%, p=0.06). Conclusions: Evacuating CCATT patients with Hgb ≤ 8 g/dl had similar serious adverse outcomes and mortality at 30 days as compared to Hgb > 8 g/dl. Patients with a Hgb ≤ 7 g/dl has a higher rate of return to duty and less incidence of in-hospital care at 30 days. EMTREE DRUG INDEX TERMS hemoglobin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) army college critically ill patient emergency physician human intensive care patient transfusion EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome adverse outcome artificial ventilation blast injury Fisher exact test flight gender hemodialysis hemoglobin blood level hospital hospital care hospital patient infection injury injury scale kidney injury medical record review model mortality nurse patient care physician pneumonia procedures rank sum test sepsis statistical significance Student t test tertiary health care vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71190143 DOI 10.1016/j.annemergmed.2013.07.361 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2013.07.361 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 368 TITLE Measure, report, improve: The quest for best practices for high-quality care in critical care transport AUTHOR NAMES Bigham M.T. Schwartz H.P. AUTHOR ADDRESSES (Bigham M.T., mbigham@chmca.org) Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH, United States. (Schwartz H.P.) Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States. CORRESPONDENCE ADDRESS M.T. Bigham, Department of Pediatrics, Division of Critical Care Medicine, One Perkins Square, Akron, OH 44308, United States. Email: mbigham@chmca.org SOURCE Clinical Pediatric Emergency Medicine (2013) 14:3 (171-179). Date of Publication: September 2013 ISSN 1522-8401 1558-2310 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT There has been increasing attention nationally to the quality of care provided by critical care transport teams. Much of this has been fostered by benchmarking work done in overlapping fields of medicine. Another important catalyst has been the landmark work by the Institute of Medicine-. Crossing the Quality Chasm. Organizations such as the Cystic Fibrosis Foundation have mature and transparent processes for measuring quality of care at different hospital systems, allowing these programs to compare themselves to others and learn from the high performers. The field of pediatric and neonatal critical care transport strives to do the same but has only recently begun to develop the performance measures and benchmarking strategies necessary to do this work. This article describes examples of quality improvement measurement and benchmarking, reviews important concepts related to continuous quality improvement, and introduces the reader to the consensus quality metrics established by the Ohio Neonatal/Pediatric Transport Quality Improvement Collaborative and by the American Academy of Pediatrics' Section on Transport Medicine. © 2013 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical practice health care quality intensive care patient transport total quality management EMTREE MEDICAL INDEX TERMS access to information accreditation article child health care Cystic Fibrosis Foundation Model data base Delphi study electronic medical record endotracheal intubation evidence based medicine human nonbiological model performance measurement system practice guideline simulation staff training EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013639912 PUI L369991587 DOI 10.1016/j.cpem.2013.08.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.cpem.2013.08.003 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 369 TITLE [Care for multi-trauma patients, from the transfer to the operating theatre to intensive care]. ORIGINAL (NON-ENGLISH) TITLE Les soins au patient polytraumatisé du départ au bloc à la réanimation. AUTHOR NAMES Dhollande N. Vigani S. Angot N. Sirabella J. AUTHOR ADDRESSES (Dhollande N., noemie.dhollande@ap-hm.fr) Service de réanimation traumatologique, CHU Nord Marseille, AP-HM, Chemin des Bourrely 13915 Marseille cedex 20, France. (Vigani S.; Angot N.; Sirabella J.) CORRESPONDENCE ADDRESS N. Dhollande, Service de réanimation traumatologique, CHU Nord Marseille, AP-HM, Chemin des Bourrely 13915 Marseille cedex 20, France. Email: noemie.dhollande@ap-hm.fr SOURCE Soins; la revue de référence infirmière (2013) :778 (38-40). Date of Publication: Sep 2013 ISSN 0038-0814 ABSTRACT Nurses caring for multi-trauma patients returning from the operating theatre need to have extensive knowledge. Their role is to prevent and detect any complications, and namely respiratory and neurological complications, and act efficiently to keep the patient's condition from deteriorating. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cooperation intensive care unit interdisciplinary communication multiple trauma (surgery) patient transport postoperative complication (diagnosis) EMTREE MEDICAL INDEX TERMS article France Glasgow coma scale human methodology nursing nursing diagnosis pain assessment resuscitation risk factor vital sign LANGUAGE OF ARTICLE French MEDLINE PMID 24218920 (http://www.ncbi.nlm.nih.gov/pubmed/24218920) PUI L563026663 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 370 TITLE Planning for the predictable emergency admission & improving the patient transfer process between a neuro-trauma ICU and ward AUTHOR NAMES Butorac L. Chalklin K. Manoel A.L. AUTHOR ADDRESSES (Butorac L.; Manoel A.L.) St. Michael's Hospital, University of Toronto, Neurocritical Care, Toronto, Canada. (Chalklin K.) St. Michael's Hospital, Trauma Neurosurgery and Mobility Programs, Toronto, Canada. CORRESPONDENCE ADDRESS L. Butorac, St. Michael's Hospital, University of Toronto, Neurocritical Care, Toronto, Canada. SOURCE Neurocritical Care (2013) 19:1 SUPPL. 1 (S162). Date of Publication: September 2013 CONFERENCE NAME 11th Annual Meeting of the Neurocritical Care Society CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2013-10-01 to 2013-10-04 ISSN 1541-6933 BOOK PUBLISHER Humana Press ABSTRACT Introduction The complex needs of neurosurgical patients present unique challenges across the continuum of care. The Trauma/Neurosurgery (TN) Program endeavored to improve patient access to care by planning for unexpected overnight admissions and enhancing the patient transfer process from the Neuro-Trauma Intensive Care Unit (TN ICU) to the TN Ward. Methods The TN program see 5 admissions overnight more than 50% of the time. In order to accommodate the Emergency patient, two less acute TN ward inpatients were bedspaced to alternate units prior to night shift to create two flow beds. The project also aimed to support an early morning patient transfer process between the TNICU and TN ward. Multidisciplinary brainstorming was held to identify processes required to discharge two patients by 09:00h from the TN ward, to be able to accommodate two patients by 10:00h from the TNICU. Process maps were developed to show the necessary communication, action items and transfer points that would support discharging patients earlier from the TN ward to accommodate TNICU transfers. Results Flow beds were successfully created over 85% of time by proactively bedspacing patients within the hospital. This reduced overnight bedspacing of patients by 50% increasing staff and patient satisfaction. Emergency department metrics including length of stay and time from admission to bed were improved by 25% and 43% respectively at the 90th percentile. Both changes were statistically significant at the 1% level. Total inpatient length of stay was reduced by over 10%. Conclusions Processes that focus on proactively planning for predictable demand, combined with strategies for demand and capacity matching, allowed for smoother flow through the TN program and an improved patient experience. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency human injury patient transport planning society ward EMTREE MEDICAL INDEX TERMS brainstorming emergency patient emergency ward hospital hospital patient intensive care unit interpersonal communication length of stay neurosurgery night patient patient satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71194617 DOI 10.1007/s12028-013-9895-1 FULL TEXT LINK http://dx.doi.org/10.1007/s12028-013-9895-1 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 371 TITLE Implementation of a standard handoff process facilitates transfer of care of cardiac surgical patients from operating room to ICU AUTHOR NAMES Dixon J. Stagg H.W. Wehbe-Janek H. Jo C. Culp W.C. Shake J.G. AUTHOR ADDRESSES (Dixon J.; Stagg H.W.; Wehbe-Janek H.; Jo C.; Culp W.C.; Shake J.G.) Scott and White Memorial Hospital, Temple, United States. CORRESPONDENCE ADDRESS J. Dixon, Scott and White Memorial Hospital, Temple, United States. SOURCE Journal of the American College of Surgeons (2013) 217:3 SUPPL. 1 (S75). Date of Publication: September 2013 CONFERENCE NAME 99th Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2013-10-06 to 2013-10-10 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: Patient handoffs are high-risk times associated with sentinel events. Effective handoff processes may enhance patient safety and communication between team members. This study assesses impact of a standardized, checklist-driven protocol for the cardiac surgery OR-to-ICU handoff, using a prospective pre-post study design. METHODS: A formalized handoff process was developed including critical handoff elements and a standardized handoff procedure, script, and checklist. Implementation of the process was preceded by a three month education period. Data was collected two months prior to education (Pre) and three months following implementation (Post). Data was collected from (A) sixty handoff observations (30 Pre and 30 Post) evaluating 52 unique parameters, and (B) surveys from OR and ICU providers on perspectives of the handoff process. Results were tabulated by percentages or descriptive statistics and compared by chi-square test, two sample t-test, or nonparametric Mann-Whitney test. Statistical significance was defined as P<0.05. RESULTS: Median time until ventilator connection, ICU monitor transfer, first cardiac index, and chest radiograph were reduced after implementation (respectively Pre vs Post, 60s vs 30s, 210s vs 160s, 708s vs 690s, and 1980s vs 1235s, P<0.05). The completion of handoff process components improved posteimplementation for 36 of 47 non-time parameters (Table represents 7 items). Providers' perspectives of the process improved in 19 of 23 survey items (P<0.001). CONCLUSIONS: A standard checklist-driven handoff process can dramatically improve key data transmission and reduce time of critical patient care steps during the high risk period of patient handoff in a cardiac surgical ICU. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) college human operating room surgeon surgical patient EMTREE MEDICAL INDEX TERMS cardiac index checklist chi square test clinical handover education heart surgery interpersonal communication parameters patient care patient safety procedures rank sum test risk sentinel event statistical significance statistics Student t test study design thorax radiography ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71167342 DOI 10.1016/j.jamcollsurg.2013.07.163 FULL TEXT LINK http://dx.doi.org/10.1016/j.jamcollsurg.2013.07.163 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 372 TITLE Patient transport experience in our institution following open heart surgery ORIGINAL (NON-ENGLISH) TITLE Enstitümüzde açik kalp cerrahisi sonrasi hasta transport deneyimimiz AUTHOR NAMES Sivrikoz N. Savran Karadeniz M. Kurnaz P. Altun D. Sungur Ülke Z. Tuǧrul M. Pempeci K. AUTHOR ADDRESSES (Sivrikoz N., ntsz06@gmail.com; Savran Karadeniz M.; Altun D.; Sungur Ülke Z.; Tuǧrul M.; Pempeci K.) I.Ü. Istanbul Tip Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dali, Çapa / Istanbul, Turkey. (Kurnaz P.) Tekirdaǧ Malkara Devlet Hastanesi, Anesteziyoloji Kliniǧi, Turkey. CORRESPONDENCE ADDRESS N. Sivrikoz, I.Ü. Istanbul Tip Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dali, Çapa / Istanbul, Turkey. Email: ntsz06@gmail.com SOURCE Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi (2013) 19:3 (127-131). Date of Publication: September 2013 ISSN 1305-5550 BOOK PUBLISHER Turkish Anaesthesiology and Intensive Care Society, Yildiz Posta Caddesi, Sinan Apt. No; 36 D: 66/67, Gayrettepe-Istanbul, Turkey. ABSTRACT Objective: Transporting critically ill patients is very often associated with problems and complications. Previous reports studied incidence of complications with associated factors for different patients groups. The aim of our study is to investigate complications during an in-hospital transport of highly special group as postoperative cardiac surgical patients. Material and Methods: All patients undergoing elective open heart surgery between January-September 2013 were included in the study. The commencement of the patient transport was determined as transfer of the patients from inbuilt to portable ventilator and ventilator. The transport was terminated wheren patients were again attached to ventilator and monitor of ICU. Hemodynamic parameters (blood pressures, heart rate, oxygen saturation) were all noted with arterial gas analysis on admission into ICU. All complications during transport were also recorded. Results: During the study period 240 subjects, including 108 adults and 132 children were enrolled in the study. Most frequent complication was respiratory alkalosis due to hyperventilation (13,75%). Other problems were hypotension (2,5%), arterial decannulation (2,5%), difficult ventilation (1,66%), respiratory acidosis (0,82%), inadvertent removal of central venous catheter (0,4%). One patient had cardiac arrest and was successfully resuscitated. Conclusion: Postoperative cardiac surgery patients could be transported with minor complications. We think that reduced incidence of adverse events was related to short transport time as well as to experienced transport team. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) open heart surgery patient transport EMTREE MEDICAL INDEX TERMS adult arterial decannulation artery disease article catheter removal central venous catheter child dyspnea heart arrest hemodynamics human hyperventilation hypotension intensive care unit major clinical study respiratory acidosis respiratory alkalosis resuscitation ventilator EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE Turkish LANGUAGE OF SUMMARY English, Turkish EMBASE ACCESSION NUMBER 2013759383 PUI L370377092 DOI 10.5222/GKDAD.2013.127 FULL TEXT LINK http://dx.doi.org/10.5222/GKDAD.2013.127 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 373 TITLE Multi-institutional comparison of helicopter transfers directly to the operating room versus the pit stop in the emergency department AUTHOR NAMES Van Der Wilden G.M. Janjua S. Wedel S.K. Agarwal S. Shapiro M.L. Andersen N.D. Odom S.R. Gates J.D. Frakes M.A. Chang Y. Velmahos G.C. Alam H.B. King D.R. De Moya M.A. AUTHOR ADDRESSES (Van Der Wilden G.M., gvanderwilden@gmail.com; Janjua S.; Chang Y.; Velmahos G.C.; Alam H.B.; King D.R.; De Moya M.A.) Clinical Research Fellow, Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Boston, MA 02114, United States. (Wedel S.K.; Frakes M.A.) Boston MedFlight, Boston, MA, United States. (Agarwal S.) Boston Medical Center and Boston University, Boston, MA, United States. (Shapiro M.L.; Andersen N.D.) Duke University Medical Center and Duke University, Durham, NC, United States. (Odom S.R.) Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States. (Gates J.D.) Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States. CORRESPONDENCE ADDRESS G.M. Van Der Wilden, Clinical Research Fellow, Surgery, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Boston, MA 02114, United States. Email: gvanderwilden@gmail.com SOURCE American Surgeon (2013) 79:9 (939-943). Date of Publication: September 2013 ISSN 0003-1348 BOOK PUBLISHER Southeastern Surgical Congress, 141 West Wieuca Road, Suite B100, Atlanta, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward operating room patient transport EMTREE MEDICAL INDEX TERMS accidental injury adult aged child comparative study conference paper controlled study female helicopter hospital cost human intensive care unit length of stay major clinical study male mortality outcome assessment school child EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013564299 MEDLINE PMID 24069995 (http://www.ncbi.nlm.nih.gov/pubmed/24069995) PUI L369768141 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 374 TITLE [Care for multi-trauma patients, from the transfer to the operating theatre to intensive care] ORIGINAL (NON-ENGLISH) TITLE Les soins au patient polytraumatisé du départ au bloc à la réanimation AUTHOR NAMES Dhollande N. Vigani S. Angot N. Sirabella J. AUTHOR ADDRESSES (Dhollande N.; Vigani S.; Angot N.; Sirabella J.) Service de réanimation traumatologique, CHU Nord Marseille, AP-HM, Chemin des Bourrely 13915 Marseille cedex 20, France. noemie.dhollande@ap-hm.fr SOURCE Soins; la revue de référence infirmière (2013) :778 (38-40). Date of Publication: 1 Sep 2013 ISSN 0038-0814 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cooperation intensive care unit interdisciplinary communication nursing procedures EMTREE MEDICAL INDEX TERMS France Glasgow coma scale human multiple trauma (surgery) nursing diagnosis pain measurement patient transport postoperative complication (diagnosis) resuscitation risk factor vital sign LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French MEDLINE PMID 24218920 (http://www.ncbi.nlm.nih.gov/pubmed/24218920) PUI L603392954 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 375 TITLE Impact of telemedicine on hospital transport, length of stay, and medical outcomes in infants with suspected heart disease: A multicenter study AUTHOR NAMES Webb C.L. Waugh C.L. Grigsby J. Busenbark D. Berdusis K. Sahn D.J. Sable C.A. AUTHOR ADDRESSES (Webb C.L., webbcl@med.umich.edu) University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, 1540 East Medical Center Drive, Ann Arbor, MI 48109, United States. (Waugh C.L.; Berdusis K.) Ann and Robert H. Lurie Children's Hospital, Chicago, IL, United States. (Grigsby J.; Busenbark D.) University of Colorado Denver, Denver, CO, United States. (Sahn D.J.) Oregon Health Sciences University, Portland, OR, United States. (Sable C.A.) Children's National Medical Center, Washington, DC, United States. CORRESPONDENCE ADDRESS C.L. Webb, University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, 1540 East Medical Center Drive, Ann Arbor, MI 48109, United States. Email: webbcl@med.umich.edu SOURCE Journal of the American Society of Echocardiography (2013) 26:9 (1090-1098). Date of Publication: September 2013 ISSN 0894-7317 1097-6795 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Background Previous single-center studies have shown that telemedicine improves care in newborns with suspected heart disease. The aim of this study was to test the hypothesis that telemedicine would shorten time to diagnosis, prevent unnecessary transports, reduce length of stay, and decrease exposure to invasive treatments. Methods Nine pediatric cardiology centers entered data prospectively on patients aged <6 weeks, matched by gestational age, weight, and diagnosis. Subjects born at hospitals with and without access to telemedicine constituted the study group and control groups, respectively. Data from patients with mild or no heart disease were analyzed. Results Data were obtained for 337 matched pairs with mild or no heart disease. Transport to a tertiary care center (4% [n = 15] vs 10% [n = 32], P =.01), mean time to diagnosis (100 vs 147 min, P <.001), mean length of stay (1.0 vs 26 days, P =.005) and length of intensive care unit stay (0.96 vs 2.5 days, P =.024) were significantly less in the telemedicine group. Telemedicine patients were significantly farther from tertiary care hospitals than control subjects. The use of inotropic support and indomethacin was significantly less in the telemedicine group. By multivariate analysis, telemedicine patients were less likely to be transported (odds ratio, 0.44; 95% confidence interval, 0.23-0.83) and less likely to be placed on inotropic support (odds ratio, 0.16; 95% confidence interval, 0.10-0.28). Conclusions Telemedicine shortened the time to diagnosis and significantly decreased the need for transport of infants with mild or no heart disease. The length of hospitalization and intensive care stay and use of indomethacin and inotropic support were less in telemedicine patients. EMTREE DRUG INDEX TERMS indometacin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child hospitalization heart disease (diagnosis) infant disease (diagnosis) length of stay patient transport telemedicine treatment outcome EMTREE MEDICAL INDEX TERMS artificial ventilation body weight brain hemorrhage (complication) child death cohort analysis controlled study drug use extracorporeal oxygenation female gestational age heart arrest (complication) human infant inotropism intensive care unit invasive procedure male multicenter study pediatric cardiology pediatric hospital prospective study review tertiary health care CAS REGISTRY NUMBERS indometacin (53-86-1, 74252-25-8, 7681-54-1) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013568341 MEDLINE PMID 23860093 (http://www.ncbi.nlm.nih.gov/pubmed/23860093) PUI L52680203 DOI 10.1016/j.echo.2013.05.018 FULL TEXT LINK http://dx.doi.org/10.1016/j.echo.2013.05.018 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 376 TITLE Safety of intrahospital transport in ventilated critically III patients: A multicenter cohort study AUTHOR NAMES Schwebel C. Clec'h C. Magne S. Minet C. Garrouste-Orgeas M. Bonadona A. Dumenil A.-S. Jamali S. Kallel H. Goldgran-Toledano D. Marcotte G. Azoulay E. Darmon M. Ruckly S. Souweine B. Timsit J.-F. AUTHOR ADDRESSES (Schwebel C., cschwebel@chu-grenoble.fr; Minet C.; Bonadona A.; Timsit J.-F.) Medical ICU, Albert Michallon Teaching Hospital, University Joseph Fourier, Grenoble, France. (Clec'h C.) Medical-Surgical ICU, Avicenne University Hospital, Bobigny, France. (Magne S.; Garrouste-Orgeas M.; Ruckly S.; Timsit J.-F.) University Grenoble 1 Integrated Research Center U 823, Albert Bonniot Institute, Rond Point de la Chantourne, La Tronche cedex, France. (Garrouste-Orgeas M.) Polyvalent ICU, Groupe Hospitalier St Joseph, Paris, France. (Dumenil A.-S.) Surgical ICU, University Hospital, Antoine Beclere, Clamart, France. (Jamali S.) Medical Surgical ICU, General Hospital, Dourdan, France. (Kallel H.) Medical Surgical ICU, General Hospital, Cayenne, France. (Goldgran-Toledano D.) Medical Surgical ICU, General Hospital, Gonesse, France. (Marcotte G.) Surgical ICU, Edouard Herriot Teaching Hospital, Lyon, France. (Azoulay E.) Medical ICU, University Hospital St Louis, Paris, France. (Darmon M.) Medical ICU, University Hospital St Etienne, St Etienne, France. (Souweine B.) Medical ICU, Gabriel Montpied University Hospital, Clermont-Ferrand, France. CORRESPONDENCE ADDRESS Medical ICU, Albert Michallon Teaching Hospital, University Joseph Fourier, Grenoble, France. SOURCE Critical Care Medicine (2013) 41:8 (1919-1928). Date of Publication: August 2013 ISSN 0090-3493 1530-0293 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Objectives: To describe intrahospital transport complications in critically ill patients receiving invasive mechanical ventilation. Design: Prospective multicenter cohort study. Setting: Twelve French ICUs belonging to the OUTCOMEREA study group. Patients: Patients older than or equal to 18 years old admitted in the ICU and requiring invasive mechanical ventilation between April 2000 and November 2010 were included. Interventions: None. Measurements and Main Results: Six thousand two hundred forty-two patients on invasive mechanical ventilation were identified in the OUTCOMEREA database. The statistical analysis included a description of demographic and clinical characteristics of the cohort, identification of risk factors for intrahospital transport and construction of an intrahospital transport propensity score, and an exposed/unexposed study to compare complication of intrahospital transport (excluding transport to the operating room) after adjustment on the propensity score, length of stay, and confounding factors on the day before intrahospital transport. Three thousand and six intrahospital transports occurred in 1,782 patients (28.6%) (1-17 intrahospital transports/patient). Transported patients had higher admission Simplified Acute Physiology Score II values (median [interquartile range], 51 [39-65] vs 46 [33-62], p < 10(-4)) and longer ICU stay lengths (12 [6-23] vs 5 [3-11] d, p < 10(-4)). Post-intrahospital transport complications were recorded in 621 patients (37.4%). We matched 1,659 intrahospital transport patients to 3,344 nonintrahospital transport patients according to the intrahospital transport propensity score and previous ICU stay length. After adjustment, intrahospital transport patients were at higher risk for various complications (odds ratio = 1.9; 95% CI, 1.7-2.2; p < 10(-4)), including pneumothorax, atelectasis, ventilator-associated pneumonia, hypoglycemia, hyperglycemia, and hypernatremia. Intrahospital transport was associated with a longer ICU length of stay but had no significant impact on mortality. Conclusions: Intrahospital transport increases the risk of complications in ventilated critically ill patients. Continuous quality improvement programs should include specific procedures to minimize intrahospital transport-related risks. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient safety patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article artificial ventilation atelectasis (complication) child cohort analysis female human hyperglycemia (complication) hypernatremia (complication) hypoglycemia (complication) infant intensive care unit length of stay major clinical study male multicenter study newborn pneumothorax (complication) preschool child priority journal propensity score prospective study risk factor school child Simplified Acute Physiology Score ventilator associated pneumonia (complication) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013482723 MEDLINE PMID 23863225 (http://www.ncbi.nlm.nih.gov/pubmed/23863225) PUI L369460254 DOI 10.1097/CCM.0b013e31828a3bbd FULL TEXT LINK http://dx.doi.org/10.1097/CCM.0b013e31828a3bbd COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 377 TITLE Reducing the risks of intrahospital transport among critically III patients AUTHOR NAMES Nuckols T.K. AUTHOR ADDRESSES (Nuckols T.K.) Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS T.K. Nuckols, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States. SOURCE Critical Care Medicine (2013) 41:8 (2044-2045). Date of Publication: August 2013 ISSN 0090-3493 1530-0293 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS critical illness editorial hospital care human intensive care intensive care unit priority journal risk reduction EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013482744 MEDLINE PMID 23863242 (http://www.ncbi.nlm.nih.gov/pubmed/23863242) PUI L369460271 DOI 10.1097/CCM.0b013e31828fd714 FULL TEXT LINK http://dx.doi.org/10.1097/CCM.0b013e31828fd714 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 378 TITLE Physician order discrepancies during patient transfer from the intensive care unit to medical and surgical wards AUTHOR NAMES Maraschiello M.A. Fowler R. Amaral A.C. Xiong W. Pinto R. AUTHOR ADDRESSES (Maraschiello M.A.; Fowler R.; Amaral A.C.; Xiong W.; Pinto R.) Sunnybrook Hospital, University of Toronto, Toronto, Canada. CORRESPONDENCE ADDRESS M.A. Maraschiello, Sunnybrook Hospital, University of Toronto, Toronto, Canada. SOURCE American Journal of Respiratory and Critical Care Medicine (2013) 187 MeetingAbstracts. Date of Publication: 2013 CONFERENCE NAME American Thoracic Society International Conference, ATS 2013 CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2013-05-17 to 2013-05-22 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: The transition of care in hospitals from one service to another represents a patient safety threat due to the loss or misinterpretation of information. The objective of this study was to evaluate the rate of omissions in transfer orders of patients from the ICU to an in-patient ward. Methods: A retrospective chart review of 100 ICU patient discharges to an in-hospital non-ICU service from January 1 to August 31 2011 at Sunnybrook Health Sciences Centre, a tertiary care university teaching hospital in Toronto, Canada. Transfer orders were abstracted from charts for the recording of: (1) accepting service and attending physician (primary outcome) and (2) antibiotic medication stop dates (secondary outcome). These variables were compared across three groups: the ICU service writing the orders (versus the accepting service), the use of pre-printed orders (versus de novo hand-generated orders), and orders written during an ' on call' period (versus daytime period, 0900-1700h). These outcomes were first described in a univariate analysis with three explanatory groups, and the primary outcome was also described in a multivariate analysis. Results: Orders written by the accepting service were significantly more likely to correctly record the attending physician and accepting service when compared to orders written by the ICU. These effect persisted after multivariable adjustment, with an Odds Ratio of 0.38 (95% CI 0.147-0.983, p=0.046). There was no difference in the primary outcome (recorded attending physician and accepting service) when comparing pre printed and hand written orders, or on call vs daytime orders. Orders completed with the use of a pre printed document were significantly more likely to record antibiotic stop dates when compared to orders written by hand but there was no difference when comparing ICU and accepting service written orders, or on call and daytime written orders. Conclusions: The receiving service and attending are incorrectly recorded for 33% of patient transfers from ICU. Antibiotic stop dates are incorrectly ordered for 47.5% of patient transfers from ICU. When the accepting service writes transfer orders, it is more likely that the accepting attending and service are recorded. When pre-printed transfer orders are used, it is more likely that correct antibiotic stop dates will be recorded. Further work is needed before recommendations can be made about the most appropriate service and process to write transfer orders from the ICU to in-patient wards. (Table Presented). EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American human intensive care unit patient transport physician society surgical ward EMTREE MEDICAL INDEX TERMS Canada drug therapy health science hospital hospital discharge hospital patient medical record review multivariate analysis patient patient safety recording risk teaching hospital tertiary health care univariate analysis university ward writing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71983392 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 379 TITLE A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer AUTHOR NAMES Weiss M.J. Bhanji F. Fontela P.S. Razack S.I. AUTHOR ADDRESSES (Weiss M.J.; Bhanji F.; Fontela P.S.; Razack S.I.) Division of Pediatric Critical Care, McGill University, Montréal, Québec, Canada. matthew-john.weiss@mail.chuq.qc.ca SOURCE Medical education (2013) 47:8 (832-841). Date of Publication: 1 Aug 2013 ISSN 1365-2923 (electronic) ABSTRACT OBJECTIVES: To assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover.METHODS: This study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotation using a written handover cognitive aid (intervention) or standard practice (control). Before rounds, an investigator generated a reference standard of the handover event by completing a handover aid. Resident handovers were then audio-recorded and transcribed by a blinded research assistant. The content of this transcript was inserted into a blank handover aid. A blinded content expert scored the quantity and accuracy of the information in this aid according to predetermined criteria and these information scores (ISs) were compared with the reference standard. The same expert also blindly scored the transcripts in five domains of clinical reasoning and effectiveness: (i) effective summary of events; (ii) expressed understanding of the care plan; (iii) presentation clarity; (iv) organisation; (v) overall handover effectiveness. Differences between intervention and control groups were assessed using the Mann-Whitney test and multivariate linear regression.RESULTS: The intervention group had total ISs that more closely approximated the reference standard (81% versus 61%; p < 0.01). The intervention group had significantly higher clinical reasoning scores when compared by total score (21.1 versus 15.9 points; p = 0.01) and in each of the five domains. No difference was observed in the duration of handover between groups (7.4 versus 7.7 minutes; p = 0.97).CONCLUSIONS: Using a novel scoring system, our simple handover cognitive aid was shown to improve information transfer and resident expression of clinical reasoning without prolonging the handover duration. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) psychology standards EMTREE MEDICAL INDEX TERMS Canada child clinical competence clinical handover controlled study health personnel attitude human intensive care unit interpersonal communication medical student patient transport randomized controlled trial regression analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23837430 (http://www.ncbi.nlm.nih.gov/pubmed/23837430) PUI L602258014 DOI 10.1111/medu.12212 FULL TEXT LINK http://dx.doi.org/10.1111/medu.12212 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 380 TITLE Severe sepsis and septic shock: Worse outcomes seen in patients transferred to icu from wards compared to emergency department AUTHOR NAMES Garcia-Diaz J. Traugott K. Seoane L. Pavlov A. Briski D. Nash T. Winterbottom F. Dornelles A. Shum L. Sundell E. AUTHOR ADDRESSES (Garcia-Diaz J.; Traugott K., ktraugott@ochsner.org; Seoane L.; Nash T.; Winterbottom F.; Dornelles A.; Shum L.; Sundell E.) Ochsner Clinic Foundation, New Orleans, United States. (Pavlov A.; Briski D.) University of Queensland, New Orleans, United States. CORRESPONDENCE ADDRESS K. Traugott, Ochsner Clinic Foundation, New Orleans, United States. Email: ktraugott@ochsner.org SOURCE American Journal of Respiratory and Critical Care Medicine (2013) 187 MeetingAbstracts. Date of Publication: 2013 CONFERENCE NAME American Thoracic Society International Conference, ATS 2013 CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2013-05-17 to 2013-05-22 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Background: Sepsis is a leading cause of death in the United States. In-hospital transfer of admitted patients to the ICU has been associated with higher mortality and length of stay (LOS) compared to patients directly admitted to ICU from the emergency department (ED). We evaluated the difference in mortality between patients admitted to the ICU from the general medical/surgical wards and ED with severe sepsis and septic shock (SS&SH) who were treated with bundled order sets. Methods: This prospective study enrolled 902 consecutive patients admitted to the MICU from July 1, 2008 to March 31, 2012 with a diagnosis of SS&SH as part of a quality improvement initiative. The quality improvement project involved ED and ICU sepsis bundles that focused on early goal directed therapy including rapid delivery of broad spectrum antibiotics. Program success was measured by number of patients receiving perfect care (PC), defined as meeting all “goals” in process of care for patients with SS&SH. Results: 767 patients were evaluated for the outcome of in-hospital mortality stratified by location, ED vs general medical/surgical ward. 606 (79%) patients were diagnosed in the ED compared to 161 (21%) on the ward. Baseline characteristics were similar between groups including average APACHE scores (ED, 23.4±8.7 vs floor, 23.9±7.4, p=0.56). In-hospital mortality was lower in patients diagnosed in ED vs floor (17.3% vs 24.8%, p=0.03). Additionally, significantly shorter LOS was demonstrated in the ED group (9.3±8.5 vs 13.9±11.4 days, p<0.001). Goals met at 6 hours (71.3% vs 57.8%, p<0.001) and antibiotics within 2 hours of diagnosis (81% vs 41%, p<0.001) occurred significantly more frequently in patients diagnosed in ED. Consequently, more patients received PC in the ED group compared to floor patients (50% vs 0.62%; p<0.001). Conclusion: Patients who develop SS&SH on the wards have an increased in-hospital mortality and hospital LOS. These patients also experience less streamlined process of care prior to ICU admission as demonstrated by a delay in time to antibiotics and less PC. Improved processes to identify these patients earlier and improve timely resuscitation and time to antibiotics may improve outcomes for this cohort. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American emergency ward human patient sepsis septic shock society ward EMTREE MEDICAL INDEX TERMS APACHE cause of death diagnosis hospital length of stay mortality prospective study resuscitation therapy total quality management United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71980932 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 381 TITLE Delayed intensive care unit transfer is associated with increased mortality in ward patients AUTHOR NAMES Churpek M.M. Yuen T.C. Edelson D.P. AUTHOR ADDRESSES (Churpek M.M., Matthew.Churpek@uchospitals.edu; Yuen T.C.; Edelson D.P.) University of Chicago, Chicago, United States. CORRESPONDENCE ADDRESS M.M. Churpek, University of Chicago, Chicago, United States. Email: Matthew.Churpek@uchospitals.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2013) 187 MeetingAbstracts. Date of Publication: 2013 CONFERENCE NAME American Thoracic Society International Conference, ATS 2013 CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2013-05-17 to 2013-05-22 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE: Early intervention improves outcomes in many conditions that are indications for intensive care unit (ICU) transfer, such as septic shock and respiratory failure. However, the impact of delayed ICU transfer on the mortality of critically ill ward patients is poorly characterized. We investigated the impact of delayed transfer by using the Cardiac Arrest Risk Triage (CART) score, a previously published vital sign-based early warning score, as an objective measure of critical illness. METHODS: We performed a cohort study at an academic hospital that included all patients admitted to the medical-surgical wards between November 2008 and January 2011. CART scores were calculated for all patients on the wards and the score cut-off corresponding to a specificity of 95% for ICU transfer was defined as the value denoting critical illness a priori. Time from when a patient first reached this CART score value until transfer to the ICU was calculated for each patient, up to a maximum of 24 hours. Patients who suffered a cardiac arrest on the wards with attempted resuscitation were counted as ICU transfers at the time of arrest. Logistic regression was used to calculate the change in odds of death in the ICU for each one-hour delay in ICU transfer time. RESULTS: A total of 54,032 admissions to the hospital wards occurred during the study period, including 2,166 patients transferred from the wards to the ICU. The median time from first critical CART score value to ICU transfer was 2.7 hours (n=403), and ICU mortality for these patients was 28%. ICU transfer was delayed for greater than six hours in 39% of these patients. Comparisons of patient characteristics between delayed (greater than six hours) and non-delayed transfers who reached the critical CART score are shown in the Table below. CONCLUSIONS: Delayed transfer to the ICU is associated with a significant increase in ICU and hospital mortality. Real-time use of an evidence-based early warning score, such as the CART score, could identify critically ill patients on the wards earlier and potentially decrease preventable in-hospital death. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American human intensive care unit mortality patient society ward EMTREE MEDICAL INDEX TERMS cohort analysis critical illness critically ill patient death early intervention emergency health service evidence based practice heart arrest hospital logistic regression analysis respiratory failure resuscitation risk septic shock surgical ward vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71984707 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 382 TITLE T(3) Trial protocol: A CRCT evaluating an organisational intervention to improve triage, treatment and transfer of stroke patients in EDs AUTHOR NAMES Middleton S. Levi C.R. D'Este C. Grimshaw J. Cadilhac D.A. Considine J. Cheung W. McInnes L. Dale S. Gerraty R.P. Fitzgerald M. AUTHOR ADDRESSES (Middleton S.; McInnes L.; Dale S.) National Centre for Clinical Outcomes Research, Australian Catholic University, Sydney, Australia. (Middleton S.; McInnes L.; Dale S.) Nursing Research Institute, St Vincent's Hospital, Sydney, Australia. (Cheung W.) Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia. (Levi C.R.) Priority Centre for Brain and Mental Health Research, Australia. (D'Este C.) University of Newcastle, Australia. (Cadilhac D.A.) National Stroke Research Institute, Melbourne, Australia. (Considine J.) Deakin University-Eastern Health, Melbourne, Australia. (Gerraty R.P.) Epsworth Centre, Melbourne, Australia. (Fitzgerald M.) Alfred Hospital, Melbourne, Australia. (Grimshaw J.) Ottawa Health Research Institute, Ottawa, Canada. CORRESPONDENCE ADDRESS S. Middleton, National Centre for Clinical Outcomes Research, Australian Catholic University, Sydney, Australia. SOURCE International Journal of Stroke (2013) 8 SUPPL. 1 (10). Date of Publication: August 2013 CONFERENCE NAME 24th Annual Scientific Meeting of the Stroke Society of Australia - STROKE 2013 CONFERENCE LOCATION Darwin, NT, Australia CONFERENCE DATE 2013-07-31 to 2013-08-02 ISSN 1747-4930 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: The QASC trial showed significant benefits for patients cared for in stroke units who received assistance to implement evidence-based treatment protocols to manage fever, hyperglycaemia and swallowing. Building on these results, this NHMRC-funded trial will rigorously implement and evaluate initiatives to improve triage, treatment and transfer of stroke patients in Emergency Departments (EDs). Methods: Design: cluster randomised control trial. EDs at 26 hospitals in three Australian states will be randomised to receive either usual care or the T3 intervention comprising: rapid Triage; Treatment with thrombolysis where appropriate, fever, hyperglycaemia and swallowing management; rapid Transfer from ED to stroke units. The intervention will consist of: multidisciplinary team building workshops; interactive education program; and sustained engagement of ED and stroke unit champions to embed collaborations. Our primary outcome is 90-day death and dependency (modified Rankin Score). We also will measure functional dependency (Barthel Index); Health Status (SF-36) and undertake medical record audits to examine quality of care outcomes and implementation efficacy. Results: A between-group, intention-to-treat analysis will be conducted adjusting for clustering. A separate process analysis will examine contextual factors that may influence successful intervention uptake. Conclusion: We will provide evidence for the effectiveness of a behaviour change intervention in emergency departments to improve stroke outcomes. Stroke is common and its costs large if not treated according to evidence-based guidelines during all phases of hospital admission. To improve the 'whole pathway' in stroke, care between EDs and stroke units must be more collaborative and evidence-based. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia cerebrovascular accident emergency health service human society stroke patient EMTREE MEDICAL INDEX TERMS Barthel index behavior change blood clot lysis clinical audit death education program emergency ward evidence based practice fever health status hospital hospital admission hyperglycemia intention to treat analysis medical record patient stroke unit swallowing team building workshop LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71565038 DOI 10.1111/ijs.12141 FULL TEXT LINK http://dx.doi.org/10.1111/ijs.12141 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 383 TITLE Primary versus secondary transport of STEMI patients: Impact on transport times and mortality AUTHOR NAMES Al Mawiri A. Vojacek J.F. Bis J. Sitina M. Stasek J. AUTHOR ADDRESSES (Al Mawiri A.; Sitina M.) Emergency Medical Service, Hradec Kralove, Czech Republic. (Vojacek J.F.; Bis J.; Stasek J.) Charles University Prague, Faculty of Medicine in Hradec Kralove, 1st Department of Medicine, Hradec Kralove, Czech Republic. CORRESPONDENCE ADDRESS A. Al Mawiri, Emergency Medical Service, Hradec Kralove, Czech Republic. SOURCE European Heart Journal (2013) 34 SUPPL. 1 (1025). Date of Publication: August 2013 CONFERENCE NAME European Society of Cardiology, ESC Congress 2013 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2013-08-31 to 2013-09-04 ISSN 0195-668X BOOK PUBLISHER Oxford University Press ABSTRACT Background: The door-balloon time (DBT) is linked to morbidity and mortality of patients with ST segment elevation myocardial infarction (STEMI). Despite preferable direct transport to catheterization laboratory (PT), still significant proportion of STEMI patients is transported via non-PCI regional hospitals or Coronary Care Units (ST) prior to percutaneous coronary intervention (PCI). This study assessed to what extent PT vs ST affects the DBT and mortality. Methods: Our region with 600 000 inhabitants uses well elaborated 24hours/365 days system of immediate transport of all patients with STEMI lasting less than 12 hours to referral catheterization laboratories in the tertiary University Hospital Cardiac Center for more than 15 years. We prospectively recorded DBT of 677 consecutive patients with STEMI, treated by PCI in the years 2008-2009. Consequent follow-up was obtained in all patients. Results: Median of DBT was 34±15.9 mins for PT patients (n=354) and 100±28.8 mins for patients with ST (n=323) (p<0.005). One-month mortality was 4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality in the PT and ST groups was 7.3 vs 20.5% (p<0.005), respectively. (Figure presented) Conclusion: The admission of patients with STEMI to regional hospitals or Coronary Care Units instead of direct transport to catheterization laboratory significantly prolongs the DBT and increases mortality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology human mortality patient society ST segment elevation myocardial infarction EMTREE MEDICAL INDEX TERMS catheterization coronary care unit follow up hospital laboratory morbidity percutaneous coronary intervention university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71261313 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 384 TITLE Investigation of outcomes among icu transfers from the floors triggered through a rapid response team AUTHOR NAMES Magaspi C.V. Kanna B. Schori M. Loganathan R. AUTHOR ADDRESSES (Magaspi C.V., Crischelle.Magaspi@nychhc.org; Kanna B.; Schori M.; Loganathan R.) Lincoln Medical and Mental Health Center, Bronx, United States. CORRESPONDENCE ADDRESS C.V. Magaspi, Lincoln Medical and Mental Health Center, Bronx, United States. Email: Crischelle.Magaspi@nychhc.org SOURCE American Journal of Respiratory and Critical Care Medicine (2013) 187 MeetingAbstracts. Date of Publication: 2013 CONFERENCE NAME American Thoracic Society International Conference, ATS 2013 CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2013-05-17 to 2013-05-22 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: ICU admissions from inpatient floors have been reported to have a longer length of stay (LOS) and higher mortality compared to those admitted directly from the emergency room. Rapid Response Teams (RRTs) are designed to identify deteriorating patients on inpatient floors and transfer patients to a higher level of care when indicated. The impact of RRTs on ICU transfers from inpatient floors has not been described. This study compared the outcomes among RRT-initiated ICU admissions compared to ICU admissions from the floor triggered by the primary team in a University affiliated center staffed 24/ 7 by intensivists and hospitalists. Methods: A retrospective study of all admissions to the medical ICU between July 2011 and June 2012 was performed. RRT activations on the medical/ surgical units, time to ICU admissions from floors, APACHE-II scores and hospital mortality were analyzed by an independent investigator. Chi square test for differences in proportion was used and p-value < 0.05 was considered significant. Results: Of 1489 ICU admissions (median APACHE-II 17.8), 245 (16.4%) patients who were admitted from the inpatient floors with a median APACHE II 16.9. Hospital mortality for ICU admissions from floor was 26(10.6%) compared to 70 (5.6%) from ER. There were 284 RRT activations on the floor, 96 (33.8%) of whom were transferred to the ICU. Among ICU admissions from the floor, 96/ 245 (39.1%) were RRT-initiated, while 149 were referred directly by the primary team. The median time to ICU referral among RRT-ICU transfers was 2.7 days compared to 4.1 days among the non-RRT-ICU group. Average APACHE-II scores in RRT-ICU group was 16.5 compared to 17.4 in non-RRT-ICU group. Hospital mortality in the RRT-ICU group was significantly higher, 18(18.7%) compared to 12(8%) in the non-RRT-ICU group [p= 0.013] Conclusion: There was a significantly higher mortality in RRT-initiated ICU admissions from the medical floor as compared to patients whose deterioration were recognized by the primary team and subsequently referred to the ICU. There were no differences in APACHE-II scores on admissions or the time to referral after admission to the inpatient floors. This is the first study to report this interesting observation in an era of widespread RRT implementation. Similar to RRT-initiated floor transfers to ICU could serve as an important variable for ICU prognostic scores and warrants additional investigation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American rapid response team society EMTREE MEDICAL INDEX TERMS APACHE Apache (people) chi square test deterioration emergency ward hospital patient human intensivist length of stay medical staff mortality patient retrospective study statistical significance university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71984863 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 385 TITLE The role of equilibrative nucleoside transporter in regulating adeonsine signaling during acute lung injury AUTHOR NAMES Weng T. Karmouty-Quintana H. Chen N.-Y. Molina J.G. Pedroza M. Eltzschig H. Blackburn M.R. AUTHOR ADDRESSES (Weng T.; Blackburn M.R.) UTHSC-Houston, Houston, United States. (Karmouty-Quintana H.; Chen N.-Y.; Molina J.G.; Pedroza M.) University of Texas, Health Science Center-Houston, Houston, United States. (Eltzschig H.) University of Colorado, Denver, United States. CORRESPONDENCE ADDRESS T. Weng, UTHSC-Houston, Houston, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2013) 187 MeetingAbstracts. Date of Publication: 2013 CONFERENCE NAME American Thoracic Society International Conference, ATS 2013 CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2013-05-17 to 2013-05-22 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Acute lung injury (ALI) is one of the most common causes of death in intensive care units due to the limited clinical management of these disorders. Endothelial cell injury is frequently observed in ALI, which normally results in widespread capillary leakage, pulmonary edema and reduced lung compliance. However, the detailed mechanisms involved remain elusive. Better understanding of the molecular pathways promoting endothelial barrier dysfunction could provide new candidate targets for ALI therapy. Adenosine is a small nucleoside which is generated following hypoxia and/or cellular stress and serves beneficial functions during acute injuries. The levels of extracellular adenosine can be tightly regulated by equilibrative nucleoside transporters (ENTs), which transport adenosine through the plasma membrane and deplete adenosine in the extracellular space. In our study, we found that Ent2 is negatively regulated by hypoxia following tissue injury and is one of the major mechanisms by which extracellular adenosine is accumulated. Inhibition of Ents with dipyridamole, a pharmacologic reagent, or genetic deletion of Ent2 in mice resulted in selective protection from bleomycin-induced ALI by enhancing extracellular adenosine, damping inflammation and decreasing vascular leakage. We also observed that mice pretreated with the adenosine A2B receptor (ADORA2B) agonist BAY 60-6583 were protected from bleomycin-induced ALI, while genetically modified mice lacking ADORA2B were no longer protected by dipyridamole in bleomycin-induced ALI, suggesting ADORA2B as the major adenosine receptor contributing to the protective effects of dipyridamole. Interestingly, by enhancing adenosine levels with BAY 60-6583 or dipyridamole at a time when bleomycin-induced ALI had already been established, we demonstrated for the first time that adenosine signaling through ADORA2B has a therapeutic effect on already established ALI. In summary, we have highlighted a role of adenosine signaling in preventing or treating ALI and identified Ent2 and ADORA2B as key mediators in establishing pulmonary protection from bleomycin-induced ALI. Our results may provide important pre-clinical information for the use of dipyridamole and adenosine receptor agonists in the treatment of ALI. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) equilibrative nucleoside transporter EMTREE DRUG INDEX TERMS adenosine adenosine receptor adenosine receptor stimulating agent bleomycin dipyridamole nucleoside receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute lung injury American society EMTREE MEDICAL INDEX TERMS agonist capillary leak syndrome cell damage cell membrane cell stress death diseases endothelium cell extracellular space gene deletion genetically engineered mouse strain hypoxia inflammation injury intensive care unit lung compliance lung edema mouse protection therapy therapy effect tissue injury LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71983673 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 386 TITLE A clinical audit of the transfer of stroke patients from a non-tertiary hospital to a tertiary hospital: Who, why, and how? AUTHOR NAMES Do-Nguyen D. Granger A. AUTHOR ADDRESSES (Do-Nguyen D.; Granger A.) Osborne Park Hospital, Perth, Australia. (Do-Nguyen D.; Granger A.) Sir Charles Gairdner Hospital, Perth, Australia. CORRESPONDENCE ADDRESS D. Do-Nguyen, Osborne Park Hospital, Perth, Australia. SOURCE International Journal of Stroke (2013) 8 SUPPL. 1 (36). Date of Publication: August 2013 CONFERENCE NAME 24th Annual Scientific Meeting of the Stroke Society of Australia - STROKE 2013 CONFERENCE LOCATION Darwin, NT, Australia CONFERENCE DATE 2013-07-31 to 2013-08-02 ISSN 1747-4930 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: The National Stroke Foundation (NSF) recommends “all patients with stroke should be treated in a stroke unit (level-A)”[1]. Non-tertiary hospitals such as Joondalup Health Campus (JHC) do not have a dedicated stroke unit or neurosurgical services; therefore patients may be transferred to the nearest tertiary hospital, Sir Charles Gairdner Hospital (SCGH). There are no formal patient selection guidelines or transfer protocols to guide this process. Aims: To review the transfer of stroke patients from JHC to SCGH and formulate a transfer protocol. Methods: A retrospective case note audit reviewed patients with an ICD-10 diagnosis of stroke who were transferred from JHC to SCGH between June 2010 and July 2011. Results: Of 183 stroke patients identified at JHC, nine were transferred to SCGH. The most common indication was for stroke unit management, followed by neurosurgical review. All cases were discussed with the accepting neurology team with neurosurgery consulted when indicated. Discussion: Although it is recommended all stroke patients be managed in a stroke unit, it is not feasible to transfer all stroke patients from JHC to SCGH. In keeping with NSF recommendations that hospitals admitting >100 stroke patients per year have a dedicated stroke unit, guidelines would suggest a stroke unit be established at JHC [1]. This requires further feasibility analysis. Our interim solution involves developing guidelines to rationalise stroke patient selection for transfer. Transfer indications are based on existing protocols and reviewing the evidence for each indication. Formalising transfer guidelines also included developing communication and transfer process protocols. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia cerebrovascular accident clinical audit human society stroke patient tertiary care center EMTREE MEDICAL INDEX TERMS diagnosis health hospital ICD-10 interpersonal communication neurology neurosurgery non profit organization patient patient selection stroke unit LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71565128 DOI 10.1111/ijs.12143 FULL TEXT LINK http://dx.doi.org/10.1111/ijs.12143 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 387 TITLE T3 stroke trial protocol: Triage, treatment and transfer of patients with stroke emergency departments AUTHOR NAMES Middleton S. Levi C. D'Este C. Grimshaw J. Cadilhac D. Considine J. Cheung W. McInnes L. Dale S. Gerraty R. Fitzgerald M. Cadigan G. Denisenko S. Longworth M. McElduff P. Quinn C. AUTHOR ADDRESSES (Middleton S.; McInnes L.; Dale S.) National Centre for Clinical Outcomes Research, Australian Catholic University, Australia. (Middleton S.; McInnes L.; Dale S.) Nursing Research Institute, St Vincent's Hospital, Australia. (Levi C.) University of Newcastle, Priority Centre for Brain, Mental Health Research, Australia. (D'Este C.; McElduff P.) University of Newcastle, Australia. (Grimshaw J.) Ottawa Health Research Institute, Ottawa, Canada. (Cadilhac D.) National Stroke Research Institute, Australia. (Considine J.) Deakin University-Eastern Health, Australia. (Cheung W.) Department of Diabetes and Endocrinology, Westmead Hospital, Australia. (Gerraty R.) Epsworth Centre, Australia. (Fitzgerald M.) Alfred Hospital, Australia. (Cadigan G.) Statewide Stroke and Dementia Clinical Networks, Australia. (Denisenko S.) Victorian Stroke Clinical Network, Australia. (Longworth M.) Statewide Stroke Services, Agency for Clinical Innovation, Australia. (Quinn C.) Speech Pathology Department, Prince of Wales Hospital, Australia. CORRESPONDENCE ADDRESS S. Middleton, National Centre for Clinical Outcomes Research, Australian Catholic University, Australia. SOURCE International Journal of Stroke (2013) 8 SUPPL. 2 (18). Date of Publication: August 2013 CONFERENCE NAME 9th Australasian Nursing and Allied Health Stroke Conference, Smart Strokes 2013 CONFERENCE LOCATION Brisbane, QLD, Australia CONFERENCE DATE 2013-08-22 to 2013-08-23 ISSN 1747-4930 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Building on results from the Quality in Acute Stroke Trial, this NHMRC-funded trial will rigorously implement and evaluate initiatives to improve triage, treatment and transfer of patients with stroke in Emergency Departments (EDs) in three Australian states. Aims: To evaluate a nurse-initiated multidisciplinary organisational intervention to improve the Triage, Treatment and Transfer of stroke patients in Emergency Departments (ED) Methods: Design: cluster randomised control trial Hospitals in ACT, NSW, QLD and VIC with Emergency departments, pre-existing stroke units and who currently perform thrombolysis will be randomised to receive either usual care or the T3 Intervention comprising: Ë Triage: Rapid triage Ë Treatment: Thrombolysis where appropriate; fever, hyperglycaemia and swallowing management Ë Transfer: Collaboration between ED and stroke unit staff for rapid transfer from ED to stroke units The intervention will consist of multidisciplinary team building workshops, an interactive education program and sustained engagement of ED and stroke unit champions to embed collaborations. Our primary outcome is 90-day death and dependency (modified Rankin Score). We also will measure functional dependency (Barthel Index); Health Status (SF-36) and undertake medical record audits to examine quality of care outcomes and implementation efficacy. Results: An intention-to-treat analysis will be conducted adjusting for clustering. A separate process analysis will examine contextual factors that may influence successful intervention uptake. Conclusion: We will provide evidence for the effectiveness of a behaviour change intervention in EDs to improve stroke outcomes. To improve the 'whole pathway' in stroke, care between EDs and stroke units must be more collaborative and evidence-based. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular accident emergency health service emergency ward health human nursing patient EMTREE MEDICAL INDEX TERMS Barthel index behavior change blood clot lysis clinical audit death education program evidence based practice fever health status hospital hyperglycemia intention to treat analysis medical record nurse stroke patient stroke unit swallowing team building workshop LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71227177 DOI 10.1111/ijs.12172 FULL TEXT LINK http://dx.doi.org/10.1111/ijs.12172 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 388 TITLE Lightning and thunder! the field of tension between emergency and the sekundärtransport. Angelö stes a problem? ORIGINAL (NON-ENGLISH) TITLE Blitz und donner! das spannungsfeld zwischen notfall- und sekundärtransport. ein gelöstes problem? AUTHOR NAMES Peter C. Popp E. AUTHOR ADDRESSES (Peter C., christoph.peter@med.uni-heidelberg.de; Popp E.) Sektion Notfallmedizin, Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Germany. CORRESPONDENCE ADDRESS C. Peter, Sektion Notfallmedizin, Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Email: christoph.peter@med.uni-heidelberg.de SOURCE Intensiv- und Notfallbehandlung (2013) 38:2 (69-77). Date of Publication: 2013 ISSN 0947-5362 BOOK PUBLISHER Dustri-Verlag Dr. Karl Feistle, Bajuwarenring 4, Oberhaching, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine patient transport EMTREE MEDICAL INDEX TERMS human intensive care unit physician preventive health service review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English, German EMBASE ACCESSION NUMBER 2013419285 PUI L369244413 DOI 10.5414/IBX00397 FULL TEXT LINK http://dx.doi.org/10.5414/IBX00397 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 389 TITLE Delay of transfer from the intensive care unit: A prospective observational study of incidence, causes, and financial impact AUTHOR NAMES Johnson D.W. Schmidt U.H. Bittner E.A. Christensen B. Levi R. Pino R.M. AUTHOR ADDRESSES (Johnson D.W., danielwj77@gmail.com) Department of Anesthesiology, University of Nebraska Medical Center, 984455 Nebraska Medical Center, Omaha, NE 68198-4455, United States. (Schmidt U.H., uschmidt@partners.org; Bittner E.A., ebittner@partners.org; Pino R.M., rpino@partners.edu) Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States. (Christensen B., benjc@mit.edu; Levi R., retsef@mit.edu) Sloan School of Management, Massachusetts Institute of Technology, 50 Memorial Dr, Cambridge, MA 02142, United States. CORRESPONDENCE ADDRESS D.W. Johnson, Department of Anesthesiology, University of Nebraska Medical Center, 984455 Nebraska Medical Center, Omaha, NE 68198-4455, United States. Email: danielwj77@gmail.com SOURCE Critical Care (2013) 17:4 Article Number: R128. Date of Publication: 4 Jul 2013 ISSN 1364-8535 1466-609X (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Introduction: A paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes, and costs of delayed transfer from a surgical intensive care unit (SICU).Methods: An IRB-approved prospective observational study was conducted from January 24, 2010, to July 31, 2010, of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least 1 extra day. Reasons for delay were examined, and extra costs associated were estimated.Results: Transfer to the floor was delayed in 22% (n = 160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean, 1.5 days; median, 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were lack of available surgical-floor bed (71% (114 of 160)), lack of room appropriate for infectious contact precautions (18% (28 of 160)), change of primary service (Surgery to Medicine) (7% (11 of 160)), and lack of available patient attendant ("sitter" for mildly delirious patients) (3% (five of 160)). A positive association was found between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman rho = 0.27; P < 0.0001).Conclusions: Delay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical-floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary. © 2013 Johnson et al.; licensee BioMed Central Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article cost benefit analysis delirium hospitalization human major clinical study observational study priority journal EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013527318 MEDLINE PMID 23826830 (http://www.ncbi.nlm.nih.gov/pubmed/23826830) PUI L52674805 DOI 10.1186/cc12807 FULL TEXT LINK http://dx.doi.org/10.1186/cc12807 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 390 TITLE Perceived Patient Safety Culture in a Critical Care Transport Program AUTHOR NAMES Erler C. Edwards N.E. Ritchey S. Pesut D.J. Sands L. Wu J. AUTHOR ADDRESSES (Erler C., cerler@iupui.edu) School of Nursing, Indiana University, 1111 Middle Drive, NU 425, Indianapolis, IN 46202, United States. (Edwards N.E.; Sands L.) School of Nursing, Purdue University, West Lafayette, IN, United States. (Ritchey S.) LifeLine Critical Care Transport, Indiana University Health, Terre Haute, IN, United States. (Pesut D.J.) School of Nursing, University of Minnesota, Minneapolis, MN, United States. (Wu J.) School of Medicine, Indiana University, Indianapolis, IN, United States. CORRESPONDENCE ADDRESS C. Erler, School of Nursing, Indiana University, 1111 Middle Drive, NU 425, Indianapolis, IN 46202, United States. Email: cerler@iupui.edu SOURCE Air Medical Journal (2013) 32:4 (208-215). Date of Publication: July-August 2013 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Background The purpose of this study was to examine the association among selected safety culture dimensions and safety outcomes in the context of a critical care transport (CCT) program. Methods A descriptive cross-sectional correlational design used the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture to validate perceived safety culture among personnel (n = 76) in a large Midwestern CCT program. Results Findings revealed significant associations between 1) teamwork and frequency of error reporting (r =.428, P <.001), overall perception of safety (r =.745, P <.001), and perceived patient safety grade (r = -.681, P <.001); 2) between perception of manager actions promoting safety and frequency of error reporting (r =.521, P <.001), overall perception of safety (r =.779, P <.001), and perceived patient safety grade (r = -.756, P <.001); and 3) between communication openness and frequency of error reporting (r =.575, P <.001), overall perception of safety (r =.588, P <.001), and perceived patient safety grade (r = -.627, P <.001). Conclusion The study supports other literature showing significant associations among safety culture dimensions and safety outcomes and provides a framework for future research on safety culture in CCT programs. © 2013 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical care transport emergency health service patient safety EMTREE MEDICAL INDEX TERMS article cross-sectional study health care personnel health program human intensive care intensive care unit patient transport priority journal questionnaire EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013416822 MEDLINE PMID 23816215 (http://www.ncbi.nlm.nih.gov/pubmed/23816215) PUI L369232460 DOI 10.1016/j.amj.2012.11.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.11.002 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 391 TITLE Screening for congenital hypothyroidism in newborns transferred to neonatal intensive care AUTHOR NAMES Korzeniewski S.J. Kleyn M. Young W.I. Chaiworapongsa T. Schwartz A.G. Romero R. AUTHOR ADDRESSES (Korzeniewski S.J., sKorzeni@med.wayne.edu; Chaiworapongsa T.; Schwartz A.G.; Romero R.) National Institute of Child Health and Human Development, Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, United States. (Korzeniewski S.J., sKorzeni@med.wayne.edu; Chaiworapongsa T.) Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Hutzel Women's Hospital, 3990 John R., Detroit, MI 48201, United States. (Kleyn M.; Young W.I.) Michigan Department of Community Health, Newborn Screening Follow-up, Lansing, MI, United States. CORRESPONDENCE ADDRESS S.J. Korzeniewski, Perinatal Epidemiology Unit, Perinatology Research Branch (NICHD/NIH), United States. Email: sKorzeni@med.wayne.edu SOURCE Archives of Disease in Childhood: Fetal and Neonatal Edition (2013) 98:4 (F310-F315). Date of Publication: July 2013 ISSN 1359-2998 1468-2052 (electronic) BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Objective: To evaluate the effectiveness of four dried blood spot testing protocols used in newborn screening for congenital hypothyroidism (CH) among newborns transferred to the neonatal intensive care unit (NICU). Design, setting and patients: Michigan newborns transferred to the NICU from 1998 to 2011 and screened for CH are included in this population-based retrospective cohort study. Main outcome measures: Screening performance metrics are computed and logistic regression is used to test for differences in the likelihood of detection across four periods characterised by different testing protocols. Results: Primary thyrotropin (TSH) plus retest at 30 days of life or discharge achieved the greatest detection rate (2.6: 1000 births screened). The odds of detection was also significantly greater in this period compared with the tandem thyroxine (T4) and TSH testing period and separately compared with TSH testing alone, adjusted for birth weight, sex and race (OR 1.5; CI 1.0 to 2.2; p=0.046, and OR 2.2; CI 1.5 to 3.4, respectively). Approximately half of the cases detected during primary TSH plus serial testing periods were identified by retest. Conclusions: Primary TSH testing programmes that do not incorporate serial screening may fail to identify approximately half of newborns with congenital thyroid hormone deficiency transferred to the NICU. Tandem T4 and TSH testing programmes also likely miss cases who otherwise would receive treatment if serial testing were conducted. Further research is necessary to determine the optimal newborn screening protocol for CH; strategies combining tandem T4 and TSH with serial testing conditional on birthweight may be useful. EMTREE DRUG INDEX TERMS thyrotropin (endogenous compound) thyroxine (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital hypothyroidism (congenital disorder) newborn intensive care newborn screening EMTREE MEDICAL INDEX TERMS article birth weight cohort analysis dried blood spot testing female follow up human major clinical study male newborn priority journal retrospective study United States CAS REGISTRY NUMBERS thyrotropin (9002-71-5) thyroxine (7488-70-2) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013405961 MEDLINE PMID 23183553 (http://www.ncbi.nlm.nih.gov/pubmed/23183553) PUI L52328782 DOI 10.1136/archdischild-2012-302192 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2012-302192 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 392 TITLE A network-based approach using intra-hospital patient transfers to identify high-risk wards during nosocomial outbreaks AUTHOR NAMES Ciccolini M. Arends J. Grundmann H. Friedrich A.W. AUTHOR ADDRESSES (Ciccolini M.; Arends J.; Grundmann H.; Friedrich A.W.) Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. CORRESPONDENCE ADDRESS M. Ciccolini, Medical Microbiology and Infection Control, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. SOURCE Antimicrobial Resistance and Infection Control (2013) 2 SUPPL. 1. Date of Publication: June 20, 2013 CONFERENCE NAME 2nd International Conference on Prevention and Infection Control, ICPIC 2013 CONFERENCE LOCATION Geneva, Switzerland CONFERENCE DATE 2015-06-25 to 2015-06-28 ISSN 2047-2994 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction: Initial detection of a nosocomial outbreak can sometimes occur only after a considerable time has passed since the appearance of the index case(s). During this high-risk period from emergence to detection, within-hospital patient movements can disseminate the nosocomial pathogen to different admission wards. Following outbreak detection, a rapid, robust estimate of potentially exposed wards is of crucial importance in order to focus the implementation of infection prevention measures. Methods: We employ a mathematical approach, together with detailed patient location data and information on suspected cases, to estimate the potential number of exposed wards during an outbreak high-risk period. The model allows for different patient-to-patient transmission probability depending on time since last exposure, relative order in the transmission chain (first, or higher order contact), and on whether patients were located in the same room. Model output consists of a risk score associated with each ward, and an exposure network, defined as all the exposed wards, together with precise information on dangerous contacts between them. Standard software was employed to visualize the exposure network growth throughout time. Results: This framework was successfully applied during a recent multiresistant K. pneumoniae outbreak at a large university hospital in the Netherlands. A 4 month high-risk period resulted in 35 (out of 59) potentially exposed wards. The 10 wards with the highest modelcalculated risk score were selected for post-exposure microbiological screening, which resulted in 154 additional screened patients. Further patients were screened, as controls, on other wards not included in the calculation. The complete exposure network was reconstructed, and the potential maximum reach of the outbreak was estimated. No additional positive patients were found and the outbreak was stopped. Conclusion: Due to the high level of patient exchange between different admission wards, determining their level of exposure during a prolonged high risk period rapidly becomes a complex task. Our network-based approach has been a valuable tool in reducing this complexity, focusing infection control interventions during an ongoing outbreak. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient human infection control patient transport prevention risk ward EMTREE MEDICAL INDEX TERMS exposure infection prevention Klebsiella pneumoniae model Netherlands pathogenesis patient screening software university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72036230 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 393 TITLE Adverse events during intrahospital transport of critically ill patients: Incidence and risk factors AUTHOR NAMES Parmentier-Decrucq E. Poissy J. Favory R. Nseir S. Onimus T. Guerry M.-J. Durocher A. Mathieu D. AUTHOR ADDRESSES (Parmentier-Decrucq E., erika.parmentier@chru-lille.fr; Poissy J.; Favory R.; Nseir S.; Onimus T.; Guerry M.-J.; Durocher A.; Mathieu D.) Service d'Urgence Respiratoire, Réanimation Médicale et Medecine Hyperbare, Université de Lille II et Centre Hospitalier et Universitaire de Lille, Lille 59037, France. CORRESPONDENCE ADDRESS E. Parmentier-Decrucq, Service d'Urgence Respiratoire, Réanimation Médicale et Medecine Hyperbare, Université de Lille II et Centre Hospitalier et Universitaire de Lille, Lille 59037, France. Email: erika.parmentier@chru-lille.fr SOURCE Annals of Intensive Care (2013) 3:1 (1-10). Date of Publication: 2013 ISSN 2110-5820 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Background: Transport of critically ill patients for diagnostic or therapeutic procedures is at risk of complications. Adverse events during transport are common and may have significant consequences for the patient. The objective of the study was to collect prospectively adverse events that occurred during intrahospital transports of critically ill patients and to determine their risk factors. Methods: This prospective, observational study of intrahospital transport of consecutively admitted patients with mechanical ventilation was conducted in a 38-bed intensive care unit in a university hospital from May 2009 to March 2010. Results: Of 262 transports observed (184 patients), 120 (45.8%) were associated with adverse events. Risk factors were ventilation with positive end-expiratory pressure >6 cmH(2)O, sedation before transport, and fluid loading for intrahospital transports. Within these intrahospital transports with adverse events, 68 (26% of all intrahospital transports) were associated with an adverse event affecting the patient. Identified risk factors were: positive end-expiratory pressure >6 cmH(2)O, and treatment modification before transport. In 44 cases (16.8% of all intrahospital transports), adverse event was considered serious for the patient. In our study, adverse events did not statistically increase ventilator-associated pneumonia, time spent on mechanical ventilation, or length of stay in the intensive care unit. Conclusions: This study confirms that the intrahospital transports of critically ill patients leads to a significant number of adverse events. Although in our study adverse events have not had major consequences on the patient stay, efforts should be made to decrease their incidence. © 2013 Parmentier-Decrucq et al.; licensee Springer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient iatrogenic disease (complication) patient transport risk assessment EMTREE MEDICAL INDEX TERMS article artificial ventilation controlled study disease association female human incidence intensive care unit length of stay major clinical study male observational study positive end expiratory pressure priority journal prospective study risk factor ventilator associated pneumonia (complication) EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013366187 PUI L369082254 DOI 10.1186/2110-5820-3-10 FULL TEXT LINK http://dx.doi.org/10.1186/2110-5820-3-10 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 394 TITLE Discussion: Inter- and intra-hospital transport of the critically ill AUTHOR ADDRESSES SOURCE Respiratory Care (2013) 58:6 (1021-1023). Date of Publication: 1 Jun 2013 ISSN 0020-1324 1943-3654 (electronic) BOOK PUBLISHER American Association for Respiratory Care, 9425 N. MacArthur Blvd. Suite 100, Irving, United States. EMTREE DRUG INDEX TERMS activated carbon anticonvulsive agent antihypertensive agent antiinfective agent atropine bicarbonate bronchodilating agent calcium epinephrine furosemide gluconate calcium glucose heparin infusion fluid mannitol naloxone narcotic analgesic agent neuromuscular blocking agent nitric oxide (drug therapy) paracetamol sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS abnormal laboratory result article artificial ventilation blood gas analysis bradycardia (complication) capnometry cardiopulmonary insufficiency (drug therapy) chest tube child health care computer assisted tomography cyanosis (complication) defibrillator device failure electrocardiograph endotracheal tube extracorporeal oxygenation health care access heart arrest (complication) heart infarction heart muscle revascularization human hypotension (complication) hypothermia (complication) incidence intensive care unit laryngeal mask laryngoscope mechanical ventilator medical specialist nasal cannula nasogastric tube nuclear magnetic resonance imaging outcome assessment oxygen saturation patient care patient monitoring patient safety portable equipment pulmonary hypertension pulse oximetry radiodiagnosis resuscitation risk assessment risk benefit analysis risk reduction tachycardia (complication) tracheostomy tube treatment planning ventilator associated pneumonia (complication) CAS REGISTRY NUMBERS activated carbon (64365-11-3, 82228-96-4) adrenalin (51-43-4, 55-31-2, 6912-68-1) atropine (51-55-8, 55-48-1) bicarbonate (144-55-8, 71-52-3) calcium (14092-94-5, 7440-70-2) furosemide (54-31-9) gluconate calcium (299-28-5) glucose (50-99-7, 84778-64-3) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) mannitol (69-65-8, 87-78-5) naloxone (357-08-4, 465-65-6) nitric oxide (10102-43-9) paracetamol (103-90-2) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013345063 PUI L369024656 DOI 10.4187/respcare.02404 FULL TEXT LINK http://dx.doi.org/10.4187/respcare.02404 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 395 TITLE Quality metrics in neonatal and pediatric critical care transport: a consensus statement. AUTHOR NAMES Bigham M.T. Schwartz H.P. AUTHOR ADDRESSES (Bigham M.T., mbigham@chmca.org) Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA. (Schwartz H.P.) CORRESPONDENCE ADDRESS M.T. Bigham, Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA. Email: mbigham@chmca.org SOURCE Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2013) 14:5 (518-524). Date of Publication: Jun 2013 ISSN 1529-7535 ABSTRACT The transport of neonatal and pediatric patients to tertiary care medical centers for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. Accurate assessment of quality indicators and patient outcomes requires the use of a standard language permitting comparisons among transport programs. No consensus exists on a set of quality metrics for benchmarking transport teams. The aim of this project was to achieve consensus on appropriate neonatal and pediatric transport quality metrics. Candidate quality metrics were identified through literature review and those metrics currently tracked by each program. Consensus was governed by nominal group technique. Metrics were categorized in two dimensions: Institute of Medicine quality domains and Donabedian's structure/process/outcome framework. Two-day Ohio statewide quality metrics conference. Nineteen transport leaders and staff representing six statewide neonatal/pediatric specialty programs convened to achieve consensus. Two hundred fifty-seven performance metrics relevant to neonatal/pediatric transport were identified. Eliminating duplicate and overlapping metrics resulted in 70 candidate metrics. Nominal group methodology yielded 23 final quality metrics, the largest portion representing Donabedian's outcome category (n = 12, 52%) and the Institute of Medicine quality domains of effectiveness (n = 7, 30%) and safety (n = 9, 39%). Sample final metrics include measurement of family presence, pain management, intubation success, neonatal temperature control, use of lights and sirens, and medication errors. Lastly, a definition for each metric was established and agreed upon for consistency among institutions. This project demonstrates that quality metrics can be achieved through consensus building and provides the foundation for benchmarking among neonatal and pediatric transport programs and quality improvement projects. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport quality control EMTREE MEDICAL INDEX TERMS child conference paper consensus consensus development cooperation human infant methodology newborn organization and management patient safety preschool child standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 23867429 (http://www.ncbi.nlm.nih.gov/pubmed/23867429) PUI L563043529 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 396 TITLE Demographics of ventilated infants with bronchiolitis transferred to paediatric intensive care in yorkshire and humber in 2010/2011 and 2011/2012 AUTHOR NAMES Kelly A.B. Rajah F. AUTHOR ADDRESSES (Kelly A.B.; Rajah F.) Embrace,Yorkshire and Humber Infant and Children's Transport Service, Sheffield Children's Hospital, Barnsley, United Kingdom. CORRESPONDENCE ADDRESS A.B. Kelly, Embrace,Yorkshire and Humber Infant and Children's Transport Service, Sheffield Children's Hospital, Barnsley, United Kingdom. SOURCE Intensive Care Medicine (2013) 39 SUPPL. 1 (S159-S160). Date of Publication: June 2013 CONFERENCE NAME 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care, ESPNIC 2013 CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-06-12 to 2013-06-15 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Viral Bronchiolitis is the most common cause of acute respiratory failure in Paediatric Intensive Care (PIC) admissions in the United Kingdom. The risk factors for the development of severe bronchiolitis include prematurity, age of<2 months, low birth weight and rapid onset of severe respiratory symptoms. In 2011/2012 it had been observed that bronchiolitis infants requiring ventilation and transfer to PIC were smaller, with a higher incidence of prematurity than previous years. Aims: To determine the demographics of infants with bronchiolitis requiring ventilation and transfer by Embrace, Yorkshire and Humber Infant and Children's Transport Service, in 2010/2011 and 2011/2012; comparing groups with respect to weight; age; gestational age at birth and referral; co-morbidity; severity of illness on admission to hospital. Method: Retrospective data collected from transfer records over 2 seasons; 1 November to 30 March 2010/2011 and 2011/2012. Results: 120 infants required ventilation and transfer to PIC; 55 in 2010/2011 and 65 in 2011/2012. Patients transferred in 2011/2012 were smaller and younger. Incidence of prematurity increased markedly, 49 % in 2010/2011 compared to 60 % in 2011/2012 with a doubling of late preterm 33-37 weeks from 20 to 40 %. Over 40 % required ventilation on the day of admission to hospital; 42 % in 2010/2011 and 49 % in 2011/2012. Conclusions: The results reflect findings of other studies and staff perceptions. The increase in late preterm infants may reflect changing neonatal care, with earlier discharge or an annual variation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bronchiolitis infant intensive care newborn intensive care society EMTREE MEDICAL INDEX TERMS acute respiratory failure air conditioning child diseases gestational age hospital human low birth weight morbidity newborn care patient prematurity risk factor season United Kingdom viral bronchiolitis weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71440251 DOI 10.1007/s00134-013-2950-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-2950-8 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 397 TITLE Peri-intubation events in critically sick infants (<1year) presenting to district general hospitals (DGH's) prior to transfer to a regional picu AUTHOR NAMES Bendon A.A. Asghar R. Sundar T. Barber R. Parkins K. Phatak R. Grainger D. AUTHOR ADDRESSES (Bendon A.A.) Paediatric Anaesthetics, Manchester, United Kingdom. (Asghar R.; Parkins K.; Phatak R.) North West and North Wales Retrieval Service(NWTS), Royal Manchester Children's Hospital NHS Trust, Manchester, United Kingdom. (Sundar T.) Paediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom. (Barber R.; Grainger D.) Paediatric Intensive Care Unit, Royal Manchester Children's Hospital NHS Trust, Manchester, United Kingdom. CORRESPONDENCE ADDRESS A.A. Bendon, Paediatric Anaesthetics, Manchester, United Kingdom. SOURCE Intensive Care Medicine (2013) 39 SUPPL. 1 (S170). Date of Publication: June 2013 CONFERENCE NAME 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care, ESPNIC 2013 CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-06-12 to 2013-06-15 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Background: NWTS is a regional retrieval team (RRT)commissioned for stabilisation, retrieval of sick children to PICU in Northwest England and Wales. There is paucity of data on emergency intubation of critically ill infants. Aims: To Highlight: 1. DGH team dynamics in managing critically ill infants 2. Induction agents 3. “Peri-induction” complications 4. NWTS (RRT) role Methods: Retrospective data from retrieval forms in infants intubated in DGH between 1st December 2011 and 30th November 2012, referred to NWTS for transfer. Results: 230 infants met the inclusion criteria. Discussion: 230/604 (40 %) children, transferred by the RRT were infants, 42 % aged 1 week-6 weeks. These pose a challenge to DGH anaesthetists, with mainly adult practice and Paediatricians, with limited airway experience. 11 % were intubated in extremis, anaesthetists present in<50 % of intubations(73 % in infants>6 months), much lower than other age groups. RRT facilitated ENT management of difficult airway in four cases. Our data suggests, optimal team resource utilisation when managing critically ill infants will minimise adverse events. A prospective multi-centric study including outcome data is warranted. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) general hospital infant intubation newborn intensive care society EMTREE MEDICAL INDEX TERMS adult airway anesthesia induction anesthesist child critically ill patient dynamics emergency groups by age human otorhinolaryngology pediatrician United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71440281 DOI 10.1007/s00134-013-2950-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-2950-8 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 398 TITLE Safe travels: Transporting critically ill patients from PICU to MRI AUTHOR NAMES Durning S. AUTHOR ADDRESSES (Durning S.) Radiology/Sedation/Vascular Access, Children's Hospital of Philadelphia, West Chester, United States. CORRESPONDENCE ADDRESS S. Durning, Radiology/Sedation/Vascular Access, Children's Hospital of Philadelphia, West Chester, United States. SOURCE Journal of Radiology Nursing (2013) 32:2 (103). Date of Publication: June 2013 CONFERENCE NAME 2013 Annual Convention of the Association for Radiologic and Imaging Nursing, ARIN 2013 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2013-04-14 to 2013-04-17 ISSN 1546-0843 BOOK PUBLISHER Elsevier Inc. ABSTRACT Establishing a synergistic relationship between the Pediatric Intensive Care Unit (PICU) staff and the Magnetic Resonance Imaging (MRI) staff is supported by the overwhelming amount of research that describes the risks involved in transporting a critically ill patient out of the Intensive Care Unit (ICU), as well as an increased trend of using MRI more often as a diagnostic tool. The purpose of our work is to develop standard practices around transporting critically ill patients to MRI, and to enhance the safety and efficiency during patient transport. Our improvement plan is multifaceted and includes standardized transport set-up, improved timeliness of when PICU patients arrive to MRI, enhanced matching of acuity/resources/time of day, a communication and planning tool to efficiently schedule patients, and a standardized metal screening plan. Metrics that are currently being tracked include the timing of transport (the PICU arrival time in MRI as well as stretcher-to-table time), and the PICU patients that are scheduled prior to 5 p.m. Objectives are as follows: Objective 1: Identify risks involved in transporting critically ill pediatric patients from the ICU to MRI. Objective 2: Identify strategies to minimize risks of adverse patient events during intrahospital transport from the ICU to MRI. Objective 3: Describe metrics used to track outcomes. Objective 4: Identify potential cost savings with improved efficiency. EMTREE DRUG INDEX TERMS metal EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient human imaging nuclear magnetic resonance imaging nursing travel EMTREE MEDICAL INDEX TERMS cost control diagnosis intensive care unit interpersonal communication patient patient transport planning risk safety screening stretcher LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71111492 DOI 10.1016/j.jradnu.2013.04.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.jradnu.2013.04.009 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 399 TITLE Quality metrics in neonatal and pediatric critical care transport: a consensus statement AUTHOR NAMES Bigham M.T. Schwartz H.P. AUTHOR ADDRESSES (Bigham M.T.; Schwartz H.P.) Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA. mbigham@chmca.org () SOURCE Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2013) 14:5 (518-524). Date of Publication: 1 Jun 2013 ISSN 1529-7535 ABSTRACT OBJECTIVES: The transport of neonatal and pediatric patients to tertiary care medical centers for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. Accurate assessment of quality indicators and patient outcomes requires the use of a standard language permitting comparisons among transport programs. No consensus exists on a set of quality metrics for benchmarking transport teams. The aim of this project was to achieve consensus on appropriate neonatal and pediatric transport quality metrics.DESIGN: Candidate quality metrics were identified through literature review and those metrics currently tracked by each program. Consensus was governed by nominal group technique. Metrics were categorized in two dimensions: Institute of Medicine quality domains and Donabedian's structure/process/outcome framework.SETTING: Two-day Ohio statewide quality metrics conference.SUBJECTS: Nineteen transport leaders and staff representing six statewide neonatal/pediatric specialty programs convened to achieve consensus.MEASUREMENT AND MAIN RESULTS: Two hundred fifty-seven performance metrics relevant to neonatal/pediatric transport were identified. Eliminating duplicate and overlapping metrics resulted in 70 candidate metrics. Nominal group methodology yielded 23 final quality metrics, the largest portion representing Donabedian's outcome category (n = 12, 52%) and the Institute of Medicine quality domains of effectiveness (n = 7, 30%) and safety (n = 9, 39%). Sample final metrics include measurement of family presence, pain management, intubation success, neonatal temperature control, use of lights and sirens, and medication errors. Lastly, a definition for each metric was established and agreed upon for consistency among institutions.CONCLUSIONS: This project demonstrates that quality metrics can be achieved through consensus building and provides the foundation for benchmarking among neonatal and pediatric transport programs and quality improvement projects. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) organization and management standards EMTREE MEDICAL INDEX TERMS child consensus consensus development cooperation human infant intensive care newborn patient safety patient transport preschool child procedures quality control United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23867429 (http://www.ncbi.nlm.nih.gov/pubmed/23867429) PUI L602286267 DOI 10.1097/PCC.0b013e31828a7fc1 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e31828a7fc1 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 400 TITLE Inter- and intra-hospital transport of the critically ill AUTHOR NAMES Blakeman T.C. Branson R.D. AUTHOR ADDRESSES (Blakeman T.C., Thomas.Blakeman@uc.edu; Branson R.D.) Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States. CORRESPONDENCE ADDRESS T. C. Blakeman, Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati OH 45267-0558, United States. Email: Thomas.Blakeman@uc.edu SOURCE Respiratory Care (2013) 58:6 (1008-1023). Date of Publication: 1 Jun 2013 ISSN 0020-1324 1943-3654 (electronic) BOOK PUBLISHER American Association for Respiratory Care, 9425 N. MacArthur Blvd. Suite 100, Irving, United States. ABSTRACT Intra- and inter-hospital transport is common due to the need for advanced diagnostics and procedures, and to provide access to specialized care. Risks are inherent during transport, so the anticipated benefits of transport must be weighed against the possible negative outcome during the transport. Adverse events are common in both in and out of hospital transports, the most common being equipment malfunctions. During inter-hospital transport, increased transfer time is associated with worse patient outcomes. The use of specialized teams with the transport of children has been shown to decrease adverse events. Intra-hospital transports often involve critically ill patients, which increases the likelihood of adverse events. Radiographic diagnostics are the most common in-hospital transport destination and the results often change the course of care. It is recommended that portable ventilators be used for transport, because studies show that use of a manual resuscitator alters blood gas values due to inconsistent ventilation. The performance of new generation transport ventilators has improved greatly and now allows for seamless transition from ICU ventilators. Diligent planning for and monitoring during transport may decrease adverse events and reduce risk. © 2013 Daedalus Enterprises. EMTREE DRUG INDEX TERMS activated carbon antiarrhythmic agent anticonvulsive agent antihypertensive agent antiinfective agent atropine bicarbonate bronchodilating agent calcium cimetidine diphenhydramine dobutamine dopamine epinephrine furosemide gluconate calcium glucose heparin infusion fluid insulin lidocaine mannitol naloxone narcotic analgesic agent neuromuscular blocking agent paracetamol sedative agent sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation assisted ventilation bradycardia capnometry cyanosis device failure diagnostic equipment evidence based practice health care personnel health care utilization heart arrest hospital equipment human hypotension hypothermia mechanical ventilator medication error nonhuman nuclear magnetic resonance imaging patient monitoring patient safety pediatrics portable equipment practice guideline preventive medicine tachycardia DEVICE TRADE NAMES EMV , United StatesImpact Instrumentation HT70 , United StatesNewport LTV 1200 , United StatesCareFusion T1 , United StatesHamilton DEVICE MANUFACTURERS (United States)CareFusion (United States)Hamilton (United States)Impact Instrumentation (United States)Newport CAS REGISTRY NUMBERS activated carbon (64365-11-3, 82228-96-4) adrenalin (51-43-4, 55-31-2, 6912-68-1) atropine (51-55-8, 55-48-1) bicarbonate (144-55-8, 71-52-3) calcium (14092-94-5, 7440-70-2) cimetidine (51481-61-9, 70059-30-2) diphenhydramine (147-24-0, 58-73-1) dobutamine (34368-04-2, 49745-95-1, 52663-81-7, 61661-06-1) dopamine (51-61-6, 62-31-7) furosemide (54-31-9) gluconate calcium (299-28-5) glucose (50-99-7, 84778-64-3) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) insulin (9004-10-8) lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9) mannitol (69-65-8, 87-78-5) naloxone (357-08-4, 465-65-6) paracetamol (103-90-2) sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013345062 MEDLINE PMID 23709197 (http://www.ncbi.nlm.nih.gov/pubmed/23709197) PUI L369024655 DOI 10.4187/respcare.02404 FULL TEXT LINK http://dx.doi.org/10.4187/respcare.02404 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 401 TITLE Prevention of corneal abrasions in critical care transport AUTHOR NAMES Kent R. Rajah F. AUTHOR ADDRESSES (Kent R.; Rajah F.) Embrace, Sheffield Childrens' NHS Trust, Barnsley, United Kingdom. CORRESPONDENCE ADDRESS R. Kent, Embrace, Sheffield Childrens' NHS Trust, Barnsley, United Kingdom. SOURCE Intensive Care Medicine (2013) 39 SUPPL. 1 (S140). Date of Publication: June 2013 CONFERENCE NAME 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care, ESPNIC 2013 CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-06-12 to 2013-06-15 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Background: Corneal abrasion is a concern for all children who are deeply sedated or receiving neuromuscular blocking agents whilst being ventilated. It is possible that the risks are increased during the transport process due the increased frequency of patient intervention and patient movement during this time. A variation in practice has been observed in corneal abrasion prevention strategies within Embrace Transport Service∗. There are no guidelines within this area of practice. Objectives: To establish the incidence and type of corneal abrasion strategy use within critical care transport. Provide evidence for the formation of guidelines. Method: All Embrace medical and nursing staff were given a questionnaire to complete consisting of 10 questions. Results: There were 39 replies (100 % response rate). 97 % of staff can list corneal abrasion strategies, but currently only 3 % consider it for neonates and 18 % consider it for children they transfer ventilated. For both neonates and paediatrics six different varieties of eye protection are currently used including passive closure, no eye protection, Geliperm, lacrilube, tape and eye drops. No consultants or medical trainees had received education on corneal abrasion prevention. Conclusions: Inadequate eye protection is used in both neonatal and paediatric transport. Guidelines are required for consistency. Education and training is required within this area. ∗Embrace is Yorkshire and Humber Infant and Children's Transport Service. EMTREE DRUG INDEX TERMS eye drops neuromuscular blocking agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abrasion intensive care newborn intensive care prevention society EMTREE MEDICAL INDEX TERMS child consultation education eye protection human infant newborn nursing staff patient pediatrics questionnaire risk student LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71440192 DOI 10.1007/s00134-013-2950-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-2950-8 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 402 TITLE Paediatric intensive care transport in victoria: What has changed over the last ten years? AUTHOR NAMES Cooke A. Oberender F. AUTHOR ADDRESSES (Cooke A.; Oberender F.) Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Australia. CORRESPONDENCE ADDRESS A. Cooke, Paediatric Intensive Care, Royal Children's Hospital, Melbourne, Australia. SOURCE Intensive Care Medicine (2013) 39 SUPPL. 1 (S199-S200). Date of Publication: June 2013 CONFERENCE NAME 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care, ESPNIC 2013 CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-06-12 to 2013-06-15 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Objectives: The Victorian Paediatric Emergency Transport Service (PETS) provides advice on management and performs retrieval of critically ill children throughout Victoria, Tasmania and Southern New South Wales. This study aimed to evaluate changes in referrals and retrievals over the past 10 years. Methods: Data was extracted from the PETS database for 2002-2011, inclusive. Severity of illness was categorised by the level of organ-support required during retrieval and the data obtained analysed for proportions and trends over time (z-test). Results: There were 7,281 referrals to PETS resulting in 6,377 transfers (88 %) of which 3,338 (46 %) were performed by the PETS team, 35 % by air. There was a highly significant increase in the number of referrals and PETS transfers per year (p<0.01). There was a small but significant increase in the proportion of referrals from regional hospitals and children transferred with non-invasive ventilation (p<0.01). The rate of PETS referrals is significantly higher in non-metropolitan communities (1.1/1,000 children) compared with metropolitan communities (0.37/1,000 children, p<0.01, z-test). Conclusions: Over the last 10 years there has been a marked increase in the overall activity of PETS. However, the proportion of children referred for critical illness requiring invasive mechanical ventilation and/or circulatory support has not changed suggesting that the increased activity is not due to a change in referral patterns. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care newborn intensive care society EMTREE MEDICAL INDEX TERMS artificial ventilation assisted circulation Australia child community critical illness critically ill patient data base diseases emergency hospital human noninvasive ventilation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71440366 DOI 10.1007/s00134-013-2950-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-2950-8 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 403 TITLE Established and proven catheter-related bloodstream infection precautions for paediatric intensive care patients are transferable to extracorporeal membrane oxygenation AUTHOR NAMES Harry C. MacFarlane L. Wylie G. Davidson M. Spenceley N. AUTHOR ADDRESSES (Harry C.; MacFarlane L.; Davidson M.; Spenceley N.) Paediatric Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, United Kingdom. (Wylie G.; Davidson M.; Spenceley N.) Extracorporeal Life Support Organisation, Royal Hospital for Sick Children, Glasgow, United Kingdom. (Davidson M.; Spenceley N.) Faculty of Health Sciences and Medicine, University of Glasgow, United Kingdom. CORRESPONDENCE ADDRESS C. Harry, Paediatric Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, United Kingdom. SOURCE Pediatric Critical Care Medicine (2013) 14:5 SUPPL. 1 (S117). Date of Publication: June 2013 CONFERENCE NAME 9th International Conference of the Pediatric Cardiac Intensive Care Society CONFERENCE LOCATION Miami Beach, FL, United States CONFERENCE DATE 2012-12-09 to 2012-12-12 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: Catheter-related bloodstream infections (CR-BSI) impact on patient morbidity, mortality and healthcare expenditure. We aimed to identify if well-established interventions to reduce CR-BSI in routine paediatric intensive care patients could be effective in paediatric patients supported on extracorporeal membrane oxygenation (ECMO). Methods: A retrospective observational study was performed in a national, tertiary level paediatric intensive care unit (PICU) with a mixed general and cardiac population. Patients supported on ECMO in PICU were studied in four epochs between January 2006 and April 2012. Practice change was implemented, including staff education and introduction of central line insertion and maintenance 'bundles.' Weekly consultant led microbiology 'joint rounds' were also instigated. Results: Local surveillance data reported a 50% incidence of CR-BSI in patients supported on ECMO in PICU between January 2006 and August 2008 (55.3BSI/1000 ECMO days). There was an initial reduction to 35% incidence (45BSI/1000 ECMO days) between July 2009 and March 2010. There have been further reductions in CR-BSI incidence in subsequent epochs 26BSI/1000 ECMO days (20% incidence) from April 2010 - 2011 and 25BSI/1000 ECMO days (incidence 21%) from April 2011 - 2012. Conclusions: CR-BSI have a significant impact on the paediatric population, including children supported on ECMO. Following a multi-faceted practice change, we have successfully reduced our incidence and impact of BSI on our ECMO cohort in our institution. The active review of infection incidence and identifying strategies to reduce sepsis in any ECMO cohort is essential and forms an important element of our patient safety program. EMTREE DRUG INDEX TERMS recombinant erythropoietin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) catheter infection extracorporeal oxygenation human intensive care patient society EMTREE MEDICAL INDEX TERMS central venous catheter child consultation health care cost infection intensive care unit microbiology morbidity mortality observational study patient safety population sepsis staff training LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71160702 DOI 10.1097/PCC.0b013e318292b29c FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e318292b29c COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 404 TITLE Obstetric and perinatal follow-up in an oocyte donation program: Why should we transfer only one embryo AUTHOR NAMES Clua Obradó E. Rodríguez Barredo D. Latre Navarro L. Vázquez Rodríguez A. Barri Ragué P.N. Coroleu Lletget B. Tur Padró R. AUTHOR ADDRESSES (Clua Obradó E.; Rodríguez Barredo D.; Latre Navarro L.; Vázquez Rodríguez A.; Barri Ragué P.N.; Coroleu Lletget B.; Tur Padró R.) Institut Universitari Dexeus, Medicina de la Reproducción, Barcelona, Spain. CORRESPONDENCE ADDRESS E. Clua Obradó, Institut Universitari Dexeus, Medicina de la Reproducción, Barcelona, Spain. SOURCE Human Reproduction (2013) 28 SUPPL. 1 (i286-i287). Date of Publication: June 2013 CONFERENCE NAME 29th Annual Meeting of the European Society of Human Reproduction and Embryology, ESHRE 2013 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2013-07-07 to 2013-07-10 ISSN 0268-1161 BOOK PUBLISHER Oxford University Press ABSTRACT Study question: To analyze the incidence of obstetric and perinatal complications in oocyte recipients,whoperformed the cycle and were monitored (pregnancyand delivery) in the same center, in order to inform about the real risk of complications and to assess about the number of embryos to transfer. Summary answer: Our results show a higher incidence of gestational diabetes and Cesarean sections in older women. Multiple pregnancy is the main cause of the higher obstetric and perinatal complications. Additionally, the advanced age in these patients determines increased obstetric complications. Preconceptional counseling and transfer of a single embryo is highly recommended. What is known already: There is a widespread belief that pregnancy outcome is worse in oocyte donation than in autologous IVF. There is a general consensus on the fact that such pregnancies tend to be at increased risk of obstetric and perinatal complications. However, there is no general agreement on whether this increased risk is due to the advanced age of these patients or to their tendency to multiple pregnancy as a result of the number of embryos transferred. Study design, size, duration: Retrospective descriptive study of the pregnancies and deliveries achieved with a total of 183 cycles of donor oocytes (DO) that were performed and monitored in our center between 2000 and 2009. Participants/materials, setting, methods: Participants: 183 oocyte recipients/ 243 live births. Outcome measures: preeclampsia (PE), gestational diabetes, premature rupture of membranes (PROM), preterm birth, cesarean section rate, low birthweight, admission to neonatal intensive care unit and perinatal mortality. Chi-square test was used to compare the groups according to type of gestation and to age. Main results and the role of chance: The recipient's age was 40.1 ± 5.3 years (46% < 40 years/54% ≥ 40 years). Sixty-nine percent were singletons (124/ 183) and 32% were multiples (59/183). By age: Gestational diabetes (8.2% vs 28.6%) and cesarean section rate (65.9% vs 81.6%) were statistically higher (p < 0.05) in patients ≥40 years. By type of gestation: PE (5.6% vs 22%), PROM(3.2% vs 13.6%), preterm and very preterm birth (at < 28, 34 and 37 weeks), cesarean section rate (70.2% vs 83.1%), admission to neonatal intensive care unit (2.4 vs 13.4%), low birth weight (5.6% vs 59.7%) and very low birth weight (0 vs 6.7%), were statistically higher (p < 0.05) in multiples. By age plus gestation: diabetes is related only to age (≥40 years) and PE and preterm birth are associated with multiple pregnancy. Limitations, reason for caution: When we observe the results related to both variables (age and type of gestation) they seem clinically relevant although statistically significant differences cannot be confirmed because the sample is too fragmented thus not having enough statistical power. Wider implications of the findings: Preconceptional counseling in oocyte donation programs before the process is highly recommended. It seems necessary to advise the patients about the risks associated with multiple pregnancy and advanced maternal age before starting the cycle, as well as to transfer a single embryo in good prognosis patients with good quality embryos in order to avoid multiple pregnancy and the risk of the complications involved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) embryo embryology follow up human oocyte donation reproduction society EMTREE MEDICAL INDEX TERMS cesarean section chi square test consensus counseling diabetes mellitus donor female intensive care unit live birth low birth weight maternal age membrane multiple pregnancy newborn disease newborn intensive care oocyte patient perinatal mortality preeclampsia pregnancy pregnancy diabetes mellitus pregnancy outcome premature labor prognosis recipient risk rupture study design very low birth weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71335692 DOI 10.1093/humrep/det219 FULL TEXT LINK http://dx.doi.org/10.1093/humrep/det219 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 405 TITLE The significance of genetic polymorphisms of glutathione s-transferase family in the development of pneumonia in premature born babies AUTHOR NAMES Shunko E.Y. Gorovenko N.G. Kovalova O.M. Rossokha Z. Goncharova J. AUTHOR ADDRESSES (Shunko E.Y.) Neonatology, National Medical Academy of Postgraduate Education, Kiev, Ukraine. (Gorovenko N.G.; Rossokha Z.) National Medical Academy of Post-Graduate Education named after P.L. Shupik, Kiev, Ukraine. (Kovalova O.M.; Goncharova J.) Ukrainian Medical Dental Academy, Poltava, Ukraine. CORRESPONDENCE ADDRESS E.Y. Shunko, Neonatology, National Medical Academy of Postgraduate Education, Kiev, Ukraine. SOURCE Intensive Care Medicine (2013) 39 SUPPL. 1 (S94). Date of Publication: June 2013 CONFERENCE NAME 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care, ESPNIC 2013 CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2013-06-12 to 2013-06-15 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Background and aims: To investigate associations between polymorphism of GSTM1, GSTT1, GSTP1 genes and the development of pneumonia in premature born babies during their treatment in neonatal intensive care units. Methods: We investigated associations between polymorphisms of GSTM1, GSTT1 and GSTP1 genes and the development of pneumonia amongst 120 premature newborns at <36 weeks gestation (median birthweight 1,475 g, range 700-2,480 g; gestation 30.8 weeks, range 27-36; 68 male). In these children we measured the rate of use of oxygen support, CPAP, and mechanical ventilation. Differences between groups were determined by parametric (independent t test) or non-parametric techniques (Mann-Whitney U test) depending on their distribution. Analysis was performed using SPSS. Results:The AG and GG GSTP1 genotypes were associated with the development of pneumonia in premature newborns. In premature born babies with genotype GG gene GSTR1 the duration of mechanical ventilation was significantly greater than in newborns with AG or AA genotypes (Me = 8.0 and 4.4, 3.5 days). Babies with a combination of non-functional alleles of the GSTM1 gene and the A313G single nucleotide change of GSTP1 gene required the use of oxygen support significantly more than babies with functional genotypes (51.5 and 4.8 %, p<0.01). Conclusions: These data to support a role of polymorphism of GSTP1 in the development of pneumonia in premature newborns. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) glutathione transferase EMTREE DRUG INDEX TERMS nucleotide oxygen silver EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) baby genetic polymorphism newborn intensive care pneumonia society EMTREE MEDICAL INDEX TERMS allele artificial ventilation birth weight child gene genotype human intensive care unit male newborn positive end expiratory pressure pregnancy prematurity rank sum test Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71440052 DOI 10.1007/s00134-013-2950-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-2950-8 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 406 TITLE Transport risk index of physiologic stability, version II (TRIPS-II): A simple and practical neonatal illness severity score AUTHOR NAMES Lee S. Aziz K. Dunn M. Clarke M. Kovacs L. Ojah C. Ye X. AUTHOR ADDRESSES (Lee S., sklee@mtsinai.on.ca; Dunn M.) Department of Paediatrics, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada. (Lee S., sklee@mtsinai.on.ca; Ye X.) Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada. (Aziz K.) Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. (Clarke M.) Department of Pediatrics, Queen's University, Kingston, ON, Canada. (Kovacs L.) Department of Pediatrics, McGill University, Montreal, QC, Canada. (Ojah C.) Department of Pediatrics, Saint John Regional Hospital, Saint John, NB, Canada. CORRESPONDENCE ADDRESS S. Lee, Department of Paediatrics, University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada. Email: sklee@mtsinai.on.ca SOURCE American Journal of Perinatology (2013) 30:5 (395-400). Date of Publication: 2013 ISSN 0735-1631 1098-8785 (electronic) BOOK PUBLISHER Thieme Medical Publishers, Inc., 333 7th Avenue, New York, United States. ABSTRACT Objective Derive and validate a practical assessment of infant illness severity at admission to neonatal intensive care units (NICUs). Study Design Prospective study involving 17,075 infants admitted to 15 NICUs in 2006 to 2008. Logistic regression was used to derive a prediction model for mortality comprising four empirically weighted items (temperature, blood pressure, respiratory status, response to noxious stimuli). This Transport Risk Index of Physiologic Stability, version II (TRIPS-II) was then validated for prediction of 7-day and total NICU mortality. Results TRIPS-II discriminated 7-day (receiver operating curve [ROC] area, 0.90) and total NICU mortality (ROC area, 0.87) from survival. Furthermore, there was a direct association between changes in TRIPS-II at 12 and 24 hours and mortality. There was good calibration across the full range of TRIPS-II scores and the gestational age at birth, and addition of TRIPS-II improved performance of prediction models that use gestational age and baseline population risk variables. Conclusion TRIPS-II is a validated benchmarking tool for assessing infant illness severity at admission and for up to 24 hours after. © 2013 by Thieme Medical Publishers, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disease severity infant disease EMTREE MEDICAL INDEX TERMS article blood pressure female gestational age human infant intensive care unit major clinical study male mortality priority journal risk assessment survival temperature EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013310278 MEDLINE PMID 23023554 (http://www.ncbi.nlm.nih.gov/pubmed/23023554) PUI L52233070 DOI 10.1055/s-0032-1326983 FULL TEXT LINK http://dx.doi.org/10.1055/s-0032-1326983 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 407 TITLE Unexpected events occuring during the intrahospital transport of critically ill ICU patients AUTHOR NAMES Pradeep M.V. Rao S.M. AUTHOR ADDRESSES (Pradeep M.V.; Rao S.M.) Department of Critical Care Medicine, Yashoda Hospital, Somajiguda, Hyderbad, India. CORRESPONDENCE ADDRESS M.V. Pradeep, Department of Critical Care Medicine, Yashoda Hospital, Somajiguda, Hyderbad, India. SOURCE Indian Journal of Critical Care Medicine (2013) 17 SUPPL. 2 (25). Date of Publication: May 2013 CONFERENCE NAME 19th Annual Conference of ISCCM, Criticare 2013 CONFERENCE LOCATION Kolkata, India CONFERENCE DATE 2013-03-01 to 2013-03-06 ISSN 0972-5229 BOOK PUBLISHER Medknow Publications and Media Pvt. Ltd ABSTRACT Objectives: 1. To observe the number and types of unexpected-events(UEs) occurring during intrahospital transport of critically ill ICU patients. 2. Interventions provided along with outcome. Methods: This was a prospective observational study of 100 intrahospital critically ill ICU patients of our hospital transported for diagnostic purposes during april 2012-September 2012. The escorting Intensivist completed the data during transport. Major Unexpected-events (UEs) were defined as fall in saturation >5% from baseline, BP variation > 20% from baseline, cardiac arrest, accidental extubation and arrhythmias. Minor UEs were Nasogastric tube and IV/Central-Line displacement. Miscellaneous UEs were oxygen probe/ECG lead displacement, Arterial line/IV line/ventilator tube tangling and transport related issues. The interventions provided and outcome were documented. Results: A total of 100 patients were observed prospectively for UEs during intrahospital transfer of critically ill patients. The overall UEs observed were 109 among 64 patients. Among the UEs which occurred the maximum were miscellaneous causes 79 (72.47%) like oxygen probe 28 (25.68%) or ECG lead displacement 29 (26.60%), major events like fall in spo2 >5% observed in 8 (7.33%) patients, BP variation >20% from baseline in 14 (12.84%) patients, Altered mental status in 3 (2.75%) and arrhythmias in 3 (2.75%) patients. Among 64 (100%) patients with UEs, 3 (2.75%) patients with serious adverse events have been aborted from transport. Conclusion: Unexpected-events(UEs) are commonly seen in critically ill ICU patients who are transported from one place to other, but these major unexpected adverse events can be reduced when critically ill patients are accompanied by Intensivist/ Medically qualified person during transport and following strict transport guidelines. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient human patient EMTREE MEDICAL INDEX TERMS diagnosis electrocardiogram extubation heart arrest heart arrhythmia hospital intensivist mental health nasogastric tube observational study patient transport tube LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71239374 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 408 TITLE Intrahospital transport of high risk ICU patients on manual ventilation: An audit from a University Hospital AUTHOR NAMES Chakraborty N. Gurjar M. K Baronia A. Azim A. Poddar B. Singh R.K. AUTHOR ADDRESSES (Chakraborty N.; Gurjar M.; K Baronia A.; Azim A.; Poddar B.; Singh R.K.) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. CORRESPONDENCE ADDRESS N. Chakraborty, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. SOURCE Indian Journal of Critical Care Medicine (2013) 17 SUPPL. 2 (28). Date of Publication: May 2013 CONFERENCE NAME 19th Annual Conference of ISCCM, Criticare 2013 CONFERENCE LOCATION Kolkata, India CONFERENCE DATE 2013-03-01 to 2013-03-06 ISSN 0972-5229 BOOK PUBLISHER Medknow Publications and Media Pvt. Ltd ABSTRACT Objective: To know indications and incidence of adverse events during intrahospital transport of high risk ICU patients. Material & Method: A prospective audit was done between 01, September 2012 to 30, November 2012 in 12 bedded ICU of department of critical care medicine from a university hospital. Transport of high risk patient (requiring ventilator support) was done on manual ventilation with Bain's circuit by trained registrar and accompanied by nurse. Vitals were monitored. Proforma include: demographic profile, vitals, IV infusions, ABG (same settings on ventilator before and after transport), indication and duration of transport and adverse events (high risk or serious adverse event). Results: There were 32 intrahospital transports (21 patients); 12 (60%) requiring vasopressors. Mean SOFA score was 8.87. Indications: mainly diagnostic 29 (90%), [18 CT scan, 5 MRI, 3 USG or Doppler, 2 NCV study], followed by 5 (15%) for intervention [4 NJ tube placement, 1 CT guided intervention]. Median duration of transport was 60 min (30 - 180 min). Seven patients needed increment of sedation, while one muscle relaxant. After transport, mean heart rate and mean vasopressor requirement were increased significantly (p=0.026 and p=0.04 respectively); while systolic BP, PaO2/FiO2 ratio, PCO2 did not differ significantly. Total adverse events were in 18 (56%) transport which were high risk [13 (39%) patient related and 6 (18%) equipment related]. Amongst patient related events 9 (28%) had CVS followed by respiratory in 5 (15.6%). Seven (21.8%) had hypotension, followed by 4 (12.5%) tachypnea, 3 (9%) tachycardia 2 (6%) hypertension, 1 (3%) bradycardia and 1 (3%) increased airway pressure. Among equipments: 4 (12.5%) monitor related, followed by 1 (3%) infusion pump, 1 (3%) elevator malfunction. Conclusion: Intrahospital transports of ventilated patient are at high risk for adverse events including significant increment of vasopressor; while there is no significant impact on blood gases. EMTREE DRUG INDEX TERMS hypertensive factor muscle relaxant agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit human manual ventilation patient risk university hospital EMTREE MEDICAL INDEX TERMS airway pressure blood gas bradycardia building computer assisted tomography diagnosis heart rate high risk patient hypertension hypotension infusion pump intensive care intravenous drug administration nuclear magnetic resonance imaging nurse sedation Sequential Organ Failure Assessment Score tachycardia tachypnea tube ventilated patient ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71239382 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 409 TITLE Close monitoring of temperature and timing of sample transport in a large hospital in summer time AUTHOR NAMES Rapi S. Salti S. Ognibene A. Brogi M. Melli F. Simonetti S. Abbruscato R. Veroni F. AUTHOR ADDRESSES (Rapi S.; Salti S.; Ognibene A.; Brogi M.; Melli F.; Simonetti S.; Abbruscato R.; Veroni F.) Central Laboratory, Laboratory Department, AOU Careggi, Florence, Italy. CORRESPONDENCE ADDRESS S. Rapi, Central Laboratory, Laboratory Department, AOU Careggi, Florence, Italy. SOURCE Biochimica Clinica (2013) 37 SUPPL. 1 (S353). Date of Publication: 2013 CONFERENCE NAME 20th IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine, EuroMedLab, 45th Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology, SIBioC 2013 CONFERENCE LOCATION Milan, Italy CONFERENCE DATE 2013-05-19 to 2013-05-23 ISSN 0393-0564 BOOK PUBLISHER Biomedia Srl ABSTRACT Background: Handling and intra-hospital transfer of biological samples can affect analytical results, given the temperature variation and the time delay itself. Standardization of transport methods and temperature monitoring need to be pursued, particularly in centralized laboratory, where long distance may need to be covered. We decided to investigate timing delay and temperature variation occurring from blood draw moment and sample centrifugation; we conduct a survey in summer and we valuated the possible advantages of a new transport box that allows time and temperature monitoring. Methods: Careggi hospital is located in several buildings with an area of over 2 square Kms. Internal biological transport is assured by cars on request for emergency and scheduled for routine samples. The survey was performed monitoring time and temperature of routine delivery from 4 different units care in august 2012. Three clinical wards were located in the same building nearby the laboratory (200 m) and the forth in a structure more distant (1 Km). The latter and two of the previous three used specific transport box (H-BIN Biotransport, Becton Dickinson UK) and the samples were tracked by a monitoring system (BD T&T, Becton Dickinson UK). The forth unit carried on with the standard transport system becoming the naÏve condition reference. A total amounts of 219 shipments were monitored, 169 employing specific transport box and 50 using traditional bag provided by a thermometer for temperature registrations. Results: Overall median transfer time was 51 min (range 30-123 min); noticeably no difference was found between buildings location. Mean shipments temperatures resulted 26.0 °C and 27.3 °C with and without transport box respectively (P <0.01). Discussion: The close monitoring of sample shipments allows to verify the quality of pre-analytical phase and to underline possible drawbacks in samples transfer. The use of specifically designed transport boxes resulted in a closer temperature control even if the transport temperature does not appear to be a major problem. Ninetieth percentile of transport time is a criticism in our pre analytical phase; a fixed limit of shipment time can be used to avoid the analysis of sensible tests with significant pre analytical improvements. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical chemistry hospital laboratory molecular biology monitoring society summer temperature EMTREE MEDICAL INDEX TERMS blood car centrifugation emergency registration standardization temperature measurement thermometer transport at the cellular level United Kingdom ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71436320 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 410 TITLE Factors contributing to adverse events after ICU discharge: A survey of liaison nurses AUTHOR NAMES Elliott M. Worrall-Carter L. Page K. AUTHOR ADDRESSES (Elliott M., S00072102@myacu.edu.au) St Vincent's Centre for Nursing Research, Melbourne, Australia. (Elliott M., S00072102@myacu.edu.au) Holmesglen Institute, Melbourne, Australia. (Elliott M., S00072102@myacu.edu.au) Locked Bag 4115, Fitzroy MDC, Victoria 3065, Australia. (Worrall-Carter L.) St Vincent's Centre for Nursing Research, Australian Catholic University, Melbourne, Australia. (Page K.) Clinical Care Engagement, Heart Foundation, Melbourne, Australia. CORRESPONDENCE ADDRESS M. Elliott, Locked Bag 4115, Fitzroy MDC, Victoria 3065, Australia. Email: S00072102@myacu.edu.au SOURCE Australian Critical Care (2013) 26:2 (76-80). Date of Publication: May 2013 ISSN 1036-7314 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Background: A significant number of patients experience an adverse event when discharged from intensive care to a ward. More than half of these events may be preventable with better standards of care. Aim: To explore the opinions of an expert group of clinicians around factors contributing to adverse events in patients discharged from ICU. Method: Online survey of Australian ICU Liaison Nurses (n= 39) using a validated questionnaire of 25 items. Results: The response rate was 92.8%. Key contributing factors included a lack of experienced ward staff, patient co-morbidities and the clinically challenging nature of many patients. Conclusion: Modifying processes of care may decrease the risk or impact of adverse events in this high risk patient population. © 2012 Australian College of Critical Care Nurses Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport treatment outcome EMTREE MEDICAL INDEX TERMS article clinical handover comorbidity critical illness health care quality health care survey hospital discharge human mortality qualitative research standard LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 22948080 (http://www.ncbi.nlm.nih.gov/pubmed/22948080) PUI L52188838 DOI 10.1016/j.aucc.2012.07.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.aucc.2012.07.005 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 411 TITLE VRE transmission via the reusable breathing circuit of a transport ventilator: Outbreak analysis and experimental study of surface disinfection AUTHOR NAMES Schulz-Stübner S. Schmidt-Warnecke A. Hwang J.-H. AUTHOR ADDRESSES (Schulz-Stübner S., schust@t-online.de) Deutsches Beratungszentrum für Hygiene, Schnewlinstr. 10, 79098 Freiburg im Breisgau, Germany. (Schmidt-Warnecke A.) Synlab Hygieneinstitut Berlin-Brandenburg (Zweigniederlassung der Synlab Umweltinstitut GmbH), Turmstr. 21 Haus M Eingang O, 10559 Berlin, Germany. (Hwang J.-H.) Klinik für Anästhesiologie und Operative Intensivmedizin, Sana Krankenhaus Gerresheim, Gräulinger Str. 120, 40625 Düsseldorf, Germany. CORRESPONDENCE ADDRESS S. Schulz-Stübner, Deutsches Beratungszentrum für Hygiene, Schnewlinstr. 10, 79098 Freiburg im Breisgau, Germany. Email: schust@t-online.de SOURCE Intensive Care Medicine (2013) 39:5 (975-976). Date of Publication: May 2013 ISSN 0342-4642 1432-1238 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. EMTREE DRUG INDEX TERMS disinfectant agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial transmission breathing circuit disinfection epidemic mechanical ventilator vancomycin resistant Enterococcus EMTREE MEDICAL INDEX TERMS bacterial colonization bacterium contamination breathing circuit bacterial filter clinical article colony forming unit critically ill patient enterococcal infection Enterococcus faecium human intensive care intensive care unit letter nonhuman DEVICE TRADE NAMES Drager Oxylog 2000 transport ventilator , GermanyDrager Schulke mikrozid AF , GermanySchuelke and Mayr DEVICE MANUFACTURERS (Germany)Drager (Germany)Schuelke and Mayr EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013623879 MEDLINE PMID 23404473 (http://www.ncbi.nlm.nih.gov/pubmed/23404473) PUI L52441274 DOI 10.1007/s00134-013-2842-y FULL TEXT LINK http://dx.doi.org/10.1007/s00134-013-2842-y COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 412 TITLE Mannitol dosing error during intra-facility transfer for intracranial emergencies AUTHOR NAMES Elliott C.A. MacKenzie M. O'Kelly C. AUTHOR ADDRESSES (Elliott C.A.; MacKenzie M.; O'Kelly C.) Edmonton, Canada. CORRESPONDENCE ADDRESS C.A. Elliott, Edmonton, Canada. SOURCE Canadian Journal of Neurological Sciences (2013) 40:3 SUPPL. 1 (S16-S17) CONFERENCE NAME 48th Annual Congress of the Canadian Neurological Sciences Federation CONFERENCE LOCATION Montreal, QC, Canada CONFERENCE DATE 2013-06-12 to 2013-06-14 ISSN 0317-1671 BOOK PUBLISHER Canadian Journal of Neurological Sciences ABSTRACT Background: Mannitol is commonly used to treat elevated intracranial pressure. We analyzed mannitol dosing errors at peripheral hospitals prior to transport to tertiary care facilities for intracranial emergencies. Methods: We conducted a retrospective review of the Shock Trauma Air Rescue Society (STARS) electronic patient database of helicopter medical evacuations in Alberta, Canada between 2004-2012 limited to patients receiving mannitol before transfer. We extracted data on mannitol administration; patient characteristics including diagnosis, mechanism, GCS, weight, age and pupils. Results: 120 patients received a mannitol infusion initiated at a peripheral hospital for intracranial emergency (median gcs 6; range 3 - 13). There was a 23% error rate, including an underdosing rate (<0.25 g/kg) of 8.3% (10/120), an overdosing rate (>1.5g/kg) of 7.5% (9/120), and a non-bolus administration rate (> 1 hour) of 6.7% (8/120). A process analysis was used to identify potential factors leading to these errors and will be presented. Conclusions: Mannitol administration at peripheral hospitals is prone to dosing error. Our analysis suggests potential strategies, such as a pre transport checklist, to mitigate this risk. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) mannitol EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency EMTREE MEDICAL INDEX TERMS Canada checklist data base diagnosis helicopter hospital human infusion injury intracranial pressure patient risk society tertiary health care weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71096039 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 413 TITLE Pssst... AINS secrets! Today from the area of critical care transfer ORIGINAL (NON-ENGLISH) TITLE Pssst⋯ AINS-secrets! Heute aus dem bereich intensivverlegung AUTHOR NAMES Gill-Schuster D. Ockelmann P. Bergold M. Zacharowski K. AUTHOR ADDRESSES (Zacharowski K., Kai.Zacharowski@kgu.de) FRCA Direktor der Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt Am Main, Theodor-Stern-Kai 7, 60 590 Frankfurt am Main, Germany. (Gill-Schuster D.; Ockelmann P.; Bergold M.) CORRESPONDENCE ADDRESS K. Zacharowski, FRCA Direktor der Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt Am Main, Theodor-Stern-Kai 7, 60 590 Frankfurt am Main, Germany. Email: Kai.Zacharowski@kgu.de SOURCE Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie (2013) 48:2 (102-105). Date of Publication: 2013 ISSN 0939-2661 1439-1074 (electronic) BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS article EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 2013174639 MEDLINE PMID 23504465 (http://www.ncbi.nlm.nih.gov/pubmed/23504465) PUI L52491192 DOI 10.1055/s-0032-1333090 FULL TEXT LINK http://dx.doi.org/10.1055/s-0032-1333090 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 414 TITLE Patient-driven resource planning of a health care facility evacuation AUTHOR NAMES Petinaux B. Yadav K. AUTHOR ADDRESSES (Petinaux B., bpetinaux@mfa.gwu.edu; Yadav K.) Department of Emergency Medicine, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037, United States. CORRESPONDENCE ADDRESS B. Petinaux, Department of Emergency Medicine, George Washington University, 2150 Pennsylvania Avenue NW, Washington, DC 20037, United States. Email: bpetinaux@mfa.gwu.edu SOURCE Prehospital and Disaster Medicine (2013) 28:2 (120-126). Date of Publication: April 2013 ISSN 1049-023X 1945-1938 (electronic) BOOK PUBLISHER Cambridge University Press, Shaftesbury Road, Cambridge, United Kingdom. ABSTRACT Introduction The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old. Methods Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period. Results Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe. Conclusion Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within the facility and the community to provide for the safest evacuation of patients. Copyright © World Association for Disaster and Emergency Medicine 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster planning hospital patient care patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article child cross-sectional study female health personnel attitude human infant intensive care unit male middle aged newborn operating room preschool child United States walking difficulty LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23257081 (http://www.ncbi.nlm.nih.gov/pubmed/23257081) PUI L368683279 DOI 10.1017/S1049023X12001793 FULL TEXT LINK http://dx.doi.org/10.1017/S1049023X12001793 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 415 TITLE Early identification of children at risk for critical care: Standardizing communication for inter-emergency department transfers AUTHOR NAMES Sahyoun C. Fleegler E. Kleinman M. Monuteaux M.C. Bachur R. AUTHOR ADDRESSES (Sahyoun C., cs2476@columbia.edu; Fleegler E.; Monuteaux M.C.; Bachur R.) Divisions of Emergency Medicine, Department of Anesthesia, Boston Children's Hospital, Boston, MA, United States. (Kleinman M.) Critical Care Medicine, Department of Anesthesia, Boston Children's Hospital, Boston, MA, United States. (Sahyoun C., cs2476@columbia.edu) Columbia University, Morgan Stanley Children's Hospital of New York, Division of Pediatric Emergency Medicine, 622 West 168th St, PH 137, New York, NY 10032, United States. CORRESPONDENCE ADDRESS C. Sahyoun, Columbia University, Morgan Stanley Children's Hospital of New York, Division of Pediatric Emergency Medicine, 622 West 168th St, PH 137, New York, NY 10032, United States. Email: cs2476@columbia.edu SOURCE Pediatric Emergency Care (2013) 29:4 (419-424). Date of Publication: April 2013 ISSN 0749-5161 1535-1815 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT BACKGROUND: Interfacility transfers occur frequently and often involve critically ill patients. Clear communication at the time of patient referral is essential for patient safety. OBJECTIVES: The objective of this work was to study whether a standardized inter-emergency department (ED) transfer communication template for pediatric patients with respiratory complaints identifies patients that require intensive care unit (ICU) admission. METHODS: We created a template to structure the communication between referring and receiving providers involved in inter-ED transfers of children with respiratory complaints. The template was designed for use by nonphysicians to prompt specific questions that would trigger notification of the ED attending based on signs of critical illness. The template was retrospectively applied to determine whether it would have properly triggered attending physician notification of a child ultimately requiring ICU admission. RESULTS: Of 285 transferred children, 61 (21%) were admitted to an ICU from the receiving ED. The sensitivity of the communication template in predicting the need for ICU admission was 84% (95% confidence interval [CI], 72%-92%), negative predictive value of 95% (95% CI, 90%-97%), specificity of 77% (95% CI, 71%-82%), positive predictive value of 50% (95% CI, 40%-60%). Of the 10 patients admitted to an ICU who were not identified by the tool, none were critically ill upon arrival. Of the individual communication elements, the sensitivity and negative predictive value ranged from 3% to 38% and from 79% to 86%, respectively. CONCLUSIONS: A standardized communication template for inter-ED transfers can identify children with respiratory complaints who require ICU admission. Next steps include real-time application to judge screening performance compared with current nonstandardized intake protocols.© Copyright 2013 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care interpersonal communication patient referral patient safety EMTREE MEDICAL INDEX TERMS article asthma bronchiolitis child child safety cohort analysis controlled study critical illness croup Delphi study emergency ward human infant major clinical study pneumonia predictive value preschool child EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013250406 MEDLINE PMID 23528500 (http://www.ncbi.nlm.nih.gov/pubmed/23528500) PUI L52509560 DOI 10.1097/PEC.0b013e318289d7c1 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0b013e318289d7c1 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 416 TITLE Interhospital transport with extracorporeal life support: Results and perspectives after 5 years experience ORIGINAL (NON-ENGLISH) TITLE Transport interhospitalier sous extracorporeal life support : Résultats et perspectives après cinq ans d'expérience AUTHOR NAMES Desebbe O. Rosamel P. Henaine R. Vergnat M. Farhat F. Dubien P.Y. Bastien O. AUTHOR ADDRESSES (Desebbe O.; Rosamel P., prosamel@aol.com; Bastien O.) Service d'anesthésie-réanimation, Hôpital cardiovasculaire et pneumologique Louis-Pradel, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron cedex, France. (Desebbe O.; Bastien O.) Laboratoire EA4169, Université Claude-Bernard Lyon 1, 69003 Lyon, France. (Henaine R.; Vergnat M.; Farhat F.) Service de chirurgie cardiaque, Hôpital cardiovasculaire et pneumologique Louis-Pradel, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron cedex, France. (Dubien P.Y.) Samu de Lyon, Hôpital édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France. CORRESPONDENCE ADDRESS P. Rosamel, Service d'anesthésie-réanimation, Hôpital cardiovasculaire et pneumologique Louis-Pradel, Hospices civils de Lyon, 28, avenue du Doyen-Lépine, 69677 Bron cedex, France. Email: prosamel@aol.com SOURCE Annales Francaises d'Anesthesie et de Reanimation (2013) 32:4 (225-230). Date of Publication: April 2013 ISSN 0750-7658 1769-6623 (electronic) BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT Objective: Describing the experience of a referral center for interhospital patients transport treated with extracorporeal circulatory or respiratory support (ECLS), the difficulties encountered and the results obtained. Study design: Retrospective and observational study. Patients and methods: All patients with respiratory or circulatory failure accepted for extracorporeal assistance for which routine medical transport was life threatening. Statistical analysis: A descriptive analysis was performed (median and interquartile deviation). Comparison of biological data was performed using a non-parametric Wilcoxon test and 5 years overall survival was determined by a Kaplan-Meier analysis. Results: Over a 55-month period, 29 patients were selected for transportation under ECMO or ECLS. Indication was respiratory failure in 38 % of cases, hemodynamic instability in 52 % of cases and combined symptoms in 10 % of cases. Average duration of transportation was 40. km (9-64. km). No complication related to transport was observed. Incidence of intrahospital death was 57 %. There was no correlation between death and indication of ECLS. Five-year survival was 55 % and 39 % for venovenous and arteriovenous ECLS, respectively. Conclusion: In our experience, interhospital transport of patients under ECMO is feasible in satisfactory conditions of safety with trained team and standard procedures. © 2013 Société française d'anesthésie et de réanimation (Sfar). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extracorporeal circulation extracorporeal life support patient transport EMTREE MEDICAL INDEX TERMS article death extracorporeal oxygenation health care quality hemodynamics human ischemia (therapy) observational study overall survival patient safety respiratory failure (therapy) retrospective study survival time treatment indication EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 2013252956 MEDLINE PMID 23499393 (http://www.ncbi.nlm.nih.gov/pubmed/23499393) PUI L52489090 DOI 10.1016/j.annfar.2013.02.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.annfar.2013.02.006 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 417 TITLE Safety standards for intrahospital transfer of critical care patients AUTHOR NAMES Ashton-Cleary D. AUTHOR ADDRESSES (Ashton-Cleary D.) Royal Cornwall Hospital, Truro, United Kingdom. CORRESPONDENCE ADDRESS D. Ashton-Cleary, Royal Cornwall Hospital, Truro, United Kingdom. SOURCE Critical Care (2013) 17 SUPPL. 2 (S108). Date of Publication: 19 Mar 2013 CONFERENCE NAME 33rd International Symposium on Intensive Care and Emergency Medicine CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2013-03-19 to 2013-03-22 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction The aim was to assess care of patients during intrahospital transfer. The UK Royal College of Anaesthetists has defined auditable standards for the care of patients and the training of escorting medical and nursing staf in this context [1]. Methods Patients in a 27-bed combined general and neurosurgical critical care unit were studied in January 2011 and May 2012. Patients undergoing radiology department imaging or intervention were identif ed from the electronic imaging library. Records of these transfers were sought in the critical care electronic notes and the standards of documentation graded on a f ve-point scale (very good, good, average, minimal, absent). Documentation of the grade and training of escorting staf was also sought. Between the two study periods, a transfer safety checklist was introduced. Results A total of 20.9% of 143 patients underwent one or more transfers in January 2011 (40 transfers). In May 2012, 26.4% of 151 patients underwent 57 transfers. In the first period, documentation was graded as minimal (limited to a statement that the patient had left the critical care unit) or absent in 77.5% of transfers. In the 62.5% of patients transferred whilst on invasive ventilation, 88.0% had no documentation by the doctor and in 84.0% it was not known which doctor had escorted the patient. There was only slight improvement in the second period (71.9% minimal or absent documentation, 80.0% no documentation by the doctor, 72.0% not known which doctor escorted). In the documentation available, six severe complications were noted during the second period (including episodes of severe bradycardia, hypotension and pupil dilatation). Conclusion On average our unit conducts nearly two critical care transfers each day. Severe complications seem to complicate at least 10% of these, stressing the risk, need for good care and ongoing training. The intervention made in this audit had little impact on the standard of documentation. However, it has raised the issue within the consciousness of the staf . It is important to identify interventions that have failed to reach a gold standard to provide the impetus to seek other solutions. As a result of this study, the author has devised new hospital protocols and specif c training courses to improve standards of transfer medicine locally. The study also identif ed our portable head CT scanner to have the potential to reduce transfers by 52% and so this has been strongly promoted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine human intensive care patient patient transport safety EMTREE MEDICAL INDEX TERMS air conditioning anesthesist bradycardia checklist clinical audit college computed tomography scanner consciousness documentation gold standard hospital hypotension imaging library mydriasis nursing physician radiology department risk training United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71030581 DOI 10.1186/cc12222 FULL TEXT LINK http://dx.doi.org/10.1186/cc12222 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 418 TITLE Activity and case-mix changes in a medical ICU after the geographical transfer of a third-level university hospital AUTHOR NAMES Cebrián J.C. Monsalve F.M. Bonastre J.B. AUTHOR ADDRESSES (Cebrián J.C.; Monsalve F.M.; Bonastre J.B.) Hospital Universitario, Politecnico la Fe, Valencia, Spain. CORRESPONDENCE ADDRESS J.C. Cebrián, Hospital Universitario, Politecnico la Fe, Valencia, Spain. SOURCE Critical Care (2013) 17 SUPPL. 2 (S186-S187). Date of Publication: 19 Mar 2013 CONFERENCE NAME 33rd International Symposium on Intensive Care and Emergency Medicine CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2013-03-19 to 2013-03-22 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction Information about big hospital geographical transfer is scarce in the medical literature. On 20 February 2011 our hospital (in fact, a big university complex) was transferred from their previous location in the north-center of our city towards a new southern peripheral, geographical location. This transfer has been done without any changes in assisted population or nursing/medical staf . The only change was a slight increase in bed number (21 to 24). Our aim is to analyze changes in activity indexes (length of stay, occupancy rate, and so forth) and case mix (origin, previous quality of life and NYHA score, main diagnostic groups, severity scores, in-ICU and in-hospital mortality). Methods To compare our number of admissions, related activity and case-mix indicators 1 year before and after the geographical change was done. We analyzed our whole number of patients admitted to the ICU. We used the chi-square test for categorical variables and one-way analysis of variance for quantitative data. Minitab and Statbas statistical programs were used. We plotted activity data using the Barber-Johnson 1 diagram. Results A total of 2,774 cases (63% males; mean age 61 years) were admitted to our ICU during the period (1 year before and after the transfer). No differences between both groups were founded in demographic data, Knaus score and NYHA status. Regarding their origin, we found more patients admitted from other hospital centers (20 vs. 29%; P <0.001). APACHE II score increased from 17.24 to 19.08% (P <0.001) and a slight increase change in SAPS 3 score was also found (52.29 to 53.75; P <0.01). Our in-ICU mortality remains lower (15.5 to 15.6%) whereas observed mortality decreased (22.37 to 19.88%; P <0.001). An increase in our neurologic patients has been the most consistent change regarding diagnostic groups. The activity indexes show a slightly decrease in occupancy rate (79.2 vs. 76.8). Conclusion According to the previous data our ICU seems to perform better in the new location with a decrease in the standardized mortality rate. On the other hand, we are admitting more patients transferred from other hospitals. A better occupancy rate was found. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) case mix emergency medicine intensive care university hospital EMTREE MEDICAL INDEX TERMS analysis of variance APACHE chi square test city diagnosis related group hairdresser hospital human length of stay male medical literature mortality New York Heart Association class patient population quality of life Simplified Acute Physiology Score university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71030798 DOI 10.1186/cc12443 FULL TEXT LINK http://dx.doi.org/10.1186/cc12443 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 419 TITLE Improving maintenance of critical care land and aeromedical transfer equipment AUTHOR NAMES Ashton-Cleary D. Boyd N. AUTHOR ADDRESSES (Ashton-Cleary D.; Boyd N.) Royal Cornwall Hospital, Truro, United Kingdom. CORRESPONDENCE ADDRESS D. Ashton-Cleary, Royal Cornwall Hospital, Truro, United Kingdom. SOURCE Critical Care (2013) 17 SUPPL. 2 (S107-S108). Date of Publication: 19 Mar 2013 CONFERENCE NAME 33rd International Symposium on Intensive Care and Emergency Medicine CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2013-03-19 to 2013-03-22 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction The aim was to assess the content and state of repair of equipment carried for transfer of critical care patients to other hospitals. By chance, several items of date-expired stock were identif ed in the Data presented as n (%). transfer kit whilst moving a patient to a tertiary centre. This raised the possibility of a more extensive problem with the equipment bags. Due to the geographical location of our district general hospital we undertake around 70 transfers of critical care patients to other hospitals per year (16% by air) and it is clearly important that our equipment is well maintained for these journeys. Methods We maintain two identical sets of equipment (syringes, fluid, airway management items, and so forth) and drug bags to take on transfers; one equipment and one drug bag taken on each trip. The contents of all four bags were checked and itemised. By careful consideration of the aims of the bags (to provide emergency equipment and drugs for managing one patient during an en-route emergency) a new inventory was devised. Excess items were removed to lighten the bags and improve accessibility to the essential items. Expired stock was removed. A daily checking procedure and tamper-proof seals on the bags were instigated and the bags were reassessed 12 months later. Results A total of 13.9% of drug items and 29.2% of equipment items had expired or would do so within 30 days of the initial assessment. The combined weight of one equipment and one drug bag was reduced from 14 to 9 kg (36% reduction) by introducing the new inventory. At reassessment in November 2012, only 10 items of equipment (3.2%) were expired or near to expiry and there were no expired drug items (4.1% near to expiry). In total, 0.3 kg (26 small items) of extraneous equipment had been added through over-restocking and was removed. Conclusion These bags are designed for a clinician to manage a patient when an emergency arises during transfer of a critical care patient. By the introduction of simple measures, the risks posed by expired items or cluttered equipment bags have almost been eradicated. Signif cant weight savings have been made; this of ers improved ergonomics for staf and is also an important consideration for aeromedical operations. Our department was surprised to discover the extent of decline of our equipment and it may be that other departments would f nd themselves in a similar position. The anaesthetic registrars who routinely escort the transfer patients have a vested interest to maintain this equipment and this has secured their buy-in to the new checking procedure with clear results. EMTREE DRUG INDEX TERMS anesthetic agent prednicarbate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine intensive care EMTREE MEDICAL INDEX TERMS emergency ergonomics general hospital hospital human liquid patient procedures respiration control risk syringe weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71030580 DOI 10.1186/cc12221 FULL TEXT LINK http://dx.doi.org/10.1186/cc12221 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 420 TITLE The Impact of postintubation chest radiograph during pediatric and neonatal critical care transport AUTHOR NAMES Sanchez-Pinto N. Giuliano J.S. Schwartz H.P. Garrett L. Gothard M.D. Kantak A. Bigham M.T. AUTHOR ADDRESSES (Sanchez-Pinto N.; Giuliano J.S.; Schwartz H.P.; Garrett L.; Gothard M.D.; Kantak A.; Bigham M.T.) CORRESPONDENCE ADDRESS N. Sanchez-Pinto, SOURCE Pediatric Critical Care Medicine (2013). Date of Publication: 2013 ISSN 1529-7535 BOOK PUBLISHER The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies ABSTRACT OBJECTIVES: Tracheal intubation is necessary in the setting of pediatric/neonatal critical care transport but information regarding usefulness and efficiency of a confirmatory postintubation chest radiograph is limited. We hypothesize that routine postintubation chest radiograph to confirm tracheal tube position is not informative and can be eliminated to improve efficiency without compromising safety in transport. DESIGN: This was a prospective observational study. The primary study outcome was the rate of tracheal tube repositioning after postintubation chest radiograph and the secondary outcome was the on-scene time. Additional data obtained included the initial accuracy of tracheal tube depth based on Pediatric Advanced Life Support and Neonatal Resuscitation Program guidelines. SETTING: A children's hospital-based pediatric/neonatal critical care transport team in northeastern Ohio. PATIENTS: All pediatric/neonatal patients intubated by the transport team during the 18-month study period (January 2009-July 2010). MEASUREMENTS AND MAIN RESULTS: There were 77 patients enrolled (43 pediatric, 34 neonatal). A postintubation chest radiograph was obtained 85.7% of the time and showed tracheal tube malposition in 47% of cases. No difference was seen in the rate of malpositioned tracheal tubes in the neonatal group compared with pediatric group (51.7% vs. 43.2%, p = 0.54). The calculated tracheal tube depth based on the Neonatal Resuscitation Program and Pediatric Advanced Life Support guidelines was correct in 50% of the neonates and 41.9% of the pediatric patients. In patients with appropriate initial tracheal tube depth by calculations, the tracheal tube was repositioned at similar rates after postintubation chest radiograph in both neonatal and pediatric patients (50% vs. 41.9%, p = 0.48). When comparing mean onscene times for patients with/without a postintubation chest radiograph, the neonatal patients saved 33 mins on average when no chest radiograph was obtained (mean ± SD: 60.6 ± 35.8 min vs. 93.8 ± 23.8 min, p = 0.01). There was no statistical difference in on-scene time for pediatric patients whether they did or did not receive a postintubation chest radiograph. CONCLUSIONS: Although postintubation chest radiographs may extend the overall on-scene transport times in select patients, our data show that the postintubation chest radiographs remain informative in pediatric/neonatal critical care specialty transport and should be obtained when feasible. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care thorax radiography EMTREE MEDICAL INDEX TERMS endotracheal intubation endotracheal tube human newborn observational study patient pediatric advanced life support pediatric hospital resuscitation safety United States LANGUAGE OF ARTICLE English MEDLINE PMID 23439465 (http://www.ncbi.nlm.nih.gov/pubmed/23439465) PUI L52459431 DOI 10.1097/PCC.0b013e3182772e13 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182772e13 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 421 TITLE A delicate handoff: Improving transfer of care from the neurologic intensive care unit (ICU) to non-ICU neurologic hospital services AUTHOR NAMES Morparia N. Coon E. Fabris R. Klaas J. Burkholder D. Broomall E. Graff-Radford J. Moore S. Morita H. Rubin M. Britton J. AUTHOR ADDRESSES (Morparia N.; Coon E.; Fabris R.; Klaas J.; Burkholder D.; Broomall E.; Graff-Radford J.; Moore S.; Morita H.; Rubin M.; Britton J.) Mayo Clinic Rochester, Rochester, United States. CORRESPONDENCE ADDRESS N. Morparia, Mayo Clinic Rochester, Rochester, United States. SOURCE Neurology (2013) 80:1 MeetingAbstracts. Date of Publication: 12 Feb 2013 CONFERENCE NAME 65th American Academy of Neurology Annual Meeting CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2013-03-16 to 2013-03-23 ISSN 0028-3878 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT OBJECTIVE: To implement a standardized documentation template for physician use during transfer from the neurosciences intensive care unit (ICU) to non-ICU neurology hospital services. BACKGROUND: Transfer of neurologic patients from an ICU to hospital services is a complex process leading to discontinuity in care with potential for errors. DESIGN/METHODS: A survey methodology was used to identify problem areas in the Neurosciences ICU to non-ICU transfer process. A standardized documentation template was developed with sections addressing medication reconciliation, urinary catheter use, vital sign parameters, rehabilitation consultation and outstanding test results. Physicians during the three-month intervention period were trained to incorporate elements of the template into the transfer note. Physician satisfaction regarding the transfer process was assessed before and after intervention. RESULTS: The survey response rate was 37.5% pre-intervention and 19% post-intervention. The compliance rate of the standardized transfer template was 93%. Overall, satisfaction with the transfer process by accepting physicians was unchanged in the post-intervention period (p=0.34). There was a significant decline in the average number of patient transfers with urinary catheter (1.74 to 0.79; p=0.04), but not in the number of times that medications had not been reconciled (1.84 to 1.26; p=0.20). The majority of accepting physicians felt that the transfer template made documentation easier to complete (74%) and saved time for the physician in the transfer process (95%). Of accepting physicians, 84% felt that the template should continue, with the most useful aspects being medication reconciliation and reducing urinary catheter use. Of transferring physicians, 88% felt that the template reminded them to address an issue prior to patient transfer. CONCLUSIONS: The implementation of standardized documentation for the transfer of neurologic patients from the ICU to the non-ICU hospital services was beneficial to both transferring and accepting physicians, and decreased the number of patients transferred with urinary catheters, potentially preventing infections. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital service intensive care unit neurology EMTREE MEDICAL INDEX TERMS compliance (physical) consultation documentation drug therapy human infection medication therapy management methodology parameters patient patient transport physician rehabilitation satisfaction urinary catheter vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71130920 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 422 TITLE Safety of patients transferred from the operating room to the intensive care unit AUTHOR NAMES Kaplow R. AUTHOR ADDRESSES (Kaplow R., roberta.kaplow@emoryhealthcare.org) Emory University Hospital, Atlanta, GA, United States. CORRESPONDENCE ADDRESS R. Kaplow, Emory University Hospital, Atlanta, GA, United States. Email: roberta.kaplow@emoryhealthcare.org SOURCE Critical Care Nurse (2013) 33:1 (68-70). Date of Publication: February 2013 ISSN 0279-5442 1940-8250 (electronic) BOOK PUBLISHER American Association of Critical Care Nurses, 101 Columbia, Suite 100, Aliso Viejo, United States. ABSTRACT On the basis of the physician's preference or the intraoperative course, patients may be admitted directly from the operating room to the intensive care unit (ICU). Therefore, ICU nurses must be familiar with standards of care for patients in the immediate postoperative period, anesthetic agents, and management of potential complications. By focusing on the following aspects of postanesthesia care, patient safety and optimal outcomes can be achieved. © 2013 American Association of Critical-Care Nurses. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit operating room patient transport EMTREE MEDICAL INDEX TERMS article methodology safety LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23377159 (http://www.ncbi.nlm.nih.gov/pubmed/23377159) PUI L368290405 DOI 10.4037/ccn2013866 FULL TEXT LINK http://dx.doi.org/10.4037/ccn2013866 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 423 TITLE Patient transfer check off decreases fall rate on stroke unit AUTHOR NAMES Ashcraft S. Coon L. Bussey C. Cargal J. Allred A. AUTHOR ADDRESSES (Ashcraft S.; Coon L.; Bussey C.; Cargal J.; Allred A.) Cone Health, Greensboro, United States. CORRESPONDENCE ADDRESS S. Ashcraft, Cone Health, Greensboro, United States. SOURCE Stroke (2013) 44:2 MeetingAbstract. Date of Publication: February 2013 CONFERENCE NAME 2013 International Stroke Conference and Nursing Symposium of the American Heart Association/American Stroke Association CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2013-02-06 to 2013-02-08 ISSN 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and Issues: Protecting stroke patients from falls and injury is fundamental to providing exceptional care. An increased risk for falls has been recognized among persons with diagnoses of stroke and other neurological disorders. Our Stroke Unit's comprehensive fall prevention program, while helpful, did not adequately identify stroke patients who would fall. While instituting video monitoring of patients at high risk for falls provided a 20% reduction in fall rate, stroke patients evaluated at low and moderate risk continued to fall. Purpose: The purpose of our practice change was to determine if implementing high risk measures on all patients admitted to a stroke unit until demonstration of five safe transfers would decrease the number of patient falls. Methods: Utilizing a shared responsibility model, our Stroke Unit engaged all staff members in the falls prevention program. Each patient was evaluated using the current falls risk assessment tool. If the patient was scored high risk, full falls prevention measures were maintained. For patients scoring low to moderate risk, a safe patient transfer check off procedure was implemented. Each patient was monitored five times to ensure independent demonstration of all aspects of transfer without support. Upon five safe transfers, the patient's bed alarm could be shut off and general fall preventative measures maintained. Unit secretaries checked the bed alarm system twice a day to monitor proper activation of alarms. A report was created representing the retrieved information for the charge nurse. The charge nurse followed up with nurses whose patient alarms were not on and ensured proper activation. Results: Since implementation of the safe patient transfer check off, we have seen an additional 33% reduction in fall rate compared to our post-implementation of video monitoring rate (3.48/1000 patient days compared to 5.20/1000 patient days). There were zero falls for patients who were successfully checked off on safe transfers. Conclusion: Implementing a safe transfer check off for mild to moderate fall risk patients on a Stroke Unit may be a successful strategy to prevent falls and fall related injuries. Engaging all staff members in the program increased awareness of the importance of falls prevention. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular accident heart human nursing patient transport stroke unit EMTREE MEDICAL INDEX TERMS charge nurse diagnosis fall risk injury model monitoring neurologic disease nurse patient prevention procedures responsibility risk risk assessment stroke patient videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71144160 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 424 TITLE Management of criticallyill cirrhotic patients: Transfer in intensive care unit or stop of care? ORIGINAL (NON-ENGLISH) TITLE Prise en charge du patient cirrhotique grave : Transfert en réanimation ou limitation des soins ? AUTHOR NAMES Colin M. Langlois J. Kipnis E. Lebuffe G. Mathurin P. Dharancy S. AUTHOR ADDRESSES (Colin M., marie.colin@chru-lille.fr; Mathurin P.; Dharancy S.) CHRU Lille, Ȟopital Claude Huriez, Maladies de l'appareil digestif et de la nutrition, 59037 Lille Cedex, France. (Langlois J.; Kipnis E.; Lebuffe G.) CHRU Lille, Ȟopital Claude Huriez, P̌ole médico-chirurgical Huriez, Lille, France. CORRESPONDENCE ADDRESS M. Colin, CHRU Lille, Ȟopital Claude Huriez, Maladies de l'appareil digestif et de la nutrition, 59037 Lille Cedex, France. Email: marie.colin@chru-lille.fr SOURCE Hepato-Gastro (2013) 20:2 (133-140). Date of Publication: February 2013 ISSN 1253-7020 1952-4048 (electronic) BOOK PUBLISHER John Libbey Eurotext, 127, avenue de la Republique, Montrouge, France. ABSTRACT Cirrhosis is an independent prognostic factor formortality in Intensive Care Unit (ICU). The improvedmanagement of acute complications of cirrhosis and a 'fast tracking' access to liver transplantation are the keystones of reflection in the setting of invasive acute care. ICU admission is amultiparametric decision taking into account patient related factors, type of complications, intensive care scores and the existence of a therapeutical project. The decision between active resuscitation or withholding and withdrawal of life-sustaining treatment in critically-ill cirrhotic patient is difficult to make. In fact, the occurrence of a complication in these patients is often a turning point in the natural history and often leads to multi-organ failure. These procedures of withholding and withdrawal of life-sustaining treatment regulated by law have been developed to address these difficult ethical questions. The hepato-gastroenterologist plays a central role in this multidisciplinary reflection. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit liver cirrhosis patient care EMTREE MEDICAL INDEX TERMS critically ill patient decision making human liver transplantation multiple organ failure resuscitation review treatment withdrawal EMBASE CLASSIFICATIONS Gastroenterology (48) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2013239502 PUI L368729619 DOI 10.1684/hpg.2013.0839 FULL TEXT LINK http://dx.doi.org/10.1684/hpg.2013.0839 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 425 TITLE Management of Critically-Ill cirrhotic patients: Transfer in intensive care unit or stop of care? ORIGINAL (NON-ENGLISH) TITLE Prise en charge du patient cirrhotique grave: Transfert en réanimation ou limitation des soins? AUTHOR NAMES Colin M. Langlois J. Kipnis E. Lebuffe G. Mathurin P. Dharancy S. AUTHOR ADDRESSES (Colin M., marie.colin@chru-lille.fr; Mathurin P.; Dharancy S.) CHRU Lille, Hopital Claude Huriez, Maladies de l'Appareil Digestif et de La Nutrition, Lille Cedex, France. (Langlois J.; Kipnis E.; Lebuffe G.) CHRU Lille, Hôpital Claude Huriez, Pôle Médico-Chirurgical Huriez, Service de Réanimation Chirurgicale, Lille, France. (Lebuffe G.) CHRU Lille, Hopital Claude Huriez, Pôle Médico-Chirurgical Huriez, Service d'Anesthésie et Transplantation Hépatique, Lille, France. SOURCE Hepato-Gastro et Oncologie Digestive (2013) 20:2 (133-140). Date of Publication: 1 Feb 2013 ISSN 2115-5631 (electronic) 2115-3310 BOOK PUBLISHER John Libbey Eurotext, 127, avenue de la Republique, Montrouge, France. contact@jle.com ABSTRACT Cirrhosis is an independent prognostic factor for mortality in Intensive Care Unit (ICU). The improved management of acute complications of cirrhosis and a "fast tracking" access to liver transplantation are the keystones of reflection in the setting of invasive acute care. ICU admission is a multiparametric decision taking into account patient related factors, type of complications, intensive care scores and the existence of a therapeutical project. The decision between active resuscitation or withholding and withdrawal of life-sustaining treatment in critically-ill cirrhotic patient is difficult to make. In fact, the occurrence of a complication in these patients is often a turning point in the natural history and often leads to multi-organ failure. These procedures of withholding and withdrawal of life-sustaining treatment regulated by law have been developed to address these difficult ethical questions. The hepato-gastroenterologist plays a central role in this multidisciplinary reflection. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient intensive care unit liver cirrhosis treatment withdrawal EMTREE MEDICAL INDEX TERMS human life sustaining treatment liver transplantation multiple organ failure resuscitation review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Gastroenterology (48) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 20160901331 PUI L613607900 DOI 10.1684/hpg.2013.0839 FULL TEXT LINK http://dx.doi.org/10.1684/hpg.2013.0839 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 426 TITLE Protracted outbreak of multidrug-resistant acinetobacter baumannii after intercontinental transfer of colonized patients AUTHOR NAMES Landelle C. Legrand P. Lesprit P. Cizeau F. Ducellier D. Gouot C. Bréhaut P. Soing-Altrach S. Girou E. Brun-Buisson C. AUTHOR ADDRESSES (Landelle C., caroline.landelle@gmail.com; Lesprit P.; Cizeau F.; Ducellier D.; Gouot C.; Bréhaut P.; Soing-Altrach S.; Girou E.; Brun-Buisson C.) Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Centre Hospitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hopitaux de Paris, Université Paris 12, Créteil, France. (Legrand P.) Service de Bactériologie-Virologie-Hygiène, Centre Hôspitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris 12, Créteil, France. (Brun-Buisson C.) Service de Réanimation Médicale, Centre Hôspitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hopitaux de Paris, Universite Paris 12, Créteil, France. CORRESPONDENCE ADDRESS C. Landelle, Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Centre Hospitalier Universitaire Albert Chenevier-Henri Mondor, Assistance Publique-Hopitaux de Paris, Université Paris 12, Créteil, France. Email: caroline.landelle@gmail.com SOURCE Infection Control and Hospital Epidemiology (2013) 34:2 (119-124). Date of Publication: February 2013 ISSN 0899-823X BOOK PUBLISHER University of Chicago Press, 1427 E. 60th Street, Chicago, United States. ABSTRACT objective. To describe the course and management of a protracted outbreak after intercontinental transfer of 2 patients colonized with multidrug-resistant Acinetobacter baumannii (MDRAB). design. An 18-month outbreak investigation. setting. An 860-bed university hospital in France. patients. Case patients (ie, carriers) were those colonized or infected with an MDRAB isolate. methods. During the epidemic period, all intensive care unit (ICU) patients and contacts of carriers who were transferred to wards were screened for MDRAB carriage. Contact precautions, environmental screening, and auditing of healthcare worker (HCW) practices were implemented; rooms were cleaned with hydrogen peroxide mist disinfection. One ICU, in which most of the cases occurred, was closed on 4 occasions for thorough cleaning and disinfection. results. The 2 index case patients were identified as 2 patients who carried the same MDRAB strain and who were admitted to the hospital after repatriation from Tahiti 5 months apart. During an 18-month period, a total of 84 secondary cases occurred. Reintroduction of MDRAB into the ICUs occurred from patients previously colonized or from healthcare personnel. Termination of the outbreak was only achieved when all carriers from wards or the ICU were cohorted to an isolation unit with dedicated healthcare personnel. conclusions. Intercontinental transfer of carriers of MDRAB can result in extensive outbreaks and serious disruption of the hospital's organization. Transmission from carriers most likely occurred via the hands of HCWs, poor cleaning protocols, airborne spread, and contaminated water from sink traps. This protracted outbreak was controlled only after implementation of an extensive control program and eventual cohorting of all carriers in an isolation unit with dedicated healthcare personnel. © 2012 by The Society for Healthcare Epidemiology of America. All rights reserved. EMTREE DRUG INDEX TERMS aminoglycoside cephalosporin ciprofloxacin colistin hydrogen peroxide imipenem penicillin derivative rifampicin sultamicillin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter infection (epidemiology) multidrug resistance patient transport EMTREE MEDICAL INDEX TERMS article cleaning disease surveillance disinfection health care personnel health program human infection control intensive care unit major clinical study mass screening CAS REGISTRY NUMBERS cephalosporin (11111-12-9) ciprofloxacin (85721-33-1) colistin (1066-17-7, 1264-72-8) hydrogen peroxide (7722-84-1) imipenem (64221-86-9) rifampicin (13292-46-1) sultamicillin (76497-13-7) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013030384 MEDLINE PMID 23295556 (http://www.ncbi.nlm.nih.gov/pubmed/23295556) PUI L368093571 DOI 10.1086/669093 FULL TEXT LINK http://dx.doi.org/10.1086/669093 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 427 TITLE Reasons for repeat imaging in the pediatric emergency department (ED) and the impact of a state wide trauma image repository system AUTHOR NAMES Thompson T.M. Lovvorn J. Lynch A. Hunter E. AUTHOR ADDRESSES (Thompson T.M.; Lovvorn J.; Lynch A.) Univ of Arkansas for Medical Sciences, Little Rock, United States. (Hunter E.) Children's Mercy, Kansas City, United States. CORRESPONDENCE ADDRESS T.M. Thompson, Univ of Arkansas for Medical Sciences, Little Rock, United States. SOURCE Journal of Investigative Medicine (2013) 61:2 (454). Date of Publication: February 2013 CONFERENCE NAME American Federation for Medical Research Southern Regional Meeting, AFMR 2013 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2013-02-21 to 2013-02-23 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: Many patients transferred from outside facilities have the same radiographic studies repeated in the ED for a variety of reasons. This practice exposes patients to addition radiation which can have harmful effects on and increase costs to the patient. Previously we determined the reasons for repeat radiographic imaging in our ED.With the advent of a state wide Trauma Image Repository (TIR) in 2012, which can send high quality images ahead of the patient to the receiving hospital, we are evaluating whether the types and reasons for repeat imaging in our ED has changed. Methods Used: A prospective study was designed to identify patients who require repeat radiographic imaging upon arrival to the ED of a tertiary pediatric hospital, commencing in January 2011 and currently ongoing. Upon arrival, an evaluation sheet was filled out by ED staff to identify the type of study and the reason it was obtained. The results were analyzed using SSPS and reported in aggregate. Summary of Results: To date, 139 subjects were identified in the pre TIR study period; approximately 45% were identified as trauma patients. 70.3% of these patients had repeat plain films, 16.7% had a repeated CT scan, and 7.2% had both a repeated CT scan and plain films. The most common reasons cited for repeat imaging were poor quality film/inadequate views (43%), no films sent with patient at time of transfer (20%), and inability to open the film disk that was sent (12%). Only 18% of repeat images were clinically indicated due to a patient status change that warranted further evaluation. Data collection in the post TIR period is currently ongoing but preliminary data analysis indicates an approximate 8% decrease in repeat trauma imaging studies. Conclusions: Repeat imaging for intra-hospital transfer to a tertiary facility is sometimes unavoidable. However, in our institution, clinical indication was not the primary reason for repeat studies. This practice incurs both a monitory cost and additional radiation exposure to the patient. The use of a state wide TIR, which can send images to the receiving facility may be one way to decrease radiation exposure and costs to the patient. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward imaging injury medical research EMTREE MEDICAL INDEX TERMS computer assisted tomography data analysis hospital human information processing patient pediatric hospital prospective study radiation radiation exposure Tertiary (period) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70993220 DOI 10.231/JIM.0b013e3182820c55 FULL TEXT LINK http://dx.doi.org/10.231/JIM.0b013e3182820c55 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 428 TITLE Transfer out of intensive care: an evidence-based literature review. AUTHOR NAMES Cypress B.S. AUTHOR ADDRESSES (Cypress B.S., brigitte.cypress@lehman.cuny.edu) Lehman College and The Graduate Center, City University of New York, NY, USA. CORRESPONDENCE ADDRESS B.S. Cypress, Email: brigitte.cypress@lehman.cuny.edu SOURCE Dimensions of critical care nursing : DCCN (2013) 32:5 (244-261). Date of Publication: 2013 Sep-Oct ISSN 1538-8646 (electronic) ABSTRACT Critical care beds are a finite resource. Transfer or discharge of patients from the intensive care unit affects the flow of patients in critical care. Effective whole hospital bed management is key to the successful management of the critical care service. However, admission to the critical care unit alone can be extremely frightening, distressing, and traumatic not only for the patients but their families as well. Although transfer to the medical floors is a positive step toward physical recovery, it can be equally traumatic, and many patients and their families exhibit stress, fear, and anxiety. The purpose of this article was to systematically review the effects of intensive care unit transfer or discharge to medical-surgical floors on adult critically ill patients, their family members and nurses. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness hospital discharge intensive care unit patient transport EMTREE MEDICAL INDEX TERMS anxiety (etiology) evidence based nursing family human mental stress (etiology) psychological aspect review LANGUAGE OF ARTICLE English MEDLINE PMID 23933644 (http://www.ncbi.nlm.nih.gov/pubmed/23933644) PUI L563078956 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 429 TITLE A blueprint for critical care transport research AUTHOR NAMES Jaynes C.L. Werman H.A. White L.J. AUTHOR ADDRESSES (Jaynes C.L., cathy.jaynes@tcmtr.org; Werman H.A.) Center for Medical Transport Research, 2827 W. Dublin-Granville Road, Columbus, OH 43235-2712, United States. (Werman H.A.; White L.J.) Ohio State University, Columbus, OH, United States. CORRESPONDENCE ADDRESS C.L. Jaynes, Center for Medical Transport Research, 2827 W. Dublin-Granville Road, Columbus, OH 43235-2712, United States. Email: cathy.jaynes@tcmtr.org SOURCE Air Medical Journal (2013) 32:1 (30-35). Date of Publication: January-February 2013 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Introduction: An estimated 500,000 critical care patient transports occur annually in the United States. Little research exists to inform optimal practices, promote safety, or encourage responsible, cost-effective use of this resource. Previous efforts to develop a research agenda have not yielded significant progress in producing much-needed scientific study. Purpose: Identify and characterize areas of research needed to direct the development of evidence-based guidelines Methods: The study used a modified Delphi technique to develop a concept map of the research domains in critical care transport. Proprietary, internet-based software was used for both data collection and analysis. The study was conducted in 3 phases: brainstorming, categorizing, and prioritizing, using experts from all aspects of critical care transport. Results: A total of 101 research questions were developed and ranked by 27 participants representing the transport community and stakeholders. An 8-cluster solution was developed with multidimensional scaling and hierarchical cluster analysis to identify the following research areas: clinical care, education/training, finance, human factors, patient outcomes, safety, team configuration, and utilization. A plot characterized each domain by urgency and feasibility. Conclusion: The content and concepts represented by the cluster map can help direct research planning in the critical care transport industry and prioritize funding decisions. © 2013 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article evidence based medicine health care utilization human outcome assessment patient safety practice guideline priority journal research priority software EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013001041 MEDLINE PMID 23273307 (http://www.ncbi.nlm.nih.gov/pubmed/23273307) PUI L368005500 DOI 10.1016/j.amj.2012.11.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.11.001 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 430 TITLE Pediatric and neonatal interfacility transport: Results from a national consensus conference AUTHOR NAMES Stroud M.H. Trautman M.S. Meyer K. Moss M.M. Schwartz H.P. Bigham M.T. Tsarouhas N. Douglas W.P. Romito J. Hauft S. Meyer M.T. Insoft R. AUTHOR ADDRESSES (Stroud M.H., stroudmichaelh@uams.edu; Moss M.M.) Department of Pediatrics, Section of Critical Care Medicine, University of Arkansas for Medical Sciences, United States. (Trautman M.S.) Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Indian University School of Medicine, United States. (Trautman M.S.; Meyer K.; Moss M.M.; Schwartz H.P.; Bigham M.T.; Tsarouhas N.; Douglas W.P.; Romito J.; Hauft S.; Meyer M.T.; Insoft R.) American Academy of Pediatrics, Section on Transport Medicine, United States. (Meyer K.) Department of Pediatrics, Miami Children's Hospital, United States. (Schwartz H.P.) Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. (Bigham M.T.) Department of Pediatrics, Section of Critical Care Medicine, Akron Children's Hospital, Akron, OH, United States. (Tsarouhas N.) Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. (Douglas W.P.) Maryland Regional Neonatal Transport Program, Baltimore, MD, United States. (Hauft S.) Department of Pediatrics, Washington University, School of Medicine, United States. (Meyer M.T.) Department of Pediatrics, Section of Critical Care Medicine, Medical College of Wisconsin, United States. (Insoft R.) Department of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, United States. (Stroud M.H., stroudmichaelh@uams.edu) 1 Children's Way, Little Rock, AR 72202, United States. CORRESPONDENCE ADDRESS M.H. Stroud, 1 Children's Way, Little Rock, AR 72202, United States. Email: stroudmichaelh@uams.edu SOURCE Pediatrics (2013) 132:2 (359-366). Date of Publication: August 2013 ISSN 1098-4275 (electronic) 0031-4005 BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT The practice of pediatric/neonatal interfacility transport continues to expand. Transport teams have evolved into mobile ICUs capable of delivering state-of-the-art critical care during pediatric and neonatal transport. The most recent document regarding the practice of pediatric/neonatal transport is more than a decade old. The following article details changes in the practice of interfacility transport over the past decade and expresses the consensus views of leaders in the field of transport medicine, including the American Academy of Pediatrics' Section on Transport Medicine. Pediatrics 2013;132:359-366 Copyright © 2013 by the American Academy of Pediatrics. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn care patient transport EMTREE MEDICAL INDEX TERMS accreditation administrative personnel air medical transport article clinical research consensus disaster medicine health care quality health economics helicopter human intensive care unit law medical education medical society patient safety priority journal quality control simulation teamwork working time EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013518765 MEDLINE PMID 23821698 (http://www.ncbi.nlm.nih.gov/pubmed/23821698) PUI L369593966 DOI 10.1542/peds.2013-0529 FULL TEXT LINK http://dx.doi.org/10.1542/peds.2013-0529 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 431 TITLE Vertical hospital evacuations: a new method. AUTHOR NAMES Iserson K.V. AUTHOR ADDRESSES (Iserson K.V.) University of Arizona and the AZ-1 Disaster Medical Assistance Team, Tucson, AZ, USA. CORRESPONDENCE ADDRESS K.V. Iserson, University of Arizona and the AZ-1 Disaster Medical Assistance Team, Tucson, AZ, USA. Email: kvi@u.arizona.edu SOURCE Southern medical journal (2013) 106:1 (37-42). Date of Publication: Jan 2013 ISSN 1541-8243 (electronic) ABSTRACT Rarely are hospitals forced to evacuate their nonambulatory patients; however, when a disaster occurs, evacuating nonambulatory patients, particularly from multilevel facilities, represents a major logistical hurdle. Hospital disaster plans often rely on outside agencies and limited equipment to perform vertical evacuations. This article describes a novel method using readily available materials (patient mattresses and bedsheets) to effect a rapid, safe vertical evacuation. This method also can be used in nonhealthcare facilities for less-than-fully ambulatory individuals. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bed disaster planning patient lifting patient transport EMTREE MEDICAL INDEX TERMS article hospital human intensive care unit methodology organization and management United States LANGUAGE OF ARTICLE English MEDLINE PMID 23263312 (http://www.ncbi.nlm.nih.gov/pubmed/23263312) PUI L366384991 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 432 TITLE Making good better: Implementing a standardized handoff in pediatric transport AUTHOR NAMES Weingart C. Herstich T. Baker P. Garrett M.L. Bird M. Billock J. Schwartz H.P. Bigham M.T. AUTHOR ADDRESSES (Weingart C.; Herstich T.; Bigham M.T., mbigham@chmca.org) Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, United States. (Baker P.; Garrett M.L.; Billock J.) Department of Nursing, Akron Children's Hospital, Akron, OH, United States. (Garrett M.L.) Transport Services, Akron Children's Hospital, Akron, OH, United States. (Bird M.) Medical Services, Akron Children's Hospital, Akron, OH, United States. (Schwartz H.P.) Department of Pediatrics, Children's Hospital, Medical Center of Cincinnati, Cincinnati, OH, United States. CORRESPONDENCE ADDRESS M.T. Bigham, Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, United States. Email: mbigham@chmca.org SOURCE Air Medical Journal (2013) 32:1 (40-46). Date of Publication: January-February 2013 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Background: Failures in communication lead to adverse events in healthcare. Handoffs, defined as the transfer of information, responsibility, and authority from one provider to another, have been identified as a cause of communication failure compromising patient safety. Locally, there was dissatisfaction among caregivers working on the general care and intensive care units regarding the quality of information received from the pediatric transport team for transferred patients. Methods: Using the Model for Improvement, a quality improvement team was engaged to lead this improvement effort. The team developed a standardized and scripted transport handoff process that incorporated parental input. The primary measure was provider satisfaction (reported as overall handoff score, OHS). Secondary outcomes included the use of components outlined by the Joint Commission's guidelines for safe handoff. Data were collected using a Likert-style survey and collated using Microsoft Excel. Results: Baseline measures of OHS were 81.5 ± 19.4 (mean±SD) with an interval analysis showing no improvement (81.6±17.4, P=0.99). Further modifications were made to both education and process with an improved OHS (88.8±11.1, P<0.05). Certain specific handoff components showed the greatest improvement according to caregivers. Conclusion: This practical, low-cost quality-improvement project may help others improve handoff communication and provide safe, high-quality care. © 2013 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport practice guideline EMTREE MEDICAL INDEX TERMS article caregiver health care quality health survey human intensive care unit interpersonal communication outcome assessment priority journal standardization total quality management EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013001034 MEDLINE PMID 23273309 (http://www.ncbi.nlm.nih.gov/pubmed/23273309) PUI L368005493 DOI 10.1016/j.amj.2012.06.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.06.005 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 433 TITLE 21st critical care transport medicine conference: We're going to austin-live music capital of the world! AUTHOR NAMES Newman M. Petersen P. Wojdyla K. AUTHOR ADDRESSES (Newman M.) International Association of Flight and Critical Care Paramedics, United States. (Petersen P.) Air Medical Physician Association, United States. (Wojdyla K.) Air and Surface Transport Nurses Association, Austin Convention and Visitors Bureau, United States. CORRESPONDENCE ADDRESS M. Newman, International Association of Flight and Critical Care Paramedics, United States. SOURCE Air Medical Journal (2013) 32:1 (28-29). Date of Publication: January-February 2013 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport consensus development EMTREE MEDICAL INDEX TERMS certification conference paper emergency medicine human intensive care patient care patient transport practice guideline priority journal professionalism United States EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013001039 MEDLINE PMID 23273306 (http://www.ncbi.nlm.nih.gov/pubmed/23273306) PUI L368005498 DOI 10.1016/j.amj.2012.10.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.10.007 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 434 TITLE Pharmacy resident takes care to new height AUTHOR NAMES Traynor K. AUTHOR ADDRESSES (Traynor K.) CORRESPONDENCE ADDRESS K. Traynor, SOURCE American Journal of Health-System Pharmacy (2013) 70:19 (1648). Date of Publication: 1 Oct 2013 ISSN 1535-2900 (electronic) 1079-2082 BOOK PUBLISHER American Society of Health-Systems Pharmacy EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport pharmacy EMTREE MEDICAL INDEX TERMS airplane crew critically ill patient emergency medicine emergency ward health care system helicopter human intensive care unit note physician EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014800444 MEDLINE PMID 24048595 (http://www.ncbi.nlm.nih.gov/pubmed/24048595) PUI L600050632 DOI 10.2146/news130069 FULL TEXT LINK http://dx.doi.org/10.2146/news130069 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 435 TITLE The generation, transfer, and implementation of evidence in health care is critical for consistent improvement in health outcomes. AUTHOR NAMES Lisy K. AUTHOR ADDRESSES (Lisy K.) CORRESPONDENCE ADDRESS K. Lisy, SOURCE Journal of nursing measurement (2013) 21:3 (347-348). Date of Publication: 2013 ISSN 1061-3749 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) evidence based nursing health care delivery health care quality total quality management EMTREE MEDICAL INDEX TERMS editorial human methodology organization and management treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 24620509 (http://www.ncbi.nlm.nih.gov/pubmed/24620509) PUI L372795719 DOI 10.1891/1061-3749.21.3.347 FULL TEXT LINK http://dx.doi.org/10.1891/1061-3749.21.3.347 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 436 TITLE Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events AUTHOR NAMES Brady P.W. Muething S. Kotagal U. Ashby M. Gallagher R. Hall D. Goodfriend M. White C. Bracke T.M. DeCastro V. Geiser M. Simon J. Tucker K.M. Olivea J. Conway P.H. Wheeler D.S. AUTHOR ADDRESSES (Brady P.W., patrick.brady@cchmc.org; Muething S.; White C.; Conway P.H.) Divisions of Hospital Medicine, 3333 Burnet Ave, Cincinnati, OH 45229, United States. (Brady P.W., patrick.brady@cchmc.org; Muething S.; Kotagal U.; Ashby M.; Bracke T.M.; Olivea J.; Wheeler D.S.) James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, United States. (Wheeler D.S.) Critical Care Medicine, Department of Pediatrics, Cincinnati, OH, United States. (Goodfriend M.) Family Relations, Cincinnati, OH, United States. (Gallagher R.; Hall D.; Goodfriend M.; DeCastro V.; Tucker K.M.) Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. (Geiser M.; Simon J.) Division of Quality Services, Akron Children's Hospital, Akron, OH, United States. (Conway P.H.) Centers for Medicare and Medicaid Services, Office of Clinical Standards and Quality, Baltimore, MD, United States. CORRESPONDENCE ADDRESS P.W. Brady, Divisions of Hospital Medicine, 3333 Burnet Ave, Cincinnati, OH 45229, United States. Email: patrick.brady@cchmc.org SOURCE Pediatrics (2013) 131:1 (e298-e308). Date of Publication: January 2013 ISSN 0031-4005 1098-4275 (electronic) BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT BACKGROUND AND OBJECTIVE: Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or s3 fluid boluses in first hour after arrival or before transfer. METHODS: The setting for our observational time series study was a quaternary care children's hospital. Before initiating tests of change, 2 investigators reviewed recent serious safety events (SSEs) and floor-to-ICU transfers. Collectively, 5 risk factors were associated with each event: family concerns, high-risk therapies, presence of an elevated early warning score, watcher/clinician gut feeling, and communication concerns. Using the model for improvement, an intervention was developed and tested to reliably and proactively identify patient risk and mitigate that risk through unit-based huddles. A 3-times daily inpatient huddle was added to ensure risks were escalated and addressed. Later, a 'robust' and explicit plan for at-risk patients was developed and spread. RESULTS: The rate of UNSAFE transfers per 10 000 non-ICU inpatient days was significantly reduced from 4.4 to 2.4 over the study period. The days between inpatient SSEs also increased significantly. CONCLUSIONS: A reliable system to identify, mitigate, and escalate risk was associated with a near 50% reduction in UNSAFE transfers and SSEs. Copyright © 2013 by the American Academy of Pediatrics. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health service intensive care unit patient transport unrecognized situation awareness failures events EMTREE MEDICAL INDEX TERMS article child health care emergency care family counseling high risk patient hospital patient human interpersonal communication observational study pediatric hospital physician attitude priority journal risk assessment risk reduction scoring system EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013062452 MEDLINE PMID 23230078 (http://www.ncbi.nlm.nih.gov/pubmed/23230078) PUI L368184715 DOI 10.1542/peds.2012-1364 FULL TEXT LINK http://dx.doi.org/10.1542/peds.2012-1364 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 437 TITLE Improving patient safety in the ICU by prospective identification of missing safety barriers using the bow-tie prospective risk analysis model. AUTHOR NAMES Kerckhoffs M.C. van der Sluijs A.F. Binnekade J.M. Dongelmans D.A. AUTHOR ADDRESSES (Kerckhoffs M.C., M.Kerckhoffs@gmail.com) Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, TheNetherlands. (van der Sluijs A.F.; Binnekade J.M.; Dongelmans D.A.) CORRESPONDENCE ADDRESS M.C. Kerckhoffs, Email: M.Kerckhoffs@gmail.com SOURCE Journal of patient safety (2013) 9:3 (154-159). Date of Publication: Sep 2013 ISSN 1549-8425 (electronic) ABSTRACT To improve patient safety, potential critical events should be analyzed for the existence of preventive barriers. The aim of this study was to prospectively identify existing and missing barriers using the Bow-Tie model. We expected that the analysis of these barriers would lead to feasible recommendations to improve safety in daily patient care. Multidisciplinary teams of doctors and nurses on a 28 bed ICU conducted the study. The Bow-Tie analysis was performed on intrahospital transportation, unplanned extubation, and communication, which led to 9 critical events. For each event, potential threats and consequences were defined and placed in a Bow-Tie diagram. Then, barriers were determined, ways to prevent the threat or limit the consequences. The barriers were defined as existing or missing and analyzed for feasibility. Intrahospital transportation: this hazard led to 7 critical events, the Bow-Tie analysis to 52 missing but implementable barriers and 8 practical recommendations. For example, a pretransportation checklist.Unplanned extubation: this Bow-Tie analysis revealed 15 implementable missing barriers (of a total of 32) and led to 22 recommendations. One of them was optimizing treatment of delirium.Communication: this analysis showed 21 barriers, of which, 12 were missing but feasible to implement. These barriers led to 7 recommendations such as the need to cosign after the handover of a patient. Prospective risk analysis using the Bow-Tie model proved usable to identify existing and missing barriers for potential critical events. Many missing barriers seemed feasible to implement and led to practical recommendations and improvements in patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient safety risk assessment EMTREE MEDICAL INDEX TERMS article human methodology Netherlands patient transport prospective study standard statistics tertiary care center LANGUAGE OF ARTICLE English MEDLINE PMID 23965838 (http://www.ncbi.nlm.nih.gov/pubmed/23965838) PUI L563067139 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 438 TITLE Safe transport of intra-aortic balloon pump-dependent patients by skilled air and land critical care Crews AUTHOR NAMES Allendes F. MacDonald R.D. AUTHOR ADDRESSES (Allendes F.) McMacster University, Canada. (MacDonald R.D.) Ornge, University of Toronto, Canada. CORRESPONDENCE ADDRESS F. Allendes, McMacster University, Canada. SOURCE Air Medical Journal (2013) 32:5 (251-252). Date of Publication: September-October 2013 CONFERENCE NAME 2013 Air Medical Transport Conference, AMTC 2013 CONFERENCE LOCATION Virginia Beach, VA, United States CONFERENCE DATE 2013-10-21 to 2013-10-21 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Transfer of intra-aortic balloon pump (IABP)- dependent patients between health care facilities is increasingly common. The transfers are typically time-sensitive and require specialized staff or other personnel familiar with operation of the IABP and management of a potentially unstable patient to ensure patient safety. There are few reports of interfacility transfer of IABP-dependent patients by paramedics alone. This study examined such transfers carried out by specially trained critical care flight paramedics in a large air medical and land critical care transport service. Methods: This retrospective, descriptive review of prospectively collected data for IABP-dependent patient transfers in Ontario, Canada from September 2003 to January 2013. Call records and patient care reports were reviewed to capture demographic, patient care, adverse events, and transferrelated data. Adverse events, including resuscitation medication, procedure, and patient instability, were independently reviewed by 2 investigators. Results: There were 140 IABP-dependent patients transported during the study period. Fifty-five were carried out by land critical care transfer vehicle, 60 by helicopter, and 25 by fixed wing aircraft. The mean patient age was 62.7 ± 13.9 years, and the majority (72.1%) was male. Fifty-two patients (37.1%) were inotrope- or vasopressor-dependent, and 38 (27.1%) were intubated and mechanically ventilated. The most common indications for IABP insertion were acute myocardial infarction requiring prompt surgical intervention (n±59), cardiogenic shock (n±30), and bridge to definitive care (n±23). The mean transport time was 89 ± 80 minutes. There were 47 complications in 35 patients, most commonly hypotension (SBP±90 mm Hg; n±18) or tachyarrhythmia requiring therapy (n±14). There were 3 IABP malfunctions and 2 cases where the transport vehicle was inoperable resulting in a transport delay. One patient with cardiogenic shock died just prior to departing the referral hospital. Paramedics managed all complications without assistance from other health care personnel. Conclusion: This study demonstrates that specially trained critical care flight paramedics can safely transfer potentially unstable intra-aortic balloon pump-dependent patients to definitive cardiac surgical care. EMTREE DRUG INDEX TERMS hypertensive factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport human intensive care intraaortic balloon pump patient EMTREE MEDICAL INDEX TERMS acute heart infarction aircraft Canada cardiogenic shock drug therapy flight forelimb health care facility health care personnel helicopter hospital hypotension male patient care patient safety patient transport personnel procedures resuscitation surgery tachycardia therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71267251 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 439 TITLE Critical care transportation by paramedics: A cross-sectional survey AUTHOR NAMES Raynovich W. Hums J. Stuhlmiller D.F. Bramble J.D. Kasha T. Galt K. AUTHOR ADDRESSES (Raynovich W., billr@creighton.edu) Emergency Medical Services Medical Education Program, Creighton University, 2514 Cuming Street, Omaha NE 68131, United States. (Hums J.; Stuhlmiller D.F.) International Association of Flight and Critical Care Paramedics, Snellville, GA, United States. (Stuhlmiller D.F.) LifeNet of NewYork/Guthrie Air, Albany, NY, United States. (Bramble J.D.; Kasha T.; Galt K.) Center for Health Services Research and Patient Safety, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, United States. CORRESPONDENCE ADDRESS W. Raynovich, Emergency Medical Services Medical Education Program, Creighton University, 2514 Cuming Street, Omaha NE 68131, United States. Email: billr@creighton.edu SOURCE Air Medical Journal (2013) 32:5 (280-288). Date of Publication: 2013 ISSN 1532-6497 (electronic) 1067-991X BOOK PUBLISHER Mosby Inc., customerservice@mosby.com ABSTRACT Objective The purpose of this study was to gather data from paramedics practicing in the critical care transport setting to guide development of the education, training, and clinical practices for certification as a critical care paramedic. Methods A paper survey of 1991 randomly selected nationally registered (NREMT) paramedics was conducted. Nine paramedics with residences in small US Pacific Island territories were not included in the survey. Results We received 610 responses (30.6%). Respondents that stated that they provided critical care transport services reported using pediatric skills and equipment the most and intracranial pressure monitoring the least. Paramedics served as the primary provider for pediatric patients (72.5%), 12-lead electrocardiogram (66.3%), intravenous infusion pump (76.7%), mechanical ventilator (66.9%), central line management (63.1%), and chest tube management (63.3%). Paramedics served in a team member capacity most often with neonatal isolette (71.8%), intra-aortic balloon pump (79.2%), and ICP monitoring (64.9%). The majority provided ground critical care transport (249) compared to 44 rotor-wing and 6 fixed-wing. Sixteen respondents reported serving as primary providers on combinations of ground, rotor-, and fixed-wing services. Conclusions Paramedics reported being the primary provider on the critical care transport team and performing skills while using equipment and administering medications that exceeded their education and training as paramedic and, at times, without the benefit of any additional education or training. National appreciation of this reality should spur development of standardized education, licensing or certification, and continuing education to prepare paramedics for their role as critical care medical providers. © 2013 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care paramedical profession EMTREE MEDICAL INDEX TERMS article central venous catheterization cross-sectional study electrocardiogram human intraaortic balloon pump intracranial pressure monitoring intravenous drug administration mechanical ventilator Pacific islands paramedical education paramedical personnel priority journal pump EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013568477 MEDLINE PMID 24001916 (http://www.ncbi.nlm.nih.gov/pubmed/24001916) PUI L369787761 DOI 10.1016/j.amj.2013.05.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2013.05.008 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 440 TITLE Occurrence of secondary insults of traumatic brain injury in patients transported by critical care air transport teams from Iraq/Afghanistan: 2003-2006. AUTHOR NAMES Dukes S.F. Bridges E. Johantgen M. AUTHOR ADDRESSES (Dukes S.F.) United States Air Force School of Aerospace Medicine, 2510 5th Street, Wright-Patterson AFB, OH 45433, USA. (Bridges E.; Johantgen M.) CORRESPONDENCE ADDRESS S.F. Dukes, United States Air Force School of Aerospace Medicine, 2510 5th Street, Wright-Patterson AFB, OH 45433, USA. SOURCE Military medicine (2013) 178:1 (11-17). Date of Publication: Jan 2013 ISSN 0026-4075 ABSTRACT Traumatic brain injury patients are susceptible to secondary insults to the injured brain. A retrospective cohort study was conducted to describe the occurrence of secondary insults in 63 combat casualties with severe isolated traumatic brain injury who were transported by the U.S. Air Force Critical Care Air Transport Teams (CCATT) from 2003 through 2006. Data were obtained from the Wartime Critical Care Air Transport Database, which describes the patient's physiological state and care as they are transported across the continuum of care from the area of responsibility (Iraq/Afghanistan) to Germany and the United States. Fifty-three percent of the patients had at least one documented episode of a secondary insult. Hyperthermia was the most common secondary insult and was associated with severity of injury. The hyperthermia rate increased across the continuum, which has implications for en route targeted temperature management. Hypoxia occurred most frequently within the area of responsibility, but was rare during CCATT flights, suggesting that concerns for altitude-induced hypoxia may not be a major factor in the decision when to move a patient. Similar research is needed for polytrauma casualties and analysis of the association between physiological status and care across the continuum and long-term outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport brain injury (epidemiology) soldier EMTREE MEDICAL INDEX TERMS adolescent adult anoxia (epidemiology) article cohort analysis female fever (epidemiology) human hypertension (epidemiology) hypotension (epidemiology) injury scale intensive care male middle aged retrospective study statistics United States war LANGUAGE OF ARTICLE English MEDLINE PMID 23356112 (http://www.ncbi.nlm.nih.gov/pubmed/23356112) PUI L368519110 DOI 10.7205/MILMED-D-12-00177 FULL TEXT LINK http://dx.doi.org/10.7205/MILMED-D-12-00177 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 441 TITLE [The transition process from the intensive care unit to the ward: a review of the literature] ORIGINAL (NON-ENGLISH) TITLE El proceso de transición de la unidad de cuidados intensivos al área de hospitalización: una revisión bibliográfica AUTHOR NAMES Vázquez Calatayud M. Portillo M.C. AUTHOR ADDRESSES (Vázquez Calatayud M.; Portillo M.C.) Área de Investigación, Formación y Desarrollo Profesional en Enfermería, Clínica Universidad de Navarra, Pamplona, España. mvazca@unav.es SOURCE Enfermería intensiva / Sociedad Española de Enfermería Intensiva y Unidades Coronarias (2013) 24:2 (72-88). Date of Publication: 2013 Apr-Jun ISSN 1578-1291 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care facility intensive care unit patient transport EMTREE MEDICAL INDEX TERMS human patient satisfaction LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY Spanish MEDLINE PMID 23375829 (http://www.ncbi.nlm.nih.gov/pubmed/23375829) PUI L603062458 DOI 10.1016/j.enfi.2012.12.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.enfi.2012.12.002 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 442 TITLE [Modes of mechanical ventilation during transferring the patient to spontaneous breathing]. AUTHOR NAMES Chemykh A.S. AUTHOR ADDRESSES (Chemykh A.S.) CORRESPONDENCE ADDRESS A.S. Chemykh, SOURCE Anesteziologiia i reanimatologiia (2013) :1 (74-76). Date of Publication: 2013 Jan-Feb ISSN 0201-7563 ABSTRACT Mechanical ventilation (MV) has become a general treatment in the intensive care unit in recent years. Mechanical ventilation is a resuscitation treatment; however MV causes many implications therefore it is to be finished as soon as the patient's condition begins improve. Modern transferring the patient to spontaneous breathing decreases implications number. Significant part of mechanical ventilation time (40%) is a time of weaning from mechanical ventilation. Weaning from MV is an economical, clinical and ethical problem. Many ventilation modes have introduced in clinical practice through the microprocessor technologies development. Supporting ventilation modes help to avoid some adverse effects of mechanical ventilation. The article deals with historical approaches development their advantages and limitations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation (adverse drug reaction) intensive care unit EMTREE MEDICAL INDEX TERMS article human lung function test methodology resuscitation time LANGUAGE OF ARTICLE Russian MEDLINE PMID 23808263 (http://www.ncbi.nlm.nih.gov/pubmed/23808263) PUI L369361818 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 443 TITLE Analysis of the interface and data transfer from ICU to normal wards in a German University Hospital AUTHOR NAMES Vollmer A.-M. Skonetzki-Cheng S. Prokosch H.-U. AUTHOR ADDRESSES (Vollmer A.-M.; Skonetzki-Cheng S.; Prokosch H.-U.) Departmant of Medical Informatics, Friedrich-Alexander University, Erlangen, Germany SOURCE Studies in health technology and informatics (2013) 192 (1104). Date of Publication: 2013 ISSN 0926-9630 ABSTRACT Typically general wards and intensive care units (ICU) have very different labor organizations, structures and IT-systems in Germany. There is a need for coordination, because of the different working arrangements. Our team investigated the interface between ICU and general ward and especially the respective information transfer in the University hospital in Erlangen (Bavaria, Germany). The research team used a combination of interviews, observations and the analysis of transfer records and forms as part of a methodical triangulation. We identified 41 topics, which are discussed or presented in writing during the handover. In a second step, we investigate the requirements of data transmission in expert interviews. A data transfer concept from the perspective of the nurses and physicians was developed and we formulated recommendations for improvements of process and communication for this interface. Finally the data transfer concept was evaluated by the respondents. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) organization and management procedures EMTREE MEDICAL INDEX TERMS clinical handover computer interface electronic medical record Germany health care facility hospital management information retrieval intensive care unit medical record patient transport university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23920878 (http://www.ncbi.nlm.nih.gov/pubmed/23920878) PUI L603662121 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 444 TITLE The incidence of fever in US critical care air transport team combat trauma patients evacuated from the theater between March 2009 and March 2010 AUTHOR NAMES Minnick J.M. Bebarta V.S. Stanton M. Lairet J.R. King J. Torres P. Aden J. Ramirez R. AUTHOR ADDRESSES (Minnick J.M., jodymm13@yahoo.com; Torres P.) Air Force Enroute Care Research Center, US Army Institute of Surgical Research, San Antonio, Military Medical Center, Ft. Sam Houston, TX, United States. (Bebarta V.S.) Enroute Care Research Center, USAF, and Chair, Medical Toxicology, Department of Emergency Medicine, San Antonio Military Medical Center, Ft. Sam Houston, TX, United States. (Stanton M.) Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, United States. (Lairet J.R.) Department of Emergency Medicine, Emory University, Atlanta, GA, United States. (King J.) Department of Emergency Medicine, Air Force Enroute Care Research Center, US Army Institute of Surgical Research, San Antonio, Military Medical Center, Ft. Sam Houston, TX, United States. (Aden J.) US Army Institute of Surgical Research, Ft. Sam Houston, TX, United States. (Ramirez R.) Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, United States. CORRESPONDENCE ADDRESS J.M. Minnick, Email: jodymm13@yahoo.com SOURCE Journal of Emergency Nursing (2013) 39:6 (e101-e106). Date of Publication: November 2013 ISSN 1527-2966 (electronic) 0099-1767 ABSTRACT Introduction: Most critically ill injured patients are transported out of the theater by Critical Care Air Transport Teams (CCATTs). Fever after trauma is correlated with surgical complications and infection. The purposes of this study are to identify the incidence of elevated temperature in patients managed in the CCATT environment and to describe the complications reported and the treatments used in these patients. Methods: We performed a retrospective review of available records of trauma patients from the combat theater between March 1, 2009, and March 31, 2010, who were transported by the US Air Force CCATT and had an incidence of hyperthermia. We then divided the cohort into 2 groups, patients transported with an elevation in temperature greater than 100.4°F and patients with no documented elevation in temperature. We used a standardized, secure electronic data collection form to abstract the outcomes. Descriptive data collected included injury type, temperature, use of a mechanical ventilator, cooling treatment modalities, antipyretics, intravenous fluid administration, and use of blood products. We also evaluated the incidence of complications during the transport in patients who had a recorded elevation in temperature greater than 100.4°F. Results: A total of 248 trauma patients met the inclusion criteria, and 101 trauma patients (40%) had fever. The mean age was 28 years, and 98% of patients were men. The mechanism of injury was an explosion in 156 patients (63%), blunt injury in 11 (4%), and penetrating injury in 45 (18%), whereas other trauma-related injuries accounted for 36 patients (15%). Of the patients, 209 (84%) had battle-related injuries and 39 (16%) had non-battle-related injuries. Traumatic brain injury was found in 24 patients (24%) with an incidence of elevated temperature. The mean temperature was 101.6°F (range, 100.5°F-103.9°F). After evaluation of therapies and treatments, 80 trauma patients (51%) were intubated on a mechanical ventilator (P < .001). Of the trauma patients with documented fever, 22 (22%) received administration of blood products. Nineteen patients received antipyretics during their flight (19%), 9 received intravenous fluids (9%), and 2 received nonpharmacologic cooling interventions, such as cooling blankets or icepacks. We identified 1 trauma patient with neurologic changes (1%), 6 with hypotension (6%), 48 with tachycardia (48%), 33 with decreased urinary output (33%), and 1 with an episode of shivering or sweating (1%). We did not detect any transfusion reactions or deaths during flight. Conclusion: Fever occurred in 41% of critically ill combat-injured patients evacuated out of the combat theater in Iraq and Afghanistan. Fewer than 20% of patients with a documented elevated temperature received treatments to reduce the temperature. Intubation of patients with ventilators in use during the transport was the only factor significantly associated with fever. Serious complications were rare, and there were no deaths during these transports. © 2013 Emergency Nurses Association. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport fever (epidemiology) injury (epidemiology) intensive care patient care soldier EMTREE MEDICAL INDEX TERMS adolescent adult article battle blunt trauma (epidemiology) brain injury (epidemiology) comorbidity Critical care transport female Flight medicine human incidence intensive care nursing Iraq male methodology middle aged military medicine nursing penetrating trauma (epidemiology) retrospective study statistics war young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23684131 (http://www.ncbi.nlm.nih.gov/pubmed/23684131) PUI L1052586049 DOI 10.1016/j.jen.2013.02.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.jen.2013.02.001 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 445 TITLE Number of women requiring care at a tertiary hospital equipped with a neonatal intensive care unit at night in an area with a population of 2 million AUTHOR NAMES Yamada T. Cho K. Morikawa M. Yamada T. Akaishi R. Ishikawa S. Minakami H. AUTHOR ADDRESSES (Yamada T., taka0197@med.hokudai.ac.jp; Cho K.; Morikawa M.; Yamada T.; Akaishi R.; Ishikawa S.; Minakami H.) Department of Obstetrics, Hokkaido University, Graduate School of Medicine, N15W7, Sapporo 060-8638, Japan. CORRESPONDENCE ADDRESS T. Yamada, Department of Obstetrics, Hokkaido University, Graduate School of Medicine, N15W7, Sapporo 060-8638, Japan. Email: taka0197@med.hokudai.ac.jp SOURCE Journal of Obstetrics and Gynaecology Research (2013) 39:12 (1592-1595). Date of Publication: December 2013 ISSN 1447-0756 (electronic) 1341-8076 BOOK PUBLISHER Blackwell Publishing Asia, 5F 3-11-14 Iidabashi, Chiyoda-ku, Tokyo, Japan. ABSTRACT Aim: Women with imminent premature labor (IPL) are transported to a tertiary hospital equipped with neonatal intensive care unit (NICU) even during the night. However, there have been no extensive studies of the occurrence rate of night IPL. The aim of this study was to determine the occurrence rate of night IPL in an area with a population of 2 million. Materials and Methods: A retrospective analysis was conducted using data collected by the Sapporo Obstetric System for Emergency Patients launched in October 2008, in which women, physicians, and ambulance staff who sought appropriate obstetric/gynecological facilities available in the night (19.00-06.00 hours) were informed of candidate hospitals by coordinators through telephone consultation. This system covered the Sapporo area, which has a population of 2 000 000 and 17 000 births annually. Approximately 14% and 86% of women received antenatal care at six and 35 obstetric facilities with and without NICU, respectively, in this area. Night IPL was defined as a threatened premature labor and transport to one of six tertiary hospitals with NICU between 19.00 and 06.00 hours the next morning. Results: During a 4-year period from 1 October 2008 to 30 September 2012, the Sapporo Obstetric System for Emergency Patients received 158 ± 23 (mean ± standard deviation) monthly telephone consultations (range 114-218 per month). The monthly number of patients with night IPL was 3.0 ± 2.2 (range 0-9 per month). Conclusions: The monthly number of cases of night IPL was around three among women who received antenatal care at obstetrics facilities without NICU in an area with a population of 2 000 000. © 2013 The Authors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport premature labor tertiary care center EMTREE MEDICAL INDEX TERMS article female human maternity ward prenatal care prevalence teleconsultation EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014214220 PUI L372697743 DOI 10.1111/jog.12113 FULL TEXT LINK http://dx.doi.org/10.1111/jog.12113 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 446 TITLE Design of a medical record review study on the incidence and preventability of adverse events requiring a higher level of care in Belgian hospitals. AUTHOR NAMES Vlayen A. Marquet K. Schrooten W. Vleugels A. Hellings J. De Troy E. Weekers F. Claes N. AUTHOR ADDRESSES (Vlayen A.) Hasselt University, Faculty of Medicine, Patient Safety Group, Agoralaan Building D, Room D58, Diepenbeek 3590, Belgium. (Marquet K.; Schrooten W.; Vleugels A.; Hellings J.; De Troy E.; Weekers F.; Claes N.) CORRESPONDENCE ADDRESS A. Vlayen, Hasselt University, Faculty of Medicine, Patient Safety Group, Agoralaan Building D, Room D58, Diepenbeek 3590, Belgium. Email: annemie.vlayen@uhasselt.be SOURCE BMC research notes (2012) 5 (468). Date of Publication: 2012 ISSN 1756-0500 (electronic) ABSTRACT Adverse events are unintended patient injuries that arise from healthcare management resulting in disability, prolonged hospital stay or death. Adverse events that require intensive care admission imply a considerable financial burden to the healthcare system. The epidemiology of adverse events in Belgian hospitals has never been assessed systematically. A multistage retrospective review study of patients requiring a transfer to a higher level of care will be conducted in six hospitals in the province of Limburg. Patient records are reviewed starting from January 2012 by a clinical team consisting of a research nurse, a physician and a clinical pharmacist. Besides the incidence and the level of causation and preventability, also the type of adverse events and their consequences (patient harm, mortality and length of stay) will be assessed. Moreover, the adequacy of the patient records and quality/usefulness of the method of medical record review will be evaluated. This paper describes the rationale for a retrospective review study of adverse events that necessitate a higher level of care. More specifically, we are particularly interested in increasing our understanding in the preventability and root causes of these events in order to implement improvement strategies. Attention is paid to the strengths and limitations of the study design. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) iatrogenic disease (epidemiology, prevention) medical error (prevention) methodology patient transport treatment outcome EMTREE MEDICAL INDEX TERMS article Belgium (epidemiology) clinical audit cluster analysis disability hospital hospital admission human incidence intensive care unit length of stay medical record mortality multicenter study patient safety retrospective study risk factor time LANGUAGE OF ARTICLE English MEDLINE PMID 22931859 (http://www.ncbi.nlm.nih.gov/pubmed/22931859) PUI L369014138 DOI 10.1186/1756-0500-5-468 FULL TEXT LINK http://dx.doi.org/10.1186/1756-0500-5-468 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 447 TITLE Proactive vs. reactive rapid response systems: Decreasing unplanned ICU transfers AUTHOR NAMES Danesh V. Guerrier L. Health O. Jimenez E. AUTHOR ADDRESSES (Danesh V.; Guerrier L.; Health O.; Jimenez E.) Orlando Regional Medical Center, United States. CORRESPONDENCE ADDRESS V. Danesh, Orlando Regional Medical Center, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (1). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Rapid Response Teams (RRT) traditionally respond to patient deteriorations identified by nurses outside of the ICU. ICU admissions from inpatient areas are indicators of physiological decline and are associated with increased mortality. Next steps for RRT are to proactively identify patients at-risk, and to act as a resource to increase anticipatory nursing care while promoting expertise-sharing among nurses. Hypothesis: Increased presence of a Rapid Response Team RN (RRT RN) guided by warning score algorithms to proactively round on patients at risk for deterioration can decrease the number of unplanned ICU transfers. Methods: Proactive rounds by an RRT RN in all inpatient areas of a 270-bed community hospital were guided by algorithms (Rothman Severity of Illness Index) within the EMR to identify patients at risk for deterioration. The RRT RN inspected graphics (vital signs, laboratory values, nursing assessments and an indexed value) and proactively rounded on 8+ patients per day while delegating additional patients to charge RNs for follow-up. Reasons and interventions for each visit were recorded prospectively (October 2011-March 2012). Data was collected retrospectively for the prior 12-month period for comparison using Wilcoxon rank sum tests. A reactive RRT remained active during both periods. Results: Proactive visits were conducted on 1,444 occasions. Nursing-driven interventions were implemented 533 times (37%). When interventions resulted from proactive rounds, they were most often related to anticipatory nursing care such as coaching on vital signs (48%), calls to providers (36%), or diagnostics (36%). ICU transfers from wards were not significant, but transfers from Intermediate Critical Care Units (ICCU) decreased significantly (3.16/1,000 patient days vs 1.91/1,000 patient days, p=.028). Conclusions: Differences in the frequency of assessments between the wards and ICCUs may contribute to changes in detection of patient instability. The interventions and coaching on anticipatory nursing care to staff RNs during proactive rounds may be associated with a dramatic increase in the stabilization of patients in ICCUs and corresponding decreases in unplanned ICU transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care rapid response team society EMTREE MEDICAL INDEX TERMS algorithm community hospital deterioration diagnosis follow up hospital patient human hypothesis laboratory mortality nurse nursing nursing assessment nursing care patient rank sum test risk severity of illness index vital sign ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065183 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 448 TITLE Improving patient care during transitions from the ICU to the general care floor via staff and family collaboration and a novel patient/familycentered transfer brochure AUTHOR NAMES Meaburn A. Boylan A. Ford D. Nivea K. Byrne J. AUTHOR ADDRESSES (Meaburn A.; Boylan A.; Ford D.; Nivea K.; Byrne J.) Medical University of South Carolina, United States. CORRESPONDENCE ADDRESS A. Meaburn, Medical University of South Carolina, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (225). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The transition from the ICU to the general floor can cause “relocation stress” and contribute to slower recovery and reduce patient/family satisfaction. To improve patient/family centered care, our Medical Intensive Care Unit (MICU) developed and implemented a transfer rounding team and tool. Hypothesis: Our hypothesis was transfer rounding data would provide valuable patient and family input to make meaningful patient and family-centered changes in the MICU transfer process. Methods: Our study population was a convenience sample of all MICU patients between October 2010- March 2012 within 24-48 hours after transfer. Our transfer rounding team included staff nurses, patient care technicians, and a patient liaison. The transfer survey consisted of five validated patient satisfaction questions scored on a 1-5 Likert scale. Additionally, patients and family responded to questions about opportunities for improvement, educational needs, recognition of staff, comfort of our waiting room and noise levels/sleep quality. The patient and family survey data was used to develop performance reports. Transfer rounding satisfaction data was reviewed monthly at MICU leadership and quality meetings and the quarterly hospital in-patient satisfaction meeting. Results: In 2011, n=233 transfer surveys were completed with an average score of 4.64 on questions related to pain management, physician attention, care of personal belongings, nursing staff responsiveness, and interdisciplinary teamwork. The rounding data was utilized to update our patient educational materials, implement a sleep protocol, enhance our staff recognition program, secure funding for an afterhours concierge, provide real-time service recovery, and develop a novel transfer brochure. The transfer brochure was developed using a patient and family interviews to incorporate their recommendations. Conclusions: The survey tool is simple to use and easily integrated into daily practice. Other intensive care units at our institution have adopted our transfer rounding survey process and transfer brochure. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient care society EMTREE MEDICAL INDEX TERMS analgesia comfort convenience sample funding hospital hospital patient hypothesis intensive care unit interview leadership Likert scale noise nursing staff patient patient satisfaction physician population satisfaction sleep staff nurse teamwork waiting room LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71066032 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 449 TITLE Clonal spread and patient risk factors for acquisition of extensively drug-resistant Acinetobacter baumannii in a neonatal intensive care unit in Italy AUTHOR NAMES Zarrilli R. Di Popolo A. Bagattini M. Giannouli M. Martino D. Barchitta M. Quattrocchi A. Iula V.D. de Luca C. Scarcella A. Triassi M. Agodi A. AUTHOR ADDRESSES (Zarrilli R., rafzarri@unina.it; Di Popolo A.; Bagattini M.; Giannouli M.; Martino D.; Triassi M.) Department of Preventive Medical Sciences, Hygiene Section, University 'Federico II', Naples, Italy. (Zarrilli R., rafzarri@unina.it) CEINGE Advanced Biotechnologies, Naples, Italy. (Barchitta M.; Quattrocchi A.; Agodi A.) Department GF Ingrassia, University of Catania, Catania, Italy. (Iula V.D.; de Luca C.) Department of Molecular and Cellular Biology and Pathology 'L. Califano', University 'Federico II', Naples, Italy. (Scarcella A.) Department of Paediatrics, University 'Federico II', Naples, Italy. CORRESPONDENCE ADDRESS R. Zarrilli, Department of Preventive Medical Sciences, University of Naples 'Federico II', Via Pansini 5, 80131 Napoli, Italy. Email: rafzarri@unina.it SOURCE Journal of Hospital Infection (2012) 82:4 (260-265). Date of Publication: December 2012 ISSN 0195-6701 1532-2939 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT Aim: To report an outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii in the neonatal intensive care unit (NICU) of an Italian university hospital. Patient risk profiles for acquisition of A. baumannii and measures used to control the outbreak are described. Methods: Antibiotic susceptibility of strains was evaluated by microdilution. Genotyping was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing. Carbapenemase genes were analysed by polymerase chain reaction and DNA sequencing. A case-control study was designed to identify risk factors for acquisition of A. baumannii. Findings: A. baumannii was isolated from 22 neonates, six of whom were infected. One major PFGE type was identified, assigned to sequence type (ST) 2, corresponding to International Clone II; this was indistinguishable from isolates from the adult ICU in the same hospital. A. baumannii isolates were resistant to aminoglycosides, quinolones and classes of β-lactam antibiotics, but were susceptible to tigecycline and colistin. Carbapenem resistance was associated with the presence of transposon Tn2006 carrying the bla(OxA-23) gene. Length of NICU stay, length of exposure to A. baumannii, gestational age, use of invasive devices and length of exposure to invasive devices were significantly associated with acquisition of A. baumannii on univariate analysis, while length of exposure to central venous catheters and assisted ventilation were the only independent risk factors after multi-variate analysis. Conclusions: This XDR A. baumannii outbreak in an NICU was probably caused by intrahospital transfer of bacteria via a colonized neonate whose mother was admitted to the adult ICU. Strengthened infection control measures were necessary to control the outbreak. © 2012 The Healthcare Infection Society. EMTREE DRUG INDEX TERMS aminoglycoside antibiotic agent beta lactam antibiotic carbapenemase cephalosporin derivative colistin (drug therapy, intravenous drug administration) cotrimoxazole penicillin G quinoline derived antiinfective agent sultamicillin tigecycline EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter baumannii Acinetobacter infection (drug therapy, drug resistance, drug therapy, epidemiology) newborn intensive care EMTREE MEDICAL INDEX TERMS antibiotic sensitivity article bacterium isolate controlled study DNA sequence epidemic female genotype gestational age human infection control Italy length of stay major clinical study male newborn risk factor transposon CAS REGISTRY NUMBERS colistin (1066-17-7, 1264-72-8) cotrimoxazole (8064-90-2) penicillin G (1406-05-9, 61-33-6) sultamicillin (76497-13-7) tigecycline (220620-09-7) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012675639 MEDLINE PMID 23102814 (http://www.ncbi.nlm.nih.gov/pubmed/23102814) PUI L52272041 DOI 10.1016/j.jhin.2012.08.018 FULL TEXT LINK http://dx.doi.org/10.1016/j.jhin.2012.08.018 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 450 TITLE Endotracheal tube exchange in pediatric patients after transfer from non-pediatric facilities AUTHOR NAMES Frugoni B. Khanna S. Bush R. Peterson B. Shellington D. AUTHOR ADDRESSES (Frugoni B.; Khanna S.; Bush R.; Peterson B.; Shellington D.) Rady Children's Hospital, San Diego, United States. CORRESPONDENCE ADDRESS B. Frugoni, Rady Children's Hospital, San Diego, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (108-109). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: We describe the incidence of and indication for endotracheal tube exchange in intubated pediatric patients transferred to a pediatric intensive care unit. Hypothesis: We hypothesize that pediatric patients who are intubated at non-pediatric facilities require endotracheal tube exchange more frequently than a previously reported rate of 4%. Methods: We performed a retrospective chart review of pediatric patients age 0-18 years admitted to our pediatric ICU from outside facilities over a 4 year period. Data collected included age, PRISM scores, indication for intubation, endotracheal tube size, presence of cuff, air leak, necessity of tube exchange, and the timing of that exchange. Data was analyzed via contingency tables using Fisher Exact Test and Pearson Chi-Square where appropriate. Results: Over the study period, 260 patients met inclusion criteria. Of these patients, 58 (22.3%) required endotracheal tube exchange in the first 5 days of care. A majority of tube exchanges (81%) were required for excessive air leak around the endotracheal tube causing loss of tidal volume and inadequate ventilation. Patients 0-1 years old and 1-7 years old required endotracheal tube change more frequently than patients > 7 years old (26.9% vs 28% vs 9%, p = 0.004). Cuffed endotracheal tubes were used in significantly fewer patients 0-1 years and 1-7 years compared to > 7 years (15.8% vs 19.2% vs 92.2%, p < 0.001). Patients requiring endotracheal tube exchange had higher PRISM scores (9.2 vs 13.5, p = 0.003). Those intubated for respiratory or cardiac disease had a higher likelihood of requiring exchange (38.2% vs 31.2% vs 10%, p < 0.001). Conclusions: In this cohort of transported, intubated pediatric patients, we found a higher incidence of subsequent endotracheal tube exchange than previously reported. Endotracheal tube exchange occurred more frequently in younger, sicker patients. Future studies should evaluate whether placement of cuffed endotracheal tubes by non-pediatric providers in young patients would reduce the need for subsequent tube exchange without increased risk of other complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) endotracheal tube human intensive care patient society EMTREE MEDICAL INDEX TERMS air conditioning contingency table cuff Fisher exact test heart disease hypothesis intensive care unit intubation medical record review risk tidal volume tube LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065587 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 451 TITLE Look what the ccatt brought in: Epidemiology of usaf critical care air transport team operations in contemporary warfare AUTHOR NAMES Galvagno S. DuBose J. Fang R. Grissom T. Smith R. Scalea T. AUTHOR ADDRESSES (Galvagno S.; DuBose J.; Fang R.; Grissom T.; Scalea T.) University of Maryland, Medical Center R Adams Cowley Shock Trauma Center, United States. (Smith R.) United States Air Force, United States. CORRESPONDENCE ADDRESS S. Galvagno, University of Maryland, Medical Center R Adams Cowley Shock Trauma Center, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (10). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: US Air Force Critical Care Air Transport Teams (CCATTs) are a unique component of the military medical evacuation system. An understanding of the epidemiology of contemporary warfare is essential for pre-deployment training and optimal outcomes for critically injured warriors. We performed an epidemiological analysis of military patients transported by CCATTs during a discrete period of time. Hypothesis: The epidemiology of contemporary wartime casualties requiring critical care air transport contrasts with the characteristcs of patients seen in previous conventional conflicts. Methods: The primary source of data was the US Transportation Command (TRANSCOM) Regulating and Command and Control (C2) Evacuation System (TRAC2ES). Secondary sources were reviewed and abstracted to compare injury patterns. Descriptive statistics were used to describe the cohort. Results: Final analysis of 2011 TRAC2ES data included 396 CCATT patient transports, representing 290 patients after duplicate transports were removed. The median age was 25 years (IQR, 22 to 33). The majority of transports were male (97.6 %). The most common ICD-9-CM diagnosis was bilateral lower extremity amputation (40%). Nineteen cases of acute coronary syndromes were reported (6.6%). Nine patients with stroke were transported (3.1%). Forty-six cases of traumatic brain injury were reported (15.9%), although reporting for this injury was inconsistent. Only two patients (0.7%) had a primary diagnosis of burns. 125 subjects were injured as the result of an improvised explosive device (IED) explosion (43%), of which 87 (66%) occurred while patients were dismounted from vehicles. In 2011, more non-battle related injuries and illnesses were reported, as compared to historic data from 2001-06. Conclusions: The epidemiology of patients transported by CCATT has changed with contemporary warfare. Amputations and IED injuries were more prevalent in 2011. A higher prevalence of non-battle related injuries and explosion-related injuries may be expected in similar future conflicts. Studies of CCATT epidemiology will help focus training programs and direct evidence-based practices aimed at improving both survival and morbidity for the most severely injured casualties. EMTREE DRUG INDEX TERMS explosive EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) epidemiology intensive care society war EMTREE MEDICAL INDEX TERMS accident acute coronary syndrome air force amputation army cerebrovascular accident devices diagnosis diseases evidence based practice human hypothesis ICD-9 injury leg amputation male morbidity patient patient transport prevalence statistics survival traffic and transport training traumatic brain injury LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065215 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 452 TITLE Impact of a transfer center to manage transfer of pediatric patients from the emergency department to the intensive care unit in an academicbased setting and a community-based setting AUTHOR NAMES Vats A. Hatfield M. Cocks A. Warnick R. Hirsh D. AUTHOR ADDRESSES (Vats A.) Emory University, School of Medicine, Children's Healthcare of Atlanta, United States. (Hatfield M.; Cocks A.; Warnick R.; Hirsh D.) Children's Healthcare of Atlanta, United States. CORRESPONDENCE ADDRESS A. Vats, Emory University, School of Medicine, Children's Healthcare of Atlanta, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (27). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Transfer of care (TOC) of patients from the Emergency Department (ED) to the Intensive Care Unit (ICU) can be problematic with several aspects of TOC operating independently (e.g. physician transfer/handoff, nurse-to-nurse transfer, and bed placement/coordination) that can lead to delayed transfer time, delays in treatment, misinformation, and errors. Transfer centers (TC) have been utilized at many institutions to improve quality of care and efficiency for acceptance of patients from outside institutions. Use of a TC to manage ED-to-ICU transfer suggests a decrease in disposition-to-exit time (DTE) in a pilot study (Hatfield, et al, CCM 2011:39(S12)p27). Hypothesis: Use of a TC to coordinate all ED-to-ICU patient transfers at a pediatric healthcare system will lead to decreased ED length of stay (LOS), decreased DTE, and decreased errors. Methods: Children's Healthcare of Atlanta (Children's) established a TC in 2009 for referrals from outside centers. The study was performed on two campuses: an Academic Children's Hospital (ACH) affiliated with a University, and a Community Based Hospital (CBH) within Children's. Children's has an occurrence notification system (ONS) used to report and monitor patient care related occurrences/errors. The TC was implemented for all ED-to-ICU transfers on May 16, 2011. DTE and ED LOS for 6 month periods prior to (PRE = 12/15/10-5/15/11) and after implementation (POST=12/15/11-5/15/12) were compared (reported as mean+SD). ONS rates related to ED TOC were monitored. Results: ACH had 426 patients PRE and 433 POST. For ACH, DTE decreased from 87.2+65.8 to 69.4+48.0 minutes (p<0.005), and ED LOS was unchanged from 246+116 to 236+109 minutes (p=0.133). ACH had an ONS rate of 3.5/month PRE and 0.5/month POST. CBH had 362 patients PRE and 359 POST. For CBH, DTE was unchanged from 69.0+48.7 to 65.0+35.9 minutes (p=0.204), and ED LOS unchanged from 216+96 to 229+107 minutes (p=0.096). CBH had zero ONS PRE and POST. Conclusions: Utilization of a TC to manage ED-to-ICU patient TOC had a positive impact on DTE and errors (based on ONS rates) for the ACH, but no significant impact on the CBH. ED LOS was not significantly changed on either campus. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) community emergency ward human intensive care intensive care unit patient society EMTREE MEDICAL INDEX TERMS child health care health care system hospital hypothesis length of stay nurse patient care patient transport pediatric hospital physician pilot study university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065278 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 453 TITLE Institution of a multi-specialty transfer process improves the admission of patients directly from the or to ICU AUTHOR NAMES Roth M. Dobrzynski J. Fenimore P. Fillo M. Oberhansli T. Peters C. Propper K. Wanner K. Fulda G. AUTHOR ADDRESSES (Roth M.; Dobrzynski J.; Fenimore P.; Fillo M.; Oberhansli T.; Peters C.; Propper K.; Wanner K.; Fulda G.) Christiana Care Health System, United States. CORRESPONDENCE ADDRESS M. Roth, Christiana Care Health System, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (29). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Every time a patient changes their level of care, the health care team must handoff essential information. Failure to adequately complete this process can lead to patient harm. While current research has focused on resident handoffs the critical care team is multi-professional (MP). There is less research on the multi-professional handoff. We developed a MP committee to assess our current hand off system for patients admitted directly from the OR to the SICU. Hypothesis: The goal of this study was to determine if a MP handoff would improve staff perception of handoff quality and Pt care. Methods: In 2012 we empowered a MP team of attendings in anesthesiology and critical care, nurse anesthetist, ICU nurses and fellows, and respiratory therapist to evaluate our current handoff process on direct admits from the OR to the ICU. A new process was developed to make the handoff MP. This includes a standardized report process and written communication checklist. A 10 item handoff survey on a 4 point Likert scale was developed. Of the 10 items, four had objective measures, three evaluated process, and 2 communications, the 10th item was an overall rating. Compliance and perceptions of the handoff process before and after establishing the MP handoff was compared. Responses before and after were tested using Mann Whitney U with significance set at 0.05. Results: There were 124 presurvey and 93 post-survey responses. The average increase was 0.31 (range 0.01- 0.51). There was an overall improvement and in 3 objective (30 & 5 min notice, resident presence on arrival), 2 process (Clear role defined & tine for questions), and 2 communication (adequate phone & in-person report given) measures (p < 0.05). Increased, improvements in pt stability and having a clear transition were NS. CRNAs and RN were more likely to report improvements then MDs or RTs. All team members thought the care was improved with a MP handoff. Conclusions: A structured MP handoff improves information exchange and process of care on direct admits from the OR to ICU. The checklist improves the ability to monitor the performance of the MP team and subjectively improved patient care. A future prospective evaluation of patient outcomes is warranted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient society EMTREE MEDICAL INDEX TERMS anesthesiology checklist health care hypothesis interpersonal communication Likert scale nurse nurse anesthetist patient care respiratory therapist LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065286 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 454 TITLE Mortality among unplanned intensive care unit transfer cases AUTHOR NAMES Mochizuki T. AUTHOR ADDRESSES (Mochizuki T.) St. Luke's International Hospital, United States. CORRESPONDENCE ADDRESS T. Mochizuki, St. Luke's International Hospital, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (193). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Rapid response systems (RRS) are very important for hospitalized patients whose conditions deteriorate acutely. However, a unified RRS protocol is not practicable because facilities vary across hospitals. Hypothesis: We aimed to find the associations between causes and mortality in unplanned intensive care unit (ICU) transfer cases. Methods: Our prospective observational study included unplanned ICU transfer cases to 42 ICU beds in an urban teaching hospital from December 1, 2010 to November 30, 2011. We measured mortality as well as causes (6 types) and objectives (4 types) of ICU transfer. We analyzed the associations between mortality and these causes/objectives. Results: The 205 unplanned ICU transfer cases observed constituted 1.3% of all hospitalized patients. The mortality in these cases constituted 27.3% of overall hospital mortality. The causes of ICU transfer were failure of initial management (3%), failure to predict sudden patient deterioration (24%), failure to prevent sudden deterioration (1%), complications of the procedure (19%), early transfer after predicting sudden deterioration (28%), and difficulty in predicting sudden deterioration (25%). The objectives of ICU transfer were respiratory management (46%), circulatory management (28%), neurological management (19%), and monitoring (31%). The cause with the highest mortality was failure to predict sudden patient deterioration (48%). The objective with the highest mortality was respiratory management (43.2%). Conclusions: Our results indicate the characteristics of unplanned ICU transfer cases in our hospital and that the prognosis of patients undergoing unplanned ICU transfer with sudden, severe deterioration is poor, and that their prognosis is good if ICU transfers for monitoring occurs at an early stage. Thus, it is important to understand the trends in each hospital to develop an effective RRS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care intensive care unit mortality society EMTREE MEDICAL INDEX TERMS deterioration hospital hospital patient human hypothesis monitoring observational study patient procedures prognosis rapid response team teaching hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065911 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 455 TITLE Improving emgergency department to intensive care unit transfer time does not effect morbidity or mortality AUTHOR NAMES Frost J. Syed M. Mazer J. Reinert S. Carino G. AUTHOR ADDRESSES (Frost J.; Syed M.; Carino G.) Miriam Hospital, United States. (Mazer J.) Miriam Hospital, Rhode Island Hospital, United States. (Reinert S.) Brown University, United States. CORRESPONDENCE ADDRESS J. Frost, Miriam Hospital, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (197-198). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Emergency Department (ED) patient flow and prolonged waits for inpatient beds are constant problems for many institutions. Current data is inconclusive on outcomes of critically ill patients with extended stays in the ED. Since October 2009, as part of a collaborative quality improvement (QI) project between the ICU and ED, we have worked to reduce the amount of time critically ill patients spend in the ED. Hypothesis: The objective of this study was to determine if this reduction in time was associated with higher mortality. Methods: As part of the QI project, all patients admitted to the ICU through the ED between October 2009 and August 2011 were collected. Time of admission decision in the ED and time of arrival in the ICU were recorded. We compared hospital mortality, ICU and hospital length of stay for patients above and below a 90 minute threshold. We also compared mortality in the subgroups of respiratory failure, shock and stroke. Results: There was an observed decline in the mean duration of stay in the ED post decision to admit from October 2009 (130+/-72 minutes, n=49) to August 2011 (69+/-30 minutes, n= 53), p <.01. During the study period, 317 patients were admitted <=90 minutes and 209 were >90 minutes. The survival rate for those admitted <=90 minutes was 86.7% and 90.3% for those >90 minutes (p=0.234). There was also no difference in mean ICU or hospital length of stay. For the subgroups of respiratory failure, shock and stroke, we also found no differences in hospital mortality. Conclusions: As part of a collaborative initiative to improve ED to ICU flow, we were able to decrease the duration of stay post ICU admission decision in the ED. Importantly, we did not find a difference in hospital mortality. Furthermore, we did not see any difference in ICU or hospital length of stay between the groups. These results were consistent in easily defined subgroups of patients including those with respiratory failure, shock and stroke. These data suggest that improvements in patient flow of critically-ill patients may be accomplished without adversely affecting mortality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care intensive care unit morbidity mortality society EMTREE MEDICAL INDEX TERMS cerebrovascular accident critically ill patient emergency ward hospital hospital patient human hypothesis length of stay patient respiratory failure survival rate total quality management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065928 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 456 TITLE Elective bedside tracheostomy at the intensive care unit: A safe option compared to the operating room? AUTHOR NAMES Do Ceará V.D.A. Fernandes I. Queiroz-Asfor Pontes-Arruda A. Martins L.F. Távora H.F. Dos Santos M.C.F.C. Furtado-Lima B. De Castro L.G. Neto H.M.-C. AUTHOR ADDRESSES (Do Ceará V.D.A.; Furtado-Lima B.; De Castro L.G.; Neto H.M.-C.) Faculdade de Medicina Christus, Brazil. (Fernandes I.; Queiroz-Asfor; Martins L.F.; Távora H.F.; Dos Santos M.C.F.C.) Hospital Fernandes Távora, Brazil. (Pontes-Arruda A.) Hospital Fernandes Távora, Faculdade de Medicina Christus, Brazil. CORRESPONDENCE ADDRESS V.D.A. Do Ceará, Faculdade de Medicina Christus, Brazil. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (199). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: To evaluate the incidence of minor and major complications associated with open surgical tracheostomy performed at the bedside. Hypothesis: Tracheostomy is a frequently performed procedure, and historically has had a high reported complication rate. This has led some authors to suggest that a tracheostomy should be done only in the operating room (OR). Concerns regarding the hazards of transporting critically ill patients to the OR may inhibit the use of tracheostomy. Bedside tracheostomy in the Intensive Care Unit (ICU) has been shown to be safe, but this concept has not been widely accepted. Methods: This was a prospetive and cohort study evaluating all elective and open surgical tracheostomies performed at the beside in the intensive care department of a tertiary hospital during one year(July/2008 to June/2009). Data regarding the demographic charateristicas of the patients (such as age, gender, APACHE II score) as well and the incidence of minor and major complications was collected. Results: A total of 46 elective procedures were evaluated. The mean age was 70.7±14.9 years, APACHE II 25.5±7.0, and 58.7% of the included patients were males. It was observed an incidence of 6.52% of major complications (one infection and two major bleeding episodes associated with the procedure), no minor complications were observed. Conclusions: The incidence of complications associated with open surgical tracheostomy performed at the ICU bedside in the population evaluated in this work was considered similar to what has been previously described in the literature (Petrotos et al.Crit Care Med 27,1999) and, therefore, was considered safe and without the inconvenience and inherent risks of intra-hospital transport of critically ill and potentially unstable patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care intensive care unit operating room society tracheostomy EMTREE MEDICAL INDEX TERMS APACHE bleeding cohort analysis critically ill patient gender hazard hospital human hypothesis infection male patient population procedures risk tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065935 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 457 TITLE Evaluation of post-pyloric feeding tube placement using electromagnetic placement device in the PICU AUTHOR NAMES Brown A.-M. Handwork C. Perebzak C. Nagy K. Gothard M. AUTHOR ADDRESSES (Brown A.-M.; Handwork C.; Perebzak C.; Nagy K.) Akron Children's Hospital, United States. (Gothard M.) BIOSTATS, United States. CORRESPONDENCE ADDRESS A.-M. Brown, Akron Children's Hospital, United States. SOURCE Critical Care Medicine (2012) 40:12 SUPPL. 1 (79). Date of Publication: December 2012 CONFERENCE NAME 42nd Critical Care Congress of the Society of Critical Care Medicine, SCCM 2013 CONFERENCE LOCATION San Juan, Puerto Rico CONFERENCE DATE 2013-01-19 to 2013-01-23 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: When gastric feeding is not tolerated in the Pediatric ICU (PICU), a post-pyloric feeding tube (PPFT) may be placed, both requiring radiologic confirmation. Conventional bedside PPFT placement (CBP) may require multiple attempts/tubes, radiation exposures (RE), intra-hospital transports (IHT) and staff time. PPFT placement using an electromagnetic (EM) tipped stylet that emits a signal detected by the Cortrak© device (Corpak MedSystems) allows the user to track the progress across the pylorus. Few PICU studies have been done with this device. Our hospital purchased the device and we launched an efficacy study as part of the implementation process. Hypothesis: There is no difference in the number of RE, IHT, insertion costs (IC), or # attempts to achieve PPFT between CBP and the Cortrak© device. Methods: Quasi-experimental design comparing data from a historical control group (Jan-Jun 2011), to a prospective intervention group (Jan-Jun 2012). Sample/Setting: PICU patients < 18years of age and? 3kg requiring PPFT in a 23 bed freestanding pediatric teaching hospital. PICU nurse practitioners were trained in device use Sept 2011, followed by a “washout” period Oct-Dec 2011. Primary outcome was number of RE. Demographic/outcomes data obtained from Virtual PICU Performance System (VPS, LLC). Results: Total subjects N=77 (pre-32, post-45). There were no differences between groups in gender, age, PICU length of stay, diagnostic groups, or severity of illness scores (p >0.05). There were differences between control vs intervention groups in mean number of RE (1.6 vs 1.2, p=.024), successful insertion attempts [29/68 (42.6%) vs 54/84 (64.3%) p=.008, OR 3.72 (95% C.I., 1.35 - 10.26)], IHT (0.3 vs 0.1, p=.013), number of tubes charged (1.3 vs 1.0 p=.004) and costs per episode ($488.64 vs $356.59, p=.008). Conclusions: Our results indicate strong evidence for use of the Cortrak or similar device as an adjunct for PPFT placement in pediatrics, positively impacting safety, efficacy, and efficiency and timeliness. Limitations include diverse group RN inserters in control vs small NP intervention group. Historical controls may introduce bias but no differences were detected. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) devices feeding apparatus intensive care society EMTREE MEDICAL INDEX TERMS control group diagnosis related group diseases experimental design feeding gender hospital human hypothesis length of stay nurse practitioner patient pediatrics pylorus radiation exposure safety teaching hospital tube LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71065474 DOI 10.1097/01.ccm.0000425605.04623.4b FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000425605.04623.4b COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 458 TITLE [Pages of the past: hospitalization and regime for patients with myocardial infarction]. AUTHOR NAMES Syrkin A.L. Sazonova I.S. AUTHOR ADDRESSES (Syrkin A.L.; Sazonova I.S.) CORRESPONDENCE ADDRESS A.L. Syrkin, SOURCE Klinicheskaia meditsina (2012) 90:9 (79-80). Date of Publication: 2012 ISSN 0023-2149 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart infarction (therapy) patient transport EMTREE MEDICAL INDEX TERMS article disease management emergency health service history hospitalization human methodology LANGUAGE OF ARTICLE Russian MEDLINE PMID 23214022 (http://www.ncbi.nlm.nih.gov/pubmed/23214022) PUI L366369266 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 459 TITLE Interfacility transportation of the critical care patient and its medical direction. Policy statement. AUTHOR NAMES American College of Emergency Physicians AUTHOR ADDRESSES (American College of Emergency Physicians) SOURCE Annals of emergency medicine (2012) 60:5 (677). Date of Publication: Nov 2012 ISSN 1097-6760 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport physician EMTREE MEDICAL INDEX TERMS article emergency medicine human manpower standard LANGUAGE OF ARTICLE English MEDLINE PMID 23089103 (http://www.ncbi.nlm.nih.gov/pubmed/23089103) PUI L366362900 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 460 TITLE Interfacility transfers of noncritically ill children to academic pediatric emergency departments AUTHOR NAMES Bosch D. Li J. Monuteaux M. Bachur R. AUTHOR ADDRESSES (Li J.; Monuteaux M.; Bachur R.) (Bosch D.) Denver Health Medical Center, Denver, United States. CORRESPONDENCE ADDRESS D. Bosch, Denver Health Medical Center, Denver, United States. SOURCE Journal of Emergency Medicine (2012) 43:5 (e382-e383). Date of Publication: November 2012 CONFERENCE NAME 1st Pan-Pacific Emergency Medicine Congress CONFERENCE LOCATION Seoul, South Korea CONFERENCE DATE 2012-10-23 to 2012-10-26 ISSN 0736-4679 BOOK PUBLISHER Elsevier USA ABSTRACT There are over 27 million pediatric Emergency Department (ED) visits annually in the United States. Of these, 89% occur in general EDs, many of which operate without dedicated pediatric staff. Previous studies have raised growing concerns regarding children receiving suboptimal care in rural, non-academic centers, and other recent studies have shown that critically ill pediatric patients have improved outcomes when cared for in a Pediatric Intensive Care Unit. However, whether these outcomes translate to non-critically ill patients has not been well studied. The current study was a cross-sectional analysis to evaluate pediatric inter-facility transfers with regards to ED management and disposition at the receiving facility. Included in the 1-year study period were patients younger than 18 years of age with an inter-facility transport to one of 29 tertiary care pediatric hospitals in the United States. The primary study measures were diagnoses and ED management. These measures were compared in patients categorized into three groups based upon disposition: 1) those directly discharged from the ED, 2) those admitted for < 24 h, and 3) those admitted for more than 24 h. During the study period, 22,891 inter-facility transfers were included in the data analysis. Overall, 24.7% of patients were discharged directly from the ED, 17% were admitted for < 24 h, and 58.4% required more than 24 h of hospitalization. Orthopedic injuries were the most common diagnoses for which patients were transferred, of which 48.5% of patients were discharged directly from the ED, 27.1% were admitted for < 24 h, and 25.4% required more than 24 h of hospitalization. Regardless of diagnosis, approximately 21% of patients who were directly discharged from the ED received no medications, testing, or procedures. In addition, 33% received nothing more than acetaminophen, ibuprofen, ondansetron, or a plain radiograph. The most common diagnoses in these patients were orthopedic/ hand injuries (16%), non-surgical abdominal pain (6.2%), and gastroenteritis/dehydration (5.5%). Of patients transferred for orthopedic conditions, 48.5% were discharged from the ED. This was true for 72.5% of non-surgical abdominal pain patients and 40.4% of those with viral gastroenteritis/dehydration. The authors concluded that it is not ideal to transfer all children to academic pediatric hospitals considering that 41.7% of such patients had a < 24-h hospital stay, suggesting low acuity. They encourage ongoing physician and nurse education in pediatrics, with a focus on abdominal pain, gastroenteritis, orthopedics, asthma, and seizures. Reducing unnecessary inter-facility transports in low-acuity patients could potentially decrease duplication in testing and treatment, which wastes resources and leads to decreased patient satisfaction. EMTREE DRUG INDEX TERMS ibuprofen ondansetron paracetamol EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child emergency medicine emergency ward human EMTREE MEDICAL INDEX TERMS abdominal pain asthma critically ill patient data analysis diagnosis drug therapy gastroenteritis hand injury hospital hospitalization injury intensive care unit nursing education orthopedics patient patient satisfaction pediatrics physician procedures seizure tertiary health care United States waste X ray film LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70931271 DOI 10.1016/j.jemermed.2012.09.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.jemermed.2012.09.012 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 461 TITLE Face-to-face handoff: Improving transfer to the pediatric intensive care unit after cardiac surgery AUTHOR NAMES Vergales J.E. Addison N.G. Nicholson E.A. Carver D.J. Baum V.C. Gangemi J.J. AUTHOR ADDRESSES (Nicholson E.A.) (Vergales J.E.; Addison N.G.; Carver D.J.) Pediatrics, University of Virginia, Charlottesville, United States. (Baum V.C.) Anesthesiology, University of Virginia, Charlottesville, United States. (Gangemi J.J.) Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, United States. CORRESPONDENCE ADDRESS J.E. Vergales, Pediatrics, University of Virginia, Charlottesville, United States. SOURCE Pediatric Critical Care Medicine (2012) 13:6 (709). Date of Publication: November 2012 CONFERENCE NAME American Academy of Pediatrics Section on Critical Care National Conference and Exhibition, AAP 2012 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2012-10-21 to 2012-10-21 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose: The transfer of children after cardiac surgery to the intensive care unit (ICU) is a critical step in ensuring smooth post-operative management. This requires excellent communication and coordination among a variety of providers to make certain details are not overlooked and the handoff process is accurate, complete and efficient. Methods: We sought to develop a comprehensive, primarily face-to-face, handoff process that begins initially in the operating room and concludes at the bedside in the ICU. The system involves formalized process steps, utilizing a variety of essential providers across multiple disciplines, with the goal of improving overall accuracy and efficiency. After an initial trial period to accommodate unforeseen problems, the final process was evaluated by the use of observer checklists to evaluate quality metrics and timing in all subsequent patients admitted to the ICU following cardiac surgery. Results: Prior to initiation of the new system, only 73% of providers at our institution believed that information transfer was smooth from one unit to another. Similarly, only 41% believed the process to be standard among all providers, and just 58% believed there was good interdisciplinary communication and efficiency at the time of transfer. 30 cases were observed after the new system was finalized. The admitting nurse travelled to the operating room near the completion of the case to receive face-to-face handoff prior to assisting in the transport to the ICU. The total time to stabilize, secure and transport the patient was not prolonged (mean of 26.0 minutes ± 8.5) and was not statistically significant when stratified across RACHS-1 categories (p=0.82), meaning that even the most complex patients were able to be transported efficiently. Similarly, the time from patient arrival in the ICU to completion of handoff was rapid (mean of 7.8 minutes ± 4.2) and also did not differ when stratified to complexity of the surgery (p=0.30). This step included the stabilization of lines, drains and airways, drawing necessary labs, reporting of an initial arterial blood gas, obtaining a chest radiograph and initiation of face-to-face handoff among all providers caring for the child. Accuracy of information was assured by the use of a standardized electronic post-operative note completed during the case by the anesthesiologist, with 100% compliance, and available prior to the patient's arrival in the ICU. Further, all subspecialties and ancillary services involved were able to be present 90% of the time for the final steps of the handoff. Conclusion: A standardized process-driven system, that emphasizes face-to-face communication, can be implemented for transferring patients to the ICU after cardiac surgery. It can improve efficiency and accuracy of the information in addition to improving overall communication between the many providers caring for these critical patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart surgery intensive care intensive care unit pediatrics EMTREE MEDICAL INDEX TERMS airway anesthesist arterial gas checklist child human interdisciplinary communication interpersonal communication nurse operating room patient surgery thorax radiography LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70931471 DOI 10.1097/PCC.0b013e31826df088 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e31826df088 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 462 TITLE 2012 critical care transport workplace and salary survey AUTHOR NAMES Greene M.J. AUTHOR ADDRESSES (Greene M.J., mgreene@fitchassoc.com) Fitch and Associates, LLC, Platte City, MO, United States. CORRESPONDENCE ADDRESS M.J. Greene, Fitch and Associates, LLC, Platte City, MO, United States. Email: mgreene@fitchassoc.com SOURCE Air Medical Journal (2012) 31:6 (276-280). Date of Publication: November-December 2012 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Critical care transport (CCT) is provided in a unique and challenging out-of-hospital environment. The workplace and salaries for CCT staff are similarly unique and distinct within the health care industry. An industry-specific workplace and salary survey was conducted under Federal Safe Harbor guidelines to update information for 2012. As safety is a key concern for CCT workers and organizations, the survey elicited industry best practices under safety management system (SMS) categories. © 2012 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care occupational safety EMTREE MEDICAL INDEX TERMS health care industry human medical practice medical staff practice guideline priority journal review risk assessment salary workplace EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Occupational Health and Industrial Medicine (35) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012636533 MEDLINE PMID 23116868 (http://www.ncbi.nlm.nih.gov/pubmed/23116868) PUI L365948353 DOI 10.1016/j.amj.2012.09.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.09.004 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 463 TITLE Reducing cost at the end of life by initiating transfer to inpatient hospice in the emergency department AUTHOR NAMES DeVader T.E. DeVader S.R. Jeanmonod R. AUTHOR ADDRESSES (DeVader T.E.; DeVader S.R.; Jeanmonod R.) Kaweah Delta Med. Ctr., Visalia, CA, USA; Arcadia Univ., Glenside, PA, USA; St. Luke's Hosp. and Hlth. Care Netwk., Bethlehem, PA, USA CORRESPONDENCE ADDRESS T.E. DeVader, SOURCE Annals of Emergency Medicine (2012) 60:4 SUPPL. 1 (S73). Date of Publication: October 2012 CONFERENCE NAME American College of Emergency Physicians, ACEP Research Forum 2012 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2012-10-08 to 2012-10-09 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: The objective of this study was to determine the cost savings associated with transferring patients directly from the emergency department (ED) to an inpatient hospice unit. Methods: This is a retrospective cohort of patients who died at an inpatient hospice unit from July 1, 2008, to June 30, 2010. The study site was an academic tertiary Level-1 trauma center with approximately 75,000 ED visits annually. Using inpatient hospice unit admission records and the hospital's electronic medical record, the place of transfer initiation to the inpatient hospice unit was determined. The places of transfer initiation included the ED, Intensive Care Unit (ICU), and the general medical floor. All patients admitted to the inpatient hospice unit during the specified time frame were eligible for inclusion in the study. Exclusion criteria included patients transferred to the inpatient hospice unit who were not admitted to the hospital from the ED, patients who were trauma alerts, patients who were enrolled in Hospice but transfer to the inpatient hospice unit was not completed, and patients who were admitted to the inpatient hospice unit from other hospitals. Cost and charges pertaining to the hospitalization were determined from financial records, with admission to ED to time of death comprising the time period assessed. All dollars were adjusted for inflation to 2010 dollars. Since data was not normally distributed, nonparametric statistical tests were utilized for median dollar comparisons. The study was deemed exempt by the institutional review board. Results: A total of 372 patients met study criteria. Forty three patients were transferred directly from the ED to the inpatient hospice unit, 31 patients were transferred from the ICU to the inpatient hospice unit, 226 patients were transferred from the medical floor to the inpatient hospice unit and 72 patients had combined ICU and floor stays prior to transfer. Hospital charges were reduced in patients transferred from the ED ($3,652) versus those transferred from all inpatient services ($65,156, p < 0.0001). Although part of this can be attributed to room and board charges (median ED room and board charges $0, median inpatient room and board charges $26,591.13, p < 0.0001), there were also differences in charges for laboratory studies ($783.54 versus $3,440.13, p < 0.0001) and radiology studies ($446.90 versus $3,992.63, p < 0.0001). When the ED portions of the patients' stays were viewed independently of other hospital charges, the ED charges generated by patients transferred directly to an inpatient hospice unit were less than those who were admitted to the hospital prior to transfer ($1,321.00 versus $1,641.00, p < 0.0001). Total cost for the patient's hospital and inpatient hospice unit stay was also reduced for patients who were transferred to an inpatient hospice unit directly from the ED as opposed to those who were admitted to the hospital prior to transfer ($3,347.35 versus $11,119.90, p < 0.0001). All charge and cost differentials were accentuated when comparing patients with ICU stays to patients transferred directly from the ED (Table 1). (Table Presented) Conclusion: Initiating transfers to an inpatient hospice unit from the ED significantly reduces hospital charges (ED, room and board, laboratory, and radiology) and hospital costs with the most significant savings in those patients who spend any time in the ICU during their hospitalization. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) college emergency physician emergency ward hospice hospital patient human EMTREE MEDICAL INDEX TERMS cost control electronic medical record emergency health service hospital hospital charge hospital cost hospitalization injury institutional review intensive care unit laboratory patient radiology Tertiary (period) time of death LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70897289 DOI 10.1016/j.annemergmed.2012.06.180 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2012.06.180 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 464 TITLE 'Tubes' and catheter positions in neonates transferred to a tertiary neonatal intensive care unit over a 2 year period AUTHOR NAMES Nepali G. Tasbihi M. Egyepong J. AUTHOR ADDRESSES (Nepali G.; Egyepong J.) Neonatal Intensive Care Unit, Luton and Dunstable Hospital NHS Trust, Luton, United Kingdom. (Tasbihi M.) Department of Paediatric, Luton and Dunstable University Hospital NHS Trust, Luton, United Kingdom. CORRESPONDENCE ADDRESS G. Nepali, Neonatal Intensive Care Unit, Luton and Dunstable Hospital NHS Trust, Luton, United Kingdom. SOURCE Archives of Disease in Childhood (2012) 97 SUPPL. 2 (A373-A374). Date of Publication: October 2012 CONFERENCE NAME 4th Congress of the European Academy of Paediatric Societies CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2012-10-05 to 2012-10-09 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Introduction • Endotracheal tubes (ETT), Chest tubes (CT), Nasogastric tubes (NGT), umbilical artery and venous catheters (UAC, UVC), Long lines (LL) are crucial in the management of babies transferred and admitted to neonatal intensive care units (NICU). Optimal positions must be ascertained before transfer and on admission to avoid complications. • To the best of our knowledge, there has not been any published data looking at admission positions of all these tubes and catheters. Aim To determine: • positions of these tubes and lines on admission of babies transferred for intensive care to a tertiary NICU. • any radiological and other complications that may have been associated with sub-optimally placement on admission. Methods Retrospective study • All babies transferred in • Inclusion criteria: Admission X-ray done within 12 hrs Results • 148 babies were admitted for tertiary neonatal care of which 127 met inclusion criteria. Patients were stratified as < 1 kg, 1-2 kg and >2 kg. Correctly positioned tubes were as follows: • < 1 kg: 33% ETT, 81%NGT, 48% UAC • 1-2 kg: 31% ETT, 100% NGT, 33%UAC • >2kg: 54% ETT, 100% NGT, 31%UAC Conclusion • Infants less than 1 kg were at higher risk of suboptimally positioned tubes and lines. • Position prior to transfer and on admission must be ascertained to minimise complications. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) catheter intensive care unit newborn newborn intensive care organization Tertiary (period) tube EMTREE MEDICAL INDEX TERMS baby chest tube endotracheal tube human infant intensive care intravenous catheter nasogastric tube newborn care patient retrospective study risk umbilical artery X ray LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71063240 DOI 10.1136/archdischild-2012-302724.1311 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2012-302724.1311 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 465 TITLE Is delayed ICU referral associated with adverse maternal outcome? A study at tertiary level hospital in India AUTHOR NAMES Khan M.S. Sultana T. AUTHOR ADDRESSES (Khan M.S.) Dept of Anesthesiology, Lady Hardinge Medical College, New Delhi, India. (Sultana T.) Dept of Obstetrics and Gynecology, Lady Hardinge Medical College, New Delhi, India. CORRESPONDENCE ADDRESS M.S. Khan, Dept of Anesthesiology, Lady Hardinge Medical College, New Delhi, India. SOURCE International Journal of Gynecology and Obstetrics (2012) 119 SUPPL. 3 (S389). Date of Publication: October 2012 CONFERENCE NAME 20th FIGO World Congress of Gynecology and Obstetrics CONFERENCE LOCATION Rome, Italy CONFERENCE DATE 2012-10-07 to 2012-10-12 ISSN 0020-7292 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objectives: Delay in ICU referral is a common phenomenon in the government hospitals of developing nations. This kind of delay has been associated with adverse outcomes in various ICU populations. Present study was designed to find out association between delayed ICU referral and 28-day mortality in obstetric critically ill patients. Materials: A retrospective cohort study was performed on obstetric patients referred to the surgical-medical ICU of LHMC and SSK Hospital, New Delhi, India from January 2010 to December 2011. All critically ill women admitted to ICU during pregnancy or within 6 weeks of delivery and ICU length of stay (ICU LOS) greater than 24 hours of admission were included in the study. Methods: ICU referral was classified as either delayed referral (DR) or immediate referral (IR). We defined the delayed ICU referral as “ICU referral after 6 hours of admission to gynecology casualty”. Times of admission to gynecology casualty, first ICU referral and ICU admission, indication of ICU referral, ICU diagnosis, interventions required, course during ICU stay and maternal outcome were recorded for each patient on a pre-structured data sheet. The primary outcomes analyzed were the 28-day maternal mortality, SAPS (Simplified Acute Physiological score) II and ICU LOS. Results: One hundred and twenty six obstetric patients were included in study. Delayed referral was recorded in about 47% of patients. Mean delay in ICU referral was 7.96±9.47 hours which was significantly higher among DR group as compared to IR group (1.31±1.20 vs 14.61±9.45; p < 0.001). The overall 28-day mortality was 27.8% percent which was significantly higher in DR group as compared to IR group (38.9% vs 17.9%; p < 0.001). ICU LOS was also longer in DR group. Patients in DR group had significantly higher SAPS II scores as compared to those in IR group (43.19±9.52 vs 29.66±5.42; p < 0.0001). There were no significant differences in the two groups with respect to age, gestational age, parity, number of antenatal visits and co-morbidities. Conclusions: This study outlines the impact of delayed ICU referral on maternal mortality in developing nations. This delay is potentially preventable. Hospital administration should take solid steps to minimize delays in decision making, pre-ICU care and intra-hospital transfer of critically ill patients. Specific institutional triage algorithm should be developed at obstetric emergency room for timely referral of high priority obstetric patients to the ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) gynecology hospital India obstetrics EMTREE MEDICAL INDEX TERMS accident adverse outcome algorithm cohort analysis critically ill patient decision making diagnosis emergency health service emergency ward female gestational age government hospital management human length of stay maternal mortality morbidity mortality obstetric emergency obstetric patient parity patient population pregnancy solid LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70905696 DOI 10.1016/S0020-7292(12)60793-0 FULL TEXT LINK http://dx.doi.org/10.1016/S0020-7292(12)60793-0 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 466 TITLE Reduction in late-onset sepsis on relocating a neonatal intensive care nursery AUTHOR NAMES Jones A.R. Kuschel C. Jacobs S. Doyle L.W. AUTHOR ADDRESSES (Jones A.R.; Kuschel C.; Jacobs S.; Doyle L.W., lwd@unimelb.edu.au) Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, 20 Flemington Road, Parkville, VIC 3052, Australia. (Doyle L.W., lwd@unimelb.edu.au) Critical Care and Neurosciences Theme, Murdoch Childrens Research Institute, Parkville, Australia. (Jones A.R.; Kuschel C.; Jacobs S.; Doyle L.W., lwd@unimelb.edu.au) Neonatal Services, Royal Women's Hospital, Melbourne, VIC, Australia. CORRESPONDENCE ADDRESS L.W. Doyle, Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, 20 Flemington Road, Parkville, VIC 3052, Australia. Email: lwd@unimelb.edu.au SOURCE Journal of Paediatrics and Child Health (2012) 48:10 (891-895). Date of Publication: October 2012 ISSN 1034-4810 1440-1754 (electronic) BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT Aims: The aims of this study were to compare rates of late-onset sepsis (LOS) in very preterm or very low birthweight infants before and after relocation to a new nursery and to determine risk factors for LOS. Methods: The study was undertaken at The Royal Women's Hospital, Melbourne, which relocated to a new site in June 2008. Infants with birthweight <1500 g or <32 weeks' gestation, born between July and December 2007 (n= 149) and July and December 2008 (n= 152) were included. Each septic episode was identified from blood cultures taken from patients >48 h after birth and was categorised as definite, probable, uncertain or no sepsis. Results: Overall, 117 infants had 218 septic episodes. The proportion of infants with clinical LOS decreased from 29.5% in 2007 to 22.4% in 2008 after the relocation, although this was not statistically significant. There was a significant (P < 0.05) reduction in the severity (definite LOS = most severe) of sepsis in 2008 compared with 2007, and in rates of coagulase-negative staphylococcal LOS. Significant risk factors for LOS were: lower birthweight (g; mean -351, 95% confidence interval (CI) -446, -256); lower gestational age (weeks; mean -2.3, 95% CI -2.8, -1.7) and presence of a percutaneous inserted central catheter (odds ratio (OR) 2.56, 95% CI 1.03, 6.67). Conclusions: There was a significant reduction in the severity of LOS in very preterm and/or very low birthweight infants that correlated with the relocation from the old to new nursery. Smaller and more immature infants with percutaneous central catheters were more at risk. © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) late onset sepsis newborn care newborn sepsis sepsis EMTREE MEDICAL INDEX TERMS antibiotic therapy artery catheter article birth weight blood culture central venous catheterization coagulase negative Staphylococcus disease association disease severity endotracheal tube Escherichia coli gestational age hospital hygiene human immaturity infant infection risk intravenous catheter Klebsiella pneumoniae length of stay major clinical study newborn newborn intensive care patient transport positive end expiratory pressure prematurity priority journal Pseudomonas aeruginosa risk factor Streptococcus agalactiae treatment duration very low birth weight EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012625494 MEDLINE PMID 22897216 (http://www.ncbi.nlm.nih.gov/pubmed/22897216) PUI L52172744 DOI 10.1111/j.1440-1754.2012.02524.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1440-1754.2012.02524.x COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 467 TITLE Do we need to reconcile medicines when patients are transferred between wards and critical care? AUTHOR NAMES Hebron B. Graham-Clarke E. Shafia A. Sohal K. AUTHOR ADDRESSES (Hebron B.; Shafia A.; Sohal K.) Aston University, Birmingham, United Kingdom. (Hebron B.; Graham-Clarke E.) Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom. CORRESPONDENCE ADDRESS B. Hebron, Aston University, Birmingham, United Kingdom. SOURCE International Journal of Pharmacy Practice (2012) 20 SUPPL. 2 (81). Date of Publication: October 2012 CONFERENCE NAME Royal Pharmaceutical Society, RPS Annual Conference 2012 CONFERENCE LOCATION Birmingham, United Kingdom CONFERENCE DATE 2012-09-09 to 2012-09-10 ISSN 0961-7671 BOOK PUBLISHER Pharmaceutical Press ABSTRACT Introduction: In December 2007, the National Institute for Clinical Excellence and the National Patient Safety Agency developed patient safety guidance to improve the accuracy of recording medication history through reconciliation. Subsequent audits have confirmed that appropriate continuation of maintenance medication improves the care of patients in hospital( 1). Our previous work indicated that transfer of care during critical care units might raise similar issues. The aim of the present study was to compare medicine reconciliation during the transfer from primary care to the hospital setting with that during the transfer into and out of critical care. Method: Five retrospective audits were performed between January 2009 and October 2011 to examine changes in maintenance medication recorded from admission to discharge. The study was conducted on the medical admission units [MAU] and critical care services [CCS] on the 2 hospital of the Trust. The audits examined changes during admission to hospital from primary care and from a hospital ward to CCS, from CCS to a ward and subsequent discharge from hospital. Only those patients, who were hospitalised, or only those remaining on critical care, for more than 24 hours were included. Patients who were transferred, died, readmitted to CCS or whose notes were not available were excluded. Within each patient's medical records, the initial assessment record, the ward discharge summary, the critical care service admission and discharge forms and medication records were scrutinised to identify any changes in maintenance medication during the admission. The data was gathered by pharmaceutical staff and final year undergraduate students, and reviewed by a consultant or senior pharmacist with expertise in the area. Approval by the Clinical Effectiveness Committee of the Trust was given for this analysis. Results: During the course of the study 576 patients who were admitted to MAU met the entry criteria, of whom the notes of 196 were available for analysis and 195 patients admitted to CCS who met the entry criteria, of whom the notes of 63 were available. A total of 2345 medicines were examined, of which 390 [16.6%] required amendment of the prescription. Most discrepancies [365 of the 390 - 93%] were for omission of medicines of which the most common were cardiovascular medicines [11%] followed by those with an action on the central nervous system [9%]. Errors were greater on admission to hospital affecting 196 patients [19.6%] and on discharge from CCS, affecting 126 patients [66%], than on transfer from MAU to a ward [8% of patients] or from a ward to CCS [6.5% of patients]. Discussion: This study has found that on admission to hospital, most discrepancies in medication history are omissions of maintenance medication. This supports other reports in the literature where reconciliation on admission to hospital has been described(1). Maintenance medicines are often stopped on CCS as patients are unable to take oral medicines and rapid intravenous treatment is available to treat acute conditions. We have found that this is often not communicated on discharge from CCS to other wards. During the course of this work similar results have been reported from Canada(2). We believe that CCS should be regarded as a transition of care requiring a further reconciliation of medication from that on admission to hospital. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care organization human intensive care patient ward EMTREE MEDICAL INDEX TERMS acute disease Canada central nervous system clinical audit clinical effectiveness consultation drug therapy hospital medical record patient safety pharmacist prescription primary medical care recording stomatology undergraduate student LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70879083 DOI 10.1111/j.2042-7174.2012.00235.x FULL TEXT LINK http://dx.doi.org/10.1111/j.2042-7174.2012.00235.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 468 TITLE Hemodynamic and oxygen transport during aortocoronary shunting on the working heart AUTHOR NAMES Ibadov R.A. Mansurov A.A. Arifjanov A.S. Mansurov Z.N. Strijkov N.A. AUTHOR ADDRESSES (Ibadov R.A.; Mansurov A.A.; Arifjanov A.S.; Mansurov Z.N.; Strijkov N.A.) Republican Specialized Center of Surgery named after acad. V. Vakhidov, Tashkent, Uzbekistan. CORRESPONDENCE ADDRESS R.A. Ibadov, Republican Specialized Center of Surgery named after acad. V. Vakhidov, Tashkent, Uzbekistan. SOURCE Intensive Care Medicine (2012) 38 SUPPL. 1 (S160). Date of Publication: October 2012 CONFERENCE NAME 25th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2012 CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2012-10-13 to 2012-10-17 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT OBJECTIVE. To evaluate the impact of the algorithm based on a combination of transpulmonary dilution and continuous venous blood oxygen saturation monitoring on preoperative infusion therapy and hemodynamic correction and on the length of postoperative stay in an intensive care unit and at hospital after aortocoronary bypass surgery without extracorporeal circulation. SUBJECTS AND METHODS. The patients were randomized to two hemodynamic monitoring groups: 1. routine monitoring (RM) (n = 20) and 2. complex monitoring (CM) (n = 20). In the RM group, therapy was based on the values of central venous pressure, mean blood pressure (BP mean), and heart rate (HR). In the CM group, it was founded on the values of intrathoracic blood volume index, BP mean, HR, central venous saturation (ScvO(2)), and cardiac index (CI). Measurements were made before, during, and 2, 4 and 6 h after surgery. RESULTS. In the CM group, colloidal solutions and dobutamine were significantly more frequently used, which was followed by increases in ScvO(2) and CI as compared with the baseline values. The frequency of use of ephedrine was significantly higher in the RM group. The algorithm based on complex monitoring reduced the time of achieving the criteria for transferring from the intensive care unit and the length of postoperative hospital stay by 15 and 25 %, respectively. CONCLUSION. Thus, the goal-oriented algorithm based on the complex monitoring of hemodynamic and oxygen transport makes it possible to reveal hemodynamic disturbances and correct them early, which can improve an early postoperative period during aortocoronary bypass surgery on the working heart. EMTREE DRUG INDEX TERMS dobutamine ephedrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart intensive care oxygen transport shunting society EMTREE MEDICAL INDEX TERMS algorithm blood oxygen tension blood volume cardiac index central venous pressure colloid coronary artery bypass surgery dilution extracorporeal circulation group therapy heart rate hemodynamic monitoring hemodynamics hospital hospitalization human infusion intensive care unit mean arterial pressure monitoring patient postoperative period surgery venous blood LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71013795 DOI 10.1007/s00134-012-2683-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-012-2683-0 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 469 TITLE Regional paediatric intensive care (PIC) transport services: Benefits of 2 becoming 1! AUTHOR NAMES Lakin B. Parkins K. Walker C. Barber R. Santo S. Claydon-Smith K. AUTHOR ADDRESSES (Lakin B.; Parkins K.; Walker C.; Barber R.; Santo S.; Claydon-Smith K.) North West and North UK Paediatric Transport Service, Warrington, United Kingdom. CORRESPONDENCE ADDRESS B. Lakin, North West and North UK Paediatric Transport Service, Warrington, United Kingdom. SOURCE Archives of Disease in Childhood (2012) 97 SUPPL. 2 (A278). Date of Publication: October 2012 CONFERENCE NAME 4th Congress of the European Academy of Paediatric Societies CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2012-10-05 to 2012-10-09 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Background Approximately 1.7 million children North West and North Wales (UK) and 600-700 are transferred annually from 31 hospitals into 2 regional PICUs. Prior to 2010 specialist PIC transport teams were unit based but review (2007) revealed problems: • Minimum 30% PIC transfers by non-specialised teams (associated with adverse incidents) • Poor access to clinical advice • Delays finding PIC bed • Delays mobilising specialist PIC transport team • Adverse incidents associated with inexperienced medical personnel (specialist teams) Regional Paediatric Transport Service (NWTS) started 2010 with a single point of contact providing advice, organisation transfer and PIC bed. Methods Several database audits (first 12 months) to assess quality of retrievals compared to previous data. Results 91.6% PIC transfers done by NWTS in first year (target > 85%). Retrieval times (median) Mobilisation 29.5mins (pre NWTS 80mins); stabilisation 102 mins (pre NWTS 110mins); total retrieval time 201mins (pre NWTS 310mins) Winter data consultant present 50% (n=40) retrievals - supporting inexperienced staff. Snapshot (6 weeks) audit showed patient management advice was substantial and potentially avert admission. For example, 13 children were initially referred, but with advice over 3 (median) phone calls (range 2-8) remained in the local centre. Better utilisation PIC beds refusal rate 5.8% versus 37% pre-NWTS. Satisfaction survey (referring hospitals) demonstrated overall satisfaction excellent or good in domains including comparison with previous arrangements and clinical care. Conclusions Our data suggest that improvement in quality has occurred since the launch of NWTS, including improved utilisation of regional PICU beds. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care organization EMTREE MEDICAL INDEX TERMS child clinical audit consultation data base hospital human medical personnel medical specialist patient care satisfaction United Kingdom winter LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71062902 DOI 10.1136/archdischild-2012-302724.0973 FULL TEXT LINK http://dx.doi.org/10.1136/archdischild-2012-302724.0973 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 470 TITLE Identifying pre-analytic variables that contribute to hemolysis in neonatal blood specimens: Sample collection site, transportation method and lipid emulsion infusion status AUTHOR NAMES Tolan N.V. Kaleta E.J. Karon B.S. Baumann N.A. AUTHOR ADDRESSES (Tolan N.V.; Kaleta E.J.; Karon B.S.; Baumann N.A.) Mayo Clinic, Rochester, United States. CORRESPONDENCE ADDRESS N.V. Tolan, Mayo Clinic, Rochester, United States. SOURCE Clinical Chemistry (2012) 58:10 SUPPL. 1 (A148). Date of Publication: October 2012 CONFERENCE NAME 64th Annual Scientific Meeting of the American Association for Clinical Chemistry, AACC 2012 CONFERENCE LOCATION Los Angeles, CA, United States CONFERENCE DATE 2012-07-17 to 2012-07-19 ISSN 0009-9147 BOOK PUBLISHER American Association for Clinical Chemistry Inc. ABSTRACT Objective: A quality improvement project was initiated to identify major pre-analytic variables associated with specimen hemolysis in the Neonatal Intensive Care Unit (NICU) with the goal of reducing the rate of hemolysis in neonatal specimens. In this study, the effects of sample collection site, specimen transportation method and lipid emulsion infusion status were systematically investigated. Methodology: Over a period of two months, specimen collection site information and lipid emulsion infusion status were recorded for patients in the NICU at Saint Marys Hospital (Rochester, MN) who had orders for routine chemistry tests (direct and total bilirubin, CRP, Mg, Phosphorus) performed in the Central Clinical Laboratory (CCL), located 1.5 miles from the NICU. All samples were collected in microtainer serum separator tubes. Chemistry analytes and H-index, to quantitate hemolysis, were measured on Roche Modular analytics (Roche Diagnostics, Indianopolis, IN). In addition, specimen transport from NICU to CCL was alternated between being hand-carried or transported by the pneumatic tube system. The data were analyzed as a binary function of hemolyzed or non-hemolyzed using the most stringent H index cut-off for the tests included (direct bilirubin). Results: Thirty-nine unique patients (20 males and 19 females) ranging in age from 28 to 68 days old (median = 46 days) were included in the study. A total of 137 samples were collected through either arterial/venous line (66%) or venipuncture (34%). The percentage of hemolyzed specimens for each collection site was 41% (21/51), 15% (7/46) and 13% (5/40) for arterial line, venipuncture and venous line, respectively. In this study 67% of patients were prescribed lipid emulsion infusion. Rates of hemolysis were 38% (8/21) for infants receiving lipid infusion at the time of sample collection, 24% (13/54) for infants prescribed lipid emulsion but for whom the infusion was paused at the time of sample collection, and 24% (11/45) for infants without a prescription for lipid emulsion therapy. Specimens that were hand-carried to the laboratory had a hemolysis rate of 9% (3/32) compared to 20% (11/54) for samples sent through the pneumatic tube. Among samples sent through the pneumatic tube, the percentage of hemolyzed samples was greatest when the patient was receiving lipids at the time of phlebotomy, 50% (6/12); compared to when the lipids were paused, 30% (10/33) and when no lipids were prescribed, 33% (8/24). Conclusions: In our study, the largest contributor to serum sample hemolysis in NICU patients was the method of sample acquisition (arterial line collection), followed by lipid infusion status at time of collection and the transport method. The data also suggest that there is an additive effect of lipid infusion at the time of sample acquisition and transport through the pneumatic tube system. The trends identified provide a starting point for practice improvements that may reduce hemolysis rates in the NICU patient population including reducing arterial line collections when possible and changes in lipid emulsion infusion protocols. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) lipid emulsion EMTREE DRUG INDEX TERMS bilirubin bilirubin glucuronide lipid phosphorus EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American blood clinical chemistry hemolysis infusion traffic and transport EMTREE MEDICAL INDEX TERMS arterial line Christian clinical laboratory diagnosis female hospital human infant intensive care unit intravenous catheter laboratory male methodology newborn intensive care patient phlebotomy population prescription serum therapy total quality management tube vein puncture LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72249848 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 471 TITLE Saving more than money: Comparison of emergency department versus hospital-initiated transfers to hospice AUTHOR NAMES DeVader T.E. DeVader S.R. Jeanmonod R. AUTHOR ADDRESSES (DeVader T.E.; DeVader S.R.; Jeanmonod R.) Kaweah Delta Med. Ctr., Visalia, CA, USA; Arcadia Univ., Glenside, PA, USA; St. Luke's Hosp. and Hlthcare. Netwk., Bethlehem, PA, USA CORRESPONDENCE ADDRESS T.E. DeVader, SOURCE Annals of Emergency Medicine (2012) 60:4 SUPPL. 1 (S108-S109). Date of Publication: October 2012 CONFERENCE NAME American College of Emergency Physicians, ACEP Research Forum 2012 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2012-10-08 to 2012-10-09 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: For patients seeking care in the emergency department (ED) in whom hospice was ultimately consulted, we sought to determine differences in time to consultation and time to death as a function of whether the patient was receiving care in the ED, the intensive care unit, or the inpatient ward. Methods: This is a retrospective cohort study of patients who were seen in the ED at evaluation and were ultimately transferred to an inpatient hospice unit from a single tertiary care 500-bed hospital with an ED census of 75,000 patients annually Patients were identified using inpatient hospice unit records of all admitted patients who died during the 2-year study period (July 1, 2008 to June 30, 2010), with subsequent identification of site of transfer initiation using the electronic medical record. Site of transfer initiation was categorized as »ED,« »ICU,« »Inpatient,« or »Combined« (for those patients who spent time on the inpatient ward as well as in the intensive care unit). Inpatient hospice unit patients were excluded if they were transferred to the inpatient hospice unit from a site other than the study institution, if they were transferred from an inpatient service without having been initially evaluated in the ED, or if their admission was the result of a trauma alert. Data regarding time in days (d) to hospice consultation and time in days (d) to death once admitted to the inpatient hospice unit were recorded in a standardized Excel spreadsheet. Since data was not normally distributed, nonparametric statistical tests were utilized for median time comparisons. The study was reviewed by the institutional review board and found to be exempt. Results: A total of 372 patients were enrolled. Of these, 43 patients were transferred to the inpatient hospice unit directly from the ED, 226 patients were transferred from the inpatient service, 31 patients were transferred from the intensive care unit, and 72 patients had both inpatient and intensive care unit stays prior to transfer. By definition, patients transferred to the inpatient hospice unit from the ED had 0 days to hospice consultation and 0 days to hospice transfer. For patients who were admitted to the intensive care unit from the ED and then transferred, the median time to hospice consultation was 2d, with a median time to transfer of 3d (p < 0.0001, Mann-Whitney). For patients admitted to the inpatient service and then transferred to the inpatient hospice unit, the median time to hospice consultation was 4d with a median time to transfer of 5d (p < 0.0001, Mann-Whitney). For patients with combined inpatient and intensive care unit stays after admission from the ED, median time to hospice consultation was 8.5d, with a median time to hospice transfer of 11d (p < 0.0001). The median time to hospice consultation for all inpatient hospice unit patients who were hospitalized prior to transfer was 4d, with a median time to transfer of 6d. The median time spent in hospice prior to death for patients transferred directly to the inpatient hospice unit from the ED was 2d. The median time spent on hospice prior to death for ED patients who were hospitalized prior to transfer was 3d (p = 0.2). Conclusion: Admission to the hospital can delay appropriate consultation of hospice and timely transfer to an inpatient hospice unit. Patients transferred to an inpatient hospice unit from the ED spend a similar amount of time on hospice compared to those transferred from other sites. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) college emergency physician emergency ward hospice hospital human money EMTREE MEDICAL INDEX TERMS cohort analysis consultation death electronic medical record hospital patient injury institutional review intensive care unit patient population research tertiary health care ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70897388 DOI 10.1016/j.annemergmed.2012.06.282 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2012.06.282 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 472 TITLE Assessment of need for training of junior doctors in intra hospital transfer of acutely ILL patients AUTHOR NAMES Prasad C.N. Hayes R. Ranganathan M. AUTHOR ADDRESSES (Prasad C.N.; Hayes R.; Ranganathan M.) George Eliot Hospital, Anaesthetics/ITU, Nuneaton, United Kingdom. CORRESPONDENCE ADDRESS C.N. Prasad, George Eliot Hospital, Anaesthetics/ITU, Nuneaton, United Kingdom. SOURCE Intensive Care Medicine (2012) 38 SUPPL. 1 (S62). Date of Publication: October 2012 CONFERENCE NAME 25th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2012 CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2012-10-13 to 2012-10-17 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Junior doctors are key providers of care to sick patient. Most acutely ill and critically ill patients are transferred within hospital-for investigations or treatment or from ED to the wards. Transfers involve risk of morbidity and mortality. Managing these risks specifically is not always a part of junior doctor training. OBJECTIVES. To explore the need for formal training of Junior doctors for Intra hospital transfer of acutely ill patients. METHODS. Questionnaire circulated amongst Foundation Year 1/2, Core Anaesthetic Trainees. Questions related to: Training in anaesthesia/ITU, life support training. Training in patient transfers. Experience in patient transfers. Confidence in patient transfers. Need for training in patient transfers. RESULTS. No doctors in their foundation years had any form of training in transfer of patients within hospitals. Of the doctors in specialist training only 2 had received training in patient transfers, only one of which had been assessed. No doctors had attended a formal transfer course. 100 % of FY&CT doctors that responded felt they required formal training in patient transfers. EMTREE DRUG INDEX TERMS anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital human intensive care patient physician society EMTREE MEDICAL INDEX TERMS critically ill patient hospital patient medical specialist morbidity mortality non profit organization patient transport questionnaire risk student ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71013433 DOI 10.1007/s00134-012-2683-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-012-2683-0 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 473 TITLE “Case mix” changes in a medical intensive care unit after a geographical transfer of a third level, university hospital AUTHOR NAMES Cebrián Domènech J. Monsalve Vila F. Bonastre Mora J. Vacacela Córdova K. AUTHOR ADDRESSES (Cebrián Domènech J.; Monsalve Vila F.; Bonastre Mora J.; Vacacela Córdova K.) Hospital Universitario y Politécnico La Fe, ICU, Valencia, Spain. CORRESPONDENCE ADDRESS J. Cebrián Domènech, Hospital Universitario y Politécnico La Fe, ICU, Valencia, Spain. SOURCE Intensive Care Medicine (2012) 38 SUPPL. 1 (S106). Date of Publication: October 2012 CONFERENCE NAME 25th Annual Congress of the European Society of Intensive Care Medicine, ESICM 2012 CONFERENCE LOCATION Lisbon, Portugal CONFERENCE DATE 2012-10-13 to 2012-10-17 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Information about big hospital geographical transfer is scarce in the medical literature. On February 20th of 2011 our Hospital (in fact, a big university complex) was transferred from their previous location in the North-Center of our city towards a new Southern peripheral, geographical location. This transfer has been done without any changes in assisted population nor nursing or medical staff. OBJECTIVES. Our aim is to analyze possible changes in the main characteristics of our “Case Mix” (Origin, previous quality of life and NYHA score, main diagnostic groups, severity scores, and in ICU, in hospital mortality). METHODS. A number of 2,774 cases (63 % males; mean age 61 years) were admitted in our medical ICU during the study period (1 year before and after the transfer).We have compared both groups (previous and before) by using simple statistical contrasts (Chi square and Oneway analysis of variance). Bonferroni0s correction, if appropriate, was done to overcome the problem of multiple contrasts. Minitab and Statbas statistical packets were used. RESULTS. No differences between both groups were founded in demographic data, Knaus score and NYHA status. Regarding their origin, we have founded more patients admitted from other hospital centers (20 vs. 29 %; p<0.001). Apache II score increase from 17.24 to 19.08 (p<0.001) and a slight increase change in Saps 3 score was founded too (52.29 to 53.75; p<0.01). In spite of these increases in severity indexes and their associated mortality, our in ICU mortality remains lower (15.5-15.6 %) whereas observed in hospital mortality decreased (22.37-19.88; p<0.001). An increase in our neurologic patients has been the most consistent change regarding diagnostic groups. (Figure presented) CONCLUSIONS. According to the previous data our ICU seems to perform better in the new location with a decrease in Standardized Mortality Rate. On the other hand we are admitting more patients transferred from other hospitals. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) case mix intensive care intensive care unit society university hospital EMTREE MEDICAL INDEX TERMS analysis of variance city diagnosis related group hospital human male medical literature medical staff mortality New York Heart Association class nursing patient population quality of life Simplified Acute Physiology Score university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71013602 DOI 10.1007/s00134-012-2683-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-012-2683-0 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 474 TITLE In-house preparation of hydrogels for batch affinity purification of glutathione S-transferase tagged recombinant proteins AUTHOR NAMES Buhrman J.S. Rayahin J.E. Köllmer M. Gemeinhart R.A. AUTHOR ADDRESSES (Buhrman J.S., jbuhrm2@uic.edu; Rayahin J.E., jrayah2@uic.edu; Köllmer M., mkollmer@uic.edu; Gemeinhart R.A., rag@uic.edu) Department of Biopharmaceutical Sciences, University of Illinois, Chicago, IL, 60612-7231, United States. (Gemeinhart R.A., rag@uic.edu) Department of Bioengineering, University of Illinois, Chicago, IL, 60607-7052, United States. (Gemeinhart R.A., rag@uic.edu) Department of Ophthalmology and Visual Science, University of Illinois, Chicago, IL, 60612-4319, United States. CORRESPONDENCE ADDRESS R.A. Gemeinhart, Department of Biopharmaceutical Sciences, University of Illinois, Chicago, IL, 60612-7231, United States. Email: rag@uic.edu SOURCE BMC Biotechnology (2012) 12 Article Number: 63. Date of Publication: 18 Sep 2012 ISSN 1472-6750 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: Many branches of biomedical research find use for pure recombinant proteins for direct application or to study other molecules and pathways. Glutathione affinity purification is commonly used to isolate and purify glutathione S-transferase (GST)-tagged fusion proteins from total cellular proteins in lysates. Although GST affinity materials are commercially available as glutathione immobilized on beaded agarose resins, few simple options for in-house production of those systems exist. Herein, we describe a novel method for the purification of GST-tagged recombinant proteins.Results: Glutathione was conjugated to low molecular weight poly(ethylene glycol) diacrylate (PEGDA) via thiol-ene " click" chemistry. With our in-house prepared PEGDA:glutathione (PEGDA:GSH) homogenates, we were able to purify a glutathione S-transferase (GST) green fluorescent protein (GFP) fusion protein (GST-GFP) from the soluble fraction of E. coli lysate. Further, microspheres were formed from the PEGDA:GSH hydrogels and improved protein binding to a level comparable to purchased GSH-agarose beads.Conclusions: GSH containing polymers might find use as in-house methods of protein purification. They exhibited similar ability to purify GST tagged proteins as purchased GSH agarose beads. © 2012 Buhrman et al.; licensee BioMed Central Ltd. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) glutathione transferase glutathione transferase green fluorescent protein fusion protein hybrid protein recombinant protein EMTREE DRUG INDEX TERMS cell protein microsphere poly(ethylene glycol)diacrylate polymer resin unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) enzyme purification EMTREE MEDICAL INDEX TERMS article click chemistry Escherichia coli hydrogel protein analysis protein expression CAS REGISTRY NUMBERS glutathione transferase (50812-37-8) EMBASE CLASSIFICATIONS Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012579941 MEDLINE PMID 22989306 (http://www.ncbi.nlm.nih.gov/pubmed/22989306) PUI L52220306 DOI 10.1186/1472-6750-12-63 FULL TEXT LINK http://dx.doi.org/10.1186/1472-6750-12-63 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 475 TITLE The use of a modified pediatric early warning score to assess stability of pediatric patients during transport AUTHOR NAMES Petrillo-Albarano T. Stockwell J. Leong T. Hebbar K. AUTHOR ADDRESSES (Petrillo-Albarano T., toni.petrillo@choa.org; Stockwell J.; Hebbar K.) Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, United States. (Petrillo-Albarano T., toni.petrillo@choa.org; Stockwell J.; Hebbar K.) Children's Healthcare of Atlanta at Egleston, Rollins School of Public Health, Emory University, Atlanta, GA, United States. (Leong T.) Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States. CORRESPONDENCE ADDRESS T. Petrillo-Albarano, Critical Care Medicine Division, Children's Healthcare of Atlanta at Egleston, 1405 Clifton Rd NE, Atlanta, GA 30322, United States. Email: toni.petrillo@choa.org SOURCE Pediatric Emergency Care (2012) 28:9 (878-882). Date of Publication: September 2012 ISSN 0749-5161 1535-1815 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT OBJECTIVE: Pediatric early warning scores (PEWSs) have been used effectively in limited patient care areas. Children's Transport, at Children's Healthcare of Atlanta, transports approximately 5000 children annually. In an effort to consistently assess patient acuity and the impact of our team's interventions, we instituted a modified "transport PEWS" (TPEWS). METHODS: The existing PEWS was modified to reflect the transport environment. A retrospective chart review was conducted of 100 consecutive children transported by Children's Transport in March 2009. Transport PEWS given during triage by the dispatch center (TPEWStri), TPEWS calculated at referring facility by the team (TPEWSref), and final TPEWS at the accepting institution (TPEWSacc) were compared. RESULTS: Eighty-six patients were transported by ground. The median age was 50.4 months. Sixty patients (60%) received some intervention from the transport team. Median TPEWSref was 3 (0-9) upon initial assessment, and TPEWSacc was 2 (0-9) on arrival at the accepting facility (P = 0.0001). Seventy-three percent (73/100) of patients were transported to the emergency room; 15 (15%) of 100 to the general inpatient area, and 12 (12%) of 100 to the intensive care unit. In addition, a triage TPEWS (TPEWStri) was calculated from information given from the referring facility in 59 of the 100 patients. A significant difference in TPEWStri and TPEWSref was noted (P = 0.0001). CONCLUSIONS: In this cohort of pediatric transport patients, TPEWS appears to be a helpful additional assessment tool. Transport PEWS may function as a tool for assessing severity of illness, hence optimizing transport dispatch and patient disposition. © 2012 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport scoring system transport pediatric early warning score EMTREE MEDICAL INDEX TERMS adolescent adult child clinical assessment emergency health service emergency ward human infant intensive care unit major clinical study preschool child retrospective study review school child EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012526041 MEDLINE PMID 22929132 (http://www.ncbi.nlm.nih.gov/pubmed/22929132) PUI L52185773 DOI 10.1097/PEC.0b013e31826763a3 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0b013e31826763a3 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 476 TITLE A novel approach to safety: The neurocritical care transport and resource nurse AUTHOR NAMES Olson D.M. Conrad C.L. Sullivan S.L. AUTHOR ADDRESSES (Olson D.M.; Conrad C.L.; Sullivan S.L.) Duke University Medical Center, Dep. Medicine/Neurology, Durham, United States. CORRESPONDENCE ADDRESS D.M. Olson, Duke University Medical Center, Dep. Medicine/Neurology, Durham, United States. SOURCE Neurocritical Care (2012) 17 SUPPL. 2 (S265). Date of Publication: September 2012 CONFERENCE NAME 10th Annual Meeting of the Neurocritical Care Society CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2012-10-04 to 2012-10-07 ISSN 1541-6933 BOOK PUBLISHER Humana Press ABSTRACT Introduction: Intrahospital transport of neurocritical care unit (NCCU) patients is associated with accidental line removal, unplanned extubation, and hemodynamic instability. Further, because patients must be accompanied by a nurse during intrahospital transport, there is an inherent reduction in home unit staffing which reduces direct patient care and monitoring for other NCCU patients. The purpose of this project was to assess the impact of a Neurocritical Care Transport Nurse (NTRN) on patient safety, improved direct patient care time and improved staff satisfaction. Methods: The 3-month NTRN pilot program was initiated in our 16 bed NCCU. For three months, the NTRN worked five 8-hour shifts per week. The NTRN accompanied patients during intrahospital transports, assisted with admissions, functioned as resource nurse in the NCCU, and relieved nurses for meal breaks. Data was collected in real time and included time-inmotion data, adverse event records, and a pre-post work-flow surveys. Results: The NTRN completed 103 intrahospital transports with were zero safety events. The mean length of time for intrahospital transport prior to the pilot was significantly greater than transport by the NTRN (87 vs. 28 minutes; p<.001). The mean time it took nurses to stabilize a new admission/post-op patients was reduced from 85 minutes to 28 minutes. Staff surveys were overwhelmingly positive with 89% of nurses reporting the NTRN saved them time; 24% reported increased opportunity for meal breaks, and 71% attributed reduced overtime due to the NTRN program. Individual nurses reported that the NTRN program saved them an average of 47.5 minutes each shift (8.7 hours per shift). Conclusions: The NTRN pilot program was associated with fewer safety events, increased staff satisfaction, more rapid attention to patient needs and reduced overtime. The program should be implemented full time and evaluated for potential costsavings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human nurse safety society EMTREE MEDICAL INDEX TERMS extubation monitoring patient patient care patient safety satisfaction workflow LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70930202 DOI 10.1007/s12028-012-9775-0 FULL TEXT LINK http://dx.doi.org/10.1007/s12028-012-9775-0 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 477 TITLE Survey of head-injured patients transferred to St George's neuro intensive care unit AUTHOR NAMES Boss J. AUTHOR ADDRESSES (Boss J.) St George Hospital, Australia. CORRESPONDENCE ADDRESS J. Boss, St George Hospital, Australia. SOURCE Anaesthesia and Intensive Care (2012) 40:5 (876). Date of Publication: September 2012 CONFERENCE NAME Australian and New Zealand College of Anaesthetists Annual Scientific Meeting, ANZCA 2012 CONFERENCE LOCATION Perth, WA, Australia CONFERENCE DATE 2012-05-12 to 2012-05-16 ISSN 0310-057X BOOK PUBLISHER Australian Society of Anaesthetists ABSTRACT Introduction: Outcome after primary brain injury is improved by minimising secondary brain injury. Prevention of secondary brain injury starts during resuscitation and continues through transfer to the definitive care unit. The Association of Anaesthetists of Great Britain and Ireland published clinical guidelines “Transfer of the brain injured patient” 20061. We aimed to investigate the south-west Thames region's compliance with these guidelines, and identify and address areas for improvement. Methods: We prospectively analysed all head injured patients admitted to St George's hospital neuro intensive care unit during September 2010 using a proforma designed in accordance with the Association of Anaesthetists of Great Britain and Ireland guidelines. We then locally advertised our results and educated the region's hospitals. We repeated our survey for all patients admitted during April 2011. Results: We analysed a total of 71 patients referred from 15 hospitals within the region over the two time periods. Physiological parameter control, including PaO2 >10 KPa, PaCO2 <5 KPa and MAP >80 mmHg, remained high between the two investigation periods and problems with intravenous access remained stable (Figure 1). However, the treatment of neurological deterioration, such as drop in GCS and pupillary changes, improved following the education. The grade of doctor transferring the patient increased, as did completeness of the documentation accompanying the patient. Conclusions: Although both sets of data demonstrated that hospitals have a high compliance with recognised guidelines, there was room for improvement. Using the Internet to distribute survey data and educational material seems to confer an increased adherence to national clinical guidelines and improvement in the care of the head injured patient. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesist college human intensive care unit New Zealand patient EMTREE MEDICAL INDEX TERMS brain brain injury deterioration documentation education hospital Internet Ireland physician prevention resuscitation United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71053232 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 478 TITLE The critically-ill pediatric hemato-oncology patient: Epidemiology, management, and strategy of transfer to the pediatric intensive care unit AUTHOR NAMES Demaret P. Pettersen G. Hubert P. Teira P. Emeriaud G. AUTHOR ADDRESSES (Demaret P., demaret.pierre@gmail.com; Pettersen G., geraldine.pettersen.hsj@ssss.gouv.qc.ca; Emeriaud G., guillaume.emeriaud@umontreal.ca) Division of pediatric critical care medicine, Department of Pediatrics, Sainte-Justine Hospital, Chemin de la Côte-Sainte-Catherine, Montreal, H2J3V6, Canada. (Hubert P., philippe.hubert@nck.aphp.fr) Division of pediatric critical care medicine, Hôpital Necker-Enfants Malades, Rue de Sèvres, 75007 Paris, France. (Teira P., pierre.teira.hsj@ssss.gouv.qc.ca) Division of pediatric hemato-oncology, Department of Pediatrics, Sainte-Justine Hospital, Chemin de la Côte-Sainte-Catherine, Montreal, H2J3V6, Canada. CORRESPONDENCE ADDRESS P. Demaret, Division of pediatric critical care medicine, Department of Pediatrics, Sainte-Justine Hospital, Chemin de la Côte-Sainte-Catherine, Montreal, H2J3V6, Canada. Email: demaret.pierre@gmail.com SOURCE Annals of Intensive Care (2012) 2:1 (1-20). Date of Publication: 2012 ISSN 2110-5820 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Cancer is a leading cause of death in children. In the past decades, there has been a marked increase in overall survival of children with cancer. However, children whose treatment includes hematopoietic stem cell transplantation still represent a subpopulation with a higher risk of mortality. These improvements in mortality are accompanied by an increase in complications, such as respiratory and cardiovascular insufficiencies as well as neurological problems that may require an admission to the pediatric intensive care unit where most supportive therapies can be provided. It has been shown that ventilatory and cardiovascular support along with renal replacement therapy can benefit pediatric hemato-oncology patients if promptly established. Even if admissions of these patients are not considered futile anymore, they still raise sensitive questions, including ethical issues. To support the discussion and potentially facilitate the decision-making process, we propose an algorithm that takes into account the reason for admission (surgical versus medical) and the hematooncological prognosis. The algorithm then leads to different types of admission: full-support admission, "pediatric intensive care unit trial" admission, intensive care with adapted level of support, and palliative intensive care. Throughout the process, maintaining a dialogue between the treating physicians, the paramedical staff, the child, and his parents is of paramount importance to optimize the care of these children with complex disease and evolving medical status. © 2012 Demaret et al. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer patient childhood cancer (epidemiology, therapy) critically ill patient hematologic malignancy (epidemiology, therapy) EMTREE MEDICAL INDEX TERMS algorithm bone marrow transplantation cancer epidemiology cancer mortality cancer prognosis disease association extracorporeal circulation extracorporeal oxygenation graft versus host reaction (complication) hematopoietic stem cell transplantation human intensive care unit kidney dysfunction leukemia (therapy) lung disease patient care pediatrics postoperative care priority journal renal replacement therapy respiratory failure review sepsis (complication) septic shock tumor lysis syndrome EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012439062 PUI L365316793 DOI 10.1186/2110-5820-2-14 FULL TEXT LINK http://dx.doi.org/10.1186/2110-5820-2-14 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 479 TITLE End of life in intensive care: Is transfer home an alternative? AUTHOR NAMES Tellett L. Pyle L. Coombs M. AUTHOR ADDRESSES (Tellett L., Lynda.Tellett@suht.swest.nhs.uk; Pyle L.) E Level Cardiac Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. (Coombs M., mc9@soton.ac.uk) Cardiac Intensive Care Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. CORRESPONDENCE ADDRESS L. Tellett, E Level Cardiac Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. Email: Lynda.Tellett@suht.swest.nhs.uk SOURCE Intensive and Critical Care Nursing (2012) 28:4 (234-241). Date of Publication: August 2012 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT The past decade has witnessed an increased focus on improving the quality of end of life care internationally. This has resulted in the development of specific health policy work streams to support patient choice and improve standards of care and patient experience. One concept well explored in areas outside of critical care is that of home care at the end of life. This paper seeks to challenge assumptions and practices about the options for transferring the critically ill patient home at end of life.As a piece of collaborative writing from a bereaved family member and critical care nursing team, this paper explores care given to one gentleman at the end of his life. In this, his journey is detailed, the decisions made are outlined and the experience for him and his family are examined with a retrospective narrative account from his wife that is woven throughout the paper.In this paper, we are not asserting that transfer home at end of life is desirable or feasible for all critically ill patients. We are challenging practitioners to consider when and how the initiative of transferring critically ill patients home at end of life, may occur. © 2012 Elsevier Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) home care intensive care unit patient preference patient transport terminal care EMTREE MEDICAL INDEX TERMS article congenital heart malformation human human relation male patient care planning United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 22406252 (http://www.ncbi.nlm.nih.gov/pubmed/22406252) PUI L51899198 DOI 10.1016/j.iccn.2012.01.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2012.01.006 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 480 TITLE Efficacy of information interventions in reducing transfer anxiety from a critical care setting to a general ward: A systematic review and meta-analysis AUTHOR NAMES Brooke J. Hasan N. Slark J. Sharma P. AUTHOR ADDRESSES (Brooke J., j.m.brooke@greenwich.ac.uk) University of Greenwich, G308, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, United Kingdom. (Hasan N.; Slark J.; Sharma P.) Imperial College Cerebrovascular Research Unit (ICCRU), Imperial College, London W6 8RF, United Kingdom. CORRESPONDENCE ADDRESS J. Brooke, University of Greenwich, G308, Southwood Site, Avery Hill Road, Eltham, London SE9 2UG, United Kingdom. Email: j.m.brooke@greenwich.ac.uk SOURCE Journal of Critical Care (2012) 27:4 (425.e9-425.e15). Date of Publication: August 2012 ISSN 0883-9441 1557-8615 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Purpose: Our aim was to undertake a comprehensive systematic review on the efficacy of information interventions on reducing anxiety in patients and family members on transfer from a critical care setting to a general ward. Materials and methods: MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Google Scholar databases from 1990 to January 1, 2011, were searched. Bibliographies of identified articles were reviewed. Only high-quality randomized controlled trials comparing an intervention to reduce transfer anxiety with standard care, where transfer anxiety is measured by the validated State Trait Anxiety Inventory, were included. Data were extracted to estimate standard mean differences (SMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) using both fixed and random effects model. Results: Of 266 studies identified in the primary search, 5 studies enrolling 629 participants met the inclusion criteria, family members' transfer anxiety was significantly reduced in the intervention arm of information provision (OR, 1.70; 95% CI, 1.15-2.52; P = .01) compared with those who received standard care (OR, 0.42; 95% CI; 0.276-0.625; P < .001), and patients' transfer anxiety was significantly reduced in one study. Conclusions: Providing information to understand a future ward environment can significantly reduce patients' and family members' transfer anxiety from the critical care setting when compared with standard care. © 2012 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety patient transport transfer anxiety EMTREE MEDICAL INDEX TERMS clinical effectiveness coronary care unit family attitude family counseling human intensive care unit intermethod comparison length of stay nursing care outcome assessment patient attitude patient care planning patient education personalized medicine review State Trait Anxiety Inventory systematic review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012432412 MEDLINE PMID 22824085 (http://www.ncbi.nlm.nih.gov/pubmed/22824085) PUI L365298268 DOI 10.1016/j.jcrc.2012.01.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcrc.2012.01.009 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 481 TITLE Low adverse event incidence during intra-hospital transportation of critically ill mechanically ventilated patients with a multidisciplinary team AUTHOR NAMES Bocchile R.L.R. Timenetsky K.T. Machado M.M. Fuhrmann K.F. Giovanetti E.A. Eid R.A.C. AUTHOR ADDRESSES (Bocchile R.L.R., raquel_case@einstein.br; Timenetsky K.T.; Machado M.M.; Fuhrmann K.F.; Giovanetti E.A.) Hospital Albert Einstein, Sao Paulo, Brazil. (Eid R.A.C.) Hospital Israelita Albert Einstein, Sao Paulo, Brazil. CORRESPONDENCE ADDRESS R.L.R. Bocchile, Hospital Albert Einstein, Sao Paulo, Brazil. Email: raquel_case@einstein.br SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Intra-hospital transport is a very common procedure in critically ill patients submitted to invasive and noninvasive mechanical ventilation, mainly due to transfer the patients to the operate room or to the tomography or magnetic resonance room to perform exams. However, adverse events are described in the literature to occur around 60% during transportation. These transports usually require a specialized multidisciplinary team. In our hospital we have a specialized multidisciplinary team for the transportation of mechanically ventilated patients and we wanted to know our adverse event incidence. Objective: To evaluate the incidence of adverse events during intra-hospital transportation of mechanically ventilated critically ill patients with a multidisciplinary team. Method: We prospectively evaluated the incidence of adverse events of critically ill patients submitted to invasive and noninvasive mechanical ventilation during intra-hospital transportation with a specialized multidisciplinary team during a 3 month period. All patients were monitored with a transport monitor (Datascope®) that display ECG, noninvasive arterial pressure, and oxygen saturation. Results: The specialized multidisciplinary team performed 44 intra-hospital transportations, of these 50% were transported with invasive mechanical ventilation and 50% with noninvasive ventilation. Of the 22 patients transported with invasive mechanical ventilation, 60% were orothraqueal intubated and 40% were tracheostomized. The median age was 79 years (range of 27-101), and 50% were male. The most frequent hospital admission diagnosis was due to cancer (22.7%), followed by stroke (18.2%), pneumonia (13.6%) and sepsis (11.3%). The most common reason for intra-hospital transportation was acute respiratory failure (45.4%) followed by unit change (31.8%) and exams (16%). The median time of transportation was 30 minutes (range of 10-180 minutes). There was only 1 (2.3%) adverse event related to mechanical ventilator battery failure. Conclusions: Intra-hospital transportation of mechanically ventilated patients performed by a specialized multidisciplinary team showed a low adverse event incidence. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American critically ill patient hospital human society traffic and transport ventilated patient EMTREE MEDICAL INDEX TERMS acute respiratory failure arterial pressure artificial ventilation cerebrovascular accident diagnosis electrocardiogram hospital admission male mechanical ventilator neoplasm noninvasive ventilation nuclear magnetic resonance oxygen saturation patient pneumonia procedures sepsis tomography LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71986162 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 482 TITLE Discrepancies in arterial PO2 (Pao2) measurements between a point of care testing (POCT) analyzer and standard laboratory analysis of samples transported via pneumatic tube system (PTS) AUTHOR NAMES Borders M.K. Sofronescu A.-G. Huckabee D.D. Boylan A.M. Byrne J. Ford D.W. Strange C. Epps J.A. Schmidt C.A. Washington K.Q. Warren M. Zhu Y. AUTHOR ADDRESSES (Borders M.K.; Sofronescu A.-G.; Huckabee D.D.; Boylan A.M., boylana@musc.edu; Byrne J.; Ford D.W.; Strange C.; Epps J.A.; Schmidt C.A.; Washington K.Q.; Warren M.; Zhu Y.) Medical University of South Carolina, Charleston, United States. CORRESPONDENCE ADDRESS A.M. Boylan, Medical University of South Carolina, Charleston, United States. Email: boylana@musc.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: POCT assessment of arterial blood gases is an increasingly common method of measurement for guiding ventilator management in intensive care units. We observed discrepancies in Pao2values between our POCT analyzer and specimens transported to our laboratory via PTS. The purpose of this quality improvement (QI) study was to determine accuracy of Pao values obtained via POCT 2 analyzer, PTS transport, and hand delivery to the laboratory. Methods: The QI project took place in our medical intensive care unit and consisted of two stages. First, we analyzed 24 arterial blood gas samples from 12 patients via POCT and laboratory analyzers. Samples were sent to the laboratory via PTS at ambient temperature. Subsequently, we obtained arterial blood from 18 different patients (three 0.5 cc samples per patient), and each patient's blood was tested using three techniques: 1) the POCT analyzer, 2) sent via PTS (laboratory analyzer), and 3) walked to the laboratory (laboratory analyzer) in a timely fashion by staff. We compared Pao 2 results via a two-sided, dependent paired t-test. Results: With the initial evaluation, eight of the twelve specimens had a Pao 2 difference greater than 10 mmHg, which was considered clinically significant. This prompted the subsequent phase of the study in which we compared Pao 2 values obtained via the three different techniques. The largest variation in Pao 2 results was found between samples sent via PTS versus POCT or walked to the laboratory. Specifically, the mean difference between POCT analysis and samples sent via PTS was 18.4 mmHg (95% CI 9.4-27.4 mmHg) and the mean difference between walked samples and PTS samples was 9.7mmHg (95% CI 5.9-13.5 mmHg). Additionally, we found lower paO2's for each sample analyzed via POCT as compared to laboratory analysis regardless of delivery technique (PTS versus walked). Conclusion: Arterial blood gas samples sent via PTS have more Pao 2 variability than samples tested using POCT or walked to the laboratory. The discrepancies may be due to air bubbles which are mixed in the sample when transported via PTS. This theory is also supported by the observation of consistently lower Pao 2 values obtained via POCT which might avoid the introduction microscopic air resulting from transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American analyzer arterial oxygen tension laboratory oxygen tension point of care testing society tube EMTREE MEDICAL INDEX TERMS arterial blood arterial gas blood environmental temperature human intensive care unit patient Student t test total quality management ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71993151 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 483 TITLE Outcomes of direct emergency room to ICU admission vs. Later ICU transfer for patients with severe sepsis AUTHOR NAMES Leung S. Rakowski E. Gong M.N. AUTHOR ADDRESSES (Leung S., sleung@montefiore.org) Albert Einstein College of Medicine, Bronx, United States. (Rakowski E.; Gong M.N.) Montefiore Medical Center, Bronx, United States. CORRESPONDENCE ADDRESS S. Leung, Albert Einstein College of Medicine, Bronx, United States. Email: sleung@montefiore.org SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Approximately half of the patients admitted to an ICU with severe sepsis were transferred from a non-ICU floor rather than admitted directly from the Emergency Department (ED). The purpose of this study is to evaluate the 1-year survival difference who were directly admitted to the ICU from ED compared with those who were transferred from the wards. To date, survival analysis in this area is lacking. Methods: This was a nested case control study from a retrospective cohort analysis of hospitalized patients admitted for severe sepsis over a four-month period at two tertiary hospitals of the Montefiore Medical Center (MMC), Bronx, New York. The inclusion criterion was patients admitted with severe sepsis based on the ICD-9 codes indicative of infection concurrent with new onset organ dysfunction who were admitted to an ICU within 7 days of hospital admission. Cases were defined as direct ICU admissions from the ED (Direct Admissions) and controls were defined as patients who transferred from the wards to the ICU (ICU Transfers). Because the groups compared were not randomly assigned, we reduced bias with propensity score weighting of the group comparisons. All statistical analyses were performed using STATA version 11.2. Results: Between December 1, 2009 and March 31, 2010, there were 163 Direct Admissions and 110 ICU Transfers. The median (IQR) time in the transfer group from admission to ICU transfer was 1.8 (1.1, 3.4) days. Compared to Direct Admissions, ICU Transfers had more history of moderate to severe liver disease (p<0.01). The mean (SD) APACHE II score upon ICU admission for the Direct Admission and ICU Transfers was 23.5 (5.8) and 22.3 (5.6) respectively (p=0.07). The median (IQR) ICU lengths of stay (LOS) for the Direct Admissions and ICU Transfers were 4.0 (2.0, 7.0) and 3.1 (1.7, 6.3) days respectively (p=0.10). The median (IQR) hospital LOS for the Direct Admissions and ICU Transfers were 11.8 (7.2, 23.2) and 14.9 (8.1, 24.0) days respectively (p=0.09). The crude 1-year mortality rate was 49.7% for Direct Admissions and 58.2% for ICU Transfers (p=0.18). In propensity-weighted analyses, the 1-year mortality was associated with age ≥65 (HR 1.83 [95%C.I. 1.07-3.11]), APACHE II score ≥23 (HR 2.28 [95%C.I. 1.30-4.01]), lactate ≥4 mmol, but not Direct Admissions (HR 0.85 [95%C.I. 0.52-1.38]). Conclusion: For patients admitted with severe sepsis, after adjusting for the propensity of direct ICU admission, early ICU admission did not show 1-year survival benefits. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American emergency ward human patient sepsis society EMTREE MEDICAL INDEX TERMS APACHE case control study cohort analysis hospital hospital admission hospital patient ICD-9 infection liver disease mortality propensity score statistical analysis survival tertiary care center United States ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71993152 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 484 TITLE How can nurses facilitate patient's transitions from intensive care?. A grounded theory of nursing. AUTHOR NAMES Häggström M. Asplund K. Kristiansen L. AUTHOR ADDRESSES (Häggström M., marie.haggstrom@miun.se) Department of Health Sciences, Mid Sweden University, SE-85170 Sundsvall, Sweden. (Asplund K.; Kristiansen L.) Mid Sweden University, Sweden. CORRESPONDENCE ADDRESS M. Häggström, Department of Health Sciences, Mid Sweden University, SE-85170 Sundsvall, Sweden. Email: marie.haggstrom@miun.se SOURCE Intensive and Critical Care Nursing (2012) 28:4 (224-233). Date of Publication: August 2012 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Objectives: Intensive care patients often experience feelings of powerlessness and vulnerability when being transferred from an intensive care unit to a general ward. The aim of this study was to develop a grounded theory of nurses care for patients in the ICU transitional care process. Methods: Group interviews, individual interviews and participant observations were conducted with nurses in two hospitals in Sweden and were analysed using grounded theory. Result: The substantive theory shows the process of nursing care activities - from the contexts of the ICU and the general ward. The main concern was to achieve a coordinated, strengthening, person-centered standard of care to facilitate patient transitions. The core category " being perceptive and adjustable" was a strategy to individualise, that was related to the other categories; " preparing for a change" and " promoting the recovery" . However, the nurses were forced to " balance between patient needs and the caregivers' resources" and consequently were compromising their care. Conclusions: To facilitate an ICU-patient's transition, individual care planning is needed. It is also essential that the patients are adequately prepared for the change to facilitate the transitional care. Knowledge about transitional needs, empowerment and patient-education seems to be important issues for facilitating transitions. © 2012 Elsevier Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital discharge nurse attitude patient care patient care planning patient transport EMTREE MEDICAL INDEX TERMS aftercare article clinical trial human intensive care unit multicenter study nurse patient relationship observation social support Sweden verbal communication LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 22386583 (http://www.ncbi.nlm.nih.gov/pubmed/22386583) PUI L51887147 DOI 10.1016/j.iccn.2012.01.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2012.01.002 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 485 TITLE Transport of pediatric patients with the assistance of a physical therapy team AUTHOR NAMES Valério N. Remondini R. Giovanetti E.A. Do Prado C. Troster E.J. AUTHOR ADDRESSES (Valério N.; Remondini R., rremondini@yahoo.com.br; Giovanetti E.A.; Do Prado C.; Troster E.J.) Hospital Israelita Albert Einstein, São Paulo, Brazil. CORRESPONDENCE ADDRESS R. Remondini, Hospital Israelita Albert Einstein, São Paulo, Brazil. Email: rremondini@yahoo.com.br SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Transport of critically ill pediatric patients by untrained professionals tends to be associated with a higher incidence of complications than transport led by specialized pediatric critical care teams. Transport teams should be capable of ensuring a high degree of patient stability, as well as have access to the equipment and supplies required for Advanced Life Support and emergency treatment en route. The level of care and monitoring provided during transport of these patients should approach that provided in a pediatric intensive care unit (PICU) setting. Inadequate ventilator support, airway loss or obstruction of the airway device, lack of monitoring, equipment failure, and lack of or errors in drug use and administration are the most common untoward events occurring during pediatric transport. The involvement of physical therapists in pediatric transport teams optimizes patient care, particularly of mechanically ventilated children, and reduces the risk of clinical complications during transport. Methods: Retrospective study of information added to a database of all events of physical therapist-assisted ground transport of mechanically ventilated pediatric patients between 24 August 2010 and 24 September 2011. During the referred period, 25 children between the ages of 4 months and 14 years were transported. These patients were transported under the care of the emergency department transport team, which comprised a physician, a nurse, and a nursing technician, with the assistance of the duty PICU physical therapist. Management of mechanical ventilation is the core objective of the physical therapist in this setting. The therapist's roles include choosing the most adequate ventilator to the patient's respiratory condition, monitoring, and adjusting ventilator settings, as well as care of the chosen airway device. After each transport, the physical therapist who was involved in the case added information on the transport event and patient characteristics to the database. All participating physical therapists were trained by the local transport team, which comprised seven physical therapists in charge of training and validating all providers involved in ground and air medical transport of adult and pediatric patients. Results: No untoward events occurred during physical therapist-assisted transport of pediatric patients. Vital signs and ventilator parameters remained stable and airways were maintained satisfactorily in all cases. Conclusion: The involvement of physical therapists in the transportation of pediatric patients adds a specificity component to pediatric transport and retrieval teams and minimizes clinical complications, particularly those associated with mechanical ventilation, which is considered a risk factor for mortality during pediatric transport. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American human patient physiotherapy society EMTREE MEDICAL INDEX TERMS adult air medical transport airway artificial ventilation child critically ill patient data base device failure devices drug use emergency treatment emergency ward intensive care intensive care unit monitoring mortality nurse nursing obstruction parameters patient care physician physiotherapist retrospective study risk risk factor traffic and transport ventilator vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71986362 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 486 TITLE The impact of the new Turkish regulation, imposing single embryo transfer after assisted reproduction technology, on neonatal intensive care unit utilization: A single center experience AUTHOR NAMES Guzoglu N. Kanmaz H.G. Dilli D. Uras N. Erdeve O. Dilmen U. AUTHOR ADDRESSES (Guzoglu N., nguzoglu@gmail.com; Kanmaz H.G.; Uras N.; Erdeve O.; Dilmen U.) Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Talatpasa Bulvari, Samanpazari, 06230 Ankara, Turkey. (Dilli D.) Department of Neonatology, Sami Ulus Children's Hospital, Ankara, Turkey. (Dilmen U.) Department of Pediatry, Yildirim Beyazit University, Ankara, Turkey. CORRESPONDENCE ADDRESS N. Guzoglu, Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Talatpasa Bulvari, Samanpazari, 06230 Ankara, Turkey. Email: nguzoglu@gmail.com SOURCE Human Reproduction (2012) 27:8 (2384-2388). Date of Publication: August 2012 ISSN 0268-1161 1460-2350 (electronic) BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. ABSTRACT Objectives and aim: IVF has become an efficient and widely used treatment for infertile couples, however, it is responsible for an increasing number of multifetal pregnancies and adverse neonatal outcomes. This study aimed to assess a health service utilization in one neonatal intensive care unit (NICU), as a response to the 2010 Turkish reproductive regulation requiring single embryo transfer (SET). methods: All assisted reproductive technology (ART) pregnancies delivered at Zekai Tahir Burak Maternity Teaching Hospital between February 2010 and October 2011 were included in this study. Subjects were divided into two groups: Group 1 consisted of infants conceived before the ART regulation, and born between February 2010 and October 2010, and Group 2 consisted of infants conceived after the ART regulation, and born between November 2010 and October 2011. results: Upon comparing the study groups, we observed a significant decrease in the incidence of multiple births in Group 2. The mean gestational age and mean birthweight were significantly higher in Group 2. The rates of prematurity and low birthweight, very low birthweight and extremely low birthweight infants were significantly lower in Group 2. Similarly, the rates of NICU admission, respiratory distress syndrome, necrotizing enterocolitis anemia and pneumonia/sepsis, and the need for respiratory support (mechanical ventilation and nasal continuous positive airway pressure) were significantly lower in Group 2. conclusions: According to our data, NICU utilization was reduced and the early post-natal outcomes of the babies were improved after the new Turkish regulation on ART imposing SET. However, multicenter studies are needed to generalize our results to the whole country. © The Author 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) embryo transfer health care utilization infertility therapy EMTREE MEDICAL INDEX TERMS adult anemia (epidemiology) article artificial ventilation birth weight female gestational age human infant low birth weight (epidemiology) major clinical study male morbidity multiple pregnancy necrotizing enterocolitis (epidemiology) newborn newborn intensive care pneumonia (epidemiology) positive end expiratory pressure pregnancy outcome prematurity (epidemiology) respiratory distress (epidemiology) sepsis (epidemiology) Turkey (republic) very low birth weight (epidemiology) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012693233 MEDLINE PMID 22617124 (http://www.ncbi.nlm.nih.gov/pubmed/22617124) PUI L366131032 DOI 10.1093/humrep/des171 FULL TEXT LINK http://dx.doi.org/10.1093/humrep/des171 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 487 TITLE Is physiology just physiology? Ward vital sign comparisons before cardiac arrest, ICU transfer, and death AUTHOR NAMES Churpek M.M. Yuen T.C. Edelson D.P. AUTHOR ADDRESSES (Churpek M.M.; Yuen T.C.; Edelson D.P.) University of Chicago, Chicago, United States. CORRESPONDENCE ADDRESS M.M. Churpek, University of Chicago, Chicago, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE: Clinical deterioration of ward patients can be signaled by transfer to an ICU, cardiac arrest, or death. While all three of these outcomes have been utilized in the literature to test various risk prediction algorithms and rapid response team calling criteria, there is no consensus, making comparison across studies challenging. It is unknown how patients who experience these outcomes compare to one another in terms of vital signs or how models derived to predict each of these outcomes would predict the other two. METHODS: We performed a retrospective cohort study at an academic hospital that included all patients hospitalized on the general wards between November 8 and January . We calculated mean ward vital signs in the 4 hours prior to ward CA, ICU transfer, or death. Three logistic regression models were calculated for each of the outcomes within 4 hours of each simultaneous vital sign set in the entire hospitalized cohort. Last value carried forward imputation was used for incomplete vital sign sets. Areas under the receiver operating characteristic curves (AUCs) were calculated for each of the three models in predicting the outcome for which it was derived, as well as for the other two outcomes. RESULTS: A total of ,74,88 vital sign sets were obtained from 4738 patients, of which 88 experienced a CA, 77 died, 99 were transferred to the ICU, and 458 experienced none of the those outcomes. Differences in mean vital signs in the 4 hours prior to each event are shown below (Table 1). (Table presented) Logistic regression coefficients for each derived model is shown in Table 2 below. (Table presented) The Figure below illustrates the AUCs of each derived model in of the three outcomes. Each model performed better in the model it was derived in than the other two derived model (P<.5 for each) and the AUCs for predicting mortality were highest for each of the three models. (Figure presented) CONCLUSIONS: Models derived to predict cardiac arrest, mortality and ICU transfer have some notable differences in the weighting and direction of some of the included vital sign covariates. However, despite these differences, the different models perform similarly for each of the three outcomes, with mortality being the easiest to predict and ICU transfer the most difficult. Model performance is strongly associated with the chosen outcome, and studies should be interpreted with these differences in mind. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American death heart arrest physiology society vital sign ward EMTREE MEDICAL INDEX TERMS algorithm cohort analysis consensus deterioration hospital human logistic regression analysis model mortality patient prediction rapid response team receiver operating characteristic risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71986003 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 488 TITLE Effect of contactless continuous patient monitoring in a medical-surgical unit on intensive care unit transfers: A controlled clinical trial AUTHOR NAMES Zimlichman E. Terrence J. Argaman D. Shinar Z. Brown H. AUTHOR ADDRESSES (Zimlichman E., EZIMLICHMAN@PARTNERS.ORG) Brigham and Women's Hospital, Boston, United States. (Terrence J.; Brown H.) California Hospital Medical Center, Los Angeles, United States. (Argaman D.; Shinar Z.) Earlysense LTD, Ramat Gan, Israel. CORRESPONDENCE ADDRESS E. Zimlichman, Brigham and Women's Hospital, Boston, United States. Email: EZIMLICHMAN@PARTNERS.ORG SOURCE American Journal of Respiratory and Critical Care Medicine (2012) 185 MeetingAbstracts. Date of Publication: 2012 CONFERENCE NAME American Thoracic Society International Conference, ATS 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-05-18 to 2012-05-23 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: Most patients in acute care hospitals are considered at low or average risk for life threatening events, and thus are hospitalized in non-intensive care units (ICUs). However, these patients might deteriorate clinically and require emergency care. For patients with unexpected clinical deterioration delayed or suboptimal intervention is associated with increased morbidity and mortality. Technology applications that allow for continuous vital sign monitoring designed for non-ICU settings may help hospitals achieve meaningful results when implementing as part of a rapid response system. The EarlySense system is a piezo-electric sensor based contact-less continuous measurement monitoring system for heart rate, respiration rate and bed motion. Objective: To determine the effects of continuous patient monitoring using the Earlysense monitor in a medical-surgical unit on ICU transfers and ICU length of stay for patients initially admitted to non-ICU units. Methods: The study was conducted in a 316 bed acute care hospital as a pre-post evaluation study. Earlysense monitors were implemented in a 36-bed medical-surgical unit including bed side monitors, central nursing station display and nurse pagers. We have used two control groups a historic control for the same unit pre-implementation and a oesister unit that did not go through the implementation. We have reviewed charts for co-morbidity, acuity level and study outcomes for patients in each study group. Results: We have reviewed a total of 4000 patient charts a 1000 patients in the intervention arm and 3000 for the three control arms. Patient's demographics data is presented on table 1. For the evaluation unit we have measured a 39.5% decrease in ICU transfers with a 36.4% decrease in total ICU days comparing pre to post intervention periods (borderline significance, p=0.07) (Table 2). Comparing the intervention to the control unit we did not find a statistical significant difference in transfers (26 vs. 20 respectively, p=0.3) but did find a statistically borderline decrease in total ICU days (p=0.07). Total hospital length of stay has decreased significantly in the evaluation unit following the intervention. Conclusions: Continuous monitoring of patients in a medical-surgical unit using the Earlysense contact less vital signs monitor has resulted in a statistically borderline reduction in number of patients transferred to the ICU and total number of ICU days with a reduction in average hospital length of stay. We believe, giving these clear trends, that a larger scale study will show significant effects and would also be able to assess effect on mortality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American controlled clinical trial human intensive care unit patient monitoring society EMTREE MEDICAL INDEX TERMS arm breathing rate control group deterioration emergency care evaluation study heart rate hospital length of stay monitor monitoring morbidity mortality nurse nursing station patient rapid response team risk sensor technology vital sign LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71988366 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 489 TITLE Comment on "Under-triage as a Significant Factor Affecting Transfer Time between the Emergency Department and the Intensive Care Unit" AUTHOR NAMES Bergs J. Gillet J.-B. AUTHOR ADDRESSES (Bergs J., jochen.bergs@uzleuven.be) Emergency Department, and Jonas Tundo, MSc, Department of Management, Information and Reporting, University Hospital Leuven, Leuven, Belgium. (Gillet J.-B.) University of Massachusetts, Amherst, MA, United States. CORRESPONDENCE ADDRESS J. Bergs, Emergency Department, and Jonas Tundo, MSc, Department of Management, Information and Reporting, University Hospital Leuven, Leuven, Belgium. Email: jochen.bergs@uzleuven.be SOURCE Journal of Emergency Nursing (2012) 38:4 (320-321). Date of Publication: July 2012 ISSN 0099-1767 1527-2966 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit patient transport sepsis (therapy) EMTREE MEDICAL INDEX TERMS female human letter male utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 22677097 (http://www.ncbi.nlm.nih.gov/pubmed/22677097) PUI L52045762 DOI 10.1016/j.jen.2011.09.022 FULL TEXT LINK http://dx.doi.org/10.1016/j.jen.2011.09.022 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 490 TITLE Acute care nurse practitioner led critical care transport team leads to improved door to imaging time in acute ischemic stroke patients AUTHOR NAMES Steiner S. Winfield M. Manacci C. Kralovic D. Hussain M. AUTHOR ADDRESSES (Steiner S.; Winfield M.; Manacci C.; Kralovic D.; Hussain M.) Critical Care Transport Services, Cleveland Clinic, United States. CORRESPONDENCE ADDRESS S. Steiner, Critical Care Transport Services, Cleveland Clinic, United States. SOURCE Air Medical Journal (2012) 31:4 (168-169). Date of Publication: July-August 2012 CONFERENCE NAME 2012 Critical Care Transport Medicine Conference CONFERENCE LOCATION Nashville, TN, United States CONFERENCE DATE 2012-04-02 to 2012-04-04 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Background: In evaluating the acute ischemic stroke patient, targeting time intervals for imaging and treatment times are paramount in optimizing outcomes. This can be augmented by a collaborative approach with a hospitalbased critical care transport team that can extend primary stroke program care to a referring facility's bedside. The suspicion of a vessel occlusion causing an acute ischemic stroke in patients at an outside hospital triggers an “Auto Launch” process, which bypasses the usual hospital transfer process to expedite care transitions for patients with time-sensitive emergencies. Referring facilities directly contact a critical care transport coordinator, who launches the transport team. The team includes an acute care nurse practitioner (ACNP), who evaluates the stroke patient on arrival to the outside facility, including a National Institutes of Health Stroke Scale, and transitions the patient directly to the computed tomography (CT) scanner/magnetic resonance imaging (MRI) on return to the receiving facility. The stroke neurologist and team meet the patient directly in the CT scanner for definitive determinations for further care. A Critical Care Transport Team with an ACNP on board can augment not only door to CT and MRI times, but also time to evaluation by a stroke neurologist and time to intervention, often by bypassing the Emergency Department on their arrival and proceeding directly to studies or time-sensitive intervention as appropriate. Objective: To describe a stroke program with a coordinated approach with a critical care transport (CCT) team to facilitate rapid care transitions as well as decreased time to imaging in patients with acute ischemic stroke by having an ACNP on board during transport and throughout the continuum of care. Methods: A retrospective audit of a database of patients undergoing hyperacute evaluation of acute ischemic stroke symptoms from April 30, 2010 to July 31, 2011 was performed. Demographic information, types of imaging performed, hyperacute therapies administered, and the time to imaging modalities and treatment were collected and analyzed. Results: A total of 107 patients, 28 males, and 36 females, with a mean age of 70, were included in the analysis. Sixty-four (60%) of the patients were transferred via the CCT team over 26.42 average nautical miles. The mean time of call to arrival was 1 hour 19 minutes. The CCT Team continued tissue plasminogen activator (tPA) infusion in 27 patients and initiated tPA infusion in two patients. Sixty-four patients had CT imaging performed, and 64 had MRI performed after the CT. [The average door to CT completed time was 22 minutes, and the average door to MRI completed time was 1 hour 29 minutes, compared with 1 hour 8 minutes and 2 hours 36 minutes in patients not arriving by CCT Team], P < .05. Conclusion: Collaboration between the stroke team and critical care transport team has allowed acute ischemic stroke patients to be taken directly to the CT/MRI scanner, allowing for rapid evaluation, definitive treatment decisions, and the potential for improved patient outcomes by decreasing the door to imaging time. EMTREE DRUG INDEX TERMS tissue plasminogen activator EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute care nurse practitioner brain ischemia human imaging intensive care stroke patient EMTREE MEDICAL INDEX TERMS cerebrovascular accident clinical audit computed tomography scanner computer assisted tomography data base emergency emergency ward female hospital infusion male National Institutes of Health Stroke Scale neurologist nuclear magnetic resonance imaging occlusion patient therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70816230 DOI 10.1016/j.amj.2012.04.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.04.009 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 491 TITLE An analysis of lack of available literature for pain management in air medical and critical care transport: A research opportunity AUTHOR NAMES Brozen R. AUTHOR ADDRESSES (Brozen R.) Dartmouth-Hitchcock Advanced Response Team, Dartmouth Medical School, Section of Emergency Medicine, Lebanon, United States. CORRESPONDENCE ADDRESS R. Brozen, Dartmouth-Hitchcock Advanced Response Team, Dartmouth Medical School, Section of Emergency Medicine, Lebanon, United States. SOURCE Air Medical Journal (2012) 31:4 (169). Date of Publication: July-August 2012 CONFERENCE NAME 2012 Critical Care Transport Medicine Conference CONFERENCE LOCATION Nashville, TN, United States CONFERENCE DATE 2012-04-02 to 2012-04-04 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Objective: Air Medical and Critical Care Transport (AMT/CCT) traditionally only use opiate pain medications to manage patients' pain during interfacility and scene transports. Many other methods of pain management are available to medical providers. We attempted to analyze the amount and quality of literature devoted specifically to pain management during AMT and CCT. Methods: A literature search was performed using combinations of traditional transport terms and pain management terms in MeSH Medline terminology on PubMed and Ovid. Results: When pain management is entered in PubMed, 19 subcategories, such as postoperative, acute, chronic, cancer, and so on, are suggested by the search engine. For pain management alone, there are 99,113 biomedical literature citations and abstracts. With limits set to include human and randomized controlled trial, there are 11,719. The 19 subcategories have a range of citations from 398 to 40,443 (average, 9,572). With limits set, the range is 20 to 7,554 (average, 1,420). Pairing the terms prehospital, EMS, HEMS, helicopter, air medical transport, and aeromedical, the range is 4 to 192 (average, 54), and with limits the range is 0 to 11 (average, 2). Pairing the terms alternative, nontraditional, and acupuncture, the average is 2,686, and 443 with limits. Conclusion: A dearth of published research exists on pain management in either AMT or CCT when compared with other areas of pain management. Helicopter, HEMS, aeromedical, and air medical transport pain management literature contains a single published human randomized controlled trial cited in Medline. Opportunity exists for further research and improvement in patient care. EMTREE DRUG INDEX TERMS opiate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) analgesia intensive care EMTREE MEDICAL INDEX TERMS acupuncture air medical transport drug therapy helicopter hospital patient human Medline neoplasm pain patient patient care randomized controlled trial search engine LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70816231 DOI 10.1016/j.amj.2012.04.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.04.009 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 492 TITLE Prehospital use of hydroxocobalamin for cyanide toxicity in a rotarywing primary aeromedical evacuation and critical care transport program AUTHOR NAMES Vu E.N. Peet H.E. Bernklau R.P. Wand R.T. Wheeler S.J. Tallon J.M. AUTHOR ADDRESSES (Vu E.N.; Peet H.E.; Bernklau R.P.; Wand R.T.; Wheeler S.J.; Tallon J.M.) British Columbia Ambulance Service, Provincial Air Evac and Critical Care Transport Programs, Vancouver, Canada. CORRESPONDENCE ADDRESS E.N. Vu, British Columbia Ambulance Service, Provincial Air Evac and Critical Care Transport Programs, Vancouver, Canada. SOURCE Air Medical Journal (2012) 31:4 (171). Date of Publication: July-August 2012 CONFERENCE NAME 2012 Critical Care Transport Medicine Conference CONFERENCE LOCATION Nashville, TN, United States CONFERENCE DATE 2012-04-02 to 2012-04-04 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Cyanide (CN) toxicity is an underreported and underrecognized cause of morbidity and mortality associated with closed-space severe burns and inhalation injury. The risk of CN toxicity from acts of terrorism or industrial accidents remains high. With the recent release of hydroxocobalamin (OHCo) in North America, the ability of EMS personnel to mitigate the morbidity and mortality associated with suspected or confirmed CN toxicity has improved substantially. Methods: OHCo was introduced into our prehospital CBRNE hazardous substance response program in June 2011. This program has 24-hour CBRNE paramedic advisors screening such calls, and 24-hour on-line medical oversight. Our CCP flight paramedics are equipped for the prehospital use of OHCo for confirmed or suspected CN toxicity. Our teams have monitoring and point-of-care field testing allowing for on-scene assessment of arterial blood gases, lactate, and carboxyhemoglobin, thereby facilitating prehospital triage and decision-making processes to expedite administration of the antidote in the field. Indications for the administration of OHCo include: CN level > 39 ?mol/L, or high clinical index of exposure (e.g., smoke inhalation, known CN exposure/ingestion) and altered LOC (Glasgow Coma Scale [GCS] < 13), shock (SBP < 90 mmHg), or lactate greater tan 8 mmol/L. Results: Over a 4-month period, OHCo has been used 3 times. All 3 patients were involved in separate trailer/ vehicle fires, with severe burns (30%, 45%, 90% TBSA full-thickness burns). Two had a pH of 7.20, one had a lactate of 4 mmol/L, and one had a COHgb level of 21%. All were obtunded with GCS 3, 6, and 7 before intubation. No complications were reported with the administration of OHCo in any patient. All were successfully transported to definitive care. Conclusion: We report the successful implementation of a prehospital OHCo program for confirmed or suspected CN toxicity. Further studies are required to assess the effect of the antidote in this patient population. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cyanide hydroxocobalamin EMTREE DRUG INDEX TERMS antidote carboxyhemoglobin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care toxicity EMTREE MEDICAL INDEX TERMS arterial gas dangerous goods decision making emergency health service exposure fire flight Glasgow coma scale human inhalation injury intubation monitoring morbidity mortality North America occupational accident patient personnel pH population risk screening smoke terrorism thickness LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70816235 DOI 10.1016/j.amj.2012.04.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.04.009 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 493 TITLE Improving the transfer of traumatic brain-injured patients AUTHOR NAMES Batuwitage B.T. Brennan K. Jankowski S. AUTHOR ADDRESSES (Batuwitage B.T.; Brennan K.; Jankowski S.) Department of Anaesthetics, Royal Hallamshire Hospital, Sheffield, United Kingdom. CORRESPONDENCE ADDRESS B.T. Batuwitage, Department of Anaesthetics, Royal Hallamshire Hospital, Sheffield, United Kingdom. SOURCE Journal of Neurosurgical Anesthesiology (2012) 24:3 (253). Date of Publication: July 2012 CONFERENCE NAME Annual Scientific Meeting of the Neuroanaesthesia Society of Great Britain and Ireland 2012 CONFERENCE LOCATION Belfast, Northern Ireland, United Kingdom CONFERENCE DATE 2012-05-10 to 2012-05-11 ISSN 0898-4921 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: High-quality transfer of patients with brain injury improves outcome.1 A prospective audit of the transfer of severe traumatic brain-injured (TBI) patients to our neurosurgical center using a data collection form designed to provide guidance and improve transfer quality was undertaken. The aim was to identify delays in transfer and their causes and assess quality of transfer. Methods: Intubated TBI patients urgently transferred to the neurosurgical intensive care unit (NICU) or to neurosurgical theatres over a 10-month period were included. Forms were placed in critical care and emergency (Table presented) departments (ED) of referring hospitals and were completed during or after transfer. Data on the quality of the transfer were collected at the neurosurgical center; any missing data were collected retrospectively. Results: Thirty-one TBI patients were transferred over the study period. Complete data on transfer time were available for 27. Average time from admission to ED of referring hospital to admission to the neurosurgical center was 7 hours and 3 minutes, this varied widely among referring hospitals. Twenty of 27 (74%) of transfers were delayed. Two of 20 (10%) of delays were unavoidable. Eighteen of 20 (90%) were deemed avoidable. (Table 1) illustrates causes for avoidable delays. Eleven of 31 (35%) of transfers were undertaken by junior trainees. Pretransfer arterial blood gas results were documented in 18/31 (58%). A contemporaneous record was kept in 22/31 (71%). In 11 patients, data were collected on admission to the neurosurgical center. In 2/11 this decreased below the targets set for a high-quality transfer. Conclusions: There were many areas where transfer of TBI patients could be improved. We plan to discuss our findings with neurosurgeons, medical staff in referring hospitals and continue to use our transfer forms with an aim to improve the standards of transfer in our region. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain human Ireland patient society United Kingdom EMTREE MEDICAL INDEX TERMS arterial gas brain injury clinical audit emergency hospital information processing intensive care intensive care unit medical staff neurosurgeon student LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70819359 DOI 10.1097/ANA.0b013e318258b649 FULL TEXT LINK http://dx.doi.org/10.1097/ANA.0b013e318258b649 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 494 TITLE How to transport the critically ill children? AUTHOR NAMES Dzulfikar D.L.H. AUTHOR ADDRESSES (Dzulfikar D.L.H.) Department of Child Health, Padjadjaran University, Dr. Hasan Sadikin Hospital Bandung, Indonesia. CORRESPONDENCE ADDRESS D.L.H. Dzulfikar, Department of Child Health, Padjadjaran University, Dr. Hasan Sadikin Hospital Bandung, Indonesia. SOURCE Critical Care and Shock (2012) 15:3 (66-67). Date of Publication: 2012 CONFERENCE NAME 19th International Symposium on Critical Care and Emergency Medicine 2012 CONFERENCE LOCATION Kuta, Bali, Indonesia CONFERENCE DATE 2012-07-12 to 2012-07-14 ISSN 1410-7767 BOOK PUBLISHER Indonesian Society of Critical Care Medicine ABSTRACT Safe transport of the critically ill children remains a global important issues. The importance is because of high risk mortality and morbidity that exists during the transport process. The goal is to stabilize the patient condition and to refer the patient to a better facility and more specialized personnel to prevent further deterioration. Thus, extremely ill patients can be transferred with minimal risk with this approach. In critically ill children, the indications for emergency transport are most likely due to respiratory problems (32%), trauma (22%), neurologic (15%), neonatal (15%), and several other emergencies (9%). Transfers can be primary or secondary. Primary transport occurs from the scene of acute illness or injury to hospital and secondary transport is transfer of patient between a referring and receiving hospital. The intra-hospital and inter-hospital transfer of critically ill patients is an inevitable part of emergency department practice. Transportation of patients within a hospital for the purpose of undergoing diagnostic, procedures, therapeutic, or transfer to a specialized unit are called intra-hospital transport and transportation between hospitals by several transfer mode are called inter-hospital transport. Transfer can be safely accomplished even in extremely ill patients. Those involved in transfers have the responsibility for ensuring that everything necessary in pre-transport, during transport, and after-transport/arrival is well prepared. In pre-transport, good coordination and communication between personnel, trained personnel, adequate equipment and medication, mode of transport, and monitoring during transport are required. During transport, an algorithm is provided for the inter- and intrahospital transport of critically ill patient for assuring patient condition. After transport, the receiving teams reevaluate patient condition with SOAP approach and should make the retrieval process uneventful. Although, transport of critically ill patient carries inherent morbidity and mortality risk, with safe transport of critically ill children, patient safety is enhanced and this will give better outcome in those who received the measures. Establishing an organized and efficient safe transport process supported by adequate personnel and equipment resources is mandatory. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child critically ill patient emergency medicine human intensive care EMTREE MEDICAL INDEX TERMS acute disease algorithm deterioration diagnostic procedure drug therapy emergency emergency ward hospital injury interpersonal communication monitoring morbidity mortality patient patient safety patient transport personnel responsibility risk traffic and transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71527474 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 495 TITLE Design and evaluation of a multi-disciplinary web-based handoff tool AUTHOR NAMES Schnipper J.L. Karson A.S. Morash S.K. Glotzbecker B. Milone M.J. Yolin Raley D.S. Nolido N.V. Horsky J. Leinen L. Bhan I. Dankers C. Church K.L. Minahan J.A. Yoon C. AUTHOR ADDRESSES (Schnipper J.L.; Glotzbecker B.; Milone M.J.; Yolin Raley D.S.; Nolido N.V.; Horsky J.; Church K.L.; Minahan J.A.; Yoon C.) Brigham and Women's Hospital, Boston, United States. (Schnipper J.L.; Karson A.S.; Glotzbecker B.; Bhan I.; Dankers C.) Harvard Medical School, Boston, United States. (Karson A.S.; Morash S.K.; Bhan I.; Dankers C.) Massachusetts General Hospital, Boston, United States. (Horsky J.; Leinen L.) Partners Healthcare, Boston, United States. CORRESPONDENCE ADDRESS J.L. Schnipper, Brigham and Women's Hospital, Boston, United States. SOURCE Journal of General Internal Medicine (2012) 27 SUPPL. 2 (S156-S157). Date of Publication: July 2012 CONFERENCE NAME 35th Annual Meeting of the Society of General Internal Medicine, SGIM 2012 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2012-05-09 to 2012-05-12 ISSN 0884-8734 BOOK PUBLISHER Springer New York ABSTRACT BACKGROUND: Failures in communication among healthcare personnel during intra-hospital handoffs in care are known threats to patient safety. In August, 2009, our healthcare system held a multi-stakeholder summit on handoffs, developed consensus around the need for a system-wide electronic handoff tool, and recommended a pilot study to develop and evaluate this technology. METHODS: We adapted a web-based, multi-disciplinary handoff tool used by a single residency program. Enhancements to the existing tool included: 1) implementation at a second hospital in our system; 2) support for simultaneous handoffs by nurses, residents/PAs, and attendings with shared information among the different roles; 3) custom structured templates for each user group; and 4) the ability to create progress notes and multiple sign-out forms from the same core data. The tool was refined and tested on a generalmedicine teaching service at one hospital and a hematologic malignancy PA service at the other. For 3 months pre-intervention and 4 months post-implementation, we surveyed receivers of handoffs regarding continuity of care and evaluated signout content using explicit criteria. We also conducted formal usability testing using simulated cases.We conducted principal components analysis to derive categories from the survey questions and create composite scores for each category. RESULTS: We received survey responses from 315 clinicians (66% response rate). In a pre-post analysis, 2 of 5 composite scores improved: perceived negative impact of handoff on clinical information and decision-making (composite score 14.7 pre, 10.2 post, p=0.01), and negative subjective rating of handoff quality and accuracy (28.4 vs. 25.8, p=0.01). Among survey questions to nurses, 10 improved, including an increase in how well handoffs prepared them for things that might go wrong (47.3 vs. 65.2, p=0.01). In the explicit review of written sign-outs, inclusion of 5 data elements (e.g., % tasks with if/then statements) increased, but decreases were noted in other data elements. Usability testing revealed a tension between desire for a clinical narrative and the use of structured template fields. CONCLUSIONS: A multi-disciplinary, web-based sign-out tool was able to increase subjective measures of sign-out quality and impact on clinical decision-making, particularly among nurses. Much of the improvement may have come from the ability to produce both a progress note and sign-out with one tool, which led to more frequent updating of sign-outs and greater faith in their accuracy. The use of customized “templated” fields was inconsistent and suggests that these should be minimized to those most necessary for continuity of care. Greater improvements in care may require further enhancements in usability of the tool, training in use of the tool, and education in best practices in handoffs in care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) internal medicine society EMTREE MEDICAL INDEX TERMS clinical decision making consensus decision making education health care personnel health care system hematologic malignancy hospital human interpersonal communication narrative nurse patient care patient safety pilot study principal component analysis teaching technology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71296576 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 496 TITLE Development of a potassium repletion protocol to decrease interruptions during ICU transfer of care AUTHOR NAMES Shvets L. Khan W. Ali M. Carson M.P. AUTHOR ADDRESSES (Shvets L.; Khan W.; Ali M.; Carson M.P.) Jersey Shore University Medical Center, Neptune, United States. CORRESPONDENCE ADDRESS L. Shvets, Jersey Shore University Medical Center, Neptune, United States. SOURCE Journal of General Internal Medicine (2012) 27 SUPPL. 2 (S160-S161). Date of Publication: July 2012 CONFERENCE NAME 35th Annual Meeting of the Society of General Internal Medicine, SGIM 2012 CONFERENCE LOCATION Orlando, FL, United States CONFERENCE DATE 2012-05-09 to 2012-05-12 ISSN 0884-8734 BOOK PUBLISHER Springer New York ABSTRACT BACKGROUND: Resident work hour limitations have highlighted the importance of avoiding interruptions during transitions of care, especially in the intensive care unit (ICU). Calls regarding abnormal potassium (K+) results are a common cause of such interruptions in our ICU. We implemented an automated K+repletion protocol for ICU patients with mild hyperkalemia and collected data to a) determine if it could decrease the number of phone calls made by nurses and received by residents, b) monitor and assess the response to the repletion dictated by the protocol, and c) determine whether protocol use changed the average time to first K+dose. METHODS: ICU nurses and residents completed surveys regarding the current potassium replacement system, and for a week tracked the relative number of calls/pages made regarding K+repletion. A written order set was developed, approved by the ICU committee and piloted for a month. The nurses used the automated protocol to direct K+ repletion only for patients whose eGFR was>=50 cc/min AND initial morning K+was between 3.3 and 3.9 meq/L (Protocol Used Group). For those with an eGFR<50 OR an initial K+<=3.2, the nurses called/paged the residents as usual (Standard Care). The protocol was only used once per day. The following were recorded each day: initial K+levels, creatinine, eGFR, K+supplement dose, time to administration, repeat K+values, and medications. K+repletion was separately tracked for those with eGFR<50 cc/min. RESULTS: Prior to the pilot program, residents received an average of 7 pages/day from nurses during morning sign-out rounds regarding potassium repletion orders. The median time to the first K+dose was longer for the Standard Care patients, and was over 9 hours for 4 (Table), but the difference between the mean time to repletion was not significantly different (Wilcoxn-Rank Sum p=0.13). 14 additional patients with an eGFR <50 (range 12-44) treated by Standard Care were tracked: the average morning K+was 3.5 meq/L, the average repletion dose was 43 meq of KCl, and the average next morning K+value was 3.7 meq/L, similar to the patients with an eGFR>=50. The nurses and residents thought the protocol was an effective tool. CONCLUSIONS: The pilot protocol was well received by the staff, did not cause hyperkalemia, prevented long delays in repletion, and prevented 2-3 interruptions/day during the morning transition of care when the pilot was implemented. Those with an eGFR<50 received similar repletion doses without developing hyperkalemia. Patients on the protocol received less total repletion because it was only implemented for those with a K+>=3.3 meq/L. The protocol is now in place as part of our standard, computerized, ICU order set and except for those with critically low K+, it is being used to address the first daily K+ regardless of eGFR. As 88% of patients had a K+>=3.3 meq/L, it has the potential to prevent at least 5-6 interruptions per day. (Table Presented). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) potassium EMTREE DRUG INDEX TERMS creatinine potassium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) internal medicine society EMTREE MEDICAL INDEX TERMS drug therapy human hyperkalemia intensive care unit nurse patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71296585 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 497 TITLE Improved neonatal outcomes after the new Turkish regulation on assisted reproduction technology imposing single embryo transfer AUTHOR NAMES Guzoglu N. Kanmaz H.G. Uras N. Erdeve O. Dilli D. Dilmen U. AUTHOR ADDRESSES (Guzoglu N.; Kanmaz H.G.; Uras N.; Erdeve O.; Dilmen U.) Zekai Tahir Burak Maternity Teaching Hospital, Neonatology, Ankara, Turkey. (Dilli D.) Sami Ulus Children Hospital, Neonatology, Ankara, Turkey. CORRESPONDENCE ADDRESS N. Guzoglu, Zekai Tahir Burak Maternity Teaching Hospital, Neonatology, Ankara, Turkey. SOURCE Human Reproduction (2012) 27 SUPPL. 2. Date of Publication: 2012 CONFERENCE NAME 28th Annual Meeting of the European Society of Human Reproduction and Embryology, ESHRE 2012 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2012-07-01 to 2012-07-04 ISSN 0268-1161 BOOK PUBLISHER Oxford University Press ABSTRACT Objectives and Aim: In vitro fertilization (IVF) has become an efficient and widely used treatment for infertile couples however it is responsible for the increasing number of multifetal pregnancies and adverse neonatal outcomes. The aim of this study was to assess efficacy of the 2010 Turkish reproductive regulation obligating single embryo transfer (SET) to decrease incidence of multiple pregnancies and impact of a mandatory policy of SET embryo transfer on neonatal intensive care unit (NICU) admissions in addition to morbidity and mortality rates for our hospital. Material and Methods: Between February 2010 and October 2011 all assisted reproductive technology (ART) pregnancies delivered at Zekai Tahir Burak Maternity Teaching Hospital were subjected to this study. Subjects were divided into two groups; Group 1 consisted of infants delivered before ART regulation between February 2010 and October 2010 and Group 2 consisted of infants delivered after the ART regulation between November 2010 and October 2011. Results: Comparing the study groups, we observed a significant decrease in the incidence of multiple births in Group 2. Mean gestational age was significantly lower and significantly higher rates of <28 w and <37 w were found in Group 1. Mean birth weight was significantly lower and the incidence of low birth weight, very low birth weight and extremely low birth weight were significantly higher in Group 1. NICU admission rates and the incidence of respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, pneumonia and sepsis, anemia, bronchopulmonary dysplasia and mortality rates were significantly higher in Group 1. Conclusion: Implementation of new Turkish ART regulation which obligates SET successfully decreased the rates of multiple births and resulted in better neonatal outcomes and may also have a beneficial effect on long term results. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) embryo transfer embryology human infertility therapy reproduction society EMTREE MEDICAL INDEX TERMS anemia birth weight extremely low birth weight gestational age hospital in vitro fertilization infant intensive care unit low birth weight lung dysplasia morbidity mortality multiple pregnancy necrotizing enterocolitis newborn intensive care patent ductus arteriosus pneumonia policy pregnancy respiratory distress syndrome sepsis teaching hospital technology very low birth weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71113503 DOI 10.1093/humrep/27.s2.79 FULL TEXT LINK http://dx.doi.org/10.1093/humrep/27.s2.79 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 498 TITLE Time from CT to groin puncture lower in patients transferred from outside hospitals compared to the local emergency room AUTHOR NAMES Nogueira R. Glenn B. Belagaje S. Anderson A. Frankel M. Nahab F. Gupta R. AUTHOR ADDRESSES (Nogueira R.; Glenn B.; Belagaje S.; Anderson A.; Frankel M.; Nahab F.; Gupta R.) Department of Neurology, Emory University, School of Medicine, Atlanta, United States. CORRESPONDENCE ADDRESS R. Nogueira, Department of Neurology, Emory University, School of Medicine, Atlanta, United States. SOURCE Journal of NeuroInterventional Surgery (2012) 4 SUPPL. 1 (A70). Date of Publication: July 2012 CONFERENCE NAME 9th Annual Meeting of the Society of NeuroInterventional Surgery, SNIS 2012 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2012-07-23 to 2012-07-26 ISSN 1759-8478 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Introduction Patients being transferred from outside facilities are often excluded from intra-arterial therapy due to delays in transfer, evaluation and imaging. The Marcus Stroke and Neuroscience Center at Grady Memorial Hospital is a unique prototype for stroke reperfusion therapies in the future. The CT scanner and biplane angiography suite are housed in the intensive care unit. Patients being transferred from outside facilities are brought directly to the intensive care unit where imaging and reperfusion therapies can be performed rapidly. We sought to determine if there were time differences in patients evaluated in our emergency room compared to transfers from outside facilities. Materials and Methods A prospective database of consecutive intra-arterial therapy at the Marcus Stroke Center was reviewed. Patients treated from October 2010eJanuary 2012 were reviewed. We assessed demographic, radiographic and clinical variables in addition to if patients were transferred from outside facilities. We assessed times from CT to groin puncture for patients evaluated in our emergency room and compared them to patients transferred from outside hospitals. Patients with anterior circulation strokes <8 h from symptom onset were assessed. Patients with posterior circulation strokes were excluded. We performed Fisher's exact testing for categorical variables and student's t-test for continuous variables. Results A total of 165 patients with a mean age of 66613 years with a mean NIHSS of 1965. A total of 109 (65%) patients were transferred from outside hospitals. Patients from outside facilities were significantly less likely to have hypertension (61% vs 81%, p<0.01) but there were no baseline differences in age, NIHSS, clot location and time from symptom onset. Patients transferred from outside facilities had significantly lower times from CTat our institution to groin puncture compared to patients from our emergency room (42620 min vs 74±30 min, p<0.0001). Conclusions The presence of a biplane angiography suite in the neurological intensive care unit may help to reduce times to reperfusion in patients being transferred from an outside facility. Developing systems of care to reduce times to reperfusion will require assessment of systems of care that focus on available resources. Efficient systems to treat patients from outside hospitals may help to improve the ability to offer treatments to more patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward hospital human inguinal region patient puncture society surgery EMTREE MEDICAL INDEX TERMS aircraft angiography cerebrovascular accident computed tomography scanner data base hypertension imaging intensive care unit intraarterial drug administration National Institutes of Health Stroke Scale reperfusion Student t test therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70899062 DOI 10.1136/neurintsurg-2012-010455c.56 FULL TEXT LINK http://dx.doi.org/10.1136/neurintsurg-2012-010455c.56 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 499 TITLE Emergent interfacility evacuation of critical care patients in combat AUTHOR NAMES Franco Y.E. Lorenzo R.A.D. Salyer S.W. AUTHOR ADDRESSES (Franco Y.E.) C.R. Darnall Army Medical Center, Fort Hood, TX, United States. (Lorenzo R.A.D., Robert.DeLorenzo@amedd.army.mil; Salyer S.W.) Department of Clinical Investigation, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234-6200, United States. CORRESPONDENCE ADDRESS R.A.D. Lorenzo, Department of Clinical Investigation, Brooke Army Medical Center, 3851 Roger Brooke Dr., Fort Sam Houston, TX 78234-6200, United States. Email: Robert.DeLorenzo@amedd.army.mil SOURCE Air Medical Journal (2012) 31:4 (185-188). Date of Publication: July-August 2012 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT During the Second Iraq War (Operation Iraqi Freedom), high-intensity, low-utilization medical and surgical services, such as neurosurgical care, were consolidated into a centralized location within the combat zone. This arrangement necessitated intra-theater air medical evacuation of critically ill or injured patients from outlying combat support hospitals (CSH) to another combat zone facility having the needed services. A case series is presented of intratheater transfer of neurosurgical patients in Iraq during 2005-06. Ninety-eight patients are included in the series, with typical transfer distances of 40 miles (approximately 20-25 minutes of flight time). All patients were transported with a CSH nurse in addition to the standard Army EMT-B flight medic. Seventy-six percent of cases were battle injury, 17 were non-battle injuries, and the balance were classified as non-injury mechanisms. Seventy-six percent of cases were head injuries, with the balance involving burns, stroke, and other injuries. At 30 days, 12 of the patients had died, and 9 remained hospitalized in a critical care setting. None of the patients died during evacuation. Intratheater and interfacility transfer of critical care patients in the combat theater often involves severely head-injured and other neurosurgical cases. Current Army staffing for helicopter transport in these case requires a nurse or other advanced personnel to supplement the standard EMT-B flight medic. © 2012 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport war EMTREE MEDICAL INDEX TERMS air medical transport army article battle injury burn patient cerebrovascular accident combat support hospital head injury health care facility health service helicopter hospital human Iraq major clinical study mortality neurosurgery nurse paramedical personnel priority journal surgical patient EMBASE CLASSIFICATIONS Internal Medicine (6) Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012380722 MEDLINE PMID 22748416 (http://www.ncbi.nlm.nih.gov/pubmed/22748416) PUI L365149015 DOI 10.1016/j.amj.2011.09.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2011.09.004 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 500 TITLE The development of a portable life support device for transporting pre-hospital critically ill patients AUTHOR NAMES Song Z.-X. Wu T.-H. Meng X.-J. Lu H.-Z. Zheng J.-W. Wang H.-T. AUTHOR ADDRESSES (Song Z.-X., song9705@163.com; Wu T.-H.; Meng X.-J.; Lu H.-Z.; Zheng J.-W.; Wang H.-T.) Institute of Medical Equipment, Academy of Military Medical Science, Tianjin 300161, China. CORRESPONDENCE ADDRESS Z.-X. Song, Institute of Medical Equipment, Academy of Military Medical Science, Tianjin 300161, China. Email: song9705@163.com SOURCE Chinese Critical Care Medicine (2012) 24:6 (323-326). Date of Publication: 10 Jun 2012 ISSN 1003-0603 BOOK PUBLISHER Heilongjiang Institute of Science and Technology Information, 74 Yinhnag St, Nangang-qu, Harbin, China. ABSTRACT Objective: To describe a portable life support device for transportation of pre-hospital patients with critical illness. Methods: The characteristics and requirements for urgent management during transportation of critically ill patients to a hospital were analyzed. With adoption of the original equipment, with the aid of stale of the art soft ware, the overall structure, its installation, fixation, freedom from interference, operational function were studied, and the whole system of life support and resuscitation was designed. Results: The system was composed by different modules, including mechanical ventilation, transfusion, aspiration, critical care, oxygen supply and power supply parts. The system could be fastened quickly to a stretcher to form portable intensive care unit (ICU), and it could be carried by different size vehicles to provide nonstop treatment by using power supply of the vehicle, thus raising the efficiency of urgent care. Conclusion: With characteristics of its small size, lightweight and portable, the device is particularly suitable for narrow space and extreme environment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient life support device medical device patient transport portable equipment EMTREE MEDICAL INDEX TERMS article artificial ventilation aspiration emergency care human intensive care intensive care unit oxygen supply power supply resuscitation software transfusion EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE Chinese LANGUAGE OF SUMMARY English, Chinese EMBASE ACCESSION NUMBER 2012422993 MEDLINE PMID 22681658 (http://www.ncbi.nlm.nih.gov/pubmed/22681658) PUI L365272881 DOI 10.3760/cma.j.issn.1003-0603.2012.06.002 FULL TEXT LINK http://dx.doi.org/10.3760/cma.j.issn.1003-0603.2012.06.002 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 501 TITLE A 5-year review of transfers of suspected single ventricle cardiac lesions through west of Scotland neonatal transport service AUTHOR NAMES Daspal S. Jackson L. AUTHOR ADDRESSES (Daspal S.; Jackson L.) West Of Scotland Neonatal Transport, United Kingdom. CORRESPONDENCE ADDRESS S. Daspal, West Of Scotland Neonatal Transport, United Kingdom. SOURCE Journal of Maternal-Fetal and Neonatal Medicine (2012) 25 SUPPL. 2 (25). Date of Publication: June 2012 CONFERENCE NAME 23rd European Congress of Perinatal Medicine CONFERENCE LOCATION Paris, France CONFERENCE DATE 2012-06-13 to 2012-06-16 ISSN 1476-7058 BOOK PUBLISHER Informa Healthcare ABSTRACT Introduction: Single ventricle cardiac lesions are best managed in dedicated tertiary cardiac service centre involving a multidisciplinary team. The West of Scotland Neonatal Transport Service has always adopted a role in bridging between multidisciplinary team management by providing safe and stable transfer. Our aim was to review the demographic & clinical details of the infants transferred with single ventricle cardiac lesions by a national neonatal transport team. Methods: A retrospective review of suspected/confirmed single ventricle cardiac lesion transfers to and from a national cardiology service between August 2006 and July 2011. Information was collated from transport logs, referral letters and cardiology database for each case. Data was analysed by using descriptive statistics. Results: A total of 57 infants were transferred with wide variation of age between 1 and 23 days (Mean 3.2 days). A total 38 infants (67%) stayed in the West of Scotland with neonatal intensive care unit being the highest receiver (51%). A variety of defects were transferred during this study period with hypoplastic left heart being the commonest (46%) followed by pulmonary atresia (26%). Prostin therapy was used in 54 cases (95%) with half of them required low dose (<10 ng/kg/min). Interestingly there was a correlation between increased number of antenatal diagnosis and use of low dose of prostin (<10 ng/kg/min) with correlation coefficient of 0.94. A total of 18 infants (31%) were ventilated. Only one infant on low dose of prostin required ventilatory support whereas all the seven infants of higher dose of prostin (>20 ng/kg/min) required ventilatory support prior to transfer. All infants remained stable with mean oxygen saturation of 85% (StdV 12.13) and mean blood pressure of 49 mmHg (StdV 8.2). End tidal carbon dioxide (EtCO2) was recorded in all ventilated infants (Mean 5.6 KpA, StdV 1.6) with similar blood gas carbon dioxide measurement (Mean 5.9 KpA, StdV 1.4). Adequate systemic oxygen delivery was noted with a mean pH of 7.34 (StdV 0.09) and mean lactate of 3 mmol (StdV 2.6). In nine transfers (16%), inotropic supports were used (Dobutamine in 6 transfers and Dopamine in 3 transfers). Discussion: The relationship between dose of prostin infusion and antenatal diagnosis was likely due to smaller requirement of prostin to maintain ductal patency. Although there was increasing trend of ventilatory requirement in higher dose of prostin infusion, this could be due to infant's general condition rather than prostin effect. Conclusion: Our data showed a recognised association between antenatal diagnosis of cardiac defects and a low dose prostin requirement as well as less ventilatory requirement which would have favourable effect on the cardiac physiology. Carbon dioxide monitoring should be standard practice when transferring ventilated cardiac infants. We appreciate that the results from this study would provide useful information for future research & audit. EMTREE DRUG INDEX TERMS carbon dioxide dobutamine dopamine oxygen prostaglandin E2 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart injury heart single ventricle perinatal care United Kingdom EMTREE MEDICAL INDEX TERMS blood gas capnometry cardiology clinical audit correlation coefficient data base end tidal carbon dioxide tension general condition heart human infant infusion inotropism intensive care unit low drug dose mean arterial pressure monitoring newborn intensive care oxygen saturation pH physiology prenatal diagnosis pulmonary valve atresia statistics Tertiary (period) therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70781395 DOI 10.3109/14767058.2012.679162 FULL TEXT LINK http://dx.doi.org/10.3109/14767058.2012.679162 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 502 TITLE Can cardiac surgery patients transfer from ICU the same day as surgery? AUTHOR NAMES Manji R.A. Arora R.C. Bell D.D. Menkis A. Jacobsohn E. AUTHOR ADDRESSES (Manji R.A.; Arora R.C.; Menkis A.) Surgery, University of Manitoba, Winnipeg, Canada. (Bell D.D.; Jacobsohn E.) Anesthesia, University of Manitoba, Winnipeg, Canada. CORRESPONDENCE ADDRESS R.A. Manji, Surgery, University of Manitoba, Winnipeg, Canada. SOURCE Canadian Journal of Anesthesia (2012) 59 SUPPL. 1. Date of Publication: June 2012 CONFERENCE NAME 2012 Annual Meeting of the Canadian Anesthesiologists' Society, CAS CONFERENCE LOCATION Quebec City, QC, Canada CONFERENCE DATE 2012-06-15 to 2012-06-18 ISSN 0832-610X BOOK PUBLISHER Springer New York LLC ABSTRACT Introduction: Ability to transfer a patient out of the cardiac surgery ICU (CSICU) same day as surgery would assist with improving flow of cardiac surgery patients through the system as it would allow two patients to “occupy” the same bed in a 24 hour period. Objective: To characterize patients that are ward transfer ready ≤ 4 hours or >4 hours post arrival in CSICU. Methods: Local HREB approval was granted. From Mar 2008 to Mar 2009, all cardiac surgery patients admitted to CSICU were specifically evaluated for earliest transfer time possible using specified criteria relating to bleeding, urine output, hemodynamic/respiratory status, neurological status and cardiac rhythm status. They were divided into two groups: early transfer group (ETG) were patients ready for transfer ≤ 4 hours from arrival in ICU who actually were transferred to ward in stable condition within 24 hours and late transfer group (LTG) which were all other patients. Multivariable logistic regression identified patients requiring longer ICU stay. Results: There were 1010 patients enrolled in the study of which 274 (27.1%) were in the ETG having a transfer ready time of 2.1 ± 1.1 hours (mean ± SD). There were no readmissions to ICU and no in-hospital mortality in the ETG group. Logistic regression revealed emergency operation (OR 17.6; 95% CI 2.4 - 129.9; p=0.01), congestive heart failure (OR 2.9; 95% CI 1.5 - 5.7; p<0.01), cerebrovascular disease (OR 2.2; 95% CI 1.2 - 3.9; p<0.01), procedure involving aortic valve (OR 2.2; 95% CI 1.2 - 3.9; p<0.01); and procedure involving thoracic aorta (OR 5.0; 95% CI 1.5 - 17.3; p<0.01) to be associated with longer stay with peripheral vascular disease (p=0.06) and chronic renal failure (p=0.08) trending to be significantly associated with longer stay. Variables not significant in the model, suggesting they would be suitable for early transfer (assuming they did not also have one of the longer stay factors), were: isolated CABG, open chamber procedure, redo cardiac surgery, stable angina, and pre-operative arrhythmias. ICU length of stay in the two groups was - median (interquartile range): ETG 20.5 (18.0 - 22.3) versus LTG 40.8 (22.5 - 68.4) hours - p<0.01. Discussion: Our data suggest that there are predictable factors that could be used to decide which patients may be transferable to the ward same day as surgery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesist Canadian heart surgery human society surgery surgical patient EMTREE MEDICAL INDEX TERMS aortic valve astronomy bleeding cerebrovascular disease chronic kidney failure congestive heart failure emergency surgery heart arrhythmia heart rhythm hospital readmission length of stay logistic regression analysis model mortality patient peripheral vascular disease procedures stable angina pectoris thoracic aorta urine volume ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71888702 DOI 10.1007/s12630-012-9785-6 FULL TEXT LINK http://dx.doi.org/10.1007/s12630-012-9785-6 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 503 TITLE Intrahospital transport: Safe passage or potential for disaster? AUTHOR NAMES Winemiller M. Stermer C. AUTHOR ADDRESSES (Winemiller M.; Stermer C.) Clin III, York Hospitals, York, United States. CORRESPONDENCE ADDRESS M. Winemiller, Clin III, York Hospitals, York, United States. SOURCE Journal of Radiology Nursing (2012) 31:2 (74). Date of Publication: June 2012 CONFERENCE NAME 2012 Annual Convention of the Association for Radiologic and Imaging Nursing, ARIN 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-03-24 to 2012-03-28 ISSN 1546-0843 BOOK PUBLISHER Elsevier Inc. ABSTRACT Transport of acutely ill patients throughout the hospital can be potentially unsafe and place the patient at an increased risk for complications, morbidity, and mortality. Acutely ill patients are defined as any nonintensive care unit patient on continuous monitoring being transported to treatments, diagnostic procedures, or a higher level of care within the hospital setting. Limited resources such as expertise of transport staff and equipment also add to the potential for complications during transport. A wide variation in practice exists because there are currently no best practices for transport of the non-intensive care unit patient. Some patients may be transported with portable monitors with qualified staff in attendance and others may be transported by non-licensed personnel only. Radiology and imaging nurses as well as other procedural area staff share concerns about patient safety, notably, that monitoring may be interrupted during procedures and transport. An interdisciplinary evidence-based practice project was conducted to address these concerns. Recommendations from the project support the continuation of the same physiologic monitoring during procedures and transport that the patient receives on a nursing unit. Based on the evidence, changes were made to policies that specified personnel, equipment, monitoring, and communication throughout the transport and procedure. Other practice changes included the development of a checklist to ensure appropriate resources are provided. Implementation of these practice changes has resulted in an established standard of care for these patients and improved patient safety during transport. Objective 1: To describe the necessary components of safe intrahospital patient transport. Content for Objective 1: Components include: 1. Detailed policies and protocols, 2. Pre-transport coordination, 3. Qualifications of transport personnel, 4. Type and availability of transport equipment, 5. Monitoring parameters during transport, and 6. Communication and documentation. Objective 2: To explore the benefits of using a checklist or scorecard for patient transport. Content for Objective 2: Checklist or scorecard establishes: 1. The decision to transport, 2. Patient acuity assessment, 3. Identification of proper equipment, 4. Transport team, 5. Handoff communication, 6. Consistent practice, and 7. Improved patient safety. Objective 3: To describe the necessary components of safe intrahospital patient transport. Content for Objective 3: Components include: 1. Detailed policies and protocols, 2. Pre-transport coordination, 3. Qualifications of transport personnel, 4. Type and availability of transport equipment, 5. Monitoring parameters during transport, and 6. Communication and documentation. Objective 4: To explore the benefits of using a checklist or scorecard for patient transport. Content for Objective 4: Checklist or scorecard establishes: 1. The decision to transport, 2. Patient acuity assessment, 3. Identification of proper equipment, 4. Transport team, 5. Handoff communication, 6. Consistent practice, and 7. Improved patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) imaging nursing EMTREE MEDICAL INDEX TERMS checklist diagnostic procedure documentation evidence based practice health care quality hospital human intensive care unit interpersonal communication monitoring morbidity mortality nurse nursing unit parameters patient patient safety patient transport personnel policy procedures radiology risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70817119 DOI 10.1016/j.jradnu.2012.03.019 FULL TEXT LINK http://dx.doi.org/10.1016/j.jradnu.2012.03.019 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 504 TITLE 2012 ARIN Convention and Poster Abstracts AUTHOR ADDRESSES SOURCE Journal of Radiology Nursing (2012) 31:2. Date of Publication: June 2012 CONFERENCE NAME 2012 Annual Convention of the Association for Radiologic and Imaging Nursing, ARIN 2012 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-03-24 to 2012-03-28 ISSN 1546-0843 BOOK PUBLISHER Elsevier Inc. ABSTRACT The proceedings contain 17 papers. The topics discussed include: nurses in leadership and decision-making roles: new I.R. model; warning: triaging for improved patient outcomes; comparison of skin antisepsis agents; improvement of nursing skill and competence using interdisciplinary simulation training; our journey on the path to magnet status; synergistic nursing professionals in radiology to enhance patient care; initial assessment of outpatients previously scheduled for ultrasound-guided invasive procedures; double-checking of the medical request before ultrasound examinations: a way to ensure a safe examination; intrahospital transport: safe passage or potential for disaster?; the planning & implementation of multidisciplinary peer review; and PET/CT with retrograde bladder filling: to cath or not to cath?. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) imaging nursing EMTREE MEDICAL INDEX TERMS antisepsis bladder filling competence decision making examination human invasive procedure leadership magnet model nurse nursing competence outpatient patient patient care peer review planning radiology simulation skin ultrasound LANGUAGE OF ARTICLE English PUI L70817122 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 505 TITLE Transfer patterns of guillain-barŕe syndrome patients in the Netherlands AUTHOR NAMES Van Leeuwen N. Lingsma H.F. Vanrolleghem A.M. Van Doorn P.A. Sturkenboom M. Steyerberg E.W. Jacobs B.C. AUTHOR ADDRESSES (Van Leeuwen N.; Lingsma H.F.; Steyerberg E.W.) Centre for Medical Decision Making, Department of Public Health, Rotterdam, Netherlands. (Vanrolleghem A.M.; Sturkenboom M.) Department of Medical Informatics, Rotterdam, Netherlands. (Van Doorn P.A.; Jacobs B.C.) Department of Neurology, Rotterdam, Netherlands. (Jacobs B.C.) Department of Immunology, Erasmus Medical Center, Rotterdam, Netherlands. CORRESPONDENCE ADDRESS N. Van Leeuwen, Centre for Medical Decision Making, Department of Public Health, Rotterdam, Netherlands. SOURCE Journal of the Peripheral Nervous System (2012) 17:2 (276-277). Date of Publication: June 2012 CONFERENCE NAME 2012 Peripheral Nerve Society/Inflammatory Neuropathy Consortium Meeting, PNS/INC CONFERENCE LOCATION Rotterdam, Netherlands CONFERENCE DATE 2012-06-24 to 2012-06-27 ISSN 1085-9489 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Guillain-Barré syndrome (GBS) patients have a highly heterogeneous disease course with often a long duration of admission, which results in frequent transfers within and between hospitals, especially between medium and intensive care units (ICU). Little is known about these transfers, despite the fact that transfers have a major impact on patient and public health care. Therefore we aimed to describe frequency, timing, and circumstances of transfers within and between hospitals in an unselected cohort of Dutch GBS patients. All 123 Dutch hospitals were requested to report patients diagnosed with GBS between 2009 and 2010. Information regarding clinical course and transfers was obtained via neurologists, general practitioners and discharge letters from hospital. We included 87 GBS patients from 33 hospitals with a representative combination ofmild and severe cases, as reflected by the range in maximal GBS disability scores: 1 or 2 (28%), 3 or 4 (53%), 5 (19%), and 6 (1%). Four (5%) patients had a mild GBS and were not admitted to hospital. 71 (82%) were originally admitted at a neurology department in an academic or non-academic hospital. The other 11 patients (13%) were admitted at the ICU, internal medicine, or pediatrics department. The median hospital stay was 42 days (IQR 20-64 days). Of the 83 admitted patients, 40% had at least one (single) transfer to another department or hospital, in which more than 50% within 2 days after admission. 25 (30%) patients were transferred 2 times or more during their hospital stay, 2 (2%) patients were transferred 4 times, 30 (36%) patients stayed in an ICU anytime during their hospital stay. Eight (13%) of 60 patients originally admitted to a non-academic hospital were transferred to an academic center. Eventually, 41 (49%) patients went home after discharge, while the others were referred to a rehabilitation center (46%) or nursing home (5%). This study shows the high frequency of transfers of GBS patients and that transfer patterns are very heterogeneous. In the future we aim to identify which subgroups of patients are at risk for transfer, and to develop the most patient friendly and cost-effective strategy to guide these transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human Netherlands neuropathy patient peripheral nerve EMTREE MEDICAL INDEX TERMS disability disease course general practitioner hospital hospitalization intensive care unit internal medicine neurologist neurology nursing home pediatrics public health service rehabilitation center risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71387849 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 506 TITLE An audit on intrahospital transfers of critically ill patients AUTHOR NAMES Trapani Galea Feriol P. Buttigieg M. Sciberras S. AUTHOR ADDRESSES (Trapani Galea Feriol P.; Buttigieg M.; Sciberras S.) Mater Dei Hospital, Department of Anaesthesiology and Intensive Care, Msida, Malta. CORRESPONDENCE ADDRESS P. Trapani Galea Feriol, Mater Dei Hospital, Department of Anaesthesiology and Intensive Care, Msida, Malta. SOURCE European Journal of Anaesthesiology (2012) 29 SUPPL. 50 (217). Date of Publication: June 2012 CONFERENCE NAME European Anaesthesiology Congress, EUROANAESTHESIA 2012 CONFERENCE LOCATION Paris, France CONFERENCE DATE 2012-06-09 to 2012-06-12 ISSN 0265-0215 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background and Goal of Study: Patient safety during intrahospital transfers has not received as much attention in the literature as interhospital transfers. Indeed our institution does not have a specific guideline for transfer of critically ill patients.The purpose of this audit was to assess the logistics, quality and safety of intrahospital transfers requiring input from on-call anaesthetists within a 800-bed hospital. Material and Methods: A prospective audit of 100 intrahospital transfers was carried out within Mater Dei Hospital, between 13-07-11 and 20-09-11. Coordination and collection of data was carried out by one of the authors (P.Trapani Galea Feriol) who interviewed the on call anaesthetists after a 24 hour shift using the data collection form. Statistical analysis (chi squared test when appropriate) was carried out to demonstrate a statistically significant relationship between clinical incidents and the following variables: different time of day, referring clinical area and number of staff accompanying the anaesthetist. Results and Discussion: Of the 100 patient transfers requiring anaesthetic cover studied, the commonest reason for requesting an anaesthetist was to accompany a ventilated patient (43%). Most transfers occurred between 14.00 and 20.00 hours and 70% of transfers lasted less than 30 minutes. Analysis of data regarding accompanying personnel revealed that 45% were not accompanied by a porter. In 24% of transfers the anaesthetist was only supported by one paramedic member of staff with a median of 2 paramedic personnel accompanying a transfer (range 1-3).Clinical incidents (defined according to the 2011 Clinical Incident Management Policy DoH Western Australia) occurred in 10% of transfers. Statistical analysis did not reveal any statistically significant relationship between clinical incident frequency and number of people accompanying a transfer (p=0.50) or time of day(p=0.41). Conclusion: This study confirmed that intrahospital transfers may be associated with a clinically significant clinical incident rate, although we did not demonstrate a statistically significant association with any variable studied. This has stimulated interest to draw up a local transfer checklist and improve education and training to optimise safety for intrahospital transfers. EMTREE DRUG INDEX TERMS anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesiology clinical audit critically ill patient human patient transport EMTREE MEDICAL INDEX TERMS anesthesist Australia checklist education hospital information processing patient safety personnel policy safety statistical analysis ventilated patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71084709 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 507 TITLE Review on the need of telemetry monitoring in general ward after transferring out from coronary care unit in STEMI patients who remained in Killip 1 after undergoing successful primary percutaneous intervention AUTHOR NAMES Tan V.H. Tong K.L. Ng F.C. Loh D. Yap Q.Y. Goh P.P. AUTHOR ADDRESSES (Tan V.H.; Tong K.L.; Goh P.P.) Cardiology Department, Changi General Hospital, Singapore, Singapore. (Ng F.C.; Loh D.; Yap Q.Y.) Coronary Care Unit, Changi General Hospital, Singapore, Singapore. CORRESPONDENCE ADDRESS F.C. Ng, Coronary Care Unit, Changi General Hospital, Singapore, Singapore. SOURCE Circulation (2012) 125:19 (e793). Date of Publication: 15 May 2012 CONFERENCE NAME World Congress of Cardiology Scientific Sessions 2012, WCC 2012 CONFERENCE LOCATION Dubai, United Arab Emirates CONFERENCE DATE 2012-04-18 to 2012-04-21 ISSN 0009-7322 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: With the increasing number of patients with heart diseases requiring telemetry monitoring in general ward after transferred out from Coronary Care Unit (CCU), there is an urgent need to ensure appropriate telemetry allocation in view of limited numbers of telemetry available. Objectives: We assess the need of telemetry monitoring in general wards after transferred out from CCU in patients with ST elevation myocardial infarction (STEMI) who remained in Killip Class 1 after undergoing successful primary percutaneous coronary intervention (PPCI). Methods: This was a retrospective study over 12-month period. Inclusion criteria including patients presented with STEMI who remained in Killip 1 after undergoing successful PPCI. Study end point was in-hospital occurrence of sustained ventricular tachycardia (>30 seconds) or ventricular fibrillation (VF) post PPCI. Exclusion criteria include patients on intra-aortic balloon counterpulsation (IABP), temporary pacemaker, urgent CABG or unsuccessful PPCI. Results: A total of 271 patients had STEMI and underwent PPCI in year 2010. 197 patients (72.7%) patients remained in Killip 1 after PPCI. In the Killip 1 group, mean age was 53.6 ± 11.3 years. Majorities were male (89.8%), smoker (52.3%) and have dyslipidaemia (82.7%). None of the patients developed sustained ventricular tachycardia or VF. 9 patients (4.6%) developed reperfusion arrhythmia (accelerated idioventricular rhythm) post PPCI which were transient in nature and no treatment required. Conclusion: STEMI patients who remained in Killip 1 after successful PPCI were not at risk of developing sustained ventricular tachycardia or ventricular fibrillation. They may not require telemetry monitoring in general wards and this may improve utilisation of limited numbers of telemetry. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology coronary care unit human monitoring patient ST segment elevation myocardial infarction telemetry ward EMTREE MEDICAL INDEX TERMS aortic balloon counterpulsation heart arrhythmia heart disease heart ventricle fibrillation heart ventricle tachycardia hospital male pacemaker percutaneous coronary intervention reperfusion retrospective study risk smoking supraventricular tachycardia LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71051588 DOI 10.1161/CIR.0b013e31824fcdb3 FULL TEXT LINK http://dx.doi.org/10.1161/CIR.0b013e31824fcdb3 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 508 TITLE Rapid response team-triggered procalcitonin measurement predicts infectious intensive care unit transfers AUTHOR NAMES Wunderink R.G. Diederich E.R. Caramez M.P. Donnelly H.K. Norwood S.D. Kho A. Reed K.D. AUTHOR ADDRESSES (Wunderink R.G.; Diederich E.R.; Caramez M.P.; Donnelly H.K.; Norwood S.D.; Kho A.; Reed K.D.) CORRESPONDENCE ADDRESS R. G. Wunderink, SOURCE Critical Care Medicine (2012). Date of Publication: 4 May 2012 ISSN 0090-3493 1530-0293 (electronic) BOOK PUBLISHER Society of Critical Care Medicine and Lippincott Williams & Wilkins ABSTRACT OBJECTIVE:: Determine if procalcitonin at the time of initial rapid response team activation identifies patients who are likely to need subsequent intensive care unit transfer. DESIGN:: Prospective observational cohort study. SETTING:: Urban, tertiary care hospital with rapid response team activation through an electronic modified early warning score. PATIENTS:: One hundred nineteen oncology and 100 consecutive non-oncology patients after initial rapid response team visit precipitated by an elevated electronic modified early warning score were recruited. Rapid response team activations by request of nursing or for other reasons were not studied. Five oncology patients seen by a rapid response team for complications of interleukin-2 therapeutic infusions were subsequently excluded. INTERVENTIONS:: Residual serum from the next ordered clinical test (within 12 hrs) was retrieved, frozen, and stored for procalcitonin determination. A second sample 12-24 hrs after the initial specimen was also retrieved if available and if the patient had not yet been transferred to the intensive care unit. MEASUREMENTS AND MAIN RESULTS:: Seventy-three patients (33%) were transferred to the intensive care unit. Rapid response team activations that did not result in intensive care unit transfer had significantly lower procalcitonin levels (median 0.28 ng/mL [interquartile range 0.09-1.24]) than those that resulted in intensive care unit transfer (median 0.51 ng/mL [interquartile range 0.11-1.97], p = .0001) but the area under the receiver operating curve was only 0.656. The change in procalcitonin level in patients with intensive care unit transfers was very heterogeneous but was significantly increased compared to the change in patients not transferred to the intensive care unit. Procalcitonin levels for intensive care unit transfers for probable or definite infection were 2.28 ng/mL [interquartile range 0.68-8.05], and were significantly greater than rapid response team visits that did not result in transfer (p = .0001). The difference between infectious and noninfectious intensive care unit transfers (0.95 ng/mL [interquartile range 0.26-1.89]) was also significant (p = .03). The procalcitonin levels of patients with noninfectious intensive care unit transfers were also different than the levels of patients who never transferred (p = .04). CONCLUSIONS:: Preliminary results suggest procalcitonin levels in patients at the time of initial visit by a rapid response team correlate with the need for subsequent intensive care unit transfer, particularly for infectious reasons. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) procalcitonin EMTREE DRUG INDEX TERMS interleukin 2 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit rapid response team EMTREE MEDICAL INDEX TERMS cohort analysis hospital human infection infusion nursing oncology patient serum tertiary health care PUI L51988658 DOI 10.1097/CCM.0b013e31824fc027 FULL TEXT LINK http://dx.doi.org/10.1097/CCM.0b013e31824fc027 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 509 TITLE Factors affecting the success of prehospital intubation in an air and land critical care transport service: Results of a multivariate analysis AUTHOR NAMES MacDonald A.M. MacDonald R.D. Lee J.S. AUTHOR ADDRESSES (MacDonald A.M., anna.macdonald@utoronto.ca; MacDonald R.D.; Lee J.S.) Division of Emergency Medicine, University of Toronto, Canada. CORRESPONDENCE ADDRESS A.M. MacDonald, Division of Emergency Medicine, University of Toronto, Canada. Email: anna.macdonald@utoronto.ca SOURCE Canadian Journal of Emergency Medicine (2012) 14 SUPPL. 1 (S24). Date of Publication: May 2012 CONFERENCE NAME 2012 CAEP/ACMU Scientific Abstracts CONFERENCE LOCATION Niagara Falls, ON, Canada CONFERENCE DATE 2012-06-02 to 2012-06-06 ISSN 1481-8035 BOOK PUBLISHER Decker Publishing ABSTRACT Introduction: Paramedics perform tracheal intubation in the prehospital environment, and the morbidity associated with failed attempts causes some to question the appropriateness of intubation in this setting. To inform this discussion, we should understand the factors that predict the success of prehospital intubation. This study aims to determine the factors that affect success on first attempt of paramedic intubations in a rapid sequence intubation (RSI)-capable critical care transport service. Methods: We conducted a multivariate logistic analysis on a prospectively collected database from a critical care transport service that provides scene responses and interfacility transport in Ontario. The study population includes all intubations by flight paramedics from January 2006 to July 2009. The primary outcome is success on first attempt. A list of potential factors predicting success was obtained from a review of the literature and includes age, sex, Glasgow Coma Scale, location of intubation attempt, paralytics and sedation given, a difficult airway prediction score, and type of call (trauma, medical or cardiac arrest). Results: Data from 549 intubations were analyzed. The success rate on first attempt at intubation was 57.7%, and the overall success rate was 87.4%. A total of 498 had complete data for all predictive variables and were included in the multivariate analysis. The factors found to be statistically significant were age per decade (OR 1.1, CI 1.04-1.2), female gender (OR 1.5, CI 1.03-2.32), paralytics given (OR 2.7, CI 1.5-4.7), and sedation given (OR 0.6, CI 0.41-0.91). This model demonstrated a good fit (Hosmer-Lemeshow = 8.906), with an AUC of 0.632. Conclusions: Use of a paralytic agent, age, and gender were associated with increased success of intubation. The association of sedative use alone with decreased success was unexpected and may be due to confounding related to the indications for sedation, such as patient agitation. Our findings may have implications for RSI-capable paramedics and require further study. EMTREE DRUG INDEX TERMS sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) airway emergency health service emergency medicine intensive care intubation multivariate analysis EMTREE MEDICAL INDEX TERMS agitation Canada data base endotracheal intubation environment female flight gender Glasgow coma scale heart arrest human injury model morbidity patient population prediction sedation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70843530 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 510 TITLE Transporting the adult critically ill patient AUTHOR NAMES Martin T. AUTHOR ADDRESSES (Martin T.) Royal Hampshire County Hospital, Winchester, United Kingdom. CORRESPONDENCE ADDRESS T. Martin, Royal Hampshire County Hospital, Winchester, United Kingdom. SOURCE Surgery (2012) 30:5 (219-224). Date of Publication: May 2012 ISSN 0263-9319 1878-1764 (electronic) BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT More than 10,000 intensive care patients are transferred each year in the UK, of whom the vast majority are accompanied by staff from the referring hospital. The high frequency of transfer of critically ill patients is primarily due to the escalating complexity of healthcare, the concentration of skills into specialized regional centres, and the relative lack of availability of intensive care unit (ICU) beds. The care practised during the constraints of patient transfer (whether within or between hospitals) should attempt to mirror the detailed attention provided in the hospital ICU, and it is the responsibility of the transport team to ensure the efficacy of the process and safety of the patient. This is achieved through careful preparation and planning and preparation starts with adequate and appropriate training of transfer personnel as well as selection of equipment which is fit for purpose. Success is based on anticipation and prevention of potential complications and hazards to the patient and transfer team. This article gives an overview of the hazards, organization, and planning of patient transfers, and highlights the importance of interdisciplinary teamwork, good communications, and appropriate decision-making. It also discusses special situations encountered in the transfer or retrieval of patients with complex needs, such as those requiring intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation. © 2012 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS allied health education article counterpulsation devices extracorporeal oxygenation hazard health care personnel human intensive care intensive care unit interdisciplinary communication patient safety planning priority journal teamwork United Kingdom EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012264795 PUI L364768920 DOI 10.1016/j.mpsur.2012.02.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.mpsur.2012.02.004 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 511 TITLE Heliox in children with croup: A strategy to hasten improvement AUTHOR NAMES Kline-Krammes S. Reed C. Giuliano Jr. J.S. Schwartz H.P. Forbes M. Pope J. Besunder J. Gothard M.D. Russell K. Bigham M.T. AUTHOR ADDRESSES (Kline-Krammes S.) Department of Pediatrics, Division of Emergency Medicine, Akron Children's Hospital, Akron, OH, United States. (Reed C.; Russell K.) Department of Respiratory Care, Akron Children's Hospital, Akron, OH, United States. (Giuliano Jr. J.S.) Department of Pediatrics, Division of Critical Care Medicine, Yale Children's Hospital, New Haven, CT, United States. (Schwartz H.P.) Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States. (Forbes M.; Pope J.; Besunder J.; Bigham M.T., mbigham@chmca.org) Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH 44308-1066, United States. (Gothard M.D.) Rebecca D. Considine Clinical Research Institute, Akron Children's Hospital, Akron, OH, United States. CORRESPONDENCE ADDRESS M.T. Bigham, Department of Pediatrics, Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH 44308-1066, United States. Email: mbigham@chmca.org SOURCE Air Medical Journal (2012) 31:3 (131-137). Date of Publication: May-June 2012 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Objective: Upper airway obstruction is responsive to the reduction in airflow turbulence provided by helium/oxygen (heliox) admixture. Our pediatric critical care transport team (PCCTT) has used heliox for children with upper airway obstruction from croup. We sought to describe our experience with heliox on transport and hypothesized that heliox-treated children with croup would show a more rapid clinical improvement. Methods: Children with croup transported by our PCCTT and admitted to the PICU were evaluated. We analyzed pretransport care, transport interventions, and outcomes. Croup scores (Modified Taussig) were assigned retrospectively according to respiratory therapy charting. Data were analyzed using appropriate statistical tests, including Pearson's chi-square test, Fisher's exact test, Mann-Whitney U rank comparison, and two-sample t-test. Results: Thirty-five children met inclusion criteria. Demographics were similar between groups. The pretransport medical care was similar between groups. Children receiving heliox had a higher baseline croup score [mean (SD) = 5.7(2.3) vs no heliox 2.9 (2.0), P < 0.001]. The improvement in croup scores over the first 60 minutes of transport was more rapid in the heliox-treated children (P < 0.001). There was no difference in the number of children requiring additional nebulized racemic epinephrine during transport. The PICU length of stay (P = 0.59) and hospital length of stay (P = 0.64) were similar between groups. Conclusion: Heliox added to standard transport treatment for critically ill children with croup provides a more rapid improvement in croup scores. Heliox for croup during transport does not prolong intensive care unit stay. A prospective clinical trial is warranted to evaluate heliox in pediatric transport. © 2012 Air Medical Journal Associates. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) heliox EMTREE DRUG INDEX TERMS epinephrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood disease croup (therapy) patient transport EMTREE MEDICAL INDEX TERMS body temperature body weight breathing rate child clinical article consciousness controlled study critically ill patient cyanosis disease severity emergency care female heart rate human infant intensive care unit length of stay lung clearance male medical history nebulization oxygen saturation preschool child priority journal retrospective study review skin color stridor treatment duration CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) heliox (58933-55-4) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012244969 MEDLINE PMID 22541348 (http://www.ncbi.nlm.nih.gov/pubmed/22541348) PUI L364707582 DOI 10.1016/j.amj.2011.08.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2011.08.004 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 512 TITLE Intrahospital transport of critically ill patients (excluding newborns) recommendations of the Société de Réanimation de Langue Française (SRLF), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Société Française de Médecine d'Urgence (SFMU) AUTHOR NAMES Quenot J.-P. Milési C. Cravoisy A. Capellier G. Mimoz O. Fourcade O. Gueugniaud P.-Y. AUTHOR ADDRESSES (Quenot J.-P., quenot@chu-dijon.fr) Service de Réanimation Médicale, CHU Bocage Central Gabriel, 14 rue Paul Gaffarel, 21 079 Dijon, France. (Milési C.) Service de Réanimation Pédiatrique, CHU Lapeyronie, 371 avenue du doyen Gaston Giraud, 34 295 Montpelier, France. (Cravoisy A.) Service de Réanimation Médicale, CHU Hôpital Central, 29, avenue du Maréchal de Lattre de Tassigny, 54 035 Nancy, France. (Capellier G.) Service de Réanimation Médicale, CHU Hôpital Jean Minjoz, 3, Boulevard Fleming, 25 000 Besançon, France. (Mimoz O.) Service d'Anesthésie Réanimation, CHU de la Milétrie, 2 rue de la Milétrie, 86 021 Poitiers, France. (Fourcade O.) Pôle Anesthesie Réanimation, CHU pavillon urgences et réanimation, Hôpital Purpan, place du Docteur Baylac, 31 059 Toulouse, France. (Gueugniaud P.-Y.) Service Aide Médicale Urgente, CHU hospices civils, 162, avenue Lacassagne, 69 003 Lyon, France. CORRESPONDENCE ADDRESS J.-P. Quenot, Service de Réanimation Médicale, CHU Bocage Central Gabriel, 14 rue Paul Gaffarel, 21 079 Dijon, France. Email: quenot@chu-dijon.fr SOURCE Annals of Intensive Care (2012) 2:1 (1-6). Date of Publication: 2012 ISSN 2110-5820 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Critically ill adult patients often require multiple examinations in the hospital and need transport from one department to another, or even between hospitals. However, to date, no guidelines exist regarding optimum practices for transport of these fragile patients. We present recommendations for intrahospital transport of critically ill patients, excluding newborns, developed by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), the Société Française d'Anesthésie et de Réanimation (SFAR), and the Société Française de Médecine d'Urgence (SFMU). The recommendations cover five fields of application: epidemiology of adverse events; equipment, monitoring, and maintenance; preparation of patient before transport; human resources and training for caregivers involved in transport processes; and guidelines for planning, structure, and traceability of transport processes. © 2012 Quenot et al. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS caregiver human intensive care unit patient monitoring practice guideline priority journal review EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012220900 PUI L364638386 DOI 10.1186/2110-5820-2-1 FULL TEXT LINK http://dx.doi.org/10.1186/2110-5820-2-1 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 513 TITLE Neuroradiological pattern of peripartum cerebro vascular disease medicating transfer to determine care unit ORIGINAL (NON-ENGLISH) TITLE Aspects neuroradiologiques de la pathologie vasculaire cérébrale du peripartum nécessitant un transfert en milieu de reanimation AUTHOR NAMES Lakhdar R. Baffoun N. Hammami N. Nagi S. Baccar K. Drissi S. Kaddour C. AUTHOR ADDRESSES (Lakhdar R.) Service de cardiologie, CHU La Rabta, Tunisia. (Baffoun N.; Baccar K.; Kaddour C.) Service d'anesthésie et de réanimation, Institut national de neurologie de Tunis, Tunisia. (Hammami N.; Nagi S.; Drissi S.) Service de radiologie, Institut national de neurologie de Tunis Faculté de médecine de Tunis, Université de Tunis El Manar, Tunisia. CORRESPONDENCE ADDRESS R. Lakhdar, Service de cardiologie, CHU La Rabta, Tunisia. SOURCE Tunisie Medicale (2012) 90:3 (223-232). Date of Publication: 2012 ISSN 0041-4131 BOOK PUBLISHER Maison du Medicine, 16 rue de Touraine, Tunis Belvedere, Tunisia. ABSTRACT Background: Pregnancy and puerperium are considered a period of a high risk of stroke responsible in a part of the morbidity and mortality in women. Imaging is the pivotal tool to diagnostics and care. Aim: To investigate the clinical and imaging features cerebrovascular complications during pregnancy and in post partum period. Methods: We report a retrospective analysis of forty four patients (November 2002 - October 2010) admitted in the intensive car department of the national institute of neurology for cerebro-vascular complications during pregnancy and in post partum period. Results: Cerebro-vascular imaging modalities included cerebral computed tomography (CCT) with and without contrast in 94% of cases, magnetic resonance imaging (MRI) in 30.6% of cases completed by venous angiography MRI in 27.2% of cases and angiography MRI of Willis polygon in 11.3% of cases and by cerebral angiography in 13.6% of cases. Posterior reversible encephalopathy syndrome (PRES) is diagnosed in 61.4% of cases followed by meningo-cerebral haemorrhage (MCH) in 29.5% and finally cerebral venous thrombosis (CVT) and arterial ischemia in 4.5% of cases each one. The cerebro-vascular complications are revelled in 86.3% of the cases during the postpartum and were associated with the eclampsia or preeclampsia in 90.9% of the cases (n=40). CCT showed typical lesions of PRES in 23 patients. It confirms the presence of hematoma in the 13 patients with MCH and find hypodense lesion in one case with ischemic stroke. CCT show direct (delta sign) and indirect signs of CVT. MRI confirms the diagnostic of PRES, when done (11 of 12 cases) and show cortical sub cortical hyper signal on T2 and FLAIR and hypo signal on T1 sequences. MRI was normal in one case. It shows hemorrhagic lesion in the 2 cases of MCH, thrombosis in the cases of CVT and ischemic lesion in the cases of ischemic stroke. CCT and MRI done within 48 hours from admission were decisive for early diagnostic and for fast and adequate care. Conclusion: Early recognition of stroke in peri partum by cerebral imaging is of paramount importance for prompt diagnosis and treatment to improve maternal morbidity and mortality. EMTREE DRUG INDEX TERMS contrast medium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular disease (diagnosis) EMTREE MEDICAL INDEX TERMS article brain angiography brain hemorrhage (diagnosis) brain ischemia (diagnosis) cerebral computed tomography cerebral sinus thrombosis (diagnosis) clinical article computer assisted tomography disease association eclampsia female human intensive care unit meningo cerebral hemorrhage (diagnosis) nuclear magnetic resonance imaging perinatal period phlebography posterior reversible encephalopathy syndrome preeclampsia EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Radiology (14) Drug Literature Index (37) LANGUAGE OF ARTICLE English, French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2012205595 MEDLINE PMID 22481194 (http://www.ncbi.nlm.nih.gov/pubmed/22481194) PUI L364596309 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 514 TITLE Handover patterns: an observational study of critical care physicians. AUTHOR NAMES Ilan R. LeBaron C.D. Christianson M.K. Heyland D.K. Day A. Cohen M.D. AUTHOR ADDRESSES (Ilan R.) Department of Medicine and Critical Care Program, Queen's University, Kingston General Hospital, Etherington Hall, Kingston, ON, Canada, K7L 3N6. (LeBaron C.D.; Christianson M.K.; Heyland D.K.; Day A.; Cohen M.D.) CORRESPONDENCE ADDRESS R. Ilan, Department of Medicine and Critical Care Program, Queen's University, Kingston General Hospital, Etherington Hall, Kingston, ON, Canada, K7L 3N6. Email: ilanr@kgh.kari.net SOURCE BMC health services research (2012) 12 (11). Date of Publication: 2012 ISSN 1472-6963 (electronic) ABSTRACT Handover (or 'handoff') is the exchange of information between health professionals that accompanies the transfer of patient care. This process can result in adverse events. Handover 'best practices', with emphasis on standardization, have been widely promoted. However, these recommendations are based mostly on expert opinion and research on medical trainees. By examining handover communication of experienced physicians, we aim to inform future research, education and quality improvement. Thus, our objective is to describe handover communication patterns used by attending critical care physicians in an academic centre and to compare them with currently popular, standardized schemes for handover communication. Prospective, observational study using video recording in an academic intensive care unit in Ontario, Canada. Forty individual patient handovers were randomly selected out of 10 end-of-week handover sessions of attending physicians. Two coders independently reviewed handover transcripts documenting elements of three communication schemes: SBAR (Situation, Background, Assessment, Recommendations); SOAP (Subjective, Objective, Assessment, Plan); and a standard medical admission note. Frequency and extent of questions asked by incoming physicians were measured as well. Analysis consisted of descriptive statistics. Mean (± standard deviation) duration of patient-specific handovers was 2 min 58 sec (± 57 sec). The majority of handovers' content consisted of recent and current patient status. The remainder included physicians' interpretations and advice. Questions posed by the incoming physicians accounted for 5.8% (± 3.9%) of the handovers' content. Elements of all three standardized communication schemes appeared repeatedly throughout the handover dialogs with no consistent pattern. For example, blocks of SOAP's Assessment appeared 5.2 (± 3.0) times in patient handovers; they followed Objective blocks in only 45.9% of the opportunities and preceded Plan in just 21.8%. Certain communication elements were occasionally absent. For example, SBAR's Recommendation and admission note information about the patient's Past Medical History were absent from 22 (55.0%) and 20 (50.0%), respectively, of patient handovers. Clinical handover practice of faculty-level critical care physicians did not conform to any of the three predefined structuring schemes. Further research is needed to examine whether alternative approaches to handover communication can be identified and to identify features of high-quality handover communication. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical practice intensive care interpersonal communication patient care patient transport EMTREE MEDICAL INDEX TERMS article Canada comparative study health services research human intensive care unit prospective study standard time university hospital videorecording LANGUAGE OF ARTICLE English MEDLINE PMID 22233877 (http://www.ncbi.nlm.nih.gov/pubmed/22233877) PUI L364592201 DOI 10.1186/1472-6963-12-11 FULL TEXT LINK http://dx.doi.org/10.1186/1472-6963-12-11 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 515 TITLE Medical transport of children with complex chronic conditions AUTHOR NAMES Lerner C.F. Kelly R.B. Hamilton L.J. Klitzner T.S. AUTHOR ADDRESSES (Lerner C.F., clerner@mednet.ucla.edu; Kelly R.B., rkelly@mednet.ucla.edu; Hamilton L.J., lhamilton@mednet.ucla.edu; Klitzner T.S., tklitzner@mednet.ucla.edu) Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States. CORRESPONDENCE ADDRESS C.F. Lerner, Department of Pediatrics, Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States. Email: clerner@mednet.ucla.edu SOURCE Emergency Medicine International (2012) 2012 Article Number: 837020. Date of Publication: 2012 ISSN 2090-2840 2090-2859 (electronic) BOOK PUBLISHER Hindawi Publishing Corporation, 410 Park Avenue, 15th Floor, 287 pmb, New York, United States. ABSTRACT One of the most notable trends in child health has been the increase in the number of children with special health care needs, including those with complex chronic conditions. Care of these children accounts for a growing fraction of health care resources. We examine recent developments in health care, especially with regard to medical transport and prehospital care, that have emerged to adapt to this remarkable demographic trend. One such development is the focus on care coordination, including the dissemination of the patient-centered medical home concept. In the prehospital setting, the need for greater coordination has catalyzed the development of the emergency information form. Training programs for prehospital providers now incorporate specific modules for children with complex conditions. Another notable trend is the shift to a family-centered model of care. We explore efforts toward regionalization of care, including the development of specialized pediatric transport teams, and conclude with recommendations for a research agenda. © 2012 Carlos F. Lerner et al. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) childhood disease chronic disease patient transport EMTREE MEDICAL INDEX TERMS artificial heart pacemaker cardiopulmonary arrest central venous catheter cerebrospinal fluid shunting child child health care congenital heart disease education program emergency care emergency health service family centered care feeding apparatus genetic disorder health care need health care system hospital admission human hypotension intensive care unit length of stay long term care medical education medical technology occupational therapist pediatric advanced life support pharmacist physical medicine physician physiotherapist primary medical care priority journal pulse oximeter rescue personnel residency education resource management respiratory therapist review stomach tube tracheostomy United States EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012186910 PUI L364535512 DOI 10.1155/2012/837020 FULL TEXT LINK http://dx.doi.org/10.1155/2012/837020 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 516 TITLE Air Transported Pediatric Rescue Extracorporeal Membrane Oxygenation: A Single Institutional Review AUTHOR NAMES Horne D. Lee J.J. Maas M. Divekar A. Kesselman M. Drews T. Veroukis S. Hancock B.J. Hiebert B. Cronin G. Soni R. AUTHOR ADDRESSES (Horne D., drhorne@shaw.ca; Lee J.J.; Maas M.) Department of Surgery, Cardiac Surgery, University of Manitoba, Paediatrics and Child Health, Winnipeg, MB, Canada. (Divekar A.; Soni R.) Department of Surgery, Cardiology, University of Manitoba, Paediatrics and Child Health, Winnipeg, MB, Canada. (Kesselman M.; Drews T.; Veroukis S.) Department of Surgery, Intensive Care, University of Manitoba, Paediatrics and Child Health, Winnipeg, MB, Canada. (Hancock B.J.; Hiebert B.) Department of Surgery, Paediatric Surgery, University of Manitoba, Paediatrics and Child Health, Winnipeg, MB, Canada. (Cronin G.) Department of Surgery, Quality and Decision Support, University of Manitoba, Paediatrics and Child Health, Winnipeg, MB, Canada. CORRESPONDENCE ADDRESS D. Horne, Cardiac Surgery program, St. Boniface General Hospital, 3500-9, 409 Tache Ave., Winnipeg, MB R2H 2A6, Canada. Email: drhorne@shaw.ca SOURCE World Journal for Pediatric and Congenital Hearth Surgery (2012) 3:2 (236-240). Date of Publication: April 2012 ISSN 2150-1351 2150-136X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background: Pediatric extracorporeal membrane oxygenation (ECMO) programs are sophisticated endeavors usually found only in high-volume cardiac surgical programs. Worldwide, many cardiology programs do not have on-site pediatric cardiac surgery expertise. Our single-center experience shows that an organized multidisciplinary rescue-ECMO program, in collaboration with an accepting facility, can achieve survival rates comparable to modern era on-site ECMO. Methods: A retrospective review was conducted of all patients initiated on rescue-ECMO from 2004 to 2009 in a single academic pediatric hospital without a pediatric cardiac surgery program. All aspects of ECMO were formalized using Failure Mode Effects Analysis. Results: Eight patients were initially cannulated for ECMO at our institution. Six were subsequently transported by air to the receiving facility 1,305 km away. Extracorporeal membrane oxygenation was initiated in 0.2% of our Pediatric Intensive Care Unit admissions and in 0.52% of all our pediatric cardiac patients. Mean age was 4.0 years (7 weeks to 15 years). Indications for ECMO initiations were cardiogenic shock (n = 5) and acute respiratory distress syndrome (n = 3). Six had veno-arterial- and two had veno-veno ECMO. Two patients were not transported (one death and one weaned locally). Six patients were successfully transported within 2 to 24 hours, with a survival to hospital discharge rate of 67% (four of six). Median total time on ECMO was 5.5 days. Complication rate was 50% (4/8). Conclusions: Our rescue-ECMO survival results were comparable to that of current published results from established pediatric ECMO programs. Air transport of ECMO patients can be performed safely using an organized multidisciplinary team approach. © World Society for Pediatric and Congential Heart Surgery 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport extracorporeal oxygenation patient transport rescue personnel EMTREE MEDICAL INDEX TERMS adolescent adult respiratory distress syndrome (therapy) application site bleeding (complication) application site infection (complication) article brain hemorrhage (complication) cannulation cardiac patient cardiogenic shock (therapy) child clinical article controlled study health program hospital discharge human infant intensive care unit patient safety pediatric hospital portal vein thrombosis (complication) preschool child priority journal retrospective study school child survival rate treatment duration treatment indication treatment outcome veno arterial extracorporeal oxygenation veno veno extracorporeal oxygenation EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012469568 PUI L365403081 DOI 10.1177/2150135111428627 FULL TEXT LINK http://dx.doi.org/10.1177/2150135111428627 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 517 TITLE Evaluation of the bedside pediatric early warning system score for pediatric placement after inter-facility transports AUTHOR NAMES Keyes J. Yen K. Meyer M. Gorelick M. AUTHOR ADDRESSES (Keyes J.; Meyer M.; Gorelick M.) Medical College of Wisconsin, Milwaukee, United States. (Yen K.) UT Southwestern Medical Center, Dallas, United States. CORRESPONDENCE ADDRESS J. Keyes, Medical College of Wisconsin, Milwaukee, United States. SOURCE Academic Emergency Medicine (2012) 19 SUPPL. 1 (S349). Date of Publication: April 2012 CONFERENCE NAME 2012 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2012 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-05-09 to 2012-05-12 ISSN 1069-6563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: The Bedside Pediatric Early Warning System (BPEWS) score is a pediatric assessment tool that combines seven clinical measurements for the assessment of severity of illness. This tool has been shown to be effective in identifying sick children in the hospital setting. The effectiveness of this tool in identifying pediatric patients undergoing inter-facility transport that require critical care placement has not been evaluated. Objectives: We hypothesize that children with higher BPEWS scores are more likely to be admitted to the pediatric intensive care unit (PICU) or emergency department (ED) than the general pediatric unit. Methods: A random sample of pediatric patients transported by the Children's Hospital of Wisconsin (CHW) Transport Team during a one-year period were assessed. All patient transports to the neonatal intensive care unit and all patients with tracheostomies who were admitted to the PICU according to placement protocols were excluded. Data were collected utilizing a retrospective chart review and included the components of the BPEWS score (heart rate, respiratory rate, systolic blood pressure, oxygen saturation, oxygen therapy, respiratory effort, and capillary refill time) at two different time points during the transport: when the transport team arrived at the outside facility, and again when the transport team arrived at CHW. Mann-Whitney test was used to compare the BPEWS scores at each time point with patient placement to PICU, ED, or general inpatient unit. Results: Data have been collected for 144 patients. Overall, 36% were admitted to the PICU, 32% to the ED, and 32% to the floor. Forty percent are female. Significant differences were found in BPEWS scores based on site of admission. For the initial time point (team arrival at outside facility), scores for PICU, ED, and general inpatient unit were 7.63, 3.26, and 4.59, respectively (p < 0.001). The final time point (team arrival at CHW) BPEWS scores were 6.94, 2.65, and 3.65, respectively (p < 0.001). Conclusion: The BPEWS score, measured at two time points in the transport process, is associated with site of admission. The highest scores are seen for patients admitted to the PICU and the lowest for those admitted to the ED. Logistic regression with ROC curves is planned to determine the optimal BPEWS score to discriminate placement in the PICU compared to the general inpatient unit. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine society EMTREE MEDICAL INDEX TERMS breathing rate capillary child diseases emergency ward female heart rate hospital hospital patient human intensive care intensive care unit logistic regression analysis medical record review newborn intensive care oxygen saturation oxygen therapy patient patient transport pediatric hospital pediatric ward random sample rank sum test receiver operating characteristic systolic blood pressure tracheostomy United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70745826 DOI 10.1111/j.1553-2712.2012.01332.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1553-2712.2012.01332.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 518 TITLE Comparison of door to balloon times in patients presenting directly or transferred to a regional heart center with STEMI AUTHOR NAMES Ehlers J. Wurstle A.V. Gruberg L. Singer A.J. AUTHOR ADDRESSES (Ehlers J.; Wurstle A.V.; Gruberg L.; Singer A.J.) Stony Brook University, Stony Brook, United States. CORRESPONDENCE ADDRESS J. Ehlers, Stony Brook University, Stony Brook, United States. SOURCE Academic Emergency Medicine (2012) 19 SUPPL. 1 (S104-S105). Date of Publication: April 2012 CONFERENCE NAME 2012 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2012 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-05-09 to 2012-05-12 ISSN 1069-6563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Based on the evidence, a door-to-balloon- TIME (DTBT) of less than 90 minutes is recommended by the AHA/ACC for patients with STEMI. In many regions, patients with STEMI are transferred to a regional heart center for percutaneous coronary intervention (PCI). Objectives: We compared DTBT for patients presenting directly to a regional heart center with those for patients transferred from other regional hospitals. We hypothesized that DTBT would be significantly longer for transferred patients. Methods: Study Design-Retrospective medical record review. Setting-Academic ED at a regional heart center with an annual census of 80,000 that includes a catchment area of 12 hospitals up to 50 miles away. Patients-Patients with acute STEMI identified on ED 12-lead ECG. Measures-Demographic and clinical data including time from triage to ECG, from ECG to activation of regional catheterization lab, and from initial triage to PCI (DTBT). Outcomes-Median DTBT and percentage of patients with a DTBT under 90 minutes. Data Analysis- Median DTBT compared with Mann Whitney U tests and proportions compared with chi-square tests. Results: In 2010 there were 379 catheterization lab activations for STEMI: 183 were in patients presenting directly, and 196 in transferred patients. Thrombolytics were administered in 19 (9.7%) transfers. Compared with patients presenting directly to the heart center, transferred patients had longer median [IQR] DTBT (127 [105-151] vs. 64 [49-80]; P < 0.001). Transferred patients also had longer door to ECG (9 [5-18] vs. 5 [2-8]; P < 0.001) and ECG to catheterization lab activation times (18 [12-38] vs. 8 [4-17]; P < 0.001). The percentages of patients with a DTBT within 90 minutes in direct and transfer patients were 83% vs. 17%; P < 0.001. Conclusion: Most patients transferred to a regional heart center do not meet national DTBT guidelines. Consideration should be given to administering thrombolytics in transfer patients, especially if the transport time is prolonged. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit emergency medicine human patient society ST segment elevation myocardial infarction EMTREE MEDICAL INDEX TERMS catchment catheterization chi square test clinical study data analysis electrocardiogram emergency health service hospital medical record review percutaneous coronary intervention population research rank sum test study design LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70745357 DOI 10.1111/j.1553-2712.2012.01332.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1553-2712.2012.01332.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 519 TITLE Identifying the patient at risk-when to rapidly transfer to the intensive care unit? AUTHOR NAMES Mégarbane B. AUTHOR ADDRESSES (Mégarbane B.) Department of Medical and Toxicological Critical Care, INSERM U705, Paris-Diderot University, Paris, France. CORRESPONDENCE ADDRESS B. Mégarbane, Department of Medical and Toxicological Critical Care, INSERM U705, Paris-Diderot University, Paris, France. SOURCE Clinical Toxicology (2012) 50:4 (274-275). Date of Publication: April 2012 CONFERENCE NAME 2012 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, EAPCCT 2012 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2012-05-25 to 2012-06-01 ISSN 1556-3650 BOOK PUBLISHER Informa Healthcare ABSTRACT Background: Poisonings represent one of the first causes of admission to the emergency room. Due to the significant morbidities and mortality that may result from overdoses, transfer to the intensive care unit (ICU) should sometimes be mandatory. Our objective was to identify clinical criteria indicating ICU transfer. Methods: Review of published data on severity criteria of poisoning and analysis of their pertinence in helping physicians in the emergency room (ER) to identify patients at risk requiring ICU transfer. Results: Poisoning should be considered as severe and transferred to the ICU if: (i) close monitoring is required in relation to a significant drug exposure; (ii) life-threatening symptoms occur including loss of consciousness, respiratory, and circulatory failure; (iii) the patient appears more vulnerable to the drug e.g. if presenting specific morbidities or chronic organ insufficiencies.(1) Poisoning features could result either from the direct effects of the drug or from non-specific complications (like aspiration pneumonia with a psychotropic drug or anoxic encephalopathy with cardiotoxicant-induced severe collapse). Absence of severe symptoms on hospital admission does not necessarily mean no severe poisoning. Thus, assessing poisoning severity should not only rely on the routine criteria of severity and organ failure used in critical medicine but also include prognosticators, mainly in the case of exposure to substances resulting in organ injuries. Risk evaluation should take into account the dose, the formulation (sustained release), the different co-ingestions (additive or synergic effects), the delay in management since exposure, patient's medical conditions, the possible active metabolites from the ingested toxicant, and the possible occurrence of delayed symptoms. General scores (either physiological scores like APACHE-I or II, SAPS-II or III, and SOFA scores as well as specific poisoning scores like Poisoning Severity Score or Toxscore) are interesting for retrospectively stratifying poisoned patients amongst a study population but are quite limited for deciding at the individual level for patient referral to the ICU. Regarding psychotropic drugs, there is no clear relationship between the patient's Glasgow coma scale (GCS) score on admission and his final prognosis. Decreased GCS score does not mandate tracheal intubation in the emergency department.(2) The alert/verbal/painful/unresponsive (AVPU) responsiveness scale provides a rapid simple method of assessing consciousness level in most poisoned patients except those intoxicated with alcohol.(3) In cardiotoxicant overdose, occurrence of hypotension does not necessarily mean the presence of circulatory failure and does not necessarily require catecholamine administration. In contrast, in poisoned patients with a past history of significant hypertension or advanced cardiac disease, apparently normal values of blood pressure may be associated with progressive deterioration of microcirculation that would either not be indentified, or recognized too late in the emergency department. Thus, abnormal signs of microcirculation resulting from hypotension should be assessed by regular monitoring in the ICU, including low urine output, increased concentrations of plasma lactate, serum creatinine and transaminases. We believe that any symptomatic patient in relation to cardiotoxicant ingestion should therefore be transferred to the ICU.(1) Prognosticators, including clinical, biological, ECG, and analytical parameters are drug-specific. They are generally more often identified based on retrospective approaches then prospectively assessed, ideally using multicentre studies, if their specificity, sensitivity, and predictive values appear interesting. Several prognosticators have been determined regarding antidepressants, acetaminophen, aspirin, chloroquine, colchicine, paraquat, corrosives and organophosphates. They may be helpful in indicating ICU transfer. Some of them are immediately available as soon as the patient is admitted to the ER. Others, based on specific assays (like verapamil concentrations in verapamil poisonings(4)) or complicated calculations (measurement of the terminal 40-millisecond frontal plane axis in tricyclic antidepressant poisoning(5)), appear less useful as they are not available in the majority of hospitals. Recently, in a case-control study, Manini and colleagues reported the utility of serum lactate concentration in the emergency room for predicting drug overdose fatalities, identifying the optimal cutoff point to be 3.0 mmol/L with 84% sensitivity and 75% specificity.(6) However, we assessed that the usefulness of serum lactate in predicting beta-blocker-overdose fatality appears limited, due to mild elevations despite extreme severity(7), highlighting the impossibility of evaluating poisoning prognosis based on a unique measurement in the emergency room. On the other hand, excessive admission in the ICU may also result in non-useful expenses and limited bed availability. The patient's low risk was assessed when none of the following criteria was present in the emergency room(8) : need for intubation, seizures, unresponsiveness to verbal stimuli, PaO(2) ≥ 45 mmHg, any rhythm except sinus, second- or third-degree atrioventricular block, QRS ≥ 0.12 s or systolic pressure < 100 mmHg. In this study, of 151 low-risk patients, none developed a high-risk condition after admission, and none required an intensive care intervention. The use of these predictive criteria eliminated over half the intensive care days without compromising quality of care. Conclusion: ICU transfer may be mandatory if poisoned patients present with organ failure in order to set up adequate monitoring and invasive symptomatic treatments if necessary. Routinely available emergent prognosticators are required: they are drug-dependent. In contrast, general scores have limited interests at the individual level. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) poison EMTREE DRUG INDEX TERMS acetylsalicylic acid alcohol aminotransferase antidepressant agent beta adrenergic receptor blocking agent catecholamine chloroquine colchicine organophosphate paracetamol paraquat psychotropic agent tricyclic antidepressant agent verapamil EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care unit patient risk EMTREE MEDICAL INDEX TERMS analytical parameters APACHE aspiration pneumonia assay blood pressure brain disease case control study complete heart block concentration (parameters) consciousness consciousness level creatinine blood level deterioration drug exposure drug overdose electrocardiogram emergency emergency ward endotracheal intubation exposure fatality Glasgow coma scale heart disease hospital hospital admission hypertension hypotension ingestion intensive care intoxication intubation ischemia lactate blood level metabolite microcirculation monitoring morbidity mortality multicenter study normal value organ injury palliative therapy patient referral physician population predictive value prognosis rhythm seizure Sequential Organ Failure Assessment Score Simplified Acute Physiology Score sustained drug release systolic blood pressure urine volume verbalization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71197319 DOI 10.3109/15563650.2012.669957 FULL TEXT LINK http://dx.doi.org/10.3109/15563650.2012.669957 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 520 TITLE How many poisoned patients transported by emergency medical services actually require hospital treatment? AUTHOR NAMES Amlin T.C. Coffman S.A. Morgan D.L. Blair H.W. AUTHOR ADDRESSES (Amlin T.C.; Morgan D.L.) Emergency Department, Scott and White Memorial Hospital, Temple, United States. (Coffman S.A.) Texas A and M Health Science Center, Temple, United States. (Morgan D.L.; Blair H.W.) Central Texas Poison Center, Temple, United States. CORRESPONDENCE ADDRESS T.C. Amlin, Emergency Department, Scott and White Memorial Hospital, Temple, United States. SOURCE Clinical Toxicology (2012) 50:4 (333-334). Date of Publication: April 2012 CONFERENCE NAME 2012 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, EAPCCT 2012 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2012-05-25 to 2012-06-01 ISSN 1556-3650 BOOK PUBLISHER Informa Healthcare ABSTRACT Objective: Every year in the USA, emergency medical services (EMS) providers respond to thousands of calls for toxic exposures. However, these emergency providers have limited training in toxicology. Previous studies have demonstrated that EMS providers may effectively use poison centers (PCs) to determine those patients who do not require transportation to a hospital emergency department (ED). Our goal was to retrospectively determine the number of transported poisoned patients who did and who did not require treatment at one hospital. Methods: This was a retrospective review of PC charts of calls from Jan 2010 to Dec 2010. Inclusion criteria were (1) toxic exposure, (2) patient transported by EMS to one large teaching hospital, and (3) there was a call to a PC from a staff member at that hospital after the patient arrived. A patient was determined to have required treatment if any medical treatment (including activated charcoal) was administered in the ED or the patient was admitted to the hospital for medical or psychiatric treatment. Results: There were 193 PC charts that met the inclusion criteria. The patients' ages ranged from 1 month to 69 years old. There were over 50 different substance exposures, and 53% were intentional. Over half (50.8%) were admitted, 41.5% were discharged home from the ED, and 7.8% left against medical advice or disposition was unknown. Of those admitted to the hospital, 39.8% were admitted to psychiatry, 36.7% went to the intensive care unit (ICU), and 23.5% went to internal medicine. There was one death. Of the 80 discharged home, 14 received some ED treatment. Therefore, 66 (34.1%) did not appear to require transportation to the hospital. Conclusion: This is the first study of the disposition of poisoned patients transported to an ED by EMS providers. This small study reveals that over half are admitted to the hospital (many to the ICU). However, about one-third of all transported poisoned patients may not require transportation if a PC had been utilized at the scene. If some of these patients could remain at the scene with PC follow-up, this could decrease both pre-hospital and hospital resources. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) poison EMTREE DRUG INDEX TERMS activated carbon EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service hospital human patient EMTREE MEDICAL INDEX TERMS death emergency emergency ward exposure follow up intensive care unit internal medicine poison center psychiatric treatment psychiatry teaching hospital therapy toxicology traffic and transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71197540 DOI 10.3109/15563650.2012.669957 FULL TEXT LINK http://dx.doi.org/10.3109/15563650.2012.669957 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 521 TITLE Factors affecting success of prehospital intubation in an air and land critical care transport service: Results of a multivariate analysis AUTHOR NAMES MacDonald A. MacDonald R.D. Lee J.S. AUTHOR ADDRESSES (MacDonald A.) University of Toronto, Toronto, Canada. (MacDonald R.D.) Ornge Transport Medicine, Mississauga, Canada. (Lee J.S.) Sunnybrook Health Sciences Centre, Toronto, Canada. CORRESPONDENCE ADDRESS A. MacDonald, University of Toronto, Toronto, Canada. SOURCE Academic Emergency Medicine (2012) 19 SUPPL. 1 (S141-S142). Date of Publication: April 2012 CONFERENCE NAME 2012 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2012 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-05-09 to 2012-05-12 ISSN 1069-6563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: Prehospital providers perform tracheal intubation in the prehospital environment, and failed attempts are of concern due to the danger of hypoxia and hypotension. Some question the appropriateness of intubation in this setting due to the morbidity risk associated with intubation in the field. Thus it is important to gain an understanding of the factors that predict the success of prehospital intubation attempts to inform this discussion. Objectives: To determine the factors that affect success rates on first attempt of paramedic intubations in a rapid sequence intubation (RSI) capable critical care transport service. Methods: We conducted a multivariate logistic analysis on a prospectively collected database of airway management from an air and land critical care transport service that provides scene responses and interfacility transport in the Province of Ontario. The study population includes all intubations performed by flight paramedics from January 2006 to July 2009. The primary outcome is success on first attempt. A list of potential factors predicting success was obtained from a review of the literature and included age, sex, Glasgow Coma Scale, location of intubation attempt, paralytics and sedation given, a difficult airway prediction score, and type of call (trauma, medical, or cardiac arrest). Results: Data from 549 intubations were analysed. The success rate on first attempt at intubation was 317/549 (57.7%) and the overall success rate was 87.4%. The mean age was 43.5 years and 69.4% were male and 56.4% were trauma patients. Of these, 498 had complete data for all predictive variables and were included in the multivariate analysis. The factors that were found to be statistically significant were age per decade (OR 1.12, CI 1.04-1.2), female sex (OR 1.5, CI 1.03-2.32), paralytics given (OR 2.66, CI 1.5-4.7), and sedation given (OR 0.61, CI 0.41-0.91). This model demonstrated a good fit (Hosmer Lemeshow = 8.906) with an AUC of 0.632. Conclusion: Use of a paralytic agent, age, and sex were associated with increased success of intubation. The association of sedative use only with decreased success of intubation was unexpected and may be due to confounding related to the indications for sedation, such as patient agitation. Our findings may have implications for RSI-capable paramedics and require further study. EMTREE DRUG INDEX TERMS sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine intensive care intubation multivariate analysis society EMTREE MEDICAL INDEX TERMS agitation airway Canada data base endotracheal intubation environment female flight Glasgow coma scale heart arrest human hypotension hypoxia injury male model morbidity patient population prediction respiration control sedation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70745424 DOI 10.1111/j.1553-2712.2012.01332.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1553-2712.2012.01332.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 522 TITLE Risk factors for unplanned transfer to intensive care within 24 hours of admission from the emergency department in an integrated health care system AUTHOR NAMES Delgado M.K. Liu V. Pines J.M. Kipnis P. Escobar G.J. AUTHOR ADDRESSES (Delgado M.K.) Stanford University, School of Medicine, Stanford, United States. (Liu V.; Kipnis P.; Escobar G.J.) Kaiser Permanente, Division of Research, Oakland, United States. (Pines J.M.) George Washington University, Washington, United States. CORRESPONDENCE ADDRESS M.K. Delgado, Stanford University, School of Medicine, Stanford, United States. SOURCE Academic Emergency Medicine (2012) 19 SUPPL. 1 (S162). Date of Publication: April 2012 CONFERENCE NAME 2012 Annual Meeting of the Society for Academic Emergency Medicine, SAEM 2012 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-05-09 to 2012-05-12 ISSN 1069-6563 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background: ED patients admitted to hospital wards who are subsequently transferred to the intensive care unit (ICU) within 24 hours have higher mortality than direct ICU admissions. Objectives: Describe risk factors for unplanned transfer to the ICU within 24 hours of ward arrival from the ED. Methods: Retrospective cohort analysis of all ED non- ICU admissions (N = 178,315) to 14 U.S. community hospitals from 2007-09. We tabulated patient demographics, clinical characteristics, and hospital volume by the outcome of unplanned ICU transfer. We present factors that were independently associated with unplanned ICU transfer within 24 hours after adjusting for patient and hospital differences in a multilevel mixed-effects logistic regression model. Results: Of all ED non-ICU admissions, 4,252 (2.4%) were transferred to the ICU within 24 hours. After adjusting for patient and hospital differences, the top five admitting diagnoses associated with unplanned transfer were: sepsis (odds ratio [OR] 2.6; 95% CI 2.1- 3.1), catastrophic conditions (OR 2.3; 95% 1.9-2.8), pneumonia/acute respiratory infections (OR 1.6; 95% CI 1.4-1.8), acute myocardial infarction (AMI) (OR 1.6; 95% CI 1.3-1.8), and chronic obstructive pulmonary disease (COPD) (OR 1.5; 95% CI 1.3-1.7). Other factors associated with unplanned transfer included: male sex, Comorbidity Points Score (COPS) >145, Laboratory Acute Physiology Score (LAPS) >7, and arriving on the ward between 11 PM-7 AM. Decreased risk of unplanned transfer was found with admission to monitored transitional care units vs. non-monitored wards (OR 0.86; 95% CI 0.80-0.96) and admission to a high-volume vs. low-volume hospital (OR 0.73; 95% CI 0.59-0.89). Conclusion: ED patients admitted with respiratory conditions, sepsis, AMI, multiple comorbidities, and abnormal lab results are at higher risk for unplanned ICU transfer and may benefit from better inpatient triage from the ED, earlier intervention to prevent acute decompensation, or closer monitoring. More research is needed to determine how intermediate care units, hospital volume, time of day, and sex affect risk of unplanned ICU transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine emergency ward integrated health care system intensive care risk factor society EMTREE MEDICAL INDEX TERMS acute heart infarction chronic obstructive lung disease cohort analysis community hospital comorbidity diagnosis emergency health service hospital hospital patient human intensive care unit laboratory logistic regression analysis male model monitoring mortality patient physiology respiratory tract infection risk sepsis United States ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70745461 DOI 10.1111/j.1553-2712.2012.01332.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1553-2712.2012.01332.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 523 TITLE Evidence-based inpatient handovers: A literature review and research agenda AUTHOR NAMES Scott P. Ross P. Prytherch D. AUTHOR ADDRESSES (Scott P., Philip.scott@port.ac.uk; Ross P.; Prytherch D.) Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, United Kingdom. CORRESPONDENCE ADDRESS P. Scott, Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth, United Kingdom. Email: Philip.scott@port.ac.uk SOURCE Clinical Governance (2012) 17:1 (14-27). Date of Publication: 2012 ISSN 1477-7274 1758-6038 (electronic) BOOK PUBLISHER Emerald Group Publishing Ltd., Howard House, Wagon Lane, Bingley, United Kingdom. ABSTRACT Purpose - The objective of this review is to address two research questions: What is evidence-based best practice for intra-hospital inpatient handovers? What areas need further research? The paper aims to take a particular interest in the interpersonal skills involved in successful handover, theoretically-based approaches to implementing improvements in handovers, and whether there is sufficient data to construct an evaluation methodology. Design/methodology/approach - The paper takes the form of a narrative synthesis based on search of PubMed, CINAHL and the Cochrane Library. Findings - A total of 82 papers, comprising 29 implementation studies, 13 conceptual models or improvement methods, five subject reviews and 35 background papers were identified. None of the studies met the normal parameters of evidence-based medicine, but this is unsurprising for a complex healthcare service intervention. Research limitations/implications - Those papers published in English between 2000 and July 2010 that were indexed in CINAHL, Medline or the Cochrane Library or found opportunistically were the only ones to be reviewed. The authors did not search any grey literature or hand-search any journals. Practical implications - The evidence is sufficient to justify widespread adoption of the guiding principles for inpatient handover best practice, provided that concurrent evaluation is also undertaken. Originality/value - This is the first comprehensive review published in the peer-reviewed literature that examines the evidence base for the practice of inpatient handovers across healthcare professions and specialties. © Emerald Group Publishing Limited. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) evidence based inpatient handovers evidence based practice good clinical practice EMTREE MEDICAL INDEX TERMS Cinahl Cochrane Library communication skill health care access health care delivery health care quality health service human information dissemination medical information medical research medical specialist Medline paramedical personnel patient care patient education patient information patient referral patient safety patient transport peer review practice guideline primary medical care priority journal responsibility review social support teamwork EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012090311 PUI L364249453 DOI 10.1108/14777271211200710 FULL TEXT LINK http://dx.doi.org/10.1108/14777271211200710 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 524 TITLE Evolution of an incompatibility group IncA/C plasmid harboring bla (CMY-16) and qnrA6 genes and its transfer through three clones of Providencia stuartii during a two-year outbreak in a Tunisian burn unit AUTHOR NAMES Arpin C. Thabet L. Yassine H. Messadi A.A. Boukadida J. Dubois V. Coulange-Mayonnove L. Andre C. Quentina C. AUTHOR ADDRESSES (Arpin C., corinne.arpin@bacterio.u-bordeaux2.fr; Yassine H.; Dubois V.; Coulange-Mayonnove L.; Andre C.; Quentina C.) Univ. Bordeaux, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France. (Thabet L.; Messadi A.A.) Hôpital Aziza Othmana, Tunis, Tunisia. (Boukadida J.) Hôpital Universitaire Farhat Hached, Sousse, Tunisia. CORRESPONDENCE ADDRESS C. Arpin, Univ. Bordeaux, Microbiologie Fondamentale et Pathogénicité, UMR 5234, Bordeaux, France. Email: corinne.arpin@bacterio.u-bordeaux2.fr SOURCE Antimicrobial Agents and Chemotherapy (2012) 56:3 (1342-1349). Date of Publication: March 2012 ISSN 0066-4804 1098-6596 (electronic) BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. ABSTRACT During a 2-year period in 2005 and 2006, 64 multidrug-resistant Providencia stuartii isolates, including 58 strains from 58 patients and 6 strains obtained from the same tracheal aspirator, were collected in a burn unit of a Tunisian hospital. They divided into four antibiotypes (ATB1 to ATB4) and three SmaI pulsotypes (PsA to PsC), including 49 strains belonging to clone PsA (48 of ATB1 and 1 of ATB4), 11 strains to clone PsB (7 of ATB2 and 4 of ATB3), and 4 strains to clone PsC (ATB3). All strains, except for the PsA/ATB4 isolate, were highly resistant to broad-spectrum cephalosporins due to the production of the plasmidmediated CMY-16 β-lactamase. In addition, the 15 strains of ATB2 and ATB3 exhibited decreased quinolone susceptibility associated with QnrA6. Most strains (ATB1 and ATB3) were gentamicin resistant, related to an AAC(6′)-Ib′ enzyme. All these genes were located on a conjugative plasmid belonging to the incompatibility group IncA/C(2) of 195, 175, or 100 kb. Despite differences in size and in number of resistance determinants, they derived from the same plasmid, as demonstrated by similar profiles in plasmid restriction analysis and strictly homologous sequences of repAIncA/C(2), unusual antibiotic resistance genes (e.g., aphA- 6), and their genetic environments. Further investigation suggested that deletions, acquisition of the ISCR1 insertion sequence, and integron cassette mobility accounted for these variations. Thus, this outbreak was due to both the spread of three clonal strains and the dissemination of a single IncA/C(2) plasmid which underwent a remarkable evolution during the epidemic period. Copyright © 2012, American Society for Microbiology. All Rights Reserved. EMTREE DRUG INDEX TERMS amikacin cefepime cefotaxime cefoxitin ceftazidime cephalosporin chloramphenicol ciprofloxacin clavulanic acid cloxacillin florfenicol gentamicin isepamicin neomycin netilmicin norfloxacin ofloxacin spectinomycin streptomycin sulfonamide tetracycline ticarcillin trimethoprim EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) nucleotide sequence Providencia stuartii EMTREE MEDICAL INDEX TERMS antibiotic resistance antibiotic sensitivity article bacterial gene bacterial strain burn unit clone epidemic gene cassette gene deletion gene insertion sequence gene transfer genetic variability human integron major clinical study minimum inhibitory concentration plasmid priority journal restriction mapping CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) cefepime (88040-23-7) cefotaxime (63527-52-6, 64485-93-4) cefoxitin (33564-30-6, 35607-66-0) ceftazidime (72558-82-8) cephalosporin (11111-12-9) chloramphenicol (134-90-7, 2787-09-9, 56-75-7) ciprofloxacin (85721-33-1) clavulanic acid (58001-44-8) cloxacillin (61-72-3, 642-78-4) florfenicol (73231-34-2) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) isepamicin (58152-03-7) neomycin (11004-65-2, 1404-04-2, 1405-10-3, 8026-22-0) netilmicin (56391-56-1, 56391-57-2) norfloxacin (70458-96-7) ofloxacin (82419-36-1) spectinomycin (1695-77-8, 21736-83-4, 23312-56-3) streptomycin (57-92-1) tetracycline (23843-90-5, 60-54-8, 64-75-5, 8021-86-1) ticarcillin (29457-07-6, 34787-01-4, 4697-14-7) trimethoprim (738-70-5) MOLECULAR SEQUENCE NUMBERS GENBANK (FJ855437, JN193566, JN193567, JN193568) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012103086 MEDLINE PMID 22155825 (http://www.ncbi.nlm.nih.gov/pubmed/22155825) PUI L364279870 DOI 10.1128/AAC.05267-11 FULL TEXT LINK http://dx.doi.org/10.1128/AAC.05267-11 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 525 TITLE Design and evaluation of a multidisciplinary web-based handoff tool AUTHOR NAMES Schnipper J. Karson A. Morash S. Glotzbecker B. Milone M. Raley D.Y. Nolido N. Horsky J. Leinen L. Bhan I. Dankers C. Church K. Minahan J. Yoon C. AUTHOR ADDRESSES (Schnipper J.; Glotzbecker B.; Milone M.; Raley D.Y.; Nolido N.; Horsky J.; Church K.; Minahan J.; Yoon C.) Brigham and Women's Hospital, Boston, United States. (Karson A.; Morash S.; Bhan I.; Dankers C.) Massachusetts General Hospital, Boston, United States. (Leinen L.) Partners Health Care, Boston, United States. CORRESPONDENCE ADDRESS J. Schnipper, Brigham and Women's Hospital, Boston, United States. SOURCE Journal of Hospital Medicine (2012) 7 SUPPL. 2 (S11-S12). Date of Publication: March 2012 CONFERENCE NAME 2012 Annual Meeting of the Society of Hospital Medicine, SHM 2012 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2012-04-01 to 2012-04-04 ISSN 1553-5592 BOOK PUBLISHER Wiley Blackwell ABSTRACT Background: Failures in communication among healthcare personnel during intrahospital handoffs in care are known threats to patient safety. In August, 2009, our healthcare system held a multistakeholder summit on handoffs, developed consensus around the need for a system-wide electronic handoff tool, and recommended a pilot study to develop and evaluate this technology. Methods: We adapted a web-based handoff tool used by a single residency program. Enhancements to the existing tool included: (1) ability to implement the tool at a second hospital in our system; (2) support for simultaneous handoffs by nurses, residents/PAs, and attendings with shared information among the different roles; (3) custom structured templates for each user group; and (4) the ability to create progress notes and multiple sign-out forms from the same core data. The tool was refined and tested on a general medicine teaching service at one hospital and a hematologic malignancy PA service at the other. For 3 months preintervention and 4 months postimplementation, we surveyed receivers of handoffs regarding continuity of care and evaluated signout content using explicit criteria. We also conducted formal usability testing using simulated cases. We conducted principal components analysis to derive categories from the survey questions and create composite scores for each category. Results: We received survey responses from 315 clinicians (66% response rate). In a pre-post analysis, two of five composite scores improved: perceived negative impact of handoff on clinical information and decision-making (composite score 14.7 pre, 10.2 post, p = 0.01), and negative subjective rating of handoff quality and accuracy (28.4 vs 25.8, p = 0.01). Among survey questions to nurses, 10 improved, including an increase in how well handoffs prepared them for things that might go wrong (47.3 vs 65.2, p = 0.01). In the explicit review of written sign-outs, inclusion of five data elements (e.g., % tasks with if/then statements) increased, but decreases were noted in other data elements. Usability testing revealed a tension between desire for a clinical narrative and the use of structured template fields. Conclusions: A multidisciplinary, webbased sign-out tool was able to increase subjective measures of sign-out quality and impact on clinical decision-making, particularly among nurses. Much of the improvement may have come from the ability to produce both a progress note and sign-out with one tool, which led to more frequent updating of sign-outs and greater faith in their accuracy. The use of customized “templated” fields was inconsistent and suggests that these should be minimized to those most necessary for continuity of care. Greater improvements in care may require further enhancements in usability of the tool, training in use of the tool, and education in best practices in handoffs in care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital society EMTREE MEDICAL INDEX TERMS clinical decision making consensus decision making education general practice health care personnel health care system hematologic malignancy human interpersonal communication narrative nurse patient care patient safety pilot study principal component analysis teaching technology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70698008 DOI 10.1002/jhm.1927 FULL TEXT LINK http://dx.doi.org/10.1002/jhm.1927 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 526 TITLE Recognition of infantile botulism: A case illustrating the importance of rapid reassessment after hospital transfers AUTHOR NAMES Trost M. AUTHOR ADDRESSES (Trost M.) Children's Hospital Los Angeles, Los Angeles, United States. CORRESPONDENCE ADDRESS M. Trost, Children's Hospital Los Angeles, Los Angeles, United States. SOURCE Journal of Hospital Medicine (2012) 7 SUPPL. 2 (S269-S270). Date of Publication: March 2012 CONFERENCE NAME 2012 Annual Meeting of the Society of Hospital Medicine, SHM 2012 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2012-04-01 to 2012-04-04 ISSN 1553-5592 BOOK PUBLISHER Wiley Blackwell ABSTRACT Case Presentation: A 7-month-old Caucasian male was admitted to a hospital in central California due to complaints of poor feeding. There was remote history of choking on a plastic bead which was removed by mother. Five days prior to admission he was noted to have difficulty biopsy showing malignant cells. breastfeeding and decreased activity. Family denied fever and endorsed constipation. They had recently moved to a new house in a rural area near a large corn field. The patient and siblings were unimmunized. Initially there was concern for retained foreign body or retropharyngeal abscess. He received neck radiographs and CT scan which were normal. Lab work showed a mild leukocytosis and elevated platelet count. He was started on broad spectrum antibiotics but developed new respiratory distress. At this point there was also concern for atypical infection such as epiglottitis or diphtheria given his unimmunized status. He was transferred to our tertiary care facility for further evaluation. His initial exam was significant for ptosis, hypotonia, and difficulty handling secretions. Shortly after arrival the patient had an episode of apnea and bradycardia that required chest compressions, intubation, and transfer to the intensive care unit. Due to history and physical exam, we suspected botulism. He received one dose of baby botulism immune globulin (baby BIG) and stool was positive for botulism toxin type A. The patient improved, was extubated after 8 days, and was feeding well with good muscle strength at the time of discharge. Discussion: Infantile botulism occurs when an infant ingests Clostridium botulinum spores which germinate in the intestinal tract and release neurotoxins that block acetylcholine release. It is a rare disorder with an average of 71 cases per year in the United States, of which half occur in California. Recognized risk factors are exposure to honey or soil. Clinical diagnosis is based on classic findings of constipation, hypotonia, and a weak cry. Definitive diagnosis requires indirect detection of toxin in stool, which is done only by state health departments or the CDC and can take several days. Electromyogram studies also support the diagnosis, but can be normal in early disease. Treatment is therefore often initiated based on clinical suspicion alone. Baby BIG should be given as soon as possible to inactivate unbound toxin. Most patients have prolonged hospital stays requiring intubation and intensive supportive care. Infant botulism has also been implicated in cases of Sudden Infant Death Syndrome. Prognosis is generally good if the disease is recognized. Conclusions: This case illustrates how infantile botulism is often confused with other diagnoses. When accepting transferred patients, hospitalists must reassess patients and reconsider the differential diagnosis. An up to date literature review is presented to improve recognition and patient outcomes. EMTREE DRUG INDEX TERMS antibiotic agent botulinum antiserum botulinum toxin neurotoxin plastic toxin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) botulism hospital society EMTREE MEDICAL INDEX TERMS acetylcholine release apnea baby bacterial spore biopsy bodily secretions bradycardia cancer cell Caucasian Clostridium botulinum compression computer assisted tomography constipation diagnosis differential diagnosis diphtheria diseases electromyogram epiglottitis exposure feeding female fever foreign body honey hospitalization human infant infection intensive care unit intestine intubation leukocytosis male medical staff mother muscle hypotonia muscle strength neck patient platelet count prognosis ptosis public health service respiratory distress retropharyngeal abscess risk factor rural area sibling soil sudden infant death syndrome tertiary health care thorax United States X ray film LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70698428 DOI 10.1002/jhm.1927 FULL TEXT LINK http://dx.doi.org/10.1002/jhm.1927 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 527 TITLE Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs AUTHOR NAMES Petrovic M.A. Aboumatar H. Baumgartner W.A. Ulatowski J.A. Moyer J. Chang T.Y. Camp M.S. Kowalski J. Senger C.M. Martinez E.A. AUTHOR ADDRESSES (Petrovic M.A., rpetrov@jhmi.edu; Aboumatar H.; Baumgartner W.A.; Ulatowski J.A.; Chang T.Y.; Camp M.S.; Kowalski J.; Senger C.M.; Martinez E.A.) Johns Hopkins University, School of Medicine, Tower 711, 600 North Wolfe Street, Baltimore, MD 21287, United States. (Moyer J.) Johns Hopkins Hospital, Baltimore, MD, United States. (Martinez E.A.) Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. CORRESPONDENCE ADDRESS M.A. Petrovic, Johns Hopkins University, School of Medicine, Tower 711, 600 North Wolfe Street, Baltimore, MD 21287, United States. Email: rpetrov@jhmi.edu SOURCE Journal of Cardiothoracic and Vascular Anesthesia (2012) 26:1 (11-16). Date of Publication: February 2012 ISSN 1053-0770 1532-8422 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Objectives: Perioperative handoffs are a particularly high-risk period given patients' postprocedural physiology, their physical transport through the hospital, and the triad transfer of personnel, information, and technology. The authors piloted a new perioperative handoff process to guide patient transfers from the cardiac operating room (OR) to the cardiac surgical intensive care unit (CSICU). The aim of the study was to evaluate the impact of a standardized handoff process on patient care and provider satisfaction. Design: A prospective, unblinded intervention study. Setting: A CSICU in a teaching hospital. Participants: Two hundred thirty-eight health care practitioners during the transfer of care of 60 patients. Interventions: The implementation of a standardized handoff protocol and checklist. Measurements and Main Results: After the protocol's implementation, the presence of all handoff core team members at the bedside increased from 0% at baseline to 68% after intervention. The percentage of missed information in the surgery report decreased from 26% to 16% (p = 0.03), but the percentage of missed information in the anesthesia report showed no significant change (19% to 17%, p > 0.05). Handoff satisfaction scores among intensive care unit (ICU) nurses increased from 61% to 81%. On average, the duration of handoff increased by 1 minute. Conclusions: A standardized handoff protocol that guides the transfer of care from the OR team to the CSICU team can reduce the risk of missed information and improve satisfaction among perioperative providers. © 2012 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health personnel attitude patient care patient transport EMTREE MEDICAL INDEX TERMS anesthesia article health care personnel human intensive care unit major clinical study operating room patient information perioperative period priority journal prospective study EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012011544 MEDLINE PMID 21889365 (http://www.ncbi.nlm.nih.gov/pubmed/21889365) PUI L51601582 DOI 10.1053/j.jvca.2011.07.009 FULL TEXT LINK http://dx.doi.org/10.1053/j.jvca.2011.07.009 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 528 TITLE Quality improvement of microsurgery through telecommunication-the postoperative care after microvascular transfer of intestine AUTHOR NAMES Chen H.-C. Kuo H.-C. Chung K.-P. Chen S.-H. Tang Y.-B. Su S. AUTHOR ADDRESSES (Chen H.-C.) Plastic Surgery, China Medical Hospital, China Medical University, Taiwan. (Kuo H.-C., simon@isu.edu.tw) Health Management, I-Shou University, Kaohsiung County, Taiwan. (Chung K.-P.; Su S.) Health Policy and Management, National Taiwan University, Taiwan. (Chen S.-H.; Tang Y.-B.) Plastic Surgery, National Taiwan University Hospital, Taiwan. CORRESPONDENCE ADDRESS H.-C. Kuo, I-Shou University, Kaohsiung County, Taiwan. Email: simon@isu.edu.tw SOURCE Microsurgery (2012) 32:2 (96-102). Date of Publication: February 2012 ISSN 0738-1085 1098-2752 (electronic) BOOK PUBLISHER Wiley-Liss Inc., 111 River Street, Hoboken, United States. ABSTRACT The purpose of this report is to describe the use of telecommunication to improve the quality of postoperative care following microsurgery, especially following microvascular transfer of intestinal transfer for which shortening of ischemia time is of utmost importance to achieve high success rate. From 2003 to 2009 microvascular transfer of intestinal flaps had been performed in 112 patients. After surgery the patients were put in intensive care unit and the flaps were checked every 1 hour. The image for circulatory status of the flaps was sent directly to the attending surgeon for judgment. The information was sent through intranet and the surgeon can get access to the intranet through internet if necessary. Among the 112 cases, there were 9 cases of reexploration. The average duration between the time of problem detection and the time of starting reexploration was 54 min in 7 cases, and other 2 cases were delayed to enter the operating room which had been occupied by other cases of major trauma. Only two flaps were lost completely, two patients developed narrowing at the junction of cervical esophagus and thoracic esophagus. The rate of salvage for intestinal flap is apparently higher than those reported in the literature. In the postoperative management of microsurgery in ICU, telecommunication can help to reduce the ischemia time after vascular compromise in the transfer of free intestinal flap. Telecommunication is really an easy and effective tool in improving the outcome of reconstructive surgery. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. Copyright © 2012 Wiley Periodicals, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) microsurgery microvascular surgery telecommunication EMTREE MEDICAL INDEX TERMS article catheter infection (complication) cervical esophagus esophagus health care quality human intensive care unit intestine intestine necrosis (complication) ischemia major clinical study operating room pneumonia (complication) postoperative care priority journal reoperation thoracic esophagus thrombosis (complication) treatment failure wound dehiscence (complication) EMBASE CLASSIFICATIONS Surgery (9) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012063702 MEDLINE PMID 22267277 (http://www.ncbi.nlm.nih.gov/pubmed/22267277) PUI L51827509 DOI 10.1002/micr.20965 FULL TEXT LINK http://dx.doi.org/10.1002/micr.20965 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 529 TITLE Operation mountain rescue AUTHOR NAMES Bowen L. Dykes L. AUTHOR ADDRESSES (Bowen L., Lowribowen@gmail.com) University Hospital, Cardiff, United Kingdom. (Dykes L.) Ysbyty Gwynedd, Bangor, United Kingdom. CORRESPONDENCE ADDRESS L. Bowen, University Hospital, Cardiff, United Kingdom. Email: Lowribowen@gmail.com SOURCE Anaesthesia (2012) 67 SUPPL. 1 (29). Date of Publication: February 2012 CONFERENCE NAME Winter Scientific Meeting of the Association of Anaesthetists of Great Britain and Ireland, AAGBI 2012 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2012-01-18 to 2012-01-20 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT The RCoA 2010 CCT curriculum has created training units focusing on Trauma, Resuscitation, Stabilization and Transfer Medicine [1]. Ysbyty Gwynedd receives around 100 casualties a year brought in by Mountain Rescue/RAF teams from the mountains of Snowdonia. Injuries arise from hill walking, scrambling, ice/rock climbing or paragliding and often require operative fixation; some need intensive care therapy or transfer to tertiary referral centres Methods To identify the anaesthetic challenges and workload posed by mountain casualties brought to a district general hospital by RAF/Mountain Rescue, the database of mountain casualties, case notes, theatre ledgers and ICU admissions records were examined for the time period March 2004-August 2010 Results Over a six and a half year period, 144 operations (mainly orthopaedic trauma) were carried out on 122 casualties. NCEPOD criteria were followed, with only four operations after midnight: 63% of the operations took place on designated day trauma lists. There were seven interhospital transfers: four neurosurgical, one cardiothoracic, one orthopaedic and one maxillofacial. Only 12 intrahospital transfers to radiology or ICU were documented. There were 26 critical care admissions: 21 multiple traumas, two hypothermia, two psychiatric and a post-cardiac arrest. Two patients died in the emergency department despite the cardiac arrest team's best efforts. Discussion The workload is mainly orthopaedic lower limb fractures who are generally assisted off the mountains (upper limb injuries mostly selfevacuate). The database only reflects casualties requiring assistance from SAR services, thus underestimates the true treated numbers. Two-thirds of operations take place on a dedicated trauma list conferring valuable learning experience for trainees. Few tertiary centre transfers occur as massive injuries do not generally survive to admission. Improvement is needed on poor documentation of trauma call attendance or intrahospital transfers. Most critical care admissions are polytrauma which involve resuscitation, theatre trips and transfers. These skills are not specific to mountain trauma, but added to other more conventionally sustained trauma fulfils all training needs of any grade of anaesthetist for several essential units in the 2010 Curriculum [1]. EMTREE DRUG INDEX TERMS anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesist human Ireland United Kingdom winter EMTREE MEDICAL INDEX TERMS accident arm climbing curriculum data base documentation emergency ward general hospital heart arrest hypothermia injury intensive care learning leg limb fracture limb injury multiple trauma patient patient transport radiology resuscitation skill student Tertiary (period) therapy walking workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71056048 DOI 10.1111/j.1365-2044.2011.07058.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2044.2011.07058.x COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 530 TITLE Does hospital transfer predict mortality in very low birth weight infants requiring surgery for necrotizing enterocolitis? AUTHOR NAMES Kelley-Quon L.I. Tseng C. Scott A. Jen H.C. Calkins K.L. Shew S.B. AUTHOR ADDRESSES (Kelley-Quon L.I.; Tseng C.; Scott A.; Jen H.C.; Calkins K.L.; Shew S.B.) UCLA, Los Angeles, United States. (Kelley-Quon L.I.) Robert Wood Johnson Foundation Clinical Scholars Program, Los Angeles, United States. CORRESPONDENCE ADDRESS L.I. Kelley-Quon, UCLA, Los Angeles, United States. SOURCE Journal of Surgical Research (2012) 172:2 (213). Date of Publication: February 2012 CONFERENCE NAME 7th Annual Academic Surgical Congress of the Association for Academic Surgery, AAS and the Society of University Surgeons, SUS CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2012-02-14 to 2012-02-16 ISSN 0022-4804 BOOK PUBLISHER Academic Press Inc. ABSTRACT Introduction: Necrotizing enterocolitis (NEC) is one of the leading causes of infant mortality and the most common reason for emergent surgery in very low birth weight (VLBW, <1500g) infants. However, surgical capabilities are not available in all neonatal intensive care units (NICUs). the goal of this study was to investigate whether transfer for higher level of surgical care affects mortality for VLBW infants with surgical NEC. Methods: VLBWinfants who underwent NEC surgery from 1999-2007 were retrospectively reviewed from the California Patient Discharge Linked Birth Cohort Database. Hospital admissions/transfers from birth to first discharge home were identified. Hospitals were stratified by NICU levels 2A- 3C. NEC diagnosis and surgeries were identified by ICD9 codes. Transfer for emergent NEC surgery was defined as surgery ≥2d after transfer. Infants were categorized as either transferred for surgery or received surgery at their primary NICU. Mortality was analyzed with multivariate logistic regression using a fixed effects model at the individual hospital level. Covariates included transferring NICU level, peritoneal drainage, surgery <7d after birth (as a proxy for spontaneous intestinal perforation), birth weight (BW), maternal age, prenatal care, insurance, gender and major medical comorbidities. Results: Overall, 1,272 VLBW infants (BW: 8606260g) with surgical NEC were identified from 70 hospitals with a 39% mortality. the majority of the cohort underwent surgery at a 3C level NICU (63%). Overall, 406 (32%) infants were transferred for surgical care leaving 866 (68%) who had surgery at their primary NICU. Surgery <7d after birth occurred in 213 (17%) infants, most (73%) with a BW<1000g. Unadjusted mortality was not increased for infants transferred for surgery versus those not transferred for surgery, 37% vs. 40% (p=0. 25). on multivariate analysis, adjusted mortality for infants transferred for surgery did not differ from those who received surgery at their primary NICU (OR 0. 46, 95% CI 0. 12-1. 72). Lower BW, peritoneal drainage as sole surgical intervention, grade IV intraventricular hemorrhage, pulmonary interstitial emphysema, and pulmonary hemorrhage were associated with increased odds of mortality (p<0. 05). Surgery <7d after birth was associated with decreased odds of mortality (OR 0. 11, 95% CI 0. 04-0. 27). Exclusion of this subset on subsequent analysis did not impact the effect of transfer on mortality. Conclusions: VLBW infants with surgical NEC do not demonstrate increased risk of mortality when transferred emergently for higher level of surgical care. It is otherwise uncertain whether lack of surgically capable NICU's contributes to mortality prior to transfer or whether morbidity is affected for infants who survive transport. Future efforts must engage health professionals at all levels caring for this vulnerable population in order to truly maximize resource allocation and safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital human mortality necrotizing enterocolitis society surgeon surgery university very low birth weight EMTREE MEDICAL INDEX TERMS abdominal drainage birth weight brain hemorrhage custodial care data base diagnosis emphysema gender health practitioner hospital discharge infant infant mortality insurance intensive care unit intestine perforation logistic regression analysis lung hemorrhage maternal age model morbidity multivariate analysis newborn intensive care prenatal care resource allocation risk safety United States vulnerable population LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70651245 DOI 10.1016/j.jss.2011.11.305 FULL TEXT LINK http://dx.doi.org/10.1016/j.jss.2011.11.305 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 531 TITLE Acute care nurse practicioner led critical care transport team leads to improved door to imaging time in acute ischemic stroke patients AUTHOR NAMES Winfield M.M. McNeil J.A. Steiner S.L. Manacci C.F. Kralovic D. Hussain M.S. AUTHOR ADDRESSES (Winfield M.M.; McNeil J.A.; Steiner S.L.; Manacci C.F.; Kralovic D.; Hussain M.S.) Cleveland Clinic, Cleveland, United States. CORRESPONDENCE ADDRESS M.M. Winfield, Cleveland Clinic, Cleveland, United States. SOURCE Stroke (2012) 43:2 Meeting Abstracts. Date of Publication: February, 2012 CONFERENCE NAME 2012 International Stroke Conference and Nursing Symposium CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2012-02-01 to 2012-02-03 ISSN 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: In evaluating the acute ischemic stroke (AIS) patient, targeting time intervals for imaging and treatment times are paramount in optimizing outcomes. Initial evaluation by skilled providers who can facilitate the extension of a tertiary care facility can positively influence patient outcomes. A collaborative approach with a hospital based Critical Care Transport (CCT) Team can extend primary stroke program care out to a referring facility's bedside. In the Cleveland Clinic Health System, the suspicion of a large vessel occlusion causing AIS in patients at an outside hospital triggers an “Auto Launch” process, bypassing typical transfer processes to expedite care transitions for patients with time sensitive emergencies. Referring facilities contact a CCT Coordinator, with immediate launching of the transport team that consists of an Acute Care Nurse Practitioner (ACNP) who evaluates the patient at outside facility, performs NIHSS and transitions the patient directly to CT/MRI upon return to Cleveland Clinic facility. Patient is met by the Stroke Neurology Team at CT scanner for definitive care. A CCT Team with an ACNP on board can augment not only door to CT and MRI times, but also time to evaluation by a stroke neurologist and time to intervention, bypassing the Emergency Department upon their arrival and proceeding directly to studies and/or time sensitive intervention as appropriate. Objective: To describe a stroke program with a coordinated approach with a CCT Team to facilitate rapid care transitions as well as decreased time to imaging in patients with AIS by having an ACNP on board during transport and throughout the continuum of care. Methods: A retrospective audit of a database of patients undergoing hyperacute evaluation of acute ischemic stroke symptoms from April 30, 2010 to July 31, 2011 was performed. Demographic information, types of imaging performed, hyperacute therapies administered and time intervals to imaging modalities and treatment were collected and analyzed. Results: 107 patients total, 28 males, and 36 females with a mean age of 70 were included in the analysis. 60% [64] of patients transferred via the CCT Team over 26.42 average nautical miles. The mean time of call to arrival was 1 hr and 19 min. The CCT Team monitored tPA infusion in 27 patients and initiated tPA infusion in 2 patients. 64 patients had CT imaging performed and 64 had MRI performed following the CT. [The average door to CT completion was 22 min, the average door to MRI completion was 1 hr and 29 min, compared to 1 hr and 8 min and 2 hr and 36 min, respectively, in patients not arriving by CCT Team], p<0.05. Conclusion: Collaboration between the Stroke Neurology Team and CCT Team has allowed acute ischemic stroke patients to be taken directly to CT/MRI scanner, allowing for rapid evaluation, definitive treatment decisions, and the potential for improved patient outcomes by decreasing the door to imaging time. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia cerebrovascular accident emergency care human imaging intensive care nurse nursing stroke patient EMTREE MEDICAL INDEX TERMS acute care nurse practitioner clinical audit computed tomography scanner data base emergency emergency ward female health care hospital infusion male National Institutes of Health Stroke Scale neurologist neurology nuclear magnetic resonance imaging occlusion patient tertiary health care therapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70925715 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 532 TITLE Using Six Sigma methodology to reduce patient transfer times from floor to critical-care beds. AUTHOR NAMES Silich S.J. Wetz R.V. Riebling N. Coleman C. Khoueiry G. Abi Rafeh N. Bagon E. Szerszen A. AUTHOR ADDRESSES (Silich S.J.) Six Sigma Certified Blackbelt for Staten Island University Hospital in Staten Island, New York, USA. (Wetz R.V.; Riebling N.; Coleman C.; Khoueiry G.; Abi Rafeh N.; Bagon E.; Szerszen A.) CORRESPONDENCE ADDRESS S.J. Silich, Six Sigma Certified Blackbelt for Staten Island University Hospital in Staten Island, New York, USA. Email: ssilich@siuh.edu SOURCE Journal for healthcare quality : official publication of the National Association for Healthcare Quality (2012) 34:1 (44-54). Date of Publication: 2012 Jan-Feb ISSN 1945-1474 (electronic) ABSTRACT In response to concerns regarding delays in transferring critically ill patients to intensive care units (ICU), a quality improvement project, using the Six Sigma process, was undertaken to correct issues leading to transfer delay. To test the efficacy of a Six Sigma intervention to reduce transfer time and establish a patient transfer process that would effectively enhance communication between hospital caregivers and improve the continuum of care for patients. The project was conducted at a 714-bed tertiary care hospital in Staten Island, New York. A Six Sigma multidisciplinary team was assembled to assess areas that needed improvement, manage the intervention, and analyze the results. Results: The Six Sigma process identified eight key steps in the transfer of patients from general medical floors to critical care areas. Preintervention data and a root-cause analysis helped to establish the goal transfer-time limits of 3 h for any individual transfer and 90 min for the average of all transfers. The Six Sigma approach is a problem-solving methodology that resulted in almost a 60% reduction in patient transfer time from a general medical floor to a critical care area. The Six Sigma process is a feasible method for implementing healthcare related quality of care projects, especially those that are complex. © 2011 National Association for Healthcare Quality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport total quality management EMTREE MEDICAL INDEX TERMS article critical illness (therapy) health care quality health services research human interdisciplinary communication length of stay mortality organization and management standard statistics teaching hospital time United States LANGUAGE OF ARTICLE English MEDLINE PMID 23552174 (http://www.ncbi.nlm.nih.gov/pubmed/23552174) PUI L369194710 DOI 10.1111/j.1945-1474.2011.00184.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1945-1474.2011.00184.x COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 533 TITLE Waiting time for transfer of patients with prostaglandin dependant congenital heart defects to tertiary cardiac centers AUTHOR NAMES Al Mesned A.R. Al Akhfash A.A. Sayed M. AUTHOR ADDRESSES (Al Mesned A.R., almesnid@yahoo.com; Al Akhfash A.A.; Sayed M.) Paediatric Cardiology, Prince Sultan Cardiac Center, Al-Qassim, Saudi Arabia. CORRESPONDENCE ADDRESS A.R. Al Mesned, Paediatric Cardiology, Prince Sultan Cardiac Canter, PO Box 896, Al-Qassim 51421, Saudi Arabia. Email: almesnid@yahoo.com SOURCE Journal of the Saudi Heart Association (2012) 24:2 (79-83). Date of Publication: April 2012 ISSN 2212-5043 (electronic) 1016-7315 BOOK PUBLISHER Elsevier ABSTRACT Worldwide congenital heart defects (CHD) are the leading cause of infant deaths owing to congenital anomalies. Delay in diagnosing and operating in neonates with prostaglandin dependant CHD may lead to significant morbidity and mortality.Objectives: To assess the time interval needed for acceptance and transfer of patients with critical CHD to a tertiary cardiac center and the impact on the patient's survival.Study design: Retrospective database reviews of all cases diagnosed to have prostaglandin dependant (PG) CHD at Prince Sultan Cardiac Center-Qassim during a 43. months period (from May 2007 to December 2010).Results: During the study period 104 patients were diagnosed to have PG dependant CHD. Patients with PG dependant systemic circulation constitute 60% of patients. Patients with ventricular septal defect (VSD) associated with coarctation of the aorta constituted 16% of patients. The mean waiting time for transfer to a tertiary cardiac center was 10. ±. 10. days. Twenty-two (21%) patients died while waiting for acceptance and transfer. Eleven patients were diagnosed with hypoplastic left heart syndrome (HLHS). There was no significant difference in the waiting time for those with or without HLHS, with a mean of 9. days for both. Six of our patients had infections with positive blood cultures. The mean waiting period for those with proved infection was 25. days compared with 8. days for those with no proved infection (. p value. <. 0.005).Conclusion: There are a significant number of patients with severe CHD who die while waiting for acceptance and transfer to a tertiary cardiac center. The causes for delay could be the presence of infection, prematurity and low birth weight. The limited numbers of tertiary cardiac centers in Saudi Arabia as well as cardiac ICU beds are among the factors delaying the acceptance of patients requiring cardiac surgery. © 2011 . EMTREE DRUG INDEX TERMS prostaglandin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart malformation patient transport tertiary health care watchful waiting EMTREE MEDICAL INDEX TERMS adolescent aortic arch interruption aortic coarctation aortic stenosis article blood culture child clinical article coronary care unit great vessels transposition heart right ventricle double outlet heart ventricle septum defect human hypoplastic left heart syndrome infant newborn preschool child priority journal pulmonary valve atresia school child survival systemic circulation EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Drug Literature Index (37) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012222435 PUI L51712675 DOI 10.1016/j.jsha.2011.10.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.jsha.2011.10.004 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 534 TITLE Sim-man vs powerpoint for teaching critical care transport medicine airway management decision- Making AUTHOR NAMES Holmes J. Carleton S. Hart K. Leblanc D. Lindsell C. AUTHOR ADDRESSES (Holmes J.) Maine Medical Center, United States. (Carleton S.; Hart K.; Leblanc D.; Lindsell C.) University of Cincinnati, United States. CORRESPONDENCE ADDRESS J. Holmes, Maine Medical Center, United States. SOURCE Air Medical Journal (2012) 31:6 (257). Date of Publication: November-December 2012 CONFERENCE NAME 2012 Air Medical Transport Conference, AMTC 2012 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2012-10-22 to 2012-10-22 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Airway management decision-making is a fundamental skill in critical care transport medicine (CCTM). The complexity and acuity of CCTM patients render the educational model of see one, do one, teach one incompatible with patient safety. Highfidelity simulation has been shown to be effective for teaching airway management, but whether it is superior to didactic training remains unclear. We hypothesized that simulation training would be more effective than didactic training for teaching CCTM provider orientees airway management decision-making. Methods: Twelve PGY-1 emergency medicine residents, orienting to become flight physicians, participated in this IRB-approved, randomized crossover study. Two three-hour educational sessions with specific, identical objectives regarding CCTM airway management decision-making were delivered. One session used traditional didactic classroom teaching; the other used six airway scenarios pre-programmed on a Laerdal high-fidelity Sim-Man with debriefing after each scenario. Participants completed both sessions in one day, with six completing didactic education followed by simulation education and six completing simulation education followed by didactic education. Before either session, participants completed a baseline knowledge assessment. They also completed a post-test knowledge assessment after each session. Each test asked slightly different questions but tested the same content. Paired samples t-tests were used to compare pre- and post-test scores. Independent samples t-tests were used to compare scores between groups. Results: All 12 participants completed the training. Overall, the mean pre-test score was 41% and the mean score for post-test 1 was 47%. Post-test 1 scores did not differ between participants completing didactic education first and participants completing simulation education first (48% vs 46%, p=0.610). Overall, the mean post-test 2 score was 60%, which was significantly higher than baseline (p Conclusion: Contrary to our hypothesis, simulation training was not superior to didactic training in facilitating immediate recall of the educational content. Our study is limited by a small sample size, and by the didactic and simulation sessions having been taught by different instructors. The data suggest that tandem training using both methods, in either order, did result in statistically significant improvement in immediate recall of CCTM airway management decision-making principles. Further study is indicated to clarify the optimal distribution, timing, and ordering of didactic and simulation education. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport decision making human intensive care male respiration control teaching EMTREE MEDICAL INDEX TERMS airway crossover procedure education educational model emergency medicine flight hypothesis patient patient safety physician recall sample size simulation skill Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71267276 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 535 TITLE Implementing a critical care transport provider risk assessment tool: Translating subjective factors into objective measurable data AUTHOR NAMES Singleton J. Carr B. Hodgson N. Wicinski S. Kunkel S. AUTHOR ADDRESSES (Singleton J.; Carr B.; Hodgson N.; Wicinski S.) Metro Life Flight, United States. (Kunkel S.) Champion EMS, Flight for Life, United States. CORRESPONDENCE ADDRESS J. Singleton, Metro Life Flight, United States. SOURCE Air Medical Journal (2012) 31:6 (260). Date of Publication: November-December 2012 CONFERENCE NAME 2012 Air Medical Transport Conference, AMTC 2012 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2012-10-22 to 2012-10-22 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Metro Life Flight is a critical care transport program that has provided both air and ground services for 30 years. Life Flight crews work in a challenging, fast paced and demanding environment. At times the ability to recognize circumstances that may inhibit safe and effective care can be clouded by the desire to help. Providing invaluable service to Northeast Ohio and beyond, these medical providers work either a 12 hour or a 24 hour shift. Until the implementation of the crew fatigue risk tool, there was only subjective interpretation of a crew members fatigue. This tool has helped to standardize and define fatigue criteria as well as allow for risk mitigation and remediation. Further development of the process created a method for crew members to report, aggregate and communicate risk levels in real-time. Methods: Self reporting of fatigue factors through an automated tool completed by medical crew at the start of each shift and upon return to base after completion of missions. Results: During the 1st quarter of 2012 a total of 1157 records were reviewed for compliance and risk status. 1106 (94%) resulted as green or low risk, 51 (6%) were yellow or medium risk and there were no reported incidences of service interruption for staff going into the red or high risk category. We focused our review on the issues that surround the yellow category to assess the factors that drove this risk elevation. The following categories were examined and resulted: Overall risk assessment ratings Medium status related to years of experience Medium status by time of day Medium status by rest hours Medium status related to shift length Medium status by personnel The average green or low score was 11/17 with a high of 17 and a low score of 5. The average yellow or medium score was 19/29 with a high of 25 and a low score of 18. Conclusion: This process provides an improved, safe and universal way of reporting fatigue and identifying those that could be at risk to suffer high levels of fatigue. Providers that have a high level of fatigue are at risk to make errors that could impact the safety of patients as well as other crew members. This tool provides a nonpunitive reporting method for staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care risk assessment EMTREE MEDICAL INDEX TERMS airplane crew crew member environment fatigue flight human patient personnel risk safety United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71267283 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 536 TITLE Minor changes monumental impact: Improving critical care transport services AUTHOR NAMES McCool S. Loehr A. Hunt C. AUTHOR ADDRESSES (McCool S.; Loehr A.; Hunt C.) Children's Mercy Hospital, United States. CORRESPONDENCE ADDRESS S. McCool, Children's Mercy Hospital, United States. SOURCE Air Medical Journal (2012) 31:6 (260). Date of Publication: November-December 2012 CONFERENCE NAME 2012 Air Medical Transport Conference, AMTC 2012 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2012-10-22 to 2012-10-22 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: In trauma or illness, quick access to specialized critical care resources can mean the difference between life or death. To better serve the areas pediatric patients and improve outcomes, one Pediatric Critical Care Transport Team (CCTT) evaluated the efficiency of current staff scheduling processes to reduce missed transports. Methods: The CCTT Operations Committee (OC) was developed to evaluate the departments staffing and scheduling plan efficiency and effectiveness in relation to transport activity, specifically completed and missed transports. When the project began, the CCTTs daily staffing plan provided the following coverage: 0700-1930 2 Transport Teams 1000-2230 1 Transport Team 1700-0530 1 Transport Team 1900-0730 2 Transport Team The OC utilize transport data, such as total missed transports, missed/delayed transports due to team availability, time requests were received, frequency of open shifts, and transport activity to evaluate scheduling practices and their impact on operations, patient and staff safety, and costs. This data supported replacing the 1700 shift with a 1500 shift. The 1700 shift was viewed as undesirable by staff. Data also revealed that the transport request volumes increased nominally between 1200 and 0230. The 1500 shift provides more appropriate coverage for this surge. The new staffing model would also allow the 24 hr shift CCTT members adequate time to sleep during the early morning hours when there were fewer transport requests. Results: Drastic improvements were seen in the efficiencies of transport operations. Within the first year of implementation, missed transports due to no teams available decreased by 36.6% during the hours of the new 1500 shift. In addition, when comparing data from 11/2008-02/2009 and 11/2010-02/2011, typically the busiest transport months, the number of total missed transports decreased by half. In 11/2008-02/2009, 8.6% overall transport requests received by the department resulting in a missed transport, constituted a total of 146 missed transports. In 11/2010-02/2011, only 4.5% of all transport requests resulted in a missed transport, reducing the total number of missed transports to 76. Conclusion: Significant improvements can be attributed to the implementation of the OCs recommendations. By engaging direct care staff in evaluating the effectiveness and efficiency of the departments staffing plan, the CCTT has been able to enhance availability. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care EMTREE MEDICAL INDEX TERMS death diseases human injury model patient safety sleep LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71267284 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 537 TITLE Missed opportunities during pediatric residency training: Report of a 10-year follow-up survey in critical care transport medicine AUTHOR NAMES Kline-Krammes S. Wheeler D.S. Schwartz H.P. Forbes M. Bigham M.T. AUTHOR ADDRESSES (Kline-Krammes S.; Forbes M.; Bigham M.T., mbigham@chmca.org) Division of Pediatric Critical Care, Akron Children's Hospital Medical Center, One Perkins Square, Akron, OH 44308, United States. (Wheeler D.S.) Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. (Schwartz H.P.) Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States. CORRESPONDENCE ADDRESS M.T. Bigham, Division of Pediatric Critical Care, Akron Children's Hospital Medical Center, One Perkins Square, Akron, OH 44308, United States. Email: mbigham@chmca.org SOURCE Pediatric Emergency Care (2012) 28:1 (1-5). Date of Publication: January 2012 ISSN 0749-5161 1535-1815 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT OBJECTIVES: The Accreditation Council for Graduate Medical Education requires pediatric residency training programs to provide exposure to the prehospital management and transport of patients. The authors hypothesized that compared with a similar study a decade prior, current pediatric residency training programs have reduced requirements for participation in transport medicine, thus reducing further the opportunities for residents to learn the management of critically ill infants and children. METHODS: In 2009, a questionnaire was distributed to 182 pediatric residency program directors. The authors obtained information regarding the neonatal and pediatric transport teams, the training program size, and the pediatric residents' role in the transport team. RESULTS: Sixty-eight (37%) of the 182 surveyed institutions responded. Residents were involved in neonatal and pediatric transports in 42.8% and 55.0% of programs, respectively. When involved in transports, residents were the neonatal and pediatric team leaders 44.4% and 42.4% of the time, respectively. Evaluation of resident transport performance occurred consistently in only 23.3% (neonatal) and 21% (pediatric) of programs. Most programs (90.3%) endorsed the concept of a curriculum that would uniquely provide an integrated experience in critical care transport to increase resident exposure, competence, and confidence. CONCLUSIONS: Pediatric residency participation in neonatal and pediatric critical care transport continued to decline among training programs. Residents participating in transports were less likely to function as team leaders and frequently did not receive performance evaluations. Most respondents welcomed a curriculum that would increase residents' exposure to the critically ill infants and children transported by neonatal and pediatric teams. Copyright © 2012 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care residency education transport medicine EMTREE MEDICAL INDEX TERMS article education program follow up health care facility health survey human medical education questionnaire EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012016927 MEDLINE PMID 22193690 (http://www.ncbi.nlm.nih.gov/pubmed/22193690) PUI L51781832 DOI 10.1097/PEC.0b013e31823ed4ab FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0b013e31823ed4ab COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 538 TITLE Sim-Man vs powerpoint for teaching critical care transport Medicine airway management decision-making AUTHOR NAMES Holmes J. Carleton S. Hart K. LeBlanc D. Lindsell C. AUTHOR ADDRESSES (Holmes J.) Maine Medical Center, United States. (Carleton S.; Hart K.; LeBlanc D.; Lindsell C.) University of Cincinnati, United States. CORRESPONDENCE ADDRESS J. Holmes, Maine Medical Center, United States. SOURCE Air Medical Journal (2012) 31:5 (226). Date of Publication: September-October 2012 CONFERENCE NAME 2012 Air Medical Transport Conference, AMTC 2012 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2012-10-22 to 2012-10-24 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Airway management decision-making is a fundamental skill in critical care transport medicine (CCTM). The complexity and acuity of CCTM patients render the educational model of see one, do one, teach one incompatible with patient safety. Highfidelity simulation has been shown to be effective for teaching airway management, but whether it is superior to didactic training remains unclear. We hypothesized that simulation training would be more effective than didactic training for teaching CCTM provider orientees airway management decision-making. Methods: Twelve PGY-1 emergency medicine residents, orienting to become flight physicians, participated in this IRB-approved, randomized crossover study. Two three-hour educational sessions with specific, identical objectives regarding CCTM airway management decision-making were delivered. One session used traditional didactic classroom teaching; the other used six airway scenarios pre-programmed on a Laerdal high-fidelity Sim-Man with debriefing after each scenario. Participants completed both sessions in one day, with six completing didactic education followed by simulation education and six completing simulation education followed by didactic education. Before either session, participants completed a baseline knowledge assessment. They also completed a post-test knowledge assessment after each session. Each test asked slightly different questions but tested the same content. Paired samples t-tests were used to compare pre- and post-test scores. Independent samples t-tests were used to compare scores between groups. Results: All 12 participants completed the training. Overall, the mean pre-test score was 41% and the mean score for post-test 1 was 47%. Post-test 1 scores did not differ between participants completing didactic education first and participants completing simulation education first (48% vs 46%, p=0.610). Overall, the mean post-test 2 score was 60%, which was significantly higher than baseline (p Conclusion: Contrary to our hypothesis, simulation training was not superior to didactic training in facilitating immediate recall of the educational content. Our study is limited by a small sample size, and by the didactic and simulation sessions having been taught by different instructors. The data suggest that tandem training using both methods, in either order, did result in statistically significant improvement in immediate recall of CCTM airway management decision-making principles. Further study is indicated to clarify the optimal distribution, timing, and ordering of didactic and simulation education. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport decision making human intensive care male respiration control teaching EMTREE MEDICAL INDEX TERMS airway crossover procedure education educational model emergency medicine flight hypothesis patient patient safety physician recall sample size simulation skill Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70875443 DOI 10.1016/j.amj.2012.07.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.07.007 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 539 TITLE Implementing a critical care transport provider risk assessment tool: Translating subjective factors into objective measurable data AUTHOR NAMES Singleton J. Carr B. Hodgson N. Wicinski S. Kunkel S. AUTHOR ADDRESSES (Singleton J.; Carr B.; Hodgson N.; Wicinski S.; Kunkel S.) Metro Life Flight Champion EMS, Flight for Life, United States. CORRESPONDENCE ADDRESS J. Singleton, Metro Life Flight Champion EMS, Flight for Life, United States. SOURCE Air Medical Journal (2012) 31:5 (229). Date of Publication: September-October 2012 CONFERENCE NAME 2012 Air Medical Transport Conference, AMTC 2012 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2012-10-22 to 2012-10-24 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Metro Life Flight is a critical care transport program that has provided both air and ground services for 30 years. Life Flight crews work in a challenging, fast paced and demanding environment. At times the ability to recognize circumstances that may inhibit safe and effective care can be clouded by the desire to help. Providing invaluable service to Northeast Ohio and beyond, these medical providers work either a 12 hour or a 24 hour shift. Until the implementation of the crew fatigue risk tool, there was only subjective interpretation of a crew members fatigue. This tool has helped to standardize and define fatigue criteria as well as allow for risk mitigation and remediation. Further development of the process created a method for crew members to report, aggregate and communicate risk levels in real-time. Methods: Self reporting of fatigue factors through an automated tool completed by medical crew at the start of each shift and upon return to base after completion of missions. Results: During the 1st quarter of 2012 a total of 1157 records were reviewed for compliance and risk status. 1106 (94%) resulted as green or low risk, 51 (6%) were yellow or medium risk and there were no reported incidences of service interruption for staff going into the red or high risk category. We focused our review on the issues that surround the yellow category to assess the factors that drove this risk elevation. The following categories were examined and resulted: Overall risk assessment ratings Medium status related to years of experience Medium status by time of day Medium status by rest hours Medium status related to shift length Medium status by personnel The average green or low score was 11/17 with a high of 17 and a low score of 5. The average yellow or medium score was 19/29 with a high of 25 and a low score of 18. Conclusion: This process provides an improved, safe and universal way of reporting fatigue and identifying those that could be at risk to suffer high levels of fatigue. Providers that have a high level of fatigue are at risk to make errors that could impact the safety of patients as well as other crew members. This tool provides a nonpunitive reporting method for staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care risk assessment EMTREE MEDICAL INDEX TERMS airplane crew crew member environment fatigue flight human patient personnel risk safety United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70875450 DOI 10.1016/j.amj.2012.07.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.07.007 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 540 TITLE Minor changes monumental impact: Improving critical care transport services AUTHOR NAMES McCool S. Loehr A. Hunt C. AUTHOR ADDRESSES (McCool S.; Loehr A.; Hunt C.) Children's Mercy Hospital, United States. CORRESPONDENCE ADDRESS S. McCool, Children's Mercy Hospital, United States. SOURCE Air Medical Journal (2012) 31:5 (229). Date of Publication: September-October 2012 CONFERENCE NAME 2012 Air Medical Transport Conference, AMTC 2012 CONFERENCE LOCATION Seattle, WA, United States CONFERENCE DATE 2012-10-22 to 2012-10-24 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: In trauma or illness, quick access to specialized critical care resources can mean the difference between life or death. To better serve the areas pediatric patients and improve outcomes, one Pediatric Critical Care Transport Team (CCTT) evaluated the efficiency of current staff scheduling processes to reduce missed transports. Methods: The CCTT Operations Committee (OC) was developed to evaluate the departments staffing and scheduling plan efficiency and effectiveness in relation to transport activity, specifically completed and missed transports. When the project began, the CCTTs daily staffing plan provided the following coverage: 0700-1930 2 Transport Teams 1000-2230 1 Transport Team 1700-0530 1 Transport Team 1900-0730 2 Transport Team The OC utilize transport data, such as total missed transports, missed/delayed transports due to team availability, time requests were received, frequency of open shifts, and transport activity to evaluate scheduling practices and their impact on operations, patient and staff safety, and costs. This data supported replacing the 1700 shift with a 1500 shift. The 1700 shift was viewed as undesirable by staff. Data also revealed that the transport request volumes increased nominally between 1200 and 0230. The 1500 shift provides more appropriate coverage for this surge. The new staffing model would also allow the 24 hr shift CCTT members adequate time to sleep during the early morning hours when there were fewer transport requests. Results: Drastic improvements were seen in the efficiencies of transport operations. Within the first year of implementation, missed transports due to no teams available decreased by 36.6% during the hours of the new 1500 shift. In addition, when comparing data from 11/2008-02/2009 and 11/2010-02/2011, typically the busiest transport months, the number of total missed transports decreased by half. In 11/2008-02/2009, 8.6% overall transport requests received by the department resulting in a missed transport, constituted a total of 146 missed transports. In 11/2010-02/2011, only 4.5% of all transport requests resulted in a missed transport, reducing the total number of missed transports to 76. Conclusion: Significant improvements can be attributed to the implementation of the OCs recommendations. By engaging direct care staff in evaluating the effectiveness and efficiency of the departments staffing plan, the CCTT has been able to enhance availability. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care EMTREE MEDICAL INDEX TERMS death diseases human injury model patient safety sleep LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70875451 DOI 10.1016/j.amj.2012.07.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2012.07.007 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 541 TITLE An evaluation of repeat imaging in the pediatric emergency department: Is it clinically indicated, safe, or cost effective? AUTHOR NAMES Hunter E. Lovvorn J. Lynch A. Thompson T. AUTHOR ADDRESSES (Lovvorn J.; Lynch A.; Thompson T.) Arkansas Children's Hospital, Little Rock, United States. (Hunter E.) Children's Mercy Hospital, Kansas City, United States. CORRESPONDENCE ADDRESS E. Hunter, Children's Mercy Hospital, Kansas City, United States. SOURCE Journal of Investigative Medicine (2012) 60:1 (397). Date of Publication: January 2012 CONFERENCE NAME American Federation for Medical Research Southern Regional Meeting, AFMR 2012 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2012-02-09 to 2012-02-11 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: Many patients transported from outside facilities have the same radiographic studies repeated in the ED for a multitude of reasons. This practice exposes patients to addition radiation and incurs a monetary cost billed to the patient. We sought to determine the reasons for repeat radiographic imaging in the ED and to assess both the monetary and radiation cost to the patient. Methods Used: A prospective study was designed to identify patients who required repeat radiographic imaging upon arrival to the ED of a tertiary pediatric hospital between January 2011- October 2011. Upon arrival, a score sheet was filled out by ED staff to identify the type of study and the reason it was obtained. The results were analyzed using SPSS and reported in aggregate. Summary of Results: 139 subjects were identified in the study period. The most common reasons cited for repeat imaging was poor quality film/inadequate views (43%), no films sent with patient at time of transfer (21%) and requested by the service (9%). Only 16 % of patients had repeat imaging because it was clinically indicated; e.g. a change in clinical status. Types of repeated studies include 70% plain films, 18% CTs and 9 % Ultrasound or MRI, with ∼3% representing other studies. Eight percent of subjects received multiple repeat imaging modalities during this study. The average cost of a chest x-ray billed to the patient from our hospital is $140 and incurs 0.1 milliSeverts (mSv) of radiation. This is equal to 10 days of background radiation exposure the average person in the US receives. The cost of a Head CT billed to a patient is $1,870 and incurs on average 2mSv which is equivalent to 4 months of background radiation exposure. Radiation doses incurred from outside referral facilities are typically higher and this does not include radiology technician or radiologist cost. Conclusions: Repeat imaging for intra-hospital transfer to a tertiary facility is common. However, in our institution, clinical indication was not the primary reason. This practice incurs both a monitory cost and additional radiation exposure to the patient. This preliminary study will allow us to identify potential targets for quality improvement and improve patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward imaging medical research EMTREE MEDICAL INDEX TERMS hospital human ionizing radiation nuclear magnetic resonance imaging patient patient safety pediatric hospital prospective study radiation radiation dose radiation exposure radiologist radiology Tertiary (period) thorax radiography total quality management ultrasound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70982247 DOI 10.231/JIM.0b013e3182820c55 FULL TEXT LINK http://dx.doi.org/10.231/JIM.0b013e3182820c55 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 542 TITLE The effect of repeated audit on the quality of transfer of brain-injured patients into a regional neurosciences centre AUTHOR NAMES Messer P.B. Sweenie A.C. Whittle R.J. Mceleavy I.M. AUTHOR ADDRESSES (Messer P.B., benmesser@doctors.net.uk; Sweenie A.C.; Whittle R.J.; Mceleavy I.M.) Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom. CORRESPONDENCE ADDRESS P. B. Messer, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom. Email: benmesser@doctors.net.uk SOURCE Journal of the Intensive Care Society (2012) 13:1 (39-42). Date of Publication: January 2012 ISSN 1751-1437 BOOK PUBLISHER Stansted News Ltd, 134 South Street, Bishop's Stortford, Hertfordshire, Essex, United Kingdom. ABSTRACT Brain injury is common and transfer of such patients to a neuroscience centre is a frequently occurring event. Transfer is a time of potential instability and can contribute to physiological changes that could cause secondary brain injury. UK data suggest that there has been a gradual improvement in quality and outcome of transfers of brain-injured patients during the last three decades. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) have published guidelines to improve the safety and quality of transfers. Over a seven-year period, we audited transfers four times and implemented three successive interventions aimed at improving the quality of transfers of brain-injured patients into the regional neurosciences centre. We observed a significant improvement in the transfer of patients according to AAGBI guidelines across most domains of patient care. The use of repeated cycles of audit and intervention significantly improved the quality of transfer of brain-injured patients, which could improve patient safety and outcome. © The Intensive Care Society 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain injury clinical audit patient transport EMTREE MEDICAL INDEX TERMS arterial pressure article end tidal carbon dioxide tension human intensive care unit patient care patient safety total quality management EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012110538 PUI L364307683 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 543 TITLE Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients AUTHOR NAMES Nakayama D.K. Lester S.S. Rich D.R. Weidner B.C. Glenn J.B. Shaker I.J. AUTHOR ADDRESSES (Nakayama D.K., Nakayama.Don@mccg.org; Lester S.S.; Rich D.R.; Weidner B.C.; Glenn J.B.; Shaker I.J.) Department of Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, GA 31201, United States. CORRESPONDENCE ADDRESS D.K. Nakayama, Department of Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, GA 31201, United States. Email: Nakayama.Don@mccg.org SOURCE Journal of Pediatric Surgery (2012) 47:1 (112-118). Date of Publication: January 2012 ISSN 0022-3468 1531-5037 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Background: Intrahospital transfers are necessary but hazardous aspects of pediatric surgical care. Plan-Do-Study-Act processes identify risks during hospitalization and improve care systems and patient safety. Methods: A multidisciplinary team developed a checklist that documented patient data and handoffs for all intrahospital transfers involving pediatric surgical inpatients. The checklist summarized major clinical events and provided concurrent summaries by 3-month quarters (Q) over 1 year. Results: There were 903 intrahospital transfers involving 583 inpatients undergoing surgery. Total handoffs were documented in 436 (75% of 583), with greater than 1 handoff in 202 (46% of 436). Documented problems occurred in 31 transfers (3.4%), the most during Q1 (19/191; 9.9%). Incidence fell to 3.5% (9/260) in Q2, 0.4% (1/243) in Q3, and 1.0% (2/209) in Q4 (P <.001). Patient care issues (14/31; 45%) were most common, followed by documentation (10, 32%) and process problems (7, 23%). The quality improvement team was able to resolve patient instability during transport (5 in Q1, none in Q3, Q4) and poor pain control (3 in Q2, 1 in Q3, Q4). Of the patients, 3.2% had identified problems with patient care during intrahospital transfer. Conclusions: Plan-Do-Study-Act review emphasizes ongoing process analysis by multidisciplinary teams. Checklists reinforce communication and provide feedback on whether system goals are being achieved. © 2012 Elsevier Inc. All rights reserved. EMTREE DRUG INDEX TERMS analgesic agent (drug therapy) antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient safety patient transport pediatric surgery EMTREE MEDICAL INDEX TERMS article checklist feedback system hospital patient human incidence major clinical study medical documentation medical information patient care patient coding postoperative pain (complication, drug therapy) priority journal total quality management treatment planning EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012032317 MEDLINE PMID 22244402 (http://www.ncbi.nlm.nih.gov/pubmed/22244402) PUI L364091762 DOI 10.1016/j.jpedsurg.2011.10.030 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpedsurg.2011.10.030 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 544 TITLE Neonatal land transport ORIGINAL (NON-ENGLISH) TITLE Kopneni prijevoz novorocrossed d signenčadi AUTHOR NAMES Bregun-Doronjski A. AUTHOR ADDRESSES (Bregun-Doronjski A., adoronjski@yahoo.co.uk) Institut za Zdravstvenu Zaštitu Djece I Omladine Vojvodine, Vojvodanskih brigada 12, 21000 Novi Sad, Serbia. CORRESPONDENCE ADDRESS A. Bregun-Doronjski, Institut za Zdravstvenu Zaštitu Djece I Omladine Vojvodine, Vojvodanskih brigada 12, 21000 Novi Sad, Serbia. Email: adoronjski@yahoo.co.uk SOURCE Paediatria Croatica, Supplement (2011) 55:SUPPL. 1 (151-161). Date of Publication: 2011 ISSN 1330-724X BOOK PUBLISHER Children's Hospital Zagreb, Klaiceva 16, Zagreb, Croatia. ABSTRACT Improved perinatal care over the past decades (prenatal diagnosis and good timing of the prenatal transport) has resulted in the fact that seriously ill newborns are born in larger perinatal centers (with level III of perinatal care). In these centers newborns are provided with high level of care and treatment. When this is not the case, the newborn prognosis is largely affected by the level of perinatal care. Due to the lack of needed treatment, they have to be transferred to the higher level of perinatal care. The sooner the problem is identified, the better is the neonatal outcome. However, the postnatal transport is tied with the higher morbidity and mortality than the prenatal transport (transport in utero), particularly with the extremely immature and very immature neonates. In order to achieve proper medical transport for these high-risk and vulnerable neonates, there is a need for highly skilled staff and sophisticated medical equipment. In an ideal world neonatal transport team is one of the important factors in neonatal care. This procedure is followed by treatment in the neonatal intensive care unit (NICU) where the personnel and the equipment are dedicated to these babies. By the type of transport (land, air, water), and organization (one way, two way) and a different personnel in the transport team, neonatal transport is organized differently in various countries. It is extremely important to have highly educated, knowledgeable and well equipped transport service providers. The need for stabilizing the patient prior the transport is essential. Moreover, all the necessary medical and technical procedures are to be performed before and during transport (regardless of the participants in the transport team). Special procedures (surfactant replacement therapy, "cooling", prostaglandin treatment etc.) should be applied by an experienced team that has the knowledge and skills in these techniques, as well as in monitoring of the patient and possible complications. There are some special procedures in the neonatal transport of surgical patients like stomach emptying before the transport, ventilation, prone or supine positioning etc. EMTREE DRUG INDEX TERMS prostaglandin surfactant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn period patient transport EMTREE MEDICAL INDEX TERMS health care personnel high risk patient human induced hypothermia intensive care unit knowledge medical device morbidity mortality newborn care patient monitoring perinatal care prognosis review skill EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE unknown LANGUAGE OF SUMMARY English, unknown EMBASE ACCESSION NUMBER 2011655568 PUI L363010363 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 545 TITLE Intra-hospital transport: From aeronautic to medicine ORIGINAL (NON-ENGLISH) TITLE Transports intrahospitaliers: De l'aéronautique à la médecine AUTHOR NAMES Rayeh-Pelardy F. Mimoz O. AUTHOR ADDRESSES (Rayeh-Pelardy F.) Service des urgences-Samu-Smur, CHU de Poitiers, 86021 Poitiers, France. (Mimoz O., o.mimoz@chu-poitiers.fr) Service d'anesthésie réanimation, Inserm ERI 23, université de Poitiers, CHU de Poitiers, 86021 Poitiers, France. (Mimoz O., o.mimoz@chu-poitiers.fr) Pôle anesthésie-réanimations-urgences-Samu-Smur-médecine légale, Inserm ERI 23, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France. CORRESPONDENCE ADDRESS O. Mimoz, Service d'anesthésie réanimation, Inserm ERI 23, université de Poitiers, CHU de Poitiers, 86021 Poitiers, France. Email: o.mimoz@chu-poitiers.fr SOURCE Annales Francaises d'Anesthesie et de Reanimation (2011) 30:12 (875-876). Date of Publication: December 2011 ISSN 0750-7658 1769-6623 (electronic) BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital care intra hospital transport EMTREE MEDICAL INDEX TERMS anesthesia checklist editorial resuscitation EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2011682462 MEDLINE PMID 22100623 (http://www.ncbi.nlm.nih.gov/pubmed/22100623) PUI L51720238 DOI 10.1016/j.annfar.2011.10.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.annfar.2011.10.015 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 546 TITLE Can the use of apache II score in hypotensive patients in the general ward predict intensive care unit transfer? AUTHOR NAMES Khalid I. Almasari A. Alkhammash S. Qabajah M. Khalid T. Al-Zyoud A. AUTHOR ADDRESSES (Khalid I.; Almasari A.; Alkhammash S.; Qabajah M.; Khalid T.; Al-Zyoud A.) King Faisal Specialist Hospital, Research Center, Jeddah, Saudi Arabia. CORRESPONDENCE ADDRESS I. Khalid, King Faisal Specialist Hospital, Research Center, Jeddah, Saudi Arabia. SOURCE Critical Care Medicine (2011) 39 SUPPL. 12 (140). Date of Publication: December 2011 CONFERENCE NAME Critical Care Congress 2012 CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2012-02-04 to 2012-02-08 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Severity scores are used in patients admitted to the Intensive Care Unit (ICU). However, usefulness of a severity score for triaging at the time of initial evaluation in hypotensive patients in the general ward is not clear. Hypothesis: We hypothesized that calculating APACHE II score at the time of new onset hypotension in the ward would help prognosticate transfer of patients to the ICU. Methods: Rapid response team (RRT) is activated for any hypotensive patient with SBP<90 mm of Hg in our tertiary care hospital. We retrospectively looked at all those encounters from Jan 2009 till Oct 2010. Patients were divided into two groups; those who did not require an ICU transfer after RRT evaluation, and the other who were transferred to the ICU within 48 hours. APACHE II scores were calculated from the data available at the time of RRT call. We also looked at the 28 day mortality as a secondary outcome. Data was analyzed using student t-test and Pearson chi-square test, as appropriate. Results: A total of 281 hypotensive patients were identified. 126 patients were treated and stabilized in the ward while 155 were transferred to the ICU. 44/155 of the later were deemed stable initially but later deteriorated and admitted to the ICU within 48 hours. The mean APACHE II score for patients who remained in the ward was 16.5 + 6.9 and for those transferred to the ICU was 20 + 5.4 (p<0.0001). Using Receiver Operating Characteristic analysis, an APACHE II score of 20 as a cutoff to predict ICU transfer had an area under the curve of 0.67, and sensitivity, specificity and positive predictive value of 61%, 74% and 74% respectively. 28 day mortality in patients who remained in the ward was 4.7% (6/126) and in those transferred to ICU was 31% (48/155), p<0.0001. An alarming 44% (21/48) of patients (mean APACHE II 21.7) who died in ICU were deemed stable at the initial RRT evaluation, but had to be transferred later. Conclusions: An APACHE II score of 20 or more is associated with an ICU transfer in hypotensive patients in the general ward. As an adjunctive tool it may help identify borderline patients, which in our study had the highest mortality. These results should be validated prospectively in a multicenter study. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antihypertensive agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care intensive care unit patient ward EMTREE MEDICAL INDEX TERMS APACHE area under the curve chi square test hospital hypotension hypothesis mortality multicenter study predictive value rapid response team receiver operating characteristic Student t test tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71058818 DOI 10.1097/01.ccm.0000408627.24229.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 547 TITLE Intrahospital transport of critically ill patients (excluding newborns). AUTHOR NAMES Quenot J.P. Milési C. Cravoisy A. Capellier G. Mimoz O. Fourcade O. Gueugniaud P.Y. Soc. de Reanimation de Langue Francaise Societe Francaise d'anesthesie et de reanimation Société française de médecine d'urgence AUTHOR ADDRESSES (Quenot J.P.) Service de réanimation médicale, CHU Bocage-Central-Gabriel, 14, rue Paul-Gaffarel, 21079 Dijon, France. (Milési C.; Cravoisy A.; Capellier G.; Mimoz O.; Fourcade O.; Gueugniaud P.Y.; Soc. de Reanimation de Langue Francaise; Societe Francaise d'anesthesie et de reanimation; Société française de médecine d'urgence) CORRESPONDENCE ADDRESS J.P. Quenot, Service de réanimation médicale, CHU Bocage-Central-Gabriel, 14, rue Paul-Gaffarel, 21079 Dijon, France. Email: jean-pierre.quenot@chu-dijon.fr SOURCE Annales françaises d'anesthèsie et de rèanimation (2011) 30:12 (e83-87, 952-956). Date of Publication: Dec 2011 ISSN 1769-6623 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS article human monitoring practice guideline standard LANGUAGE OF ARTICLE English, French MEDLINE PMID 22100622 (http://www.ncbi.nlm.nih.gov/pubmed/22100622) PUI L560066388 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 548 TITLE Are subinhibitory concentrations of antibiotics the only culprit of antibiotic resistance? AUTHOR NAMES Krcmery V. AUTHOR ADDRESSES (Krcmery V., vladimir.krcmery@szu.sk) St. Elizabeth University, College of Health and Social Sciences, Namestie 1. maja No 1, 811 01 Bratislava, Slovakia. CORRESPONDENCE ADDRESS V. Krcmery, St. Elizabeth University, College of Health and Social Sciences, Namestie 1. maja No 1, 811 01 Bratislava, Slovakia. Email: vladimir.krcmery@szu.sk SOURCE Future Microbiology (2011) 6:12 (1391-1394). Date of Publication: December 2011 ISSN 1746-0913 1746-0921 (electronic) BOOK PUBLISHER Future Medicine Ltd., 2nd Albert Place, Finchley Central, London, United Kingdom. ABSTRACT Evaluation of: Gullberg E, Cao S, Berg OG et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 7(7), e1002158 (2011). Subinhibitory concentrations of antibiotics and antifungals promote resistance. Antibiotic consumption including hospital use, and country use, including patients self-medications is one of the major drivers of antibiotic or antifungal resistance. However, consumption of antibiotics should be distinguished between the hospital and community. Hospital consumption, poor hospital hygiene and intrahospital transfer have been determined as major risk factors for development of resistance. The correlation between resistance and consumption in the community is not so clear. Therefore consumption of antibiotics and antifungals alone cannot explain the selection of resistant bacterial and fungal mutants and other factors have to be investigated. © 2011 Future Medicine Ltd. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antibiotic agent EMTREE DRUG INDEX TERMS amphotericin B cotrimoxazole echinocandin fluconazole macrolide nystatin penicillin G quinolone derivative tetracycline derivative voriconazole EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance EMTREE MEDICAL INDEX TERMS acute leukemia antifungal resistance article bone marrow transplantation Candida dubliniensis Candida glabrata Candida parapsilosis Candida rugosa Candida tropicalis Clavispora lusitaniae Enterobacter cloacae Escherichia coli hospital hygiene human intensive care unit methicillin resistant Staphylococcus aureus Meyerozyma guilliermondii neutropenia nonhuman Pichia kudriavzevii priority journal risk factor Yarrowia lipolytica CAS REGISTRY NUMBERS amphotericin B (1397-89-3, 30652-87-0) cotrimoxazole (8064-90-2) echinocandin (80619-41-6) fluconazole (86386-73-4) nystatin (1400-61-9, 34786-70-4, 62997-67-5) penicillin G (1406-05-9, 61-33-6) voriconazole (137234-62-9) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011656282 PUI L363012383 DOI 10.2217/fmb.11.129 FULL TEXT LINK http://dx.doi.org/10.2217/fmb.11.129 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 549 TITLE Predictive score for clinical complications during intra-hospital transports of infants treated in a neonatal unit AUTHOR NAMES Vieira A.L.P. dos Santos A.M.N. Okuyama M.K. Miyoshi M.H. de Almeida M.F.B. Guinsburg R. AUTHOR ADDRESSES (Vieira A.L.P.; dos Santos A.M.N., ameliamiyashiro@yahoo.com.br; Okuyama M.K.; Miyoshi M.H.; de Almeida M.F.B.; Guinsburg R.) Department of Pediatrics, Neonatal Division of Medicine, Federal University of São Paulo, São Paulo/SP, Brazil. CORRESPONDENCE ADDRESS A. M. N. dos Santos, Department of Pediatrics, Neonatal Division of Medicine, Federal University of São Paulo, São Paulo/SP, Brazil. Email: ameliamiyashiro@yahoo.com.br SOURCE Clinics (2011) 66:4 (573-577). Date of Publication: 2011 ISSN 1807-5932 BOOK PUBLISHER Universidade de Sao Paulo, Av.Dr.Arnaldo 455-Cerqueira Cesar, Sao Paulo, Brazil. ABSTRACT OBJECTIVE: To develop and validate a predictive score for clinical complications during intra-hospital transport of infants treated in neonatal units. METHODS: This was a cross-sectional study nested in a prospective cohort of infants transported within a public university hospital from January 2001 to December 2008. Transports during even (n = 301) and odd (n = 394) years were compared to develop and validate a predictive score. The points attributed to each score variable were derived from multiple logistic regression analysis. The predictive performance and the score calibration were analyzed by a receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test, respectively. RESULTS: Infants with a mean gestational age of 35±4 weeks and a birth weight of 2457±841 g were studied. In the derivation cohort, clinical complications occurred in 74 (24.6%) transports. Logistic regression analysis identified five variables associated with these complications and assigned corresponding point values: gestatin at birth [,28 weeks (6 pts); 28-34 weeks (3 pts); >34 weeks (2 pts)]; pre-transport temperature [<36.3°C or >37°C (3 pts); 36.3-37.0°C (2 pts)]; underlying pathological condition [CNS malformation (4 pts); other (2 pts)]; transport destination [surgery (5 pts); magnetic resonance or computed tomography imaging (3 pts); other (2 pts)]; and pre-transport respiratory support [mechanical ventilation (8 pts); supplemental oxygen (7 pts); no oxygen (2 pts)]. For the derivation and validation cohorts, the areas under the ROC curve were 0.770 and 0.712, respectively. Expected and observed frequencies of complications were similar between the two cohorts. CONCLUSION: The predictive score developed and validated in this study presented adequate discriminative power and calibration. This score can help identify infants at risk of clinical complications during intra-hospital transports. © 2011 CLINICS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) nervous system malformation (complication) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article epidemiology female human infant male methodology risk assessment standard statistics validation study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 21655749 (http://www.ncbi.nlm.nih.gov/pubmed/21655749) PUI L361932403 DOI 10.1590/S1807-59322011000400009 FULL TEXT LINK http://dx.doi.org/10.1590/S1807-59322011000400009 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 550 TITLE The use of pews to predict provider intervention and adverse events during air transport of critically ill children with congenital heart disease AUTHOR NAMES Wolf M. Hoar E. Patel M. Petrillo-Albarano T. Simsic J. AUTHOR ADDRESSES (Wolf M.; Hoar E.; Patel M.; Petrillo-Albarano T.) Children's Healthcare of Atlanta, United States. (Simsic J.) Emory University, Children's Healthcare of Atlanta, Egleston, United States. CORRESPONDENCE ADDRESS M. Wolf, Children's Healthcare of Atlanta, United States. SOURCE Critical Care Medicine (2011) 39 SUPPL. 12 (62). Date of Publication: December 2011 CONFERENCE NAME Critical Care Congress 2012 CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2012-02-04 to 2012-02-08 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Children with congenital heart disease (CHD) are often transferred from referring hospitals to tertiary care centers via air transport for management. Hypothesis: The purpose of this study was to examine (1) medical interventions or adverse events during air transports and (2) utility of PEWS in predicting need for intervention or adverse events during air transport. Methods: Retrospective review from January 2006-August 2008 of all children with CHD air transported to the cardiac intensive care unit. N = 79. Transport assessment and events during transport were reviewed. Medical interventions were defined as intubation, volume administration, acidosis management, sedation, and need for IV access. Adverse events were intubation/extubation, addition of inotrope, and CPR. Results: Mean age at transport 12 ± 36 months; median 7.5 days (0 days-16 yrs). 54 (68%) were <1 mos. Most common diagnoses were transposition of great arteries (19%); coarctation of aorta (14%); hypoplastic left heart syndrome (7%). Mean initial PEWS score 4.9 - 2.7; median 5 (0-9). 36 (46%) PEWS <4 and 43 (54%) PEWS 5. Medical interventions occurred in 62% of transports. Adverse events occurred in 3 (3.8%). Medical interventions were more frequent in patients with PEWS 5 vs PEWS <4 (88(90%) vs 10(10%); p = 0.001); and in intubated vs non-intubated patients (89(91%) vs 8(8%); p = 0.001). Of 36 patients on PGE, 24 (67%) were intubated. Medical interventions were more frequent in neonates on PGE vs not on PGE (59 (60%) vs 20 (20%); p = 0.06). Conclusions: Adverse events were uncommon during the air transport of children with CHD. PEWS 5, intubation, and PGE were predictive of medical interventions by the transport team. PGE infusion does not appear to be a risk for intubation prior to or during transport. Frequent need for medical interventions, especially with PEWS 5 supports the importance of a pediatric transport team, and the use of PEWS as a triage tool in patients with CHD transported by air. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child congenital heart disease critically ill patient human intensive care EMTREE MEDICAL INDEX TERMS acidosis aorta artery diagnosis emergency health service hospital hypoplastic left heart syndrome hypothesis infusion intensive care unit intubation newborn patient risk sedation tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71058556 DOI 10.1097/01.ccm.0000408627.24229.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 551 TITLE Invasive circulation assist devices for intrahospital and interhospital transport ORIGINAL (NON-ENGLISH) TITLE Invasive kreislaufunterstützungssysteme bei intra-und interhospitalen transporten AUTHOR NAMES Fürnau G. Thiele H. AUTHOR ADDRESSES (Fürnau G., fuerg@med.uni-leipzig.de; Thiele H., thielh@medizin.uni-leipzig.de) Klinik für Innere Medizin/Kardiologie, Universität Leipzig, Herzzentrum Strümpellstraße 39, 04289 Leipzig, Germany. CORRESPONDENCE ADDRESS G. Fürnau, Klinik für Innere Medizin/Kardiologie, Universität Leipzig, Herzzentrum Strümpellstraße 39, 04289 Leipzig, Germany. Email: fuerg@med.uni-leipzig.de SOURCE Notfall und Rettungsmedizin (2011) 14:8 (630-634). Date of Publication: December 2011 ISSN 1434-6222 1436-0578 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT The use of left ventricular assist devices is becoming increasingly more common. Current developments allow percutaneous canulation without the setting of a cardiac surgery department or a perfusionist. This brings assist device treatment also to smaller facilities and makes the transfer of unstable patients from the primary clinic to specialized centers for extended treatment possible. This review describes the different systems and current experience in patient transfer. © Springer-Verlag 2011. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart assist device patient transport EMTREE MEDICAL INDEX TERMS article experience human EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2012047168 PUI L51739376 DOI 10.1007/s10049-011-1417-0 FULL TEXT LINK http://dx.doi.org/10.1007/s10049-011-1417-0 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 552 TITLE Adverse events leading to ICU transfer from inpatient units: Investigating trends and prevent-ability AUTHOR NAMES Miles A. Spaeder M. Stockwell D. AUTHOR ADDRESSES (Miles A.; Spaeder M.; Stockwell D.) Children's National Medical Center, United States. CORRESPONDENCE ADDRESS A. Miles, Children's National Medical Center, United States. SOURCE Critical Care Medicine (2011) 39 SUPPL. 12 (175). Date of Publication: December 2011 CONFERENCE NAME Critical Care Congress 2012 CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2012-02-04 to 2012-02-08 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: A portion of unplanned transfers to an ICU from inpatient units results from adverse events (AEs). We examined trends in AE-related ICU transfer to identify at-risk populations. Hypothesis: AEs (and their preventability) may be more common in some populations depending on diagnosis, time of day, and weekday vs. weekend. Methods: A retrospective observational study of ICU transfers from inpatient units during a 1-year period in a tertiary care children's hospital. Transfers were identified via electronic health record and investigated to establish if an AE had occurred. Predefined AEs included ICU transfers in < 12 hours of admission to acute care, re-admissions to an ICU in <24 hours of ICU discharge, and cardiopulmonary arrests on an acute care unit. We determined the preventability of the AEs and categorized them by type, diagnosis, time of day, and weekday vs. weekend to examine trends. Results: 533 ICU transfers occurred with 114 (21.4%) AEs; 27 (23.7%) were preventable. The majority were transfers in <12 hours of admission (60.5%; 15.9% of these were preventable), cardiopulmonary arrests (16.7%; 15.8% preventable) and ICU re-admissions in <24 hours (15.8%; 61.1% preventable). Reasons for transfer included respiratory distress (48.2%), sepsis (13.2%), and need for increased monitoring (9.6%). Among the 55 AEs related to respiratory distress, associated diagnoses were pneumonia (29.1%), status asthmaticus (21.8%), bronchiolitis (16.4%) and upper airway disease (12.7%). Night events accounted for 57% (65) of AE-related transfers with 25% deemed preventable. All 3 preventable cardiopulmonary arrests and all 5 preventable sepsis-related AEs occurred at night as did 73.3% of total sepsis-related AEs. The incidence of preventable AEs on weekends (29.4%) was higher than the overall incidence of preventable events. Conclusions: Understanding reasons for ICU transfers is crucial in order to recognize areas for improvement in care. Status asthmaticus, pneumonia, and bronchiolitis were the most common diagnoses involved in AE-related ICU transfer and may suggest areas for future research to improve assessment of likely clinical course. Nights and weekends were not significantly associated with an increase in AEs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient human intensive care EMTREE MEDICAL INDEX TERMS asthmatic state bronchiolitis cardiopulmonary arrest diagnosis disease course electronic medical record emergency care hypothesis monitoring night observational study pediatric hospital pneumonia population respiratory distress respiratory tract disease risk sepsis tertiary health care upper respiratory tract LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71058945 DOI 10.1097/01.ccm.0000408627.24229.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 553 TITLE Transport time-out: Improving safety in critically ill patient transport AUTHOR NAMES Fairfax L. Kaylor C. Huynh T. AUTHOR ADDRESSES (Fairfax L.; Kaylor C.; Huynh T.) Carolinas Medical Center, United States. CORRESPONDENCE ADDRESS L. Fairfax, Carolinas Medical Center, United States. SOURCE Critical Care Medicine (2011) 39 SUPPL. 12 (178). Date of Publication: December 2011 CONFERENCE NAME Critical Care Congress 2012 CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2012-02-04 to 2012-02-08 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Intrafacility transport of critically ill patients is associated with adverse events. Key components to promote safety include assurance of transport necessity and provision of adequate personnel, resources and equipment. This requires a formalized process with consistent structure and interdisciplinary communication. Hypothesis: We hypothesized that implementation of a safety verification process (SVP) will reduce the incidence of adverse events associated with intrafacility transport of critically ill patients. Methods: A multi-professional team developed and implemented a SVP in our 29-bed ICU over an 11-week period. The SVP consisted of nursing and respiratory staff assessing transport necessity, patient condition, required personnel and equipment. Transports were categorized as green, yellow or red based on increasing order of concern. A minimum of two staff members and emergency medications were required for each transport. Ventilated patients had in-line CO2 detection and portable suction. Documents and data included category of transports, compliance and number of transports aborted. Results: Sixty-eight SVP forms were completed prior to transport with 39 green, 18 yellow and 11 red. Transport concerns were present in 29% of cases; all were communicated to physician resulting in 3 procedures changed to bedside and 1 aborted. Adequate staffing was present in 91%, with more staff than required accompanying 19% of transports. A physician or advanced practitioner accompanied 72% of red transports. No adverse events were reported. Conclusions: Our multi-professional initiative for intrafacility transport led to more effective staff communication, improved triage and sufficient resources to ensure transport safety. Multi-professional collaboration was paramount in achieving a culture of safety in our ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient human intensive care patient transport safety EMTREE MEDICAL INDEX TERMS drug therapy emergency emergency health service hypothesis interdisciplinary communication interpersonal communication nursing patient personnel physician procedures suction ventilated patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71058953 DOI 10.1097/01.ccm.0000408627.24229.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 554 TITLE Use of a transfer center to manage the transfer of pediatric patients from the emergency department to the intensive care unit: A pilot study AUTHOR NAMES Hatfield M. Cocks A. Warnick R. Hirsh D. Vats A. AUTHOR ADDRESSES (Hatfield M.; Cocks A.; Warnick R.; Hirsh D.; Vats A.) Children's Healthcare of Atlanta, United States. (Vats A.) Emory University School of Medicine, United States. CORRESPONDENCE ADDRESS M. Hatfield, Children's Healthcare of Atlanta, United States. SOURCE Critical Care Medicine (2011) 39 SUPPL. 12 (27). Date of Publication: December 2011 CONFERENCE NAME Critical Care Congress 2012 CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2012-02-04 to 2012-02-08 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Transfer of care of patients is recognized as problematic. The transfer of care of patients from the Emergency Department (ED) to the Intensive Care Unit (ICU) has several aspects of transfer that operate independently (ED-to-ICU physician transfer/handoff, nurse-to-nurse transfer, and bed placement) that can lead to delays in transfer to a higher level of care, delays in treatment, delays in care for other waiting ED patients, misinformation, and errors. Transfer centers (TC) have been utilized at many institutions to improve quality of care and efficiency for acceptance of patients from outside institutions. Hypothesis: Use of a TC to coordinate all ED to ICU patient transfers at an academic pediatric hospital will lead to decreased ED length of stay (LOS), decreased disposition to exit time (DTE), and decreased errors. Methods: Children's Healthcare of Atlanta has a TC that was established in 2009 for referrals from outside centers. The study was performed on the Egleston campus which is affiliated with Emory University. The institution has an occurence notification system (ONS) utilized for reporting and monitoring patient care related occurrences and errors. The TC was implemented as a trial for all ED to ICU transfers from May 16-July 11, 2011. DTE and ED LOS for the trial period were compared to same time period one year earlier (YE) and the same time period immediately prior (IP). ONS rates related to ED transfer of care were monitored. Results: 118 patients were transferred from the ED to ICU during the study period compared to 129 YE and 154 IP. Average DTE decreased to 69.9+47.5 minutes (78.3+48.7 YE, p = 0.17. 80.2+51.6 IP, p = 0.09) and ED LOS decreased to 215 + 99 minutes (229+ 110 YE, p = 0.281. 241 +114 IP, p = 0.04). The campus ONS rate was 3.5/month in 2009-2011. There were zero ONS reports during the study period. Conclusions: In this pilot trial of utilizing a TC to manage transfer of patients from the ED to ICU, there was a decrease DT and ED LOS in the time period immediately after initiation of the process change. The trial has also been associated with a decreased ONS rate. Further study is warranted to see if the results of this trial period are sustained. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward human intensive care intensive care unit patient pilot study EMTREE MEDICAL INDEX TERMS child health care hypothesis length of stay monitoring nurse patient care patient transport pediatric hospital physician therapy delay university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71058449 DOI 10.1097/01.ccm.0000408627.24229.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 555 TITLE Falling through the cracks: information breakdowns in critical care handoff communication. AUTHOR NAMES Abraham J. Nguyen V. Almoosa K.F. Patel B. Patel V.L. AUTHOR ADDRESSES (Abraham J.) Center for Cognitive Informatics and Decision Making, School of Biomedical Informatics, UTHealth, Houston, TX, USA. (Nguyen V.; Almoosa K.F.; Patel B.; Patel V.L.) CORRESPONDENCE ADDRESS J. Abraham, Center for Cognitive Informatics and Decision Making, School of Biomedical Informatics, UTHealth, Houston, TX, USA. SOURCE AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium (2011) 2011 (28-37). Date of Publication: 2011 ISSN 1942-597X (electronic) ABSTRACT Handoffs have been recognized as a major healthcare challenge primarily due to the breakdowns in communication that occur during transitions in care. Consequently, they are characterized as being "remarkably haphazard". To investigate the information breakdowns in group handoff communication, we conducted a study at a large academic hospital in Texas. We used multifaceted qualitative methods such as observations, shadowing of care providers and their work activities, audio-recording of handoffs, and care provider interviews to examine the handoff communication workflow, with particular emphasis on investigating the sources of information breakdowns. Using a mixed inductive-deductive analysis approach, we identified two critical sources for information breakdowns - lack of standardization in handoff communication events and unsuccessful completion of pre-turnover coordination activities. We propose strategic solutions that can effectively help mitigate the handoff communication breakdowns. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit interpersonal communication patient care patient transport EMTREE MEDICAL INDEX TERMS article human medical error (prevention) nonbiological model organization and management statistics United States university hospital workflow LANGUAGE OF ARTICLE English MEDLINE PMID 22195052 (http://www.ncbi.nlm.nih.gov/pubmed/22195052) PUI L560078251 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 556 TITLE Intrahospital transport increases the risk of VAP in critically ill surgical patients AUTHOR NAMES Kelliher K. Nailor M. Staff I. Brautigam R. Butler K. AUTHOR ADDRESSES (Kelliher K.; Nailor M.; Staff I.; Brautigam R.; Butler K.) Hartford Hospital, United States. CORRESPONDENCE ADDRESS K. Kelliher, Hartford Hospital, United States. SOURCE Critical Care Medicine (2011) 39 SUPPL. 12 (102). Date of Publication: December 2011 CONFERENCE NAME Critical Care Congress 2012 CONFERENCE LOCATION Houston, TX, United States CONFERENCE DATE 2012-02-04 to 2012-02-08 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The purpose of this study was to determine whether intrahospital transport (IHT) is a risk factor for ventilator associated pneumonia (VAP). Hypothesis: We hypothesized that IHT of critically ill surgical patients was an independent risk factor for VAP. Methods: A retrospective review of consecutive admissions to the neurotrauma/general surgery intensive care unit (SICU) from January thru September 2010 was performed. Patients were included if they were intubated within 24 hours of admission and required mechanical ventilation for >48 hours. Clinical suspicion of VAP was based on ATS/IDSA criteria and confirmed by sampling lower respiratory secretions (BAL>104 cfu/ml). Age, gender, ethnicity, BMI, APACHE II, length of stay, mortality and discharge disposition were collected. Data are expressed as mean±SD. Results: A total of 1300 patients were admitted to the SICU, 413 patients required mechanical ventilation, 128 (31%) met inclusion criteria. The mean age was 54±21 years, 67% were male, APACHE II 19±6, mean BMI 29±8 and mean SICU LOS 16±13 days. VAP was identified in 51 (40%) patients and occurred more frequently (85%) in patients >50 years compared to younger patients (P = 0.015). There were no differences in ethnicity, APACHE II, or BMI in the VAP( +) or VAP(-) groups. ICU LOS (21 ± 13 days vs. 13 - 11 days, ( +)vs.(-), P<0.01) and hospital LOS (31±19 days vs. 22±19 days, (+)vs.(-), P = 0.01) were significantly longer for VAP (+) patients. The mean number of IHT's for all patients was 3 - 2 (range 0-9) with 75% of patients transported more than once. The most common destination was radiology for CT imaging (75% of all patients and 93% of those with multiple transports). On multivariate analysis patients transported out of the ICU 2 times had a significantly greater rate of VAP independent of demographic and illness severity measures (OR = 2.8, CI = 1.02-7.6, P<0.045). Sixty-four percent of patients survived to hospital discharge; home (18%), rehab (29%) or skilled nursing facility (17%). Conclusions: Intrahospital transport is an important risk factor for VAP in the SICU patient. Quality improvement initiatives aimed at reducing the rate of VAP must address risks inside and outside of the intensive care unit. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient human intensive care risk surgical patient EMTREE MEDICAL INDEX TERMS APACHE artificial ventilation bodily secretions disease severity ethnicity gender hospital hospital discharge hypothesis imaging intensive care unit length of stay male mortality multivariate analysis nursing home patient radiology risk factor sampling surgery total quality management ventilator associated pneumonia LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71058690 DOI 10.1097/01.ccm.0000408627.24229.88 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000408627.24229.88 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 557 TITLE Three percent saline administration during pediatric critical care transport AUTHOR NAMES Luu J.L. Wendtland C.L. Gross M.F. Mirza F. Zouros A. Zimmerman G.J. Barcega B. Abd-Allah S.A. AUTHOR ADDRESSES (Luu J.L.; Wendtland C.L.; Gross M.F.; Mirza F.; Zouros A.; Zimmerman G.J.; Barcega B.; Abd-Allah S.A.) CORRESPONDENCE ADDRESS J. L. Luu, SOURCE Pediatric Emergency Care (2011). Date of Publication: 30 Nov 2011 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams & Wilkins, Inc. ABSTRACT OBJECTIVES: The purpose of this study was to describe the administration of 3% saline (3%S) during pediatric critical care transport. METHODS: A retrospective study was performed on pediatric patients who underwent critical transport to Loma Linda University Children's Hospital from January 1, 2003, to June 30, 2007, and were given 3%S. Patients' demographics, admission diagnosis, route and amount of 3%S administration, serum electrolytes, vital signs, radiographic data, and Glasgow Coma Scale scores were collected and analyzed. RESULTS: A total of 101 children who received 3%S infusions during pediatric critical care transport were identified. Mean patient age was 5.9 years, and mean patient weight was 27.6 kg. The main indications for infusing 3%S were suspected cerebral edema (41%), intracranial bleed with edema (51%), and symptomatic hyponatremia (6%). The amount of 3%S bolus ranged from 1.2 to 24 mL/kg, with a mean of 5.4 mL/kg. Serum electrolytes before and after 3%S infusion demonstrated significant increases in sodium, chloride, and bicarbonate levels (P < 0.05). A significant reduction was also seen in serum urea nitrogen levels and anion gap. Radiographic imaging performed before 3%S infusion demonstrated findings consistent with concerns of increased intracranial pressure such as intracranial bleed and cerebral edema. The route of initial 3%S infusions was mainly through peripheral intravenous lines (96%). No complications related to the 3%S delivery such as local reactions, renal abnormalities, or central pontine myelinolysis were observed. CONCLUSIONS: It seems 3%S may be administered safely during pediatric critical transport and administration routes can include peripheral lines. With the importance of initiating therapy early to improve patient outcomes, the use of 3%S may benefit transported children with brain injury and suspected intracranial hypertension. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) sodium chloride EMTREE DRUG INDEX TERMS bicarbonate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS anion gap brain edema brain injury central pontine myelinolysis child diagnosis drug administration route edema electrolyte blood level Glasgow coma scale human hyponatremia imaging infusion intracranial hypertension Loma patient pediatric hospital retrospective study therapy university urea nitrogen blood level vital sign weight PUI L51747822 DOI 10.1097/PEC.0b013e31823aff59 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0b013e31823aff59 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 558 TITLE A clinical nurse specialist intervention to facilitate safe transfer from ICU. AUTHOR NAMES St-Louis L. Brault D. AUTHOR ADDRESSES (St-Louis L.) Critical Care and Cardiac Surgery, Jewish General Hospital, Intensive Care Unit, 3755 Chemin de la Côte Ste-Catherine, Montréal, Quebec, Canada. (Brault D.) CORRESPONDENCE ADDRESS L. St-Louis, Critical Care and Cardiac Surgery, Jewish General Hospital, Intensive Care Unit, 3755 Chemin de la Côte Ste-Catherine, Montréal, Quebec, Canada. Email: lstlouis@nurs.jgh.mcgill.ca SOURCE Clinical nurse specialist CNS (2011) 25:6 (321-326). Date of Publication: 2011 Nov-Dec ISSN 1538-9782 (electronic) ABSTRACT The purpose of this article was to describe an innovative quality initiative implemented by the clinical nurses specialist in medicine to facilitate the transition process between the intensive care unit and the medical wards. Safely transferring patients with complex health conditions from an area of high technology and increased monitoring, like the intensive care unit, to an area with lower nurse-to-patient ratio is an intricate process. The care of these patients, once transferred, also requires varying levels of expertise. As indicated in the nursing literature, this type of transition is often associated with high stress levels for the patient and family, as well as for the healthcare providers. To maximize patient safety and ensure optimal care for this patient population, well-defined mechanisms must be put in place. DESCRIPTION OF THE PROJECT/INNOVATION: The introduction of a formal assessment, consultation, and follow-up process conducted by a clinical nurse specialist (CNS). On average, 150 patients are assessed each year by the CNS. Among these patients, 15% are considered at high risk for complications upon transfer to the unit. INTERPRETATION/CONCLUSION/IMPLICATIONS: A systematic evaluation of patients by the CNS, before their transfer from the ICU to a medical unit, has been proven beneficial in ensuring a comprehensive patient care plan. Patients and families have verbalized that this intervention is helpful. Staff members have indicated that this safety initiative is useful in planning patient transfers. The next step would be to formally measure patient, family, and staff satisfaction with this initiative. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit nurse patient safety patient transport EMTREE MEDICAL INDEX TERMS article health care quality human nursing methodology research organization organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 22016020 (http://www.ncbi.nlm.nih.gov/pubmed/22016020) PUI L560044082 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 559 TITLE 2011 critical care transport workplace and salary survey AUTHOR NAMES Greene M.J. AUTHOR ADDRESSES (Greene M.J., mgreene@fitchassoc.com) LLC, Platte City, MO, United States. CORRESPONDENCE ADDRESS M.J. Greene, LLC, Platte City, MO, United States. Email: mgreene@fitchassoc.com SOURCE Air Medical Journal (2011) 30:6 (306-312). Date of Publication: November-December 2011 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Critical care transport (CCT) leaders from 260 organizations were invited to participate in an online, hosted survey of industry compensation and workplace practices. Approximately 150 questions were presented to participants, soliciting a broad base of information on CCT organizations, personnel, compensation, and workplace practices, notably alertness and fatigue management. CCT organizational salaries are represented by common job class and reported by summary with minimum, middle, and maximum hourly rates in a national aggregate and by Association of Air Medical Services region. © 2011 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport occupational health salary and fringe benefit work environment EMTREE MEDICAL INDEX TERMS alertness compensation demography emergency health service fatigue health care organization health care survey medical staff occupational safety practice guideline priority journal review EMBASE CLASSIFICATIONS Occupational Health and Industrial Medicine (35) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011609193 MEDLINE PMID 22055178 (http://www.ncbi.nlm.nih.gov/pubmed/22055178) PUI L362871772 DOI 10.1016/j.amj.2011.10.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2011.10.001 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 560 TITLE Does a team base knowledge transfer intervention to manage fever, hyperglycaemia and swallowing dysfunction, improve 90-day outcomes following stroke? AUTHOR NAMES Middleton S. Ward J. Grimshaw J. Griffiths R. D'Este C. Dale S. Drury P. Cheung N. Quinn C. Evans M. Cadhilac D. McElduff P. Levi C. AUTHOR ADDRESSES (Middleton S.) Nursing Research Institute, St Vincent's and Mater Health Sydney, Australian Catholic University, Darlinghurst, Australia. (Ward J.) Department of Epidemiology, Community Medicine, University of Ottawa, Canada. (Middleton S.; Dale S.; Drury P.) National Centre for Clinical Outcomes Research (NaCCOR), Australian Catholic University, North Sydney, Australia. (Grimshaw J.) Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada. (Griffiths R.) School of Nursing and Midwifery, University of Western Sydney, Penrith, Australia. (D'Este C.) Centre for Clinical Epidemiology, Biostatistics, Faculty of Health, The University of Newcastle, Callaghan, Australia. (Dale S.; Drury P.) Nursing Research Institute, St Vincents and Mater Health Sydney, School of Nursing (NSW and ACT), Australian Catholic University, Darlinghurst, Australia. (Cheung N.) Department of Diabetes and Endocrinology, Westmead Hospital, University of Sydney, Westmead, Australia. (Quinn C.) Speech Pathology Department, Prince of Wales Hospital, Randwick, Australia. (Evans M.; Levi C.) Priority Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, Australia. (Cadhilac D.) Public Health Division, National Stroke Research Institute, Heidelberg Repatriation Hospital, Heidelberg, Australia. (Cadhilac D.) University of Melbourne, Melbourne, Australia. (McElduff P.; Levi C.) Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia. CORRESPONDENCE ADDRESS S. Middleton, Nursing Research Institute, St Vincent's and Mater Health Sydney, Australian Catholic University, Darlinghurst, Australia. SOURCE Stroke (2011) 42:11 (e587-e588). Date of Publication: November 2011 CONFERENCE NAME 2nd Canadian Stroke Congress, 2011 CONFERENCE LOCATION Ottawa, ON, Canada CONFERENCE DATE 2011-10-02 to 2011-10-04 ISSN 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: We conducted a single blind cluster randomized controlled trial of a multidisciplinary implementation intervention targeting clinicians' evidence-based management of fever, hyperglycaemia and swallowing dysfunction following acute stroke. Methods: 19 Australian acute stroke units were recruited and randomised to intervention (n=10) or control (n=9) group. The intervention consisted of evidence-based treatment protocols to manage fever, hyperglycaemia and swallowing dysfunction, multidisciplinary team building workshops, staff education programs and local stroke unit coordinator engagement. The control group ASUs received an abridged copy of the Australian acute stroke guidelines relevant to the management of fever, hyperglycaemia and swallowing. We recruited baseline and post-intervention patient cohorts, comparing 90 day death or dependency (modified Rankin scale >2); functional dependency (Barthel Index); and physical and mental health scores (SF-36) for patients blind to stroke unit allocation and collected processes of care data. Intention to treat analyses were undertaken adjusting for baseline data and clustering. Results: A total of 1699 patients participated (690 pre-intervention; 1009 post-intervention). Irrespective of stroke severity, patients from intervention ASU's were significantly less likely to be dead or dependent at 90-days (42% vs 58%) (p=0.002) than patients from control stroke units (number needed to treat 6.4) with improved SF-36 mean physical health scores (45.6 vs 42.5, p=0.002). Patients from intervention stroke units demonstrated significant reductions in: mean temperature reading (p=0.001); number of febrile (=>37.5°C) patients (p<0.001); mean blood glucose (p=0.02); and improved swallowing screening within 24 hours of admission (p<0.001). Conclusion: Patients who received care in stroke units delivering the multidisciplinary intervention demonstrated an absolute reduction for 90-day death or dependency of 16%. This landmark study provides compelling evidence that a team base knowledge transfer intervention to manage fever, hyperglycaemia and swallowing dysfunction can decrease death and disability and improve health status. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular accident fever hyperglycemia swallowing EMTREE MEDICAL INDEX TERMS Barthel index control group death disability education program evidence based practice glucose blood level health health status human intention to treat analysis mental health patient randomized controlled trial randomized controlled trial (topic) Rankin scale reading screening staff training stroke unit team building temperature workshop LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70918201 DOI 10.1161/STR.0b013e3182301bf4 FULL TEXT LINK http://dx.doi.org/10.1161/STR.0b013e3182301bf4 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 561 TITLE Transport time out for cardiovascular intensive care unit patients traveling off of the unit AUTHOR NAMES Boord J.B. Symlar R. Cunningham B.L. McPherson J. Burns K. Byrd J. AUTHOR ADDRESSES (Boord J.B.; Symlar R.; Cunningham B.L.; McPherson J.; Burns K.; Byrd J.) Vanderbilt Univ, Nashville, United States. CORRESPONDENCE ADDRESS J.B. Boord, Vanderbilt Univ, Nashville, United States. SOURCE Circulation: Cardiovascular Quality and Outcomes (2011) 4:6 MeetingAbstracts2010. Date of Publication: November 2011 CONFERENCE NAME Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2010 Scientific Sessions, QCOR 2010 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2010-05-19 to 2010-05-21 ISSN 1941-7705 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: Transportation of critically ill patients to other areas for diagnostic testing or procedures can present risks to patient safety. It is necessary to ensure that the same level of care and support be provided for critically ill patients when they are removed from the ICU environment. There were no established processes available in the literature to address this safety issue. Aim: To establish a “transport time out” checklist process for transport of critically ill patients outside of the ICU environment. This process ensures that patient care and monitoring continues at the level deemed necessary by patient condition without interruption. Methods: A multidisciplinary team of nurses, physicians, and respiratory therapists created an algorithm to ensure that crucial care elements were considered prior to leaving the ICU environment with a critically ill patient. Elements were categorized in the “Airway, Breathing, Circulation, Drugs (ABCD)” format. Tools developed included a flowchart and transport time out check list (Figure). Results: The checklist outlines essential equipment and supplies for respiratory care, intravenous infusions, and clinical monitoring. The process has been in use for over 9 months encompassing approximately 330 patient transports. The process was rapidly and widely accepted by nursing staff. No adverse events during transport have occurred since implementation of the transport time out process. Conclusion: Use of a “transport time out” checklist process potentially can decrease the likelihood of adverse events during transport of a critically ill patient from the ICU. The process was simple and easy to implement. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiovascular disease cerebrovascular accident human intensive care unit outcomes research patient patient care total quality management travel EMTREE MEDICAL INDEX TERMS airway algorithm breathing checklist critically ill patient devices diagnosis environment intravenous drug administration monitoring nurse nursing staff patient safety patient transport physician procedures respiratory care respiratory therapist risk safety traffic and transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71256882 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 562 TITLE Factors that influence neonatal transport in Attica, Greece AUTHOR NAMES Mouskou S. Varakis C. Vassilaki N. Krikri A. Pyrros D. AUTHOR ADDRESSES (Mouskou S.; Vassilaki N.; Krikri A.; Pyrros D.) National Centre of Emergency Care (EKAB) Headquaters, Athens, Greece. (Varakis C.) Economist, Dr. University of Athens, Athens, Greece. CORRESPONDENCE ADDRESS S. Mouskou, National Centre of Emergency Care (EKAB) Headquaters, Athens, Greece. SOURCE Intensive Care Medicine (2011) 37 SUPPL. 2 (S404). Date of Publication: November 2011 CONFERENCE NAME 22nd Annual Congress of the European Society of Paediatric and Neonatal Intensive Care, ESPNIC 2011 CONFERENCE LOCATION Hannover, Germany CONFERENCE DATE 2011-11-02 to 2011-11-05 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Introduction: Since premature and seriously ill neonates continue to be born in hospitals without an appropriate infrastructure, there is a continuous need for postnatal transfer to neonatal intensive care units (NICY). Purpose: To list the frequency, the main causes of neonatal transport in Attica and to examine a connection between the type of transport and the existence or not of NICY at the hospital of uptake. Materials and methods: All neonates that had to be transferred to NICY in Attica during 2009. For statistical analysis we used the Chisquare test, from SPSS-15. Statistical significance was set at P<0.05. Results: 1580 neonateswere in need to be transported: 633 fromAttica's hospitals, 200 by airtransport, 226 from peripheral hospitals and 507 neonates remained on the waiting list. The greatest percentage of neonates that is being transported derives from Attica's NICU's (62.2%). Most of neonates are transported on the first day of life (51.7%). Respiratory distress (55.6%), prematurity (47.6%) and congenital heart disease (12.6%) are the main causes of transport. Additional 17.8% of neonatal transport takes place because of exceeded hospitalization capacity of the NICU's. Neonates with congenital heart disease are transported mainly from NICU's of peripheral hospitals (P<0.001), whereas neonates transported due to prematurity derive mainly from hospitals in Attica (P<0.001). Neonates that are being transported for intermediate care derive from peripheral hospitals without a NICU (P<0.001). Conclusion: There is an increased need for neonatal transport in Attica. Increasing the number of intermediate care units in peripheral hospitals and the hospitalization capacity of Attica's NICU's one would reduce the number of neonatal emergency transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Greece newborn intensive care society EMTREE MEDICAL INDEX TERMS congenital heart disease emergency hospital hospital admission hospitalization intensive care unit newborn prematurity respiratory distress statistical analysis statistical significance LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70638693 DOI 10.1007/s00134-011-2387-x FULL TEXT LINK http://dx.doi.org/10.1007/s00134-011-2387-x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 563 TITLE Can we easily anticipate on admission pediatric patient transfers from intermediate to intensive care? AUTHOR NAMES Hamze-Sinno R. Abdoul H. Neve M. Jones P. Tsapis M. Dauger S. AUTHOR ADDRESSES (Hamze-Sinno R.; Neve M.; Jones P.; Tsapis M.; Dauger S., stephane.dauger@rdb.aphp.fr) Pediatric Intensive Care Unit, Department of Pediatrics and Internal Medicine, Robert-Debré Hospital, AP-HP Diderot-Paris VII University, Paris, France. (Abdoul H.) Unit of Epidemiology, Robert-Debré Hospital, AP-HP, INSERM CIE 5, Diderot-Paris VII University, Paris, France. CORRESPONDENCE ADDRESS S. Dauger, Pediatric Intensive Care Unit, Robert-Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France. Email: stephane.dauger@rdb.aphp.fr SOURCE Minerva Anestesiologica (2011) 77:10 (1022-1023). Date of Publication: October 2011 ISSN 0375-9393 BOOK PUBLISHER Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Torino, Italy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital admission patient transport EMTREE MEDICAL INDEX TERMS breathing rate cardiovascular disease heart rate hematologic disease hospital discharge human intensive care unit length of stay letter medical record review mortality neurologic disease outcome assessment patient identification patient monitoring pediatric ward respiratory failure risk factor EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011547803 MEDLINE PMID 21952602 (http://www.ncbi.nlm.nih.gov/pubmed/21952602) PUI L362681070 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 564 TITLE Impact of hospital transfers on mortality in an intensive care unit of central kentucky AUTHOR NAMES Diaz-Guzman E. Ihle R. Davenport D. Mitrache I. Mannino D. AUTHOR ADDRESSES (Diaz-Guzman E.; Ihle R.; Davenport D.; Mitrache I.; Mannino D.) University of Kentucky, Lexington, United States. CORRESPONDENCE ADDRESS E. Diaz-Guzman, University of Kentucky, Lexington, United States. SOURCE Chest (2011) 140:4 MEETING ABSTRACT. Date of Publication: October 2011 CONFERENCE NAME CHEST 2011 CONFERENCE LOCATION Honolulu, HI, United States CONFERENCE DATE 2011-10-22 to 2011-10-26 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT PURPOSE: Studies have reported that patients transferred to higher levels of care following admission have excess mortality and length of stay (LOS). Additionally, it has been suggested that patients transferred to a tertiary care ICU are more severely ill and consume more resources. METHODS: We performed a retrospective chart review of all patients admitted to the medical ICU at University of Kentucky (UKMC) between 2007 and 2009. Data was collected from hospital admissions data, US Census Bureau, and Social Security Death Index. Zip code was used for US Census data analysis of percentage of residents at the poverty level (PL) and percentage at two times the poverty level (PL2). RESULTS: There were 2003 admissions to the ICU. Ten admissions were excluded due to lack of data. Mean age was 55.6±16.0 years; 88% were Caucasian decent and 54% were male. APACHE IV score ranged from 5 to 213 (median 69). The mean PL of the cohort was 20.6%±10.5% while the mean PL2 was 43.6%±14.7%. This compares to Kentucky rates of 15.8% and 35.9%, respectively. Multivariable regression analysis showed that age (OR 1.011; 95% CI 1.001-1.021) and APACHE IV score (OR 1.039; CI 1.035-1.044) were predictors of higher mortality. Race, gender, PL and PL2, insurance status, distance to UKMC, admitting source (ward vs. emergency department), use of dialysis, and day of admission were not associated with ICU mortality. ICU admissions from outside hospital transfers were associated with shorter LOS and lower mortality when compared to other admission sources (OR 0.610; CI 0.442-0.842). Similarly, total charges (142x103 vs. 197x103, p=0.0001) were different between outside hospital transfers and intra-hospital transfers. CONCLUSIONS: Age and APACHE IV score are good predictors of mortality in our ICU. Compared to intra-hospital transfers, admissions from referral institutions are associated with shorter LOS, lower mortality and cost. CLINICAL IMPLICATIONS: Inter-hospital transfer to an ICU is associated with lower mortality, cost and LOS. This may reflect referral bias. Further studies are needed to confirm these findings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care unit mortality United States EMTREE MEDICAL INDEX TERMS APACHE Caucasian data analysis death dialysis emergency ward gender hospital admission human insurance length of stay male medical record review patient population research poverty regression analysis social security tertiary health care university ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70634685 DOI 10.1378/chest.1113925 FULL TEXT LINK http://dx.doi.org/10.1378/chest.1113925 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 565 TITLE Critical care transfers: Using audit to make a difference AUTHOR NAMES Shonfeld A. Riyat A. Kotecha A. Sacks M. AUTHOR ADDRESSES (Shonfeld A., adamshonfeld@gmail.com; Riyat A.; Kotecha A.; Sacks M.) St Mary's Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS A. Shonfeld, St Mary's Hospital, London, United Kingdom. Email: adamshonfeld@gmail.com SOURCE Anaesthesia (2011) 66:10 (946-947). Date of Publication: October 2011 ISSN 0003-2409 1365-2044 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS anesthetic equipment capnometry clinical audit critically ill patient emergency ward human letter medical device patient safety EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011518298 MEDLINE PMID 21916863 (http://www.ncbi.nlm.nih.gov/pubmed/21916863) PUI L362564278 DOI 10.1111/j.1365-2044.2011.06879.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2044.2011.06879.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 566 TITLE Factors associated with clinical complications during intra-hospital transports in a neonatal unit in Brazil AUTHOR NAMES Vieira A.L.P. Dos santos A.M.N. Okuyama M.K. Miyoshi M.H. Almeida M.F.B.D. Guinsburg R. AUTHOR ADDRESSES (Vieira A.L.P., ameliamiyashiro@yahoo.com.br; Dos santos A.M.N.; Okuyama M.K.; Miyoshi M.H.; Almeida M.F.B.D.; Guinsburg R.) Disciplina de Pediatria Neonatal, Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil. CORRESPONDENCE ADDRESS A.L.P. Vieira, Disciplina de Pediatria Neonatal, Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Email: ameliamiyashiro@yahoo.com.br SOURCE Journal of Tropical Pediatrics (2011) 57:5 (368-374) Article Number: fmq111. Date of Publication: October 2011 ISSN 0142-6338 1465-3664 (electronic) BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. ABSTRACT Objective: Analyze factors associated with clinical complications during intra-hospital transport of neonatal intensive care unit (NICU) patients.Methods: Prospective study of 641 infants submitted to 1197 intra-hospital transports at a public university NICU. Factors associated with clinical complications during intra-hospital transports were studied by multiple logistic regression analysis.Results: Included infants had a mean gestational age of 35.1 ± 3.8 weeks and a birth weight of 2328 ± 906 g. Underline diseases were: malformations (71.9%), infections (7.6%), respiratory distress (4.1%) and others (16.4%). Patients were transported for surgical procedures (22.6%), magnetic resonance (10.6%), tomography imaging (20.9%), contrasted exams (18.2%), ultrasound (10.4%) and others (17.3%). Clinical complications occurred in 327 (27.3%) transports and were associated (odds ratio; 95% CI) with: central nervous system malformations (1.6; 95% CI 1.0-2.0); use of supplemental oxygen (4.0; 95% CI 2.8-5.6); mechanical ventilation (5.0; 95% CI 3.5-7.5); transport for surgeries (4.0; 95% CI 1.1-14.0) and duration of the transport longer than 120 min (1.6; 95% CI 1.1-2.4).Conclusions: Intra-hospital transports are associated with increased risk of clinical complications. © The Author [2010]. Published by Oxford University Press. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation birth weight Brazil central nervous system malformation computer assisted tomography congenital malformation contrast radiography echography female gestational age human hypothermia infant infection major clinical study male multivariate logistic regression analysis newborn nuclear magnetic resonance imaging oxygen therapy prospective study respiratory distress risk factor surgical patient EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012008664 MEDLINE PMID 21123316 (http://www.ncbi.nlm.nih.gov/pubmed/21123316) PUI L364021149 DOI 10.1093/tropej/fmq111 FULL TEXT LINK http://dx.doi.org/10.1093/tropej/fmq111 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 567 TITLE Improving adverse drug event detection in critically ill patients through intensive care unit transfer summary screening AUTHOR NAMES Anthes A. Harinstein L.M. Smithburger P.L. Seybert A.L. Kane-Gill S.L. AUTHOR ADDRESSES (Anthes A.) University of Pittsburgh Medical Center, Pittsburgh, United States. (Harinstein L.M.) Cleveland Clinic, Cleveland, United States. (Smithburger P.L.; Seybert A.L.; Kane-Gill S.L.) University of Pittsburgh, School of Pharmacy, Pittsburgh, United States. CORRESPONDENCE ADDRESS A. Anthes, University of Pittsburgh Medical Center, Pittsburgh, United States. SOURCE Pharmacotherapy (2011) 31:10 (313e). Date of Publication: October 2011 CONFERENCE NAME 2011 Annual Meeting of the American College of Clinical Pharmacy CONFERENCE LOCATION Pittsburgh, PA, United States CONFERENCE DATE 2011-10-16 to 2011-10-19 ISSN 0277-0008 BOOK PUBLISHER Pharmacotherapy Publications Inc. ABSTRACT PURPOSE: Hospital discharge notes have been studied as a form of surveillance; however, ICU transfer summaries have not been studied for this purpose. Improving ADE prevention strategies relies upon improving detection. METHODS: A retrospective electronic medical record review was conducted among medical ICU patients. Inclusion criteria included patients ≥18 years of age admitted between January through April 2009 with an ICU length of stay ≥24 hours. Two scales were utilized to assess chart documentation for ADEs: 1) Harvard Medical Practice Scale (MPS) and 2) Leonard Evidence Assessment Scale. The Harvard MPS was used to rank the strength of the wording in the medical record with a score of 4 (more than 50-50) up through 6 (virtually certain) indicating the presence of an ADE. The Leonard criteria were used to score causality with 1 out of 4 criteria indicating unlikely presence of an ADE and 4 out of 4 indicating a definite ADE occurrence. RESULTS: Demographic information indicates 50% of the patients were male with a mean age of 60.3 years (+/- 16). 258 unique patients had ICU transfer summaries screened and evaluated for ADEs. 105 patients had at least 1 ADE with a total of 139 ADEs. The Harvard MPS scores collected were 4 (39.6%), 5 (51.8%) and 6 (7.9%). The Leonard scores were 2 of 4 (17.3%), 3 of 4 (54.7%) and 4 of 4 (28.1%). Most common medications associated with an ADE were furosemide, ciprofloxacin, warfarin and heparin. Most common ADEs were Clostridium difficile, hypotension, acute kidney injury and hyperglycemia. CONCLUSION: 41% of ICU transfer summaries contained a description of an ADE; therefore, reviewing ICU transfer summaries is a useful method of detecting ICU-specific ADEs and should be considered as part of an ADE surveillance system. Understanding contributing medications and resulting reactions of ADEs will aid in future prevention strategies. EMTREE DRUG INDEX TERMS ciprofloxacin furosemide heparin warfarin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse drug reaction clinical pharmacy college critically ill patient intensive care unit screening EMTREE MEDICAL INDEX TERMS acute kidney failure documentation drug therapy electronic medical record epidemiology hospital discharge human hyperglycemia hypotension length of stay male medical practice medical record medical record review patient Peptoclostridium difficile prevention LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70647885 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 568 TITLE Critical care air transport team (CCATT) short term outcomes of casualties with spinal fractures moved with the vacuum spine board between 2009 and 2010 AUTHOR NAMES Lairet J.R. McCafferty R. Lairet K. Muck A. Balls A. Minnick J. Torres P. King J. AUTHOR ADDRESSES (Lairet J.R.; McCafferty R.; Lairet K.; Muck A.; Balls A.; Minnick J.; Torres P.; King J.) Wilford Hall Medical Center, Lackland AFB, United States. (Lairet J.R.; McCafferty R.; Lairet K.; Muck A.; Balls A.; Minnick J.; Torres P.; King J.) US Army Institute of Surgical Research, Ft Sam Houston, United States. CORRESPONDENCE ADDRESS J.R. Lairet, Wilford Hall Medical Center, Lackland AFB, United States. SOURCE Annals of Emergency Medicine (2011) 58:4 SUPPL. 1 (S241). Date of Publication: October 2011 CONFERENCE NAME American College of Emergency Physicians, ACEP 2011 Research Forum CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2011-10-15 to 2011-10-16 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc. ABSTRACT Study Objectives: The purpose of this studyis to describe the outcome of patients managed by USAF CCATT with the Vacuum Spine Board (VSB) to stabilize unstable thoracic and lumbar spine fractures deployed in support of Operation Iraqi Freedom and Operation Enduring Freedom between July2009 and June 2010. Methods: We performed a retrospective chart review of available records of patients who were transported by USAF CCATT on the VSB between July1, 2009 and June 30, 2010. A standardized abstraction form was used. We included the following demographic data: age, and sex of the patient. We recorded descriptive data to include: mechanism of injury (MOI), if the patient was transported on mechanical ventilator, administration of vasoactive medications, and administration of blood products during transport. Short term events/outcomes were documented to include: death, skin breakdown resulting from the use of the VSB, decline in neurological status related to the spinal injury, desaturation of the patient below 90%, hypotension belowa systolic BP of90 mmHg, loss of airway and/or chest tubes during transport. A search of the Joint Theater Trauma Registry (JTTR) was also carried out for reported complications and the Injury Severity Score (ISS) of the included patients. All data was reported in a descriptive manner. Results: A total of 73 patients met the inclusion criteria, resulting in a total of 107 patient moves on the VSB. Seven patients (9.6%) had a cervical injury, 59 (80.8%) had a thoracic/lumbar injury and 7 (9.6%) suffered both a cervical and a thoracic/lumbar injury. The mean age was 28.9 years (SD 8.3) and 95.9% were male. The MOI was explosion in 48 (65.8%), blunt in 22 (30.1%) and penetrating in 3 (4.1%). The mean ISS was 23.5 (SD 13.4). When evaluating the treatment received during transport, 102 of the patient moves were on oxygen therapy (95.3%), 64 were mechanically ventilated (59.8%), 10 received vasoactive medications (9.4%) and 13 received blood products during the flight (12.2%). When we evaluated the cohort for events or complications occurring during transport, we encountered a total of 10 skin breakdown events related to the VSB (9.3%). The study cohort revealed 2 cases of neurological deterioration during transport which was attributed to progression of the original neurological insult (1.9%). We also noted 3 episodes of transient desaturation (2.8%) and 13 episodes of transient hypotension (12.2%). We did not encounter any deaths, loss of airway or chest tubes during transport. The primary limitation is the retrospective nature of this study. Other limitations include the descriptive nature of the study as well as the small number of casualties studied. Conclusion: The VSB was successfully used to stabilize spine injuries during transport. We did note a skin breakdown rate of 9.3%. A risk/benefit assessment must be performed before deciding to use the VSB to transport casualties with spinal injuries. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) accident college emergency physician human intensive care spine spine fracture vacuum EMTREE MEDICAL INDEX TERMS airway blood death deterioration drug therapy fatty acid desaturation flight hypotension injury injury scale lumbar spine male medical record review oxygen therapy patient register skin spine injury tube ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70551449 DOI 10.1016/j.annemergmed.2011.06.218 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2011.06.218 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 569 TITLE Transport as a system: Reorganization of perinatal assistance in northern Lombardy AUTHOR NAMES Martinelli S. Vergani P. Zanini R. Bellù R. Farina C. Tagliabue P. AUTHOR ADDRESSES (Martinelli S., stefano.martinelli@ospedaleniguarda.it) Neonatology and Neonatal Intensive Care Unit, Niguarda “Ca’ Granda” Hospital, Milan, Italy. (Vergani P.) Obstetrics and Gynaecology Unit, Milano Bicocca University, MBBM Foundation, Monza, Italy. (Zanini R.) Departments of Obstetrics and Pediatrics, Hospitals of Lecco Province, Italy. (Bellù R.) Neonatology and Neonatal Intensive Care Unit, Manzoni Hospital, Lecco, Italy. (Farina C.; Tagliabue P.) Neonatology and Neonatal Intensive Care Unit, MBBM Foundation, Monza, Italy. CORRESPONDENCE ADDRESS S. Martinelli, Neonatology and Neonatal Intensive Care Unit, Niguarda “Ca’ Granda” Hospital, Milan, Italy. Email: stefano.martinelli@ospedaleniguarda.it SOURCE Journal of Maternal-Fetal and Neonatal Medicine (2011) 24 Supplement 1 (122-125). Date of Publication: 23 Sep 2011 ISSN 1476-4954 (electronic) 1476-7058 BOOK PUBLISHER Taylor and Francis Ltd, healthcare.enquiries@informa.com ABSTRACT The organization of perinatal care has been a pivotal mean for improvement in neonatal survivals. Despite the excellent standard of assistance in Lombardy, Obstetrics and Neonatal Units of MBBM Foundation-Monza, Manzoni Hospital-Lecco and Niguarda Hospital-Milan put forward a pilot project proposing reorganization of perinatal care in the northern part of Lombardy. The main goals of the project are implementation of maternal transport system and use of neonatal back transport as a system to increase the availability of intensive care beds. The project’s fundamental steps and critical points will be discussed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport perinatal care EMTREE MEDICAL INDEX TERMS article automation health care availability hospital bed human information system intensive care unit Italy priority journal EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160698000 PUI L612378877 DOI 10.3109/14767058.2011.607670 FULL TEXT LINK http://dx.doi.org/10.3109/14767058.2011.607670 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 570 TITLE Under-triage as a significant factor affecting transfer time between the emergency department and the intensive care unit AUTHOR NAMES Yurkova I. Wolf L. AUTHOR ADDRESSES (Yurkova I.) Elaine Rehabilitation Center, Hadley, MA, United States. (Wolf L., Noblewolf3@aol.com) University of Massachusetts, Amherst, MA, United States. CORRESPONDENCE ADDRESS L. Wolf, 110 Middle St., Hadley, MA 01035, United States. Email: Noblewolf3@aol.com SOURCE Journal of Emergency Nursing (2011) 37:5 (491-496). Date of Publication: September 2011 ISSN 0099-1767 1527-2966 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Introduction: The purpose of the study was to identify factors that affect transfer times between the emergency department and the intensive care unit (ICU) in a community hospital. Patients who are transferred from the emergency department to the ICU are usually in critical condition and in need of prompt treatment by qualified personnel. As a result of delayed transfers, a patient may experience complications, such as increased mortality rates and longer hospital stays. Methods: A quantitative descriptive correlational design was used in this study. Data were collected from the charts of 75 patients who were transferred from the emergency department to the ICU of a 142-bed community hospital in the eastern United States. "Delayed patients" were identified as those who were transferred after more than 4 hours. Results: Forty-four patients (58.7%) spent more than 4 hours in the emergency department. Nineteen out of 25 patients (76%) with an Emergency Severity Index designation of 3 were identified as delayed. Delayed status and an Emergency Severity Index designation of 3 showed a significant correlation (r = -339, P = .004). Eleven patients (64.7%) diagnosed with sepsis were delayed, compared with 6 who were not delayed. A total of 70.4% of female patients were delayed, compared with 52.1% of male patients. Discussion: This study provides a more comprehensive view of the factors involved in delayed patient transfer and provides data needed for effective interventions to be developed. The results suggest significant problems with the under-triage of critically ill patients, specifically patients with sepsis. Future research should include a larger group of subjects and a multifactorial analysis. © 2011 Emergency Nurses Association. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit patient transport sepsis (diagnosis, therapy) EMTREE MEDICAL INDEX TERMS age article community hospital comparative study critical illness (therapy) emergency treatment evaluation study female human male mortality needs assessment risk factor sex difference standard time treatment outcome United States utilization review LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 21549418 (http://www.ncbi.nlm.nih.gov/pubmed/21549418) PUI L51408682 DOI 10.1016/j.jen.2011.01.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.jen.2011.01.016 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 571 TITLE Intrahospital transfer of intensive care patients: Prospective evaluation in a tertiary hospital AUTHOR NAMES Quesada Suescun A. Muñoz C. Cordero M. Gómez Marco V. Iglesias-Posadilla D. García Miguelez A. Suarez V.J. López Sánchez M. Burón F.J. Ballesteros M.A. AUTHOR ADDRESSES (Quesada Suescun A.; Muñoz C.; Cordero M.; Gómez Marco V.; Iglesias-Posadilla D.; García Miguelez A.; Suarez V.J.; López Sánchez M.; Burón F.J.; Ballesteros M.A.) Marqués de Valdecilla Universitary Hospital, Critical Care Department, Santander, Spain. (Quesada Suescun A.) Marques de Valdecilla Institute for Formation and Research (IFIMAV), Santander, Spain. CORRESPONDENCE ADDRESS A. Quesada Suescun, Marqués de Valdecilla Universitary Hospital, Critical Care Department, Santander, Spain. SOURCE Intensive Care Medicine (2011) 37 SUPPL. 1 (S224). Date of Publication: September 2011 CONFERENCE NAME 24th Annual Congress of the European Society of Intensive Care Medicine, ESICM LIVES 2011 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2011-10-01 to 2011-10-05 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Intrahospital transfer of patients from intensive care units leads toimportant risks and the probability of side effects. The development of standardization transferprotocols can be a strategy to improve clinical safety and assistance quality. Following severalnotifications recorded at the website of our service about adverse events potentially avoidable,we proposed this study.OBJECTIVES. To record and describe the incidents during Intrahospital transport of patientsfrom intensive care units (ICU) in our hospital.METHODS. A descriptive prospective study of intra-hospital transfer from ICU patients atthe “Marqués de Valdecilla” University Hospital, during November 2010 to March 2011. Thedata are shown in absolute value and/or percentage.RESULTS. There were 145 intrahospital transports in 98 patients. 69% of these transfers weremade from the neurocritical ICU, and 31% from the polyvalent ICU. Most of them were madeto the radiology department (57.2% CT, 3.4% MRI, 6.2% interventional radiology), followedby the transfers to the operating room (29.7%). Monitoring progress (24.5%) and diagnosis(36%) were the main reasons, leading to a change in the management in 50% of the cases.Patients and/or their relatives were informed before the transfer in 66.2% of the cases. In almostall transfers, previous appropriate measures were taken: bag transfer verification (92.4%);availability of oxygen cylinders for 30 min (97.3%); equipment battery life (99.3%); checkingalarms (96.5%); isolated venous access (100%); nasogastric tube bag drainage (81.1%); urinarycatheter clamped (91.7%); and aspiration of respiratory secretions (87.1%). Transferswere made by nurses (100%), orderly (100%) and doctors (25.9% staff, 81% residents).Coordination with reception service was marked by poor communication in 5% of casesinvolving delays, which did not exceed 5 min at admission to the surgical ward or at receptionin the radiology department. There was no sentinel case in the study group.CONCLUSIONS.Measures of patient preparation and verification of equipment were carriedout correctly. Coordination with reception service must be a strategy for improvement in ourenvironment. We believe that systematic use of a “check list” can improve safety in thetransfer of critical patients. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient patient transport society tertiary health care EMTREE MEDICAL INDEX TERMS aspiration bodily secretions checklist diagnosis hospital intensive care unit interpersonal communication interventional radiology monitoring nasogastric tube nuclear magnetic resonance imaging nurse nursing assistant operating room physician prospective study radiology department risk safety side effect standardization surgical ward university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70639685 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 572 TITLE Improving communication during patient transfers between the operating room and neuroscience intensive care unit AUTHOR NAMES Olm-Shipman C. Yagoda D. Tehan T. Guanci M. Nozari A. Nahed B. Farren S. O'Malley T. Scheer K. Rosand J. Cobb J.P. Kimberly W.T. AUTHOR ADDRESSES (Olm-Shipman C.; Yagoda D.; Tehan T.; Guanci M.; Nozari A.; Nahed B.; Farren S.; O'Malley T.; Scheer K.; Rosand J.; Cobb J.P.; Kimberly W.T.) Massachusetts General Hospital, Boston, United States. CORRESPONDENCE ADDRESS C. Olm-Shipman, Massachusetts General Hospital, Boston, United States. SOURCE Neurocritical Care (2011) 15:1 SUPPL. 1 (S196). Date of Publication: September 2011 CONFERENCE NAME 9th Annual Meeting of the Neurocritical Care Society CONFERENCE LOCATION Montreal, QC, Canada CONFERENCE DATE 2011-09-21 to 2011-09-24 ISSN 1541-6933 BOOK PUBLISHER Humana Press ABSTRACT Introduction The transfer of patient information and responsibility of care between services is a process prone to variation and one which may contribute to errors in care and higher health care costs. We designed and implemented a quality improvement initiative to reduce variability and improve communication during the handoff process between the operating room and Neuroscience ICU. Methods We convened a multidisciplinary team that included representation from Neurosurgery, Neuroanesthesia, Neurocritical Care, Nursing, and Administration. We defined key elements of an ideal handoff and compared this list to the results of 17 observed ICU handoffs. We constructed a process map highlighting fail points, and applied root cause analysis to uncover their underlying sources. We designed process interventions to correct the fail points, including a bedside transfer aid that defined team member roles, structured the handoff sequence, and highlighted key information to be communicated. We also improved communication mechanisms between the OR and ICU to assist with preparation of patient arrival. Following the implementation of these interventions, we performed 17 observations to assess efficacy. Results We observed a two- to ten-fold improvement in the handoff process metrics, including the provision of a one-hour warning notification, a group neurological exam to define the patient's baseline function, and the presence of all team members during the handoff (all P<0.001).Moreover, a Likert scale rating of clinician satisfaction in the ICU increased from a median of 3 (IQR 2, 3) to 4 (IQR 3, 4) (P<0.0001). Conclusions Brevity, organization, and efficiency contributed to the successful implementation of this handoff improvement initiative. A multidisciplinary team representing each stakeholder was critical, as process solutions often required incremental changes in practice across specialties. The interventions improved both the handoff process and clinician satisfaction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care unit interpersonal communication operating room patient transport society EMTREE MEDICAL INDEX TERMS anesthesia health care cost Likert scale neurosurgery nursing patient patient information responsibility root cause analysis satisfaction total quality management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71193791 DOI 10.1007/s12028-011-9625-5 FULL TEXT LINK http://dx.doi.org/10.1007/s12028-011-9625-5 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 573 TITLE Impact of intra-hospital transport in ventilated critically ill patients AUTHOR NAMES Schwebel C. Clec'h C. Magne S. Minet C. Garrouste-Orgeas M. Bonadona A. Soufir L. Darmon M. Azoulay E. Souweine B. Timsit J.-F. AUTHOR ADDRESSES (Schwebel C.; Minet C.; Bonadona A.; Timsit J.-F.) Centre Hospitalier Universitaire, Grenoble, France. (Clec'h C.) Centre Hospitalier, Avicenne, France. (Magne S.) Institut Albert Bonniot, Grenoble, France. (Garrouste-Orgeas M.; Soufir L.) Hopital Saint Joseph, Paris, France. (Darmon M.) Centre Hospitalier Universitaire, Saint-Etienne, France. (Azoulay E.) Hopital Saint-Louis, Paris, France. (Souweine B.) Centre Hospitalier Universitaire, Clermont-Ferrand, France. CORRESPONDENCE ADDRESS C. Schwebel, Centre Hospitalier Universitaire, Grenoble, France. SOURCE Intensive Care Medicine (2011) 37 SUPPL. 1 (S9). Date of Publication: September 2011 CONFERENCE NAME 24th Annual Congress of the European Society of Intensive Care Medicine, ESICM LIVES 2011 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2011-10-01 to 2011-10-05 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT Intra-hospital transport (IHT) of critically ill patients is routinely required for diagnostic or therapeutic procedures in daily practice. Complications in IHT may be life threatening [1]. OBJECTIVES. To describe IHT related adverse events (AE) in ventilated critically ill patients: (1) incidence ofAErelated to the first IHT (2) description of targeted AE, evolution of SAPS II post-IHT, outcome in ICU. METHODS. 6252 ventilated patients (invasive mechanical ventilation) from a multicentric (12 ICU) database were prospectively considered. Statistical analysis included: (1) description of demographic and clinical characteristics of the cohort, (2) identification of risk factors for IHT and construction of a propensity score to be transported, (3) matched exposed/non exposed study to compare IHT related AE (IHT to operating room excluded). Matching criteria: propensity score, length of stay (LOS) and confounding factors on day before IHT. A written procedure but no check-list was available for IHT at each ICU location. RESULTS.IHT was required for 28.7% patients. 3,006 IHT were performed for 1,782 patients (1-17 IHT/patient). Transported patients had higher SAPS II (52 ± 19.2 vs. 49.4) at admission, higher ICU LOS (12 days [6; 23] vs. 5 [3; 11] and higher ICU mortality (31.4% vs. 28.7%), p<10(-4)). 37.4% patients exhibited complications post-TIH. Risk factors associated with IHT included in the propensity score were: origin (transfert) and type of patients, diagnosis at admission and SAPS II. 1,782 transported patients were matched with 4,460 non transported patients. After adjustment transported patients were at higher risk of AE (OR 2,1, IC 95% [1.7-2.3], p<0.0001), i.e. pneumothorax (OR 3.2, IC95% [1.7-6.4], p = 0.0005, atelectasis (OR 3,4, IC95% [1.6-7; 2], p = 0.001), ventilator associated pneumonia (OR 1,5 IC95% [1.1-2.0] p = 0.001), hypo (OR 2 IC95% [1.3-2.9], p = 0.0008) and hyperglycemia (OR 2,5 IC95% [2.1-3], p<10(-4)). Transported patients had a significant longer post-IHT ICU LOS with non significant mortality rate (OR = 0.9, IC 95% [0.7-0.9], p = 0.9). DISCUSSION. Conditions (planned vs. emergency IHT), medical supervision (senior vs. junior), context (off-hours, workload, ICU occupancy) and effective impact of IHT in patient's management are limiting factors for direct IHT imputability in targeted AE occurrence. However, these data highlight the potential consequences of IHT rising the need for a benefit/ risk evaluation and preventive measures (check-list). CONCLUSION. IHT is a procedure at risk for AEin ventilated critically ill patients justifying a dedicated policy in a continuous quality improvement program. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient hospital intensive care society EMTREE MEDICAL INDEX TERMS artificial ventilation atelectasis checklist data base diagnosis emergency hospital patient human hyperglycemia length of stay mortality operating room patient patient care pneumothorax policy procedures propensity score risk risk factor statistical analysis total quality management ventilated patient ventilator associated pneumonia workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70638825 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 574 TITLE Intrahospital critical care transfers: Are we taking them seriously enough? AUTHOR NAMES Scanlan M.S. Chakrabarti K. Browett K. Scott C. AUTHOR ADDRESSES (Scanlan M.S.; Chakrabarti K.; Browett K.; Scott C.) Sheffield Teaching Hospitals NHS Foundation Trust, Critical Care Department, Sheffield, United Kingdom. CORRESPONDENCE ADDRESS M.S. Scanlan, Sheffield Teaching Hospitals NHS Foundation Trust, Critical Care Department, Sheffield, United Kingdom. SOURCE Intensive Care Medicine (2011) 37 SUPPL. 1 (S10). Date of Publication: September 2011 CONFERENCE NAME 24th Annual Congress of the European Society of Intensive Care Medicine, ESICM LIVES 2011 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2011-10-01 to 2011-10-05 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Despite evidence showing a high incidence of complications during intrahospital critical care transfer [1], UK national guidelines have yet to be published. We report current practice and adverse event rates in a tertiary referral centre in the UK. OBJECTIVES. (1) To determine current practice in critical care intrahospital transfer. (2) To reveal the incidence of complications. METHODS. A proforma was designed with reference to ANZCA [2] standards. The monitoring period was from 17/11/2010 to 28/1/2011. The proforma was divided into two parts. The critical care technician accompanying the transfer completed the first part prospectively. The second part was collected retrospectively by analysing data from the computer record. RESULTS. There were 30 intrahospital transfers. The minimal grade of doctor was Specialty Registrar year 3 (ST3). Mean transfer time was 41 min. All transfers recorded were between 0800 and 2000 hours to ensure technician presence. (Figure presented) The results demonstrate there is poor clinical assessment of the patient and ventilator/alarm settings pre-transfer, and poor documentation of the transfer. There is a varied practice in choosing pre-transfer equipment. Only a small number of transfers (13%) were performed on unstable patients. There was a 10%adverse event rate, which is lower than published data [1, 2]. CONCLUSIONS. Despite relatively experienced doctors with experienced staff accompanying, there still remains a measurable adverse event rate in critical care patients. A clear policy and formal staff training is needed to optimise safety and minimize the attendant risks associated with intrahospital transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS clinical assessment computer documentation human monitoring patient patient transport physician policy risk safety staff training Tertiary (period) United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70638829 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 575 TITLE Ortho-geriatric patient transfer between departments and hospitals prolongs hospital stay and effects survival AUTHOR NAMES Barat I. AUTHOR ADDRESSES (Barat I.) Region Hospital Horsens, Hojbjerg, Denmark. CORRESPONDENCE ADDRESS I. Barat, Region Hospital Horsens, Hojbjerg, Denmark. SOURCE European Geriatric Medicine (2011) 2 SUPPL. 1 (S87). Date of Publication: September 2011 CONFERENCE NAME 7th Congress of the EUGMS CONFERENCE LOCATION Malaga, Spain CONFERENCE DATE 2011-09-28 to 2011-09-30 ISSN 1878-7649 BOOK PUBLISHER Elsevier ABSTRACT Objective.- To assess the impact of transferring orthogeriatric patients between departments and hospitals on the length of hospitalization and the death rate. An observational correlation study. Background.- Transfer of the orthogeriatric patientswas a routine in the Region hospital of Horsens, Denmark until 01-01-2009. Postoperative patients with hip fracture were transferred to two nearby hospitals for geriatric medical care and rehabilitation purposes. Due to structural changes in the hospital this praxis was terminated in 2009. The patients were then operated and rehabilitated in the orthopedic department with daily geriatric care and supervision. Methods.- All patients with hip fracture admitted to the hospital during the period of 01-01-2007 and 12-31-2010 were included. The total length of stay from admission to discharge was calculated by adding all intrahospital and interhospital transfers. The differences between the periods of 2007-2008 (period.1) and 2009-2010 (period.2) were compared by t-test statistic. Dates of death were collected from the national population register and data were assessed in a similar manner. Results.- During a 4 years period 833 patients (mean age 79.8, female 69.2%) were admitted with hip fracture to the orthopedic department. While in period.1 38% of the patients were transferred, only 5% were transferred in period.2 (mostly due to complications). The mean total length of hospital stay in period.1 was 18.1 days while in period.2 10.5 days (P < 0.001, mean diff. 7.7, 95CI 5.94-9.40). The mean 30 days death rate in period.1 was 6.1% and in period.2 2.9% (P = 0.026 mean diff. 3.2, 95CI 0.39-6.00). The mean 3 months death rate in period.1 was 11.1% and in period.2 6.9% (P = 0.033 mean diff. 4.2, 95CI 0.34-8.13). Conclusion.- The study shows a correlation between the transfer of orthogeriatric patients, the prolongation of hospitalization and the increase of death rates. Although no causal conclusion can be made, the differences in death rates is unmistakable. Three to four percent of the patients survived longer in period 2. Also the economical issue is remarkable. By avoiding transfer the hospitalstay was reduced by 7.7 days for each patient and saved the hospital about 1600 bed-days a year. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) geriatric patient hospital hospitalization human patient transport survival EMTREE MEDICAL INDEX TERMS correlational study death Denmark female geriatric care hip fracture length of stay medical care mortality patient population register rehabilitation Student t test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70705525 DOI 10.1016/j.eurger.2011.06.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.eurger.2011.06.002 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 576 TITLE Perceived patient safety of health care providers in a critical care transport program AUTHOR NAMES Erler C. Pesut D. Jingwei W. Richey S. Edwards N. Sands L. AUTHOR ADDRESSES (Erler C.; Pesut D.; Jingwei W.) Indiana University, Indianapolis, United States. (Richey S.) IU Health LifeLine, Indianapolis, United States. (Edwards N.; Sands L.) Purdue University, West Lafayette, United States. CORRESPONDENCE ADDRESS C. Erler, Indiana University, Indianapolis, United States. SOURCE Air Medical Journal (2011) 30:5 (256). Date of Publication: September-October 2011 CONFERENCE NAME 2011 Air Medical Transport Conference, AMTC CONFERENCE LOCATION St. Louis, MO, United States CONFERENCE DATE 2011-10-17 to 2011-10-19 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT Introduction: Safety culture among health care providers has been studied in various contexts however; there are limited investigations of safety culture variables in critical care transport (CCT) programs. This study examined the association between safety dimensions and safety outcome measures of healthcare providers in a CCT program. Methods: A descriptive cross-sectional correlational design, was conducted using a convenience sample (-Acny<76) of CCT personnel in a large CCT program. The Hospital Survey on Patient Safety Culture included the following safety culture factors: communication openness, teamwork, and managerial expectations and actions to promote safety. Safety outcomes included overall safety perception, error reporting frequency and patient safety grade. Results: Findings revealed a significant association between teamwork within the program and error reporting frequency (r < .428, p <0.001) and significant association between teamwork and safety outcomes of overall perception of safety (r < .745, p < 0.001) and perceived patient safety grade (r < -0.681, p <0.001). There was a significant association between perception of manager and actions promoting safety and the outcome variables of frequency of error reporting (r < .521, p <0.001); overall perception of safety (r < .779, p <0.001) and perceived patient safety grade (r < -.756, p <0.001). There was a significant association between communication openness and safety outcomes of frequency of error reporting (r < .575, p <0.001), overall perception of safety (r < 0.588, p <0.000) and perceived patient safety grade (r < -0.627, p <0.001). Cronbach's alpha was consistent with that reported by the Agency for Healthcare Research Quality (AHRQ) for each of the safety culture dimensions and safety outcomes. Conclusions: The study assessed health care provider perceptions of patient safety in a CCT program. Data supports a relationship between safety culture dimensions and safety outcomes. Although findings are limited to one CCT program, this study adds to the literature and evidence regarding patient safety culture in CCT programs and adaptations of the AHRQ Safety Culture survey for CCT context. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport health care personnel intensive care patient safety EMTREE MEDICAL INDEX TERMS adaptation convenience sample Cronbach alpha coefficient health care hospital human interpersonal communication manager outcome variable personnel safety teamwork LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70545236 DOI 10.1016/j.amj.2011.07.013 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2011.07.013 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 577 TITLE Which cardiac surgery patients may be suitable for transfer from ICU the same day as surgery? AUTHOR NAMES Manji R.A. Chartrand S. Arora R.C. Rivet M. Jacobsohn E. Bell D.D. Menkis A.H. AUTHOR ADDRESSES (Manji R.A.; Chartrand S.; Arora R.C.; Rivet M.; Jacobsohn E.; Bell D.D.; Menkis A.H.) Winnipeg, Canada. CORRESPONDENCE ADDRESS R.A. Manji, Winnipeg, Canada. SOURCE Canadian Journal of Cardiology (2011) 27:5 SUPPL. 1 (S197-S198). Date of Publication: September-October 2011 CONFERENCE NAME 64th Annual Meeting of the Canadian Cardiovascular Society, CCS 2011 CONFERENCE LOCATION Vancouver, BC, Canada CONFERENCE DATE 2011-10-22 to 2011-10-26 ISSN 0828-282X BOOK PUBLISHER Pulsus Group Inc. ABSTRACT INTRODUCTION: Ability to transfer a patient out of the cardiac surgery ICU (CSICU) same day as surgery would assist with improving flow of cardiac surgery patients through the system as it would allow two patients to “occupy” the same bed in a 24 hour period. OBJECTIVE: Tocharacterize patients that are ward transfer ready- 4 hours or >4 hours post arrival in CSICU. METHODS: From Mar 2008 to Mar 2009, all cardiac surgery patients admitted to CSICU were specifically evaluated for earliest transfer time possible using specified criteria relating to bleeding, urine output, hemodynamic/respiratory status, neurological status and cardiac rhythm status. They were divided into two groups: early transfer group (ETG) were patients ready for transfer ≤ 4 hours from arrival in ICU who actually were transferred to ward in stable condition within 24 hours and late transfer group (LTG) which were all other patients. Multivariable logistic regression identified patients requiring longer ICU stay. RESULTS: There were 1010 patients enrolled in the study of which 274 (27.1%) were in the ETG having a transfer ready time of 2.1 ± 1.1 hours (mean ± SD). There were no readmissions to ICU and no in-hospital mortality in the ETG group. The table below lists clinically relevant variables between the groups. Logistic regression revealed emergency operation (OR 17.6; 95% CI 2.4-129.9; P = 0.01), congestive heart failure (OR 2.9; 95% CI 1.5-5.7; P = 0.01), cerebrovascular disease (OR 2.2; 95% CI 1.2-3.9; P < 0.01), procedure involving aortic valve (OR 2.2; 95% CI 1.2-3.9; P < 0.01); and procedure involving thoracic aorta (OR 5.0; 95% CI 1.5-17.3; P < 0.01) to be associated with longer stay with peripheral vascular disease (P = 0.06) and chronic renal failure (P = 0.08) trending to be significantly associated with longer stay. Variables not significant in the model, suggesting they would be suitable for early transfer (assuming they did not also have one of the longer stay factors), were: isolated CABG, open chamber procedure, redo cardiac surgery, stable angina, and pre-operative arrhythmias. ICU length of stay in the two groups was - median (interquartile range): ETG 20.5 (18.0-22.3) versus LTG 40.8 (22.5-68.4) hours - P < 0.01. CONCLUSION: Our data suggest that there are predictable factors that could be used to decide which patients may be transferable to the ward same day as surgery. (Table presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart surgery human society surgery surgical patient EMTREE MEDICAL INDEX TERMS aortic valve astronomy bleeding cerebrovascular disease chronic kidney failure congestive heart failure emergency surgery heart arrhythmia heart rhythm length of stay logistic regression analysis model mortality patient peripheral vascular disease stable angina pectoris thoracic aorta urine volume ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70608336 DOI 10.1016/j.cjca.2011.07.318 FULL TEXT LINK http://dx.doi.org/10.1016/j.cjca.2011.07.318 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 578 TITLE Relationship between delayed admission to critical care, delayed transfers of care and waste of critical care resources in a 15 bedded district general hospital critical care unit AUTHOR NAMES Muthuswamy M.B. Beuschel S. Parry-Jones J. Jayne J. AUTHOR ADDRESSES (Muthuswamy M.B.; Beuschel S.; Parry-Jones J.) Royal Gwent Hospital, Department of Anaesthesia, Intensive Care Medicine, Newport, United Kingdom. (Jayne J.) South East Wales Critical Care Network, Pontypool, United Kingdom. CORRESPONDENCE ADDRESS M.B. Muthuswamy, Royal Gwent Hospital, Department of Anaesthesia, Intensive Care Medicine, Newport, United Kingdom. SOURCE Intensive Care Medicine (2011) 37 SUPPL. 1 (S34). Date of Publication: September 2011 CONFERENCE NAME 24th Annual Congress of the European Society of Intensive Care Medicine, ESICM LIVES 2011 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2011-10-01 to 2011-10-05 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Delayed transfers of care (DTOCs) are wasteful of critical care resources, potentially harmful to patients waiting to be discharged, and potentially harmful to patients with a delayed admission to critical care (DACC). Patients deserve care from appropriately trained staff in the correct environment in the correct timeframe. For the critically ill this means prompt admission to critical care, and for those recovering from critical illness prompt discharge for rehabilitation. DACC increases the risk of morbidity and mortality. DTOCs impact negatively on patient recovery by increasing the risk of infection, and reducing ability to provide appropriate facilities and rehabilitation. OBJECTIVE. We aimed to identify the proportion of patients where appropriate care has been delayed either due to DACC or DTOC. The economic cost of this was calculated. METHODS. Data was collected prospectively in October 2010 for all critical care referrals. A DACC was defined as a delay of more than 60 min from the point of acceptance and following completion of any intervention. DTOC was a delay of more than 4 h after a consultant decision that the patient was fit for ward discharge. The data was collated and submitted to the Critical Care Network for analysis. RESULTS. 71/101 referrals were accepted for critical care admission. 31% were DACC. All DACC were directly related temporarily with at least one DTOC. 70% of DACC were also associated with time required to clean the bed space followingDTOCdischarge to allow a patients' admission, and20% to nursing capacity due to care provided forDTOCand transfer to a ward bed. Over the study period critical care hours lost due to DTOCs was 1,352 h (56.3 days). This equates, (at a level 2 bed day cost of £900) to £50, 708 and £608,499.00/year (E 760624.00). DTOCs had a negative impact on rehabilitation of patients prior to critical care discharge affecting their sleep, and participation with physiotherapy. (Table presented) CONCLUSIONS. Despite attempts to reduce DTOC they clearly continue to present a considerable economic burden by the inefficient use of scarce critical care resources. This study also demonstrates DTOCs effects on the timely admission of the critically ill to critical care, where they should be cared for, and the negative effect on rehabilitation for patients awaiting discharge from critical care. DTOC need to be viewed as an inefficient use of resources and an adverse health event, rather than a necessary inconvenience of inadequate in-patient hospital beds. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) general hospital intensive care society waste EMTREE MEDICAL INDEX TERMS consultation critical illness critically ill patient environment health hospital bed hospital patient human infection morbidity mortality nursing patient physiotherapy rehabilitation risk sleep ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70638923 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 579 TITLE Improved patient safety during critical care transfers resulting from a sustained network approach AUTHOR NAMES Handy J. Walsh A. Suntharalingam G. AUTHOR ADDRESSES (Handy J.; Walsh A.; Suntharalingam G.) North West London Critical Care Network, London, United Kingdom. (Handy J.) Chelsea and Westminster Hospital, London, United Kingdom. (Handy J.) Imperial College London, London, United Kingdom. (Suntharalingam G.) North West London Hospitals Trust, London, United Kingdom. CORRESPONDENCE ADDRESS J. Handy, North West London Critical Care Network, London, United Kingdom. SOURCE Intensive Care Medicine (2011) 37 SUPPL. 1 (S223). Date of Publication: September 2011 CONFERENCE NAME 24th Annual Congress of the European Society of Intensive Care Medicine, ESICM LIVES 2011 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2011-10-01 to 2011-10-05 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Critical care transfers are recognised as being an intervention duringwhichpatientsmay be exposed to increased critical events. Severalmodels for improving the quality ofcritical care transfers have been proposed, all largely focusing on single interventions.OBJECTIVES.We analysed the 5 year impact of implementing amultifaceted Network strategyaimed specifically at monitoring and improving patient safety during critical care transfers.METHODS. The North West London Critical Care Network representsmember hospitals withcritical care requirements but varying capacity.The number ofmember hospitalswas 17 in 2005,increasing to 19 in 2008. Following the implementation of a Network transfer form, analysis ofearly data revealed: a high number of transfers thatwere taking place due to lack of capacity (nonclinicaltransfers); themajority of escorting personnel had not received specific training in criticalcare transfers; and a large number of critical incidents were occurring, particularly due toequipment problems. In response to these findings a strategic response was developed whichincluded: the development and implementation of transfer training aimed at addressing thespecific issues highlighted within the Network sector; the collation of hospital-specific datawhich was reported quarterly and annually at all clinical and management levels; widespreadpresentation of data and strategy within a variety of clinical and managerial groups (includingnursing, medical, physiotherapy and local critical care delivery groups); the review and renewal(where indicated) of equipment used during transfers at local sites across the sector.RESULTS. In response to the Network strategy, and despite the increased number of memberhospitals in 2008, our transfer data revealed: a sustained year-on-year reduction in level 3transfers; a sustained improvement (reversal) in the ratio of non-clinical to clinical transfers; areduction in critical incidents, in particular those due to equipment & battery problems. (Table presented) Our data also showed that neurosurgical emergencies were consistently the most commonindication for clinical transfer.CONCLUSIONS. Our strategy demonstrates that the safety of critical care transfers can besignificantly improved at local and regional levels through the adoption of a multifacetedapproach targeting: continued transfer data collection and analysis; improved clinician,managerial and commissioner awareness of transfer issues; education of escorting staff;review of recurring critical incidents with targeted strategies to reduce them. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient safety society EMTREE MEDICAL INDEX TERMS education hospital human information processing monitoring neurosurgery personnel physiotherapy safety United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70639681 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 580 TITLE Lower limb salvage in a 7-month-old infant using free tissue transfer AUTHOR NAMES Wechselberger G. Radauer W. Schimpl G. Kholosy H. Ensat F. Edelbauer M. Hladik M. AUTHOR ADDRESSES (Wechselberger G.; Kholosy H.; Ensat F.; Hladik M., michaela.hladik@bbsalz.at) Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzigen Brüder, Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria. (Radauer W.) Department of Pediatrics and Adolescent Medicine, Medical University Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria. (Schimpl G.) Department of Pediatrics and Adolescent Surgery, Medical University Salzburg, Müllner-Hauptstraße 48, 5020 Salzburg, Austria. (Edelbauer M.) Department of Pediatrics and Adolescent Medicine, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. CORRESPONDENCE ADDRESS M. Hladik, Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzigen Brüder, Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria. Email: michaela.hladik@bbsalz.at SOURCE Journal of Pediatric Surgery (2011) 46:9 (1852-1854). Date of Publication: September 2011 ISSN 0022-3468 1531-5037 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Free flap reconstruction in infants is extremely rare. A seven-and-a-half-month-old male infant sustained an extensive soft tissue defect on his left knee caused by extravasation of an intraosseous arterenol infusion. A free latissimus dorsi flap was successfully performed for soft tissue reconstruction. Indications, advantages, and outcome of the procedure are discussed. © 2011 Elsevier Inc. EMTREE DRUG INDEX TERMS low molecular weight heparin noradrenalin (adverse drug reaction, drug therapy, intraosseous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) free tissue graft latissimus dorsi flap limb salvage soft tissue defect (side effect, complication, etiology, side effect, surgery, therapy) EMTREE MEDICAL INDEX TERMS article case report cast application cast removal end to end anastomosis epiphysis extravasation (side effect) gastrocnemius muscle human immobilization infant intensive care unit ischemia (drug therapy) joint function knee male meningococcemia microsurgery muscle necrosectomy Neisseria meningitidis outcome assessment physiotherapy plastic surgery popliteus muscle postoperative period priority journal septic shock split thickness skin graft suture tibial artery tissue necrosis (side effect) wound dehiscence (complication) CAS REGISTRY NUMBERS noradrenalin (1407-84-7, 51-41-2) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Surgery (9) General Pathology and Pathological Anatomy (5) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011526968 MEDLINE PMID 21930003 (http://www.ncbi.nlm.nih.gov/pubmed/21930003) PUI L362594856 DOI 10.1016/j.jpedsurg.2011.06.037 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpedsurg.2011.06.037 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 581 TITLE Dogs leaving the ICU carry a very large multi-drug resistant enterococcal population with capacity for biofilm formation and horizontal gene transfer AUTHOR NAMES Ghosh A. Dowd S.E. Zurek L. AUTHOR ADDRESSES (Ghosh A.; Zurek L., lzurek@vet.k-state.edu) Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States. (Dowd S.E.) Medical Biofilm Research Institute, Lubbock, TX, United States. (Zurek L., lzurek@vet.k-state.edu) Department of Entomology, Kansas State University, Manhattan, KS, United States. CORRESPONDENCE ADDRESS L. Zurek, Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, United States. Email: lzurek@vet.k-state.edu SOURCE PLoS ONE (2011) 6:7 Article Number: e22451. Date of Publication: 2011 ISSN 1932-6203 (electronic) BOOK PUBLISHER Public Library of Science, 185 Berry Street, Suite 1300, San Francisco, United States. ABSTRACT The enterococcal community from feces of seven dogs treated with antibiotics for 2-9 days in the veterinary intensive care unit (ICU) was characterized. Both, culture-based approach and culture-independent 16S rDNA amplicon 454 pyrosequencing, revealed an abnormally large enterococcal community: 1.4±0.8×10(8) CFU gram(-1) of feces and 48.9±11.5% of the total 16,228 sequences, respectively. The diversity of the overall microbial community was very low which likely reflects a high selective antibiotic pressure. The enterococcal diversity based on 210 isolates was also low as represented by Enterococcus faecium (54.6%) and Enterococcus faecalis (45.4%). E. faecium was frequently resistant to enrofloxacin (97.3%), ampicillin (96.5%), tetracycline (84.1%), doxycycline (60.2%), erythromycin (53.1%), gentamicin (48.7%), streptomycin (42.5%), and nitrofurantoin (26.5%). In E. faecalis, resistance was common to tetracycline (59.6%), erythromycin (56.4%), doxycycline (53.2%), and enrofloxacin (31.9%). No resistance was detected to vancomycin, tigecycline, linezolid, and quinupristin/dalfopristin in either species. Many isolates carried virulence traits including gelatinase, aggregation substance, cytolysin, and enterococcal surface protein. All E. faecalis strains were biofilm formers in vitro and this phenotype correlated with the presence of gelE and/or esp. In vitro intra-species conjugation assays demonstrated that E. faecium were capable of transferring tetracycline, doxycycline, streptomycin, gentamicin, and erythromycin resistance traits to human clinical strains. Multi-locus variable number tandem repeat analysis (MLVA) and pulsed-field gel electrophoresis (PFGE) of E. faecium strains showed very low genotypic diversity. Interestingly, three E. faecium clones were shared among four dogs suggesting their nosocomial origin. Furthermore, multi-locus sequence typing (MLST) of nine representative MLVA types revealed that six sequence types (STs) originating from five dogs were identical or closely related to STs of human clinical isolates and isolates from hospital outbreaks. It is recommended to restrict close physical contact between pets released from the ICU and their owners to avoid potential health risks. © 2011 Ghosh et al. EMTREE DRUG INDEX TERMS ampicillin antibiotic agent cell surface protein cytolysin dalfopristin plus quinupristin DNA 16S doxycycline enrofloxacin erythromycin gelatinase genomic DNA (endogenous compound) gentamicin linezolid nitrofurantoin streptomycin tetracycline tigecycline vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial load biofilm horizontal gene transfer intensive care unit multidrug resistance EMTREE MEDICAL INDEX TERMS amplicon antibiotic resistance antibiotic sensitivity antibiotic therapy article bacterial strain bacterial transmission bacterial virulence bacterium conjugation bacterium isolate cell clone colony forming unit controlled study dog Enterococcus faecalis Enterococcus faecium feces microflora genetic variability health hazard hospital infection in vitro study microbial community microbial diversity minimum inhibitory concentration multilocus sequence typing nonhuman phenotype pulsed field gel electrophoresis pyrosequencing treatment duration variable number of tandem repeat veterinary medicine CAS REGISTRY NUMBERS ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0) dalfopristin plus quinupristin (126602-89-9) doxycycline (10592-13-9, 17086-28-1, 564-25-0) enrofloxacin (93106-60-6) erythromycin (114-07-8, 70536-18-4) gelatinase (9040-48-6) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) linezolid (165800-03-3) nitrofurantoin (54-87-5, 67-20-9) streptomycin (57-92-1) tetracycline (23843-90-5, 60-54-8, 64-75-5, 8021-86-1) tigecycline (220620-09-7) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011395437 MEDLINE PMID 21811613 (http://www.ncbi.nlm.nih.gov/pubmed/21811613) PUI L362161268 DOI 10.1371/journal.pone.0022451 FULL TEXT LINK http://dx.doi.org/10.1371/journal.pone.0022451 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 582 TITLE [Acute coronary syndrome: the system of organization of treatment]. AUTHOR NAMES Ruda M.I. AUTHOR ADDRESSES (Ruda M.I.) CORRESPONDENCE ADDRESS M.I. Ruda, SOURCE Kardiologiia (2011) 51:3 (4-9). Date of Publication: 2011 ISSN 0022-9040 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute coronary syndrome (complication, diagnosis, therapy) coronary care unit emergency health service heart ventricle fibrillation (diagnosis, etiology, therapy) patient transport EMTREE MEDICAL INDEX TERMS angioplasty article cardioversion clinical competence clinical pathway defibrillator devices drug eluting stent electrocardiography fibrinolytic therapy health service human methodology mortality organization and management standard time LANGUAGE OF ARTICLE Russian MEDLINE PMID 21627606 (http://www.ncbi.nlm.nih.gov/pubmed/21627606) PUI L362241877 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 583 TITLE Prognosis of patients transferred from intensive care units to departments of chest diseases and the factors affecting their prognosis ORIGINAL (NON-ENGLISH) TITLE yoǧun baki{dotless}mlardan göǧüs hastali{dotless}klari{dotless} kliniǧine devir ali{dotless}nan olgulari{dotless}n prognozu ve prognozu etkileyen faktörler AUTHOR NAMES Kalemci S. Sevinç C. Ellidokuz H. AUTHOR ADDRESSES (Kalemci S., skalemci79@mynet.com) Şanliurfa Suruç Devlet Hastanesi, Göǧüs Hastaliklari Bölümü, Şanliurfa, Turkey. (Sevinç C.) Dokuz Eylül Üniversitesi Tip Fakültesi, Göǧüs Hastaliklari Anabilim Dali, Izmir, Turkey. (Ellidokuz H.) Dokuz Eylül Üzniversitesi Tip Fakültesi, Halk Saǧliǧi Anabilim Dali, Halk Saǧliǧi, Izmir, Turkey. CORRESPONDENCE ADDRESS S. Kalemci, Şanliurfa Suruç Devlet Hastanesi, Göǧüs Hastaliklari Bölümü, Şanliurfa, Turkey. Email: skalemci79@mynet.com SOURCE Journal of Medical and Surgical Intensive Care Medicine (2011) 2:2 (29-33). Date of Publication: August 2011 ISSN 1309-1689 1309-6222 (electronic) BOOK PUBLISHER Turkish Society of Medical and Surgical Intensive Care Medic, Ankara, Turkey. ABSTRACT Aim: One-third of deaths due to a critical disease occur after patients are transferred from intensive care units to hospital departments. Some of the deaths occur in patients who are considered not to need further intensive care treatment or that they are adequately stabilized or recovered according to their clinical and physiological findings. Deaths in patients transferred from intensive care units to departments might result from the incomplete recovery of the primary disease or from development of new complications. The aim of this study is to monitor the prognosis of cases who have been intubated and supported with mechanical ventilation in the intensive care unit and then transferred from this unit to the chest diseases department after having been taken off mechanical ventilation, and to determine the factors affecting their prognosis. Material and Methods: Medical records of the patients who were first intubated and monitored in different intensive care units of internal diseases, anesthesia, coronary, cardio-vascular surgery and emergency departments in Dokuz Eylül University Hospital and then transferred to the Department of Chest Diseases of the same hospital between 2006 and 2008 were retrospectively investigated. Results: Seventy-eight patients were included in the study. Fifty-three patients (67.9%) from intensive care units in the internal diseases department (internal medicine, chest diseases, coronary, and the resuscitation unit of the emergency room) and 25 patients (32.1%), from surgical intensive care units (anesthesia, cardiovascular surgery) were transferred to the Department of Chest Diseases. Forty-eight patients (61.5%) were discharged from the department. Thirteen cases (16.7%) were sent back to the intensive care unit because of their deteriorating conditions. Twenty-four patients [seventeen (21.8%) in our clinic and seven in the intensive care unit where they had been sent back] lost their lives. The following were determined to play an important role in total mortality: the presence of atrial fibrillation and malignancy during the patients' stay in the intensive care unit and in the Department of Chest Diseases, high D-dimer levels in the department, the presence of atelectasis on chest radiograph, acute physiological and chronic health evaluation system scores (APACHE II) obtained in the intensive care unit, and APACHE II scores and Sequential Organ Failure Assessment (SOFA) scores. Conclusion: APACHE II scores obtained in the intensive care unit and APACHE II scores and SOFA scores obtained when the patients were transferred to the department were the most important mortality estimation parameters after patients were discharged from the intensive care units. It was also found that the presence of atrial fibrillation and/ or malignancy, high D-dimer levels and atelectasis on chest radiograph of patients who were transferred from the intensive care unit to the department led to an increase in mortality. Therefore, the decision to transfer these patients should be made more judiciously and they should be followed more carefully. EMTREE DRUG INDEX TERMS D dimer (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital department intensive care unit patient transport prognosis thorax disease EMTREE MEDICAL INDEX TERMS APACHE article artificial ventilation atelectasis (diagnosis) atrial fibrillation coronary care unit emergency ward human internal medicine major clinical study malignant neoplasm medical record mortality respiratory tract intubation retrospective study risk factor thorax radiography EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English, Turkish LANGUAGE OF SUMMARY English, Turkish EMBASE ACCESSION NUMBER 2011457701 PUI L362360058 DOI 10.5152/dcbybd.2011.07 FULL TEXT LINK http://dx.doi.org/10.5152/dcbybd.2011.07 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 584 TITLE Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation AUTHOR NAMES Bonaiuti D. Sioli P. Fumagalli L. Beghi E. Agostoni E. AUTHOR ADDRESSES (Bonaiuti D.; Sioli P.) Physical Medicine and Rehabilitation Department, S. Gerardo Hospital, Monza, Italy. (Fumagalli L.) Department of Neurosciences, San Gerardo Hospital, Monza, Italy. (Beghi E., beghi@marionegri.it) Istituto di Ricerche Farmacologiche ''Mario Negri'', Via G. la Masa 19, 20156 Milan, Italy. (Agostoni E.) Department of Neurosciences, Manzoni Hospital, Lecco, Italy. CORRESPONDENCE ADDRESS E. Beghi, Istituto di Ricerche Farmacologiche ''Mario Negri'', Via G. la Masa 19, 20156 Milan, Italy. Email: beghi@marionegri.it SOURCE Neurological Sciences (2011) 32:4 (619-623). Date of Publication: August 2011 ISSN 1590-1874 1590-3478 (electronic) BOOK PUBLISHER Springer Milan, Via Podgora 4, Milan, Italy. ABSTRACT Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks. © 2011 Springer-Verlag. EMTREE DRUG INDEX TERMS penicillin G EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute disease cerebrovascular accident patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged brain hemorrhage (complication) brain ischemia (complication) controlled study disease duration disease severity female fever (complication) gait disorder heart disease (complication) human hypertension (complication) length of stay lung embolism (complication) major clinical study male oxygen saturation patient safety pneumonia (complication) Rankin scale rehabilitation center review risk factor stroke unit CAS REGISTRY NUMBERS penicillin G (1406-05-9, 61-33-6) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011563230 MEDLINE PMID 21533563 (http://www.ncbi.nlm.nih.gov/pubmed/21533563) PUI L51400664 DOI 10.1007/s10072-011-0588-2 FULL TEXT LINK http://dx.doi.org/10.1007/s10072-011-0588-2 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 585 TITLE Transportable enhanced simulation technologies for pre-implementation limited operations testing: neonatal intensive care unit. AUTHOR NAMES Bender J. Shields R. Kennally K. AUTHOR ADDRESSES (Bender J.) Department of Pediatrics, Women & Infants' Hospital, Providence, RI 02905, USA. (Shields R.; Kennally K.) CORRESPONDENCE ADDRESS J. Bender, Department of Pediatrics, Women & Infants' Hospital, Providence, RI 02905, USA. Email: gbender@wihri.org SOURCE Simulation in healthcare : journal of the Society for Simulation in Healthcare (2011) 6:4 (204-212). Date of Publication: Aug 2011 ISSN 1559-713X (electronic) ABSTRACT Transition of a Neonatal Intensive Care Unit (NICU) to a new physical plant incurs many challenges. These are amplified when the culture of care is changing from traditional cohort-based care to the single-family room model. Altered healthcare delivery systems can be tested in situ with TESTPILOT: Transportable Enhanced Simulation Technologies for Pre-Implementation Limited Operations Testing. The aims of the study included promoting translation of existing processes and identifying staff orientation material. We hypothesized that (1) numerous process gaps would be discovered and resolved, and (2) participants would feel better prepared. A functional neonatal intensive care unit was modeled before its opening. Scenarios were developed, volunteers recruited, and rooms supplied with equipment. Participants performed usual duties in two 30-minute in situ simulations followed by facilitated debriefings. As latent safety hazards were identified, they were corrected and retested in subsequent simulations. Staff was surveyed for perceived preparedness. Ninety-six multidisciplinary participants identified 164 latent safety hazards in verbal and written communication, facilities, supplies, staffing, and training, 93% of which were resolved at transition. Staff preparedness varied but showed improving communication, workflow patterns, and awareness of equipment and supply locations. The majority stated that this simulation experience changed their practice. Simulation is very effective for identifying process gaps before major institutional change. TESTPILOT generated iterative workflow enhancements and staff orientation toward improving patient care at transition and beyond. The extensive coordination required to implement such large-scale simulations is well worth the benefit for systems refinement and patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality interdisciplinary communication newborn intensive care EMTREE MEDICAL INDEX TERMS adult article education female health care survey human male methodology middle aged newborn safety standard LANGUAGE OF ARTICLE English MEDLINE PMID 21546863 (http://www.ncbi.nlm.nih.gov/pubmed/21546863) PUI L560007203 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 586 TITLE Transfer of take-home messages in graduate ICU education AUTHOR NAMES Lautrette A. Schwebel C. Gruson D. Talbot R.W. Timsit J.-F. Souweine B. AUTHOR ADDRESSES (Lautrette A., alautrette@chu-clermontferrand.fr; Talbot R.W.; Souweine B.) Medical ICU, Pôle REUNNIRH, CHU Gabriel Montpied Teaching Hospital of Clermont-Ferrand, Université d'Auvergne-Clermont Ferrand 1, 58 Rue Montalembert, Clermont-Ferrand 63003, France. (Schwebel C.) Medical ICU, Michallon Teaching Hospital, Grenoble Cedex 9 38043, France. (Gruson D.) Medical ICU, PellegrinTeaching Hospital, Bordeaux Cedex 33000, France. (Timsit J.-F.) UFR Santé, University Joseph Fourrier and U823 Research Center, INSERM/University Joseph Fourrier, Grenoble Cedex 9 38043, France. CORRESPONDENCE ADDRESS A. Lautrette, Medical ICU, Pôle REUNNIRH, CHU Gabriel Montpied Teaching Hospital of Clermont-Ferrand, Université d'Auvergne-Clermont Ferrand 1, 58 Rue Montalembert, Clermont-Ferrand 63003, France. Email: alautrette@chu-clermontferrand.fr SOURCE Intensive Care Medicine (2011) 37:8 (1323-1330). Date of Publication: August 2011 ISSN 0342-4642 1432-1238 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Purpose: Teaching by lecture (lecture format) is widely used at congresses and in medical educational programmes. The process involves the transfer of take-home messages. The aim of this study was to assess the number of take-home messages identified by postgraduate critical care junior doctors (juniors) during lectures. Methods: This was a prospective observational study of 13 lectures. Lecturers were not informed in advance of the study. At the end of the lecture (30 or 50 min), the lecturer (senior doctor) and juniors listed the three main take-home messages on a form. Subjective elements of the juniors' appraisal (quality of the presentation, explanation of the topic's relevance, enthusiasm of the lecturer, background, case-based, delivery and personality, comprehensibility, practical applicability of information given, prioritization, presence of raw data, references, overall satisfaction) and objective elements (length of lecture, number of take-home messages written on the slides) of the lectures were recorded. Successful knowledge transfer was assessed by matching lecturers' and juniors' take-home messages. Results: In total, 367 forms completed by 367 juniors were analysed. A match equal to 3 (highest match), 2, 1 or 0 was observed in 3.8, 26.7, 48.2 and 21.2% of the forms, respectively. No single subjective or objective element of the lecture was associated with the number of identified take-home messages. Conclusions: Two-thirds of critical care junior doctors identified at best only one of the three main take-home messages of a lecture, suggesting that knowledge transfer is poor during passive format learning. These results suggest that there is a need to develop strategies to improve the performance of lecture-based learning. © 2011 Copyright jointly held by Springer and ESICM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit medical education EMTREE MEDICAL INDEX TERMS article health program human observational study postgraduate education problem based learning prospective study EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011425983 MEDLINE PMID 21660536 (http://www.ncbi.nlm.nih.gov/pubmed/21660536) PUI L51469149 DOI 10.1007/s00134-011-2256-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-011-2256-7 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 587 TITLE Intrahospital transport of critically ill patients (excluding newborns). Expert guidelines from the Société de réanimation de langue française (SRLF), Société française d'anesthésie et de réanimation (SFAR) and the Socié té française de médecine d'urgence (SFMU) ORIGINAL (NON-ENGLISH) TITLE Transport intrahospitalier des patients à risque vital (nouveau-né exclu). Recommandations formalisées d'experts sous l'égide de la Société de réanimation de langue française (SRLF), de la Société française d'anesthésie et de réanimation (SFAR) et de la Societe francaise de medecine d'urgence (SFMU) AUTHOR NAMES Quenot J.-P. Milési C. Cravoisy A. Capellier G. Mimoz O. Fourcade O. Gueugniaud P.-Y. AUTHOR ADDRESSES (Quenot J.-P., jean-pierre.quenot@chu-dijon.fr) Service de réanimation médicale, CHU Bocage-Central-Gabriel, 14, rue Paul-Gaffarel, F-21079 Dijon, France. (Milési C.) Service de réanimation pédiatrique, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, F-34295 Montpelier, France. (Cravoisy A.) Service de réanimation médicale, CHU-Hôpital Central, 29, avenue du Maréchal-de-Lattre-de-Tassigny, F-54035 Nancy, France. (Capellier G.) Service de réanimation médicale, CHU-hôpital Jean-Minjoz, 3, boulevard Fleming, F-25000 Besandşon, France. (Mimoz O.) Service d'anesthésie-réanimation, CHU de la Milétrie, 2, rue de la Milétrie, F-86021 Poitiers, France. (Fourcade O.) Pôle anesthésie-réanimation, CHU, pavillon urgences et réanimation, HôPital Purpan, place du Docteur-Baylac, F-31059 Toulouse, France. (Gueugniaud P.-Y.) Service aide médicale urgente, CHU-hospices civils, 162, avenue Lacassagne, F-69003 Lyon, France. CORRESPONDENCE ADDRESS J.-P. Quenot, Service de réanimation médicale, CHU Bocage-Central-Gabriel, 14, rue Paul-Gaffarel, F-21079 Dijon, France. Email: jean-pierre.quenot@chu-dijon.fr SOURCE Reanimation (2011) 20:4 (361-366). Date of Publication: July 2011 ISSN 1624-0693 1951-6959 (electronic) BOOK PUBLISHER Springer Paris, 1 rue Paul Cezanne, Paris, France. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS article human practice guideline EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2012060606 PUI L364157198 DOI 10.1007/s13546-011-0271-x FULL TEXT LINK http://dx.doi.org/10.1007/s13546-011-0271-x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 588 TITLE Country-to-country transfer of patients and the risk of multi-resistant bacterial infection AUTHOR NAMES Rogers B.A. Aminzadeh Z. Hayashi Y. Paterson D.L. AUTHOR ADDRESSES (Rogers B.A., benrogers@uq.edu.au; Aminzadeh Z.; Hayashi Y.; Paterson D.L.) University of Queensland Centre for Clinical Research, University of Queensland, 918 Royal Brisbane Hospital, Level 8, Herston, Brisbane 4006, Australia. (Aminzadeh Z.) Infectious Diseases Research Centre, Shaheed Beheshti University M. C., Tehran, Iran. (Hayashi Y.) Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. CORRESPONDENCE ADDRESS B. A. Rogers, University of Queensland Centre for Clinical Research, University of Queensland, 918 Royal Brisbane Hospital, Level 8, Herston, Brisbane 4006, Australia. Email: benrogers@uq.edu.au SOURCE Clinical Infectious Diseases (2011) 53:1 (49-56). Date of Publication: 1 Jul 2011 ISSN 1058-4838 1537-6591 (electronic) BOOK PUBLISHER Oxford University Press, 2001 Evans Road, Cary, United States. ABSTRACT Management of patients with a history of healthcare contact in multiple countries is now a reality for many clinicians. Leisure tourism, the burgeoning industry of medical tourism, military conflict, natural disasters, and changing patterns of human migration may all contribute to this emerging epidemiological trend. Such individuals may be both vectors and victims of healthcare-associated infection with multiresistant bacteria. Current literature describes intercountry transfer of multiresistant Acinetobacter spp and Klebsiella pneumoniae (including Klebsiella pneumoniae carbapenemase- and New Delhi metallo-β-lactamase-producing strains), methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and hypervirulent Clostridium difficile. Introduction of such organisms to new locations has led to their dissemination within hospitals. Healthcare institutions should have sound infection prevention strategies to mitigate the risk of dissemination of multiresistant organisms from patients who have been admitted to hospitals in other countries. Clinicians may also need to individualize empiric prescribing patterns to reflect the risk of multiresistant organisms in these patients. © 2011 The Author. EMTREE DRUG INDEX TERMS antibiotic agent bacterial enzyme (endogenous compound) carbapenem carbapenemase (endogenous compound) extended spectrum beta lactamase (endogenous compound) metallo beta lactamase (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial infection (drug resistance, etiology) multidrug resistance patient transport EMTREE MEDICAL INDEX TERMS Acinetobacter Acinetobacter infection (drug resistance, etiology) aerospace medicine antibiotic resistance bacterial gene bacterial strain bacterial virulence Belgium Citrobacter freundii Clostridium difficile infection (etiology) disease transmission empiricism Escherichia coli Escherichia coli infection France Gram negative bacterium health care organization hospital admission hospital infection hospital patient human infection prevention infection risk intensive care unit Ireland Klebsiella pneumoniae Klebsiella pneumoniae infection (drug resistance, etiology) medical tourism methicillin resistant Staphylococcus aureus nonhuman Peptoclostridium difficile population distribution population risk priority journal review soldier traumatic brain injury vancomycin resistant Enterococcus CAS REGISTRY NUMBERS carbapenem (83200-96-8) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Internal Medicine (6) General Pathology and Pathological Anatomy (5) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011327518 MEDLINE PMID 21653302 (http://www.ncbi.nlm.nih.gov/pubmed/21653302) PUI L361949268 DOI 10.1093/cid/cir273 FULL TEXT LINK http://dx.doi.org/10.1093/cid/cir273 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 589 TITLE Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands AUTHOR NAMES Ravelli A.C.J. Jager K.J. De Groot M.H. Erwich J.J.H.M. Rijninks-Van Driel G.C. Tromp M. Eskes M. Abu-Hanna A. Mol B.W.J. AUTHOR ADDRESSES (Ravelli A.C.J.; Jager K.J.; De Groot M.H.; Erwich J.J.H.M.; Rijninks-Van Driel G.C.; Tromp M.; Eskes M.; Abu-Hanna A.; Mol B.W.J.) Department of Medical Informatics, Academic Medical Centre, Amsterdam, Netherlands. (Ravelli A.C.J.; Jager K.J.; De Groot M.H.; Erwich J.J.H.M.; Rijninks-Van Driel G.C.; Tromp M.; Eskes M.; Abu-Hanna A.; Mol B.W.J.) Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, Netherlands. (Ravelli A.C.J.; Jager K.J.; De Groot M.H.; Erwich J.J.H.M.; Rijninks-Van Driel G.C.; Tromp M.; Eskes M.; Abu-Hanna A.; Mol B.W.J.) Department of Obstetrics and Gynaecology, Medical Centre, Amsterdam, Netherlands. CORRESPONDENCE ADDRESS A.C.J. Ravelli, Department of Medical Informatics, Academic Medical Centre, Amsterdam, Netherlands. SOURCE Obstetrical and Gynecological Survey (2011) 66:7 (396-398). Date of Publication: July 2011 ISSN 0029-7828 1533-9866 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) home hospital newborn mortality patient transport perinatal period pregnancy outcome travel EMTREE MEDICAL INDEX TERMS Apgar score car cohort analysis economic aspect ethnicity gestational age hospital admission human intensive care unit intrapartum care maternal age maternity ward Netherlands note obstetric delivery parity population primary medical care register risk factor social aspect stillbirth urbanization EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011541955 PUI L362659479 DOI 10.1097/OGX.0b013e3182338407 FULL TEXT LINK http://dx.doi.org/10.1097/OGX.0b013e3182338407 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 590 TITLE Intra-hospital transport of critically ill patients (excluding newborns) ORIGINAL (NON-ENGLISH) TITLE Transport intrahospitalier des patients à risque vital (nouveau-né exclu): Recommandations formalisées d'experts sous l'égide de la Société de réanimation de langue française (SRLF), de la Société française d'anesthésie et de réanimation (Sfar) et de la Sociéte francaise de medecine d'urgence (SFMU) AUTHOR NAMES Quenot J.-P. Milési C. Cravoisy A. Capellier G. Mimoz O. Fourcade O. Gueugniaud P.Y. AUTHOR ADDRESSES (Quenot J.-P., jean-pierre.quenot@chu-dijon.fr) Service de réanimation médicale, CHU Bocage-Central-Gabriel, 14, rue Paul-Gaffarel, F-21079 Dijon, France. (Milési C.) CHU Lapeyronie, F-34295 Montpellier, France. (Cravoisy A.) Hôpital central, CHU de Nancy, F-54035 Nancy, France. (Capellier G.) Hôpital Jean-Minjoz, CHU de Besançon, F-25000 Besançon, France. (Mimoz O.) CHU de la Milétrie, F-86021 Poitiers, France. (Fourcade O.) Pavillon urgences et réanimation, Hôpital Purpan, CHU de Toulouse, F-31059 Toulouse, France. (Gueugniaud P.Y.) CHU hospices civils de Lyon, F-69003 Lyon, France. CORRESPONDENCE ADDRESS J.-P. Quenot, Service de réanimation médicale, CHU Bocage-Central-Gabriel, 14, rue Paul-Gaffarel, F-21079 Dijon, France. Email: jean-pierre.quenot@chu-dijon.fr SOURCE Annales Francaises de Medecine d'Urgence (2011) 1:4 (278-283). Date of Publication: July 2011 ISSN 2108-6524 2108-6591 (electronic) BOOK PUBLISHER Springer Paris, 1 rue Paul Cezanne, Paris, France. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS article human EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE French, English EMBASE ACCESSION NUMBER 2012374233 PUI L365121491 DOI 10.1007/s13341-011-0080-x FULL TEXT LINK http://dx.doi.org/10.1007/s13341-011-0080-x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 591 TITLE The PICU perspective on monitoring hemodynamics and oxygen transport. AUTHOR NAMES Wong H.R. Dalton H.J. AUTHOR ADDRESSES (Wong H.R.; Dalton H.J.) CORRESPONDENCE ADDRESS H.R. Wong, SOURCE Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (2011) 12:4 Suppl (S66-68). Date of Publication: Jul 2011 ISSN 1529-7535 ABSTRACT Alterations of hemodynamics and oxygen transport balance are very common scenarios in the pediatric intensive care unit (PICU), and these alterations are as heterogeneous and diverse in nature as are the patient populations that typically exist in the PICU. Accordingly, the PICU perspective on monitoring of hemodynamics and oxygen transport balance in critically ill children must be understood in this context of heterogeneity and diversity. We provide an interpretation of the evidence supporting various monitoring strategies as presented in the The Pediatric Cardiac Intensive Care Society Evidence Based Review and Consensus Statement on Monitoring of Hemodynamics and Oxygen Transport Balance from a Pediatric Intensive Care perspective. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) oxygen (pharmacokinetics) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hemodynamics intensive care unit monitoring EMTREE MEDICAL INDEX TERMS editorial human infant methodology oxygen consumption pathophysiology physiology preschool child shock transport at the cellular level CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE English MEDLINE PMID 21857798 (http://www.ncbi.nlm.nih.gov/pubmed/21857798) PUI L560061769 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 592 TITLE The Pediatric Cardiac Intensive Care Society evidence-based review and consensus statement on monitoring of hemodynamics and oxygen transport balance AUTHOR NAMES Checchia P.A. Bronicki R.A. AUTHOR ADDRESSES (Checchia P.A.) St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, United States. (Bronicki R.A.) Children's Hospital of Orange County, University of California, Orange, CA, United States. (Bronicki R.A.) David Geffen School of Medicine, University of California, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS P. A. Checchia, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, United States. SOURCE Pediatric Critical Care Medicine (2011) 12:4 SUPPL. (S1). Date of Publication: July 2011 ISSN 1529-7535 1947-3893 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit hemodynamic monitoring medical society oxygen transport pediatrics EMTREE MEDICAL INDEX TERMS blood pressure cardiovascular function central venous pressure consensus critically ill patient editorial evidence based medicine heart rate human myocarditis (diagnosis) neonatology patient monitoring pediatric intensive care nursing physical examination priority journal pulmonary artery catheter pulmonary hypertension tissue oxygenation United States EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011369440 MEDLINE PMID 22129543 (http://www.ncbi.nlm.nih.gov/pubmed/22129543) PUI L362077274 DOI 10.1097/PCC.0b013e318220e64f FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e318220e64f COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 593 TITLE The pediatric intensive care unit perspective on monitoring hemodynamics and oxygen transport AUTHOR NAMES Wong H.R. Dalton H.J. AUTHOR ADDRESSES (Wong H.R., hector.wong@cchmc.org) Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States. (Dalton H.J.) Division of Critical Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States. CORRESPONDENCE ADDRESS H. R. Wong, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States. Email: hector.wong@cchmc.org SOURCE Pediatric Critical Care Medicine (2011) 12:4 SUPPL. (S66-S68). Date of Publication: July 2011 ISSN 1529-7535 1947-3893 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Alterations of hemodynamics and oxygen transport balance are very common scenarios in the pediatric intensive care unit (PICU), and these alterations are as heterogeneous and diverse in nature as are the patient populations that typically exist in the PICU. Accordingly, the PICU perspective on monitoring of hemodynamics and oxygen transport balance in critically ill children must be understood in this context of heterogeneity and diversity. We provide an interpretation of the evidence supporting various monitoring strategies as presented in the Pediatric Cardiac Intensive Care Society Evidence-Based Review and Consensus Statement on Monitoring of Hemodynamics and Oxygen Transport Balance from a Pediatric Intensive Care perspective. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. EMTREE DRUG INDEX TERMS beta adrenergic receptor stimulating agent (drug therapy) brain natriuretic peptide (endogenous compound) lactic acid (endogenous compound) troponin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hemodynamic monitoring intensive care unit oxygen transport pediatrics EMTREE MEDICAL INDEX TERMS asthmatic state (drug therapy) cardiogenic shock cardiovascular equipment conference paper consensus critically ill patient echocardiography electrocardiography evidence based medicine femoral pulse waveform device fulminating purpura gold standard heart function heart muscle ischemia hemodynamics human hypovolemic shock hypoxia lactate blood level muscular dystrophy near infrared spectroscopy obstructive shock oxygen saturation physical examination priority journal pulmonary artery catheter resuscitation septic shock (therapy) superior cava vein systemic vascular resistance thermodilution CAS REGISTRY NUMBERS brain natriuretic peptide (114471-18-0) lactic acid (113-21-3, 50-21-5) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Radiology (14) Cardiovascular Diseases and Cardiovascular Surgery (18) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT00510835) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011369450 PUI L362077284 DOI 10.1097/PCC.0b013e3182211c60 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182211c60 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 594 TITLE The cardiac intensive care unit perspective on hemodynamic monitoring of oxygen transport balance AUTHOR NAMES Checchia P.A. Laussen P.C. AUTHOR ADDRESSES (Checchia P.A., pchecchia@wustl.edu) Department of Pediatrics (PAC), St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, United States. (Laussen P.C.) Department of Cardiology (PCL), Children's Hospital Boston, Boston, MA, United States. (Laussen P.C.) Department of Pediatrics (PCL), Harvard Medical School, Boston, MA, United States. CORRESPONDENCE ADDRESS P. A. Checchia, Department of Pediatrics (PAC), St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, United States. Email: pchecchia@wustl.edu SOURCE Pediatric Critical Care Medicine (2011) 12:4 SUPPL. (S69-S71). Date of Publication: July 2011 ISSN 1529-7535 1947-3893 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT The purpose of this consensus statement is to present the available evidence supporting the use of a variety of hemodynamic monitors in a pediatric population. Each article within this supplement and the presentations at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society provide the evidence to support recommendations for the use of each monitoring modality. The purpose of this editorial is to interpret the evidence provided elsewhere in this supplement from the perspective of cardiac critical care. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. EMTREE DRUG INDEX TERMS nitric oxide EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit hemodynamic monitoring intensive care unit oxygen transport EMTREE MEDICAL INDEX TERMS caregiver central venous pressure conference paper consensus critically ill patient echocardiography end tidal carbon dioxide tension heart function heart output measurement heart right atrium pressure heart surgery hemodynamic parameters human lung artery pressure lung vascular resistance medical society near infrared spectroscopy nuclear magnetic resonance imaging oximetry oxygen consumption oxygen saturation oxygen therapy patient monitoring pediatrics postoperative complication (complication) priority journal pulmonary artery catheter pulmonary artery occlusion pressure quality of life resuscitation thermodilution CAS REGISTRY NUMBERS nitric oxide (10102-43-9) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Radiology (14) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011369451 MEDLINE PMID 22129553 (http://www.ncbi.nlm.nih.gov/pubmed/22129553) PUI L362077285 DOI 10.1097/PCC.0b013e3182211d3d FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182211d3d COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 595 TITLE The nursing perspective on monitoring hemodynamics and oxygen transport AUTHOR NAMES Tucker D. Hazinski M.F. AUTHOR ADDRESSES (Tucker D., dawnatucker@gmail.com) Children's Mercy Hospital, Kansas City, MO, United States. (Hazinski M.F.) Vanderbilt University School of Nursing, School of Medicine, Nashville, TN, United States. CORRESPONDENCE ADDRESS D. Tucker, Children's Mercy Hospital, Kansas City, MO, United States. Email: dawnatucker@gmail.com SOURCE Pediatric Critical Care Medicine (2011) 12:4 SUPPL. (S72-S75). Date of Publication: July 2011 ISSN 1529-7535 1947-3893 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Maintenance of adequate systemic oxygen delivery requires careful clinical assessment integrated with hemodynamic measurements and calculations to detect and treat conditions that may compromise oxygen delivery and lead to life-threatening shock, respiratory failure, or cardiac arrest. The bedside nurse constantly performs such assessments and measurements to detect subtle changes and trends in patient condition. The purpose of this editorial is to highlight nursing perspectives about the hemodynamic and oxygen transport monitoring systems summarized in the Pediatric Cardiac Intensive Care Society Evidence- Based Review and Consensus Statement on Monitoring of Hemodynamics and Oxygen Transport Balance. There is no substitute for the observations of a knowledgeable and experienced clinician who understands the patient's condition and potential causes of deterioration and is able to evaluate response to therapy. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. EMTREE DRUG INDEX TERMS biochemical marker (endogenous compound) carbon dioxide lactic acid (endogenous compound) oxyhemoglobin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hemodynamic monitoring oxygen transport pediatric intensive care nursing EMTREE MEDICAL INDEX TERMS arterial pH arterial pressure blood oxygen tension blood pressure monitoring capnometry capnometry central venous pressure conference paper consensus coronary care unit echocardiography electrocardiogram electrocardiography end tidal carbon dioxide tension exhalation expired air heart arrest heart output measurement heart rate variability hemodynamic parameters hemodynamics hemoglobin blood level Holter monitoring human near infrared spectroscopy nursing knowledge oximetry oxygen consumption patient assessment priority journal pulmonary artery catheter pulmonary hypertension pulse oximetry respiratory failure shock transducer treatment response venous oximetry CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) lactic acid (113-21-3, 50-21-5) oxyhemoglobin (9061-63-6) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011369452 MEDLINE PMID 22129554 (http://www.ncbi.nlm.nih.gov/pubmed/22129554) PUI L362077286 DOI 10.1097/PCC.0b013e3182211d5b FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182211d5b COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 596 TITLE 2011 Critical Care Transport Medicine Conference Abstracts AUTHOR ADDRESSES SOURCE Air Medical Journal (2011) 30:4. Date of Publication: July-August 2011 CONFERENCE NAME 2011 Critical Care Transport Medicine Conference CONFERENCE LOCATION Nashville, TN, United States CONFERENCE DATE 2011-04-04 to 2011-04-06 ISSN 1067-991X BOOK PUBLISHER Mosby Inc. ABSTRACT The proceedings contain 3 papers. The topics discussed include: confirmation of out-of-hospital endotracheal tube placement: factors associated with non-usage of objective methods; hems management of arterial hypertension in patients with intracranial hemorrhage; and characteristics of the helicopter emergency medical services endotracheal intubation attempt: a descriptive analysis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS brain hemorrhage emergency health service endotracheal intubation endotracheal tube helicopter hospital human hypertension patient LANGUAGE OF ARTICLE English PUI L70492671 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 597 TITLE Transportation conditions of newborns admitted to the neonatal intensive care unit ORIGINAL (NON-ENGLISH) TITLE Yenidoǧan yoǧun bakim ünitesine kabul edilen yenidoǧanlarda transport koşullari AUTHOR NAMES Yilmaz Ö. Çalkavur Ş. Olukman Ö. Yilmaz N. Atlihan F. AUTHOR ADDRESSES (Yilmaz Ö.; Olukman Ö., egefarma@yahoo.com; Yilmaz N.; Atlihan F.) Dr. Behcet Uz Cocuk Hastaliklari ve Cerrahisi Egitim ve Arastirma Hastanesi, Çocuk Saǧliǧi ve Hastaliklari Kliniǧi, Izmir, Turkey. (Çalkavur Ş.) Neonatoloji Kliniǧi, Dr. Behcet Uz Cocuk Hastaliklari ve Cerrahisi Egitim ve Arastirma Hastanesi, Izmir, Turkey. CORRESPONDENCE ADDRESS Ö. Olukman, Dr. Behcet Uz Cocuk Hastaliklari ve Cerrahisi Egitim ve Arastirma Hastanesi, Çocuk Saǧliǧi ve Hastaliklari Kliniǧi, Izmir, Turkey. Email: egefarma@yahoo.com SOURCE Turkiye Klinikleri Pediatri (2011) 20:1 (29-37). Date of Publication: 2011 ISSN 1300-0381 BOOK PUBLISHER Turkiye Klinikleri, Turkocagi Caddesi No. 30, Balgat, Turkey. ABSTRACT Objective: To evaluate the transportation conditions and affecting factors on the transportatiton of new borns postnatally referred to the newborn intensive care unit (NICU) at our hospital. Material and Methods: During the 9-months period between September 2007 and June 2008, we evaluated the transportation conditions of 83 newborns who were postnatally referred to our NICU. Referring hospitals were divided into three groups: Group A, peripheral hospital without a NICU; group B, central hospitals without NICU; group C, central hospitals, training hospital or university hospital containing NICU. Necessary criteria that should be provided for transported babies were grouped in 7 subtitles. Type of transportation,status of transportation (informed or not), age at the time of transportation, presence of air-way and resuscitation, evaluation of respiration, circulation and clinic. Total score was calculated by giving 1-2 points for correct applications and 0 point for false applications. The transport score was established from a total of 28 points. Results: The majority of the transports were from group A hospitals. In group C hospitals, the transport score and ratio of neonatal resuscitation before transportation was significantly higher than the scores of group A and B hospitals. The ratio of resuscitation after transportation and mortality rates were minimum in group C and maximum in group B. The total mortality rate was calculated as 38.6%. The mortality rate was minimum for babies transported from group C hospitals but maximum for babies transported from group B hospitals. This difference was statistically significant. Conclusion: The high transport scores and low mortality rates of group C hospitals reflect the suitability of transportation conditions. In other words better conditions of transportation from group C hospitals are strongly associated with better outcomes. Therefore the improvement of transportation will supply the high ratio of survivals. Copyright © 2011 by Türkiye Klinikleri. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article breathing circulation health care facility hospitalization human newborn resuscitation university hospital EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE Turkish LANGUAGE OF SUMMARY English, Turkish EMBASE ACCESSION NUMBER 2011284685 PUI L361804840 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 598 TITLE Adverse drug events in intra-hospital transfers to intensive care unit AUTHOR NAMES Besson M. Gasche Y. Dayer P. Desmeules J. AUTHOR ADDRESSES (Besson M.; Gasche Y.; Dayer P.; Desmeules J.) Geneva University Hospitals, University of Geneva, Switzerland. CORRESPONDENCE ADDRESS M. Besson, Geneva University Hospitals, University of Geneva, Switzerland. SOURCE Basic and Clinical Pharmacology and Toxicology (2011) 109 SUPPL. 1 (78). Date of Publication: June 2011 CONFERENCE NAME 10th Congress of the European Association for Clinical Pharmacology and Therapeutics CONFERENCE LOCATION Budapest, Hungary CONFERENCE DATE 2011-06-26 to 2011-06-29 ISSN 1742-7835 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Introduction: Adverse drug events (ADE) represent more than 6% of hospitalisations and can be life threatening. In a pilot study, we previously showed that ADE were implicated in 20% of intensive care unit (ICU) admissions. As 1/3 came from the hospital wards, we focused on assessing the contribution of ADE in intra-hospital transfers to ICU and to determine their preventability. Method: Prospective observational study. Admissions to the ICU of the Geneva University Hospitals (36 beds) for 6 months were systematically analysed from January to July 2009. Demographic and medical data, drug history, clinical evolution and outcome were systematically collected. Clinical pharmacologists and ICU specialists decided independently on drug imputability, according to WHO criteria and preventability. Results: From January to July 2009, 1310 ICU admissions were recorded, 323 of which were from the hospital wards. Most of the ADE were respiratory (30%), haemorrhagic (28%) or cardiovascular (20%) events. Accordingly drugs were mainly opioïds, benzodiazepines or both, anticoagulants and beta-blockers. Clinical pharmacologists implied twice as much an ADE in ICU admission than the ICU specialist. More than one third of the AE were considered probably related with ICU transfer and 18% were considered preventable by both specialists. Conclusion: These results confirm that ADE are frequently involved in ICU inward transfer and that one fifth are considered preventable. Our results stress the important contribution of the clinical pharmacologist for improving intra hospital serious adverse event detection and underscore the need of developing strategies to try to prevent these ADE related transfers. EMTREE DRUG INDEX TERMS anticoagulant agent benzodiazepine derivative beta adrenergic receptor blocking agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse drug reaction clinical pharmacology hospital intensive care unit therapy EMTREE MEDICAL INDEX TERMS human medical specialist observational study pilot study university hospital ward world health organization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70623095 DOI 10.1111/j.1742-7843.2011.00722.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1742-7843.2011.00722.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 599 TITLE Intrahospital transport to the radiology department: Risk for adverse events, nursing surveillance, utilization of a MET, and practice implications AUTHOR NAMES Ott L.K. Hoffman L.A. Hravnak M. AUTHOR ADDRESSES (Ott L.K., ottl@pitt.edu; Hoffman L.A.; Hravnak M.) Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria St., Pittsburgh, PA 15261, United States. CORRESPONDENCE ADDRESS L. K. Ott, Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria St., Pittsburgh, PA 15261, United States. Email: ottl@pitt.edu SOURCE Journal of Radiology Nursing (2011) 30:2 (49-54). Date of Publication: June 2011 ISSN 1546-0843 1555-9912 (electronic) BOOK PUBLISHER Elsevier Inc., 360 Park Avenue South, New York, United States. ABSTRACT Nurses providing care in the radiology department (RD) are challenged by the broad scope of conditions and varied acuity of patients served by this unit. Nurses must facilitate the required diagnostic testing and simultaneously provide the surveillance necessary to detect physiologic changes signaling the need for rescue interventions. When instability occurs, one method of rescue involves activation of a medical emergency team (MET) to bring an experienced cadre of critical care providers to the unstable patient. Despite recognition that the RD can be a high-risk area, there is little in the literature specific to the surveillance of RD patients, risk for and prevention of adverse events, MET activation or the management of patient instability specific to the RD. The purpose of this article is to examine what is known regarding risk for adverse events during intrahospital transport, utilization of a MET as a rescue intervention, and practice implications. Copyright © 2011 by the Association for Radiologic & Imaging Nursing. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport radiology nursing rapid response team EMTREE MEDICAL INDEX TERMS article health care utilization human intensive care nursing nurse nursing care nursing practice patient safety practice guideline priority journal radiology department risk assessment EMBASE CLASSIFICATIONS Radiology (14) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011308523 PUI L361891095 DOI 10.1016/j.jradnu.2011.02.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.jradnu.2011.02.001 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 600 TITLE Transport of cardiac surgical patients from operation room to ICU AUTHOR NAMES Basagan-Mogol E. Girgin N.K. Kaya F.N. Goren S. Yeniaydogmus T. AUTHOR ADDRESSES (Basagan-Mogol E.; Girgin N.K.; Kaya F.N.; Goren S.; Yeniaydogmus T.) Uludag University, School of Medicine, Department of Anaesthe-siology and Reanimation, Bursa, Turkey. CORRESPONDENCE ADDRESS E. Basagan-Mogol, Uludag University, School of Medicine, Department of Anaesthe-siology and Reanimation, Bursa, Turkey. SOURCE Journal of Cardiothoracic and Vascular Anesthesia (2011) 25:3 SUPPL. 1 (S35-S36). Date of Publication: June 2011 CONFERENCE NAME 26th Annual Meeting of the European Association of Cardiothoracic Anaesthesiologists, EACTA 2011 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2011-06-01 to 2011-06-04 ISSN 1053-0770 BOOK PUBLISHER W.B. Saunders ABSTRACT Introduction. Transport of cardiac surgical patients from the operation room to ICU is a very important procedure. The aim of this study was to evaluate the factors affecting this procedure, to display and compare the haemodynamic parameters and arterial blood gases with values taken prior to surgery in patients undergoing cardiac surgery. Method. After obtaining ethical committee approval, 100 patients scheduled for cardiac surgery, ASA grade II-IV, aged 20-72 were included. Ventilation during the transport of the patients to the ICU was performed manually. Haemodynamic parameters (HR, SAP, DAP, MAP, CVP, PAP, PCWP, CO), arterial blood gases (pH, PCO(2),PO(2), BE) and SpO(2) values were recorded in 9 measurement times: before surgery (T1), 30 and 15 min before transport (T2 and T3), at the end of surgery (T4), at transport bed (T5), at elevator (T6), in ICU (T7), at 30th and 60th min in ICU (T8 and T9). At transport bed and elevator SAP, DAP, HR, SpO(2) values were recorded. Stroke volume index (SVI) systemic and pulmonary vascular resistance indices (SVRI, PVRI) were calculated. The drugs and their dosages used during surgery and complications were recorded. Wilcoxon's signed ranks test was used for statistics. Results. Patients received 10.6±8.5 mg midazolam, 1120.4± 389.9 μg fentanyl, 153.6±52.3 mg rocuronium during surgery lasting 4.3±1.2 hr. 3 personnel (anaesthetist, surgeon, nurse) were present during transport. 22 patients needed medication during transport. Hypotension, hypertension orarrhythmias were detected in 10, 7 and 5 patients respectively. Discussion. The results highlight the interventions, ventilation strategies, haemodynamic monitoring and the presence of qualified staff during the transport process of cardiac surgical patients from operation room to ICU. EMTREE DRUG INDEX TERMS fentanyl midazolam rocuronium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) operating room surgical patient EMTREE MEDICAL INDEX TERMS air conditioning arterial gas building drug therapy heart stroke volume heart surgery hypertension hypotension lung vascular resistance monitoring nurse patient personnel pH pulmonary artery occlusion pressure statistics surgeon surgery Wilcoxon signed ranks test LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70428820 DOI 10.1053/j.jvca.2011.03.096 FULL TEXT LINK http://dx.doi.org/10.1053/j.jvca.2011.03.096 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 601 TITLE An exploration of patients' and relatives' experiences of transfer from intensive care AUTHOR NAMES Lindsay S. Bulley C. AUTHOR ADDRESSES (Lindsay S.) Raigmore Hospital, Physiotherapy Department, Inverness, United Kingdom. (Bulley C.) Queen Margaret University Edinburgh, Physiotherapy, Musselburgh, United Kingdom. CORRESPONDENCE ADDRESS S. Lindsay, Raigmore Hospital, Physiotherapy Department, Inverness, United Kingdom. SOURCE Physiotherapy (United Kingdom) (2011) 97 SUPPL. 1 (eS699). Date of Publication: June 2011 CONFERENCE NAME World Physical Therapy 2011 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2011-06-20 to 2011-06-23 ISSN 0031-9406 BOOK PUBLISHER Elsevier Ltd ABSTRACT Purpose: The evolution of intensive care medicine has considerably enhanced the survival of critically ill patients. Although for many transfer from intensive care is uncomplicated, for others, transfer marks the beginning of an uncertain road to recovery. This qualitative study aimed to analyse the perspectives of patients, and of their relatives, in an ICU unit in the United Kingdom (U.K.). Reactions to a written information booklet were also explored. Relevance: Improved understanding of the impacts of an ICU stay will enable health professionals to take actions that may develop critical care services; this will optimise the care and treatment of those transferring from the ICU. Participants: Individuals who had experienced an ICU stay of 48 hours or more, and their relatives, were invited to participate in a single interview within a week of transition from ICU. Purposive sampling ensured a variety of experiences. Fourwomen and fourmen(age range 40-70) completed interviews. All were white Caucasians living in the Highlands of Scotland, U.K. Methods: The study was carried out within the framework of Interpretative Phenomenological Analysis (IPA). Semistructured interviews (11-19 minutes) were carried out in participants' wards. A topic guide was developed to focus on experiences of an ICU stay and views regarding written information packs. Ethical approval was granted by Queen Margaret University, Edinburgh and the North of Scotland Research Ethics Committee. Analysis: Transcribed interviews were thematically analysed utilising the IPA framework. Two researchers were involved in the development of themes, iteratively developing a classification or typology of participants' views and experiences, progressing to the development of relationships between themes. Three overarching themes emerged. Results: Themes are labelled to reflect views described by interviewees. The first, 'The importance of receiving timely information' described relatives' desire for knowledge of the patient's condition and what might happen in the future. Patients also described a desire for timely information and knowledge of their condition. Some individuals described doubt when there was insufficient information. The second theme is called: 'Evaluating the ICU journey'. The impact of an ICU stay resulted in differing experiences and encompassed positive and negative emotions. Negative emotions related to uncertainty about the future; whilst positive emotions related to experiences of progression along the continuum of recovery. The last theme was labelled: 'Attributing value to a written information booklet'. This reflects individuals' appreciation of the information provided in a written information booklet. Conclusions: In this study, participants demonstrated a strong need for both timely verbal information and written information booklets. Implications: It is important that staff communicate with patients and relatives in easy to understand terms. Timely verbal communication, coupled with written information booklets, is likely to enable adjustment to unknown realities and unfamiliar environments, leading to certainty and clarity over what to expect. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) human intensive care patient physiotherapy EMTREE MEDICAL INDEX TERMS classification critically ill patient emotion environment health practitioner interview professional standard qualitative research research ethics sampling scientist semi structured interview survival United Kingdom university verbal communication ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71883126 DOI 10.1016/j.physio.2011.04.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.physio.2011.04.002 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 602 TITLE A systematic review of failures in handoff communication during intrahospital transfers. AUTHOR NAMES Ong M.S. Coiera E. AUTHOR ADDRESSES (Ong M.S.) Centre for Health Informatics, University of New South Wales, Sydney, Australia. (Coiera E.) CORRESPONDENCE ADDRESS M.S. Ong, Centre for Health Informatics, University of New South Wales, Sydney, Australia. Email: m.ong@unsw.edu.au SOURCE Joint Commission journal on quality and patient safety / Joint Commission Resources (2011) 37:6 (274-284). Date of Publication: Jun 2011 ISSN 1553-7250 ABSTRACT Handoffs serve a critical function in ensuring patient care continuity during transitions of care. Studies to date have predominantly focused on intershift handoffs, with relatively little attention given to intrahospital transfers. A systematic literature review was conducted to characterize the nature of handoff failures during intrahospital transfers and to examine factors affecting handoff communication and the effectiveness of current interventions. Primary studies investigating handoff communication between care providers during intrahospital transfers were sought in the English-language literature between 1980 and February 2011. Data for study design, population characteristics, sample size, setting, intervention specifics, and relevant outcome measures were extracted. Study results were summarized by the impact of communication breakdown during intrahospital transfer of patients, and the current deficiencies in the process. Results of interventions were summarized by their effect on the quality of handoff communication and patient safety. The initial search identified 516 individual articles, 24 of which satisfied the inclusion criteria. Some 19 were primary studies on handoff practices and deficiencies, and the remaining 5 were interventional studies. The studies were categorized according to the clinical settings involved in the intrahospital patient transfers. There is consistent evidence on the perceived impact of communication breakdown on patient safety during intrahospital transfers. Exposure of handoffs at patient transfers presents challenges that are not experienced in intershift handoffs. The distinct needs of the specific clinical settings involved in the intrahospital patient transfer must be considered when deciding on suitable interventions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) interdisciplinary communication patient care patient transport EMTREE MEDICAL INDEX TERMS human information dissemination organization and management review standard LANGUAGE OF ARTICLE English MEDLINE PMID 21706987 (http://www.ncbi.nlm.nih.gov/pubmed/21706987) PUI L362248189 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 603 TITLE Intra-hospital transport: University of Michigan SWAT Team takes the ICU to the patient. AUTHOR NAMES Stonebraker K. AUTHOR ADDRESSES (Stonebraker K.) CORRESPONDENCE ADDRESS K. Stonebraker, SOURCE The Michigan nurse (2011) 84:3 (10-12). Date of Publication: 2011 May-Jun ISSN 0026-2366 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient care patient transport EMTREE MEDICAL INDEX TERMS article human organization and management United States LANGUAGE OF ARTICLE English MEDLINE PMID 21744722 (http://www.ncbi.nlm.nih.gov/pubmed/21744722) PUI L362278540 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 604 TITLE Effect of team composition on the quality and efficiency of a paediatric intensive care transport team AUTHOR NAMES Clement M. Ramnarayan P. AUTHOR ADDRESSES (Clement M.; Ramnarayan P.) Children's Acute Transfer Service, London, United Kingdom. CORRESPONDENCE ADDRESS M. Clement, Children's Acute Transfer Service, London, United Kingdom. SOURCE Pediatric Critical Care Medicine (2011) 12:3 SUPPL. 1 (A70). Date of Publication: May 2011 CONFERENCE NAME 6th World Congress on Pediatric Critical Care: One World Sharing Knowledge CONFERENCE LOCATION Sydney, NSW, Australia CONFERENCE DATE 2011-03-13 to 2011-03-17 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Objectives: To examine the effect of three different team compositions (Consultant-led, Advanced Nurse Practitioner (ANP)-led and Fellow-led), on the quality and efficiency of a regional paediatric intensive care (PICU) transport team Methods: We conducted a retrospective analysis of prospective data from emergency transfers of critically ill children (April 2009 - August 2010). Details on patient demographics and composition of team, as well as key indicators of quality (physiological adverse events on retrieval and mortality within 24 hours of PICU admission) and efficiency (mobilization time, stabilization time and number of major interventions performed on retrieval) were collected. Analyses were adjusted for relevant confounding variables using appropriate regression models. Results: 1396 retrievals were analysed (133 consultant-led; 97 ANP-led; and 1166 fellow- led). There were no significant differences between the groups in terms of age or sex, but mean PIM-2 score and need for inotropic agents on retrieval were significantly greater for consultant-led retrievals (p<0.05). Rates of 24 hr PICU mortality and adverse events on retrieval were similar irrespective of team composition. However, stabilisation time was significantly lower among ANP-led retrievals even after adjustment for age, major interventions on retrieval and PIM-2 score (p= 0.01). Conclusions: We found no significant difference in quality in PICU retrievals performed by 3 different team compositions. ANP-led teams spent a shorter duration stabilising the patient, but performed similar numbers of major interventions. Our findings might be explained by standardization of the retrieval process as well as by the unique ability of ANP's to function both in a medical and nursing role during retrieval. EMTREE DRUG INDEX TERMS inotropic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS child confounding variable consultation critically ill patient emergency mobilization model mortality nurse practitioner nursing role patient standardization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70418700 DOI 10.1097/PCC.0b013e3182112e80 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182112e80 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 605 TITLE Delirium and coma in the ICU are associated with drug metabolism and transporter activity AUTHOR NAMES Skrobik Y. Michaud V. Leger C. Kubes P. Turgeon J. AUTHOR ADDRESSES (Skrobik Y., skrobik@sympatico.ca; Michaud V.; Turgeon J.) Universite De Montreal, Montreal, Canada. (Leger C.; Kubes P.) University of Calgary, Calgary, Canada. CORRESPONDENCE ADDRESS Y. Skrobik, Universite De Montreal, Montreal, Canada. Email: skrobik@sympatico.ca SOURCE American Journal of Respiratory and Critical Care Medicine (2011) 183:1 MeetingAbstracts. Date of Publication: 1 May 2011 CONFERENCE NAME American Thoracic Society International Conference, ATS 2011 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2011-05-13 to 2011-05-18 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Delirium and drug-induced coma are common in the critical care setting, and worsen morbidity, mortality, health care costs, and patient and caregiver distress. Adjusting opiates and benzodiazepines to patient symptoms is associated with only partial reduction in iatrogenic coma rates and no change in the incidence of delirium. Mechanisms attributable to pharmacokinetic or pharmacogenetic variables may contribute to these clinical pathologies. Coma and/or delirium may be associated with the amount of administered drug, serum drug levels, sedative drug metabolism, and/or transport across the blood brain barrier, all attributable to pharmacokinetic or pharmacogenetic variables. Specifically, midazolam and fentanyl compete with other drugs for the same systemic pathway. P-glycoprotein (MDR1) pathways affect blood brain barrier transport of opiates and benzodiazepines. Methods: in 86 consenting patients receiving intravenous fentanyl (F), midazolam (MDZ) or both, we evaluated administered drug dose, covariates likely to influence drug effect (age, BMI, renal and hepatic dysfunction, and delirium risk factors), concomitant administration of CYP3A4/5 and P-glycoprotein (MDR1) pathway-mediated drugs, MDR1 and CYP450 3A4/5 genetic polymorphisms, and drug levels for F and MDZ. Clinical outcomes (delirium and coma) were evaluated daily. Results: Days in iatrogenic coma were associated with administered F and MDZ doses (p= 0.0006 and p=0.117, respectively), with the co-administration of CYP3A4/5 inhibitors (p=0.0036), and with interleukin 1 and interleukin 6 levels. Days of delirium were not associated with either F or MDZ doses, and only associated with co-administration of MDR1 inhibitors (p=0.036). Conclusion: Iatrogenic coma and delirium do not appear to be mechanistically linked. In addition to drug exposure, coma appears to be associated with systemic drug metabolism and possibly with inflammatory status. Delirium, on the other hand, may be associated with blood brain transport mechanisms rather than systemic exposure. EMTREE DRUG INDEX TERMS ABC transporter subfamily B benzodiazepine derivative fentanyl interleukin 1 interleukin 6 midazolam opiate sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coma delirium drug metabolism society EMTREE MEDICAL INDEX TERMS blood blood brain barrier brain caregiver drug blood level drug dose drug effect drug exposure exposure genetic polymorphism health care cost human intensive care liver dysfunction morbidity mortality pathology patient pharmacokinetics risk factor LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70847000 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 606 TITLE Accumulation of carbapenemase-producing Gram-negative bacteria in a single patient linked to the acquisition of multiple carbapenemase-producing strains and to the in vivo transfer of a plasmid encoding VIM-1 AUTHOR NAMES Drieux L. Bourgeois-Nicolaos N. Cremniter J. Lawrence C. Macheras E. Jarlier V. Doucet-Populaire F. Sougakoff W. AUTHOR ADDRESSES (Drieux L.; Bourgeois-Nicolaos N.; Cremniter J.; Lawrence C.; Macheras E.; Jarlier V.; Doucet-Populaire F.; Sougakoff W.) Paris, Boulogne-Billancourt, Garches, France. CORRESPONDENCE ADDRESS L. Drieux, Paris, Boulogne-Billancourt, Garches, France. SOURCE Clinical Microbiology and Infection (2011) 17 SUPPL. 4 (S124). Date of Publication: May 2011 CONFERENCE NAME 21st ECCMID/27th ICC CONFERENCE LOCATION Milan, Italy CONFERENCE DATE 2011-05-07 to 2011-05-10 ISSN 1198-743X BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Objectives: Six imipenem-resistant strains were successively isolated from a single patient transferred from Greece to France in an Intensive Care Unit (ICU). A few days after his admission, 2 MDR Gram negative bacteria were isolated from rectal swab, Klebsiella pneumoniae (Kp1) and Providencia stuartii (Ps), and an imipenemresistant Pseudomonas aeruginosa (Pa) was cultured from tibial wound specimen. Two months later, a K. pneumoniae strain (Kp2), distinct from Kp1, was isolated from wound drain fluid. Two additional months later, 2 MDR Enterobacteriaceae, Proteus mirabilis (Pm) and Escherichia coli (Ec),were isolated from rectal swabs. The molecular bases of resistance to b-lactam antibiotics in these strains were investigated. Methods and Results: The Kp1 strain showed a synergy between imipenem and clavulanate, suggesting the production of a class A carbapenemase identified by PCR and DNA sequencing as KPC-2. Kp1 also harboured two bla genes encoding TEM-1 and the extendedspectrum β-lactamase (ESBL) SHV-12. The Ps, Pm and Ec strains were found to produce the metallo-β-lactamase (MBL) VIM-1 with an additional ESBL, SHV-5, while both Pa and Kp2 strains had blaVIM-1 alone. Genes encoding VIM-1 and SHV-5 were co-transferred to E. coli J53 by in vitro conjugation from Ps, Pm and Ec. Only blaVIM-1 was transferred from Kp2. The fingerprints obtained from plasmid DNA digestions of the transconjugants TCPs, TCPm and TCEc were highly similar, while the pattern obtained from TCKp2 was different. In all the MBL producers, the blaVIM-1 gene was integrated in a class I integron. PCR mapping of the variable region of the integron revealed three distinct types of cassette arrays, of which one corresponded to a truncated class-I integron shared by TCPs, TCPm and TCEc. In vivo conjugation in a gnotobiotic mouse model permitted the transfer of the integron carrying blaVIM-1 from the Ps strain to the recipient strain E. coli J53. Conclusions: The time sequence of β-lactamase producers detection, the molecular analysis of the genetic support of blaVIM-1 and the conjugation results obtained in vivo in the gnotobiotic mouse model strongly suggest the in-patient transfer between Ps, Pm and Ec of a plasmid carrying a truncated class-I integron harbouring blaVIM-1. This inter-species transfer, together with a probable acquisition of multiple multidrug-resistant bacteria, led to a worrying accumulation of carbapenemase-producing strains in a single patient. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carbapenemase EMTREE DRUG INDEX TERMS beta lactam antibiotic clavulanic acid DNA extended spectrum beta lactamase imipenem penicillinase plasmid DNA EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Gram negative bacterium human patient plasmid EMTREE MEDICAL INDEX TERMS bacterium conjugation digestion DNA sequence Enterobacteriaceae Escherichia coli finger dermatoglyphics France gene gnotobiotics Greece hospital patient in vitro study integron intensive care unit Klebsiella pneumoniae liquid model patient transport Proteus mirabilis Providencia stuartii Pseudomonas aeruginosa recipient species wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70599277 DOI 10.1111/j.1469-0691.2011.03558.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1469-0691.2011.03558.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 607 TITLE Advanced en-route critical care during combat operations. AUTHOR NAMES Cannon J.W. Zonies D.H. Benfield R.J. Elster E.A. Wanek S.M. AUTHOR ADDRESSES (Cannon J.W.) Uniformed Services University of the Health Sciences, Bethesda, MD, USA. (Zonies D.H.; Benfield R.J.; Elster E.A.; Wanek S.M.) CORRESPONDENCE ADDRESS J.W. Cannon, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. SOURCE Bulletin of the American College of Surgeons (2011) 96:5 (21-29). Date of Publication: May 2011 ISSN 0002-8045 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) general surgery patient transport war EMTREE MEDICAL INDEX TERMS article human military medicine LANGUAGE OF ARTICLE English MEDLINE PMID 22312820 (http://www.ncbi.nlm.nih.gov/pubmed/22312820) PUI L364448010 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 608 TITLE Standardized multidisciplinary protocol improves handover of cardiac surgery patients to the intensive care unit AUTHOR NAMES Joy B.F. Elliott E. Hardy C. Sullivan C. Backer C.L. Kane J.M. AUTHOR ADDRESSES (Joy B.F., bjoy@childrensmemorial.org; Kane J.M.) Division of Pediatric Critical Care, United States. (Elliott E.; Backer C.L.) Pediatric Cardiothoracic Surgery, United States. (Hardy C.) Pediatric Anesthesia, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States. (Sullivan C.) Children's Memorial Hospital, Children's Memorial Research Center, Chicago, IL, United States. CORRESPONDENCE ADDRESS B. F. Joy, Division of Pediatric Critical Care, United States. Email: bjoy@childrensmemorial.org SOURCE Pediatric Critical Care Medicine (2011) 12:3 (304-308). Date of Publication: May 2011 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT OBJECTIVES:: To determine whether the implementation of a standardized handover protocol could reduce the number of errors occurring during patient transitions from the operating room to the intensive care unit. DESIGN:: Prospective, interventional study. SETTING:: Pediatric cardiac intensive care unit. SUBJECTS:: Seventy-nine patient handovers in patients transitioning from the operating room to the cardiac intensive care unit after congenital cardiac surgery. INTERVENTIONS:: A preintervention assessment of patient handovers was obtained by direct observation using a standardized checklist. A teamwork-driven handover process and protocol was developed using traditional and novel quality-improvement techniques. The postimplementation observational assessment of handovers was performed using the same preintervention assessment tool. Preintervention and postintervention data metrics were analyzed and compared. MEASUREMENTS AND MAIN RESULTS:: Forty-one and 38 observations were performed in the preintervention and postintervention periods, respectively. Protocol implementation improved key areas of the handover process. Technical errors per handover were reduced from 6.24 to 1.52 (p < .0001), and critical verbal handoff information omissions were reduced from 6.33 to 2.38 (p < .0001) per handover. There was no change in duration of either the verbal handoff briefing or the overall handover process. Caregivers noted improvement in teamwork and handoff content received after the intervention. CONCLUSIONS:: A formal, structured handover process for pediatric patients transitioning to the intensive care unit after cardiac surgery can reduce medical errors that occur during the admission process and improve teamwork among caregivers. Copyright © 2011 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical protocol heart surgery patient transport EMTREE MEDICAL INDEX TERMS article cardiac patient controlled study human intensive care unit intervention study major clinical study medical error observational method operating room patient safety pediatric surgery priority journal prospective study standardization surgical patient teamwork verbal communication EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011262291 MEDLINE PMID 21057370 (http://www.ncbi.nlm.nih.gov/pubmed/21057370) PUI L51141435 DOI 10.1097/PCC.0b013e3181fe25a1 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3181fe25a1 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 609 TITLE The introduction of a nurse-led blind bedside jejunal tube insertion guideline in paediatric intensive care AUTHOR NAMES Macleod I. Greenock S. Davidson M. Spenceley N. Bird J. Gentles E. Ellis D. AUTHOR ADDRESSES (Macleod I.; Gentles E.) Women and Children's Directorate, RHSC, NHS Greater Glasgow and Clyde, United Kingdom. (Greenock S.; Davidson M.; Spenceley N.; Bird J.; Ellis D.) Paediatric Intensive Care Unit, RHSC, NHS Greater Glasgow and Clyde, United Kingdom. (Davidson M.; Spenceley N.) College of Medicine, Veterinary and Life Science, University of Glasgow, United Kingdom. (Bird J.) Department of Dietetics and Nutrition, RHSC, NHS Greater Glasgow and Clyde, United Kingdom. CORRESPONDENCE ADDRESS I. Macleod, Women and Children's Directorate, RHSC, NHS Greater Glasgow and Clyde, United Kingdom. SOURCE Pediatric Critical Care Medicine (2011) 12:3 SUPPL. 1 (A115). Date of Publication: May 2011 CONFERENCE NAME 6th World Congress on Pediatric Critical Care: One World Sharing Knowledge CONFERENCE LOCATION Sydney, NSW, Australia CONFERENCE DATE 2011-03-13 to 2011-03-17 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Objectives: To evaluate the success of jejunal tube placement in a paediatric intensive care unit (PICU) following the introduction of a nurse-led blind bedside jejunal tube insertion guideline. Methods: A prospective observational audit over a six month period. Data was entered into an electronic database and analysed using descriptive statistics. The audit was completed under clinical governance structures and registered with the local clinical effectiveness of fice, as per local guidelines. Results: 28 jejunal tube insertion attempts in 18 patients resulted in an overall success rate of 71.4%. 86% of placement attempts (n=24) were by nurses (n=8), of which 79.1% were successfully placed. On admission to PICU the study population had a median age of 43weeks (IQR 22-101, range 1-691) and median weight of 9.7kg (IQR 6-12.8, range 2.1 - 26.7). 78.6% of attempts were performed in patients who were invasively ventilated (n= 22), of which 2 were paralysed. Of the 6 attempts made in 5 non-ventilated patients, 2 attempts in the same patient were unsuccessful. Diagnostic categories included; cardiac surgery (33%), sepsis/meningococcal (22%), respiratory (11%) and burns (11%). The majority of attempts (79%) were initiated due to the unit's enteral feeding guideline, which was simultaneously introduced in January 2010. Conclusion: The use of this bedside technique of fers a reliable alternative to radiologically or endoscopically sited jejunal feeding tubes which would involve the intra-hospital transfer of a child requiring intensive care. The impact of introducing enteral feeding guidelines and nurse-led jejunal tube placement on enhancing nutritional care delivery warrants further investigation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nurse tube EMTREE MEDICAL INDEX TERMS child clinical audit clinical effectiveness data base diagnosis enteric feeding feeding apparatus health care quality heart surgery hospital intensive care unit patient population statistics ventilated patient weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70418939 DOI 10.1097/PCC.0b013e3182112e80 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182112e80 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 610 TITLE Does the use of low dose dopamine in the medical ward help prevent intensive care unit transfer? AUTHOR NAMES Khalid I. Soliman I.R. Qabajah M.R. Al-Zyoud A.A. Nisar A. DiGiovine B. AUTHOR ADDRESSES (Khalid I., doc_ik@yahoo.com; Soliman I.R.; Qabajah M.R.; Al-Zyoud A.A.) King Faisal Specialist Hospital, Research Center, Jeddah, Saudi Arabia. (Nisar A.) Oakwood Hospital, Medical Center, Dearborn, United States. (DiGiovine B.) Wayne State University, School of Medicine, Detroit, United States. CORRESPONDENCE ADDRESS I. Khalid, King Faisal Specialist Hospital, Research Center, Jeddah, Saudi Arabia. Email: doc_ik@yahoo.com SOURCE American Journal of Respiratory and Critical Care Medicine (2011) 183:1 MeetingAbstracts. Date of Publication: 1 May 2011 CONFERENCE NAME American Thoracic Society International Conference, ATS 2011 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2011-05-13 to 2011-05-18 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale: In most hospitals, patients who develop hypotension and require a vasopressor agent in addition to intravenous fluids are transferred to the intensive care unit (ICU). In our institution, however, use of up to 5 mcg/kg/min of dopamine is allowed on the medical ward to deal with the shortage of ICU beds. The impact of this policy on patient outcome is not known. Purpose: The purpose of this study is to evaluate whether using low dose dopamine in hypotensive patients in medical ward would prevent their transfer to ICU or impact their mortality. Methods: Rapid response team (RRT) is activated for any hypotensive patient with SBP <90 mm of Hg in our tertiary care hospital. We retrospectively looked at all those encounters from January 2009 till September 2010. Patients who were immediately transferred to the ICU were excluded. The patients who remained on the ward were divided into two groups; one requiring dopamine and the other without dopamine. Both groups received intravenous fluids for their hypotension. The primary outcome was transfer to the ICU within 48 hours from the RRT call and the secondary outcomes were ICU death and 28 day mortality. Data was analyzed using student's t test or Pearson's chi-square test, where appropriate. Results: A total of 346 RRT calls were activated for hypotension. 133 patients were immediately transferred to the ICU and were excluded. Out of the remaining 213 patients who stayed on the ward, 128 were treated with intravenous fluids only (F Group) and 85 required the additional use of dopamine up to 5 mcg/kg/min (D+F Group). Both groups received the same amount of fluids (F 634 ml;D+F 732 ml;p=0.37). There was no difference in the primary outcome measure of ICU transfer within 48 hours between the groups {F 22.7% (29/128 patients);D+F 28.2% (24/85 patients);p=0.35}. The ICU mortality {F10.2% (13/128);D+F10.6% (9/85);p=0.91} and the 28 day mortality was also not different {F 17.2% (22/128);D+F 12.9%(11/85);p=0.4}. The lack of difference in outcome was seen despite the fact that 72% (61/85) of the patients treated with dopamine did not require an ICU admission. Conclusion: Our experience would suggest that low dose dopamine up to 5 mcg/kg/min on the medical ward can be used safely to avoid ICU transfer in selected hypotensive patients. Identification of such patients and findings of this study need to be evaluated in a prospective trial. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) dopamine EMTREE DRUG INDEX TERMS antihypertensive agent hypertensive agent infusion fluid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit low drug dose society ward EMTREE MEDICAL INDEX TERMS chi square test death hospital human hypotension liquid mortality patient policy rapid response team Student t test tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70846068 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 611 TITLE The transfer of parents from picu to the ward AUTHOR NAMES Boyles C. Langley R. AUTHOR ADDRESSES (Boyles C.; Langley R.) Southampton University, Hospitals NHS Trust, United Kingdom. CORRESPONDENCE ADDRESS C. Boyles, Southampton University, Hospitals NHS Trust, United Kingdom. SOURCE Pediatric Critical Care Medicine (2011) 12:3 SUPPL. 1 (A64-A65). Date of Publication: May 2011 CONFERENCE NAME 6th World Congress on Pediatric Critical Care: One World Sharing Knowledge CONFERENCE LOCATION Sydney, NSW, Australia CONFERENCE DATE 2011-03-13 to 2011-03-17 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: Discharge from PICU to a general ward area can provoke stress and anxiety. Interventions to help the family cope with this have financial implications that compete with other areas of healthcare. Aim: The aim of the service evaluation was to identify parental needs at the time of discharge from PICU. An additional aim was to assess ifthe needs of parents whose child stayed longer than 7 days (Group 1) have different needs to parents whose child was discharged within 48 hours (Group 2) Results: Data was collected using a locally developed questionnaire guided by literature and interview of 3 sets of parents. The results show that there were differences in the needs of the 2 groups, although many common needs were identified. Timely communication of discharge plan, prompt assessment by ward medical staff, and follow-up by PICU staff were identified as areas for improvement. Implications: Parents of children discharged from PICU have many common needs. These can be addressed by implementing simple changes in practice such as timely communication and a discharge plan. Parents whose children stay longer than 7 days may need an individual assessment. These interventions may not only improve satisfaction of the service, but also have the potential to save costs subsequently by reducing stress and anxiety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care parent ward EMTREE MEDICAL INDEX TERMS anxiety child follow up health care interpersonal communication interview medical staff questionnaire satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70418670 DOI 10.1097/PCC.0b013e3182112e80 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182112e80 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 612 TITLE Leadership strategies in transport team recruitment and retention AUTHOR NAMES Caron S. AUTHOR ADDRESSES (Caron S.) Royal Roads University, Victoria, Canada. CORRESPONDENCE ADDRESS S. Caron, Royal Roads University, Victoria, Canada. SOURCE Pediatric Critical Care Medicine (2011) 12:3 SUPPL. 1 (A67). Date of Publication: May 2011 CONFERENCE NAME 6th World Congress on Pediatric Critical Care: One World Sharing Knowledge CONFERENCE LOCATION Sydney, NSW, Australia CONFERENCE DATE 2011-03-13 to 2011-03-17 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Objectives: This qualitative action research project was created to explore the positive potential of recruitment and retention solutions for our pediatric critical care transport team and arrive at insights, recommendations, and strategies to move forward on this innovative two-person transport team. Methods: The study involved 15 people in 2 phases of research and was conducted in Calgary, Canada. Participants included multidisciplinary stakeholders from the aero- medical transport community, neonatal intensive care unit, and pediatric intensive care unit including nurses, paramedics, respiratory therapists, and managers. Results: The main themes of education, leadership, and teamwork will be explored in this section. Education was a strong recruitment and retention strategy that was recorded in both phases of the research. The data from phase one suggested a leader that displays such leadership behaviors as inclusiveness and collaboration with team members, and has a sense of purpose. From a teamwork perspective, differences in perception may exist between the two phases of this research that influences team interaction in establishing trust in teams. Conclusion: This study expanded upon three recommendations to improve recruitment and retention. Establishing a healthy culture is the first recommendation for the RN-RRT Transport team and a crucial component of enhancing recruitment and retention practices in the transport team. The second recommendation would be to enhance communication skills to support and develop the leadership skills of RN-RRT Transport team members. The third recommendation would be to reframe the notion of the transport team to be inclusive of entire PICU staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care leadership EMTREE MEDICAL INDEX TERMS action research Canada communication skill community education intensive care unit manager newborn intensive care nurse respiratory therapist skill teamwork LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70418682 DOI 10.1097/PCC.0b013e3182112e80 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182112e80 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 613 TITLE Outcomes following a rapid response and the impact on transfer to the Intensive Care Unit AUTHOR NAMES Panico M. Pisani M. Jenq G. Araujo K. Honiden S. AUTHOR ADDRESSES (Panico M., megan.panico@yale.edu; Pisani M.; Jenq G.; Araujo K.; Honiden S.) Yale University, New Haven, United States. CORRESPONDENCE ADDRESS M. Panico, Yale University, New Haven, United States. Email: megan.panico@yale.edu SOURCE American Journal of Respiratory and Critical Care Medicine (2011) 183:1 MeetingAbstracts. Date of Publication: 1 May 2011 CONFERENCE NAME American Thoracic Society International Conference, ATS 2011 CONFERENCE LOCATION Denver, CO, United States CONFERENCE DATE 2011-05-13 to 2011-05-18 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT RATIONALE: There is conflicting data on the impact of Rapid Response Teams (RRT) on outcomes. There is no data on process of care after patients undergo an RRT. Examining outcomes from RRT's are crucial to optimizing valuable resources in the hospital. Understanding process of care and outcomes related to RRTs will help physicians to better triage patients during an RRT as well as improve discussions with patients on code status and what it means to transfer to an ICU level of care. We sought to examine the demographics of patients who underwent an RRT at our institution and evaluate outcomes. METHODS: Retrospective Descriptive Study of 260 RRT calls over three and half months in 2009. Reason for RRT call, clinical characteristics, and changes in status were collected. We examined which patients were being transferred to the ICU based on age, acuity (APACHE II) and reason for RRT. We examined changes in code status, hospital mortality and discharge location. RESULTS: of the 260 patient's evaluated (Table 1), 131 remained on the floor, 16 were transferred to step down and 113 were transferred to the ICU. The average APACHE II score for patients who remained on the floor versus those transferred to the ICU was 14.7 versus 20.9 (p<0.0001). RRT's called for hypoxia and“staff worried” were significantly more likely to be transferred to a higher level of care. Patients with dementia were less likely to be transferred to the ICU (8% to ICU vs. 21% remained on floor). of patients remaining on the floor 27% were DNR/DNI, while 9% of ICU transfers were DNR/DNI. of patients transferred to the ICU 25% had code status changes to less aggressive. Forty percent of the patient's transferred to the ICU died and, 28% of patients remaining on the floor died. Among patients admitted from home who were transferred to the ICU 35% returned home, 21% were admitted to a facility and 42% died. Among patients who were admitted from home and remained on the floor 52% returned home, 22% were admitted to a facility and 22% died. (Table presented) CONCLUSION: RRT's identify sicker patients who may benefit from ICU care. Patients with dementia and DNR/DNI orders were less likely to be transferred to the ICU after an RRT. Interestingly 25% of ICU transfers had their code status changed to DNR/DNI after RRT. Further research is needed regarding which patients receive benefit from ICU transfer after RRT's. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit society EMTREE MEDICAL INDEX TERMS APACHE dementia emergency health service hospital human hypoxia mortality patient physician rapid response team LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70849032 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 614 TITLE Immediate postoperative extubation in patients undergoing free tissue transfer AUTHOR NAMES Allak A. Nguyen T.N. Shonka Jr. D.C. Reibel J.F. Levine P.A. Jameson M.J. AUTHOR ADDRESSES (Allak A.; Nguyen T.N.; Shonka Jr. D.C.; Reibel J.F.; Levine P.A.; Jameson M.J., mjj4e@virginia.edu) Department of Otolaryngology-Head and Neck Surgery, University of Virginia, PO Box 800713, Charlottesville, VA, 22908-0713, United States. CORRESPONDENCE ADDRESS A. Allak, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, PO Box 800713, Charlottesville, VA, 22908-0713, United States. SOURCE Laryngoscope (2011) 121:4 (763-768). Date of Publication: April 2011 ISSN 0023-852X BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Objectives/Hypothesis: Extubation (cessation of ventilatory support) is often delayed in free flap patients to protect the microvascular anastomosis, presumably by reducing emergence-related agitation. We sought to determine if immediate extubation in the operating room (OR) would improve the postoperative course compared to delayed extubation in the intensive care unit (ICU). Study Design: Retrospective chart review. Methods: Medical records of all patients undergoing free tissue transfer for head and neck reconstruction between January 2009 and July 2010 were reviewed (n = 52). Patients extubated immediately postoperatively in the OR (immediate group, n = 26) were compared to patients extubated in the ICU (delayed group, n = 26). Results: Tobacco use, alcohol use, pulmonary history, case length, and free flap type were not significantly different between the two groups. Although the average ICU stay for the immediate group was significantly shorter than the delayed group (2.0 days vs. 3.4 days; P =.008), the reduction in overall hospital stay for the immediate group did not achieve statistical significance (8.2 days vs. 9.5 days; P =.21). Use of treatment for agitation (27% vs. 65%) and physical restraints (8% vs. 69%) were significantly lower in the immediate versus delayed group (P =.01 and P <.001, respectively). Although flap-related, surgical, and medical complication rates were not significantly different between the two groups, the delayed extubation group had a significantly higher incidence of pneumonia (15% vs. 0%; P =.05). Conclusions: Immediate postoperative extubation in the OR following head and neck microvascular free tissue transfer reduces ICU stay, anxiolytic use, restraint use, and incidence of pneumonia without an increase in flap- or wound-related complications. © 2011 The American Laryngological, Rhinological, and Otological Society, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extubation free tissue graft EMTREE MEDICAL INDEX TERMS agitation alcohol consumption anamnesis article cigarette smoking controlled study head and neck surgery hospitalization human incidence intensive care unit major clinical study medical record operating room pneumonia postoperative complication postoperative period priority journal EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011170651 MEDLINE PMID 21433018 (http://www.ncbi.nlm.nih.gov/pubmed/21433018) PUI L361507720 DOI 10.1002/lary.21397 FULL TEXT LINK http://dx.doi.org/10.1002/lary.21397 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 615 TITLE What do relatives experience when patients are transferred from intensive care units to general wards AUTHOR NAMES Lauberg A. Jacobsen C.J. AUTHOR ADDRESSES (Lauberg A.; Jacobsen C.J.) Aalborg Hospital of the Aarhus University Hospital, Aalborg, Denmark. CORRESPONDENCE ADDRESS A. Lauberg, Aalborg Hospital of the Aarhus University Hospital, Aalborg, Denmark. SOURCE European Journal of Cardiovascular Nursing (2011) 10 SUPPL. 1 (S25). Date of Publication: April 2011 CONFERENCE NAME 11th Annual Spring Meeting on Cardiovascular Nursing CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2011-04-01 to 2011-04-02 ISSN 1474-5151 BOOK PUBLISHER Elsevier ABSTRACT Background: In international studies the dilemma that relatives face when a patient is transferred from intensive care unit to a general ward is illustrated. The dilemma stands between a concern that the close observation in the intensive care unit is completed and transfer to a general ward is an indication that the patient is recovering. This can cause anxiety and depression in relatives. Several studies have shown that there is a correlation between relatives coping ability and patient progress in the aftermath. And it appears that support of relatives optimizes the effect of the care and rehabilitation the patient receives. Purpose: The purpose in this study is to investigate relatives' experiences from the transfer of patients from the intensive care unit to the ward with the aim of developing nursing practice. Method: A hermeneutic-phenomenological study was designed intending to gain insight in relatives' experiences and perception of the transfer. Six family members were interviewed after the transfer. Result: Relatives seem to want to be physically present to be able to exercise natural care. A need for single rooms where relatives can be present and the patient is screened from the outside world, and tranquil surroundings reduce tension. One relative said: when the threads of life are pulled out conversation is urgent. Conclusions: The professionals must pay attention to relatives in order to secure a successful transfer. Good dialogs give voice to the anxiety that relatives' experiences and are essential in nursing practice to patients and relatives. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiovascular nursing intensive care unit patient ward EMTREE MEDICAL INDEX TERMS anxiety conversation coping behavior exercise nursing practice phenomenology rehabilitation voice LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70431830 DOI 10.1016/S1474-5151(11)60092-3 FULL TEXT LINK http://dx.doi.org/10.1016/S1474-5151(11)60092-3 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 616 TITLE Performance of an automated external defibrillator during simulated rotor-wing critical care transports AUTHOR NAMES Je S.M. You J.S. Chung T.N. Park Y.S. Chung S.P. Park I.C. AUTHOR ADDRESSES (Je S.M.; You J.S.; Chung T.N.; Park Y.S.; Chung S.P.; Park I.C., incheol@yuhs.ac) Department of Emergency Medicine, Yonsei University College of Medicine, 250 Seongsanno, (134 Sinchon-dong), Seodaemun-gu, 120-752 Seoul, South Korea. CORRESPONDENCE ADDRESS I.C. Park, Department of Emergency Medicine, Yonsei University College of Medicine, 250 Seongsanno, (134 Sinchon-dong), Seodaemun-gu, 120-752 Seoul, South Korea. Email: incheol@yuhs.ac SOURCE Resuscitation (2011) 82:4 (454-458). Date of Publication: April 2011 ISSN 0300-9572 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objective: This study aimed to evaluate whether an automated external defibrillator (AED) was accurate enough to analyze the heart rhythm during a simulated rotor wing critical care transport. We hypothesized that AED analysis of the simulated rhythms during a helicopter flight would result in significant errors (i.e., inappropriate shocks, analysis delay). Methods: Three commercial AEDs were tested for analyzing the heart rhythm in a helicopter using a manikin and a human volunteer. Ventricular fibrillation (VF), sinus rhythm, and asystole were simulated by using an arrhythmia simulator of the manikin. The intervals from analysis to shock recommendation were collected on a stationary and in-motion helicopter. Sensitivity and specificity of three AEDs were also calculated. Vibration intensities were measured with a digital vibration meter placed on the chest of the manikin/human volunteer both on the stretcher and on the floor of the helicopter. Results: All AEDs correctly recommended shock delivery for the cardiac rhythms of the manikin. Sensitivity for VF was 100.0% (95% CI 91.2-100.0) and specificity for sinus rhythm and asystole were 100.0% (95% CI 91.2-100.0). Although the recorded ECG rhythms of the volunteer in an in-motion helicopter showed baseline artifacts, all AEDs analyzed the cardiac rhythm of the volunteer correctly and did not recommend shock delivery. On the floor of the helicopter, the median measured vibration intensity was 6.6m/s(2) (IQR 5.5-7.7m/s(2)) with significantly less vibrations transmitted to the manikin/human volunteer chest (manikin median 3.1m/s(2), IQR 2.2-4.0m/s(2); human volunteer median 0.95m/s(2), IQR 0.65-1.25m/s(2)). Conclusion: This study suggested that current AEDs could analyze the heart rhythm correctly during simulated helicopter transport. Further studies using an animal model would be needed before applying to patients. © 2011 Elsevier Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) automated external defibrillator intensive care EMTREE MEDICAL INDEX TERMS accuracy air medical transport article audiovisual equipment electrocardiogram heart arrest heart arrhythmia heart rhythm heart ventricle fibrillation helicopter human male patient transport priority journal rotor wing critical care transport sensitivity and specificity shock sinus rhythm thorax vibration DEVICE TRADE NAMES Heartstart MRx , United StatesPhillips Lifegain HD1 , South Koreacu medical systems Lifepak 12 , United StatesMedtronic VitalSim , NorwayLaerdal DEVICE MANUFACTURERS (South Korea)cu medical systems (Norway)Laerdal (United States)Medtronic (United States)Phillips EMBASE CLASSIFICATIONS Internal Medicine (6) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011146981 MEDLINE PMID 21236548 (http://www.ncbi.nlm.nih.gov/pubmed/21236548) PUI L51227992 DOI 10.1016/j.resuscitation.2010.11.027 FULL TEXT LINK http://dx.doi.org/10.1016/j.resuscitation.2010.11.027 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 617 TITLE Introducing physician's assistants into PICU-disparities, solutions and transferable lessons AUTHOR NAMES White H. Round J. AUTHOR ADDRESSES (White H.; Round J.) Center for Medical and Healthcare Education, St. George's, University of London, London, United Kingdom. CORRESPONDENCE ADDRESS H. White, Center for Medical and Healthcare Education, St. George's, University of London, London, United Kingdom. SOURCE Archives of Disease in Childhood (2011) 96 SUPPL. 1 (A91-A92). Date of Publication: April 2011 CONFERENCE NAME Annual Conference of the Royal College of Paediatrics and Child Health, RCPCH 2011 CONFERENCE LOCATION Warwick, United Kingdom CONFERENCE DATE 2011-04-05 to 2011-04-07 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Aims: To identify transferable lessons from the introduction of Physicians Assistants (PAs) into the Paediatric Intensive Care Unit (PICU) in a large teaching hospital. The PICU had seen increasing admissions, but trainee hours had reduced. Along with transition to consultant-delivered service, three PAs were appointed in 2010 to provide long-term support to the multidisciplinary team. PAs are well known in the US, but new to paediatrics and PICU. Methods: We sought to capture staff opinions and measure the function of PAs before starting, at 3 weeks and at 2 months after starting. An anonymous questionnaire, an online survey and semi-structured interviews were distributed to and conducted with all professionals working on the PICU. Areas explored were function of PAs, the impact on the PICU and teamworking. Results: Pre-start questionnaire-50% of the doctors and 30% of the nurses answered the questionnaire. 10/20 responses stated the addition of PA's would ease/augment their individual role. 17/30 responses expected an overall positive impact on the unit and 13/30 expected an improvement in quality/ continuity of patient care. 12/28 anticipated a threat, including reduced training opportunities and deskilling. 12/39 expected confusion regarding the role and lines of accountability of the PAs. 3 week online questionnaire-despite being sent to all 52 permanent staff, only nine completed the survey. Of the responses, two noted a positive impact, highlighting their hard work and enthusiasm, releasing more clinical time for patient care. 7/9 felt that the PAs would improve unit function in time. Concern was again expressed around training opportunities. One respondent detailed disparities in pay banding between PAs and nurses. 6/9 thought that the trust should have invested in advanced nurse practitioners instead. At 2 months, semi-structured interviews have highlighted an emerging respect for their contribution of function of the unit out of hours, patient assessment and patient-related administration. Concern of disparities in pay/abilities remains within some nurses. Conclusion: There are many solutions to workforce challenges. PAs are expected to become a viable one, but their introduction needs to encompass public relations and pay banding as well as operational and training needs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health college pediatrics physician assistant EMTREE MEDICAL INDEX TERMS consultation human intensive care unit nurse nurse practitioner patient patient assessment patient care physician public relations questionnaire semi structured interview student teaching hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70504242 DOI 10.1136/adc.2011.212563.212 FULL TEXT LINK http://dx.doi.org/10.1136/adc.2011.212563.212 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 618 TITLE I(3)-assist: Individual, interactive and integrated cardiopulmonary assist - A concept AUTHOR NAMES Wagner G. Schlanstein P. Arens J. Kopp R. Bensberg R. Rossaint R. Schmitz-Rode T. Steinseifer U. AUTHOR ADDRESSES (Wagner G.; Schlanstein P.; Arens J.; Schmitz-Rode T.; Steinseifer U.) Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Germany. (Kopp R.; Bensberg R.; Rossaint R.) Department of Intensive Care Medicine, University Hospital Aachen, RWTH Aachen University, Germany. CORRESPONDENCE ADDRESS G. Wagner, Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Germany. SOURCE Artificial Organs (2011) 35:4 (A9). Date of Publication: April 2011 CONFERENCE NAME 7th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Bypass CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2011-05-05 to 2011-05-07 ISSN 0160-564X BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Background: Current heart-lung-machines (HLMs) and extracorporeal life support (ECLS) are available in a few, often only three, sizes of components like oxygenators and heat exchangers. Considering the body weight range from neonates to adults, suitable adaptations for patients' needs are mostly impossible. Additionally, if components have to be replaced, e.g. due to failure, the entire system needs to be stopped. As the components of HLMs and ECLS are identical only in parts, another extracorporeal system must be installed when changing over from HLM to ECLS, unavoidably causing hemodilution. In order to diminish these known limitations we designed an entirely new concept conjoining HLM and ECLS. Methods: I(3)-Assist aims at developing a highly integrated and modular extracorporeal system which can be adapted to individual treatment needs of the patient. To achieve an optimized priming volume and contact surface, oxygenator and heat exchanger modules in only one size will be provided. These modules can be combined by the user to achieve the gas/heat exchange area suitable for the individual patient (e.g. one for a neonate, five for a small or eight for a tall adult). Additionally, all modules of an HLM/ECLS system will be exchangeable under operating conditions. Thus, an immediate and seamless transition between operation modes can be carried out and the system can be modified according to changing individual needs during surgery and therapy. Due to the highly integrated design the system can be placed near the operating table and can be used for inter- and intrahospital transport. The key feature of the design is the development of a safe and easy connection of the different modules. First in vitro experiments (Fig. 1) demonstrate the feasibility of the modular design regarding flow regulation and pressure build-up. Results: Using flows from 100-800 mL/min the pressure loss over each module was determined. The total loss was equal to conventional oxygenators with integrated heat exchangers. The oxygenators represented 2/3, the heat exchanger 1/3 of the loss. Due to the passive custom made dividing and collection units, each line was equally exposed to the systems flow within a range of ± 3 %. Conclusions: The I(3)-Assist project is focused on developing a highly integrated and modular system of life-supporting functional units. This system can be used as a heart-lung-machine (HLM), but also as an extracorporeal life support (ECLS), and for inter-plus intrahospital transportation. Furthermore, the system can be adapted to the individual and varying requirements of patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assisted circulation cardiopulmonary bypass EMTREE MEDICAL INDEX TERMS adaptation adult body weight heart lung machine heat hemodilution human in vitro study newborn operating table oxygenator patient surgery therapy traffic and transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70524783 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 619 TITLE Transferring VLBW infants from the delivery room (DR) to the NICU. How vigilant are we in avoiding hypoxia/hyperoxia during the first “golden hour”? AUTHOR NAMES Simionato L. Saraswat A. Dawson J.A. Thio M. Davis P.G. AUTHOR ADDRESSES (Simionato L., lauren.simionato@thewomens.org.au; Saraswat A.; Davis P.G.) Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia. (Dawson J.A.; Thio M.; Davis P.G.) Division of Neonatal Services, Royal Women's Hospital, Melbourne, Australia. (Davis P.G.) Murdoch Childrens Research Institute, Melbourne, Australia. CORRESPONDENCE ADDRESS L. Simionato, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia. Email: lauren.simionato@thewomens.org.au SOURCE Journal of Paediatrics and Child Health (2011) 47 SUPPL. 1 (16-17). Date of Publication: April 2011 CONFERENCE NAME 15th Annual Congress of the Perinatal Society of Australia and New Zealand, PSANZ 2011 CONFERENCE LOCATION Hobart, TAS, Australia CONFERENCE DATE 2011-04-10 to 2011-04-13 ISSN 1034-4810 BOOK PUBLISHER Blackwell Publishing ABSTRACT Background: Clinicians are aware of the dangers of hyperoxia and hypoxia in the DR and NICU. Less attention has been paid to the period of transportation to and early stabilisation in the NICU. We aimed to investigate the proportion of time infants spent with SpO(2) in the range 85-94% during this early postnatal period, continuing to 60 minutes after birth. Method: A prospective observational study of clinical practice was undertaken from August to November 2011. Infants <32 weeks gestation with no congenital abnormalities were enrolled. A pulse oximeter (PO) sensor was applied to the right hand after birth, remaining connected until 60 minutes of age. Clinical activities (e.g. resuscitation, line insertion) were also recorded during this time and matched with PO SpO(2) data for analysis. Analysis of hyperoxic periods was only performed when infants were in supplemental O(2). Clinicians were blinded to the aims of the study. Results: 12 infants were studied (mean (SD) birth weight 1031 (258) g, gestational age 29 (2) weeks]. Mean (SD) times spent in the transport cot and NICU were 8.6 (4.1) minutes and 35.9 (4.7) minutes respectively. During transport, median (IQR) SpO(2) was 94 (88-96) %, and in NICU 93 (90-96) %. Infants had a SpO(2) < 85% for 9.3% of transport time, and a SpO(2) > 94% for 33% of this time. In the NICU, mean 9.2% of SpO(2) was <85%, while SpO(2) was >94% for 27.4% of this time. Conclusions: SpO(2) measurements often fell outside the target range during the early postnatal period. We noted that clinicians accept saturations higher than the “safe” range during the first hour after birth. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Australia and New Zealand delivery room human infant society very low birth weight EMTREE MEDICAL INDEX TERMS birth weight clinical practice congenital disorder gestational age hyperoxia hypoxia observational study perinatal period pregnancy pulse oximeter resuscitation sensor traffic and transport LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70656097 DOI 10.1111/j.1440-1754.2011.02046.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1440-1754.2011.02046.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 620 TITLE Intrahospital transportation of the seriously ill patient. The need for an action guideline ORIGINAL (NON-ENGLISH) TITLE Transporte intrahospitalario del paciente grave. Necesidad de unaguía de actuación AUTHOR NAMES Noa Hernández J.E. González E.C. Romero J.M.C. Baños L.C.D. AUTHOR ADDRESSES (Noa Hernández J.E., jonoa@infomed.sld.cu; González E.C.; Romero J.M.C.; Baños L.C.D.) Unidad de Cuidados Intensivos, Hospital Universitario Dr. Miguel Enríquez, Ciudad de la Habana, Cuba. CORRESPONDENCE ADDRESS J.E. Noa Hernández, Unidad de Cuidados Intensivos, Hospital Universitario Dr. Miguel Enríquez, Ciudad de la Habana, Cuba. Email: jonoa@infomed.sld.cu SOURCE Enfermeria Intensiva (2011) 22:2 (74-77). Date of Publication: April-June 2011 ISSN 1130-2399 1578-1291 (electronic) BOOK PUBLISHER Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain. ABSTRACT The basics caused by the transportation of a patient in serious condition within the same hospital are varied, all of them involving a risk to the patient's stability and a responsibility for the accompanying professionals. The care that supposes the appropriate attention to the patient and the need for coordination among the parties make it necessary to homogenize the transfer criteria and those of the necessary previous maneuvers. This work has been carried out based on the lack of an intervention system that guides this practice. This work describes the possible intrahospital itineraries, the transport of this kind of patient, the phases of this type of transport as well as the most frequent physiologic alterations. The purpose of all this is to develop an action algorithm for the serious patient's intrahospital transportation and to reduce the incidence of adverse events during this transfer. A classification system that makes it possible to calculate the level of risk and to anticipate the care needs that a patient may require during the transfer is presented. © 2010 Elsevier España, S.L. y SEEIUC. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS article human methodology practice guideline standard LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY Spanish, English MEDLINE PMID 21256064 (http://www.ncbi.nlm.nih.gov/pubmed/21256064) PUI L51238619 DOI 10.1016/j.enfi.2010.08.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.enfi.2010.08.002 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 621 TITLE Serious injuries related to the Segway® personal transporter: A case series AUTHOR NAMES Boniface K. McKay M.P. Lucas R. Shaffer A. Sikka N. AUTHOR ADDRESSES (Boniface K.; McKay M.P., mmckay@mfa.gwu.edu; Lucas R.; Shaffer A.; Sikka N.) Department of Emergency Medicine, George Washington University, Washington, DC, United States. CORRESPONDENCE ADDRESS M. P. McKay, Center for Injury Prevention and Control, George Washington University Medical Center, 2150 Pennsylvania Ave, Ste 2B-409, Washington, DC 20037, United States. Email: mmckay@mfa.gwu.edu SOURCE Annals of Emergency Medicine (2011) 57:4 (370-374). Date of Publication: April 2011 ISSN 0196-0644 1097-6760 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Study objective: We describe a case series of emergency department (ED) visits for injuries related to the Segway® personal transporter. Methods: This was a retrospective case review using a free-text search feature of an electronic ED medical record to identify patients arriving April 2005 through November 2008. Data were hand extracted from the record, and further information on admitted patients was obtained from the hospital trauma registry. Results: Forty-one cases were included. The median age was 50 years, and 30 patients (73.2%) were women. Twenty-nine (70.7%) of the patients resided outside the District of Columbia, Maryland, and Virginia, and 32 (78.1%) arrived between June and September. Seven (17.1%) patients had documented helmet use. Ten (24.4%) were admitted. Four patients (40% of admitted patients) required admission to the ICU. Conclusion: The severity of trauma in this case series of patients injured by the use of the self-balancing personal transporter is significant. Further investigation into the risks of use, as well as the optimal length and type of training or practice, is warranted. A distinct E-code and Consumer Product Safety Commission's product code is needed to enable further investigation of injury risks for this mode of transportation. © 2010 American College of Emergency Physicians. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) electrical equipment emergency care multiple trauma (disease management) personal transporter EMTREE MEDICAL INDEX TERMS acetabulum fracture (disease management) achilles tendon rupture (disease management) adolescent adult aged article brain contusion (disease management) case study clavicle fracture (disease management) clinical article comminuted fracture (disease management, surgery) device safety disease registry electronic medical record emergency ward face fracture (disease management, surgery) female head injury (disease management) helmet hospital admission hospital charge human humerus fracture (disease management) injury scale (disease management) injury severity intensive care unit intraarticular fracture (disease management) lumbar spine male malleolus fracture (disease management) mandible fracture (disease management) maxillary sinus medical education medical fee medical record review mouth injury (disease management) nose fracture (disease management) olecranon fracture (disease management) pneumothorax (disease management) priority journal product safety radius head fracture (disease management) retrospective study rib fracture (disease management) scoring system subarachnoid hemorrhage (disease management) subdural hematoma (disease management) tibia fracture (disease management, surgery) traffic and transport United States zygoma arch fracture (disease management) DEVICE TRADE NAMES Segway , United Statessegway DEVICE MANUFACTURERS (United States)segway EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Otorhinolaryngology (11) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Orthopedic Surgery (33) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011177032 MEDLINE PMID 20889236 (http://www.ncbi.nlm.nih.gov/pubmed/20889236) PUI L51094550 DOI 10.1016/j.annemergmed.2010.06.551 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2010.06.551 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 622 TITLE Accumulation and transport of microbial-size particles in a pressure protected model burn unit: CFD simulations and experimental evidence AUTHOR NAMES Beauchêne C. Laudinet N. Choukri F. Rousset J. Benhamadouche S. Larbre J. Chaouat M. Benbunan M. Mimoun M. Lajonchère J. Bergeron V. Derouin F. AUTHOR ADDRESSES (Beauchêne C., christian.beauchene@edf.fr; Rousset J., jean-luc.rousset@edf.fr; Benhamadouche S., sofiane.benhamadouche@edf.fr) Electricité De France Research and Development, 6 quai Watier, 78400 Chatou, France. (Laudinet N., nicolas.laudinet@airinspace.com; Larbre J., Juliette.LARBRE@ineris.fr; Bergeron V., vance.bergeron@ens-lyon.fr) Airinspace SAS, Montigny, France. (Choukri F., firaschoukri@hotmail.fr; Derouin F., francis.derouin@sls.aphp.fr) Laboratory of Parasitology-Mycology, Saint-Louis hospital, Assistance Publique-Hôpitaux de Paris and University Paris, Diderot, France. (Chaouat M., marc.chaouat@sls.aphp.fr; Mimoun M., maurice.mimoun@sls.aphp.fr) Burn Centre, Department of Reconstructive/Plastic Surgery, Rothschild Hospital, Paris, France. (Benbunan M., marc.benbunan@sls.aphp.fr) Cell Therapy Unit, Saint-Louis hospital, Assistance Publique-Hôpitaux de Paris, France. (Lajonchère J., direction@hpsj.fr) Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France. (Bergeron V., vance.bergeron@ens-lyon.fr) CNRS UMR, Ecole Normale Supérieure de Lyon, 46 allée d'Italie, 69007, Lyon, France. CORRESPONDENCE ADDRESS F. Derouin, Laboratory of Parasitology-Mycology, Saint-Louis hospital, Assistance Publique-Hôpitaux de Paris, and University Paris, Diderot, France. Email: francis.derouin@sls.aphp.fr SOURCE BMC Infectious Diseases (2011) 11 Article Number: 58. Date of Publication: 3 Mar 2011 ISSN 1471-2334 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: Controlling airborne contamination is of major importance in burn units because of the high susceptibility of burned patients to infections and the unique environmental conditions that can accentuate the infection risk. In particular the required elevated temperatures in the patient room can create thermal convection flows which can transport airborne contaminates throughout the unit. In order to estimate this risk and optimize the design of an intensive care room intended to host severely burned patients, we have relied on a computational fluid dynamic methodology (CFD).Methods: The study was carried out in 4 steps: i) patient room design, ii) CFD simulations of patient room design to model air flows throughout the patient room, adjacent anterooms and the corridor, iii) construction of a prototype room and subsequent experimental studies to characterize its performance iv) qualitative comparison of the tendencies between CFD prediction and experimental results. The Electricité De France (EDF) open-source software Code_Saturne(® )(http://www.code-saturne.org) was used and CFD simulations were conducted with an hexahedral mesh containing about 300 000 computational cells. The computational domain included the treatment room and two anterooms including equipment, staff and patient. Experiments with inert aerosol particles followed by time-resolved particle counting were conducted in the prototype room for comparison with the CFD observations.Results: We found that thermal convection can create contaminated zones near the ceiling of the room, which can subsequently lead to contaminate transfer in adjacent rooms. Experimental confirmation of these phenomena agreed well with CFD predictions and showed that particles greater than one micron (i.e. bacterial or fungal spore sizes) can be influenced by these thermally induced flows. When the temperature difference between rooms was 7°C, a significant contamination transfer was observed to enter into the positive pressure room when the access door was opened, while 2°C had little effect. Based on these findings the constructed burn unit was outfitted with supplemental air exhaust ducts over the doors to compensate for the thermal convective flows.Conclusions: CFD simulations proved to be a particularly useful tool for the design and optimization of a burn unit treatment room. Our results, which have been confirmed qualitatively by experimental investigation, stressed that airborne transfer of microbial size particles via thermal convection flows are able to bypass the protective overpressure in the patient room, which can represent a potential risk of cross contamination between rooms in protected environments. © 2011 Beauchêne et al; licensee BioMed Central Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn unit computational fluid dynamics transport kinetics EMTREE MEDICAL INDEX TERMS aerosol airborne particle airflow article bioaccumulation computer simulation controlled study experimental design hospital design hospital equipment hospital personnel intensive care unit microbial contamination particle size prediction process model process optimization risk assessment room ventilation software temperature sensitivity temperature stress thermodynamics EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011147684 MEDLINE PMID 21371304 (http://www.ncbi.nlm.nih.gov/pubmed/21371304) PUI L51308218 DOI 10.1186/1471-2334-11-58 FULL TEXT LINK http://dx.doi.org/10.1186/1471-2334-11-58 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 623 TITLE Bacterial colonization patterns in neonates transferred from neonatal intensive care units AUTHOR NAMES Navarro L.R. Pekelharing-Berghuis M. de Waal W.J. Thijsen S.F. AUTHOR ADDRESSES (Navarro L.R.; Pekelharing-Berghuis M.; de Waal W.J.) Department of Pediatrics, Diakonessenhuis, Utrecht, Netherlands. (Thijsen S.F., sthijsen@diakhuis.nl) Department of Medical Microbiology, Diakonessenhuis, Utrecht, Netherlands. CORRESPONDENCE ADDRESS S.F. Thijsen, Department of Medical Microbiology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, Netherlands. Email: sthijsen@diakhuis.nl SOURCE International Journal of Hygiene and Environmental Health (2011) 214:2 (167-171). Date of Publication: March 2011 ISSN 1438-4639 1618-131X (electronic) BOOK PUBLISHER Urban und Fischer Verlag Jena, P.O. Box 100537, Jena, Germany. ABSTRACT After an outbreak with Enterobacter cloacae we decided to routinely nurse all neonates in isolation who were transferred from a neonatal intensive care unit (NICU) to the neonatal unit of the Diakonessenhuis until cultures for MRSA and antibiotic-resistant Gram-negative bacteria were negative. The goal of this study was to determine (1) the colonization patterns with (antibiotic-resistant) bacteria; (2) whether there is a trend in time and (3) to identify predictors for colonization. Neonates from 2001 till 2006 transferred from a NICU to our neonatal unit were included. Patients were monitored for infections. In total 287 neonates were included. The average birth weight was 1990. g and gestational age 33 weeks and 3 days. Only one patient was colonized with a highly resistant microorganism (HRMO) and no MRSA was isolated. A NICU-stay longer than one week was the only independent risk factor for bacterial colonization. Twenty-six percent of neonates were colonized with bacteria resistant to amoxicillin/clavulanate. Five neonates (1.7%) developed a bacterial infection after transfer, none of them caused by an antibiotic-resistant microorganism present at transfer. No significant trends in time were found. In conclusion, we found a low prevalence of HRMO and a low incidence of bacterial infections in neonates after transfer from a NICU. There was no significant increase in time in the prevalence of colonization with (resistant) bacteria. A NICU-stay longer than a week was an independent predictor for colonization with bacteria. Based on these observations we have ended standard culturing and nursing in isolation of these patients. © 2011 Elsevier GmbH. EMTREE DRUG INDEX TERMS antiinfective agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance bacterial infection (drug therapy, epidemiology, prevention) bacterium cross infection (drug therapy, epidemiology, prevention) epidemic infection control newborn intensive care EMTREE MEDICAL INDEX TERMS article bacterial count birth weight Enterobacter cloacae female gestational age growth, development and aging human incidence length of stay male methodology newborn risk factor LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 21316303 (http://www.ncbi.nlm.nih.gov/pubmed/21316303) PUI L51271111 DOI 10.1016/j.ijheh.2011.01.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijheh.2011.01.001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 624 TITLE The authors reply AUTHOR NAMES Ramnarayan P. Borrows E.L. Montgomery M. Lutman D. Petros A. AUTHOR ADDRESSES (Ramnarayan P.; Borrows E.L.; Montgomery M.; Lutman D.; Petros A.) Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS P. Ramnarayan, Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. SOURCE Pediatric Critical Care Medicine (2011) 12:2 (242-243). Date of Publication: March 2011 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child care immobilization intensive care patient transport pediatric stabilization EMTREE MEDICAL INDEX TERMS community hospital cost effectiveness analysis health care cost health care quality hospital personnel intensive care unit letter medical staff outcome assessment priority journal tertiary health care EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011170286 PUI L361506785 DOI 10.1097/PCC.0b013e3182070d0d FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3182070d0d COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 625 TITLE ISMP medication error report analysis - Affirmative warnings may be better understood than negative warnings; Standard neonatal intensive care unit drug infusion concentrations; Limits placed on prescription transfers by patients; Top drugs that cause violence; Vincristine caution statement reworded AUTHOR NAMES Cohen M.R. Smetzer J.L. AUTHOR ADDRESSES (Cohen M.R., mcohen@ismp.org; Smetzer J.L.) Institute for Safe Medication Practices, 200 Lakeside Drive, Horsham, PA 19044, United States. CORRESPONDENCE ADDRESS M. R. Cohen, Institute for Safe Medication Practices, 200 Lakeside Drive, Horsham, PA 19044, United States. Email: mcohen@ismp.org SOURCE Hospital Pharmacy (2011) 46:3 (157-160+165). Date of Publication: 1 Mar 2011 ISSN 0018-5787 BOOK PUBLISHER Facts and Comparisons, 111 W. Port Plaza, Ste. 300, St. Louis, United States. EMTREE DRUG INDEX TERMS mirtazapine (adverse drug reaction, drug therapy) nimodipine (intravenous drug administration) quetiapine (drug therapy) varenicline (adverse drug reaction) vincristine (intrathecal drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medication error EMTREE MEDICAL INDEX TERMS article behavior disorder (side effect) drug contraindication drug dose increase dysthymia (drug therapy) evening dosage health care personnel human incident report leukopenia (side effect) medical practice newborn intensive care posttraumatic stress disorder (drug therapy) prescription violence DRUG TRADE NAMES chantix remeron seroquel CAS REGISTRY NUMBERS mirtazapine (61337-67-5) nimodipine (66085-59-4) quetiapine (111974-72-2) varenicline (249296-44-4, 375815-87-5) vincristine (57-22-7) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011134868 PUI L361399356 DOI 10.1310/hpj4603-157 FULL TEXT LINK http://dx.doi.org/10.1310/hpj4603-157 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 626 TITLE Attitudes of paediatric intensive care nurses to development of a nurse practitioner role for critical care transport AUTHOR NAMES Davies J. Bickell F. Tibby S.M. AUTHOR ADDRESSES (Davies J., joanna.davies@gstt.nhs.uk) RGN RSCN Retrieval Nurse Practitioner and Ward Manager Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. (Bickell F.) MHM RGN RNC South Thames Retrieval Co-ordinator Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. (Tibby S.M.) Tibby MRCP Consultant Paediatric Intensivist Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. CORRESPONDENCE ADDRESS J. Davies, RGN RSCN Retrieval Nurse Practitioner and Ward Manager Paediatric Intensive Care, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. Email: joanna.davies@gstt.nhs.uk SOURCE Journal of Advanced Nursing (2011) 67:2 (317-326). Date of Publication: February 2011 ISSN 0309-2402 1365-2648 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Aim. This paper is a report of a descriptive study of the attitudes and opinions of nurses before and after the introduction of independent Retrieval Nurse Practitioners into a critical care transport service for children.Background. Little is known about nurses' attitudes to advanced practice roles, particularly when these function as part of a team in a high-risk, remote setting (distant to the base hospital). Increasing knowledge in this area may give insight into ways of improving team working and enhancing quality of patient care.Method. A qualitative questionnaire was sent to nurses pre- (June 2006) and post- (July 2007) retrieval nurse practitioner introduction. Questionnaires were analysed using an adapted phenomenological method.Findings. The response rates were 62% (2006) and 48% (2007). The main themes that emerged included fear, communication, trust, team working, role conflict, role division and role boundaries. In the first survey, most nurses anticipated difficulties during retrieval with retrieval nurse practitioners and felt anxious about the prospect of being part of a team with an independent retrieval nurse practitioner. However, by the second survey (after retrieval nurse practitioner introduction), the majority reported confidence in the retrieval nurse practitioners' knowledge and skills.Conclusion. This advanced practice development has been a challenge for the nurses and the retrieval nurse practitioners, but initial anxieties and fears of a host of anticipated problems have been largely dispelled as enhanced communication and team working were reported. © 2010 Blackwell Publishing Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health personnel attitude intensive care nurse attitude nurse practitioner patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS advanced practice nursing article child clinical competence female human intensive care unit male organization organization and management patient care psychological aspect public relations qualitative research United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 20946566 (http://www.ncbi.nlm.nih.gov/pubmed/20946566) PUI L361114062 DOI 10.1111/j.1365-2648.2010.05454.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2648.2010.05454.x COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 627 TITLE ICU transfer after elective abdominal aortic aneurysm repair can be succesfully reduced with a modified protocol. A fourteen year experience from a University Hospital AUTHOR NAMES Bakoyiannis C.N. Tsekouras N.S. Georgopoulos S. Klonaris C. Bastounis E.E. Filis K. Papalambros E. Bastounis E. AUTHOR ADDRESSES (Bakoyiannis C.N., bakogian@hotmail.com; Tsekouras N.S.; Georgopoulos S.; Klonaris C.; Papalambros E.; Bastounis E.) First Department of Surgery, University of Athens Medical School, Laiko General Hospital, Athens, Greece. (Bastounis E.E.) Department of Bioengineering, University of California, San Diego, CA, United States. (Filis K.) 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, University of Athens, Athens, Greece. CORRESPONDENCE ADDRESS C. N. Bakoyiannis, First Department of Surgery, University of Athens Medical School, Laiko General Hospital, Athens, Greece. Email: bakogian@hotmail.com SOURCE International Angiology (2011) 30:1 (43-51). Date of Publication: February 2011 ISSN 0392-9590 BOOK PUBLISHER Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Torino, Italy. ABSTRACT Aim. To compare different selective criteria for Internal Care Unit (ICU) admission in two different timeframes, after abdominal aortic aneurysm (AAA) repair. A retrosprctive audit of acquired data was performed. Methods. During a period of fourteen years (1994-2008), 1152 patients underwent an elective open operation for infrarenal abdominal aortic aneurysm, in our department. Six hundred and two patients (Group A) were treated in the period January 1994-January 2003, and 550 patients (Group B) between January 2003 and August 2008. Post-operatively, all patients were transferred to postanesthesia unit (PAU). After a 2 hours period of close observation, they were transferred either to the ICU or to the surgical ward, according to certain selective criteria (SC). In group A we used SC-A, for admission to an ICU, and in group B we used new, stricter, criteria (SC-B). Thirty-day mortality and morbidity, elective admissions to ICU, rate of subsequent ICU admission, from ward to ICU, and the mean hospital and ICU length of stay, were compared between the two groups. Results. The use of SC-B resulted in a significant reduction of elective admissions to ICU (3.1% vs 8.5%, P<0.001). Nevertheless, the portion of patients, which were transferred with a severe postoperative complication from the ward to ICU, remained similar between the two groups (1.1% vs 0,9%, in group A and B, respectively). All other endpoints were similar in both groups. Conclusions. Modifying the protocol of ICU transfer, after elective abdominal aortic aneurysm repair, we can reduce the number of patients requiring ICU, without compromising patients' safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal aortic aneurysm (surgery) abdominal aortic aneurysm repair aneurysm surgery clinical protocol elective surgery intensive care unit EMTREE MEDICAL INDEX TERMS article hospital admission hospitalization human major clinical study morbidity mortality patient safety postoperative complication (complication) postoperative period recovery room retrospective study university hospital EMBASE CLASSIFICATIONS Surgery (9) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011228950 MEDLINE PMID 21248672 (http://www.ncbi.nlm.nih.gov/pubmed/21248672) PUI L361664076 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 628 TITLE Improving patient transfer between the Intensive Care Unit and the Medical/Surgical floor of a 200-bed hospital in southern California. AUTHOR NAMES Kibler J. Lee M. AUTHOR ADDRESSES (Kibler J.) Kaiser Permanente-Orange County, USA. (Lee M.) CORRESPONDENCE ADDRESS J. Kibler, Kaiser Permanente-Orange County, USA. SOURCE Journal for healthcare quality : official publication of the National Association for Healthcare Quality (2011) 33:1 (68-76). Date of Publication: 2011 Jan-Feb ISSN 1062-2551 ABSTRACT This paper describes the work of a front-line team at a 200-bed hospital in southern California to improve the patient transfer process between the Intensive Care Unit (ICU) and the Medical/Surgical floors. Using a phased approach of assessing the problem, identifying opportunities, testing ideas, and then implementing successful ideas, the team was able to improve patient transfer time from the ICU to the Medical/Surgical Floor once the bed is assigned from 6 to < 2 hr and to reduce the number of patients experiencing extreme delays (more than 12 hr waits since the bed is assigned) from 15% to 0%. Also, as a corollary of this work, nursing overtime was reduced by 25% year to year between March 2008 and March 2009 and patient satisfaction scores were improved. A key success factor of the front-line team was the implementation of a sustainability plan where metric and process accountability is specified, together with alert flags for the metrics and actions to take if the alert flags are triggered. © 2010 National Association for Healthcare Quality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient care patient transport EMTREE MEDICAL INDEX TERMS article human organization and management time United States LANGUAGE OF ARTICLE English MEDLINE PMID 21199074 (http://www.ncbi.nlm.nih.gov/pubmed/21199074) PUI L361490667 DOI 10.1111/j.1945-1474.2010.00101.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1945-1474.2010.00101.x COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 629 TITLE Factors associated with hypothermia during intra-hospital transport in patients assisted in a Neonatal Intensive Care Unit ORIGINAL (NON-ENGLISH) TITLE Fatores associados à hipotermia durante o transporte intra-hospitalar em pacientes internados em unidade de terapia intensiva neonatal AUTHOR NAMES Vieira A.L.P. Santos A.M.N. Okuyama M.K. Miyoshi M.H. Almeida M.F.B. Guinsburg R. AUTHOR ADDRESSES (Vieira A.L.P.) Da Disciplina de Pediatria Neonatal da Unifesp, São Paulo/SP, Brazil. (Santos A.M.N., ameliamiyashiro@yahoo.com.br; Okuyama M.K.; Miyoshi M.H.; Almeida M.F.B.; Guinsburg R.) Da Disciplina de Pediatria Neonatal, Do Departamento de Pediatria da Unifesp, São Paulo, SP, Brazil. CORRESPONDENCE ADDRESS A. M. N. Santos, Da Disciplina de Pediatria Neonatal, Do Departamento de Pediatria da Unifesp, 764 - Vila Clementino, São Paulo, SP, Brazil. Email: ameliamiyashiro@yahoo.com.br SOURCE Revista Paulista de Pediatria (2011) 29:1 (13-20). Date of Publication: January/March 2011 ISSN 0103-0582 BOOK PUBLISHER Sao Paulo Pediatric Society, Alameda Santos 211, Cerq cesar, Sao Paulo, Brazil. ABSTRACT Objective: To determine frequency and factors associated with hypothermia during intra-hospital transports of patients assisted in a neonatal intensive care unit (NICU). Methods: Cross-sectional study nested in a prospective cohort of infants submitted to intra-hospital transports performed by a trained team from January 1997 to December 2008 at a NICU of a public university hospital. Transports of patients aged more than one year and/or with weight higher than 10kg were excluded. Factors associated with hypothermia during intra-hospital transports were studied by logistic regression analysis.Results: Among the 1,197 transports performed during the studied period, 1,191 (99.5%) met the inclusion criteria. The 640 transported infants had mean gestational age of 35.0±3.8 weeks and birth weight of 2341±888g. They presented the following underline diseases: single or multiple malformations (71.0%), infections (7.7%), peri/intraventricular hemorrhage (5.5%), respiratory distress (4.0%) and others (11.1%). Patients were transported for surgical procedures (22.6%), magnetic resonance (10.6%), tomography imaging (20.9%), contrasted exams (18.2%), and others (27.7%). Hypothermia occurred in 182 (15.3%) transports and was associated with (OR; 95%CI): weight at transport <1000g (3.7; 1.4-9.9), weight at transport 1000-2500g (1.5; 1.0-2.2), pre-transport axillary temperature <36.5°C (2.0; 1.4-2.9), central nervous system malformation (2.8; 1.8-4.4); use of supplemental oxygen (1.6; 1.0-2.5); mechanical ventilation prior to transport (2.5; 1.5-4.0); transport for surgeries (1.7; 1.0-2.7) and the years 2001, 2003 and 2006 (protection factors). Conclusions: Intra-hospital transports presented increased risk for hypothermia, showing that this kind of transport should be done by skilled teams with adequate equipment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hypothermia (complication) patient transport EMTREE MEDICAL INDEX TERMS apnea (complication) article artificial ventilation birth weight body temperature measurement brain hemorrhage congenital malformation controlled study cross-sectional study female gestational age human hyperglycemia (complication) hyperoxia infant major clinical study male neonatal respiratory distress syndrome newborn infection newborn intensive care nuclear magnetic resonance imaging oxygen supply EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE Portuguese LANGUAGE OF SUMMARY English, Portuguese, Spanish EMBASE ACCESSION NUMBER 2011248072 PUI L361708007 DOI 10.1590/S0103-05822011000100003 FULL TEXT LINK http://dx.doi.org/10.1590/S0103-05822011000100003 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 630 TITLE Use of telemedicine and helicopter transport to improve stroke care in remote locations AUTHOR NAMES Saler M. Switzer J.A. Hess D.C. AUTHOR ADDRESSES (Saler M.; Switzer J.A.; Hess D.C., dhess@mcg.edu) Department of Neurology, Georgia Health Sciences University, 1122 15th Street, Augusta, GA 30912, United States. CORRESPONDENCE ADDRESS D. C. Hess, Department of Neurology, Georgia Health Sciences University, 1122 15th Street, Augusta, GA 30912, United States. Email: dhess@mcg.edu SOURCE Current Treatment Options in Cardiovascular Medicine (2011) 13:3 (215-224). Date of Publication: June 2011 ISSN 1092-8464 BOOK PUBLISHER Springer Healthcare ABSTRACT Opinion statement: Intravenous recombinant tissue plasminogen activator is the only medication approved by the US Food and Drug Administration for treatment of acute stoke. Despite established efficacy, less than 3% of stroke patients receive treatment, and that number is even smaller for patients living in remote locations. This is in part due to a lack of neurologists and stroke specialists in these rural communities. The traditional model of "ship and drip" wastes crucial time, resulting in delays or loss of treatment. In this review, we discuss strategies to overcome geographic disparities in stroke care and improve acute treatment in remote locations. Helicopter transport from field to stroke center is one option to rapidly deliver patients to stroke centers. However, geography, weather, and unnecessary transport are potential drawbacks. Alternatively, "telestroke" facilitates remote evaluation of acute stroke patients via an audiovisual link and transmission of computerized tomography images. Despite the physical separation, stroke specialists are able to examine patients, review brain imaging and make correct treatment decisions; transfer to a stroke center can then be performed as appropriate. A cost-benefit analysis of telestroke is needed, although the recent proliferation of telestroke networks suggests an economic asset to some hospital systems. © 2011 Springer Science+Business Media, LLC. EMTREE DRUG INDEX TERMS tissue plasminogen activator (drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport cerebrovascular accident (drug therapy, diagnosis, drug therapy) helicopter telemedicine EMTREE MEDICAL INDEX TERMS article computer assisted tomography cost benefit analysis health care cost health care facility health care management health care quality health care utilization health service human medical decision making medical specialist rural health care stroke patient stroke unit CAS REGISTRY NUMBERS tissue plasminogen activator (105913-11-9) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Drug Literature Index (37) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011259958 PUI L51337359 DOI 10.1007/s11936-011-0124-y FULL TEXT LINK http://dx.doi.org/10.1007/s11936-011-0124-y COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 631 TITLE We're heading to music city: 19(th) critical care transport medicine conference AUTHOR NAMES Newman M. Petersen P. Wojdyla K. AUTHOR ADDRESSES (Newman M.; Petersen P.; Wojdyla K.) CORRESPONDENCE ADDRESS M. Newman, SOURCE Air Medical Journal (2011) 30:1 (32-33). Date of Publication: January-February 2011 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care medical education EMTREE MEDICAL INDEX TERMS article emergency care health care personnel human injury medical profession paramedical profession priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011018102 PUI L361056943 DOI 10.1016/j.amj.2010.10.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2010.10.006 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 632 TITLE Keeping patients safe during intrahospital transport AUTHOR NAMES Day D. AUTHOR ADDRESSES (Day D., daday@queens.org) Emergency Department, The Queens Medical Center, Honolulu, HI, United States. CORRESPONDENCE ADDRESS D. Day, Emergency Department, The Queens Medical Center, 1301 Punchbowl St, Honolulu, HI 96813, United States. Email: daday@queens.org SOURCE Critical Care Nurse (2010) 30:4 (18-32). Date of Publication: 2010 ISSN 0279-5442 BOOK PUBLISHER American Association of Critical Care Nurses, 101 Columbia, Suite 100, Aliso Viejo, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient care patient transport safety EMTREE MEDICAL INDEX TERMS article artificial ventilation devices human intensive care unit methodology monitoring nursing nursing assessment organization and management practice guideline LANGUAGE OF ARTICLE English MEDLINE PMID 20436033 (http://www.ncbi.nlm.nih.gov/pubmed/20436033) PUI L362416331 DOI 10.4037/ccn2010446 FULL TEXT LINK http://dx.doi.org/10.4037/ccn2010446 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 633 TITLE The condition of neonatal transport to NICU in Mazandaran AUTHOR NAMES Nakhshab M. Vosughi E. AUTHOR ADDRESSES (Nakhshab M., pegahch@yahoo.com) Department of Pediatrics, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran. (Vosughi E., pegahch@yahoo.com) Mazandaran University of Medical Science, Sari, Iran. CORRESPONDENCE ADDRESS M. Nakhshab, Department of Pediatrics, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran. Email: pegahch@yahoo.com SOURCE Journal of Mazandaran University of Medical Sciences (2010) 20:78 (49-57). Date of Publication: 2010 ISSN 1735-9279 1735-9260 (electronic) BOOK PUBLISHER Mazandaran University of Medical Sciences, No.2, Moallem Square, Sari, Mazandaran, Iran. ABSTRACT Background and purpose: Appropriate transport of ill neonates to the tertiary level of Neonatal Intensive Care Units (NICUs) is an important factor in their survival. Identifying important factors in neonatal transport may have a major role in prognosis and survival rates of neonates. The present study was designed to assess the current situation and problems of ill neonates transport to the NICU of BuAli teaching hospital. Materials and methods: In this descriptive study, data of all of the transported neonates to Sari Buali NICU from throughout Mazandaran were collected for a period of 6 months. Data collected include neonatal maternal demographic information and neonatal outcome recorded at BuAli hospital and stabilization of the neonate before transport and at arrival to BuAli hospital and the situation of the referral hospital at the time of admission, recorded by transport team from original hospital. Data were analyzed using SPSS software. Results: In total, 148 neonates were transferred to BuAli NICU, with the most prevalent gestational age between 28 to34 weeks (32.4%) and the majority in the first 24 hour of birth (69.6%). The most frequent reason of transport was RDS (65.5%) and TTN (12.8%). Only 50% of the patients had ABG, CXR and BS checked for stabilization purposes before transport and 10.1% of them were hypothermic. Sari Imam Khomeini hospital had the majority cases of transport (68.2%). The referral hospital situation was appropriate except for the impaired elevator (12.8%). Of those 148 neonates, 26 neonates (17.6%) died. In this study the correlation between gestational age and APGAR score with neonatal mortality was statistically significant. Conclusion: The process of current neonatal transport in Mazandaran needs to be improved in terms of a regionalized program, communication system, optimal equipment, skilled personnel, etc. It is hoped that the findings of this study would be helpful to prepare a practical program for neonatal transport in Mazandaran. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS Apgar score article blood gas analysis correlation analysis gestational age hospital building human hypothermia Iran major clinical study newborn newborn mortality outcome assessment patient referral respiratory distress syndrome teaching hospital thorax radiography EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE Persian LANGUAGE OF SUMMARY English, Persian EMBASE ACCESSION NUMBER 2011051288 PUI L361160984 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 634 TITLE Critical care transport in a combat environment: building tactical trauma transport teams before and during deployment. AUTHOR NAMES Hudson T.L. Morton R. AUTHOR ADDRESSES (Hudson T.L.; Morton R.) CORRESPONDENCE ADDRESS T.L. Hudson, Email: gateway5362@hotmail.com SOURCE Critical care nurse (2010) 30:6 (57-66; quiz 67). Date of Publication: Dec 2010 ISSN 1940-8250 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care military nursing nursing education patient care patient transport EMTREE MEDICAL INDEX TERMS article cooperation curriculum education evidence based practice human interpersonal communication nurse attitude organization and management practice guideline program development public relations quality control teaching round United States LANGUAGE OF ARTICLE English MEDLINE PMID 21123233 (http://www.ncbi.nlm.nih.gov/pubmed/21123233) PUI L360282253 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 635 TITLE Post-intubation chest x-ray during pediatric/neonatal critical care transport: Is itworththe wait? AUTHOR NAMES Garrett L. Giuliano J. Schwartz H. Bigham M. AUTHOR ADDRESSES (Garrett L.; Bigham M.) Akron Children's Hospital, United States. (Giuliano J.) Yale-New Haven Children'S Hospital, United States. (Schwartz H.) Cincinnati Children's Hospital, United States. CORRESPONDENCE ADDRESS L. Garrett, Akron Children's Hospital, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A15). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The Institute of Medicine has identified 6 features of high-quality healthcare, one of which is efficiency. In pedic/neo specialty critical care transport (P/N SCCT) some believe that a post-intubation chest xray (PI CXR) at the referral hospital is unnecessary and adds to transport inefficiency. Published neo/pedi data from theORand ICUs have found high rates ofETTmalpositioning (15-34%) using published ETT depth/size criteria (PALS, NRP, Braselow) and report the insensitivity of clinical exam in confirming correct ETT positioning. The purpose of this study is to explore the value of PICXRin the P/N SCCT setting. Hypothesis:Wehypothesize that PICXRin neo/pedi intubated by a P/N SCCT team is unnecessary and can be eliminated to improve efficiency. Methods: This IRB-approved, non-intervention study included all intubations performed by the P/N SCCT team during over 18 months. A data tool was completed by the transport nurse after each trip where intubation was required. Data were tabulated and analyzed using Microsoft Excel and SPSS v17.0. Results: 77 patients (34 neo/43 pedi) were enrolled. The neo averaged 2.1±1.0kg with mean gestational age of 31.9±5.1wks. Pedi averaged 9.8±11.7kg and 1.8±3.9yrs. PICXRwas obtained in 66 of patients (85.3% neo, 86% pedi) and PI CXR showed malpositioned ETT in 48.5% of patients. The trend of ETT malpositioning by PI CXR was more common in neo vs pedi (55% vs 37%, p=0.10). Neo ETT malpositions were more commonly deep whereas shallow ETT placement errors were more common in pedi. Neo ETT were moved 0.7±0.5cm vs 0.9±0.5 cm in pedi. Initial ETT depth was incorrectly calculated according to PALS (3x ETT inner diameter)/NRP in 50% neo and 58% pedi. PI CXR verified acceptable ETT positioning despite incorrectly calculated ETT depth in 41% neos and 56% pedi. PI CXR with subsequent ETT repositioning in appropriately calculated ETT occurred in both groups (neo 35% and pedi 72%, p=0.03). Conclusions: PI CXR remains informative for infants/children intubated by the P/N SCCT team. The trend showed ETT malpositioning was more common in neos. There are opportunities for improvement in correctly calculating appropriate ETT depth though this should not obviate the need for PI CXR. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care intubation society thorax radiography EMTREE MEDICAL INDEX TERMS gestational age health care hospital hypothesis intervention study nurse patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317280 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 636 TITLE Measuring and improving disinfection in critical care transport vehicles AUTHOR NAMES Sulis C. Estanislao R. Frakes M. Carling P. Wedel S. AUTHOR ADDRESSES (Sulis C.; Carling P.) Boston Medical Center, United States. (Estanislao R.; Frakes M.; Wedel S.) Boston MedFlight, United States. CORRESPONDENCE ADDRESS C. Sulis, Boston Medical Center, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A19). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Environmental contamination of medical equipment and high touch surfaces is believed to play a role in pathogen transmission in hospitals. There are hospital systems to assess completeness of cleaning. In critical care transport (CCT) vehicles, teams are expected to disinfect potentially contaminated surfaces after each transport and are taught that disinfection is a key component of the infection control program and the safety culture. Cleaning has not been assessed in CCT vehicles in the same manner as in hospitals. Hypothesis: A novel method to evaluate cleaning of CCT vehicles will provide objective data and improve performance. Methods: An investigator evaluated ten targets common to all transport vehicles using a previously validated fluorescent marking dye method. Cleaning was considered 'complete' if the fluorescent mark was totally removed from the target 24 hours after marking. Targets included wall and portable suction, defibrillator (buttons, touch screen), ventilator (on/off switch, reset buttons), and monitor (BP and EKG recorders, touch screen). After baseline data collection, a review of updated disinfection practices was completed in in response to the appearance of pandemic Influenza. Follow-up data were collected 2, 8, and 14 months after that review. Results: 2310 standardized targets (10 objects) were assessed for outcomes comparisons. Overall, cleaning improved from 12% to 75% of all items evaluated, p <0.00005) and improved in each vehicle type (rotor wing 12% to 79% of all items cleaned; fixed wing 2% to 75%, ground 18% to 68%; p<0.00005 for all). There was not a consistent pattern by vehicle type. By the end of the study, several targets were cleaned > 90% of the time (the monitor screen and controls and the ventilator controls) regardless of vehicle type. Conclusions: This is the first use of an objective method to assess cleaning of CCT vehicles. After identifying an opportunity for improvement, re-education and objective feedback improved performance by more than 6-fold. Potential causes of incomplete cleaning include shared responsibility for disinfection (no single crew member assigned), ineffective technique, or competing priorities related to patient management. EMTREE DRUG INDEX TERMS dye EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disinfection intensive care society EMTREE MEDICAL INDEX TERMS contamination defibrillator education feedback system follow up forelimb hospital hospital planning hypothesis infection control information processing medical device pandemic influenza pathogenesis patient care recorder responsibility safety suction ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317297 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 637 TITLE Preoperative conditions as predictors of ICU transfer after interventional cardiology in children with congenital heart disease AUTHOR NAMES Pino G. De Miguel M. Méndez D. AUTHOR ADDRESSES (Pino G.; De Miguel M.; Méndez D.) Department of Paediatric Anaesthesiology, Children's Hospital Doce de Octubre, Madrid, Spain. CORRESPONDENCE ADDRESS G. Pino, Department of Paediatric Anaesthesiology, Children's Hospital Doce de Octubre, Madrid, Spain. SOURCE Paediatric Anaesthesia (2010) 20:12 (1130). Date of Publication: December 2010 CONFERENCE NAME European Congress of Paediatric Anaesthesiology, ESPA 2010 CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2010-09-02 to 2010-09-04 ISSN 1155-5645 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Introduction: The aim of this study is to investigate possible correlation between the event of ICU transfer of paediatric patients after interventional cardiology and three preoperative conditions of those patients: age, congenital heart disease and catheterisation procedure. Methods: Retrospective study of all cardiac interventional catheterisations performed in the Children's Hospital Doce de Octubre (Madrid) from June 2008 to December 2009. A total of 263 patients were treated, being nenonates 27 of them, who were removed from the study because they must be always transferred to ICU. Moreover, six patients went to the operating room due to emergencies appeared during the catheterisation (two of them were neonates). The rest of patients (232), have been classified following three different preoperative conditions. Depending on the severity of their congenital heart disease in: group A (ASD, VSD and PDA), with 97 patients (41.8%); and group B (HLHS, TGA, Fallot, pulmonary atresia, aortic stenosis, atrioventricular canal defects,...), with 135 patients (52.8%). Depending on the type of catheterisation in: diagnosis, with 78 patients (33.6%); or interventional (balloon angioplasty, closure of arterial ducts and atrial and ventricular septal defects, coil embolisations, stents,...), with 154 patients (66.4%). With the third criteria, the age, in: children younger than 2 years, with 70 patients (30.2%); and children with 2 years or older, 162 patients (69.8%). Analysing the three criteria separately, it has been investigated if the incidence of ICU transfer in these groups is significantly different from the incidence on the total sample. The Pearson's Chi-square Test has been used for evaluating the statistical significance. Results: From the sample of 232 patients, 55 were transferred to the ICU (23.7%). According to the congenital heart disease, 45 patients from group B were transferred to ICU after the catheterisation (33.3%). According to the catheterisation procedure, 38 patients that had interventional catheterisation were transferred to the ICU (24.7%). Finally, regarding the age, 31 children below 2 years went to ICU after the intervention (44.3%). Comparative results can be seen in Figure 1. Conclusions: The most significant preoperative criterion as predictor of the ICU transfer after a catheterisation procedure appears to be the age (P < 0.0001). The congenital heart disease also implies a significant variation in the incidence of ICU transfer (P < 0.0034). But the results seem to indicate that the catheterisation procedure does not have an impact in the probability of going to the ICU (P < 0.78). Therefore, children below 2 years old have to be considered as most probable candidates to need intensive care after an interventional cardiology procedure, without discarding other preoperative conditions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesiology cardiology child congenital heart disease human EMTREE MEDICAL INDEX TERMS aortic stenosis atrioventricular canal catheterization chi square test diagnosis emergency heart ventricle septum defect intensive care newborn operating room patient pediatric hospital percutaneous transluminal angioplasty pulmonary valve atresia retrospective study statistical significance stent LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70485209 DOI 10.1111/j.1460-9592.2010.03446.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1460-9592.2010.03446.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 638 TITLE Predictors of icu transfer in patients who develop modified SIRS criteria AUTHOR NAMES Young M. Hooper M. Gowda S. Bernard G. Wheeler A. Weavind L. Rice T. AUTHOR ADDRESSES (Young M.; Hooper M.; Gowda S.; Bernard G.; Wheeler A.; Weavind L.; Rice T.) Vanderbilt University Medical Center, United States. CORRESPONDENCE ADDRESS M. Young, Vanderbilt University Medical Center, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A115). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Sepsis is defined as the systemic inflammatory response syndrome (SIRS) secondary to infection, and it commonly occurs in hospitalized patients. Patient characteristics which predict transfer to an ICU in patients with SIRS are not entirely understood. Hypothesis: We hypothesized that demographics, baseline characteristics, and physiologic parameters would predict the need for ICU transfer in a cohort of general medical patients with modified SIRS criteria. Methods: We studied 207 patients on medical wards at Vanderbilt Hospital who met modified SIRS criteria (at least one abnormal criterion being temperature or WBC count). We compared 117 consecutive patients who required transfer to the MICU with 90 consecutive patients who did not. We collected data on baseline demographics, comorbidities, physiologic condition, severity of illness, and clinical outcomes. Results: Patients transferred to the ICU were similar in age to those not transferred (54 vs. 58y, p = 0.11). Transferred patients were more likely to be male (p < 0.049) and on chronic dialysis (p = 0.026), and less likely to be immunosuppressed (p < 0.001) or have chronic lung disease (p = 0.025). At the time they met SIRS criteria, patients transferred to the ICU were more likely to be septic (p=0.014) and in shock (p=0.001) with higher WBC count (13.8 vs. 7.4, p < 0.001), heart rate (120 vs. 94, p < 0.001), respiratory rate (31 vs. 20, p < 0.001), and temperature (37.6 vs. 37.1, p = 0.001). The rate of positive blood cultures after enrollment was similar between groups (p = 0.375). In regards to outcome, patients requiring ICU transfer were more likely to be transferred to a skilled-nursing facility (p=0.001) or die during the 28-day study period (p<0.001). Conclusions: Our data suggests that in hospitalized patients meeting modified SIRS criteria at a tertiary care medical center, male gender and more severe derangements of individual SIRS criteria were associated with ICU transfer. Chronic dialysis was also associated with ICU transfer, but other comorbidities were not. We propose that additional studies of patients in other hospital settings may lead to improved models for predicting which patients with modified SIRS criteria should be transferred to an ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient society EMTREE MEDICAL INDEX TERMS blood culture breathing rate chronic lung disease dialysis gender general aspects of disease heart rate hospital hospital patient hypothesis infection leukocyte count male model nursing home sepsis systemic inflammatory response syndrome temperature tertiary health care ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317616 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 639 TITLE Whenspace is an issue: Use of video assisted laryngoscopy by critical care personnel in aeromedical transport AUTHOR NAMES Cambridge R. Haisler R. AUTHOR ADDRESSES (Cambridge R.; Haisler R.) OSF St. Francis Medical Center, United States. CORRESPONDENCE ADDRESS R. Cambridge, OSF St. Francis Medical Center, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A129). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: During critical care transport of a patient in a standard civilian helicopter, airway management is hindered due to cramped conditions.Video assisted (VA) laryngoscopy may offer an advantage over traditional directly visualized (TDV) laryngoscopy for in-flight airway placement. Hypothesis: Endotracheal intubation success and procedural time is improved using VA laryngoscopy as compared to TDV laryngoscopy in a suboptimal placed simulated patient. Methods: Study participants were asked to attempt intubation twice (medical and trauma scenarios) on a mannequin airway simulator in a civilian helicopter (Bell 230). Participants were randomized to the VA or TDV group and sat in the forward facing seat with the simulator's head against the rear bulkhead preventing standard operator positioning. Participants attempted airway visualization and indicated when they noted the best view of the larynx (based on the modified Cormack-Lehane scale). The participant then attempted endotracheal intubation, calling out when they completed their attempt. Tube location was verified by investigators after the attempt, and larynx view and attempt completion times were recorded. Results: Thirty subjects of varying training levels (EM residents, CCRNs, and paramedics) participated (17 in VA group, 13 in TDV group). No significant differences in training levels between the groups was noted (p= 2.85). The VA group was more successful than the TDV group in endotracheal intubation (33/34 (97.1%) vs. 21/26 (80.8%); p= 0.037). While VA provided a faster mean optimal view of the larynx (8.8 seconds vs. 18.5 seconds; p= 19.7), the confidence intervals overlapped. The mean time to intubation completion was similar for both methods (VA 25.87 seconds vs. TDV 25.64 seconds; p= 0.01). There were no significant differences in time to best view (p= 0.65) or time to intubation completion (p= 0.18) for scenario type. Conclusions: VA laryngoscopy provided a greater likelihood of successful tracheal intubation as compared to TDV in a simulated helicopter patient. VA laryngoscopy had no time advantage over TDV laryngoscopy for laryngeal view or subsequent endotracheal tube placement. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care laryngoscopy personnel society videorecording EMTREE MEDICAL INDEX TERMS airway confidence interval endotracheal intubation endotracheal tube flight helicopter hypothesis injury intubation larynx patient simulator tube LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317667 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 640 TITLE Improving adverse drug event detection in critically ill patients through intensive care unit transfer summary screening AUTHOR NAMES Anthes A. Kane-Gill S. Harinstein L. Smithburger P. Seybert A. AUTHOR ADDRESSES (Anthes A.; Kane-Gill S.) University of Pittsburgh Medical Center, United States. (Harinstein L.) Cleveland Clinic, United States. (Smithburger P.) University of Pittsburgh, School of Pharmacy, United States. (Seybert A.) University of Pittsburgh, United States. CORRESPONDENCE ADDRESS A. Anthes, University of Pittsburgh Medical Center, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A137). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Current ADE detection relies heavily on voluntary reporting which results in underreporting. Hospital discharge notes have been studied as a form of surveillance; however, ICU transfer summaries have not been studied for this purpose. Improving ADE prevention strategies relies upon improving detection. Hypothesis: ICU transfer summaries are an effective tool for ADE detection. Methods: A retrospective electronic medical record review was conducted among medical ICU patients. Inclusion criteria included patients ≥ 18 years of age admitted between January through April 2009 with an ICU length of stay ≥ 24 hours. Two scales were utilized to assess chart documentation for ADEs: 1) Harvard Medical Practice Scale (MPS) and 2) Leonard Evidence Assessment Scale. The Harvard MPS was used to rank the strength or confidence of the wording in the medical record with a score of 4 (more than 50-50 but close), 5 (moderate/strong) or 6 (virtually certain) indicating the presence of an ADE. The Leonard scale was used to score causality and included objective markers such as presence of symptoms or if an antidote or counteracting procedure occurred. Leonard scores of 1 out of 4 indicated unlikely ADE, 2 of 4 possible, 3 of 4 probable and 4 of 4 a certain ADE. Results: Preliminary demographic information indicates 50% of the patients were male with a mean age of 60.3 years (+/- 16). 258 unique patients had ICU transfer summaries screened and evaluated for ADEs. 105 patients had at least 1 ADE with a total of 139 ADEs. The Harvard MPS scores collected were 4 (39.6%), 5 (51.8%) and 6 (7.9%). The Leonard scores were 2 of 4 (17.3%), 3 of 4 (54.7%) and 4 of 4 (28.1%). Most common medications associated with an ADE were furosemide, ciprofloxacin, warfarin and heparin. Most common ADEs were Clostridium difficile, hypotension, acute kidney injury and hyperglycemia. Conclusions: 41% of ICU transfer summaries contained a description of an ADE; therefore, reviewing ICU transfer summaries is a useful method of detecting ICU-specific ADEs and should be considered as part of an ADE surveillance system. Understanding contributing medications and resulting reactions of ADEs will aid in future prevention strategies. EMTREE DRUG INDEX TERMS antidote ciprofloxacin furosemide heparin marker warfarin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse drug reaction critically ill patient intensive care intensive care unit screening society EMTREE MEDICAL INDEX TERMS documentation drug therapy electronic medical record epidemiology hospital discharge hyperglycemia hypotension hypothesis kidney injury length of stay male medical practice medical record medical record review patient Peptoclostridium difficile prevention voluntary reporting LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317694 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 641 TITLE Icu transfers from inpatient units: How many result from adverse events and are they preventable? AUTHOR NAMES Miles A. Jacobs B. Stockwell D. AUTHOR ADDRESSES (Miles A.; Jacobs B.; Stockwell D.) Children's National Medical Center, United States. CORRESPONDENCE ADDRESS A. Miles, Children's National Medical Center, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A173). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Unplanned transfers to an ICU from inpatient units may result from adverse events (AEs). Preventative strategies to mitigate AEs leading to ICU transfer can be implemented once risk factors are identified. Hypothesis: We hypothesized that AEs account for a significant rate of ICU transfers and that some may be preventable. Methods: A retrospective observational study of ICU transfers from inpatient units during a 6 month interval in a tertiary care children's hospital. Transfers were electronically identified via the electronic health record then investigated to establish if an AE had occurred. The preventability of the AE and associated patient harm were determined. Predefined AEs included ICU transfers in less than (<) 12 hours of hospital admission, re-admissions to an ICU in less than (<) 24 hours after ICU discharge, and cardiopulmonary arrest events. AEs that did not meet these criteria were examined for causes and trends. Results: 249 ICU transfers occurred and 48 (19.3%) were attributed to AEs. 29 (60.4%) were transfers in <12 hours of admission, 5 (10.4%) were ICU readmissions in <24 hours of ICU discharge, and 8 (16.7%) were cardiopulmonary arrests. The remainder (12.5%) included postoperative complications (3), medication effects (1), electrolyte derangements (1), and hypotension (1). The most common diagnosis associated with AE related transfer was respiratory distress (25, 52.1%) with 18 (72%) transfers in<12 hours of admission. 15 (31.3%) AEs were determined to be preventable. Of these,12 (80%) involved inappropriate triage with 8 ICU transfers in <2 hrs of admission and 4 ICU readmissions in <24 hours. Other preventable AEs included 2 (13.3%) cardiopulmonary arrests, and 1 (6.7%) patient with unresolved hyponatremia. Of all 48 AEs, 42 (87.5%) resulted in prolonged hospitalization and temporary harm, and 6 (12.5%) required treatment/intervention, resulting in temporary harm. Conclusions: Nearly one-fifth of unplanned ICU transfers resulted from AEs and almost a third were preventable. Interventions directed at triage processes are likely to reduce these events as many occurred early in admission. More than half of AE-related ICU transfers were associated with respiratory distress. EMTREE DRUG INDEX TERMS electrolyte EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient intensive care society EMTREE MEDICAL INDEX TERMS cardiopulmonary arrest diagnosis drug therapy emergency health service hospital admission hospitalization hyponatremia hypotension hypothesis medical record observational study patient pediatric hospital postoperative complication respiratory distress risk factor tertiary health care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317809 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 642 TITLE Multi-disciplinary quality improvement projects canresult inimprovementsin transfer timesfrom the emergency department to the pediatric intensive care unit AUTHOR NAMES Silverman A. Carroll C. Morgan-Gorman K. Cahill J. Koss M. Sears-Russell N. Howard K. AUTHOR ADDRESSES (Silverman A.; Carroll C.; Morgan-Gorman K.; Cahill J.; Koss M.; Sears-Russell N.; Howard K.) Connecticut Children's Medical Center, United States. CORRESPONDENCE ADDRESS A. Silverman, Connecticut Children's Medical Center, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A27). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Once a decision is made to admit a child to a pediatric intensive care unit (PICU) from a pediatric emergency department (PED), it is crucial that this intrahospital transfer occur in a timely fashion.We identified reducing the time of transfer of these critically ill children as an important quality improvement goal.Because of unit staff skills, level of monitoring and specialized modalities of care provided in the PICU, there was consensus amongst the staff of both units that rapid transfer to the PICU had the potential to improve the quality of care. Hypothesis: We hypothesized that we could reduce the transfer time from the PED to the PICU by identifying the steps involved in the transfer process and implementing changes in these processes. Methods: Physicians and nurses met on multiple occasions to identify specific steps involved in the transfer process starting in October 2009.Intervention were begun in November 2009.Transfer times were defined as the period between the time of decision to admit the child to the PICU and the time of arrival in the PICU.Those steps that had the potential for creating delays were analyzed monthly in greater depth by multidisciplinary teams of nursing and physician leaders.Outliers were analyzed in order to identify systemic changes that could streamline process. Results: Comparing October 2009 to July 2010, average time of transfer decreased from 60 minutes (n = 22) to 47 minutes (n = 27) with a monthly range during that period of 30-61 minutes.Transfers that occurred in≤30 minutes increased from 20 to 38%with a monthly range of 14 to 50%.On aggregate, transfer times decreased from 62 = 40 minutes (April-October 2009, n = 144) to 52 ± 33 minutes (November 2009-July 2010, n=222) (p=0.02).Identifiable sources or delay were difficulty in starting IVs, delays in physician-to-physician sign out, delays in nurse-to-nurse sign out and medicine delivery from pharmacy. Conclusions: Multidisciplinary quality improvement projects can result in decreased times for transfer from the PED to the PICU.Having specific targets on the Balanced Scorecard of both units and having regular physician and nurse review of performance can help achieve significant improvements. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward intensive care intensive care unit society total quality management EMTREE MEDICAL INDEX TERMS child consensus critically ill patient hypothesis monitoring nurse nursing patient transport pharmacy physician skill LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317327 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 643 TITLE Delay in transfer from the surgical ICU: Incidence, causes and financial impact AUTHOR NAMES Johnson D. Bittner E. Schmidt U. Pino R. AUTHOR ADDRESSES (Johnson D.; Bittner E.; Schmidt U.; Pino R.) Massachusetts General Hospital/Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, United States. CORRESPONDENCE ADDRESS D. Johnson, Massachusetts General Hospital/Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A28). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Minimal literature exists regarding ICU patients who are medically ready to leave the ICU but experience a significant delay before transfer to the floor. This study analyzed the incidence, causes and costs of delayed transfer from a surgical ICU. Hypothesis: Delayed transfer from the surgical ICU is common, is multi-factorial in cause, and has a significant financial impact. Methods: An IRB-approved prospective observational study was conducted from 1/24/2010 to 7/31/2010 of all 731 patients transferred from a 20-bed SICU. Data were collected on patients deemed medically ready for transfer to the floor who remained in the SICU for at least one extra day. Reasons for delay were examined. Economic analysis was performed to evaluate the additional costs of delayed transfer from the SICU. This was based on the difference in cost of ICU care versus floor care. Results: Transfer to the floor was delayed in 22% (n=160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean 1.5 days). The estimated additional cost of delayed transfer during the 27-week study period was $791, 628 ($29, 319 per week). The most common reasons for delay in transfer were: lack of available surgical floor bed [71% (114/ 160)], lack of room appropriate for infectious contact precautions [18% (28/ 160)], change of primary service (Surgery to Medicine) [7% (11/160)], and lack of available patient attendant (“sitter” for mildly delirious patients) [3% (5/160)]. There was a positive association between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman's rho- 0.27, p < 0.0001). Delayed patients were significantly more likely than nondelayed patients to be transferred during night shifts, between 19:00 to 06:59, [21% (33/160) versus 12% (67/571), chi square = 10.6, p < 0.005]. Conclusions: Delay in transfer from the SICU is common and costly. The most common reason for this delay was insufficient availability of surgical floor beds. Delay in transfer was associated with high hospital census, and delayed patients were more likely than non-delayed patients to be transferred during night shifts. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS hospital hypothesis night observational study patient population research surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317331 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 644 TITLE Impact of hospital-based pediatric transport team closure on transports and transport requests to a pediatric intensive care unit AUTHOR NAMES Cummings B. Yager P. Riley J.A. Carew A. Noviski N. AUTHOR ADDRESSES (Cummings B.; Yager P.; Riley J.A.; Carew A.; Noviski N.) Massachusetts General Hospital, United States. CORRESPONDENCE ADDRESS B. Cummings, Massachusetts General Hospital, United States. SOURCE Critical Care Medicine (2010) 38 SUPPL. 12 (A30). Date of Publication: December 2010 CONFERENCE NAME 40th Critical Care Congress of the Society of Critical Care Medicine CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2011-01-15 to 2011-01-19 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: The impact of closing a hospital-based pediatric specialized transport team on pediatric intensive care unit (PICU) admissions has not been previously published. In 2003, our pediatric transport team was discontinued and an out-of-the hospital independent specialized transport team vendor was contracted to provide pediatric critical care transports. Hypothesis: Closure of a hospital-based pediatric transport team has a negative effect on requests for transports and on transport admissions to the PICU. Methods: Review of internal PICU transport database over 9 year period. Transport volume data by fiscal year were compared between pre-change (1999-2002), transition year (2003), and post-change (2004-2007) period. The number of lost PICU admissions was estimated based on the average transports pre- and post- closure and factoring in zero as well as observed growth and refusal rates after the change. Results: During the above period, there were no changes in number of referring hospitals, hospital transfer agreements or affiliations. Transports numbers went from an average of 160/year pre-change, to 109 during the transition year to an average of 145/year post-change. Requests to transport critically ill patients to the PICU increased from an average of 169/year pre-change to an average of 175/year post-change in association with increased community outreach efforts. However, our refusal rate for transport requests increased from 5% pre-change to 17% post-change. The transport vendor was unavailable for transport for 13% of requests. Assuming no growth in the number of transport requests, we estimate the loss of 187 patients for the PICU over the 5 years post-change period. Moreover, if we use the observed annual growth rate of 13% in transports requests, we estimate the loss of 364 patients during the same period. Conclusions: Closure of a hospital-based pediatric specialized transport team affected transport activity. This impact should be taken in consideration and strategies to mitigate it put in place, whenever a similar change is considered. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care intensive care unit society EMTREE MEDICAL INDEX TERMS community critically ill patient data base growth rate hypothesis organization patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70317338 DOI 10.1097/01.ccm.0000390903.16849.8c FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000390903.16849.8c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 645 TITLE Quality improvement of doctors' shift-change handover in neuro-critical care. AUTHOR NAMES Lyons M.N. Standley T.D. Gupta A.K. AUTHOR ADDRESSES (Lyons M.N.) Postgraduate Medical Centre, The Clinical School, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK. (Standley T.D.; Gupta A.K.) CORRESPONDENCE ADDRESS M.N. Lyons, Postgraduate Medical Centre, The Clinical School, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK. Email: melinda_lyons@hotmail.com SOURCE Quality & safety in health care (2010) 19:6 (e62). Date of Publication: Dec 2010 ISSN 1475-3901 (electronic) ABSTRACT Clinical handover is a necessary process for the continuation of safe patient care; however, deficiencies in the handover process can introduce error. While the number of handover studies increases, few have validated implemented improvements with repeated audit. To improve the morning handover round on a busy critical care unit and assess sustainability of improvement through repeated audit. A quality improvement process based on prospective observational assessment of the doctor's shift-change handover was carried out, assessing the content of clinical information and effects of distractions, location and timing. The effect of a training session for the junior doctors with the introduction of a standardised handover protocol was assessed. The content of clinical information improved after the training session with introduction of a standardised protocol, but returned to baseline with a new cohort of untrained doctors. Distractions were associated with increased handover times for individual patients and for total handover time. Overall, handover time was shortest in the coffee room compared with ward and lecture theatre handovers. Individual patient handover time was positively correlated with clinical content scores. Four indices of critical illness all positively correlated with increased handover time. Early specific training is vital for quality clinical handover. Distractions during handover cause inefficiency and can adversely affect information transfer. Changing handover location according to local environment can yield improved efficiency, structure and ease of management. Adequate time must be allocated for clinical handover especially when dealing with very sick and complex patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality intensive care neurologic disease patient transport physician attitude EMTREE MEDICAL INDEX TERMS article checklist clinical audit human interview manpower methodology observation organization and management prospective study United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 20427308 (http://www.ncbi.nlm.nih.gov/pubmed/20427308) PUI L360284621 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 646 TITLE The risk of intrahospital transport to patients. AUTHOR NAMES Bambi S. AUTHOR ADDRESSES (Bambi S.) CORRESPONDENCE ADDRESS S. Bambi, SOURCE Critical care nurse (2010) 30:6 (14; author reply 14-16). Date of Publication: Dec 2010 ISSN 1940-8250 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nursing research patient transport safety EMTREE MEDICAL INDEX TERMS cause of death epidemiology human methodology mortality note organization and management radiography risk factor LANGUAGE OF ARTICLE English MEDLINE PMID 21123229 (http://www.ncbi.nlm.nih.gov/pubmed/21123229) PUI L360282249 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 647 TITLE Safe intrahospital transport of non-ICU patients AUTHOR NAMES Huber C. AUTHOR ADDRESSES (Huber C., chuber@ecri.org) Pennsylvania Patient Safety Reporting System (PA-PSRS), Plymouth Meeting, PA, United States. CORRESPONDENCE ADDRESS C. Huber, Pennsylvania Patient Safety Reporting System (PA-PSRS), Plymouth Meeting, PA, United States. Email: chuber@ecri.org SOURCE American Journal of Nursing (2010) 110:11 (66-69). Date of Publication: November 2010 ISSN 0002-936X BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) interdisciplinary communication patient transport safety EMTREE MEDICAL INDEX TERMS article human patient care risk reduction standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 20980907 (http://www.ncbi.nlm.nih.gov/pubmed/20980907) PUI L360011431 DOI 10.1097/01.NAJ.0000390531.14314.1c FULL TEXT LINK http://dx.doi.org/10.1097/01.NAJ.0000390531.14314.1c COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 648 TITLE Transport of critically III neonates with cardiac conditions AUTHOR NAMES Lee J.H. Puthucheary J. AUTHOR ADDRESSES (Puthucheary J.) Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore. (Lee J.H., leejanhau@hotmail.com) 100 Bukit Timah Road, Singapore 229899, Singapore. CORRESPONDENCE ADDRESS J. H. Lee, 100 Bukit Timah Road, Singapore 229899, Singapore. Email: leejanhau@hotmail.com SOURCE Air Medical Journal (2010) 29:6 (320-322). Date of Publication: November-December 2010 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport congenital heart disease (congenital disorder) critical illness EMTREE MEDICAL INDEX TERMS aortic coarctation (congenital disorder) article clinical article cyanotic heart disease (congenital disorder) heart right ventricle double outlet (congenital disorder) human intensive care unit newborn priority journal pulmonary valve stenosis (congenital disorder) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010609732 MEDLINE PMID 21055647 (http://www.ncbi.nlm.nih.gov/pubmed/21055647) PUI L359905345 DOI 10.1016/j.amj.2010.05.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2010.05.001 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 649 TITLE Ventilatory support in the intensive care unit AUTHOR NAMES Strachan L. Hughes M. AUTHOR ADDRESSES (Strachan L.; Hughes M.) Royal Infirmary, Glasgow, United Kingdom. CORRESPONDENCE ADDRESS L. Strachan, Royal Infirmary, Glasgow, United Kingdom. SOURCE Anaesthesia and Intensive Care Medicine (2010) 11:11 (469-473). Date of Publication: November 2010 ISSN 1472-0299 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT This article focuses on a classification of modes of mechanical ventilation, the indications for and complications of invasive and non-invasive mechanical ventilation and adjuncts to mechanical ventilation. © 2010 Elsevier Ltd. All rights reserved. EMTREE DRUG INDEX TERMS aldosterone (endogenous compound) angiotensin (endogenous compound) atrial natriuretic factor heliox nitric oxide prostacyclin (drug therapy) renin (endogenous compound) sildenafil (drug therapy) surfactant vasopressin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS aeration airway conductance airway obstruction (therapy) artificial ventilation aspiration asthmatic state breathing pattern bronchopleural fistula (complication) chronic obstructive lung disease computer assisted tomography decubitus (complication) endocrine disease (complication) endotracheal tube exhaustion (therapy) extracorporeal oxygenation fluid retention fluid therapy functional residual capacity gastrointestinal hemorrhage gastrointestinal motility disorder (complication) Guillain Barre syndrome heart output hypercapnia (therapy) hypoxemia (therapy) invasive procedure kidney blood flow kyphoscoliosis motor neuron disease necrosis (complication) negative pressure ventilation neurologic disease neuropathy (complication) non invasive procedure obesity hypoventilation syndrome oxygen consumption oxygen toxicity (complication) positive end expiratory pressure priority journal pulmonary hypertension (drug therapy) short survey sinusitis (complication) splanchnic blood flow trachea stenosis (complication) tracheoesophageal fistula (complication) venous thromboembolism (complication) ventilated patient ventilator associated pneumonia (complication) ventilator induced lung injury (complication) vocal cord disorder (complication) CAS REGISTRY NUMBERS aldosterone (52-39-1, 6251-69-0) angiotensin (1407-47-2) atrial natriuretic factor (85637-73-6) heliox (58933-55-4) nitric oxide (10102-43-9) prostacyclin (35121-78-9, 61849-14-7) renin (61506-93-2, 9015-94-5) sildenafil (139755-83-2) vasopressin (11000-17-2) EMBASE CLASSIFICATIONS Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010593920 PUI L359842954 DOI 10.1016/j.mpaic.2010.08.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.mpaic.2010.08.012 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 650 TITLE Endotracheal tube intracuff pressure during helicopter transport AUTHOR NAMES Bessereau J. Coulange M. Jacquin L. Fournier M. Michelet P. AUTHOR ADDRESSES (Bessereau J.; Coulange M.; Jacquin L.; Fournier M.; Michelet P.) Intensive Care Unit and Hyperbaric Medicine, Pôle RUSH, Ste-Marguerite Hospital, Marseille, France. CORRESPONDENCE ADDRESS J. Bessereau, Intensive Care Unit and Hyperbaric Medicine, Pôle RUSH, Ste-Marguerite Hospital, Marseille, France. SOURCE Annals of Emergency Medicine (2010) 56:5 (583-584). Date of Publication: November 2010 ISSN 0196-0644 1097-6760 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE DRUG INDEX TERMS sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) endotracheal tube endotracheal tube cuff pressure EMTREE MEDICAL INDEX TERMS air medical transport atmospheric pressure bronchospasm dysphagia helicopter human hyperbaric oxygen therapy intensive care unit letter manometry mucosal disease priority journal sore throat CAS REGISTRY NUMBERS sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010605012 MEDLINE PMID 21036300 (http://www.ncbi.nlm.nih.gov/pubmed/21036300) PUI L359886210 DOI 10.1016/j.annemergmed.2010.04.031 FULL TEXT LINK http://dx.doi.org/10.1016/j.annemergmed.2010.04.031 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 651 TITLE Emergency management of children with acute severe asthma requiring transfer to intensive care AUTHOR NAMES Dehò A. Lutman D. Montgomery M. Petros A. Ramnarayan P. AUTHOR ADDRESSES (Dehò A.; Lutman D.; Montgomery M.; Petros A.; Ramnarayan P., ramnarayan@msn.com) Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS P. Ramnarayan, Children's Acute Transport Service, Great Ormond Street Hospital, London, United Kingdom. Email: ramnarayan@msn.com SOURCE Emergency Medicine Journal (2010) 27:11 (834-837). Date of Publication: November 2010 ISSN 1472-0205 1472-0213 (electronic) BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Purpose: Children presenting to emergency departments (ED) with acute severe asthma unresponsive to initial medical therapy may require endotracheal intubation and mechanical ventilation. There is little data on complications during the acute management of children with life-threatening asthma, particularly at hospitals where specialist paediatric staff are lacking. It was hypothesised that a better understanding of complications, particularly associated with intubation and mechanical ventilation, would improve acute management in ED, aid quality improvement initiatives at district general hospitals (DGH) and form the basis for educational interventions from regional paediatric critical care units. Methods: A retrospective case note review was performed for all children referred to a regional intensive care retrieval service with status asthmaticus over a 2-year period. Initial treatment, patient-related factors, indication for endotracheal intubation and the type and occurrence of adverse events during acute management at the DGH were studied. Bivariate and multivariate analyses were undertaken to identify factors associated with the occurrence of complications. Results: 51 (85%) of the 60 children transferred to a paediatric intensive care unit for acute severe asthma required intubation. 36 (70.5%) experienced one or more complications during intubation and in the early phase of mechanical ventilation. The most common complications were hypotension (requiring fluid resuscitation and/or inotropic support) and severe bronchospasm with acute hypercarbia. The indication for intubation significantly affected the chances of a complication occurring during stabilisation. Conclusions: There is considerable morbidity in asthmatic children who are referred to paediatric intensive care. The majority of complications may be anticipated and prevented resulting in improved management at DGH. EMTREE DRUG INDEX TERMS aminophylline (drug combination, intravenous drug administration) corticosteroid (intravenous drug administration) dopamine (drug therapy) epinephrine (drug therapy) fentanyl ketamine (intravenous drug administration) magnesium sulfate (intravenous drug administration) midazolam noradrenalin (drug therapy) propofol salbutamol (drug combination, inhalational drug administration, intravenous drug administration) sevoflurane thiopental vecuronium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) asthma EMTREE MEDICAL INDEX TERMS adolescent article artificial ventilation asthmatic state atelectasis (complication) bronchospasm (complication) child disease severity emergency care endotracheal intubation fluid resuscitation human hypercapnia (complication) hypotension (complication, drug therapy) intensive care major clinical study patient transport pneumothorax (complication) priority journal retrospective study risk factor treatment indication CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) aminophylline (317-34-0) dopamine (51-61-6, 62-31-7) fentanyl (437-38-7) ketamine (1867-66-9, 6740-88-1, 81771-21-3) magnesium sulfate (7487-88-9) midazolam (59467-70-8) noradrenalin (1407-84-7, 51-41-2) propofol (2078-54-8) salbutamol (18559-94-9, 35763-26-9) sevoflurane (28523-86-6) thiopental (71-73-8, 76-75-5) vecuronium (50700-72-6) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010631502 MEDLINE PMID 20558488 (http://www.ncbi.nlm.nih.gov/pubmed/20558488) PUI L359978007 DOI 10.1136/emj.2009.082149 FULL TEXT LINK http://dx.doi.org/10.1136/emj.2009.082149 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 652 TITLE Where is the impact? AUTHOR NAMES Rampil I.J. Rampil L.S. AUTHOR ADDRESSES (Rampil I.J., ira.rampil@sunysb.edu) Health Science Center, Stony Brook University, Stony Brook, NY, United States. (Rampil L.S.) CORRESPONDENCE ADDRESS I. J. Rampil, Health Science Center, Stony Brook University, Stony Brook, NY, United States. Email: ira.rampil@sunysb.edu SOURCE Anesthesiology (2010) 113:4 (995). Date of Publication: October 2010 ISSN 0003-3022 1528-1175 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospitalization intensive care patient transport respiratory care EMTREE MEDICAL INDEX TERMS anticipation human intensive care unit letter medical research priority journal pulse oximetry respiratory therapist EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010574244 MEDLINE PMID 20864837 (http://www.ncbi.nlm.nih.gov/pubmed/20864837) PUI L359775025 DOI 10.1097/ALN.0b013e3181eff877 FULL TEXT LINK http://dx.doi.org/10.1097/ALN.0b013e3181eff877 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 653 TITLE Where is the impact? AUTHOR NAMES Taenzer A. Pyke J. McGrath S. Blike G. AUTHOR ADDRESSES (Taenzer A., andreas.h.taenzer@dartmouth.edu) Dartmouth Hitchcock Medical Center, Lebanon, NH, United States. (Pyke J.; McGrath S.; Blike G.) CORRESPONDENCE ADDRESS A. Taenzer, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States. Email: andreas.h.taenzer@dartmouth.edu SOURCE Anesthesiology (2010) 113:4 (995-996). Date of Publication: October 2010 ISSN 0003-3022 1528-1175 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS human intensive care unit letter medical education medical research mortality patient safety priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010574245 PUI L359775026 DOI 10.1097/ALN.0b013e3181eff877 FULL TEXT LINK http://dx.doi.org/10.1097/ALN.0b013e3181eff877 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 654 TITLE Transfer of critical care patients ORIGINAL (NON-ENGLISH) TITLE Die Verlegung intensivbehandlungspflichtiger Patienten AUTHOR NAMES Hiller B. AUTHOR ADDRESSES (Hiller B., benjamin.hiller@drk-kh-alzey.de) Anästhesie, DRK Krankenhaus Alzey, Kreuznacherstraße 7-9, 55232 Alzey, Germany. CORRESPONDENCE ADDRESS B. Hiller, Anästhesie, DRK Krankenhaus Alzey, Kreuznacherstraße 7-9, 55232 Alzey, Germany. Email: benjamin.hiller@drk-kh-alzey.de SOURCE Notarzt (2010) 26:4 (145-149). Date of Publication: 2010 ISSN 0177-2309 1438-8693 (electronic) BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. ABSTRACT Changes in the structure of medical care increase the amount of critical care transports. In order to minimize the risk of these transports, organizational preconditions have to be established, medical staff must be trained adequately, especially equipped transportation vehicles must be available, and the patient has to be prepared optimally. The continuation of the individual critical care therapy under the conditions of transport has to be guaranteed. Main focus of the preparation of the transport is a detailed clarification of the patients condition and the circumstances of transport. © Georg Thieme Verlag KG Stuttgart - New York. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient health care personnel patient transport EMTREE MEDICAL INDEX TERMS article hospital care human patient care training EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2010448885 PUI L359365144 DOI 10.1055/s-0030-1248483 FULL TEXT LINK http://dx.doi.org/10.1055/s-0030-1248483 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 655 TITLE Severe falciparum malaria patients transferred "late" to a high level icu in india represents a difficult research capture point to comment on predictors of mortality and related organ dysfunction AUTHOR NAMES McLachlan C.S. Taylor C.B. Li Y. Willenberg L. Matthews S. Glass P. Myburgh J. AUTHOR ADDRESSES (McLachlan C.S.; Taylor C.B.; Li Y.; Willenberg L.; Matthews S.; Glass P.; Myburgh J.) The George Institute for Global Health Australia, Division of Critical Care, Level 7, 341 George Street, Sydney, NSW 2000, Australia. CORRESPONDENCE ADDRESS C. S. McLachlan, The George Institute for Global Health Australia, Division of Critical Care, Level 7, 341 George Street, Sydney, NSW 2000, Australia. SOURCE Singapore Medical Journal (2010) 51:9 (752-753). Date of Publication: SEPTEMBER 2010 ISSN 0037-5675 BOOK PUBLISHER Singapore Medical Association, 2 College Road, Level 2, Singapore, Singapore. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit malaria falciparum mortality patient transport EMTREE MEDICAL INDEX TERMS acute kidney failure (complication, therapy) cerebral malaria disease severity hemodialysis human India letter liver dysfunction (complication) parasitemia peritoneal dialysis private hospital sample size EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Internal Medicine (6) Public Health, Social Medicine and Epidemiology (17) Hematology (25) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010652720 MEDLINE PMID 20938618 (http://www.ncbi.nlm.nih.gov/pubmed/20938618) PUI L360044630 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 656 TITLE 2010 critical care transport workplace and salary survey AUTHOR NAMES Greene M.J. AUTHOR ADDRESSES (Greene M.J.) Fitch and Associates, LLC, Platte City, MO, United States. CORRESPONDENCE ADDRESS M. J. Greene, Fitch and Associates, LLC, Platte City, MO, United States. SOURCE Air Medical Journal (2010) 29:5 (222-235). Date of Publication: September-October 2010 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Critical care transport (CCT) leaders and managers from 300 organizations were invited to participate in an online survey (participation rate, 34) with approximately 150 questions covering a broad base of CCT organizational, workplace, personnel, and salary matters. In addition to medical team composition, recruitment and retention, training, education, and benefits, the survey presents CCT crew salary data by job class by Bowley's seven-figure summary, as well as average, minimum, and maximum hourly rates. Salaries are reported in a national aggregate and by Association of Air Medical Services region. © 2010 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS air medical transport compensation health survey medical education medical service online analysis organization priority journal review salary total quality management workplace EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010486527 MEDLINE PMID 20826354 (http://www.ncbi.nlm.nih.gov/pubmed/20826354) PUI L359488534 DOI 10.1016/j.amj.2010.07.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2010.07.004 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 657 TITLE Intrahospital transfer of critical care patients to MRI: Medical staff knowledge and experience AUTHOR NAMES Mottram L.J. Farling P.A. Mcbrien M.B. AUTHOR ADDRESSES (Mottram L.J.; Farling P.A.; Mcbrien M.B.) Royal Hospital Belfast Health, Social Care Trust, Belfast, United Kingdom. CORRESPONDENCE ADDRESS L.J. Mottram, Royal Hospital Belfast Health, Social Care Trust, Belfast, United Kingdom. SOURCE Intensive Care Medicine (2010) 36 SUPPL. 2 (S150). Date of Publication: September 2010 CONFERENCE NAME 23rd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2010-10-09 to 2010-10-13 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Magnetic Resonance Imaging (MRI) is well established for a variety of indications in the elective setting, but is being increasingly utilized for imaging critically ill adults1. As a result, anaesthetists and intensive care physicians who do not regularly work inMRI may be required to manage such patients. Hospital transfers are associated with adverse incidents in the critically ill2, and the risks are likely to bemagnified in the isolated and potentially hazardousMRI environment. Wesought to determine if gaps in training exist in this area of critical care transport. OBJECTIVES. 1. To ascertain trainee and consultant experience in the MRI setting. 2. To determine level of supervision for trainees in the elective MRI setting as compared with critical care transfers to MRI. 3. To gain insight into the learning resources used by medical staff on MRI to allow existing training to be improved. METHODS. Two online surveys were conducted in February 2010, with invitations to participate via e-mail. The survey population included all anaesthesia and intensive care medicine consultants in the local tertiary neurosciences centre and all trainees for these specialties in the Northern Ireland Deanery. First year trainees were excluded. RESULTS. The response rate was 61% for consultants and 50% for trainees. In total, 35 consultants responded with over 50% having no experience of MRI at consultant level, even though 70% worked in areas where MRI skills could be required. 54 trainees completed the survey, with 70% having experience of MRI in the elective setting, all of whom had been directly supervised by a consultant. 65% of trainees had experience of critical care transfers for MRI, but this was in an unsupervised capacity more than 50% of the time. Despite this, 44% of trainees did not feel competent to work in MRI unsupervised. Web based learning was found to be a poorly utilised MRI training tool, partICUlarly among consultants.(Figure presented) CONCLUSION. We have demonstrated a need to formalize training for MRI in our institution and for trainees in the local deanery. We propose to meet this need by a combination of e-learning and experiential sessions with defined competencies. This should increase the cohort of physicians who can provide optimal care(3,4) in this unique environment and subsequently improve both service delivery and patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care medical staff nuclear magnetic resonance imaging patient patient transport society EMTREE MEDICAL INDEX TERMS anesthesia consultation critically ill patient e-mail environment health care delivery hospital imaging learning patient safety physician population risk skill student Tertiary (period) United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70290478 DOI 10.1007/s00134-010-1999-x FULL TEXT LINK http://dx.doi.org/10.1007/s00134-010-1999-x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 658 TITLE Extracorporeal oxygenation (ECMO) rescue in the treatment of severe ards with a refractory hypoxemia AUTHOR NAMES Zogheib E. Piccardo A. Guinot P. Buchalet C. Petiot S. Moubarak M. Hubert V. Besserve P. Benamar A. Monconduit J. Caus T. Dupont H. AUTHOR ADDRESSES (Zogheib E.; Guinot P.; Buchalet C.; Petiot S.; Moubarak M.; Hubert V.; Besserve P.; Benamar A.; Dupont H.) University Hospital, Anesthesiology and Intensive Care Department, Amiens, France. (Piccardo A.; Caus T.) University Hospital, Cardiac Surgery Department, Amiens, France. (Monconduit J.) University Hospital, Pneumology Department, Amiens, France. CORRESPONDENCE ADDRESS E. Zogheib, University Hospital, Anesthesiology and Intensive Care Department, Amiens, France. SOURCE Intensive Care Medicine (2010) 36 SUPPL. 2 (S358). Date of Publication: September 2010 CONFERENCE NAME 23rd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2010-10-09 to 2010-10-13 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. Severe ARDS and refractory hypoxemia were defined with a PaO2/ fraction of inspired oxygen (FiO2) ratio of B100, or uncompensated hypercapnea with a pH of \7.20 despite receiving optimal conventional treatment. The ECMO can be used as a rescue treatment in these case. OBJECTIVES. Evaluation of severe ARDS treated with extracorporeal oxygenation (ECMO). All these ARDS were due to bacterial pneumonia or H1N1 influenza. METHODS. Over the last year (December 2009-January 2010), the recourse to extracorporeal oxygenation (ECMO) was used in ten patients with severe ARDS and severe hypoxemia. Two groups were defined: bacterial pneumonia with ARDS (BP group, n = 5), and H1N1 influenza with ARDS (H1N1 group, n = 5). All ECMOs were implanted at the bedside to facilitate intra-hospital or inter-hospital transfer, because of severe hypoxemia or hemodynamic instability making impossible patient mobilization before ECMO. RESULTS. All patients in the ARDS BP group were male. There was three female and two male in the ARDS H1N1 group. The median [range] age was 54 years old [18-57] (BP) versus 21 [28-45] (H1N1), p = 0.11. The most common associated comorbidity in the group H1N1 was obesity (30 kg/m(2) [25-41] vs. 26 [17-30], p = 0.07). The time between the onset of respiratory symptoms and implantation of ECMO were longer in the BP group (12 days [6-36] vs. 1 [1-13], p = 0.06). When comparing BP and H1N1 groups, duration of ECMO (14 days [6-30] vs. 20 [10-41], p = 0.84), duration of mechanical ventilation (66 days [36-77] vs. 42 [15-75], p = 0.4), ICU length of stay (77 days [38-92] vs. 48 [21-94], p = 0.6) and duration of hospitalisation (91 days [38-112] vs. 56 [29-113], p = 0.46) were similar. In the BP group, 60% survived to hospital discharge (1 patient died on ECMO, 1 patient died after discharge from ICU). All patients of the H1N1 group survived to hospitalization. All survivors of both groups were in good health condition upon leaving the hospital. CONCLUSIONS. Given these good results, and despite long periods of mechanical ventilation, ICU duration and hospital length of stay, the standard respiratory ECMO support should be discussed again in the algorithm treatment of ARDS with refractory hypoxemia. EMTREE DRUG INDEX TERMS methaqualone oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extracorporeal oxygenation hypoxemia intensive care society EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome algorithm artificial ventilation bacterial pneumonia comorbidity female health hospital hospital discharge hospitalization hypercapnia implantation influenza length of stay male mobilization obesity patient pH survivor LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70291305 DOI 10.1007/s00134-010-2001-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-010-2001-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 659 TITLE Out of hospital transfer is an independent predictor of death or poor outcome after intracerebral hemorrhage. AUTHOR NAMES Rincon F. Akbar U. Morino T. Behrens D. Schorr C. Dellinger P. Parrillo J. Mirsen T. AUTHOR ADDRESSES (Rincon F.) Jefferson University, Philadelphia, United States. (Akbar U.; Morino T.; Behrens D.; Schorr C.; Dellinger P.; Parrillo J.; Mirsen T.) Cooper University Hospital, Camden, United States. CORRESPONDENCE ADDRESS F. Rincon, Jefferson University, Philadelphia, United States. SOURCE Neurocritical Care (2010) 13 SUPPL. 1 (S103). Date of Publication: September 2010 CONFERENCE NAME 8th Annual Meeting of the Neurocritical Care Society CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2010-09-15 to 2010-09-18 ISSN 1541-6933 BOOK PUBLISHER Humana Press ABSTRACT Introduction: Transfer of critically-ill patients from external Emergency Department (OSH-ED) has the potential of delaying the admission to the Intensive Care Unit (ICU). The effect of OSH-ED transfer on hospital outcomes of ICH patients has not been studied. Methods: We designed a retrospective cohort study using a prospectively compiled and maintained registry (Cerner Project IMPACT). ICH patients admitted to our ICU from our ED and OSH-ED within 24 hrs of stroke between 2003-2008 were selected for the analysis. Data collected included demographics, admission physiologic variables, Glasgow Coma Scale (GCS), APACHE-II, scores; and total ICU and hospital length of stay (LOS). Primary outcome was functional status at hospital discharge and secondary outcomes were ICU and hospital LOS. Poor outcome was defined as death or severe disability at hospital discharge. To assess for the impact of OSH-ED transfer on primary and secondary outcomes, demographic and admission clinical variables were used to construct logistic regression models using the outcome measure as a dependent variable. Results: A total of 296 patients were selected. The mean age was 65±14 years, of which 47% were male, 63% were white, and 66% were transferred from OSH-ED. The median hospital LOS was 6 days (Interquartile range [IQR]=4-11) and median ICU-LOS was 2 days (IQR=1-4). Overall hospital mortality was 37%. Transfer from OSH-ED was associated with a 75% probability of death or poor outcome at hospital discharge. Multivariate regression analysis showed that APACHE-II (OR, 1.2; 95% CI; 1.1-1.3), GCS ≤12 (OR, 2.8; 95% CI; 1.8-4.1), and OSH-ED transfer (OR, 1.7; 95% CI; 1.1-2.5) were independently associated with poor outcome. OSH-ED was not significantly associated with secondary outcome measures. Conclusions: This data suggests that in ICH patients, OSH-ED transfer is independently associated with poor outcome at hospital discharge. Further research is needed as to identify the potential causes for this effect. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain hemorrhage death hospital society EMTREE MEDICAL INDEX TERMS APACHE cerebrovascular accident cohort analysis critically ill patient dependent variable disability emergency ward functional status Glasgow coma scale hospital discharge intensive care unit length of stay logistic regression analysis male model mortality patient register regression analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70300724 DOI 10.1007/s12028-010-9426-2 FULL TEXT LINK http://dx.doi.org/10.1007/s12028-010-9426-2 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 660 TITLE Peribulbar blockade for retinopathyof prematurity out side the or AUTHOR NAMES Dagge A. Grac¸a A.L. Caramelo S.M. Fonseca L. AUTHOR ADDRESSES (Dagge A.; Grac¸a A.L.; Fonseca L.) Anestesia, Cuidados Intensivos e Emergencia, Centro Hospitalar do Porto-Hospital Santo Antonio, Porto, Anestesia, Portugal. (Caramelo S.M.) Emergencia e Dor, Centro Hospitalar de Tráis os Montes e Alto Douro, Vila Real, Portugal. CORRESPONDENCE ADDRESS A. Dagge, Anestesia, Cuidados Intensivos e Emergencia, Centro Hospitalar do Porto-Hospital Santo Antonio, Porto, Anestesia, Portugal. SOURCE Regional Anesthesia and Pain Medicine (2010) 35:5 (E81). Date of Publication: September-October 2010 CONFERENCE NAME 29th Annual European Society of Regional Anaesthesia, ESRA Congress 2010 CONFERENCE LOCATION Porto, Portugal CONFERENCE DATE 2010-09-08 to 2010-09-11 ISSN 1098-7339 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: Retinopathy of prematurity (ROP) is an eye disease that affects prematurely born babies, with an incidence of 78% in prematures with weight from 750 to 990g1. It is caused by disorganized growth of retinal blood vessels which result in scarring and retinal detachment. Both oxygen toxicity and relative hypoxia can contribute to its development. In prematures should be avoied proceadures that can affect their cardiovascular and respiratory stability. Case Report: Thirty seven weeks of post-conception age baby with weight of 2250g and retinopathy of prematurity grade IV was proposed for retinian criotherapy.The anesthetic plan was bilateral peribulbar blockade with single shot with 30G-needle. It was administered 1 mL of ropivacaine 0,5 %. It was performed in the Intensive Care Unit (ICU). All ASA monitoring standarts and assepsia care were performed. The child was kept under the same mid-azolam and morfine perfusions and mechanically ventilated with 100% FiO(2). The patient is the 2nd twin of gemelar gestation affected by Feto-Fetal Transfusion Syndrome. By deterioration of the 1st twin with congestive heart failure it was preformed a caesarean section at 26 weeks. It is reported the death of the 1st twin at birth in spite of the advanced life support measures. The 2nd twin borned with 740g and Apgar Rate: 6/9/9. It was admitted ICU with necessity of mechanical ventilation.She was discharged after 123 days, clinically well, weighting 3380 g. Discussion: The chosen anesthetic plan allowed greater hemodynamic stability and reduced the needs of another type of analgesia in the 24 h after surgery without other analgesics.This anesthetic technique allowed the execution of the proposed surgery minimizing the risks of respiratory depres-sion.The procedure being performed in the UCI allowed us to avoid the risks of the intra-hospital transport.Referencies: GreGORy G. Pediatric Anesthesia, Churchil Livingstone, 4° ed. Conclusions: Continuous local anaesthetic wound infusion as part of multimodal pain treatment in patients after subpectoral breast augmentation is a valuable method. EMTREE DRUG INDEX TERMS anesthetic agent morphine ropivacaine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) prematurity regional anesthesia society EMTREE MEDICAL INDEX TERMS analgesia baby blood transfusion reaction breast augmentation case report cesarean section child congestive heart failure death deterioration eye disease hospital hypoxia infusion intensive care unit intrauterine blood transfusion monitoring needle oxygen toxicity pain patient pediatric anesthesia perfusion pregnancy retina blood vessel retina detachment retrolental fibroplasia risk scar formation surgery twins weight wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70287319 DOI 10.1097/AAP.0b013e3181f3582c FULL TEXT LINK http://dx.doi.org/10.1097/AAP.0b013e3181f3582c COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 661 TITLE Going it alone: the beginning of a nurse-led retrieval service. AUTHOR NAMES Herring S. AUTHOR ADDRESSES (Herring S.) Evelina Children's Hospital, London. CORRESPONDENCE ADDRESS S. Herring, Evelina Children's Hospital, London. SOURCE Paediatric nursing (2010) 22:7 (22-24). Date of Publication: Sep 2010 ISSN 0962-9513 ABSTRACT Training for experienced paediatric intensive care nurses to work as retrieval nurse practitioners is being offered by the South Thames Retrieval Service. To date, nine such practitioners have been assessed as competent to practise independently and in their first three and a half years of practice have transferred 366 critically ill children. Potential obstacles included: limitations to prescribing, resistance to nurses performing a traditional medical role and adaptation in the paediatric intensive care unit environment. Continuing evaluation is essential to ensure a high standard of care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) nurse practitioner nursing practice patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS article child human intensive care unit organization and management program development United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 20954525 (http://www.ncbi.nlm.nih.gov/pubmed/20954525) PUI L359898836 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 662 TITLE Transport times did not change between 2004 and 2009 but thrombolysis rates increased from 10 to 18%. Results from the Austrian National Acute Stroke-Unit Registry AUTHOR NAMES Brainin M. Tatschl C. Teuschl Y. Seyfang L. Matz K. Eckhardt R. AUTHOR ADDRESSES (Brainin M.; Teuschl Y.; Seyfang L.) Department for Clinical Medicine and Preventive Medicine, Danube University Krems, Austria. (Tatschl C.; Matz K.; Eckhardt R.) LKH, Tulln, Austria. CORRESPONDENCE ADDRESS M. Brainin, Department for Clinical Medicine and Preventive Medicine, Danube University Krems, Austria. SOURCE European Journal of Neurology (2010) 17 SUPPL. 3 (65). Date of Publication: September 2010 CONFERENCE NAME 14th Congress of the European Federation of Neurological Societies, EFNS CONFERENCE LOCATION Geneva, Switzerland CONFERENCE DATE 2010-09-25 to 2010-09-28 ISSN 1351-5101 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Introduction: Successful intervention in acute stroke depends on early arrival at the stroke unit. The aim of this study was to identify time-dependent factors for referral and thrombolysis treatment in acute stroke units and to define the gains for direct referral versus referral via another hospital. Methods:Analysis of data from theAustrian NationalAcute Stroke-Unit Registry. Results: Data of 40,660 stroke patients were registered at one of 29 acute stroke units in the time between January 2003 and May 2009. Exact time of onset was known for 18,223 (58%) patients. 85 percent were admitted directly and 15% were transferred from other hospitals. The admission rates within two hours were 58% and 33% for patients admitted directly and those referred from another hospital, respectively. Accordingly, direct admission to hospitals equipped with stroke units increased the relative chance of thrombolytic treatment by odds 1.4. The rate of patients admitted within 2 hours did not change between 2004 and 2009, however, thrombolysis rates increased in the same time period significantly from 10%to 18%. Extending the time window for thrombolysis to 4h arrivals may further increase thrombolysis rate up to 21%. Conclusion: Direct referral to an acute stroke unit bears highest chance for thrombolysis treatment. While the transport times for patients referred to acute stroke units within 2 hours from onset remained constant between 2004 and 2009, corresponding thrombolysis rates had risen from 10% to 18%. Extension of the time window including four hour referrals would further increase this rate to 21%. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood clot lysis health care organization register stroke unit EMTREE MEDICAL INDEX TERMS cerebrovascular accident hospital patient stroke patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70274063 DOI 10.1111/j.1468-1331.2010.03231.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1468-1331.2010.03231.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 663 TITLE Erratum: Increase the donor pool: Transportation of a patient with fatal head injury supported with extracorporeal membrane oxygenation (The Journal of Trauma: Injury, Infection, and Critical Care) AUTHOR NAMES Tsai C.-S. AUTHOR ADDRESSES (Tsai C.-S.) CORRESPONDENCE ADDRESS C.-S. Tsai, SOURCE Journal of Trauma - Injury, Infection and Critical Care (2010) 69:3 (734). Date of Publication: September 2010 ISSN 0022-5282 1529-8809 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum priority journal EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010552250 PUI L359703887 DOI 10.1097/TA.0b013e3181ec1016 FULL TEXT LINK http://dx.doi.org/10.1097/TA.0b013e3181ec1016 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 664 TITLE Use of the bow-tie method for a prospective risk analysis of in hospital transportation of intensive care patients AUTHOR NAMES Van Slobbe-Bijlsma E.R. Dongelmans D.A. Van Der Sluijs A.F. AUTHOR ADDRESSES (Van Slobbe-Bijlsma E.R.; Dongelmans D.A.; Van Der Sluijs A.F.) Academic Medical Center, University of Amsterdam, Intensive Care Medicine, Amsterdam, Netherlands. CORRESPONDENCE ADDRESS E.R. Van Slobbe-Bijlsma, Academic Medical Center, University of Amsterdam, Intensive Care Medicine, Amsterdam, Netherlands. SOURCE Intensive Care Medicine (2010) 36 SUPPL. 2 (S400). Date of Publication: September 2010 CONFERENCE NAME 23rd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2010-10-09 to 2010-10-13 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION. In hospital transportation of Intensive Care (IC) patients for diagnostic procedures or therapeutic interventions is daily routine. The majority of IC patients are mechanically ventilated and vasoactive medication dependent. Transportation of these patients outside the safe environment of the ICU is potentially harmful, because several risks are present. OBJECTIVES. Incidents, related to the transportation of ICU patients, with adverse outcome are rare. Nevertheless we believed that the actual number of incidents is significantly higher than the ones reported in our Incident Registration System. Therefore a prospective risk analysis was performed, using the Bow-tie method. We used this method to improve patient safety and quality of in hospital transportation of ICU patients. METHODS. The Bow-tie method was performed at the ICU of the AcademicMedical Centre of the University of Amsterdam, The The Netherlands. The ICU contains 32 operational beds and approximately 120 nurses and 30medical doctors are employed. The study was performed by the Committee on Patient Safety and Quality (CPSQ). Using the Bow-tie method, supported with purchased software (BowtieXP by Governor's) multiple Bow-tie diagrams were made: (1) Incidentswith the inevitably use of lifts, (2) Incidentswith bed-side equipment, (3) Ventilation-related incidents, (4) Monitoring-related incidents, (5) Incidents concerning lines and devices, (6) Medication- related incidents and (7) Patient-related problems. An example of a Bow-tie diagram:(Figure presented) RESULTS. The great majority of defence barriers, as reported in the Bow-tie diagrams, were already effective. After analysis a list of recommendations to improve patient safety and quality during transportation was composed: 1. Revision of the Transportation protocol 2. Implementation of a checklist together with at least 30 min preparation time 3. Improving education, certification and supervision by staff members 4. Changes in design of bed-side equipment 5. Use of a lift (priority)-badge 6. Improvement of the incident registration system. The results were presented and discussed in our weekly meeting on patient safety and healthcare for all ICU personnel. By the end of this year all the recommendations will be implemented in our ICU. CONCLUSIONS. We improved the safety and quality of in hospital transportation of ICU patients by performing a prospective risk analysis. Bow-tie is a good instrument to identify health care risks. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care patient risk assessment society traffic and transport EMTREE MEDICAL INDEX TERMS adverse outcome air conditioning certification checklist devices diagnostic procedure drug therapy education environment health care monitoring Netherlands nurse patient safety personnel physician registration risk safety software university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70291472 DOI 10.1007/s00134-010-2001-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-010-2001-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 665 TITLE Reducing contact-to-balloon-time by increasing the number of primary transportations to PCI centers: Results from the myocardial infarction network Goettingen AUTHOR NAMES Jacobshagen C. Kern M. Scholz K.-H. Hasenfuss G. Maier L.S. AUTHOR ADDRESSES (Jacobshagen C.; Kern M.; Hasenfuss G.; Maier L.S.) Department of Cardiology, Georg-August-University Goettingen, Goettingen, Germany. (Scholz K.-H.) Med. Klinik I Kardiologie, St. Bernward Krankenhaus, Hildesheim, Germany. CORRESPONDENCE ADDRESS C. Jacobshagen, Department of Cardiology, Georg-August-University Goettingen, Goettingen, Germany. SOURCE European Heart Journal (2010) 31 SUPPL. 1 (768). Date of Publication: September 2010 CONFERENCE NAME European Society of Cardiology, ESC Congress 2010 CONFERENCE LOCATION Stockholm, Sweden CONFERENCE DATE 2010-08-28 to 2010-09-01 ISSN 0195-668X BOOK PUBLISHER Oxford University Press ABSTRACT The acute revascularization of occluded vessels is of crucial importance for the prognosis of patients presenting with STEMI. However, the treatment times that are recommended by international guidelines are often not met. FITT-STEMI (Feedback Intervention and Treatment Times in STEMI) is a multicenter study to assess whether standardized data collection with systematic feedback of the results of treatment can improve the quality of care and prognosis in patients with STEMI. We investigated in our myocardial infarction network of Goettingen, if an optimization of the EMS transportation modalities can improve the contact-to-balloon time. Therefore, we prospectively assessed the timing of acute treatment in our heart center (24-h standby for PCI) in all patients with STEMI (symptoms <24h). We analyzed all relevant time intervals in the rescue and treatment chain from initial contact of the patient until the reopening of the occluded coronary vessel. Following a 3-month period for data collection the analyzed treatment times were presented in an interactive feedback event to all groups involved in the treatment of STEMI patients. This procedure was repeated in the same way every 3 months. In 18 months 444 patients with assumed STEMI were included (69% male, average age 65.0 years). A total of 348 patients (78%) were treated with PCI, 19% had cardiogenic shock and 12% were resuscitated. 79% of patients had a TIMI risk score ≥3. Due to the systematic feedback events the number of primary transportations of STEMI patients to our PCI center (bypassing smaller non-PCI hospitals) could be increased from initially 48% to 71% after 18 months. This is noteworthy since 2/3 of the patients came from the catchment area of smaller non-PCI hospitals of the infarct network. The proportion of primary transports from this area was initially only 23% and was increased to 59% within 18 months. The contact-to-balloon time was reduced by 24 min for the entire group. Informing the cath lab in advance by the emergency system (56% initially, 83% after 18 months), and bypassing the emergency room (50% initially, 67% after 18 months) also contributed to the reduced contact-to-balloon time. In conclusion, our data demonstrate that by feedback events with all systems involved the proportion of primary transportations to PCI centers could be increased in patients with STEMI. The emergency management of these patients could be improved by informing the cath lab in advance and by bypassing the emergency room. This leads to a reduction of the contact-to-balloon times and may improve the prognosis of STEMI patients in the future. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology heart infarction society traffic and transport EMTREE MEDICAL INDEX TERMS cardiogenic shock catchment coronary blood vessel coronary care unit emergency emergency ward feedback system hospital infarction information processing male multicenter study patient prognosis revascularization risk ST segment elevation myocardial infarction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70282459 DOI 10.1093/eurheartj/ehq289 FULL TEXT LINK http://dx.doi.org/10.1093/eurheartj/ehq289 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 666 TITLE Quality of transfers of critically ill patients within the hospital AUTHOR NAMES Tjen C. Rowland D. Dhrampal A. Hutchinson S. AUTHOR ADDRESSES (Tjen C.; Rowland D.; Dhrampal A.; Hutchinson S.) Norfolk and Norwich University Hospital, Norwich, United Kingdom. CORRESPONDENCE ADDRESS C. Tjen, Norfolk and Norwich University Hospital, Norwich, United Kingdom. SOURCE Critical Care (2010) 14 SUPPL. 1 (S158). Date of Publication: 2010 CONFERENCE NAME 30th International Symposium on Intensive Care and Emergency Medicine, ISICEM CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2010-03-09 to 2010-03-12 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction: Transferring critically ill patients between clinical areas is recognised to be potentially hazardous [1] and associated with poor outcome [2]. This study addresses the standard of intrahospital transfer of sick patients within our Trust including monitoring, equipment availability, personnel and training. Methods: We surveyed senior ward staff on how they would conduct the theoretical transfer of a deteriorating, hypoxic, shocked patient to the ITU. Monitoring and equipment deemed necessary and its perceived availability were recorded, as was transfer personnel. We then prospectively reviewed actual transfers of patients with Early Warning Scores (EWS) of 3 or greater. Results: Theoretical transfer data were collected from 19 wards. Most (74%) requested oxygen saturation (SpO(2)) monitoring, while less than one-third wanted either non-invasive blood pressure or ECG monitoring. Some wards expressed a need to borrow equipment, while others felt this would lead to delay. Three wards considered any monitoring unnecessary. Of 13 wards declining a defibrillator/cardiac monitor, two did so due to lack of familiarity. Prospective data were gathered from 32 transfers between September and November 2009. EWS ranged from 3 to 9. The actual transfer monitoring mirrored the initial survey, but for SpO(2) monitoring (44% vs 74%, respectively). A doctor was included by 10% for the theoretical transfer and in 16% of actual transfers. Less than one-half of actual transfers had a trained member of the transfer team. These patients were better monitored but the standard of transfers did not correspond to EWS. Patients with higher EWS were neither better monitored nor accompanied. Out of hours activity comprised 21% of actual transfers. The bulk of patients were from the admission units and the majority went to critical care or radiology. Conclusions: There is considerable movement of sick patients around the hospital. Many transfers are performed by untrained staff , without adequate monitoring, and many are out of hours. There is poor understanding of risks of transfer and of appropriate monitoring. The data suggest that deficits are due partly to equipment unavailability - we are conducting a further audit to determine this. We propose additional investment and training and are compiling intrahospital transfer guidelines according to EWS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient emergency medicine hospital intensive care EMTREE MEDICAL INDEX TERMS blood pressure clinical audit electrocardiogram electrocardiography monitoring investment monitoring oxygen saturation patient patient transport personnel physician radiology risk ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70255714 DOI 10.1186/cc8703 FULL TEXT LINK http://dx.doi.org/10.1186/cc8703 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 667 TITLE Audit of severe acute maternal morbidity describing reasons for transfer and potential preventability of admissions to ICU AUTHOR NAMES Lawton B.A. Wilson L.F. Dinsdale R.A. Rose S.B. Brown S.A. Tait J. Coles C.L. McCaw A. AUTHOR ADDRESSES (Lawton B.A., bev.lawton@otago.ac.nz; Rose S.B.; Brown S.A.) Women's Health Research Centre, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand. (Wilson L.F.) Anaesthetic Department, Capital and Coast District Health Board, Wellington South, New Zealand. (Dinsdale R.A.) Intensive Care, Capital and Coast District Health Board, Wellington South, New Zealand. (Tait J.; Coles C.L.; McCaw A.) Women's and Children's Health Directorate, Capital and Coast District Health Board, Wellington South, New Zealand. CORRESPONDENCE ADDRESS B. A. Lawton, Women's Health Research Centre, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand. Email: bev.lawton@otago.ac.nz SOURCE Australian and New Zealand Journal of Obstetrics and Gynaecology (2010) 50:4 (346-351). Date of Publication: August 2010 ISSN 0004-8666 1479-828X (electronic) BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT Background: Maternal mortality is a rare event in the developed world. Assessment of severe acute maternal morbidity (SAMM) is therefore an appropriate measure of the quality of maternity care. Aims: The aim of the study was to conduct a retrospective audit of SAMM cases (pregnant women admitted to a New Zealand Intensive Care Unit) to describe clinical, socio-demographic characteristics, pregnancy outcomes and preventability. Methods: Severe acute maternal morbidity cases were reviewed by a multidisciplinary panel to determine reasons for admission to ICU, to classify organ-system dysfunction and to determine whether the SAMM case was preventable or not. Inclusion criteria were: admission to ICU between 2005 and 2007 during pregnancy or within 42 days of delivery. Results: Twenty-nine SAMM cases were reviewed, of which 10 (35%) were deemed preventable. The most common reasons for transfer to ICU were: the need for invasive vascular monitoring, hypotension and disseminated intravascular coagulation. The most frequent types of preventable events were: inadequate diagnosisrecognition of high-risk status, inappropriate treatment, communication problems and inadequate documentation. All five SAMM cases of septicaemia were deemed preventable. Of the ten preventable cases, three were Maori (50% of the Maori in total audit), four were Pacific (67% of the Pacific in total audit) and three were women of 'other' ethnicities (17.6%, 3 of 17 in the audit). Conclusions: An audit of SAMM cases describing reasons for transfer to ICU and preventability is feasible. We recommend that a prospective national SAMM audit process be introduced in New Zealand as a quality of care measure. © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) maternal morbidity EMTREE MEDICAL INDEX TERMS adolescent adult article clinical article clinical audit disease severity disseminated intravascular clotting female high risk pregnancy hospital admission human hypotension intensive care unit interpersonal communication multiple organ failure pregnancy outcome priority journal septicemia EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Hematology (25) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010450283 MEDLINE PMID 20716262 (http://www.ncbi.nlm.nih.gov/pubmed/20716262) PUI L359372334 DOI 10.1111/j.1479-828X.2010.01200.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1479-828X.2010.01200.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 668 TITLE Allergy documentation and transfer within critical care AUTHOR NAMES Hatton K. Barrett N. Lim J. McKenzie C. AUTHOR ADDRESSES (Hatton K.) Chelsea and Westminster NHS Foundation Trust, London, United Kingdom. (Barrett N.; Lim J.; McKenzie C.) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. CORRESPONDENCE ADDRESS K. Hatton, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom. SOURCE Critical Care (2010) 14 SUPPL. 1 (S151). Date of Publication: 2010 CONFERENCE NAME 30th International Symposium on Intensive Care and Emergency Medicine, ISICEM CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2010-03-09 to 2010-03-12 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction: Allergies to medication are common and potentially lifethreatening [1]. Patients enter critical care with incomplete information about their history. It is essential for safety that accurate allergy status is documented early in the critical care stay. This clinical audit (CA) was undertaken in a 43-bed, level 3 critical care unit to explore compliance with local guidelines on allergy documentation. Methods: Critical care patient episodes were obtained retrospectively for a 1-month period. Timing of allergy documentation and drug prescribing was noted from the critical care electronic system (ICIP). Allergy status prior to the critical care admission and after discharge was noted from the ward drug chart. Additional allergy data were identified from the hospital electronic patient record (EPR). The CA was repeated 1 year after implementation of recommendations. Results: Patient episodes were collated (initial CA n = 58, repeat CA n = 79). A known drug/nondrug allergy was stated in 29.3% patient episodes during the initial CA and 39.2% patient episodes in the repeat CA. Allergy status was incomplete 24 hours after critical care admission for two patients at the initial CA with a reduction to zero during the repeat. Allergy status was incomplete prior to prescribing of a new drug in critical care (excludes fluids, drugs required for emergency intubation) for 51.7% of patient episodes in the initial CA. This figure reduced to 19.0% in the repeat CA. Concordance between EPR and ICIP allergy at the outset was 68.8%, which increased to 76.5% in the repeat CA. Concordance with the ward drug chart preadmission and ICIP was 77.6%, increased to 93.9% at re-audit. Conclusions: This CA suggests that up to one in three critical care patients have a known allergy. The potential for harm is high. More than onehalf of patients admitted to critical care did not have an allergy status documented prior to prescribing a new drug. There was significant discordance between the paper medication chart and ICIP allergy. A number of factors were introduced following initial findings, including making the allergy status mandatory on ICIP, not allowing the admission summary to be saved prior to allergy documentation and ensuring current allergy documentation on EPR. EMTREE DRUG INDEX TERMS new drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) allergy documentation emergency medicine intensive care EMTREE MEDICAL INDEX TERMS clinical audit drug therapy electron spin resonance emergency hospital intubation liquid medical record patient prescription safety ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70255694 DOI 10.1186/cc8683 FULL TEXT LINK http://dx.doi.org/10.1186/cc8683 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 669 TITLE Airway management success and hypoxemia rates in air and ground critical care transport: a prospective multicenter study. AUTHOR NAMES Thomas S. Judge T. Lowell M.J. MacDonald R.D. Madden J. Pickett K. Werman H.A. Shear M.L. Patel P. Starr G. Chesney M. Domeier R. Frantz P. Funk D. Greenberg R.D. AUTHOR ADDRESSES (Thomas S.) Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma 74135, USA. (Judge T.; Lowell M.J.; MacDonald R.D.; Madden J.; Pickett K.; Werman H.A.; Shear M.L.; Patel P.; Starr G.; Chesney M.; Domeier R.; Frantz P.; Funk D.; Greenberg R.D.) CORRESPONDENCE ADDRESS S. Thomas, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma 74135, USA. Email: stephen-thomas@ouhsc.edu SOURCE Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors (2010) 14:3 (283). Date of Publication: 2010 Jul-Sep ISSN 1545-0066 (electronic) ABSTRACT OBJECTIVE: To assess critical care transport (CCT) crews' endotracheal intubation (ETI) attempts, success rates, and peri-ETI oxygenation. METHODS: Participants were adult and pediatric patients undergoing attempted advanced airway management during the period from July 2007 to December 2008 by crews from 11 CCT programs varying in geography, crew configuration, and casemix; all crews had access to neuromuscular-blocking agents. Data collected included airway management variables defined per national consensus criteria. Descriptive analysis focused on ETI success rates (reported with exact binomial 95% confidence intervals [CIs]) and occurrence of new hypoxemia (oxygen saturation [SpO(2)] dropping below 90% during or after ETI); to assess categorical variables, Fisher's exact test, Pearson chi(2), and logistic regression were employed to explore associations between predictor variables and ETI failure or new hypoxemia. For all tests, p < 0.05 defined significance. RESULTS: There were 603 total attempts at airway management, with successful oral or nasal ETI in 582 cases, or 96.5% (95% CI 94.7-97.8%). In 182 cases (30.2%, 95% CI 26.5-34.0%), there were failed ETI attempts prior to CCT crew arrival; CCT crew ETI success on these patients (96.2%, 95% CI 92.2-98.4%) was just as high as in the patients in whom there was no pre-CCT ETI attempt (p = 0.81). New hypoxemia occurred in only six cases (1.6% of the 365 cases with ongoing SpO(2) monitoring; 95% CI 0.6-3.5%); the only predictor of new hypoxemia was pre-ETI hypotension (p < 0.001). A requirement for multiple ETI attempts by CCT crews was not associated with new hypoxemia (Fisher's exact p = 0.13). CONCLUSIONS: CCT crews' ETI success rates were very high, and even when ETI required multiple attempts, airway management was rarely associated with SpO(2) derangement. CCT crews' ETI success rates were equally high in the subset of patients in whom ground emergency medical services (EMS) ETI failed prior to arrival of transport crews. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) airway obstruction (therapy) anoxia (epidemiology) endotracheal intubation patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article child clinical trial female human infant male methodology middle aged multicenter study newborn outcome assessment pathophysiology preschool child prospective study standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 20507218 (http://www.ncbi.nlm.nih.gov/pubmed/20507218) PUI L359528197 DOI 10.3109/10903127.2010.481758 FULL TEXT LINK http://dx.doi.org/10.3109/10903127.2010.481758 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 670 TITLE MEDEVAC: critical care transport from the battlefield. AUTHOR NAMES Higgins R.A. AUTHOR ADDRESSES (Higgins R.A.) California Army National Guard, Mather, C Company, 1st Battalion, 168th Aviation Regiment, 3754 Femoyer St, CA 95655, USA. CORRESPONDENCE ADDRESS R.A. Higgins, California Army National Guard, Mather, C Company, 1st Battalion, 168th Aviation Regiment, 3754 Femoyer St, CA 95655, USA. Email: ruben.a.higgins@us.army.mil SOURCE AACN advanced critical care (2010) 21:3 (288-297). Date of Publication: 2010 Jul-Sep ISSN 1559-7776 (electronic) ABSTRACT In current military operations, the survival rates of critically injured casualties are unprecedented. An often hidden aspect of casualty care is safe transport from the point of injury to a field hospital and subsequently on to higher levels of care. This en route critical care, which is provided by flight medics under the most austere and rigorous conditions, is a crucial link in the care continuum. This article introduces the role and capabilities of US Army MEDEVAC and reflects the author's recent experience in Afghanistan as a flight medic. This article provides an assessment of the operational issues, medical capabilities, and transport experiences to provide a real-world view of critical care transport from the battlefield. The MEDEVAC helicopter environment is one of the most difficult, if not the most demanding, critical care environments. This overview brings to light a small but important piece of the care continuum. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) injury (therapy) intensive care military medicine military nursing patient transport soldier EMTREE MEDICAL INDEX TERMS Afghanistan article case report health care delivery human methodology nursing organization and management United States war LANGUAGE OF ARTICLE English MEDLINE PMID 20683230 (http://www.ncbi.nlm.nih.gov/pubmed/20683230) PUI L360272619 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 671 TITLE Improvised chest tube valve for intra-hospital patient transportation. AUTHOR NAMES Flores-Franco R.A. AUTHOR ADDRESSES (Flores-Franco R.A.) CORRESPONDENCE ADDRESS R.A. Flores-Franco, SOURCE The Indian journal of chest diseases & allied sciences (2010) 52:3 (175; author reply 175-176). Date of Publication: 2010 Jul-Sep ISSN 0377-9343 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport tube wound drainage EMTREE MEDICAL INDEX TERMS equipment design human note LANGUAGE OF ARTICLE English MEDLINE PMID 20949739 (http://www.ncbi.nlm.nih.gov/pubmed/20949739) PUI L359878118 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 672 TITLE Critical path network. Bay Medical improves ED throughput via ICU. AUTHOR ADDRESSES SOURCE Hospital case management : the monthly update on hospital-based care planning and critical paths (2010) 18:7 (105-106). Date of Publication: Jul 2010 ISSN 1087-0652 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit organization and management patient transport EMTREE MEDICAL INDEX TERMS article health services research standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 20586177 (http://www.ncbi.nlm.nih.gov/pubmed/20586177) PUI L359244757 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 673 TITLE Measuring critical care air support teams' performance during extended periods of duty. AUTHOR NAMES Lamb D. AUTHOR ADDRESSES (Lamb D.) Royal Centre for Defence Medicine, Birmingham B29 6JD, United Kingdom. CORRESPONDENCE ADDRESS D. Lamb, Royal Centre for Defence Medicine, Birmingham B29 6JD, United Kingdom. Email: Di.Lamb@uhb.nhs.uk SOURCE AACN advanced critical care (2010) 21:3 (298-306). Date of Publication: 2010 Jul-Sep ISSN 1559-7776 (electronic) ABSTRACT The Royal Air Force (RAF) Critical Care Air Support Teams (CCASTs) aeromedically evacuate seriously injured service personnel. Long casualty evacuation chains create logistical constraints that must be considered when aeromedically evacuating patients. One constraint is the length of a CCAST mission and its potential effect on team member performance. Despite no evidence of patient care compromise, the RAF has commissioned a study to investigate whether CCAST mission length influences performance. Describing and understanding the role of a CCAST enabled fatigue to be defined. Factors essential to studying fatigue were then identified that were used to develop a theoretical model for designing a study to measure the effects of fatigue on CCAST performance. Relevant factors include the patient's clinical condition, team members' cognition and vigilance levels, and the occupational aviation environment. Further factors influencing overall performance include the duration and complexity of patient interventions, mission length, circadian influences, and fatigue countermeasures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care military medicine military nursing patient transport soldier EMTREE MEDICAL INDEX TERMS adaptive behavior article critical illness evaluation study fatigue (etiology, prevention) health care delivery human mental stress methodology organization and management task performance United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 20683231 (http://www.ncbi.nlm.nih.gov/pubmed/20683231) PUI L360272620 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 674 TITLE An inborn error of bile salt transport with features mimicking abusive head trauma AUTHOR NAMES Hendrickson D.J. Knisely A.S. Coulter K. Telander D.G. Quan R. Ruebner B.H. Leigh M.J. AUTHOR ADDRESSES (Hendrickson D.J.; Coulter K.; Quan R.; Leigh M.J.) University of California Davis Medical Center, Department of Pediatrics, Sacramento, CA, United States. (Knisely A.S.) Institute of Liver Studies, King's College Hospital, London, United Kingdom. (Telander D.G.) University of California Davis Medical Center, Department of Ophthalmology and Vision Science, Sacramento, CA, United States. (Ruebner B.H.) University of California Davis Medical Center, Department of Pathology, Sacramento, CA, United States. CORRESPONDENCE ADDRESS D.J. Hendrickson, Northern Nevada Pediatrics, 75 Pringle Way, Suite 301, Reno, NV 89502, United States. SOURCE Child Abuse and Neglect (2010) 34:7 (472-476). Date of Publication: July 2010 ISSN 0145-2134 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. EMTREE DRUG INDEX TERMS alpha tocopherol calcium (drug combination, drug therapy) fresh frozen plasma retinol vitamin D (drug combination, drug therapy) vitamin K group EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intrahepatic cholestasis (diagnosis, surgery) EMTREE MEDICAL INDEX TERMS anamnesis article bleeding bone radiography case report child abuse comparative genomic hybridization computer assisted tomography convalescence craniotomy disease course ear disease emergency ward female head injury (diagnosis) homelessness hospital discharge human inborn error of metabolism infant intensive care unit laboratory test liver transplantation maternal disease mental disease ophthalmoscopy physical examination retina hemorrhage (diagnosis) seizure subdural hematoma (diagnosis, surgery) vitamin D deficiency vitamin K deficiency (drug therapy) CAS REGISTRY NUMBERS alpha tocopherol (1406-18-4, 1406-70-8, 52225-20-4, 58-95-7, 59-02-9) calcium (14092-94-5, 7440-70-2) retinol (68-26-8, 82445-97-4) vitamin K group (12001-79-5) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Drug Literature Index (37) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010350182 MEDLINE PMID 20627390 (http://www.ncbi.nlm.nih.gov/pubmed/20627390) PUI L50934525 DOI 10.1016/j.chiabu.2009.11.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.chiabu.2009.11.008 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 675 TITLE The transport of critically ill patients by specialized team: A mobile ICU AUTHOR NAMES Liu D.-W. AUTHOR ADDRESSES (Liu D.-W., dwliu@medmail.com.cn) CORRESPONDENCE ADDRESS D.-W. Liu, Email: dwliu@medmail.com.cn SOURCE Chinese Critical Care Medicine (2010) 22:6 (321-322). Date of Publication: June 2010 ISSN 1003-0603 BOOK PUBLISHER Heilongjiang Institute of Science and Technology Information, 74 Yinhnag St, Nangang-qu, Harbin, China. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient intensive care unit patient transport EMTREE MEDICAL INDEX TERMS decision making editorial human questionnaire United Kingdom EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE Chinese EMBASE ACCESSION NUMBER 2010395187 MEDLINE PMID 20594460 (http://www.ncbi.nlm.nih.gov/pubmed/20594460) PUI L359201289 DOI 10.3760/cma.j.issn.1003-0603.2010.06.001 FULL TEXT LINK http://dx.doi.org/10.3760/cma.j.issn.1003-0603.2010.06.001 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 676 TITLE Neonatal outcome of 197 babies born after 706 frozen-thawed embryo transfer cycles; comparing two different cryopreservation techiques AUTHOR NAMES Karagozoglu H. Kahraman S. Yelke H. Karlikaya G. Güler Y. Kumtepe Y. AUTHOR ADDRESSES (Karagozoglu H.; Kahraman S.; Yelke H.; Karlikaya G.; Güler Y.; Kumtepe Y.) Istanbul Memorial Hospital, ART and Genetics Center, Istanbul, Turkey. CORRESPONDENCE ADDRESS H. Karagozoglu, Istanbul Memorial Hospital, ART and Genetics Center, Istanbul, Turkey. SOURCE Human Reproduction (2010) 25 SUPPL. 1 (i152). Date of Publication: June 2010 CONFERENCE NAME 26th Annual Meeting of the European Society of Human Reproduction and Embryology, ESHRE CONFERENCE LOCATION Rome, Italy CONFERENCE DATE 2010-06-27 to 2010-06-30 ISSN 0268-1161 BOOK PUBLISHER Oxford University Press ABSTRACT Objective: With improvement in assisted reproductive technologies, the number of transferred embryos has been reducing, which has resulted in more embryos being available for freezing. Embryo cryopreservation provides an increased cumulative pregnancy rate per oocyte retrieval, while decreasing the risk of multiple gestations and the risk of ovarian hyperstimulation syndrome. Our aim was to evaluate and compare the pregnancy and neonatal outcomes in infants born after frozen-thawed embryo transfer cycles at our centre after slow freezing-rapid thawing at cleavage stage (SF-group) and ultra-rapid vitrification at blastocyst stage (V-group) between 2004 and 2008. Materials and Methods: This study was conducted retrospectively at Istanbul Memorial Hospital ART and Reproductive Genetics Center between January 2004 and Dezember 2008. Main outcome measures were post-thaw survival of embryos, implantation and (multiple ) pregnancy rates, neonatal outcome including congenital birth defects while comparing two cryopreservation techniques. Mean female age was 30.6 ± 4.2 in SF-group and 31.2 ± 4.7 in V-group (n = 0.08). A total of 706 cycles yielding 197 live born babies were included. Statistical analysis was performed using t-test, chi-squared test and Monte Carlo-exact test. A p-value of < .05 was considered as statistically significant. Results:A total of 1396 slow-frozen cleavage stage embryos from 295 cycles were warmed and 1022 survived (78.0 %), which were used for embryo transfer. Mean number of embryos transferred per cycle was 2.9 ± 0.7. The implantation (IR), clinical and ongoing pregnancy rates, miscarriage, and live birh rates achieved were 15.7 %,35.6 %,26.1 %, 8.5 %,25.8 %, respectively. Of the 76 deliveries, singleton, twins, and triplets comprised of 64.5%, 31.6%, 3.9%, respectively, and 24 (31.6%) were preterm (< 37 weeks) deliveries. Low birth weight (< 2500g) (LBW) and very LBW (< 1500 g) rates are 21.7%, 15.1%, respectively. Out of 106 children live born, 50.9% were female and congenital major birth defects were observed in 2.8 % of live borns. A total of 1487 vitrified blastocyst stage embryos from 411 cycles were warmed and 1179 survived (84.1 %), which were used for embryo transfer. Mean number of embryos transferred per cycle was 2.6 ± 0.7. The implantation, clinical and ongoing pregnancy rates, miscarriage, and live birth rates achieved were 21.4 %, 42.3 %, 30.9 %, 11.2 %,29.4 %, respectively. Of the 121 deliveries, singleton, twins, and triplets comprised of 67.8 %, 28.9 %, 3.3 %, respectively, and 45 (37.2 %) were preterm deliveries. LBW and very LBW rates are 20.1 %, 5.5 %, respectively. Out of 164 children live born, 54.9 % were female and congenital major birth defects were observed in 1.8 % of live borns. The survival rate of vitrified blastocysts after warming was significantly higher than slow frozen cleavage stage embryos (n < 0.001). The mean number of transferred embryos was in V-group significantly lower than the SF-group (n < 0.001). In spite of significantly higher IR in V-group than the SF-group (n < 0.001), there was no significant difference in multiple pregnancy rates between groups (n = 0.88). This data demonstrated a higher birth weight after vitri-fied blastocyst transfer (n = 0.02). In addition admission rate to intensive care unit was higher in SF-group newborns (23.6%) than in V-group (11%).(p = 0.006) Conclusions: Vitrified blastocyst transfer leads to increased implantation rates with a better neonatal outcome with higher birth weight rates, especially the difference was distinct in very low birthweight newborns. Therefore, higher rate transfer to intensive care unit was required in infants born after slow freezing cleavage stage embryo transfers. The incidence of major birth defects was not different in both study groups. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) baby cryopreservation embryo transfer embryology reproduction society EMTREE MEDICAL INDEX TERMS birth rate birth weight blastocyst child congenital malformation embryo female freezing genetics hospital implantation infant intensive care unit live birth low birth weight multiple pregnancy newborn oocyte retrieval ovary hyperstimulation pregnancy pregnancy rate premature labor risk spontaneous abortion statistical analysis statistical significance Student t test survival survival rate technology thawing Turkey (republic) twins very low birth weight vitrification warming LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70245787 DOI 10.1093/humrep/de.25.s1.91 FULL TEXT LINK http://dx.doi.org/10.1093/humrep/de.25.s1.91 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 677 TITLE Prehospital notification from EMS enhances the shortening of transfer and intra-hospital processing times for acute stroke patients AUTHOR NAMES Cha J.K. Lee S.Y. AUTHOR ADDRESSES (Cha J.K.; Lee S.Y.) Dong-A University Hospital, Busan, South Korea. CORRESPONDENCE ADDRESS J.K. Cha, Dong-A University Hospital, Busan, South Korea. SOURCE Journal of Neurology (2010) 257 SUPPL. 1 (S198). Date of Publication: June 2010 CONFERENCE NAME 20th Meeting of the European Neurological Society CONFERENCE LOCATION Berlin, Germany CONFERENCE DATE 2010-06-19 to 2010-06-23 ISSN 0340-5354 BOOK PUBLISHER D. Steinkopff-Verlag ABSTRACT Little information is available about the effects of EMS hospital notification on transfer and intrahospital processing times in acute ischemic stroke. In this study, we retrospectively investigated the real transfer and imaging processing times for suspect acute stroke (AS) patients with EMS notification of needing intravenous tissue type plasminogen activatior (IV t-PA) and those without. Also compared between patients with and without notification were intrahospital processing times for receiving t-PA. From December 2008 to August 2009, EMS transported 102 patients with suspected AS to our stroke centre. During the same period, 33 patients received IV t-PA without prehospital notification from EMS. Mean real transfer time after EMS calls was 56.0±32.0 min. Patients with a transfer distance of more than 40 km could not arrive at our centre within 60 min. Among the 102 patients, 55 transferred via EMS to our ER for IV t-PA. The positive predictive value for stroke (90.9% vs 68.1%, p=0.005) was much higher and real transfer time was much faster in patients with an EMS t-PA call (47.7±23.1 min, p=0.004) compared to those without one (56.3±32.4 min). The 18 patients with prehospital notification who ultimately received t-PA had a significantly reduced door-to-imaging (17.8±11.0 min vs 26.9±11.5 min, p=0.01) and door-to-needle time (29.7 ± 9.6 vs 42.1 ± 18.1 min, p=0.01). Our results indicate that prehospital notification could enable rapid dispatch of AS patients needing IV t-PA to a stroke centre. In addition, it could reduce intrahospital delays, particularly, imaging processing times. EMTREE DRUG INDEX TERMS plasminogen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital processing society stroke patient EMTREE MEDICAL INDEX TERMS brain ischemia cerebrovascular accident imaging needle patient tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70233994 DOI 10.1007/s00415-010-5575-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00415-010-5575-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 678 TITLE Emergency transfer of in-patients to renal services - Admission illness severity scoring may identify those at risk of needing early critical care AUTHOR NAMES Kanagasundaram N.S. Tee S.A. Brady M. Grant L. Cosgrove J.F. AUTHOR ADDRESSES (Kanagasundaram N.S.; Tee S.A.; Brady M.; Grant L.) Renal Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom. (Kanagasundaram N.S.) Institute of Cellular Medicine, Newcastle University, United Kingdom. (Cosgrove J.F.) Peri-Operative/Critical Care Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom. CORRESPONDENCE ADDRESS N.S. Kanagasundaram, Renal Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom. SOURCE NDT Plus (2010) 3 SUPPL. 3 (iii54-iii55). Date of Publication: June 2010 CONFERENCE NAME 17th ERA-EDTA Congress - II DGfN Congress CONFERENCE LOCATION Munich, Germany CONFERENCE DATE 2010-06-25 to 2010-06-28 ISSN 1753-0784 BOOK PUBLISHER Oxford University Press ABSTRACT Introduction and Aims: Delayed transfer of in-patients for specialist renal management may affect outcomes for both ESRD and AKI patients but their arrival on the renal unit with unheralded critical illness is a risk to patient safety and an unexpected burden on local critical care services. We have already demonstrated the utility of the SOFA physiological severity scoring tool in highlighting AKI transfers at risk of needing early critical care. Use of the more familiar Modified Early Warning System (MEWS) would harmonise practice but has yet to be assessed in emergency transfers. The present study aimed to assess the utility of the admission MEWS in identifying emergency in-patient transfers to the renal unit at risk of needing early escalation of care. Methods: The local MEWS protocol carries a maximum score of 18 if urine output criteria are excluded, with threshold scores of ≥ 2 triggering increasing intensity/seniority of assessment. We conducted a retrospective, observational study of all emergency in-patient transfers from outside hospitals to our regional renal unit for the year ending 14.10.2008. Direct transfers to our transplant unit were excluded. The admission MEWS score (urine output criteria excluded) was calculated. Data collection included admission source, prior level of care, admission diagnosis and the need for escalation of care. Results: There were 136 emergency transfers with a median [range] admission MEWS score of 0 [0-5]). These comprised 127 patients with median age 68 years [16-91]. There were 71 males and 36 receiving chronic dialysis. Seventy transfers were of patients previously known to renal services with 65 for AKI. The admission sources were: ward-level (n = 71), critical care (25), accident and emergency/emergency admissions unit (39), coronary care (1). Eleven/136 transfers (MEWS: 1 [0-4]) subsequently required higher level care, a median of 2 days [0-11] after renal unit admission. Seven of these had AKI. Four patients required step-up care on the day of admission (MEWS: 1, 3, 4, 4). Three had AKI with 1 ESRD patient admitted with hypertensive encephalopathy. Two had arrived from ward-level care and 2 from accident and emergency. None of the 79 patients with an admission MEWS of 0 required day-of-transfer step-up of care in contrast to 7%, 10% and 27% of those with a MEWS of ≥ 1, 2 and 3, respectively. Conclusions: In-patient emergency transfers with a higher admission MEWS score may carry a higher risk of needing early escalation of care. Although the tool cannot determine the most appropriate venue for transfer, if applied prior to transfer, it may provide an objective rather than subjective guide to the receiving physicians about the need for early liaison with critical care and senior renal colleagues, and warn of the need for more frequent physiological observation on arrival on the unit. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) edetic acid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disease severity emergency evoked response audiometry human intensive care patient risk EMTREE MEDICAL INDEX TERMS accident critical illness diagnosis dialysis hospital hospital patient hypertension encephalopathy information processing male medical specialist observational study patient safety patient transport physician transplantation urine volume ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70483548 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 679 TITLE Chinese guidelines for the transport of critically ill patients, 2010 AUTHOR ADDRESSES CORRESPONDENCE ADDRESS Email: Kangyan@vip.sina.com SOURCE Chinese Critical Care Medicine (2010) 22:6 (328-330). Date of Publication: June 2010 ISSN 1003-0603 BOOK PUBLISHER Heilongjiang Institute of Science and Technology Information, 74 Yinhnag St, Nangang-qu, Harbin, China. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS human Influenza A virus (H1N1) intensive care unit positive end expiratory pressure practice guideline short survey EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE Chinese EMBASE ACCESSION NUMBER 2010395189 MEDLINE PMID 20594463 (http://www.ncbi.nlm.nih.gov/pubmed/20594463) PUI L359201291 DOI 10.3760/cma.j.issn.1003-0603.2010.06.004 FULL TEXT LINK http://dx.doi.org/10.3760/cma.j.issn.1003-0603.2010.06.004 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 680 TITLE Pregnancy outcomes of naturally conceived singletons and singletons after elective single embryo transfer (eSET) are comparable AUTHOR NAMES Delbaere I. Gerris J. De Neubourg D. Vansteelandt S. Martens G. Verdonk P. De Sutter P. Temmerman M. AUTHOR ADDRESSES (Delbaere I.; Gerris J.) University Ghent Obstetrics and Gynaecology, Gent, Belgium. (De Neubourg D.; Verdonk P.) Middelheim Hospital, Obstetrics and Gynaecology, Antwerp, Belgium. (Vansteelandt S.) University Ghent Applied Mathematics and Informatics, Ghent, Belgium. (Martens G.) Study Centre Perinatal Epidemiology, Obstetrics and Gynaecology, Brussels, Belgium. (De Sutter P.; Temmerman M.) University Ghent Obstetrics and Gynaecology, Ghent, Belgium. CORRESPONDENCE ADDRESS I. Delbaere, University Ghent Obstetrics and Gynaecology, Gent, Belgium. SOURCE Human Reproduction (2010) 25 SUPPL. 1 (i54). Date of Publication: June 2010 CONFERENCE NAME 26th Annual Meeting of the European Society of Human Reproduction and Embryology, ESHRE CONFERENCE LOCATION Rome, Italy CONFERENCE DATE 2010-06-27 to 2010-06-30 ISSN 0268-1161 BOOK PUBLISHER Oxford University Press ABSTRACT Introduction: Outcome differences between naturally conceived babies and children born after assisted reproduction have been studied extensively, both in singleton and twin cohorts. Results from early studies in singletons indicated that children after assisted reproduction are disadvantaged in outcome parameters such as preterm birth, low birth weight and perinatal death. These studies dated from the pre - single embryo transfer (SET) era, where singletons generally resulted from multiple embryo transfer or compulsory single embryo transfer (only one embryo available). Elective single embryo transfer was introduced in the late - nineties in order to halt the twin epidemic in assisted reproduction. When outcomes of singletons after elective SET (eSET) were compared with outcomes of singletons after double embryo transfer, substantially better outcomes were found in eSET - singletons. In this study we want to assess to which extent outcomes of eSET - singletons do or do not differ from naturally conceived singletons. Material and Methods: This is a multicentre study, comparing 725 singletons after eSET (cases) with 1450 naturally conceived singletons (controls). Every case was matched to two controls for maternal age, child's year of birth, sex of the child and mode of delivery. Databases of two infertility centers provided the cases (university hospital Ghent and Middelheim hospital Antwerp, Belgium), controls were extracted from the Flemish population - based perinatal register (Study centre perinatal Epidemiology - SPE, Belgium). Outcome indicators include gestational age, birth weight, transfer to neonatal intensive care unit, stillbirth and neonatal death. The Cochran-Mantel-Haenszel test was used for analysis. Results: The incidence of preterm birth was similar in singletons after eSET (6.9%) and naturally conceived singletons (7.0%). Likewise, no difference was found in low birth weight; 5.8% in singletons after eSET and 7.1% in naturally conceived singletons). Naturally conceived singletons had a higher chance to be transferred to neonatal intensive care when compared with singletons after eSET (15.7% versus 7.2% - RR 0.50; 95% CI 0.37 - 0.67). No statistically significant difference was found between both groups for stillbirth (0.1% in singletons after eSET and 0.4% in naturally conceived singletons - RR 0.29; 95% CI 0.04 - 2.32 and for neonatal death 0.1% in singletons after eSET and 0.3% in naturally conceived singletons (RR 0.40; 95% CI 0.05 - 3.43). Conclusions: Our results indicate no difference in adverse pregnancy outcome after assisted reproduction when comparing naturally conceived singletons with singletons after eSET. Earlier studies demonstrated the advantages of elective single embryo transfer in twin - prone patients in order to reduce the number of twins after ART. This study adds evidence to the fact that singleton pregnancies after eSET seem to be a different cohort than singletons after DET or transfer of more than two embryos. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) embryo transfer embryology pregnancy outcome reproduction society EMTREE MEDICAL INDEX TERMS baby Belgium birth weight child data base embryo epidemic epidemiology gestational age hospital infertility intensive care unit low birth weight Mantel Haenszel test maternal age newborn death newborn intensive care patient perinatal death population pregnancy register stillbirth twins university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70245548 DOI 10.1093/humrep/de.25.s1.36 FULL TEXT LINK http://dx.doi.org/10.1093/humrep/de.25.s1.36 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 681 TITLE History of the neonatal transport: progress in organization during the last thirty years ORIGINAL (NON-ENGLISH) TITLE Histoire du transport néonatal: progrès dans l'organisation au cours des 30 dernières années AUTHOR NAMES Chabernaud J.-L. Ayachi A. Lodé N. Lelong-Tissier M.-C. Diependaele J.-F. Menthonnex E. AUTHOR ADDRESSES (Chabernaud J.-L., jean-louis.chabernaud@abc.aphp.fr) Service de réanimation néonatale, Smur pédiatrique (Samu 92), CHU Antoine-Béclère (AP-HP), 157, rue de la Porte-de-Trivaux, Clamart cedex, F-92141, France. (Ayachi A.) Smur pédiatrique de Montreuil (Samu 93), CHU Avicennes Bobigny (AP-HP) et CH Montreuil, 56, boulevard de Boissière, Montreuil cedex, F-93105, France. (Lodé N.) Smur pédiatrique de R.-Debré (Samu de Paris), CHU Robert Debré (AP-HP), 48 boulevard Sérurier, Paris, F-75019, France. (Lelong-Tissier M.-C.) Smur pédiatrique de Toulouse (Samu 31), CHU Hôpital des enfants, 330, avenue de la Grande-Bretagne, TSA 70034, Toulouse cedex 9, F-31059, France. (Diependaele J.-F.) Smur pédiatrique de Lille (Samu 59), CHRU de Lille, 5, avenue Oscar-Lambret, Lille cedex, F-59037, France. (Menthonnex E.) Samu 38 Grenoble, SMUR de Grenoble (SAMU 38), CHU de Grenoble, Pôle Urgences/SAMU-SMU, BP127, Grenoble cedex 9, F-38043, France. CORRESPONDENCE ADDRESS J.-L. Chabernaud, Service de réanimation néonatale, Smur pédiatrique (Samu 92), CHU Antoine-Béclère (AP-HP), 157, rue de la Porte-de-Trivaux, Clamart cedex, F-92141, France. Email: jean-louis.chabernaud@abc.aphp.fr SOURCE Revue de médecine périnatale (2010) (1-9). Date of Publication: 2010 ISSN 1965-0833 1965-0841 (electronic) ABSTRACT Since the end of the seventies neonatal transfers in France and in most of the europeans countries are organized and realized by specialized teams often with the survey of pediatricians. The teams are « dedicated » for a region or « on call » for a neonatal intensive care unit in a perinatal network. In France, the law has changed following the « Perinatal Plan ». Neonatal transport is now defined in two levels: medical team or teamswith paramedics. In our country, the neonatal emergency transfer systems (Smur pédiatrique) have taken an important part to the diffusion of technical progress and care protocols during the last fifteen years, to improve results and for perinatal regionalisation. They also have played a role in the evaluation of the perinatal policies and in the education of pediatricians, midwifes and nurses. © 2010 Springer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) surfactant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air conditioning analgesia emergency sedation EMTREE MEDICAL INDEX TERMS diffusion education France intensive care unit newborn intensive care nurse pediatrician policy LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French PUI L50933185 DOI 10.1007/s12611-010-0067-7 FULL TEXT LINK http://dx.doi.org/10.1007/s12611-010-0067-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 682 TITLE Recommendations for the intra-hospital transport of critically ill patients AUTHOR NAMES Fanara B. Manzon C. Barbot O. Desmettre T. Capellier G. AUTHOR ADDRESSES (Fanara B., fan.ben@netcourrier.com; Manzon C., cyril.manzon@hotmail.fr; Barbot O., obarbot@chu-besancon.fr; Desmettre T., tdesmettre@chu-besancon.fr; Capellier G., gilles.capellier@univ-fcomte.fr) Department of Emergency Medicine, Jean Minjoz University Hospital, 25030 Besançon, France. CORRESPONDENCE ADDRESS G. Capellier, Department of Emergency Medicine, Jean Minjoz University Hospital, 25030 Besançon, France. Email: gilles.capellier@univ-fcomte.fr SOURCE Critical Care (2010) 14:3 Article Number: R87. Date of Publication: 14 May 2010 ISSN 1364-8535 1466-609X (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Introduction: This study was conducted to provide Intensive Care Units and Emergency Departments with a set of practical procedures (check-lists) for managing critically-ill adult patients in order to avoid complications during intra-hospital transport (IHT).Methods: Digital research was carried out via the MEDLINE, EMBASE, CINAHL and HEALTHSTAR databases using the following key words: transferring, transport, intrahospital or intra-hospital, and critically ill patient. The reference bibliographies of each of the selected articles between 1998 and 2009 were also studied.Results: This review focuses on the analysis and overcoming of IHT-related risks, the associated adverse events, and their nature and incidence. The suggested preventive measures are also reviewed. A check-list for quick execution of IHT is then put forward and justified.Conclusions: Despite improvements in IHT practices, significant risks are still involved. Basic training, good clinical sense and a risk-benefit analysis are currently the only deciding factors. A critically ill patient, prepared and accompanied by an inexperienced team, is a risky combination. The development of adapted equipment and the widespread use of check-lists and proper training programmes would increase the safety of IHT and reduce the risks in the long-term. Further investigation is required in order to evaluate the protective role of such preventive measures. © 2010 Fanara et al.; licensee BioMed Central Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS adverse outcome article checklist emergency ward human intensive care intensive care unit medical education patient safety priority journal risk benefit analysis risk reduction systematic review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011024656 MEDLINE PMID 20470381 (http://www.ncbi.nlm.nih.gov/pubmed/20470381) PUI L50913978 DOI 10.1186/cc9018 FULL TEXT LINK http://dx.doi.org/10.1186/cc9018 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 683 TITLE Therapeutic hypothermia on neonatal transport: 4-year experience in a single NICU AUTHOR NAMES Fairchild K. Sokora D. Scott J. Zanelli S. AUTHOR ADDRESSES (Fairchild K., kdf2n@virginia.edu; Sokora D.; Scott J.; Zanelli S.) Division of Neonatology, Department of Pediatrics, University of Virginia, Hospital Dr Box 800386, Charlottesville, VA 22908, United States. CORRESPONDENCE ADDRESS K. Fairchild, Division of Neonatology, Department of Pediatrics, University of Virginia, Hospital Dr Box 800386, Charlottesville, VA 22908, United States. Email: kdf2n@virginia.edu SOURCE Journal of Perinatology (2010) 30:5 (324-329). Date of Publication: May 2010 ISSN 0743-8346 1476-5543 (electronic) BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Objective: Therapeutic hypothermia instituted within 6 h of birth has been shown to improve neurodevelopmental outcomes in term newborns with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The majority of infants who would benefit from cooling are born at centers that do not offer the therapy, and adding the time for transport will result in delays in therapy, that may lead to suboptimal or no neuroprotection for some patients. Our objective was to evaluate the effect of our center's experience with therapeutic hypothermia on neonatal transport.Study Design: Retrospective review of all cases of therapeutic hypothermia at a single neonatal intensive care unit from 2005 to 2009.Result: Of 50 infants with HIE treated with hypothermia, 40 were outborn and 35 were cooled on transport. The majority of patients were passively cooled by the referring clinicians, then actively cooled by our transport team. Overcooling to 32°C occurred in 34% of patients, but there were no significant differences in admission vital signs or laboratory values between overcooled and appropriately cooled infants. The average time after birth of initiation of passive cooling was 1.4 h and active cooling was 2.7 h compared with the time of admission to our unit of 5.9 h.Conclusion: We discuss the important aspects of our program, including the education of referring and receiving clinicians and avoidance of overcooling. © 2010 Nature Publishing Group All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) induced hypothermia newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article brain disease (therapy) clinical article health care delivery hospital admission human hypoxic ischemic encephalopathy (therapy) infant outcome assessment patient referral EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010258841 MEDLINE PMID 19847186 (http://www.ncbi.nlm.nih.gov/pubmed/19847186) PUI L50680453 DOI 10.1038/jp.2009.168 FULL TEXT LINK http://dx.doi.org/10.1038/jp.2009.168 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 684 TITLE Out of hospital transfer is an independent predictor of death or poor outcome after intracerebral hemorrhage AUTHOR NAMES Rincon F. Behrens D. Morino T. Lee E. Schorr C. Dellinger P. Parrillo J. Mirsen T. AUTHOR ADDRESSES (Rincon F.; Behrens D.; Morino T.; Lee E.; Schorr C.; Dellinger P.; Parrillo J.; Mirsen T.) Cooper University Hospital, Camden, United States. CORRESPONDENCE ADDRESS F. Rincon, Cooper University Hospital, Camden, United States. SOURCE Cerebrovascular Diseases (2010) 29 SUPPL. 2 (284). Date of Publication: May 2010 CONFERENCE NAME 19th European Stroke Conference CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2010-05-25 to 2010-05-28 ISSN 1015-9770 BOOK PUBLISHER S. Karger AG ABSTRACT Introduction: Transfer of critically-ill patients from an outside Emergency Department (OSH-ED) has the potential of delaying the admission to the Intensive Care Unit (ICU). The effect of OSH-ED transfer on hospital outcome of ICH patients has not been studied. Methods:We designed a retrospective cohort study using a prospectively compiled and maintained registry (Cerner Project IMPACT). ICH patients admitted to our ICU from our ED and from OSH-ED within 24 hrs of stroke were selected for the analysis. Data collected included demographics, admission physiologic variables, Glasgow Coma Scale (GCS), APACHE-II, scores; and total ICU and hospital length of stay (LOS). Primary outcome was functional status at hospital discharge and secondary outcomes were ICU and hospital LOS. Poor outcome was defined as death or severe disability at hospital discharge. To assess for the impact of OSH-ED transfer on primary and secondary outcomes, demographic and admission clinical variables were used to construct logistic regression models using the outcome measure as a dependent variable. Results: A total of 296 patients were selected. The mean age was 65±14 years, of which 47% were male, 63% were white, and 66% were transferred from OSH-ED. The median hospital LOS was 6 days (Interquartile range [IQR]=4-11) and median ICU-LOS was 2 days (IQR=1-4). Overall hospital mortality was 37%. Transfer from OSH-ED was associated with a 75% probability of death or poor outcome at hospital discharge. Multivariate regression analysis showed that APACHE-II (OR, 1.2; 95% CI; 1.1-1.3), GCS <12 (OR, 2.8; 95% CI; 1.8-4.1), and OSH-ED transfer (OR, 1.7; 95% CI; 1.1-2.5) were independently associated with poor outcome. OSH-ED was not significantly associated with secondary outcome measures. Conclusion: This data suggests that in ICH patients, OSH-ED transfer is independently associated with poor outcome at hospital discharge. Further research is needed as to identify the potential causes for this effect. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain hemorrhage cerebrovascular accident death hospital EMTREE MEDICAL INDEX TERMS APACHE cohort analysis critically ill patient dependent variable disability emergency ward functional status Glasgow coma scale hospital discharge intensive care unit length of stay logistic regression analysis male model mortality patient register regression analysis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70330171 DOI 10.1159/000321266 FULL TEXT LINK http://dx.doi.org/10.1159/000321266 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 685 TITLE Comments AUTHOR NAMES Landy H. AUTHOR ADDRESSES (Landy H.) CORRESPONDENCE ADDRESS H. Landy, Miami, FL, United States. SOURCE Neurosurgery (2010) 66:5 (932). Date of Publication: May 2010 ISSN 0148-396X BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE DRUG INDEX TERMS carbon dioxide (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) computer assisted tomography patient transport EMTREE MEDICAL INDEX TERMS arterial pressure brain hypoxia brain injury heart rate human intensive care unit lung function note operating room outcome assessment oxygen saturation oxygenation priority journal risk assessment CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Radiology (14) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010252051 PUI L358732627 DOI 10.1227/01.NEU.0000368543.59446.A4 FULL TEXT LINK http://dx.doi.org/10.1227/01.NEU.0000368543.59446.A4 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 686 TITLE Bay Medical improves ED throughput via ICU. AUTHOR ADDRESSES SOURCE Hospital peer review (2010) 35:5 (57-59). Date of Publication: May 2010 ISSN 0149-2632 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) community hospital emergency health service intensive care unit organization and management patient transport EMTREE MEDICAL INDEX TERMS article health services research human patient satisfaction standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 20449975 (http://www.ncbi.nlm.nih.gov/pubmed/20449975) PUI L358916745 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 687 TITLE In-hospital intensive care unit transfers: Impact of bed availability AUTHOR NAMES Kelly S.G. Hawley M. O'Brien J.M. AUTHOR ADDRESSES (Kelly S.G.; Hawley M.; O'Brien J.M.) Ohio State University Medical Center, Columbus, United States. CORRESPONDENCE ADDRESS S.G. Kelly, Ohio State University Medical Center, Columbus, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (2010) 181:1 MeetingAbstracts. Date of Publication: 1 May 2010 CONFERENCE NAME American Thoracic Society International Conference, ATS 2010 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2010-05-14 to 2010-05-19 ISSN 1073-449X BOOK PUBLISHER American Thoracic Society ABSTRACT Rationale - While the utilization and need for intensive care unit (ICU) beds has continued to rise, there are currently no national criteria for ICU transfer. We studied factors associated with requesting an ICU bed, including the availability of ICU beds, level of training and predictions about patient outcome. Methods - We performed a survey study among a random sample of internal and family medicine residents and attendings at two hospitals in Columbus (one academic, one community-based). All subjects received a vignette of a patient admitted to the medical ward with community-acquired pneumonia whose condition worsened over 2 hours. Subjects randomly received a vignette in which either one or seven ICU beds were available. Respondents were asked whether they would request an ICU bed and to make predictions about patient outcome using a visual analog scale. Results - There was a wide range in the probability of requesting an ICU bed (5th percentile to 95th percentile range 10-100%). Respondents were equally likely to request an ICU bed when one or seven beds were available (63% vs. 58%, respectively; p=0.44). In unadjusted analyses, the probability of requesting an ICU bed was significantly associated with the respondent being a resident (19.8% more likely to request ICU bed, p=0.05), higher estimated mortality without immediate ICU admission (0.9% per 1%-point increase in predicted mortality, p<0.0001) and subsequent need for ICU admission if not transferred immediately (1.1% per 1%-point increase in predicted subsequent ICU need, p<0.0001). In a multivariable model, ICU bed availability was not significantly associated with the probability of requesting an ICU bed (9.6% less likely if only one bed available, p=0.10). However, the probability of requesting an ICU bed was significantly higher with higher estimates of subsequent need for ICU admission (1.1%-point higher per 1% increase in predicted need for eventual ICU admission, p<0.0001) and among respondents from the community-based hospital (13.8% higher, p=0.02). Conclusions -ICU bed availability was not associated with the probability of requesting ICU transfer. There was high variability in the probability of making such a request. Transfer was most closely associated with respondent estimates of subsequent need for ICU admission. Factors associated with predictions about subsequent need for ICU care and the influence of bed availability on decision-making by intensivists requires further study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care unit society EMTREE MEDICAL INDEX TERMS community community acquired pneumonia decision making family medicine human model mortality patient prediction random sample vignette visual analog scale ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70839123 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 688 TITLE Improving safety and documentation in intrahospital transport: Development of an intrahospital transport tool for critically ill patients AUTHOR NAMES Jarden R.J. Quirke S. AUTHOR ADDRESSES (Jarden R.J., rebecca.jarden@ccdhb.org.nz) Intensive Care Unit, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand. (Quirke S., sara.quirke@vuw.ac.nz) Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, New Zealand. CORRESPONDENCE ADDRESS R.J. Jarden, Intensive Care Unit, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand. Email: rebecca.jarden@ccdhb.org.nz SOURCE Intensive and Critical Care Nursing (2010) 26:2 (101-107). Date of Publication: April 2010 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Transporting the critically ill patient is described within the literature as a high-risk procedure. Both guidelines and minimum standards are available to inform practice. However, a practical, clinically useful, and evidence-based document (tool) for the ICU nurse to use when transporting a critically ill patient was not identified in the literature. Consequently, the development of an intrahospital transport tool is described. This transport tool was designed to mitigate the risks associated with patient transport by providing the Intensive Care Unit (ICU) nurse with an integrated documentation record, incorporating patient assessment with a procedural guideline. The result is a framework for the ICU nurse to use throughout intrahospital transfers, informing and supporting them to provide and document continuity of nursing care. The potential benefit of using this tool is enhanced patient outcomes through safer ICU intrahospital transport processes. © 2010 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness medical record patient transport practice guideline safety EMTREE MEDICAL INDEX TERMS article documentation human intensive care unit New Zealand nursing assessment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 20089403 (http://www.ncbi.nlm.nih.gov/pubmed/20089403) PUI L50768419 DOI 10.1016/j.iccn.2009.12.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2009.12.007 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 689 TITLE Transport times did not change between 2004 and 2009, but thrombolysis rates increased from 10 to 18%: Results from the national acute stroke-unit registry in Austria AUTHOR NAMES Brainin M. Tatschl C. Teuschl Y. Seyfang L. Matz K. Eckhardt R. AUTHOR ADDRESSES (Brainin M.; Tatschl C.; Teuschl Y.; Seyfang L.; Matz K.; Eckhardt R.) Dpt Neurology, Danube Clinic and Danube Univ., Tulln, Austria. CORRESPONDENCE ADDRESS M. Brainin, Dpt Neurology, Danube Clinic and Danube Univ., Tulln, Austria. SOURCE Stroke (2010) 41:4 (e347). Date of Publication: 1 Apr 2010 CONFERENCE NAME 2010 International Stroke Conference CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2010-02-23 to 2010-02-26 ISSN 0039-2499 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Background: The Austrian acute stroke unit system was set up by considering optimal transport times (in less than 45 minutes) thus ensuring optimal access from all regions in the country. The aim of this study was to identify time-dependent factors for referral and thrombolysis treatment in an acute stroke unit and to define the gains for direct referral versus referral via another hospital. Methods: Analysis of data from the Austrian National Acute Stroke-Unit Registry. Results: Data of 40,660 stroke patients registered at the 29 acute stroke units between January 2003 and May 2009 were analysed. Exact time of onset was known for 18,223 (58%) of patients. Eighty-five percent were admitted directly and 15% were transferred from other hospitals. The admission rates within two hours were 58% and 33% for patients admitted directly and those referred from another hospital, respectively; correspondingly, 71% and 49% were admitted within three hours and 78% and 63% within four hours. Direct admission to a hospital equipped with a stroke unit increased the chances of thrombolytic treatment by the odds of 1.4 compared to patients transferred via another hospital. The rate of patients admitted within 2 hours did not change between 2004 and 2009, however thrombolysis rates increased in the same time period significantly from 10% to 18%. Potential extension of the time window for thrombolysis to 4h arrivals would increase the thrombolysis rate to 21%. Conclusion: Direct referral to an acute stroke unit bears highest chances for thrombolysis treatment. While the transport times for patients referred to acute stroke units within 2 hours from onset remained constant between 2004 and 2009, corresponding thrombolysis rates had risen from 10% to 18%. Extension of the time window including four hour referrals would further increase this rate to 21%. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Austria blood clot lysis cerebrovascular accident register stroke unit EMTREE MEDICAL INDEX TERMS hospital patient stroke patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70429669 DOI 10.1161/01.str.0000366115.56266.0a FULL TEXT LINK http://dx.doi.org/10.1161/01.str.0000366115.56266.0a COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 690 TITLE Intrahospital transport of children on extracorporeal membrane oxygenation: Indications, process, interventions, and effectiveness AUTHOR NAMES Prodhan P. Fiser R.T. Cenac S. Bhutta A.T. Fontenot E. Moss M. Schexnayder S. Seib P. Chipman C. Weygandt L. Imamura M. Jaquiss R.D.B. Dyamenahalli U. AUTHOR ADDRESSES (Prodhan P., prodhanparthak@uams.edu; Fiser R.T.) Departmen of Pediatric Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States. (Cenac S.; Bhutta A.T.; Fontenot E.; Seib P.; Chipman C.; Weygandt L.; Imamura M.) Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, United States. (Moss M.) Department of Pediatrics, Critical Care and Cardiology, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States. (Schexnayder S.) Department of Pediatrics and Internal Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, United States. (Seib P.) Cardiac Cath Lab, Little Rock, AR, United States. (Jaquiss R.D.B.) Department of Pediatric Cardiac Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, United States. (Dyamenahalli U.) Department of Pediatric Cardiology and Cardiac Intensivist, University of Arkansas for Medical Sciences, Little Rock, AR, United States. CORRESPONDENCE ADDRESS P. Prodhan, Departmen of Pediatric Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States. Email: prodhanparthak@uams.edu SOURCE Pediatric Critical Care Medicine (2010) 11:2 (227-233). Date of Publication: March 2010 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT OBJECTIVE:: To evaluate indications, process, interventions, and effectiveness of patients undergoing intrahospital transport. Critically ill patients supported with extracorporeal membrane oxygenation are transported within the hospital to the radiology suite, cardiac catheterization suite, operating room, and from one intensive care unit to another. No studies to date have systematically evaluated intrahospital transport for patients on extracorporeal membrane oxygenation. DESIGN:: Retrospective cohort analysis. SETTING:: Cardiac intensive care unit in a tertiary care children's hospital. PATIENTS:: All patients on extracorporeal membrane oxygenation who required intrahospital transport between January 1996 and March 2007 were included and analyzed. MEASUREMENTS AND MAIN RESULTS:: A total of 57 intrahospital transports for cardiac catheterization and head computed tomography scans were analyzed. In 14 (70%) of 20 of patients with cardiac catheterization, a management change occurred as a result of the diagnostic cardiac catheterization. In ten (59%) of 17 patients, bedside echocardiography was of limited value in defining the critical problem. In the interventional group, the majority of transports were for atrial septostomy. In the head computed tomography group, significant pathology was identified, which led to management change. No major complications occurred during these intrahospital transports. CONCLUSIONS:: Although transporting patients on extracorporeal membrane oxygenation is labor intensive and requires extensive logistic support, it can be carried out safely in experienced hands and it can result in important therapeutic and diagnostic yields. To our knowledge, this is the first study designed to evaluate safety and efficacy of intrahospital transport for patients receiving extracorporeal membrane oxygenation support. © 2010 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extracorporeal oxygenation patient transport EMTREE MEDICAL INDEX TERMS adolescent article blalock hanlon operation child clinical article computer assisted tomography critical illness echocardiography female head heart catheterization heart surgery human infant intensive care unit male operating room point of care testing preschool child priority journal school child tertiary health care EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010172033 MEDLINE PMID 19593245 (http://www.ncbi.nlm.nih.gov/pubmed/19593245) PUI L358460128 DOI 10.1097/PCC.0b013e3181b063b2 FULL TEXT LINK http://dx.doi.org/10.1097/PCC.0b013e3181b063b2 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 691 TITLE Placental abnormalities in term neonates transported to a tertiary care facility AUTHOR NAMES Pinar H. Kostadinov S. AUTHOR ADDRESSES (Pinar H.; Kostadinov S.) Women and Infants Hospital of Rhode Island, Brown Medical School, Providence, United States. CORRESPONDENCE ADDRESS H. Pinar, Women and Infants Hospital of Rhode Island, Brown Medical School, Providence, United States. SOURCE Pediatric and Developmental Pathology (2010) 13:2 (139-140). Date of Publication: March 2010 CONFERENCE NAME Society for Pediatric Pathology (SPP)/Paediatric Pathology Society (PPS) Combined Fall Meeting CONFERENCE LOCATION Philadelphia, PA, United States CONFERENCE DATE 2009-10-14 to 2009-10-17 ISSN 1093-5266 BOOK PUBLISHER Society for Pediatric Pathology ABSTRACT Background: Despite continuing advances in prenatal care and fetal monitoring, the placenta remains a valuable source that may explain the underlying pregnancy risk factors and conditions that result in adverse pregnancy outcome. Although placental examination in sick neonates is considered as standard of care, it is frequently not performed especially in local hospitals with limited resources. As a result, when the neonatal transport team does not take the initiative for retrieving the placenta specimen, this valuable resource is lost. Hypothesis: We hypothesize that placental examination of neonates transferred to a level III neonatal intensive care unit (NICU) is underutilized. Design: We retrospectively reviewed the data for inbound neonatal transfers to Women and Infants hospital (WIH) of Rhode Island level IIIb NICU for the year of 2004. There were 185 inbound neonatal transfers from 20 community hospitals from the catchment area of WIH, which consists of Rhode Island, Southeastern Massachusetts, and Northeastern Connecticut. All but four of the hospitals had level I nurseries. The placental reports and slides were reviewed. Table presented. Results: 112 (60%) of the transported cases were term ($37 weeks gestational age). Only 12 (6.5%) placentas from the transported cases were submitted for pathologic examination. These were all term. The distribution of significant macroscopic and microscopic abnormalities in the examined placentas is summarized in Table 1. There were significantly more male (75%) than female (25%) neonates among the cases reviewed. The most common placental findings were evidence of meconium exposure (75%), evidence of intrauterine infection involving both maternal and fetal compartments (66%), and fetal erythroblastemia (50%). One placenta showed six of the described lesions. Rest of the placentas had multiple lesions and their numbers ranged between three and four. Conclusions: We conclude that the placental examination is underutilized in the care of neonates transported to a level III NICU. Since the majority of these placentas show potentially significant pathology, centers that are responsible from these transports should make a conscious effort to retrieve these samples. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn pathology society tertiary health care EMTREE MEDICAL INDEX TERMS catchment community hospital examination exposure female fetus monitoring gestational age hospital hypothesis infant intensive care unit intrauterine infection male meconium newborn intensive care nursery placenta pregnancy pregnancy outcome prenatal care risk factor United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70169713 DOI 10.2350/09-09-0710-MISC.1 FULL TEXT LINK http://dx.doi.org/10.2350/09-09-0710-MISC.1 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 692 TITLE Analysis of functional improvement in stroke patients relative to time of transfer to rehabilitation AUTHOR NAMES Anderson C. Kohler F. Redmond H. Dickson H. Renton R. AUTHOR ADDRESSES (Anderson C.; Kohler F.) Braeside Hospital, Sydney, Australia. (Redmond H.) Fairfield District Hospital, Sydney, Australia. (Dickson H.; Renton R.) Liverpool Hospital, Sydney, Australia. CORRESPONDENCE ADDRESS C. Anderson, Braeside Hospital, Sydney, Australia. SOURCE Internal Medicine Journal (2010) 40 SUPPL. 1 (1-2). Date of Publication: March 2010 CONFERENCE NAME World Congress of Internal Medicine, WCIM 2010 in Conjunction with Physicians Week CONFERENCE LOCATION Melbourne, VIC, Australia CONFERENCE DATE 2010-03-20 to 2010-03-25 ISSN 1444-0903 BOOK PUBLISHER Blackwell Publishing ABSTRACT There is some evidence that a delay in transfer of stroke patients to a rehabilitation unit results in poorer functional outcomes. Previous work by the Braeside/Liverpool/Fairfield Rehabilitation Research Group found no correlation between timing of transfer and rehabilitation outcomes however there were some methodological limitations of the study. This study attempts to overcome some of these limitations. Objective: In modern stroke units where allied health intervention is available and utilised, the timing of transfer to a rehabilitation service is not a major determining factor in functional outcome following stroke. Method: A total of 267 patients admitted to our rehabilitation units following stroke were included in the analysis. These patients were consecutive discharges between 1/1/2007 and 9/10/2009. Patients were admitted to one of two rehabilitation units in the area: one unit is a rehabilitation ward in a general community hospital, while the other is a rehabilitation unit in an adjacent freestanding hospital. Referral and admitting criteria to the two rehabilitation units are similar. Some patients are transferred between the units after receiving initial therapy in one unit, in which case the two episodes were combined. The data were analysed for differences in outcomes according to time taken for transfer to a rehabilitation unit. For analysis the patients were grouped according to their time to transfer into 3 day periods. Results: The time between onset of stroke and admission to a rehabilitation unit varied between 2 days to over 100 days. The two patients who were not transferred for over 100 days were excluded from the analysis as they were extreme outliers. The mean and median length of stay in the rehabilitation unit, admission FIM scores, FIM differences and FIM efficiency are outlined in the presentation. There were no significant differences between the groups for length of stay, total admission FIM score, FIM difference or FIM efficiency. Conclusion: Based on our data earlier transfer to a rehabilitation unit does not enhance functional outcomes after stroke. This might be because multidisciplinary rehabilitation is utilised in stroke units prior to transfer for formal rehabilitation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) internal medicine physician rehabilitation stroke patient EMTREE MEDICAL INDEX TERMS cerebrovascular accident community hospital Functional Independence Measure health hospital length of stay patient rehabilitation center rehabilitation research stroke unit therapy ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70126513 DOI 10.1111/j.1445-5994.2010.02186.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1445-5994.2010.02186.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 693 TITLE 18th Critical Care Transport Medicine Conference April 12-14, 2010 AUTHOR NAMES Newman M. Petersen P. Wojdyla K. AUTHOR ADDRESSES (Newman M.; Petersen P.; Wojdyla K.) SOURCE Air Medical Journal (2010) 29:2 (78-80). Date of Publication: March 2010/April 2010 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article critically ill patient emergency care human medical literature medical society paramedical personnel priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2010143642 PUI L358381677 DOI 10.1016/j.amj.2010.01.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2010.01.002 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 694 TITLE Unplanned intensive care unit transfers: A useful tool to improve quality of care AUTHOR NAMES Bapoje S. Gaudiani J. Narayanan V. Albert R. AUTHOR ADDRESSES (Bapoje S.; Gaudiani J.; Narayanan V.; Albert R.) Denver Health Medical Center, Denver, United States. CORRESPONDENCE ADDRESS S. Bapoje, Denver Health Medical Center, Denver, United States. SOURCE Journal of Hospital Medicine (2010) 5 SUPPL. 1 (10-11). Date of Publication: March 2010 CONFERENCE NAME 2010 Annual Meeting of the Society of Hospital Medicine, SHM 2010 CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2010-04-08 to 2010-04-11 ISSN 1553-5592 BOOK PUBLISHER John Wiley and Sons Inc. ABSTRACT Background: Whether an unplanned intensive care unit transfer (UICUT) results from an error in care and whether these transfers can be prevented has not been previously investigated. We sought to determine the causes of UlCUTs of patients to a medical ICU, whether they resulted from errors in care, and when clinical deterioration was noted, whether an earlier or different response might have prevented such transfers. Methods: This was a single-center observational cohort study of all patients between 18 and 89 years of age with UlCUTs over a period of 1 year from July 2005 to June 2006. Exclusion criteria included patients transferring from outside hospitals or from non-Medicine units, direct admissions to the ICU, readmis-sions to the ICU, planned transfers following invasive procedures, and patients who were pregnant or prisoners. We recorded demographics, admission and transfer diagnoses, reasons for unplanned ICU transfers based on a defined taxonomy (Table 1), presence of signs of clinical deterioration, mortality, judgment by 3 independent reviewers about the causes of the ICU transfer, and whether it could have been prevented. Associations between baseline and outcome variables were assessed using the x(2) test. Agreement between the reviewers was assessed using the K statistic.(table present) Results: One hundred and fifty-two patients met the study criteria. The most common diagnoses for a UICUT were respiratory failure (24%) and acute coronary syndrome (11%). The reasons for UlCUTs are listed in Table 1. Mortality was lower for patients when the transfer occurred within 24 hours of admission (4% versus 22% mortality if transfer was < 24 versus > 24 hours after admission, 0.29, P < 0.05, 95% CI 0.09-0.89). Errors in care accounted for the transfer in 29 patients (19%), but in 15 of 29 patients (52%) the errors were in triage as 14 of 15 (93%) met ICU admission criteria while still in the emergency department. One hundred and six patients (70%) had 1 or more signs of clinical deterioration within the 12 hours preceding the ICU transfer. For these patients, all 3 reviewers agreed and concluded that 94 of 109 patients (89%) even with a different or earlier intervention would still have needed a transfer to the ICU. Interobserver reliability for the 3 reviewers was good, with K = 0.60 (95% CI 0.33,0.87); K = 0.82 (95% CI 0.59,1.05); and K = 0.63 (95% CI 0.38,0.88). Conclusions: Examining the causes of UlCUTs revealed a target for improving the quality of care in our institution. As many as 19% of such transfers were potentially preventable. Our data do not support the use of rapid response teams to reduce UlCUTs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital medicine intensive care unit society EMTREE MEDICAL INDEX TERMS acute coronary syndrome cohort analysis decision making deterioration diagnosis emergency health service emergency ward hospital human invasive procedure mortality outcome variable patient prisoner rapid response team reliability respiratory failure taxonomy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71753100 DOI 10.1002/jhm.705 FULL TEXT LINK http://dx.doi.org/10.1002/jhm.705 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 695 TITLE Management of suspected myocarditis during critical-care transport AUTHOR NAMES Wolf G.K. Frakes M.A. Gallagher M. Allan C.K. Wedel S.K. AUTHOR ADDRESSES (Wolf G.K., gerhard.wolf@childrens.harvard.edu) Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, United States. (Frakes M.A.; Gallagher M.; Wedel S.K.) Boston MedFlight, Hanscom Air Force Base, Bedford, United States. (Allan C.K.) Division of Cardiac Critical Care Medicine, Department of Cardiology, Children's Hospital Boston, Boston, MA, United States. CORRESPONDENCE ADDRESS G. K. Wolf, Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, United States. Email: gerhard.wolf@childrens.harvard.edu SOURCE Pediatric Emergency Care (2010) 26:7 (512-517). Date of Publication: July 2010 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Myocarditis and malignant dysrhythmias are unusual presentations in pediatric patients. We report a series of 4 patients with myocarditis and arrhythmia who presented to community emergency departments and were transported to a pediatric tertiary-care center. Three of the patients required extracorporeal life support. We discuss considerations for stabilization and transport: airway and ventilation, hemodynamic support, induction and sedation medication choices, transport decisions, and the traits of an ideal receiving center. © 2010 by Lippincott Williams & Wilkins. EMTREE DRUG INDEX TERMS amiodarone (drug combination) dopamine (drug combination, drug therapy) inotropic agent (drug therapy) isoprenaline (drug therapy) lidocaine (drug combination) noradrenalin (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care myocarditis (drug therapy, drug therapy) patient transport EMTREE MEDICAL INDEX TERMS adolescent airway article atrioventricular block (drug therapy) bradycardia case report child community care diuresis drug dose titration drug megadose emergency ward extracorporeal oxygenation female fever heart arrhythmia heart muscle biopsy heart ventricle function hemodynamics human influenza Lyme disease lyme myocarditis (drug therapy) lyme myocarditis (drug therapy) male medical decision making nausea rehydration school child sedation tachycardia (drug therapy) tertiary health care vomiting CAS REGISTRY NUMBERS amiodarone (1951-25-3, 19774-82-4, 62067-87-2) dopamine (51-61-6, 62-31-7) isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2) lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9) noradrenalin (1407-84-7, 51-41-2) EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010402091 MEDLINE PMID 20622634 (http://www.ncbi.nlm.nih.gov/pubmed/20622634) PUI L359223974 DOI 10.1097/PEC.0b013e3181e5bfe1 FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0b013e3181e5bfe1 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 696 TITLE Endotracheal tube cuff pressures in pediatric patients intubated before aeromedical transport AUTHOR NAMES Tollefsen W.W. Chapman J. Frakes M. Gallagher M. Shear M. Thomas S.H. AUTHOR ADDRESSES (Tollefsen W.W., wtollefsen@partners.org) Harvard Affiliated Emergency Medicine, Brigham and Women's Hospital, Massachusetts General Hospital, 75 Francis St, Boston, MA 02115, United States. (Chapman J.; Shear M.) Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States. (Frakes M.; Gallagher M.; Thomas S.H.) Boston MedFlight, Boston, MA, United States. (Thomas S.H.) Department of Emergency Medicine, University of Oklahoma, School of Community Medicine, Tulsa, OK, United States. CORRESPONDENCE ADDRESS W. W. Tollefsen, Harvard Affiliated Emergency Medicine, Brigham and Women's Hospital, Massachusetts General Hospital, 75 Francis St, Boston, MA 02115, United States. Email: wtollefsen@partners.org SOURCE Pediatric Emergency Care (2010) 26:5 (361-363). Date of Publication: May 2010 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Objectives: Prolonged endotracheal tube cuff pressures (ETTCPs) greater than 30 cm H(2)O can cause complications. With increasing utilization of cuffed endotracheal tubes (ETTs) in pediatric patients comes the risk of overinflation. We evaluated the incidence of elevated ETTCP in pediatric patients intubated with cuffed ETTs, transported by a critical-care transport service and attempted to identify whether elevated ETTCP was associated with factors such as patient demographics, diagnostic category, and intubator credentials. Methods: In this prospective study, assessment of ETTCP was made upon transport crew arrival at the bedside. The study focused on a consecutive sample of pediatric patients undergoing transport with cuffed ETTs placed before transport team arrival. All patients had cuff pressures assessed by the same cuff manometry device. Pressures found to be greater than 30 cm H(2)O were corrected immediately. Results: Forty-one percent of cases met the a priori defined cutoff for elevated ETTCP of 30 cm H(2)O; 30% of those elevated cuff pressures were twice that cutoff (>60 cm H(2)O). There were no associations between high ETTCP and any of the following independent variables: demographics, physician versus nonphysician intubator, and intubation location (ie, scene vs emergency department vs intensive care unit). Conclusions: A significant number of pediatric patients transported by a critical-care transport service had elevated ETTCP. Furthermore, there was no clear risk factor for elevated cuff pressures. This is further evidence that cuff pressures should be measured in all patients. Further research should focus on the effect of educational intervention and on the possible clinical results of elevated ETTCPs. © 2010 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport endotracheal intubation endotracheal tube cuff pressure EMTREE MEDICAL INDEX TERMS adolescent article child controlled study demography emergency health service emergency ward endotracheal tube female human incidence infant intensive care unit major clinical study male manometry pressure measurement risk assessment EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010276178 MEDLINE PMID 20404779 (http://www.ncbi.nlm.nih.gov/pubmed/20404779) PUI L50890469 DOI 10.1097/PEC.0b013e3181db224d FULL TEXT LINK http://dx.doi.org/10.1097/PEC.0b013e3181db224d COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 697 TITLE Transfer Time is not a major determinant of in-hospital mortality in Primary PCI when performed in a well organized urban network AUTHOR NAMES Silvain J. Vignalou J.-B. Bellemain-Appaix A. Landivier A. Barthelemy O. Beygui F. Choussat R. Ecollan P. Collet J.-P. Montalescot G. AUTHOR ADDRESSES (Silvain J.; Vignalou J.-B.; Bellemain-Appaix A.; Landivier A.; Barthelemy O.; Beygui F.; Choussat R.; Ecollan P.; Collet J.-P.; Montalescot G.) APHP - La Pitié-Salpetrière, Cardiologie - Pr KOMAJDA, Paris, France. CORRESPONDENCE ADDRESS J. Silvain, APHP - La Pitié-Salpetrière, Cardiologie - Pr KOMAJDA, Paris, France. SOURCE Archives of Cardiovascular Diseases Supplements (2010) 2:1 (7). Date of Publication: January 2010 CONFERENCE NAME 20th European Days - Annual Meeting of the French Society of Cardiology CONFERENCE LOCATION Paris, France CONFERENCE DATE 2010-01-13 to 2010-01-16 ISSN 1878-6480 BOOK PUBLISHER Elsevier Masson SAS ABSTRACT Aim: In STEMI, controversial data exist on the relative importance of patient-dependent time (Symptom-Onset (SO) to first medical contact (FMC)) and Transfer Time (TT=time from FMC to sheath insertion). We assessed the impact of TT on in-hospital (IH) mortality in a well organized urban network using Mobile Intensive Care Units (MICU). Methods: In a web-based registry (e-PARIS), we evaluated delay in care of 705 consecutive STEMI patients transferred to the Pitié-Salpêtrière cath-lab for primary PCI. Results: Population was 63±14 y/o, 75.6% were male, 46.9% had anterior MI, 16.7% were in Killip class 2, and 3.8% had out-of-hospital cardiac arrest. Abciximab was used in 82.4%, radial approach in 87.7% and stenting in 89.7% of patients. Median time (IQR) from SO to FMC was 110 (248) min (102 (190) min when FMC was MICU and 160 (381) min when FMC was a referring hospital, p<0.0001). Median TT was 104 (75) min (95 (45) min for MICU and 151 (178 )min for patients transferred from a primary hospital, p<0.0001). When divided into quartiles, increasing TT was associated with higher IH mortality. This relation to IH mortality was striking in patients presenting early (within 2 hours of SO), and not significant in late presenters (>2 hours of SO) (fig). After adjustment for baseline characteristics, TT was not associated with mortality anymore suggesting that the sicker patients had the longest TT. Conclusions: The association between TT and early mortality is strongly dependent on patients' characteristics and time to presentation. After adjustment for these parameters, TT does not appear to be a major contributor of IH mortality in a well organized urban network for primary PCI. Improving timeto-first medical contact may be more critical. (Graph presented). EMTREE DRUG INDEX TERMS abciximab trichloroethylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology mortality society EMTREE MEDICAL INDEX TERMS heart arrest hospital intensive care unit male patient population register ST segment elevation myocardial infarction stent LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70185421 DOI 10.1016/S1878-6480(10)70022-7 FULL TEXT LINK http://dx.doi.org/10.1016/S1878-6480(10)70022-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 698 TITLE Difference in outcome in patients transferred to the ICU after rapid response team intervention compared to standard critical care consult AUTHOR NAMES Cimino M.J. Schorr C. Milcarek B. Debesa O. Parrillo J. Dellinger R.P. AUTHOR ADDRESSES (Cimino M.J.; Schorr C.; Milcarek B.; Debesa O.; Parrillo J.; Dellinger R.P.) Cooper University Hospital, United States. CORRESPONDENCE ADDRESS M.J. Cimino, Cooper University Hospital, United States. SOURCE Critical Care Medicine (2009) 37:12 SUPPL. (A252). Date of Publication: December 2009 CONFERENCE NAME 39th Critical Care Congress of the Society of Critical Care Medicine's CONFERENCE LOCATION Miami Beach, FL, United States CONFERENCE DATE 2010-01-09 to 2010-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Patients typically show abnormal signs and symptoms within 6 hours prior to an arrest. Failure to recognize these changes in condition have been linked to poor outcomes. Implementation of a rapid response team (RRT) brings critical care expertise to the bedside with the goal of earlier intervention and decreasing morbidity. Hypothesis: Activating the RRT improves outcomes for patients transferred to the ICU from a general medical surgical or progressive careor stepdown unit compared to those transferred with standard critical care consult. Methods: A retrospective review of the Cerner Project IMPACT database for patients (pts) admitted to the ICU from a general care floor, general care w/telemetry, progressive care unit or stepdown unit during April 2008-April 2009. Pts were placed in two groups based on activation of the RRT prior to transfer (RRT) vs standard (ST) ICU consult prior to transfer. Comparisons fordemographics, acuity, LOS, presenting clinical characteristics and outcome were made. Results: A total of 627 admissions were included: RRT (n=133) and ST (n=494). No significant differences were reported for age, gender, race, CPR within 24 hours of ICU admission, patient type or days on mechanical ventilation (MV) in survivors. RRT patients had longer pre-ICU LOS 10+/-12 vs 8+/-9 (p=0.01); higher APACHE II score, RRT 20+/-9 vs ST 18+/-6 (p=0.04); greater MV within1 hour of ICU adm, 55% vs 28% (p=<0.01); lower blood pressure within 1 hr of transfer, RRT 41% vs 26% (p=<0.01). More RRT patients were transferred from general care floor and progressive care unit. Mortality was higher in RRT transfers, 42.9% vs 21.7% (p=<0.01). Conclusions: Patients transferred to the ICU following RRT are sicker and have an increased mortality. However the RRT association with greater mortality does not establish cause and effect. Sinceinception of a RRT at our institution, a 40% decrease in the number of “Code Calls” has been observed over a two year period. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient society EMTREE MEDICAL INDEX TERMS APACHE artificial ventilation blood pressure data base gender hypothesis morbidity mortality physical disease by body function survivor telemetry LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70191894 DOI 10.1097/01.ccm.0000365439.11849.a2 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000365439.11849.a2 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 699 TITLE Out of hospital transfer is an independent predictor of death or poor outcome after acute stroke AUTHOR NAMES Rincon F. Morino T. Behrens D. Lee E. Schorr C. Dellinger R. Parrillo J. Mirsen T. AUTHOR ADDRESSES (Rincon F.; Morino T.; Behrens D.; Lee E.; Schorr C.; Dellinger R.; Mirsen T.) Cooper Hospital University Med Ctr, United States. (Parrillo J.) Cooper University Hospital, UMC, Netherlands. CORRESPONDENCE ADDRESS F. Rincon, Cooper Hospital University Med Ctr, United States. SOURCE Critical Care Medicine (2009) 37:12 SUPPL. (A289). Date of Publication: December 2009 CONFERENCE NAME 39th Critical Care Congress of the Society of Critical Care Medicine's CONFERENCE LOCATION Miami Beach, FL, United States CONFERENCE DATE 2010-01-09 to 2010-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Transfer of critically-illpatients from external Emergency Department (OSH-ED) has the potential of delayingthe admission to the Intensive Care Unit (ICU). The effect of OSH-ED transfer onhospital outcomes of stroke patients has not been fully studied. Hypothesis: We hypothesized that in acute stroke patients, transferfrom OSH-ED was associated with poor hospital outcome and increased ICU andhospital length of stay (LOS). Methods: We designed a retrospectivecohort study using a prospectively compiled and maintained registry (CernerProject IMPACT). Patients admitted to the ICU within 24 hrs of stroke from ourED and OSH-ED at a single center from 2003-2008 with ischemic (AIS) orhemorrhagic stroke (ICH), were selected for the analysis. Data collectedincluded demographics, admission physiologic variables, Glasgow Coma Scale(GCS), APACHE-II, scores; and total ICU and hospital length of stay (LOS). Primaryoutcome was functional status at hospital discharge and secondary outcomes wereICU and hospital LOS. Poor outcome was defined as death or severe disability athospital discharge. To assess for the impact of OSH-ED transfer on primary andsecondary outcomes, demographic and admission clinical variables were used toconstruct baseline logistic regression models using the outcome measure as adependent variable. Results: A total of 448 patientswere selected for analysis. The mean age was 65±14 years, of which 48% weremale and 65% white. There were 34% AIS, and 66% ICH. The median hospital LOSwas 7 days (Interquartile range [IQR]=4-11) and median ICU-LOS was 2 days(IQR=1-3). Overall hospital mortality was 30%. Transfer from OSH-ED wasassociated with a 65% probability of death or poor outcome at hospitaldischarge (p=0.05). Multivariate regression analysis showed that APACHE-II (OR,1.2; 95% CI; 1.1-1.2), GCS <12 (OR, 2.80; 95% CI; 2.1-3.8), andOSH-ED Transfers (OR, 1.4; 95% CI; 1.1-1.8) were independently associated withpoor outcome. OSH-ED was not significantly associated with secondary outcomemeasures. Conclusions: This data suggests that inacute stroke patients, OSH-ED is independently associated with poor outcome athospital discharge. Further research is needed as to identify the potentialcauses for this effect. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cerebrovascular accident death hospital intensive care society EMTREE MEDICAL INDEX TERMS APACHE disability emergency ward functional status Glasgow coma scale hospital discharge hypothesis intensive care unit length of stay logistic regression analysis model mortality patient register regression analysis stroke patient LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70191971 DOI 10.1097/01.ccm.0000365439.11849.a2 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000365439.11849.a2 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 700 TITLE Assessing pediatric outcomes for interfacility transport into the pediatric intensive care unit by team type and mode of transport AUTHOR NAMES Meyer M. Kuhn E. Collins M. Scanlon M. AUTHOR ADDRESSES (Meyer M.; Scanlon M.) Medical College of Wisconsin, United States. (Kuhn E.; Collins M.) Children's Hospital and Health System, United States. CORRESPONDENCE ADDRESS M. Meyer, Medical College of Wisconsin, United States. SOURCE Critical Care Medicine (2009) 37:12 SUPPL. (A314). Date of Publication: December 2009 CONFERENCE NAME 39th Critical Care Congress of the Society of Critical Care Medicine's CONFERENCE LOCATION Miami Beach, FL, United States CONFERENCE DATE 2010-01-09 to 2010-01-13 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Critically ill children often require interfacility transport to Pediatric Intensive Care Units (PICU) from community emergency departments (ED). The study purpose is to determine if severity of illness adjusted outcomes are improved for children transported by a pediatric specialty team (SPT) and if mode of transport influences outcomes. Hypothesis: To determine if severity of illness adjusted outcomes are improved for children transported by a pediatric specialty team (SPT) and if mode of transport influences outcomes. Methods: We applied a retrospective analysis of 5,308 PICU discharges from 10 hospitals where transport data (team type, mode of transport) and PRISM 3 data were collected. Data were obtained from VPS, LLC, a national pediatric critical care database. Multiple logistic regression was used to determine factors related to PICU mortality. PIM2 and PRISM3 were used to adjust for severity of illness. Results: 2,539 PICU discharges were transported from a community ED directly to a PICU. SPT transport patients tended to be more severely ill, less likely to be Hispanic or have trauma, and more likely to have a respiratory diagnosis. After adjustment for PIM 2, PRISM 3, demographic and/or diagnostic variables, there was no statistically significant difference between PICU mortality for SPT vs EMS (p=0.065, odds ratio for SPT 2.37, 95% confidence interval 0.95-5.93) or between PICU unit based teams vs institution lead teams (p=0.31, OR for FBT 1.63, 95% CI 0.64-4.15). For all team types, mode of transport (rotor vs ground) was not statistically significant (p=0.89, OR = 0.95, 95% CI 0.43-2.07). Conclusions: Based on our multi-center analysis, children transported by SPT tend to be more severely ill than those transported by EMS. These data suggest that neither the mode of transport nor the type of patient transport team was related to severity-adjusted PICU mortality, using admission PICU-determined severity of illness variables at the accepting hospital. Transport specific variables need to be identified to delineate team and mode of transport determinations prospectively. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care intensive care unit society EMTREE MEDICAL INDEX TERMS child community confidence interval critically ill patient data base diagnosis emergency ward general aspects of disease Hispanic hospital hypothesis injury mortality multivariate logistic regression analysis patient patient transport risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70192021 DOI 10.1097/01.ccm.0000365439.11849.a2 FULL TEXT LINK http://dx.doi.org/10.1097/01.ccm.0000365439.11849.a2 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 701 TITLE The long distance transport of critically ill children on extracorporeal life support AUTHOR NAMES Thiruchelvam T. Membrey M. Shekerdemian L. AUTHOR ADDRESSES (Thiruchelvam T.; Membrey M.; Shekerdemian L.) Royal Childrens Hospital, Melbourne, Australia. CORRESPONDENCE ADDRESS T. Thiruchelvam, Royal Childrens Hospital, Melbourne, Australia. SOURCE Cardiology in the Young (2009) 19 SUPPL. 2 (161). Date of Publication: November 2009 CONFERENCE NAME Cardiology 2009, 12th Annual Update on Pediatric and Congenital Cardiovascular Disease CONFERENCE LOCATION Nassau, Bahamas CONFERENCE DATE 2009-02-04 to 2009-02-08 ISSN 1047-9511 BOOK PUBLISHER Cambridge University Press ABSTRACT Background: Since 2003 the Royal Children's Hospital has offered a mobile ECLS service to cannulate and retrieve critically ill paediatric patients who are too unstable for conventional transport. Our team consists of a PICU Specialist, an ECLS nurse, a Perfusionist, and Cardiac Surgeon. Here we describe our experience transporting infants and children sustained on Extracorporeal Life Support (ECLS) to a national paediatric ECLS centre in Melbourne, Australia. Patients and Methods: Retrospective review of 13 children, mean age 58 months (range 1 day to 16 years), who were transported on ECLS to the Intensive Care Unit at The Royal Children's Hospital Melbourne, between March 2003 and September 2008. Results: Our team cannuated eleven patients at the referring ICU, three of whom required transthoracic cannulation. Two children were cannulated by their referring centre. Twelve children were placed on ECMO (veno-venous in 3, veno-arterial in 9), and one was placed on Left Ventricular Assist Device. Seven patients were retrieved from interstate PICUs by air (distance 755 km to 1675 km) and six were transported from either a rural or metropolitan ICU by road. The mean duration of retrieval was 12 hours (range 6 to 19 hours). Mean duration of ECLS was 433 hours (range 86 to 1747 hours). Nine patients survived to hospital discharge. There were no significant transport-related complications. Conclusions: A specialist team can safely perform the cannulation and long-distance transport of critically ill children on ECLS. This does not abrogate the timely referral of potential ECLS candidates and should be reserved for patients who would not otherwise tolerate transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology cardiovascular disease child critically ill patient EMTREE MEDICAL INDEX TERMS Australia cannulation devices hospital discharge infant intensive care unit medical specialist nurse patient pediatric hospital surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70089813 DOI 10.1017/S1047951109991739 FULL TEXT LINK http://dx.doi.org/10.1017/S1047951109991739 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 702 TITLE Intensive care admission and discharge - critical decision-making points. AUTHOR NAMES Lundgrén-Laine H. Suominen H. Kontio E. Salanterä S. AUTHOR ADDRESSES (Lundgrén-Laine H.; Suominen H.; Kontio E.; Salanterä S.) Department of Nursing Science, University of Turku, Turku, Finland. CORRESPONDENCE ADDRESS H. Lundgrén-Laine, Department of Nursing Science, University of Turku, Turku, Finland. Email: helja.lundgren-laine@utu.fi SOURCE Studies in health technology and informatics (2009) 146 (358-361). Date of Publication: 2009 ISSN 0926-9630 ABSTRACT Delivery of intensive care has many critical points impacting the outcomes of critically ill patients. Two important key events in intensive care are patients' admission and discharge procedures. The decision making of intensive care experts should be supported in these two points, in order to attain good quality and safe care. We hypothesize that in the future this decision-making process can be effectively supported with information technology. To reveal the complex decision-making, we studied the decision-making processes and information needs of intensive care charge nurses during patients' admission and discharge procedures. We identified several interconnected decision-making steps during these procedures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making hospital admission intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article Finland human nurse administrator organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 19592865 (http://www.ncbi.nlm.nih.gov/pubmed/19592865) PUI L355355756 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 703 TITLE An evaluation of predictive clinical indicators in patients transferred to the ICU within 24 hours of initial admission to the general wards AUTHOR NAMES Chan T.W. Rotello L.C. Means M. Morton J. Roque T. Purcell T. AUTHOR ADDRESSES (Chan T.W.; Rotello L.C.; Means M.; Morton J.; Roque T.; Purcell T.) Suburban Hospital, Bethesda, United States. CORRESPONDENCE ADDRESS T.W. Chan, Suburban Hospital, Bethesda, United States. SOURCE Chest (2009) 136:4. Date of Publication: 1 Oct 2009 CONFERENCE NAME American College of Chest Physicians Annual Meeting, CHEST 2009 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2009-10-31 to 2009-11-05 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT PURPOSE: Readmission to the ICU within 24 hours of transfer out(bounce backs) is an accepted measure of quality, however the population of patients initially admitted to the ward who subsequently require transfer to the ICU within 24 hours has not been evaluated. We describe our experience with this population of ' bounce in ' patients to the ICU. METHODS: Records of all patients initially admitted to the ward who were subsequently transfered to the ICU within a 24 hour period were evaluated to determine whether ICU admission could have been predicted during the initial workup. RESULTS: During a 7 month period 37 'bounce in' patients were identified. 15 of those were identified as having had predictable ICU admission by virtue of initial clinical condition or laboratory data. The remaining 22 patients had no data indicative of predictable ICU admission or were transferred to the ICU for reasons unrelated to their presenting diagnosis, such as need for emergent surgery or development of unanticipated dysrrythmia in non-cardiac patients. Of the 15 'bounce in' patients transferred to the ICU predictable respiratory deterioration was the major factor identified. Several other factors predicting ICU transfer included unexplained acidosis, seizure associated with DT's and new onset atrial fibrillation. Followup included education of the admitting services on the prudence of evaluation of these patient populations for ICU admission prior to admission to the general wards. CONCLUSION: A significant number of patients require transfer to the ICU within 24 hours of admission to the hospital. This presumably results in increased patient morbidity and length of stay. An evaluation of this patient population has the potential to identify opportunities within an institution for which an educational program for admitting services such as hospitalists and ED physicians could be developed. CLINICAL IMPLICATIONS: Initial admission of patients with predictive data for subsequent deterioration directly to the ICU has the potential to diminish patient morbidity and decrease length of stay for this population of 'bounce in' patients to the ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical indicator college patient physician thorax ward EMTREE MEDICAL INDEX TERMS acidosis atrial fibrillation cardiac patient deterioration diagnosis education follow up hospital hospital readmission laboratory length of stay medical staff morality morbidity population seizure surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70203156 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 704 TITLE The impact of light, noise, cage cleaning and in-house transport on welfare and stress of laboratory rats AUTHOR NAMES Castelhano-Carlos M.J. Baumans V. AUTHOR ADDRESSES (Castelhano-Carlos M.J., mjoao@ecsaude.uminho.pt) Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal. (Baumans V.) Department of Animals, Science and Society, Division of Laboratory Animal Science, Utrecht University, Netherlands. CORRESPONDENCE ADDRESS M. J. Castelhano-Carlos, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057 Braga, Portugal. Email: mjoao@ecsaude.uminho.pt SOURCE Laboratory Animals (2009) 43:4 (311-327). Date of Publication: October 2009 ISSN 0023-6772 BOOK PUBLISHER Royal Society of Medicine Press Ltd, P.O. Box 9002, London, United Kingdom. ABSTRACT Human interaction and physical environmental factors are part of the stimuli presented to laboratory animals everyday, influencing their behaviour and physiology and contributing to their welfare. Certain environmental conditions and routine procedures in the animal facility might induce stress responses and when the animal is unable to maintain its homeostasis in the presence of a particular stressor, the animal's wellbeing is threatened. This review article summarizes several published studies on the impact of environmental factors such as light, noise, cage cleaning and in-house transport on welfare and stress of laboratory rats. The behaviour and physiological responses of laboratory rats to different environmental housing conditions and routine procedures are reviewed. Recommendations on the welfare of laboratory rats and refinements in experimental design are discussed and how these can influence and improve the quality of scientific data. EMTREE DRUG INDEX TERMS anxiolytic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) animal welfare cage cleaning light noise stress EMTREE MEDICAL INDEX TERMS air conditioning animal housing auditory stimulation behavior breeding circadian rhythm environmental factor environmental impact experimental rat eye eye photography hearing interpersonal communication nonhuman odor physical activity physiology rat review sound tranquilizing activity vocalization wellbeing EMBASE CLASSIFICATIONS Physiology (2) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009512884 MEDLINE PMID 19505937 (http://www.ncbi.nlm.nih.gov/pubmed/19505937) PUI L355337415 DOI 10.1258/la.2009.0080098 FULL TEXT LINK http://dx.doi.org/10.1258/la.2009.0080098 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 705 TITLE Short term outcomes of US air force critical Care air transport team (CCATT) patients evacuated from a combat setting between 2007 and 2008 AUTHOR NAMES Beninati W. Lairet J. King J. Vojta L. Mccarthy M. Gholdson A. Henderson J. AUTHOR ADDRESSES (Beninati W.; Lairet J.; King J.; Vojta L.; Mccarthy M.; Gholdson A.; Henderson J.) Wilford Hall Medical Center, Lackland AFB, United States. CORRESPONDENCE ADDRESS W. Beninati, Wilford Hall Medical Center, Lackland AFB, United States. SOURCE Chest (2009) 136:4. Date of Publication: 1 Oct 2009 CONFERENCE NAME American College of Chest Physicians Annual Meeting, CHEST 2009 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2009-10-31 to 2009-11-05 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians ABSTRACT PURPOSE: The purpose of this study is to describe the short term outcomes of patients managed by the USAF CCATTs deployed between 2007 and 2008. METHODS: This is a retrospective chart review of patients who were transported by CCATT between March 1, 2007 and June 30, 2008. A standardized abstraction form was used. Patients were classified as medical or trauma. For trauma: mechanism of injury and the type of injury were recorded. Care given inflight was documented including: mechanical ventilation, vassoactive medications, and administration of blood products. Short term events in flight included: death, oxyhemoglobin desaturation, hypotension, decline in neurological status, and development of anuria or oliguria. RESULTS: 656 patient moves met inclusion criteria of which 425 (64.8%) were trauma and 231 (35.2%) were medical. Mechanical ventilation was required by 318 (48.5%), 68 (10.4%) received vasoactive medications, and 43 (6.6%) received blood products during the flight. There were a total of 75 events on 65 patient transports (9.9%). Of these 19 were oxyhemoglobin desaturation, 29 were hypotension, 3 were decline in neurological status, and 23 were due to anuria or oliguria. We did not encounter any deaths, loss of airway or chest tubes during transport.Of the trauma subset, the mean age was 26.7 y/o (SD 7.8), 97.4% were Male. The mechanism of injury was blast in 309 (72.7%), penetrating in 81 (19.1%) and blunt in 35 (8.2%). By type of injury: 269 were polytrauma, 80 amputations, 90 head injuries, 73 burns, 121 intraabdominal injuries and 98 intrathoracic injuries. The mean ISS was 22 (range 1 to 75).Of the 231 medical transports the mean age was 38.6 y/o (SD 13.5), 93.1% were male. The predominance of patients had cardiac disease 126 (54.6%). Other diagnoses included: pneumonia, sepsis, renal failure, GI bleed and CVA. CONCLUSION: CCATTs are successful in transporting critically injured and Ill troops with minimal short term complications. Further studies should be performed to further validate these findings. CLINICAL IMPLICATIONS: CCATTs are an effective platform to transport critically injured/ill patients. EMTREE DRUG INDEX TERMS oxyhemoglobin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air force college intensive care patient physician thorax EMTREE MEDICAL INDEX TERMS airway amputation anuria artificial ventilation blood cerebrovascular accident death diagnosis drug therapy fatty acid desaturation flight head injury heart disease hypotension injury kidney failure male medical record review multiple trauma oliguria patient transport pneumonia sepsis tube LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70203865 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 706 TITLE Interhospitalar versus intrahospitalar transfer: Differential secondary transfer to ICU and its implications in outcome AUTHOR NAMES Pinto A. Almeida C. Alves L. Lucas R. Gomes E. Aragão I. AUTHOR ADDRESSES (Pinto A.; Almeida C.; Gomes E.; Aragão I.) Centro Hospitalar Do Porto, Unidade de Cuidados Intensivos Polivalente, Porto, Portugal. (Alves L.; Lucas R.) Faculdade de Medicina da Universidade Do Porto, Servic¸ O de Higiene e Epidemiologia, Porto, Portugal. CORRESPONDENCE ADDRESS A. Pinto, Centro Hospitalar Do Porto, Unidade de Cuidados Intensivos Polivalente, Porto, Portugal. SOURCE Intensive Care Medicine (2009) 35 Suppl. 1 (S97). Date of Publication: September 2009 CONFERENCE NAME 22nd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2009-10-11 to 2009-10-14 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION: Critically ill patients from secondary hospitals, where intensive care services are either not available or limited, are appropriately transferred to the intensive care units (ICUs) of tertiary care centers. The investigation of the association between a differential access to intensive care services and patient or hospital outcomes is increasing markedly [1-4]. OBJECTIVES: The aim of this study was to compare demographic, clinical characteristics, and outcomes of patients admitted to tertiary-level intensive care units from a tertiary hospital ward (intrahospital transfer) to patients transferred from a secondary hospital ward (interhospital transfer). METHODS: Single centre retrospective study in a 12 bed mixed ICU of a tertiary university hospital. During the study period (2007-2008) 792 patients were admitted in the unit: the median of age was 55 (38-70), the males were 63.4% and the mean of SAPSII was 44 ± 15. From 498 randomly selected patients we enrolled all the 138 patients admitted from a non-ICU hospital ward, divided in Group I: from our hospital ward (n = 90) and Group II: from a secondary hospital ward (n = 46). Emergency room admitted patients from ours or another hospital were not included. Statistical analysis: Χ(2), Mann-Whitney, Fischer's test, unpaired t Student. RESULTS: The age was higher in Group I [68.5 (52.7 vs. 76.3) vs. 56 (41.0-72.3), p 0.04]. The proportion of males was no different. Post-operative admissions rate was higher in group I (34.5 vs. 5.9%, p < 0.01). At 24 h SAPSII (p 0.51), SOFA (p 0.67) were not different. Group II presented a higher diversity of admission diagnoses. In both groups the most frequent diagnoses were septic shock (50.0 vs. 54.3%, p 0.63) and severe sepsis (30.0 vs. 10.9%, p 0.013). The length of stay, mortality, ventilator associated pneumonia rate were not statistically different (p 0.61; p 0.73; p 0.64, respectively). SOFA at discharge (excluding deaths) and readmission rate (deaths and patients discharged to another hospital considered not at risk the readmission) were not significantly different (p 0.37, p 0.47, respectively) CONCLUSIONS: The interhospital transferred patients are younger, but at admission severity of the disease is comparable. These findings, within this case mix of patients, suggest there are not significant differences in mortality, length of stay, ICU-nosocomial respiratory infection or physiological disability at discharge between intrahospital and interhospital transferred patients to our unit. In this study we did not find a different impact in outcome considering these differential sources of admission. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care society EMTREE MEDICAL INDEX TERMS case mix critically ill patient death diagnosis disability emergency ward hospital hospital readmission intensive care unit length of stay male mortality patient patient transport respiratory tract infection retrospective study risk sepsis septic shock statistical analysis student Tertiary (period) tertiary health care university hospital ventilator associated pneumonia ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70190584 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 707 TITLE Air transport of critically ill patients AUTHOR NAMES Fuke N. AUTHOR ADDRESSES (Fuke N.) Emergency and Intensive Care Center, Teikyo University, Chiba Medicine Center, . CORRESPONDENCE ADDRESS N. Fuke, Emergency and Intensive Care Center, Teikyo University, Chiba Medicine Center, . SOURCE Teikyo Medical Journal (2009) 32:5 (297-305). Date of Publication: September 2009 ISSN 0387-5547 BOOK PUBLISHER Teikyo University School of Medicine, 11-1 Kaga 2-chome, Itabashi-ku, Tokyo, Japan. ABSTRACT Moving of people is increasing in modern societies. Some may go around the world for business's sake. Some who have chronic diseases would travel where sophisticated medical service could not be available. Some may suffer from injuries or diseases far away from their families or may need medical treatment which exceeds local clinics or hospitals could provide. Urgent evacuation or repatriation by air is necessary in such cases. Physicians or nurses who participate in air medical transport of critically ill patients are expected to have both skills and knowledges of intensive care and aerospace medicine. International aeromedical service companies can prepare a specialized aircraft fixed as "a flying ICU" depending on a situation but the use of commercial aircraft, on the other hand, have benefits of lower cost, frequent flights, long distant mobility. Cabin space as a medical environment has several pitafalls. HYPOBARISM : Cabin pressure is maintained at 8,000 ft above see level. This means about 0.8 atm and therefore it causes gas expansion, which may worsen pneumothrax, ileus, or decompression sickness. HYPOXIA : Lower atmosphere pressure causes oxygen partial pressure lower despite the same concentration. Those who have chronic respiratory disease, heart failure, or severe anemia may suffer from peripheral oxygen deficit. DRYNESS : Cabin humidity is only 5-15 %. Dehydration induced by insensitible perspiration may cause hemoconcentration/thrombus formation and result in pulmonary embolism. Heart-and-moisture exchanger is essential by the same reason for tracheomized or endotrachally intubated patients. 4)NOISE : Noise in a cabin make a stethoscope useless. SPACE UTILITY : A bed-rest patient needs early entrance by a lift directly from the ground and needs 2 seats' width and 3 rows' length following narrow aisle. ELECTROMAGNETICAL INTERFERENCE : Every device used in a commercial airflight must be dry battery-driven and must have no electromagnetic interference with flying instruments. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS aerospace medicine air medical transport anemia article bed rest blood clotting chronic respiratory tract disease decompression sickness dehydration disease exacerbation electromagnetism family flying heart failure hemoconcentration hospital human humidity hypobarism hypoxia ileus injury intensive care intensive care unit knowledge lung embolism medical service noise outpatient department oxygen tension skill stethoscope sweating EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY English, Japanese EMBASE ACCESSION NUMBER 2009562607 PUI L355516747 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 708 TITLE Intrahospital transport of critically ill patients - A prospective pilot study of critical events AUTHOR NAMES Mittal P. Gurnani A. AUTHOR ADDRESSES (Mittal P.) Sevenhills Hospital, Nursing, Mumbai, India. (Gurnani A.) Kailash Hospital and Research Centre, Critical Care and OT, Noida, India. CORRESPONDENCE ADDRESS P. Mittal, Sevenhills Hospital, Nursing, Mumbai, India. SOURCE Intensive Care Medicine (2009) 35 Suppl. 1 (S260). Date of Publication: September 2009 CONFERENCE NAME 22nd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2009-10-11 to 2009-10-14 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION AND OBJECTIVES: The critically ill patients on numerous occasions need to be transported from one section of the hospital to the other for diagnostic, therapeutic or operative procedures. During the intrahospital transport, a number of critical events have been reported with incidence ranging form 21 to 84%. These critical events mainly include variation in blood pressure, airway obstruction, hypoxaemia, cardiac dysrrhythmias and even frank cardiac or respiratory arrest. In addition, lack of appropriate monitors and advanced supportive care and absence of trained nurse(s) to transport a patient safely to areas within the hospital, add to the adverse untoward events during Intrahospital transport. However, the incidence of adverse outcomes from transport related complications is not well documented. So this study was designed to documents the critical events during the intrahospital transport of critically ill patients. An attempt is also made to recommend guidelines for safe transportof these patients. METHODS: 55 critically ill patients requiring movement within the hospital were prospectively studied. Cardiovascular and respiratory parameters including oxygen saturation (SpO2) and end tidal CO2 (ETCO2) were recorded using a battery powered monitor (Propaq 102 EL, Protocol Inc., USA) during the transport; ventilation wherever needed, was provided using a self inflation bag by a nurse, however a critical care nurse accompanied all the patients. A note was also made of complications related to equipment, personnel and route itself. RESULTS: 85% of patients showed critical changes in pulse (p < 0.001), 83% developed haemodynamic instability (p < 0.001). 72% showed significant fall in SpO2 (p < 0.001) and 93% of ventilator dependent patients showed changes in ETCO2 (p < 0.00). Equipment related complications were encountered in 60% of the moves (p < 0.001) while 31% of the moves (p < 0.05) required a major intervention. Inexperienced Nurse resulted in life- threatening situations during two moves. Severity of the illness and total duration of transport contributed to frequency of complications. The linear relationship was observed on regression analysis between SpO(2) and time (p < 0.05). CONCLUSIONS: We recommend a portable transport system with patient monitor, ventilator and resuscitative equipments (with sufficient power backup) along with trained Nurse and prior planning of the route for safe intrahospital transport of critically ill patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient intensive care pilot study society EMTREE MEDICAL INDEX TERMS adverse outcome air conditioning airway obstruction blood pressure diagnosis general aspects of disease hospital hypoxemia nurse oxygen saturation patient personnel planning pulse rate regression analysis respiratory arrest ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70191223 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 709 TITLE Transfer time is not a major determinant of in-hospital mortality in Primary PCI when performed in a well organized urban network AUTHOR NAMES Silvain J. Vignalou J.B. Bellemain-Appaix A. Landivier A. Barthelemy O. Beygui F. Choussat R. Ecollan P. Collet J.P. Montalesoct G. AUTHOR ADDRESSES (Silvain J.; Vignalou J.B.; Bellemain-Appaix A.; Landivier A.; Barthelemy O.; Beygui F.; Choussat R.; Ecollan P.; Collet J.P.; Montalesoct G.) Pitie-Salpetriere Hospital, AP-HP, Paris, France. CORRESPONDENCE ADDRESS J. Silvain, Pitie-Salpetriere Hospital, AP-HP, Paris, France. SOURCE European Heart Journal (2009) 30 SUPPL. 1 (924). Date of Publication: September 2009 CONFERENCE NAME European Society of Cardiology, ESC Congress 2009 CONFERENCE LOCATION Barcelona, Spain CONFERENCE DATE 2009-08-29 to 2009-09-02 ISSN 0195-668X BOOK PUBLISHER Oxford University Press ABSTRACT Aim: In STEMI, conflicting data exists on the relative importance of patientdependent time (Symptom-Onset (SO) to first medical contact (FMC)) and Transfer Time (TT=time from FMC to sheath insertion). We assessed the impact of TT on in-hospital (IH) mortality in a well organized urban network using Mobile Intensive Care Units (MICU) Methods: In a web-based registry (e-PARIS), we evaluated delay in care of 705 consecutive STEMI patients transferred to the Pitié-Salpêtrière cath-lab for primary PCI. Results: Population was 63±14 y/o, 75.6% were male, 46.9% had anterior MI, 16.7% were in Killip class 2, and 3.8% had out-of-hospital cardiac arrest. Abciximab was used in 82.4%, radial approach in 87.7% and stenting in 89.7% of patients. Median time (± IQR) from SO to FMC was 110±248 min (102±190 min when FMC was MICU and 160±381 min when FMC was a referring hospital, p<0.0001). Median TT was 104±75 min (95±45 min for MICU and 151±178 min for patients transferred from a primary hospital, p<0.0001). When divided into quartiles, increasing TT was associated with higher IH mortality. This relation to IH mortality was striking in patients presenting early (within 2 hours of SO), and not significant in late presenters (>2 hours of SO) (fig). After multivariate analysis and adjustment for the baseline characteristics, TT was not associated with mortality anymore suggesting that the sicker patients had the longest TT (Graph presented). Conclusions: The association between TT and early mortality is strongly dependent on patients' characteristics and time to presentation. After adjustment for these parameters, TT does not appear to be a major contributor of IH mortality in a well organized urban network for primary PCI. Improving time-to-first medical contact may be more critical. EMTREE DRUG INDEX TERMS abciximab trichloroethylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology mortality society EMTREE MEDICAL INDEX TERMS heart arrest hospital intensive care unit male multivariate analysis patient population register ST segment elevation myocardial infarction stent LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70356702 DOI 10.1093/eurheartj/ehp416 FULL TEXT LINK http://dx.doi.org/10.1093/eurheartj/ehp416 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 710 TITLE Deficits in referral notes during inter-hospital transfer of critically ill patients: An experience from a tertiary care centre in North India AUTHOR NAMES Azim A. Gupta G. Baronia A. Singh R. Poddar B. AUTHOR ADDRESSES (Azim A.; Gupta G.; Baronia A.; Singh R.; Poddar B.) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Critical Care Medicine, Lucknow, India. CORRESPONDENCE ADDRESS A. Azim, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Critical Care Medicine, Lucknow, India. SOURCE Intensive Care Medicine (2009) 35 Suppl. 1 (S24). Date of Publication: September 2009 CONFERENCE NAME 22nd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2009-10-11 to 2009-10-14 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION: A patient is referred to a higher centre when services are needed to maintain continuity of care. There are guidelines for the safe inter and intrahospital transport of critically ill patients but no guidelines are available for the minimal mandatory content of interhospital referral notes of critically ill patients. This problem is manifold in developing countries. OBJECTIVES: To educate the critical care physicians regarding the deficits in the physicians referral notes with which critically ill patients are referred from one centre to another. METHODS: It is a prospective observational study on 96 out of hospital referred patients transferred to our intensive care unit (ICU) over a period of 1 year. After permission from the institutes ethical committee we reviewed the referral summaries of these patients at the time of ICU admission regarding the information available of clinical details, course in the previous hospital and therapeutic interventions. Patients with more than 24 h of hospitalization before transfer were included in the study. RESULTS: There were 62 (64%) male and 34 (36%) female patients. Mean admission APACHE-II was 15.89 and Mean SOFA was 8.20. All patients had more than two organ failures and 77 (80%) patients were in circulatory shock (systolic blood pressure < 90 mmHg) at time of admission. Presenting complaints and the progression of signs and symptoms during the stay of the patient was not mentioned in any discharge summary. Progression of the organ failures was not mentioned in 86 (90%) patients. Neurological assessment was not mentioned in 89 (93%) patients. 72 (75%) patients came with vasopressor support but no information was available about the dose and duration of use of vasoactive drugs. We received 79 (80%) intubated patients with the average of one blood gas in 48-72 h without mention of ventilator settings. In 86 (90%) patients, trends of vital parameters were not available and no record of daily input /output was mentioned. There were no nutrition details available in 89 (93%) patients. None of the referrals mentioned about DVT prophylaxis, transfusions, glycemic control, dyselectrolytemia and any critical incident. None of them commented about the criteria for initiating antibiotics. 83 (86%) referral notes only commented about the clinical status of the patient at the time of discharge along with the treatment and investigations available on the day of referral to our hospital. CONCLUSION: As the specialty of critical care is expanding in developing countries it is utmost essential to educate the importance of communicating detailed patient information on the referral note. It helps to maintain continuity of care, resource utilization, prevents delay in institution of life saving therapies and in early prognostication. EMTREE DRUG INDEX TERMS antibiotic agent hypertensive factor vasoactive agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient hospital India intensive care society tertiary health care EMTREE MEDICAL INDEX TERMS APACHE blood gas developing country female glycemic control hospitalization intensive care unit male nutrition observational study patient patient care patient information physical disease by body function physician prophylaxis shock systolic blood pressure therapy transfusion ventilator LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70190293 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 711 TITLE Patterns of interfacility transfers in a non-trauma system setting: Does it differ? AUTHOR NAMES Drimousis P. Kleidi E. Theodorou D. Larentzakis A. Toutouzas K. Theodoraki M.E. Katsaragakis S. AUTHOR ADDRESSES (Drimousis P.; Kleidi E.; Theodorou D.; Larentzakis A.; Toutouzas K.; Theodoraki M.E.; Katsaragakis S.) University of Athens, Hippocration Hospital, Surgical Intensive Care Unit, Athens, Greece. CORRESPONDENCE ADDRESS P. Drimousis, University of Athens, Hippocration Hospital, Surgical Intensive Care Unit, Athens, Greece. SOURCE Intensive Care Medicine (2009) 35 Suppl. 1 (S66). Date of Publication: September 2009 CONFERENCE NAME 22nd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2009-10-11 to 2009-10-14 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT INTRODUCTION: One major issue in trauma management is to get every patient directly from the scene to the appropriate hospital for the injury he sustained. Patterns of interfacility transfers have been thouroughly investigated in trauma system settings, but scarce data are available about transfers in non trauma system settings. OBJECTIVES: This study aims to assess interfacility transfers that eventuate in the absence of a formal trauma system and to estimate the potential benefits from the implementation of a more organized process. METHODS: The 'Report of the Epidemiology and Management of Trauma in Greece' is a one year project of trauma patient reporting throughout the country. It provided data concerning the patterns of interfacility transfers. In Greece there is no formal trauma system employed and to our knowledge, all available data concerning the epidemiology of trauma in the country are either extrapolations of relevant data from other countries or based on police reports and individual hospital reports. In this study, we attempted to evaluate the paterns of interfacility transfers, Information reviewed included patient and injury characteristics, need for an operation, intensive care unit (ICU) admittance and mortality. Trauma patients were devided in two groups, the transfer group was compared to the non-transfer group. Analysis employed descriptive statistics and Chi-square test. Interfacility transfers were furthermore assessed according to each health care facility's availability of five requirements; Computed Tomography scanner, ICU, neurosurgeon, orthopedic and vascular surgeon. RESULTS: Data on 8,524 patients were analyzed; 86.3% were treated at the same facility, whereas 13.7% were transferred. In transferred group there were more male, the mean age was lower than that of the non transferred group and the injury severity score was higher. Transferred patients were admitted to ICU more often, had a higher mortality rate but were less operated on compared to non-transferred. The transfer rate from facilities with none of the five requirements was 34.3%, whereas the rate of those with at least one requirement was 12.4%. Facilities with at least three requirements transferred 43.2% of their transfer volume to units of equal resources. CONCLUSIONS: The assessment of interfacility transfers can reflect current trends in a nontrauma system setting and could indicate points for substantial improvement. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) injury intensive care society EMTREE MEDICAL INDEX TERMS chi square test computed tomography scanner epidemiology Greece health care facility hospital injury scale intensive care unit male mortality patient police statistics surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70190458 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 712 TITLE Should this stroke patient be transferred? Computed tomographic angiography predicts use of tertiary interventional services AUTHOR NAMES Thomas L.E. Goldstein J.N. Hakimelahi R. Gonzalez R.G. AUTHOR ADDRESSES (Thomas L.E.; Goldstein J.N.; Hakimelahi R.; Gonzalez R.G.) Massachusetts General Hospital, Boston, United States. CORRESPONDENCE ADDRESS L.E. Thomas, Massachusetts General Hospital, Boston, United States. SOURCE Annals of Emergency Medicine (2009) 54:3 SUPPL. 1 (S70). Date of Publication: September 2009 CONFERENCE NAME American College of Emergency Physicians, ACEP 2009 Research Forum CONFERENCE LOCATION Boston, MA, United States CONFERENCE DATE 2009-10-05 to 2009-10-06 ISSN 0196-0644 ABSTRACT Study Objectives: Many organizations have recommended that primary and comprehensive stroke centers be established to organize stroke care. However, there are no formal guidelines for determining which patients should be transferred to comprehensive stroke centers. A rapidly available prediction tool for advanced interventional services would help community hospitals determine which patients might benefit from transfer. Multislice computed tomographic scanners are widely available in U.S. emergency departments; we hypothesized that the finding of an occlusive thrombus in a proximal cerebral artery on computed tomographic angiography (CTA) would predict use of advanced neurointerventional services. Methods: Consecutive ischemic stroke patients presenting within 24 hours of symptom onset to a single academic emergency department in 2006, and who underwent emergent CTA, were retrospectively reviewed. Proximal cerebral artery occlusions on CTA were defined as distal/terminal (intracranial) internal carotid artery, proximal (M1 or M2) middle cerebral artery, and/or basilar artery. Tertiary care interventions including intra-arterial (IA) thrombolysis, mechanical clot retrieval or removal, and any neurosurgical procedure were captured. Results: During the study period, 283 patients presented within 24 hours of symptom onset, and 207 (73%) received a CTA. 25% of patients received intravenous tissue plasminogen activator, 2.4% received IA thrombolytics, 6.8% received a mechanical intervention, 3.3% underwent surgery, and 52% were admitted to the neuroscience intensive care unit. 72 (35%) showed evidence of a proximal cerebral artery occlusion on CTA, and 22 (11%) received a tertiary neurointervention. Patients with proximal thrombi had higher National Institutes of Health stroke scale scores than those without this finding (17 (IQR 9-21) vs. 4 (IQR 2-9), p<0.0001). In addition, those with proximal thrombi were more likely to receive an intervention (25% vs. 3%, p<0.001). They were more likely to undergo IA thrombolysis (8% vs. 1%, p = 0.008), a mechanical intervention (19% vs. 0%, p<0.0001), or admission to the neuroscience ICU (85% vs. 35%, p<0.0001). They were also more likely to suffer in-hospital mortality (30% vs. 6%), and less likely to be discharged home (10% vs. 48%) (p<0.001). Evidence of proximal occlusion on CTA predicts use of IA thrombolysis with sensitivity 86%, specificity 67%, PPV 8% (5-9%), and NPV 99% (97-99%). It predicts use of mechanical intervention with sensitivity 100%, specificity 70%, PPV 19%, and NPV 100%. In multivariable logistic regression controlling for age, sex, initial National Institutes of Health Stroke Scale score, and time to presentation, the only independent predictors of interventional services were increasing NIHSS (OR 1.1, 95%CI 1.01-1.2) and proximal clot on CTA (OR 5.8, 95%CI 1.7-20). Conclusion: Proximal cerebral artery occlusion on CTA is a sensitive, but not specific, independent predictor of use of advanced neurointerventional services. While not all centers can perform a comprehensive CTA, almost all emergency departments in the US can perform multislice CT scanning with contrast, and have the ability to determine presence of a thrombus in a proximal cerebral artery. CTA may be a valuable tool in determining which stroke patients would benefit from transfer to a center with comprehensive neurointerventional services. EMTREE DRUG INDEX TERMS tissue plasminogen activator EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) college computed tomographic angiography emergency physician stroke patient EMTREE MEDICAL INDEX TERMS basilar artery blood clot lysis brain artery brain ischemia cerebrovascular accident community hospital computer assisted tomography emergency ward intensive care unit internal carotid artery logistic regression analysis middle cerebral artery mortality multidetector computed tomography National Institutes of Health Stroke Scale neurosurgery occlusion occlusive cerebrovascular disease organization patient prediction surgery Tertiary (period) tertiary health care thrombus United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70251676 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 713 TITLE Information transfer during ICU ward rounds - Analysis under cognitive psychological aspects AUTHOR NAMES Kloecker K.M. Schindler N. Schindler A.W. Vagts D.A. AUTHOR ADDRESSES (Kloecker K.M.; Schindler N.; Vagts D.A.) University Hospital Rostock, Dep. of Anaesthesiology and Intensive Care Medicine, Rostock, Germany. (Schindler A.W.) KMG Hospital Guestrow, Dep. of Anaesthesiology and Intensive Care Medicine, Guestrow, Germany. (Vagts D.A.) Hetzelstift Hospital, Dep. of Anaesthesiology and Intensive Care Medicine, Weinstrasse, Neustadt, Germany. CORRESPONDENCE ADDRESS K.M. Kloecker, University Hospital Rostock, Dep. of Anaesthesiology and Intensive Care Medicine, Rostock, Germany. SOURCE Intensive Care Medicine (2009) 35 Suppl. 1 (S111). Date of Publication: September 2009 CONFERENCE NAME 22nd Annual Congress of the European Society of Intensive Care Medicine, ESICM CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2009-10-11 to 2009-10-14 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag ABSTRACT BACKGROUND: During Ward Rounds on an Intensive Care Unit physicians are confronted with a very high number and denseness of new information every day. The question is wether the human brain is capable of processing this flood of information, or if it exceeds the natural boundaries of human concentration and memory? METHODS: We conducted a prospective, observational study in the Intensive Care Unit of a university clinic with 18 beds. The information transfer and process of ward rounds was analyzed with the help of video recordings. Alltogether 8 ward round cycles were recorded, each consisting of 4 sequent ward rounds within 24 h in a 3 shift system. In the beginning of each cycle clinically relevant information of 5 patients were established and standadized. This predetermined information served as the default value in order to detect information loss throughout the 24 h. Out of these five patients 2 were chosen from the beginning (randomely chosen from Pat 1-4), one out of the middle (randomely chosen from Pat 8-11) and 2 from the end (randomely chosen from Pat 16-18) of the ward round, in order to find fluctuations in the physicians ability to concentrate and memorize information throughout the ward round, Except for the physician initially passing over the information the rest of the ward round members did not know which patients would be evaluated in the end. To test the physicians memory they were asked to fill out a questionnaire immediately after the ward round had ended on information that was given throughout the ward round. RESULTS: During the first ward round an average of 15.27 informations were given per patient. Of these only 11.42 (74.79%) were mentioned during the second ward round. During the third ward round only 7.91 (51.80%) of these informations were passed on and 8.30 (54.37%) during the fourth. A major loss of information can be discovered. Of those patients discussed in the beginning of the ward round 69.77% of the information was passed on during the course of 24 h. Of those discussed in the middle only 55.05% and in the end 38.54% of the initial information was passed on, even though the average time needed for each patient remained the same throughout the whole ward round. CONCLUSION: This shows, that towards the end of the ward round the physicians' ability to concentrate decreased and the density of information lessend. This study shows that the structure of the ward round as it is organized up until now needs to be reconsidered. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care psychological aspect society ward EMTREE MEDICAL INDEX TERMS brain density flooding hospital human intensive care unit memory observational study patient physician processing questionnaire university videorecording wether LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70190637 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 714 TITLE Pro/con debate: Do the benefits of regionalized critical care delivery outweigh the risks of interfacility patient transport? AUTHOR NAMES Singh J.M. MacDonald R.D. AUTHOR ADDRESSES (Singh J.M., jeff.singh@uhn.on.ca) Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, 2 McLaughlin - 411K, Toronto, ON M5T 2S8, Canada. (Singh J.M., jeff.singh@uhn.on.ca; MacDonald R.D., rmacdonald@ornge.ca) Research and Development, Ornge Transport Medicine, 20 Carlson Court, Suite 400, Toronto, ON M9W 7K6, Canada. (MacDonald R.D., rmacdonald@ornge.ca) Division of Emergency Medicine, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. CORRESPONDENCE ADDRESS J.M. Singh, Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, 2 McLaughlin - 411K, Toronto, ON M5T 2S8, Canada. Email: jeff.singh@uhn.on.ca SOURCE Critical Care (2009) 13:4 Article Number: 219. Date of Publication: 10 Aug 2009 ISSN 1364-8535 1466-609X (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT You are providing input in planning for critical care services to a large regional health authority. You are considering concentrating some critical care services into high-volume regional centres of excellence, as has been done in other fields of medicine. In your region, this would require several centres with differing levels of expertise that are geographically separated. Given there are inherent risks and time delays associated with interfacility patient transport, you debate whether these potential risks outweigh the benefits of regional centres of excellence. © 2009 BioMed Central Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care regionalization EMTREE MEDICAL INDEX TERMS clinical practice disease course health care cost health care delivery health care quality health service human intensive care unit patient care patient transport priority journal review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011596461 MEDLINE PMID 19678918 (http://www.ncbi.nlm.nih.gov/pubmed/19678918) PUI L362820163 DOI 10.1186/cc7883 FULL TEXT LINK http://dx.doi.org/10.1186/cc7883 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 715 TITLE Urinary glutathione S-transferase as an early marker for acute kidney injury in patients admitted to intensive care with sepsis AUTHOR NAMES Walshe C. Odejayi F. Ng S. Marsh B. AUTHOR ADDRESSES (Walshe C.; Odejayi F.; Ng S.; Marsh B.) Mater Misericordiae University Hospital, Dublin, Ireland. CORRESPONDENCE ADDRESS C. Walshe, Mater Misericordiae University Hospital, Dublin, Ireland. SOURCE Critical Care (2009) 13 Suppl. 1 (S104). Date of Publication: 2009 CONFERENCE NAME 29th International Symposium on Intensive Care and Emergency Medicine CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2009-03-24 to 2009-03-27 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction: Acute kidney injury (AKI) is common in patients admitted to intensive care. Diagnosis of AKI relies on serum creatinine and urine flow. These have disadvantages of low specificity and sensitivity and a slow rate of change. Renal damage results in release of tubular enzymes into the urine. Measurement of urinary alpha glutathione S-transferase (αGST) and pi glutathione S-transferase (πGST) may indicate AKI more acutely and accurately than current methods of diagnosis. Methods: Urine was collected from patients with a sepsis diagnosis 4 hourly over 48 hours. Urine was frozen, and urinary πGST and αGST measured. Fluid and vasopressor management was recorded, but managed independently. Serum creatinine was measured at 0, 24 and 48 hours. AKI was diagnosed using AKI Network criteria [1]. Results: We present the first 35 patients recruited, 20 were male, 15 female. Median patient age was 53 years. Median APACHE II score was 13. Median ICU length of stay was 9 days. ICU mortality was 14%, hospital mortality 23%. AKI was diagnosed in 26% of patients. Statistical significance was tested by Wilcoxon signedrank test. Although the median πGST at 0 hours was elevated (11.8 μg/l (non-AKI) versus 22 μg/l (AKI)) this was not statistically significant between the two groups, P = 0.985. πGST did not demonstrate an increased urinary level in AKI versus non-AKI (median values 0.89 μg/l vs. 3.4 μg/l at 0 hours). See Figure 1. Conclusions: A trend towards early expression of πGST was identifiable in this study. This may indicate early detection of AKI, (Graphe Presented) which may help guide therapeutic interventions. πGST does not seem to be released as a biomarker using this sepsis model, suggesting a more specific distal tubular injury. Further work is required to determine levels of πGST in nonstressed kidneys. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) glutathione transferase marker EMTREE DRUG INDEX TERMS biological marker enzyme glutathione transferase alpha hypertensive factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine intensive care kidney injury patient sepsis EMTREE MEDICAL INDEX TERMS APACHE creatinine blood level diagnosis female injury kidney length of stay liquid male micturition model mortality sensitivity and specificity statistical significance urine urine level LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70188247 DOI 10.1186/cc7416 FULL TEXT LINK http://dx.doi.org/10.1186/cc7416 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 716 TITLE Early transfer to a high-volume ICU (upgrading) reduces mortality AUTHOR NAMES Van Der Molen P. Van Straaten H.O. Zandstra D. Van Stijn I. Bosman R. Wester J. Van Der Voort P. AUTHOR ADDRESSES (Van Der Molen P.; Van Straaten H.O.; Zandstra D.; Van Stijn I.; Bosman R.; Wester J.; Van Der Voort P.) OLVG, Amsterdam, Netherlands. CORRESPONDENCE ADDRESS P. Van Der Molen, OLVG, Amsterdam, Netherlands. SOURCE Critical Care (2009) 13 Suppl. 1 (S193). Date of Publication: 2009 CONFERENCE NAME 29th International Symposium on Intensive Care and Emergency Medicine CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2009-03-24 to 2009-03-27 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction: The outcome of ICU treatment is improved in highvolume compared with low-volume ICUs [1]. It is unclear whether transfer of patients from a low-volume to a high-volume ICU (upgrading) improves outcome and whether early transfer is beneficial. Methods: In a retrospective cohort study the timing of upgrading was determined and related to mortality. Included were all upgraded patients transported to our level 3 ICU between 2002 and 2008. The APACHE II score was determined in the first (Figure presnted) 24 hours after admission to the high-volume ICU. Odds ratios, the Mann-Whitney test and multiple regression were performed. Results: Three hundred and eighty-five patients were included with a mean age of 62 years (SD = 14.8) and mean APACHE II score of 22.5 (SD = 8.4). The median time to transfer was 1 day (IQR = 4). Patients transported immediately after stabilisation to the highvolume ICU (ICU length of stay (LOS) before transfer = 0) had a mortality rate of 9% (Figure 1). Mortality in patients with ICU LOS before transport >0 was 25% (P <0.001). In a multiple regression analysis a higher APACHE II score was associated with increased mortality (OR = 1.1, 95% CI = 1.0 to 1.2), as was APACHE II predicted mortality. Immediate transfer was associated with a decrease in ICU mortality (OR = 0.38; 95% CI = 0.18 to 0.80) and hospital mortality (OR = 0.51; 95% CI = 0.27 to 0.95). In patients with upgrading as the explicit reason for transport the findings were the same (OR = 0.15; 95% CI = 0.03 to 0.71). Conclusions: In this retrospective cohort study patients who were immediately transferred from a low-volume to a high-volume level 3 ICU had a lower mortality compared with patients with delayed transfer, which was independent of the APACHE score. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine intensive care mortality EMTREE MEDICAL INDEX TERMS APACHE cohort analysis length of stay multiple regression patient rank sum test risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70188470 DOI 10.1186/cc7644 FULL TEXT LINK http://dx.doi.org/10.1186/cc7644 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 717 TITLE Hepatocellular damage following burn injury demonstrated by a more sensitive marker: Alpha-glutathione s-transferase AUTHOR NAMES Ozturk G. Ozturk N. Aksoy H. Akcay M.N. Atamanalp S.S. Acemoglu H. AUTHOR ADDRESSES (Ozturk G.; Akcay M.N.; Atamanalp S.S.) Department of General Surgery, School of Medicine, Atatürk University, Erzurum, Turkey. (Ozturk N.; Aksoy H.) Department of Biochemistry, School of Medicine, Atatürk University, Erzurum, Turkey. (Acemoglu H.) Department of Medical Education, School of Medicine, Atatürk University, Erzurum, Turkey. (Ozturk G.) Department of General Surgery, Medical Faculty, Atatürk University, 25240 Erzurum, Turkey. CORRESPONDENCE ADDRESS G. Ozturk, Department of General Surgery, Medical Faculty, Atatürk University, 25240 Erzurum, Turkey. SOURCE Journal of Burn Care and Research (2009) 30:4 (711-716). Date of Publication: July-August 2009 ISSN 1559-047X 1559-0488 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Following burn injury, some complex reactions are initiated that are mainly managed by the liver and that can cause injury at the liver. Alpha glutathione S-transferase (α-GST) is a sensitive marker that is very sensitive in the monitoring of hepatocellular damage. We tried, in this study, to demonstrate liver injury in burn patients using α-GST. Forty-four patients with burn injury treated at the Burn Treatment and Care unit of the Atatürk University Medical School between July 2006 and July 2007 were included in the study. Patient data were collected. Three blood samples were taken from the patients (at admittance [first sample], 120 hours after admittance [second sample], and on the fourteenth day [third sample]) for the analysis of α-GST, alanine amino transferase, aspartate amino transferase activities, and albumin and c-reactive protein levels. There was a statistically significant difference between α-GST activities of the study group at admission (P < .001), on the fifth day (P < .001), and the 14th day (P < .001) and those of the control group. There was a decrease in α-GST activities during the hospitalization period. Alanine amino transferase and aspartate amino transferase activities in all three samples of the study group were not different from each other and from the values obtained from the control group. The albumin levels of the study group were significantly different from those of the control group. The c-reactive protein levels of the study group were different from those of the control group at admission, on the fifth day, and fourteenth day (P < .001, P < .001, and P < .01). Our findings suggest that burn injury causes liver injury, and α-GST can be used to demonstrate this. Copyright © 2009 by the American Burn Association. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) glutathione transferase alpha (endogenous compound) EMTREE DRUG INDEX TERMS alanine aminotransferase (endogenous compound) albumin (endogenous compound) ampicillin (drug combination, drug therapy) aspartate aminotransferase (endogenous compound) C reactive protein (endogenous compound) cefazolin (drug combination, drug therapy) cefoperazone (drug combination, drug therapy) teicoplanin (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (drug therapy, drug therapy, surgery, therapy) liver cell damage EMTREE MEDICAL INDEX TERMS adolescent adult article blood sampling burn infection (complication, drug therapy) burn unit controlled study enzyme activity fasciotomy female hospital admission hospitalization human major clinical study male respiratory tract infection (complication, drug therapy) sepsis (complication, drug therapy) skin transplantation thrombophlebitis (complication, drug therapy) total parenteral nutrition university hospital wound infection (complication) CAS REGISTRY NUMBERS C reactive protein (9007-41-4) alanine aminotransferase (9000-86-6, 9014-30-6) ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0) aspartate aminotransferase (9000-97-9) cefazolin (25953-19-9, 27164-46-1) cefoperazone (62893-19-0, 62893-20-3) teicoplanin (61036-62-2, 61036-64-4) EMBASE CLASSIFICATIONS Surgery (9) Drug Literature Index (37) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009498883 MEDLINE PMID 19506503 (http://www.ncbi.nlm.nih.gov/pubmed/19506503) PUI L355292269 DOI 10.1097/BCR.0b013e3181abfd65 FULL TEXT LINK http://dx.doi.org/10.1097/BCR.0b013e3181abfd65 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 718 TITLE A computerized pharmacy generated medication reconciliation process for transfer from the intensive care unit reduces discrepancies and order writing time AUTHOR NAMES Caligiuri C. Staub M. Galloway L. Blydt-Hansen T. AUTHOR ADDRESSES (Caligiuri C.; Staub M.) Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, Canada. (Galloway L.) Department of Quality, Children's Hospital, Winnipeg, Canada. (Blydt-Hansen T.) Department of Pediatric and Child Health, Children's Hospital, Winnipeg, Canada. CORRESPONDENCE ADDRESS C. Caligiuri, Department of Pharmaceutical Services, Health Sciences Centre, Winnipeg, Canada. SOURCE Canadian Journal of Hospital Pharmacy (2009) 62:4 (345). Date of Publication: July-August 2009 CONFERENCE NAME CSHP Summer Educational Sessions (SES) 2009 CONFERENCE LOCATION Winnipeg, MB, Canada CONFERENCE DATE 2009-08-08 to 2009-08-11 ISSN 0008-4123 BOOK PUBLISHER Canadian Society of Hospital Pharmacists ABSTRACT Rationale: The Safer HealthCare Now program has identified medication errors as a critical area for improvement, especially at points of transfer between wards for hospitalized patients. CSHP 2015 Objective 1.1 strives for pharmacist medication reconciliation across the continuum of care. Description of Concept: We sought to develop and implement a multi-disciplinary transfer process to accurately communicate transfer orders from the intensive care unit (ICU) to the receiving unit for pediatric inpatients. Project Development: We developed a process for a pharmacy computer system (Cerner) to generate a complete and accurate medication reconciliation form to serve as a transfer order. On transfer from ICU, a pharmacy technician prints this transfer order form for completion by prescribers. The process was implemented January 2009. Evaluation: We retrospectively reviewed a random selection of charts for unintentional and undocumented intentional discrepancies by comparing ICU orders to transfer orders at baseline, early implementation and post implementation. We also surveyed prescribers about the length of time to complete transfer orders before and after the new process and measured time from transfer order printing to physician signing of transfer orders. (Table presented) Feedback from 5 prescribers showed a decrease in time spent writing transfer orders to an average of 5 minutes with the new process (range of 1-10 minutes). The average time for completion of the new medication reconciliation process was 27 minutes (range of 1-110 minutes) Usefulness to Practice: The pharmacy computer system generated medication reconciliation process reduced medication discrepancies and physician time spent writing ICU transfer orders for hospitalized pediatric patients, and moves towards CSHP 2015 Objective 1.1. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) drug therapy intensive care unit pharmacy summer writing EMTREE MEDICAL INDEX TERMS computer system feedback system health care hospital patient medication error patient pharmacist pharmacy technician physician printing ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70036045 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 719 TITLE Lipid transfer proteins, inflammation and atherosclerosis AUTHOR ADDRESSES SOURCE Atherosclerosis Supplements (2009) 10:2. Date of Publication: June 2009 CONFERENCE NAME 15th International Symposium on Atherosclerosis CONFERENCE LOCATION Boston, MA, United States CONFERENCE DATE 2009-06-14 to 2009-06-18 ISSN 1567-5688 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Lipid transfer proteins CETP and PLTP play roles in atherogenesis by modifying the arterial wall cholesterol flow via altering concentration and function of plasma lipoproteins and influencing inflammation. In this regard, endotoxins impair the reverse cholesterol transport (RCT) system in an endotoxemic rodent model (McGilliuddy FC. Circulation, 2009) supporting the proinflammatory role of HDL reported in chronic diseases where atherosclerosis is premature. Human population investigations favor low CETP as atheroprotective; this is supported by animal models where overexpression of huCETP is atherogenic due to HDL lowering but most likely due to apoB-LP-cholesterol concentration increasing. Thus, in spite of CETP facilitating the HDL-C-mediated RCT, apoB-LP-cholesterol concentration reduction is the probable antiatherogenic mechanism of CETP inhibition. On the other hand, although atherogenesis is linked to high experimental huCETP expression, the latter protects mice from the harmful effects of a bacterial polysaccharide infusion (Cazita PM. Shock, 2008). Also, Grion CMC (Londrina Univ., Brazil) showed that the mortality rate of severely ill patients admitted to an intensive care unit correlates with reduction of the plasma CETP concentration. Thus, the roles played by CETP on atherosclerosis and inflammation seem contradictory. High PLTP activity related to atherosclerosis in three and was protective in one clinical study but mechanisms involved could not be ascertained. In experimental animals the relation of elevated plasma PLTP concentration with atherosclerosis was confounded by HDL-C lowering and by unfavorable effects on several inflammatory markers. Coincidently, PLTP also increases in human experimental endotoxemia and in clinical sepsis (Levels JH, BBA, 2007). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) lipid transfer protein EMTREE DRUG INDEX TERMS bacterial polysaccharide cholesterol cholesterol ester transfer protein endotoxin high density lipoprotein marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) atherosclerosis inflammation EMTREE MEDICAL INDEX TERMS animal model artery wall atherogenesis Brazil cholesterol transport chronic disease clinical study endotoxemia experimental animal human infusion intensive care unit lipoprotein blood level model mortality mouse patient plasma population rodent sepsis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70105070 DOI 10.1016/S1567-5688(09)71614-9 FULL TEXT LINK http://dx.doi.org/10.1016/S1567-5688(09)71614-9 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 720 TITLE Transporting the critically ill AUTHOR NAMES Martin T. AUTHOR ADDRESSES (Martin T.) Winchester, . CORRESPONDENCE ADDRESS T. Martin, Winchester, . SOURCE Surgery (2009) 27:5 (195-200). Date of Publication: May 2009 ISSN 0263-9319 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Over 10,000 intensive care patients are transferred each year in the UK. Of these, about 90% are accompanied by staff from the referring hospital. The escalating complexity of healthcare, the concentration of skills into specialized regional centres, and the relative lack of intensive care bed availability have all led to an increase in the frequency of transfer of critically ill patients between hospitals. The care delivered in the restricted environments encountered during patient transfer, whether it be within or between hospitals, should at least attempt to emulate the detailed attention provided in the hospital intensive care unit, and it is the responsibility of the transport team to provide this care outside the ICU. This is achieved by training staff, selecting appropriate equipment and detailed planning. The likelihood of success is increased by anticipating and preventing complications and avoiding hazards to both patient and the transfer team. This article provides an overview of the hazards, organization and planning of patient transfers, and highlights the importance of interdisciplinary teamwork, good communications and appropriate decision-making. It also examines the special situations encountered during the transfer or retrieval of patients with complex needs, such as those requiring intra-aortic balloon counterpulsation or extracorporeal membrane oxygenation, and discusses the challenges and opportunities that lie ahead. © 2009. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient intensive care unit patient transport EMTREE MEDICAL INDEX TERMS aortic balloon complication (prevention) counterpulsation extracorporeal oxygenation health care delivery health care facility health care organization health care planning health care quality health hazard hospital bed human medical decision making medical staff patient care patient referral priority journal review teamwork United Kingdom EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009257366 PUI L354653450 DOI 10.1016/j.mpsur.2009.03.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.mpsur.2009.03.004 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 721 TITLE Critical care air transport team (CCATT) nurses' deployed experience. AUTHOR NAMES Brewer T.L. Ryan-Wenger N.A. AUTHOR ADDRESSES (Brewer T.L.) Nursing Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43210-1289, USA. (Ryan-Wenger N.A.) CORRESPONDENCE ADDRESS T.L. Brewer, Nursing Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43210-1289, USA. SOURCE Military medicine (2009) 174:5 (508-514). Date of Publication: May 2009 ISSN 0026-4075 ABSTRACT The objective of this study was to use descriptive and phenomenological methods with Critical Care Air Transport Team (CCATT) nurses to identify knowledge and skills required to provide care for critically ill patients in a combat environment. Unstructured interviews, focus groups, written narratives, group interviews, participant observation, and review of in-flight documentation of care were used to obtain data from 23 registered nurses who had deployed with CCATT missions. Dimensions that emerged from the data included: clinical and operational competence, personal, physical, and psychosocial readiness, soldier and survival skills, leadership, administrative concerns, group identification and integration, aircraft air and evacuation familiarity, and nurse characteristics. This information should be shared with CCATT trainers and unit personnel to better prepare them for the realities of future deployments. Future research could incorporate these data into a self-assessment scale to evaluate CCATT nurses' readiness for future deployments. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care military medicine nurse attitude EMTREE MEDICAL INDEX TERMS article attitude to health human information processing interview manpower organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 20731282 (http://www.ncbi.nlm.nih.gov/pubmed/20731282) PUI L359677256 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 722 TITLE Discussion AUTHOR NAMES Napolitano M. AUTHOR ADDRESSES (Napolitano M.) SOURCE Journal of Trauma - Injury, Infection and Critical Care (2009) 66:SUPPL. 4 (S170-S171). Date of Publication: April 2009 ISSN 0022-5282 1529-8809 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute lung injury patient transport respiratory distress EMTREE MEDICAL INDEX TERMS artificial ventilation battle injury clinical trial extracorporeal oxygenation human intensive care unit note paramedical personnel priority journal EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT00474656) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009399369 PUI L355025210 DOI 10.1097/TA.0b013e31819cdf72 FULL TEXT LINK http://dx.doi.org/10.1097/TA.0b013e31819cdf72 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 723 TITLE Study of plasmid-mediated 16S rRNA methylase genes and drug-resistant transferability of Acinetobacter baumannii isolated from burn ward AUTHOR NAMES Liu T.-X. Xue X.-D. Wei L.-H. Zhang Y.-M. AUTHOR ADDRESSES (Liu T.-X.; Xue X.-D.; Wei L.-H., weilh-99@163.com; Zhang Y.-M.) First Clinical Mediccal College, Lanzhou University, Lanzhou 730000, China. CORRESPONDENCE ADDRESS L.-H. Wei, First Clinical Mediccal College, Lanzhou University, Lanzhou 730000, China. Email: weilh-99@163.com SOURCE Chinese Journal of Burns (2009) 25:2 (98-102). Date of Publication: April 2009 ISSN 1009-2587 BOOK PUBLISHER Editorial Board of Chinese Journal of Burns, 29 Gantanyan,Main Street, Shapingba, District, Chongqing, China. ABSTRACT Objective: To investigate the drug-resistance of Acinetobacter baumannii (Ab) isolated from patients in burn ward, and study the incidence of 16S rRNA methylase genes mediated high-level aminoglycoside drug-resistance and its mechanism of transfer. Methods A total of 40 Ab clinical isolates were collected from burn ward in Gansu Province People's Hospital from May 2006 to Dec. 2007. The sensitivity of Ab for 20 antibiotics were determinated by K-B agar diffusion. The minimal inhibitory concentrations (MIC) of amikacin, gentamicin, tobramycin, netilmicin, isepamicin and kanamycin against Ab strains were determinated by agar dilution. Five kinds of 16S rRNA methylase genes including armA, rmtA, rmtB, rmtC, rmtD were amplified by PCR, the positive PCR-products were purified and sequenced, and the plasmid were extracted by alkaline lysis. The transferability of drug-resistence were determinated by conjugation and plasmid transformation tests. Results The drug-resistance rates of Ab against six aminoglycosides antibiotics was 72.5%, 72.5%, 70.0%, 67.5%, 70.0%, 70.0%, respectively. Twenty five strains were resistant to six aminoglycosides antibiotics (62.5%), among which 10 isolates were armA-positive (40.0%); rmtA, rmtB, rmtC and rmtD-postive isolates were not found. Ten transformants and 10 conjugants showed high-level resistance against aminoglycosides antibiotics, all of which the value of MIC ≥256 μg/mL carried armA gene. Conclusions: The drug-resistance of Ab clinical isolates have high drug-resistance. 16S rRNA methylases gene exists in Ab and locates in plasmid chromosome. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) aminoglycoside antibiotic agent methyltransferase RNA 16S EMTREE DRUG INDEX TERMS amikacin gentamicin isepamicin kanamycin netilmicin tobramycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter baumannii antibiotic resistance EMTREE MEDICAL INDEX TERMS agar diffusion agar dilution article bacterial strain bacterial transmission bacterium isolation burn patient burn unit China controlled study human minimum inhibitory concentration nonhuman plasmid polymerase chain reaction CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) isepamicin (58152-03-7) kanamycin (11025-66-4, 61230-38-4, 8063-07-8) methyltransferase (9033-25-4) netilmicin (56391-56-1, 56391-57-2) tobramycin (32986-56-4) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Surgery (9) LANGUAGE OF ARTICLE Chinese LANGUAGE OF SUMMARY English, Chinese EMBASE ACCESSION NUMBER 2009351539 MEDLINE PMID 19799032 (http://www.ncbi.nlm.nih.gov/pubmed/19799032) PUI L354911375 DOI 10.3760/cma.j.issn.1009-2587.2009.02.009 FULL TEXT LINK http://dx.doi.org/10.3760/cma.j.issn.1009-2587.2009.02.009 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 724 TITLE Wartime critical care air transport. AUTHOR NAMES Bridges E. Evers K. AUTHOR ADDRESSES (Bridges E.; Evers K.) Clinical Investigations Facility, 60 Medical Group, Travis AFB, CA 94535, USA. CORRESPONDENCE ADDRESS E. Bridges, Clinical Investigations Facility, 60 Medical Group, Travis AFB, CA 94535, USA. SOURCE Military medicine (2009) 174:4 (370-375). Date of Publication: Apr 2009 ISSN 0026-4075 ABSTRACT OBJECTIVES: Describe the characteristics/enroute care of casualties transported by USAF Critical Care Air Transport Teams (CCATT) during Operation Enduring Freedom/Iraqi Freedom (OEF/OIF). METHODS: Retrospective review of TRAC2ES and CCATT Mission Reports (Oct 2001-May 2006). RESULTS: 3492 patient moves (2439 patients). Moves by route: within Area of Responsibility (AOR) (n = 261); AOR-Landstuhl (LRMC) (n = 1995), Germany-CONUS (n = 1188). For AOR-LRMC: BI (64%), NBI (8%), Disease (25%). Among injured (n = 1491), 69% suffered polytrauma, primarily d/t explosions. Injury area: extremities (63%), head (55%), thorax (46%), abdomen (31%), neck (17%). Injury type: soft tissue (64%), orthopedic (45%), thoracic (35%), skull fracture (27%), brain injury (25%). Disease diagnoses: cardiac (15%) and pulmonary (8%). CONCLUSIONS: This is the first analysis of OEF/OIF CCATT patients. Phase 1 of this study demonstrates the strengths and limitations of TRAC2ES and CCATT Mission Reports to describe the characteristics/enroute care of this unique population. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport injury intensive care military medicine EMTREE MEDICAL INDEX TERMS article classification human methodology retrospective study United States war LANGUAGE OF ARTICLE English MEDLINE PMID 19485106 (http://www.ncbi.nlm.nih.gov/pubmed/19485106) PUI L354989940 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 725 TITLE A literature review of organisational, individual and teamwork factors contributing to the ICU discharge process AUTHOR NAMES Lin F. Chaboyer W. Wallis M. AUTHOR ADDRESSES (Lin F., F.Lin@griffith.edu.au) School of Nursing and Midwifery, Griffith Health, Griffith University, Gold Coast Campus, QLD 4222, Australia. (Chaboyer W.) Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith University, Gold Coast, Australia. (Wallis M.) Clinical Nursing Research, Gold Coast Health Service District, School of Nursing and Midwifery, Gold Coast, Australia. CORRESPONDENCE ADDRESS F. Lin, School of Nursing and Midwifery, Griffith Health, Griffith University, Gold Coast Campus, QLD 4222, Australia. Email: F.Lin@griffith.edu.au SOURCE Australian Critical Care (2009) 22:1 (29-43). Date of Publication: February 2009 ISSN 1036-7314 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Aim: It is everyday news that we need more intensive care unit (ICU) beds, thus effective use of existing resources is imperative. The aim of this literature review was to critically analyse current literature on how organizational factors, individual factors and teamwork factors influence the ICU discharge process. A better understanding of discharge practices has the potential to ultimately influence ICU resource availability. Methods: Databases including CINAHL, MEDLINE, PROQUEST, SCIENCE DIRECT were searched using key terms such as ICU discharge, discharge process, ICU guidelines and policies, discharge decision-making, ICU organisational factors, ICU and human factors, and ICU patient transfer. Articles' reference lists were also used to locate relevant literature. A total of 21 articles were included in the review. Results: Only a small number of ICUs used written patient discharge guidelines. Consensus, rather than empirical evidence, dictates the importance of guidelines and policies. Premature discharge, discharge after hours and discharge by triage still exist due to resources constraints, even though the literature suggests these are associated with increased mortality. Teamwork and team training appear to be effective in improving efficiency and communication between professions or between clinical areas. However, this aspect has rarely been researched in relation to ICU patient discharge. Conclusion: Intensive care patient discharge is influenced by organisational factors, individual factors and teamwork factors. Organisational interventions are effective in reducing ICU discharge delay and shortening patient hospital stay. More rigorous research is needed to discover how these factors influence the ICU discharge process. © 2008 Australian College of Critical Care Nurses Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital discharge intensive care unit patient transport EMTREE MEDICAL INDEX TERMS human organization and management patient care policy review risk management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 19138531 (http://www.ncbi.nlm.nih.gov/pubmed/19138531) PUI L50384507 DOI 10.1016/j.aucc.2008.11.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.aucc.2008.11.001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 726 TITLE Assessing ICU transfers at night: a call to reduce mortality and readmission risk. AUTHOR NAMES Morris P.E. AUTHOR ADDRESSES (Morris P.E.) CORRESPONDENCE ADDRESS P.E. Morris, SOURCE American journal of critical care : an official publication, American Association of Critical-Care Nurses (2009) 18:1 (6-8). Date of Publication: Jan 2009 ISSN 1062-3264 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital readmission intensive care unit mortality patient care patient transport EMTREE MEDICAL INDEX TERMS editorial hospital personnel human personnel management risk factor standard time LANGUAGE OF ARTICLE English MEDLINE PMID 19116393 (http://www.ncbi.nlm.nih.gov/pubmed/19116393) PUI L550156709 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 727 TITLE Intrahospital transport of critically ill patients ORIGINAL (NON-ENGLISH) TITLE Innerklinischer transport des kritisch kranken patienten AUTHOR NAMES Löw M. Jaschinski U. AUTHOR ADDRESSES (Löw M., markus.loew@klinikum-augsburg.de; Jaschinski U.) Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Augsburg, Germany. (Löw M., markus.loew@klinikum-augsburg.de) Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany. CORRESPONDENCE ADDRESS M. Löw, Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany. Email: markus.loew@klinikum-augsburg.de SOURCE Anaesthesist (2009) 58:1 (95-108). Date of Publication: January 2009 ISSN 0003-2417 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Transport of critically ill patients from the ICU for diagnostic and therapeutic purposes (e.g. CT, endoscopy, radiological catheter-assisted interventions) is a challenge and has steadily increased over the years. After risk-benefit analysis careful planning is the first step in minimizing the risk of complications. Knowledge and skillful handling of the transport equipment is mandatory to avoid life-threatening incidents as monitoring and therapy have to be continued during the transport. Proper education and experience in critical care medicine are additional characteristics of the transport team. When these prerequisites are fulfilled a "non-transportable" patient is just as unlikely as a "non-anesthetizable" patient. © 2009 Springer Medizin Verlag. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS aortic balloon extubation human hypoxia (diagnosis) intensive care unit muscle hypotonia (diagnosis) patient monitoring pneumothorax positive end expiratory pressure pulse oximetry review risk assessment EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2009049256 MEDLINE PMID 19156389 (http://www.ncbi.nlm.nih.gov/pubmed/19156389) PUI L50399724 DOI 10.1007/s00101-008-1499-3 FULL TEXT LINK http://dx.doi.org/10.1007/s00101-008-1499-3 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 728 TITLE Transfer of Patients Dependent on an Intra-aortic Balloon Pump Using Critical Care Services AUTHOR NAMES Sinclair T.D. Werman H.A. AUTHOR ADDRESSES (Sinclair T.D.) Emergency Department, The Ohio State University Medical Center, Columbus, OH, United States. (Werman H.A., hwerman@medflight.com) MedFlight of Ohio, Emergency Medicine, The Ohio State University, Columbus, OH, United States. CORRESPONDENCE ADDRESS H.A. Werman, MedFlight of Ohio, Emergency Medicine, The Ohio State University, Columbus, OH, United States. Email: hwerman@medflight.com SOURCE Air Medical Journal (2009) 28:1 (40-46). Date of Publication: January 2009/February 2009 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Introduction: The intra-aortic balloon pump (IABP) is a hemodynamic support device that provides circulatory enhancement to patients whose cardiac output is compromised. Special clinical skills are required for management of the patient with an IABP in place. Few studies have discussed the transport of the IABP-dependent patient. The current study was designed to describe the transport of IABP-dependent patients, with a focus on pretransport interventions, transport interventions, quality improvement, and complications. Methods: A review of all transports from January 1, 2004, through December 31, 2005, performed by a critical care transport program with a nurse/paramedic crew offering mobile intensive care unit (ICU), rotor-wing, and fixed-wing service was conducted. All patients who were maintained on an intra-aortic balloon pump (IABP) were eligible for inclusion. A certified perfusionist was available for consultation on all transports. Information about the IABP, including the pump timing, confirmation of balloon location, and inflation/deflation timing parameters, was collected. Proper balloon placement was verified and recorded at the sending hospital. Data were collected regarding interventions required before and during transport and complications during transport. Descriptive statistics were used. Results: During the study period, 173 transports involving an IABP were performed. The average age was 60.8 years, and 67.8% were men. Forty-one percent were flown by rotor-wing, 36.4% were transported by the mobile ICU, and 21.4% were flown by the fixed-wing transport. In 1.2% of cases, there was a change in transport mode. Twelve percent of patients required some increase in oxygen supplementation, but only one patient required intubation before transport by the transport crew. The most common pretransport medications were heparin (69%), inotropes (55%), and other infusions (46.8%). Twenty-two percent had no written confirmation of the correct balloon placement. There were no significant complications found during transport, including hemorrhage, loss of trigger signals, or cardiac arrest. Twelve percent had some abnormalities in timing of balloon inflation or deflation. Conclusion: IABP transports can be safely performed by a nurse/paramedic critical care transport team with perfusionist consultation. Few patients require significant intervention before transport. Attention must be paid to balloon inflation and deflation timing despite the existence of timing algorithms. Significant complications during transport were not seen. Future studies should explore the overall outcome of IABP-dependent patients and the role of transport mode on outcome. © 2009 Air Medical Journal Associates. EMTREE DRUG INDEX TERMS heparin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport aortic balloon intensive care patient transport EMTREE MEDICAL INDEX TERMS article bleeding health care quality heart arrest human intensive care unit intubation medical practice nurse oxygen therapy paramedical personnel priority journal CAS REGISTRY NUMBERS heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) EMBASE CLASSIFICATIONS Internal Medicine (6) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009004741 MEDLINE PMID 19131025 (http://www.ncbi.nlm.nih.gov/pubmed/19131025) PUI L354018660 DOI 10.1016/j.amj.2008.07.013 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2008.07.013 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 729 TITLE Factors associated with unoffered trauma analgesia in critical care transport AUTHOR NAMES Frakes M.A. Lord W.R. Kociszewski C. Wedel S.K. AUTHOR ADDRESSES (Frakes M.A.; Lord W.R.) LIFE STAR, Hartford Hospital, PO Box 5037, Hartford, CT 06102-5037, United States. (Frakes M.A.; Kociszewski C.; Wedel S.K.) Boston MedFlight, Bedford, MA 01730, United States. (Wedel S.K.) Boston Medical Center, Boston, MA 02118, United States. (Lord W.R.) Connecticut Children's Medical Center, Hartford, CT 06106, United States. CORRESPONDENCE ADDRESS M.A. Frakes, LIFE STAR, Hartford Hospital, PO Box 5037, Hartford, CT 06102-5037, United States. SOURCE American Journal of Emergency Medicine (2009) 27:1 (49-54). Date of Publication: January 2009 ISSN 0735-6757 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Objective: Pain relief is a key out-of-hospital patient care outcome measure, yet many trauma patients do not receive prompt analgesia. Although specialty critical care transport (CCT) teams provide analgesia frequently, successfully, and safely, there is still a population of CCT patients to whom analgesia is not offered. We report the factors associated with non-administration of analgesia and with analgesic effect in trauma patients cared for by CCT teams. Methods: This is a retrospective review of consecutive transport records for nonintubated trauma patients with self-reported pain during specialty CCT care. Patient demographics, CCT interventions, clinical traits, and pain self-reports are measured. Means comparisons are made with a univariate analysis of variance, and odds ratios (ORs) with 95% confidence intervals (CIs) are reported for between-group comparisons. Results: Of the 209 enrolled patients, 169 (80.9%; 95% CI, 75.6%-86.2%) were treated (147 received analgesia and 22 offered analgesia but refused). In patients with pain scale documentation (n = 145), self-reported pain on a scale from 0 to 10 decreased from 6.8 ± 2.8 to 3.3 ± 2.4 (P ≤ .001). Three factors were associated with absence of analgesic administration: initial pain level (OR for administration, 0.13; 95% CI, 0.04-0.40), pain scale documentation (OR, 0.31; 95% CI, 0.15-0.60), and transport program (OR, 0.36; 95% CI, 0.17-0.74). No clinical factor was associated with analgesia effectiveness in treated patients. Conclusion: The identified factors may represent opportunities for CCT teams to optimize analgesic treatment. © 2009 Elsevier Inc. All rights reserved. EMTREE DRUG INDEX TERMS fentanyl (drug therapy) morphine (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) injury (drug therapy, epidemiology) EMTREE MEDICAL INDEX TERMS adolescent adult aged analgesia article child controlled study female human intensive care major clinical study male pain assessment patient care priority journal rating scale retrospective study risk assessment CAS REGISTRY NUMBERS fentanyl (437-38-7) morphine (52-26-6, 57-27-2) EMBASE CLASSIFICATIONS Internal Medicine (6) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008553952 MEDLINE PMID 19041533 (http://www.ncbi.nlm.nih.gov/pubmed/19041533) PUI L352720457 DOI 10.1016/j.ajem.2008.01.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajem.2008.01.005 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 730 TITLE Specialty teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality AUTHOR NAMES Chang A.S.M. Berry A. Sivasangari S. AUTHOR ADDRESSES (Chang A.S.M., alvinchang72@hotmail.com) Department of Paediatrics, Selayang Hospital, Batu Caves, Malaysia. (Berry A.) NSW Neonatal and Paediatric Emergency Transport Service, Western Sydney Area Health Service, Wentworthville, Australia. (Sivasangari S.) Department of Paediatrics, Royal College of Medicine Perak, Ipoh, Malaysia. (Chang A.S.M., alvinchang72@hotmail.com) Department of Paediatrics, Selayang Hospital, Lebuhraya Selayang-Kepong, Batu Caves, Selangor, 68100, Malaysia. CORRESPONDENCE ADDRESS A. S. M. Chang, Department of Paediatrics, Selayang Hospital, Lebuhraya Selayang-Kepong, Batu Caves, Selangor, 68100, Malaysia. Email: alvinchang72@hotmail.com SOURCE Cochrane Database of Systematic Reviews (2008) :4 Article Number: CD007485. Date of Publication: 2008 ISSN 1469-493X BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical staff morbidity mortality newborn intensive care patient transport prevention EMTREE MEDICAL INDEX TERMS airway obstruction airway pressure assisted ventilation birth weight brain disease congenital disorder disease severity gestational age health care facilities and services human hypoglycemia hypotension hypothermia hypoxic ischemic encephalopathy outcome assessment oxygenation pneumothorax positive end expiratory pressure review EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008510625 PUI L352583853 DOI 10.1002/14651858.CD007485 FULL TEXT LINK http://dx.doi.org/10.1002/14651858.CD007485 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 731 TITLE The role and effectiveness of a nurse practitioner led critical care outreach service AUTHOR NAMES Pirret A.M. AUTHOR ADDRESSES (Pirret A.M., Pirret@xtra.co.nz) Department of Intensive Care Medicine, Middlemore Hospital, New Zealand. (Pirret A.M., Pirret@xtra.co.nz) School of Health, Social Services, Massey University, New Zealand. CORRESPONDENCE ADDRESS A.M. Pirret, Department of Intensive Care Medicine, Middlemore Hospital, New Zealand. Email: Pirret@xtra.co.nz SOURCE Intensive and Critical Care Nursing (2008) 24:6 (375-382). Date of Publication: December 2008 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Research measuring the effectiveness of critical care outreach (CCOR) has been mixed. The objective of this paper is to describe the role and effectiveness of a nurse practitioner (NP) led critical care outreach service (CCORS). Using a comparative study design, data on the number of intensive care unit (ICU) readmissions <72 h were analysed 12 months prior to, and 12 months following implementation of the service. Data was also collected on length of stay and APACHE II scores of ICU readmissions <72 h, ICU patient acuity, ICU readmission mortality, and ward medical emergency team (MET) and cardiac arrest calls. Data on NP referrals were collected to identify NP activities. Data analysis was completed using descriptive statistics and run and control charts. There were 133 NP referrals, which resulted in 525 patient visits. The most common interventions completed by the NP during visits included requesting of diagnostic tests and prescribing. Following introduction of the NP CCORS, there was a sustained reduction in ICU readmissions <72 h. In conclusion, a NP led CCORS has a positive effect on patient outcomes and supports development of further NP positions. © 2008 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency (epidemiology) intensive care nurse attitude nurse practitioner patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged APACHE article education evaluation study hospital readmission human length of stay middle aged mortality New Zealand (epidemiology) nursing nursing evaluation research organization and management outcome assessment patient referral professional practice statistics LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 18554911 (http://www.ncbi.nlm.nih.gov/pubmed/18554911) PUI L50175670 DOI 10.1016/j.iccn.2008.04.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2008.04.007 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 732 TITLE Supporting families through discharge from PICU to the ward: The development and evaluation of a discharge information brochure for families AUTHOR NAMES Linton S. Grant C. Pellegrini J. AUTHOR ADDRESSES (Linton S., sophie.linton@rch.org.au; Grant C., chelsea.caffin@rch.org.au; Pellegrini J., juliet.pellegrini@rch.org.au) PICU Liaison Nurse, Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, 3052, Australia. CORRESPONDENCE ADDRESS S. Linton, PICU Liaison Nurse, Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, 3052, Australia. Email: sophie.linton@rch.org.au SOURCE Intensive and Critical Care Nursing (2008) 24:6 (329-337). Date of Publication: December 2008 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Introduction: Discharge from paediatric ICU and transfer to the ward can evoke fear and anxiety. Along with the introduction of the ICU liaison nurse role, the literature suggests that the provision of written information has the greatest potential to reduce transfer anxiety. This paper will discuss the issues associated with discharge from a paediatric ICU, the process of identifying the information needs of families, the development of a written brochure and evaluation of the brochure in practice. Results: Evaluation of the 'discharge from ICU' brochure found, 95% of parents believed the brochure was easy to read, understand and helpful in improving their understanding of what to expect on the ward. 95% also found it useful to have the transfer ward details written down prior to leaving the PICU. 85% agreed the brochure helped to answer their questions in relation to the transfer. Conclusion: The introduction of a brochure explaining the process of discharge from ICU and what to expect on the wards received positive feedback from families. The brochure provides families with generic information regarding ICU transfer, however, it is important for the ICU liaison nurse to promote discussion and tailor the information for the particular experiences and needs of each patient and family situation. Crown Copyright © 2008. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health intensive care unit parent patient care patient transport teaching EMTREE MEDICAL INDEX TERMS anxiety (etiology, prevention) article Australia comprehension education evaluation study human human relation interpersonal communication needs assessment nurse nurse attitude nursing evaluation research organization and management psychological aspect publication questionnaire social support standard LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 18657975 (http://www.ncbi.nlm.nih.gov/pubmed/18657975) PUI L50219924 DOI 10.1016/j.iccn.2008.06.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2008.06.002 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 733 TITLE Moving a hospital: Consequences for critical care services AUTHOR NAMES van Lelyveld-Haas L.E.M. Tjan D.H.T. Hendriksen J. van Zanten A.R.H. AUTHOR ADDRESSES (van Lelyveld-Haas L.E.M.; Tjan D.H.T.; van Zanten A.R.H., zantena@zgv.nl) Department of Intensive Care, Gelderse Vallei Hospital, Ede, Netherlands. (Hendriksen J.) Department of Patient Care and Logistics, Gelderse Vallei Hospital, Ede, Netherlands. CORRESPONDENCE ADDRESS A.R.H. van Zanten, Department of Intensive Care, Gelderse Vallei Hospital, Ede, Netherlands. Email: zantena@zgv.nl SOURCE Netherlands Journal of Critical Care (2008) 12:1 (10-13). Date of Publication: 2008 ISSN 1569-3511 BOOK PUBLISHER NVIC - Netherlands Society of Intensive Care, Stationsweg 73 C, Ede, Netherlands. ABSTRACT Introduction: Delivering optimal patient care in a three-location hospital during the move to a single new building is complex. Limited information is available in the literature on the medical and nursing implications of moving hospitals, especially for critically ill patients. We assessed the numbers of patients, special equipment and treatments on a regular day versus the day of patient transportation. Methods: A two time-point survey of in-hospital patients, equipment and treatments on a regular day versus the day of patient transportation in a 525-bed secondary referral centre with 12 ICU beds. Data from all in-hospital patients (wards and ICU) were gathered four months before and on the day of the actual moving of patients. Four days before the hospital move, admissions to general wards were stopped, ICU admission was continued as normal. Results: The admission stop prior to the move led to a reduction in the number of in-hospital patients (118 patients (day of move) vs. 311 patients (regular day)). On the day of the move significant case-mix differences were observed on comparison with a regular day. Coronary Care patient numbers dropped markedly (2.6% vs. 0%). More patients had to be transported in special beds (8.5% vs. 0.6%). Numbers of ambulant patients and wheelchair patients were reduced (4.2% vs. 21.9% and 11.0% vs. 31.2% respectively). In addition, more patients needed to be accompanied by medical doctors (9.3% vs. 2.9%) and nurses (84.7% vs. 60.5%). The number of DNR-orders was significantly higher than on a regular day (28.9% vs. 10.3%). In the non-ICU environment special treatment frequency (e.g. oxygen therapy and indwelling catheters) did change markedly. In the ICU no decline in treatment intensity was noted. Conclusions: Physicians making decisions regarding the care of ICU patients during hospital moving should take into account that a hospital-wide admission stop will not lead to important reductions of the numbers of patients to be transported from a mixed ICU. On the other hand on regular wards, case-mix and use of special beds, equipment, and personnel resources may differ markedly from regular days. This may have implications for the planning process and allocation of personnel and budgets. Copyright © 2008, Nederlandse Vereniging voor Intensive Care. All Rights Reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital service intensive care patient transport EMTREE MEDICAL INDEX TERMS ambulatory care article controlled study critically ill patient health survey hospital admission hospital bed capacity hospital patient hospital personnel human intensive care unit major clinical study medical care medical decision making medical record nursing care oxygen therapy EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009067838 PUI L354160711 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 734 TITLE The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit. AUTHOR NAMES Huang T. Moon-Grady A.J. Traugott C. Marcin J. AUTHOR ADDRESSES (Huang T.; Moon-Grady A.J.; Traugott C.; Marcin J.) University of California Davis Children's Hospital, Sacramento, California, USA. CORRESPONDENCE ADDRESS T. Huang, University of California Davis Children's Hospital, Sacramento, California, USA. SOURCE Journal of telemedicine and telecare (2008) 14:5 (244-248). Date of Publication: 2008 ISSN 1758-1109 (electronic) ABSTRACT We examined records of all admissions to an isolated community neonatal intensive care unit (NICU) in California between 2001 and 2006. We also reviewed the echocardiograms for diagnosis, disposition of patient and necessity for transport. In 2004, a telemedicine link (mainly store-and-forward) was established to a university children's hospital (UCH) 290 km away. The number of NICU patients having an echocardiogram increased from 280 (27% of 1029 admissions) to 385 (40% of 963, P = <0.001) after telemedicine became available. There was an increase in the proportion of normal studies, from 31% to 37% (P = 0.03), and an increase in the number of patients diagnosed with cardiac pathology from 192 (19% of all admissions) to 241 (25%, P < 0.001). Twenty-four patients were transferred for cardiac reasons during each three-year period; however seven pre-telemedicine transfers were avoidable, compared with two post-telemedicine transfers (P = 0.06). There was a change in referral pattern (65% to the UCH pre-telemedicine, compared with 78% post-telemedicine) although it was not significant (P = 0.10). Thus the availability of the telecardiology link was associated with increases in the utilization of echocardiography, in the proportion of normal studies, and in the percentage of neonates diagnosed with cardiac pathology without an increase in the number transferred for cardiac reasons. There was a reduction in unnecessary transfers and a strengthened relationship with the centre providing the telecardiology service. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart malformation newborn intensive care teleradiology EMTREE MEDICAL INDEX TERMS article coronary care unit echography evaluation study health care delivery human methodology newborn patient transport statistics United States unnecessary procedure LANGUAGE OF ARTICLE English MEDLINE PMID 18632999 (http://www.ncbi.nlm.nih.gov/pubmed/18632999) PUI L550225759 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 735 TITLE Twenty-Five Years Later... Critical Care Transport, Birmingham, Alabama AUTHOR NAMES Demmons L.L. AUTHOR ADDRESSES (Demmons L.L.) SOURCE Air Medical Journal (2008) 27:6 (276-280). Date of Publication: November 2008/December 2008 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport emergency health service health care delivery EMTREE MEDICAL INDEX TERMS accident prevention aircraft accident airplane crew airplane pilot article emergency care health care facility health care financing health program health service human medical device medical staff patient care patient transport personal experience priority journal safety standard United States university hospital EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Occupational Health and Industrial Medicine (35) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008512241 MEDLINE PMID 18992686 (http://www.ncbi.nlm.nih.gov/pubmed/18992686) PUI L352587493 DOI 10.1016/j.amj.2008.08.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2008.08.008 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 736 TITLE Knowledge transfer and practice change AUTHOR NAMES Leslie G.D. AUTHOR ADDRESSES (Leslie G.D.) SOURCE Australian Critical Care (2008) 21:4 (175-176). Date of Publication: November 2008 ISSN 1036-7314 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nursing care technology EMTREE MEDICAL INDEX TERMS Australia editorial human intensive care unit LANGUAGE OF ARTICLE English MEDLINE PMID 19117537 (http://www.ncbi.nlm.nih.gov/pubmed/19117537) PUI L352552550 DOI 10.1016/j.aucc.2008.10.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.aucc.2008.10.001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 737 TITLE Improving rehabilitation following transfer from ICU AUTHOR NAMES Ball C. AUTHOR ADDRESSES (Ball C., carol.ball@royalfree.nhs.uk) Royal Free Hampstead NHS Trust, Pond St, London, NW3 2QN, United Kingdom. (Ball C., carol.ball@royalfree.nhs.uk) City Community and Health Sciences, City University, Northampton Square, London, EC1V 0HB, United Kingdom. CORRESPONDENCE ADDRESS C. Ball, Royal Free Hampstead NHS Trust, Pond St, London, NW3 2QN, United Kingdom. Email: carol.ball@royalfree.nhs.uk SOURCE Intensive and Critical Care Nursing (2008) 24:4 (209-210). Date of Publication: August 2008 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aftercare critical illness (rehabilitation) intensive care patient transport EMTREE MEDICAL INDEX TERMS editorial human needs assessment nurse attitude organization and management patient care total quality management LANGUAGE OF ARTICLE English MEDLINE PMID 18472264 (http://www.ncbi.nlm.nih.gov/pubmed/18472264) PUI L352378726 DOI 10.1016/j.iccn.2008.04.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2008.04.001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 738 TITLE The critical care air transport program. AUTHOR NAMES Beninati W. Meyer M.T. Carter T.E. AUTHOR ADDRESSES (Beninati W.; Meyer M.T.; Carter T.E.) 59 Medical Operations Group (WB), Wilford Hall Medical Center, Lackland Air Force Base, TX, USA. CORRESPONDENCE ADDRESS W. Beninati, 59 Medical Operations Group (WB), Wilford Hall Medical Center, Lackland Air Force Base, TX, USA. Email: william.beninati@lackland.af.mil SOURCE Critical care medicine (2008) 36:7 Suppl (S370-376). Date of Publication: Jul 2008 ISSN 1530-0293 (electronic) ABSTRACT BACKGROUND: The critical care air transport team program is a component of the U.S. Air Force Aeromedical Evacuation system. A critical care air transport team consists of a critical care physician, critical care nurse, and respiratory therapist along with the supplies and equipment to operate a portable intensive care unit within a cargo aircraft. DISCUSSION: This capability was developed to support rapidly mobile surgical teams with high capability for damage control resuscitation and limited capacity for postresuscitation care. The critical care air transport team permits rapid evacuation of stabilizing casualties to a higher level of care. The aeromedical environment presents important challenges for the delivery of critical care. All equipment must be tested for safety and effectiveness in this environment before use in flight. The team members must integrate the current standards of care with the limitation imposed by stresses of flight on their patient. SUMMARY: The critical care air transport team capability has been used successfully in a range of settings from transport within the United States, to disaster response, to support of casualties in combat. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport intensive care military medicine patient care patient transport EMTREE MEDICAL INDEX TERMS devices disaster planning forecasting health service human international cooperation nonbiological model organization organization and management personnel management practice guideline program development review safety United States war LANGUAGE OF ARTICLE English MEDLINE PMID 18594265 (http://www.ncbi.nlm.nih.gov/pubmed/18594265) PUI L352132287 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 739 TITLE An audit of imaging and neck management of head injured patients at their base hospital before transfer to a tertiary neurosurgical ITU AUTHOR NAMES Puxty A. Pow C. AUTHOR ADDRESSES (Puxty A.; Pow C.) Department of Neuroanaesthesia, Southern General Hospital, Glasgow, United Kingdom. CORRESPONDENCE ADDRESS A. Puxty, Department of Neuroanaesthesia, Southern General Hospital, Glasgow, United Kingdom. SOURCE Journal of Neurosurgical Anesthesiology (2008) 20:3 (213-214). Date of Publication: July 2008 CONFERENCE NAME Annual Scientific Meeting of the Neuroanaethesia Society of Great Britain and Ireland CONFERENCE LOCATION Birmingham, United Kingdom CONFERENCE DATE 2008-05-08 to 2008-05-09 ISSN 0898-4921 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: In 2005, the Intensive Care Society (ICS) published guidelines for the safe evaluation of patients who may have suffered cervical spine injury after blunt trauma.(1) Studies have shown that patients with severe traumatic head injury (Glasgow Coma Scale <8) have a 10.2% chance of a coexisting cervical spine injury.(2) We investigated the initial management of potential cervical spine injury in head injured patients transferred to a neuroscience intensive care unit. Methods: This retrospective case note review investigated 101 consecutive patients admitted to a tertiary referral neurosurgical intensive care unit. Results: Eleven percent of all patients had imaging recommended by ICS guidelines (Fig. 1) and 13% had their cervical spine “cleared” appropriately prior to transfer to the regional unit (Fig. 2). Thirty-two percent of patients had no hard collar in situ at the time of admission and, of these, 47% had undergone no imaging of the neck. Thirty-eight percent of all patients were injured in low falls (<2 m) and 44% of these had no collar applied. The only patient in the series to suffer a significant cord injury had sustained a low fall (Fig. 3). The type of imaging performed at the referring hospital was variable (Fig. 4). “figure presented” “figure presented” “figure presented” Conclusions: Significant numbers of patients who were at risk of cervical spine injury were transferred to our regional neuroscience intensive care unit with inadequate imaging and/or no cervical spine protection. Low falls continue to be a risk group for coincidental cervical spine injury that is frequently overlooked. There is large variation in imaging carried out at referring hospitals where better use of scanning facilities could help ensure more expedient clearing of “at risk” cervical spines. “figure presented”. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit hospital imaging Ireland neck patient society United Kingdom EMTREE MEDICAL INDEX TERMS blunt trauma cervical spine cervical spine injury Glasgow coma scale head injury high risk population injury intensive care intensive care unit protection risk LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70035170 DOI 10.1097/ANA.0b013e318177341b FULL TEXT LINK http://dx.doi.org/10.1097/ANA.0b013e318177341b COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 740 TITLE Survey of transfer training amongst anaesthetic trainees in Leicester and Nottingham AUTHOR NAMES Mohammad A. Zafar N. Boddy P. Moppett I. AUTHOR ADDRESSES (Mohammad A.; Zafar N.) Nottingham and East Midland School of Anaesthesia, . (Boddy P.) Leicester School of Anaesthesia, Leicester, United Kingdom. (Moppett I.) Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom. CORRESPONDENCE ADDRESS A. Mohammad, Nottingham and East Midland School of Anaesthesia, . SOURCE Journal of Neurosurgical Anesthesiology (2008) 20:3 (219-220). Date of Publication: July 2008 CONFERENCE NAME Annual Scientific Meeting of the Neuroanaethesia Society of Great Britain and Ireland CONFERENCE LOCATION Birmingham, United Kingdom CONFERENCE DATE 2008-05-08 to 2008-05-09 ISSN 0898-4921 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction: Transfer of brain-injured patients is potentially hazardous and, if not performed correctly, may lead to serious complications, including secondary brain injury. Guidelines to improve the safety and efficiency of patient transfers have been developed by the Intensive Care Society(1) and the Association of Anaesthetists of Great Britain and Ireland in association with the Neuroanaesthesia Society of Great Britain and Ireland.(2) Our aim was to assess the extent of transfer training achieved amongst anaesthetic trainees in 2 schools of anaesthesia-Leicester (a non-neurosurgical teaching hospital) and Nottingham (regional neurosurgical centre). Methods: One hundred eleven anaesthetic trainees were surveyed using a structured questionnaire: 52 from Leicester and 59 from Nottingham. The survey queried the respondents about their awareness of national guidelines, transfer training received, number of inter-hospital and intra-hospital transfers performed and whether they felt that the training available in their region was adequate. “figure presented” “figure presented” Results: There was little difference in the responses from the 2 centres. Only 52% of trainees have received any transfer training (Fig. 1) and the training undertaken is variable (Fig. 2). Fifty-four percent of those who took part in the survey were unaware of national guidelines despite the number of transfers that they had undertaken (Figs. 3 and 4). Only 9% of surveyed trainees felt that transfer training was adequate. Conclusions: This survey revealed that training of transfer skills amongst anaesthetic trainees falls well short of the recommendations. The similar responses from 2 distinct training centres suggest that this is not a purely “figure presented” “figure presented” local problem. More formalised training and increased availability of transfer training courses are required. These issues are being addressed by increasing the awareness of transfer guidelines and checklists in the induction given to trainees and by means of email circulars, website posting and local meetings. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Ireland society student United Kingdom EMTREE MEDICAL INDEX TERMS anesthesia brain brain injury checklist e-mail hospital intensive care patient patient transport safety school skill structured questionnaire teaching hospital training LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70035185 DOI 10.1097/ANA.0b013e318177341b FULL TEXT LINK http://dx.doi.org/10.1097/ANA.0b013e318177341b COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 741 TITLE Facilitating in-hospital transport of trauma patients: Design of a trauma life support trolley AUTHOR NAMES Saltzherr T.P. Luitse J.S.K. Hoogerwerf N. Vernooij A.S.N. Goslings J.C. AUTHOR ADDRESSES (Saltzherr T.P.; Luitse J.S.K.; Goslings J.C., j.c.goslings@amc.uva.nl) Trauma Unit Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. (Hoogerwerf N.) Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands. (Vernooij A.S.N.) Department of Medical Technical Development, Academic Medical Center, Amsterdam, Netherlands. CORRESPONDENCE ADDRESS J.C. Goslings, Trauma Unit Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Email: j.c.goslings@amc.uva.nl SOURCE Injury (2008) 39:7 (809-812). Date of Publication: July 2008 ISSN 0020-1383 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) equipment design hospital equipment patient transport trauma life support trolley EMTREE MEDICAL INDEX TERMS angiography article capnometry electrocardiogram emergency ward endotracheal tube information processing infusion system injury intensive care unit oxygenation priority journal radiology resuscitation suction drainage ventilator volumetry EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008277773 MEDLINE PMID 18417129 (http://www.ncbi.nlm.nih.gov/pubmed/18417129) PUI L50119866 DOI 10.1016/j.injury.2008.01.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.injury.2008.01.010 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 742 TITLE Critical care at Landstuhl Regional Medical Center. AUTHOR NAMES Fang R. Pruitt V.M. Dorlac G.R. Silvey S.V. Osborn E.C. Allan P.F. Flaherty S.F. Perello M.M. Wanek S.M. Dorlac W.C. AUTHOR ADDRESSES (Fang R.; Pruitt V.M.; Dorlac G.R.; Silvey S.V.; Osborn E.C.; Allan P.F.; Flaherty S.F.; Perello M.M.; Wanek S.M.; Dorlac W.C.) Landstuhl Regional Medical Center, Landstuhl, Germany. CORRESPONDENCE ADDRESS R. Fang, Landstuhl Regional Medical Center, Landstuhl, Germany. Email: Raymond.Fang@amedd.army.mil SOURCE Critical care medicine (2008) 36:7 Suppl (S383-387). Date of Publication: Jul 2008 ISSN 1530-0293 (electronic) ABSTRACT BACKGROUND: Landstuhl Regional Medical Center is the largest U.S. medical facility outside the United States, and it is the first permanently positioned hospital outside the combat zone providing care to the wartime sick and wounded. As of November 2007, Landstuhl Regional Medical Center personnel have treated over 45,000 patients from Operations Enduring Freedom and Iraqi Freedom. The current trauma/critical care service is a multidisciplinary, intensivist-directed team caring for a diverse range of clinical diagnoses to include battle injuries, diseases, and nonbattle injuries. Admissions arise from an at-risk population of 500,000 widely distributed over a geographic area encompassing three continents. DISCUSSION: When compared with 2001, the average daily intensive care unit census has tripled and the patient acuity level has doubled. Combat casualties account for 85% of service admissions. The clinical practice at this critical care hub continues to evolve as a result of wartime damage control trauma care, robust critical care air transport capabilities, length of stay, and other unique factors. The service's focus is to optimize patients for an uneventful evacuation to the United States for definitive care and family support. SUMMARY: Successful verification in 2007 as an American College of Surgeons level II trauma center reflects a continuing institutional commitment to providing the best possible care to the men and women serving our nation in the global war on terror. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care intensive care unit military medicine patient transport public hospital EMTREE MEDICAL INDEX TERMS Afghanistan article education enteric feeding Germany hospital admission human infection control Iraq length of stay organization organization and management patient care spine injury (prevention) statistics terrorism thromboembolism (diagnosis, etiology, prevention) total quality management treatment outcome United States war LANGUAGE OF ARTICLE English MEDLINE PMID 18594267 (http://www.ncbi.nlm.nih.gov/pubmed/18594267) PUI L352132289 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 743 TITLE Concept analysis of relocation stress: focusing on patients transferred from intensive care unit to general ward AUTHOR NAMES Son Y.J. Hong S.K. Jun E.Y. AUTHOR ADDRESSES (Son Y.J.; Hong S.K.; Jun E.Y.) Department of Nursing, Soonchunhyang University, Cheonan, Korea. CORRESPONDENCE ADDRESS Y.J. Son, Department of Nursing, Soonchunhyang University, Cheonan, Korea. SOURCE Taehan Kanho Hakhoe chi (2008) 38:3 (353-362). Date of Publication: Jun 2008 ISSN 1598-2874 ABSTRACT PURPOSE: This study was conducted to analyze and clarify the meaning of the concept for relocation stress -focusing on patients transferred from an intensive care unit to a general ward. METHODS: This study used Walker and Avant's process of concept analysis. RESULTS: Relocation stress can be defined by these attributes as follows: 1) involuntary decision about relocation, 2) moving from a familiar and safe environment to an unfamiliar one, 3) broken relationship of safety and familiarity, 4) physiological and psychosocial change after relocation. The antecedents of relocation stress consisted of these facts: 1) preparation degrees of transfer from the intensive care unit to a general ward, 2) pertinence of the information related to the transfer process, 3) change of major caregivers, 4) change in numbers of monitoring devices, 5) change in the level of self-care. There are consequences occurring as a result of relocation stress: 1) decrease in patients' quality of life, 2) decrease in coping capacity, 3) loss of control. CONCLUSION: Relocation stress is a core concept in intensive nursing care. Using this concept will contribute to continuity of intensive nursing care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit mental stress patient transport EMTREE MEDICAL INDEX TERMS adaptive behavior article caregiver concept formation health care facility human LANGUAGE OF ARTICLE Korean MEDLINE PMID 18604144 (http://www.ncbi.nlm.nih.gov/pubmed/18604144) PUI L550075151 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 744 TITLE Hazards of intra-hospital transport (IHT) AUTHOR NAMES Siegel N. Bird E. AUTHOR ADDRESSES (Siegel N.; Bird E.) SOURCE HERD (2008) 1:4 (133-136). Date of Publication: 1 Jun 2008 ISSN 1937-5867 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient safety EMTREE MEDICAL INDEX TERMS human LANGUAGE OF ARTICLE English MEDLINE PMID 22973618 (http://www.ncbi.nlm.nih.gov/pubmed/22973618) PUI L611780456 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 745 TITLE Ketamine sedation during the treatment of retinopathy of prematurity AUTHOR NAMES Lyon F. Dabbs T. O'Meara M. AUTHOR ADDRESSES (Lyon F.; Dabbs T., timothy.dabbs@leedsth.nhs.uk) Department of Ophthalmology, St James's University Hospital, Leeds, United Kingdom. (O'Meara M.) Department of Anaesthetics, St James's University Hospital, Leeds, United Kingdom. CORRESPONDENCE ADDRESS T. Dabbs, Department of Ophthalmology, St James's University Hospital, Leeds, United Kingdom. Email: timothy.dabbs@leedsth.nhs.uk SOURCE Eye (2008) 22:5 (684-686). Date of Publication: May 2008 ISSN 0950-222X 1476-5454 (electronic) BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Aims: To report the use of ketamine sedation as an alternative anaesthetic method for babies undergoing treatment for retinopathy of prematurity (ROP). Methods: All babies who underwent treatment for ROP over a 2-year period were included in this study. The babies preoperative weight, medical condition, and ventilation status was recorded. Data were collected on their ventilation status pre-, intra-, and postprocedure. Any change in their cardiac or respiratory status during or in the subsequent 3 days following the treatment was noted. Results: Eleven babies, 22 eyes, required treatment over this period. The procedure was well tolerated with only three babies having intraoperative complications, which all resolved spontaneously. Two babies had postoperative complications requiring additional ventilation. In no case was the procedure abandoned owing to anaesthetic complications. Conclusions: The use of ketamine sedation allows the laser to be performed in a ward setting and avoids the potential risk of general anaesthesia and inter- and intra-hospital transfer. It has been found to produce few intra- or postoperative complications for the infant, while providing satisfactory conditions for the treatment of ROP. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) ketamine EMTREE DRUG INDEX TERMS atropine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) retrolental fibroplasia (surgery) sedation EMTREE MEDICAL INDEX TERMS anesthesia complication (complication) article artificial ventilation body weight breathing mechanics clinical article general anesthesia health status heart function human infant intraoperative period laser surgery outcome assessment patient safety patient transport peroperative complication (complication) postoperative complication (complication) postoperative period preoperative evaluation respiratory function CAS REGISTRY NUMBERS atropine (51-55-8, 55-48-1) ketamine (1867-66-9, 6740-88-1, 81771-21-3) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Ophthalmology (12) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008247586 MEDLINE PMID 17417623 (http://www.ncbi.nlm.nih.gov/pubmed/17417623) PUI L351712366 DOI 10.1038/sj.eye.6702717 FULL TEXT LINK http://dx.doi.org/10.1038/sj.eye.6702717 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 746 TITLE Nurse testified she was with pt. at time of cardiac arrest. AUTHOR ADDRESSES SOURCE Nursing law's Regan report (2008) 48:12 (1). Date of Publication: May 2008 ISSN 1528-848X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart arrest (prevention) malpractice nursing staff patient transport EMTREE MEDICAL INDEX TERMS article compensation human legal aspect medical staff nursing resuscitation United States LANGUAGE OF ARTICLE English MEDLINE PMID 18590249 (http://www.ncbi.nlm.nih.gov/pubmed/18590249) PUI L352318539 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 747 TITLE Rhabdomyolysis and respiratory failure: Rare presentation of carnitine palmityl-transferase II deficiency AUTHOR NAMES Gentili A. Iannella E. Masciopinto F. Latrofa M.E. Giuntoli L. Baroncini S. AUTHOR ADDRESSES (Gentili A., andrea_gentili@libero.it; Iannella E.; Masciopinto F.; Latrofa M.E.; Giuntoli L.; Baroncini S.) Department of Paediatric Anaestheia and Intensive Care, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy. CORRESPONDENCE ADDRESS A. Gentili, Department of Paediatric Anaestheia and Intensive Care, S. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy. Email: andrea_gentili@libero.it SOURCE Minerva Anestesiologica (2008) 74:5 (205-208). Date of Publication: May 2008 ISSN 0375-9393 BOOK PUBLISHER Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Torino, Italy. ABSTRACT Carnitine palmityl-transferase (CPT) II deficiency is a rare disorder of the fatty acid beta-oxidation cycle. CPT II deficiency can be associated with rhabdomyolysis in particular conditions that increase the requirement for fatty acid oxidation, such as low-carbohydrate and high-fat diet, fasting, exposure to excessive cold, lack of sleep and prolonged exercise. The best known CPT II deficiency is the muscular form with episodic muscle necrosis and paroxysmal myoglobinuria after prolonged exercise. We report a case of a four-year-old male child, who, after one day of hyperthermia and fasting, developed a massive rhabdomyolysis beginning with acute respiratory failure and later complicated by acute renal failure. Appropriate management in Pediatric Intensive Care Unit (PICU) (mechanical ventilatory support, fluid supply combined with mannitol and bicarbonate infusions, administration of acetaminophen and antibiotics, and continuous venovenous haemofiltration) brought about complete resolution with an excellent outcome. Biochemical investigation of muscle biopsy and genetic analysis showed a deficiency of CPT II. The onset of CPT II deficiency with respiratory failure is extremely rare, but a correct and early diagnosis of rhabdomyolysis is the key to successful treatment. A metabolic myopathy such as CPT II deficiency should be suspected in children affected by rhabdomyolysis if trauma, crash, infections, drugs or extreme exertion can be excluded. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carnitine palmitoyltransferase (endogenous compound) carnitine palmitoyltransferase ii (endogenous compound) EMTREE DRUG INDEX TERMS bicarbonate (drug combination, drug therapy) ceftriaxone (drug combination, drug therapy) creatine kinase (endogenous compound) creatine kinase MB (endogenous compound) creatinine (endogenous compound) mannitol (drug combination, drug therapy) midazolam (drug combination, drug therapy) paracetamol (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute respiratory failure (complication, diagnosis, drug therapy, therapy) carnitine palmitoyltransferase II deficiency (diagnosis) metabolic disorder (diagnosis) rhabdomyolysis (complication, diagnosis, therapy) EMTREE MEDICAL INDEX TERMS acute kidney failure (complication, therapy) article artificial ventilation case report clinical feature continuous hemofiltration creatinine blood level diet restriction drug withdrawal early diagnosis fluid therapy genetic analysis human human tissue hyperthermia (drug therapy) intensive care unit kidney tubule necrosis laboratory test lethargy male muscle biopsy muscle rigidity muscle weakness myalgia physical examination physiotherapy preschool child CAS REGISTRY NUMBERS bicarbonate (144-55-8, 71-52-3) carnitine palmitoyltransferase (9068-41-1) ceftriaxone (73384-59-5, 74578-69-1) creatine kinase (9001-15-4) creatinine (19230-81-0, 60-27-5) mannitol (69-65-8, 87-78-5) midazolam (59467-70-8) paracetamol (103-90-2) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Urology and Nephrology (28) Clinical and Experimental Biochemistry (29) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008310237 MEDLINE PMID 18414363 (http://www.ncbi.nlm.nih.gov/pubmed/18414363) PUI L351895339 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 748 TITLE Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions AUTHOR NAMES Gregory C.J. Nasrollahzadeh F. Dharmar M. Parsapour K. Marcin J.P. AUTHOR ADDRESSES (Gregory C.J., christopher.gregory@ucdmc.ucdavis.edu; Nasrollahzadeh F.; Dharmar M.; Parsapour K.) Department of Pediatrics, University of California, Davis Children's Hospital, Davis, CA. (Marcin J.P.) University of California, Davis Center for Health Services Research in Primary Care, University of California, Davis, CA. (Gregory C.J., christopher.gregory@ucdmc.ucdavis.edu) University of California, Davis Medical Center, 2516 Stockton Blvd., Sacramento, CA 95817. CORRESPONDENCE ADDRESS C. J. Gregory, University of California, Davis Medical Center, 2516 Stockton Blvd., Sacramento, CA 95817. Email: christopher.gregory@ucdmc.ucdavis.edu SOURCE Pediatrics (2008) 121:4 (e906-e911). Date of Publication: April 2008 ISSN 0031-4005 1098-4275 (electronic) BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT OBJECTIVE. The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital. METHODS. We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13 017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality. The main independent variable was the PICU admission source: patients transferred from referring emergency departments and inpatient wards versus in-house admissions from the same hospitals' emergency departments and inpatient ward. RESULTS. Patients admitted from referring emergency departments had higher use of vasoactive infusions (7.31% vs 5.23%) and mechanical ventilation (33.45% vs 23.6%) than same-hospital emergency department admissions. Compared with in- house ward admissions, patients transferred from referring inpatient wards had higher mechanical ventilation rates (45.05% vs 28.56%) and PICU lengths of stay (8.0 vs 6.7 days). CONCLUSIONS. On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children. Copyright © 2008 by the American Academy of Pediatrics. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient hospital admission patient referral patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation child consultation controlled study disease severity emergency ward female groups by age health care quality home care hospital patient human intensive care unit length of stay major clinical study male mortality preschool child priority journal school child software EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009161564 MEDLINE PMID 18381519 (http://www.ncbi.nlm.nih.gov/pubmed/18381519) PUI L354416802 DOI 10.1542/peds.2007-2089 FULL TEXT LINK http://dx.doi.org/10.1542/peds.2007-2089 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 749 TITLE Clinical review: Critical care transport and austere critical care AUTHOR NAMES Rice D.H. Kotti G. Beninati W. AUTHOR ADDRESSES (Rice D.H.; Kotti G.; Beninati W., william.beninati@lackland.af.mil) Uniformed Services University of the Health Sciences, Wilford Hall Medical Center, 2200 Bergquist Drive, Lackland Air Force Base, TX 78236, United States. CORRESPONDENCE ADDRESS W. Beninati, Uniformed Services University of the Health Sciences, Wilford Hall Medical Center, 2200 Bergquist Drive, Lackland Air Force Base, TX 78236, United States. Email: william.beninati@lackland.af.mil SOURCE Critical Care (2008) 12:2 Article Number: 207. Date of Publication: 5 Mar 2008 ISSN 1364-8535 1466-609X (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT The development of modern intensive care units (ICUs) has allowed the survival of patients with advanced illness and injury, although at a cost of substantial infrastructure. Natural disasters and military operations are two common situations that can create critically ill patients in an environment that is austere or has been rendered austere. This has driven the development of two related strategies to care for these casualties. Portable ICU capability can be rapidly established in the area of need, providing relatively advanced capability but limited capacity and sustainability. The other strategy is to rapidly evacuate critically ill and injured patients following their initial stabilization. This permits medical personnel in the austere location to focus resources on a larger number of less critical patients. It also permits the most vulnerable patients to receive care in an advanced center. This strategy requires careful planning to overcome the constraints of the transport environment. The optimal strategy has not been determined, but a combination of these two approaches has been used in recent disasters and military operations and is promising. The critical care delivered in an austere setting must be integrated with a long-term plan to provide follow-on care. © 2008 BioMed Central Ltd. EMTREE DRUG INDEX TERMS analgesic agent antiarrhythmic agent antibiotic agent antidote antihypertensive agent cardiovascular agent hypertensive factor inotropic agent miscellaneous drugs and agents respiratory tract agent sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care delivery intensive care public health service EMTREE MEDICAL INDEX TERMS accidental injury air medical transport artificial ventilation comorbidity critically ill patient disaster emergency care emergency health service follow up health care availability health care personnel health care planning health care quality hospital care infection control infection risk integrated health care system intensive care unit long term care medical care patient care personal experience pharmaceutical care practice guideline priority journal professional competence professional practice resuscitation review standardization sustainable development wound infection EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009123379 MEDLINE PMID 18373882 (http://www.ncbi.nlm.nih.gov/pubmed/18373882) PUI L354295567 DOI 10.1186/cc6782 FULL TEXT LINK http://dx.doi.org/10.1186/cc6782 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 750 TITLE Outcomes of pediatric trauma patients transported from rural and urban scenes AUTHOR NAMES McCowan C.L. Swanson E.R. Thomas F. Handrahan D.L. AUTHOR ADDRESSES (McCowan C.L., Christy.mccowan@hsc.utah.edu) Emergency Department Clinical Operations, University of Utah School of Medicine, Salt Lake City, UT, United States. (Swanson E.R.) University Health Care, Air Med Program, University of Utah School of Medicine, Salt Lake City, UT, United States. (Thomas F.) Intermountain Life Flight Adult Services, Shock and Trauma ICU, LDS Hospital, Salt Lake City, UT, United States. (Handrahan D.L.) UCR Statistical Data Center, LDS Hospital, Salt Lake City, UT, United States. CORRESPONDENCE ADDRESS C.L. McCowan, Emergency Department Clinical Operations, University of Utah School of Medicine, Salt Lake City, UT, United States. Email: Christy.mccowan@hsc.utah.edu SOURCE Air Medical Journal (2008) 27:2 (78-83). Date of Publication: March 2008/April 2008 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Objectives: Mortality differences exist between victims of urban and rural trauma. It is unknown if these differences persist in those patients who survive to HEMS transport. This study examined the in-hospital mortality, hospital LOS, and discharge status of pediatric blunt trauma victims transported by HEMS from rural and urban scenes. Methods: Retrospective review of pediatric (< 17) transports between 1997 and 2001. 130 rural and 419 urban pediatric patients transported to area trauma centers were identified from HEMS and registry records. Results: Total mileage, flight times, and scene times were significantly longer for rural flights (P < 0.05). There were no significant differences between the groups with regard to age, gender, vitals, hospital/ICU days, and mortality. After controlling for ISS and mechanism of injury, urban patients were 9 times more likely to die compared to rural patients. Conclusions: Pediatric patients injured in urban areas had shorter total flight and scene times than pediatric patients flown from rural scenes. Higher adjusted in-hospital mortality rates in the urban group were likely a result of faster EMS response and transport times, which minimized out-of-hospital deaths. Factors prior to HEMS arrival may have more impact on the increased mortality rates of rural blunt trauma victims documented nationally. © 2008 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport childhood injury patient transport rural area urban area EMTREE MEDICAL INDEX TERMS article blunt trauma child female hospitalization human intensive care unit major clinical study male medical record review mortality priority journal register retrospective study EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008109479 MEDLINE PMID 18328971 (http://www.ncbi.nlm.nih.gov/pubmed/18328971) PUI L351324168 DOI 10.1016/j.amj.2007.10.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2007.10.001 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 751 TITLE The business case for building better hospitals through evidence-based design. AUTHOR NAMES Sadler B.L. DuBose J. Zimring C. AUTHOR ADDRESSES (Sadler B.L.) Rady Children's Hospital, San Diego, LaJolla, CA 92037, USA. (DuBose J.; Zimring C.) CORRESPONDENCE ADDRESS B.L. Sadler, Rady Children's Hospital, San Diego, LaJolla, CA 92037, USA. Email: bsadler@chsd.org SOURCE HERD (2008) 1:3 (22-39). Date of Publication: 2008 Spring ISSN 1937-5867 ABSTRACT After establishing the connection between building well-designed evidence-based facilities and improved safety and quality for patients, families, and staff, this article presents the compelling business case for doing so. It demonstrates why ongoing operating savings and initial capital costs must be analyzed and describes specific steps to ensure that design innovations are implemented effectively. Hospital leaders and boards are now beginning to face a new reality: They can no longer tolerate preventable hospital-acquired conditions such as infections, falls, and injuries to staff or unnecessary intra-hospital patient transfers that can increase errors. Nor can they subject patients and families to noisy, confusing environments that increase anxiety and stress. They must effectively deploy all reasonable quality improvement techniques available. To be optimally effective, a variety of tactics must be combined and implemented in an integrated way. Hospital leadership must understand the clear connection between building well-designed healing environments and improved healthcare safety and quality for patients, families, and staff, as well as the compelling business case for doing so. Emerging pay-for-performance (P4P) methodologies that reward hospitals for quality and refuse to pay hospitals for the harm they cause (e.g., infections and falls) further strengthen this business case. When planning to build a new hospital or to renovate an existing facility, healthcare leaders should address a key question: Will the proposed project incorporate all relevant and proven evidence-based design innovations to optimize patient safety, quality, and satisfaction as well as workforce safety, satisfaction, productivity, and energy efficiency? When conducting a business case analysis for a new project, hospital leaders should consider ongoing operating savings and the market share impact of evidence-based design interventions as well as initial capital costs. They should consider taking the 10 steps recommended to ensure an optimal, cost-effective hospital environment. A return-on-investment (ROI) framework is put forward for the use of individual organizations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) evidence based practice financial management hospital design patient safety total quality management EMTREE MEDICAL INDEX TERMS article commercial phenomena cost control economics health care facility health services research human leadership medical error (prevention) patient satisfaction reimbursement United States LANGUAGE OF ARTICLE English MEDLINE PMID 21161906 (http://www.ncbi.nlm.nih.gov/pubmed/21161906) PUI L360305579 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 752 TITLE Passing the torch: the challenge of handoffs. AUTHOR NAMES Dracup K. Morris P.E. AUTHOR ADDRESSES (Dracup K.; Morris P.E.) CORRESPONDENCE ADDRESS K. Dracup, SOURCE American journal of critical care : an official publication, American Association of Critical-Care Nurses (2008) 17:2 (95-97). Date of Publication: Mar 2008 ISSN 1062-3264 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient care patient transport safety EMTREE MEDICAL INDEX TERMS editorial human intensive care unit interpersonal communication organization and management United States LANGUAGE OF ARTICLE English MEDLINE PMID 18310641 (http://www.ncbi.nlm.nih.gov/pubmed/18310641) PUI L351603168 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 753 TITLE Long-distance transport of critically ill children on extracorporeal life support in Australia AUTHOR NAMES Perez A. Butt W.W. Millar K.J. Best D. Thiruchelvam T. Cochrane A.D. Bennett M. Shekerdemian L.S. AUTHOR ADDRESSES (Perez A.; Butt W.W.; Millar K.J.; Best D.; Thiruchelvam T.; Cochrane A.D.; Bennett M.; Shekerdemian L.S.) Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia SOURCE Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine (2008) 10:1 (34). Date of Publication: 1 Mar 2008 ISSN 1441-2772 ABSTRACT BACKGROUND: The Royal Children's Hospital, Melbourne, Victoria, provides extracorporeal life support (ECLS) for infants and children from all around Australia. Since 2003, we have offered a mobile ECLS service to retrieve critically ill children whose condition is too unstable for conventional transport. The retrieval team comprises a paediatric intensive care unit specialist, an ECLS nurse specialist, a perfusionist and a cardiac surgeon.PATIENTS AND METHODS: Retrospective review of eight children (aged between 1 day and 8 years) who were transported on ECLS to the intensive care unit at the Royal Children's Hospital, Melbourne, between 2003 and 2007.RESULTS: Seven patients underwent cannulation by our team in the referring ICU, and one underwent cannulation by the referring centre before our retrieval team arrived. Seven children were placed on ECMO (veno-venous in two, veno-arterial in five), and one was placed on a left ventricular assist device. Five children were retrieved from interstate ICUs by air, and three were transported from a metropolitan ICU by road. The median distance from the referral centre to Melbourne was 803 km, and the median duration of retrieval was 13 hours. Median duration of ECLS was 270 hours. Five patients survived to hospital discharge. There were no adverse outcomes related to transport.CONCLUSIONS: This is the first report of ECLS transport in Australia. In our experience, children who would not otherwise be transportable can be safely transported long distances on ECLS, and should be offered this if appropriate resources exist. However, this approach should not replace the timely referral of patients who are likely to need ECLS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness extracorporeal oxygenation EMTREE MEDICAL INDEX TERMS child devices human intensive care unit retrospective study Victoria LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 18304015 (http://www.ncbi.nlm.nih.gov/pubmed/18304015) PUI L611744336 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 754 TITLE Neurosurgical emergency transfers to academic centers in Cook County: A prospective multicenter study AUTHOR NAMES Byrne R.W. Bagan B.T. Slavin K.V. Curry D. Koski T.R. Origitano T.C. AUTHOR ADDRESSES (Byrne R.W., rbyrne37@aol.com; Bagan B.T.) Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States. (Slavin K.V.) Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States. (Curry D.) Department of Surgery, Division of Neurosurgery, University of Chicago, Chicago, IL, United States. (Koski T.R.) Department of Neurosurgery, Northwestern University, Chicago, IL, United States. (Origitano T.C.) Department of Neurosurgery, Loyola University, Chicago, IL, United States. (Byrne R.W., rbyrne37@aol.com) Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison, Chicago, IL 60612, United States. CORRESPONDENCE ADDRESS R. W. Byrne, Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison, Chicago, IL 60612, United States. Email: rbyrne37@aol.com SOURCE Neurosurgery (2008) 62:3 (709-715). Date of Publication: March 2008 ISSN 0148-396X BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT OBJECTIVE: The absence of surgical subspecialty emergency care in the United States is a growing public health concern. Neurosurgery is a field lacking coverage in many areas of the country; however, this is generally thought to be of greater concern in rural areas. Because of decreasing numbers of neurosurgeons, medical malpractice, and liability concerns, neurosurgery coverage is becoming a public health crisis in urban areas. Our objective was to quantify neurosurgical emergency transfers to academic medical centers in Cook County, IL, including patient demographics, reasons for transfer, time lapse in transfer, and effects on patient condition. METHODS: Data on neurosurgery emergency transfers was gathered prospectively by all five of the academic neurosurgery departments in Cook County, IL, over a 2-month period. Patient demographics devoid of identifiers, diagnosis, transfer origin, time lapse of transfer, and patient condition at the time of transfer and at the receiving hospital were recorded. RESULTS: Two-hundred thirty emergent neurosurgical transfers occurred during the study period. The most common diagnoses were parenchymal intracerebral hemorrhage (33%) and subarachnoid hemorrhage (28%). Sixty-six percent of neurosurgical transfers to academic medical facilities originated at hospitals without full-time neurosurgery coverage. The mean time to transfer for all patients was 5 hours 10 minutes (standard deviation, 3 h 42 min; range, 1-20 h 12 min). A decline in Glasgow Coma Scale score was seen in 29 patients. A shortage of neurosurgical intensive care unit beds occurred on 55% of the days in the study. Only 19% of the emergency cases were related to cranial trauma, and only 3% of transfers came from Level 1 trauma centers. CONCLUSION: A combination of factors has led to decreases in availability of neurosurgical coverage in Cook County community hospital emergency departments. This has placed an increased burden on neurosurgical departments at academic centers, and, in some cases, delays led to a decline in patient condition. Eighty-one percent of the cases were not related to cranial trauma; thus, acute care trauma surgeons would be of little use. Coordinated efforts among local governments, medical centers, and emergency medical services to regionalize subspecialty services will be necessary to manage this problem. Copyright © by the Congress of Neurological Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency surgery neurosurgery patient transport EMTREE MEDICAL INDEX TERMS abscess article brain contusion brain hemorrhage brain infarction cauda equina syndrome cerebrospinal fluid fistula cerebrovascular accident cervical spine fracture demography encephalitis epileptic state Glasgow coma scale head injury human hydrocephalus hypophysis apoplexy intensive care unit major clinical study medical specialist neuroimaging parenchyma priority journal prospective study seizure skull fracture spinal cord compression spinal cord injury subarachnoid hemorrhage traumatic brain injury United States university hospital vasculitis vasospasm EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008196389 MEDLINE PMID 18425017 (http://www.ncbi.nlm.nih.gov/pubmed/18425017) PUI L351572727 DOI 10.1227/01.neu.0000317320.79106.7e FULL TEXT LINK http://dx.doi.org/10.1227/01.neu.0000317320.79106.7e COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 755 TITLE Neurosurgical emergency transfers to academic centers in Cook County: A prospective multicenter study - Commentary AUTHOR NAMES Wilberger J.E. AUTHOR ADDRESSES (Wilberger J.E.) CORRESPONDENCE ADDRESS J. E. Wilberger, Pittsburgh, PA, United States. SOURCE Neurosurgery (2008) 62:3 (715). Date of Publication: March 2008 ISSN 0148-396X BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency surgery neurosurgery patient transport EMTREE MEDICAL INDEX TERMS hospital bed capacity human intensive care unit medical decision making nervous system injury note priority journal resource allocation telemedicine EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008196391 PUI L351572729 DOI 10.1227/01.neu.0000317320.79106.7e FULL TEXT LINK http://dx.doi.org/10.1227/01.neu.0000317320.79106.7e COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 756 TITLE An emergency medical bag set for long-range aeromedical transportation. AUTHOR NAMES Barillo D.J. Renz E. Broger K. Moak B. Wright G. Holcomb J.B. AUTHOR ADDRESSES (Barillo D.J.; Renz E.; Broger K.; Moak B.; Wright G.; Holcomb J.B.) Burn Flight Team, US Army Institute of Surgical Research, Ft. Sam, Houston, Texas, USA. CORRESPONDENCE ADDRESS D.J. Barillo, Burn Flight Team, US Army Institute of Surgical Research, Ft. Sam, Houston, Texas, USA. SOURCE American journal of disaster medicine (2008) 3:2 (79-86). Date of Publication: 2008 Mar-Apr ISSN 1932-149X ABSTRACT The global war on terror has created the need for urgent long-range aeromedical transport of severely wounded service members over distances of several thousand miles from Afghanistan or Iraq to the United States. This need is met by specialized medical transport teams such as US Air Force Critical Care Air Transport Teams (CCATT) or by the US Army Burn Flight Team (BFT). Both teams travel with multiple bags or cases of emergency equipment, which are comprehensive but cumbersome. To avoid the need to search multiple bags for equipment or drugs when an in-flight emergency occurs, many CCATT and BFT physicians also carry a personal bag of emergency supplies for rapid access. Over the last year, we have evolved and standardized an emergency equipment bag designed to provide the supplies necessary for initial management of emergencies that occur during flight and ground transport. This or a similar emergency kit would be useful for inter or intrahospital transport of critically ill or injured civilian patients, or for physicians who respond to civil emergencies, such as members of Disaster Medical Assistance Teams. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport military medicine patient transport EMTREE MEDICAL INDEX TERMS article devices equipment design human intensive care LANGUAGE OF ARTICLE English MEDLINE PMID 18522249 (http://www.ncbi.nlm.nih.gov/pubmed/18522249) PUI L352238507 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 757 TITLE Intrahospital transports of critically ill patients: A special challenge of hospital care ORIGINAL (NON-ENGLISH) TITLE Innerklinische transporte von kritisch kranken patienten: Eine besondere herausforderung in der klinischen versorgung AUTHOR NAMES Wiese C.H.R. Bartels U. Fraatz W. Bahr J. Zausig Y.A. Quintel M. Graf B.M. AUTHOR ADDRESSES (Wiese C.H.R., cwiese@zari.de; Bartels U.; Fraatz W.; Bahr J.; Zausig Y.A.; Quintel M.; Graf B.M.) Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, . (Wiese C.H.R., cwiese@zari.de) Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany. CORRESPONDENCE ADDRESS C. H. R. Wiese, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany. Email: cwiese@zari.de SOURCE Anasthesiologie und Intensivmedizin (2008) 49:3 (125-133). Date of Publication: March 2008 ISSN 0170-5334 BOOK PUBLISHER DIOmed Verlags GmbH, Am Weichselgarten 30, Erlangen, Germany. ABSTRACT During the stay in hospital intrahospital transports (IHT) of critically ill patients are often necessary for optimal patient care. The transport of intensive care patients within the hospital may be associated with many potential complications and risks. It is therefore necessary to minimize risk factors before the onset of transport. Intensive Care Unit (ICU) patients should be transported safely when adequate time is provided, preparations are made prior to IHT, and human resources and technical support are sufficiently available. Patients should be stabilized as good as possible. The standard monitoring equipment of ICUs should be used over the whole time of transport. This article focuses on the transport of critically ill patients inside the hospital. We discuss the reasons for such transports, possible complications during transports, and show how to avoid complications. © Anästh Intensivmed 2008. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness intensive care EMTREE MEDICAL INDEX TERMS devices hospital care human intensive care unit monitoring patient care patient safety patient transport review risk factor EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2008145606 PUI L351427542 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 758 TITLE Adequacy of information transferred at resident sign-out (inhospital handover of care): A prospective survey AUTHOR NAMES Borowitz S.M. Waggoner-Fountain L.A. Bass E.J. Sledd R.M. AUTHOR ADDRESSES (Borowitz S.M., Witz@virginia.edu; Waggoner-Fountain L.A.) Department of Pediatrics, University of Virginia, Charlottesville, VA, United States. (Bass E.J.; Sledd R.M.) Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States. (Borowitz S.M., Witz@virginia.edu) Division of Pediatric Gastroenterology and Nutrition, University of Virginia, Charlottesville, VA 22908, United States. CORRESPONDENCE ADDRESS S.M. Borowitz, Division of Pediatric Gastroenterology and Nutrition, University of Virginia, Charlottesville, VA 22908, United States. Email: Witz@virginia.edu SOURCE Quality and Safety in Health Care (2008) 17:1 (6-10). Date of Publication: February 2008 ISSN 1475-3898 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Background: During sign-out (handover of care), information and responsibility about patients is transferred from one set of caregivers to another. Few residency training programmes formally teach resident physicians how to sign out or assess their ability to sign out, and little research has examined the sign-out process. Objective: To characterise the effectiveness of the sign-out process between resident physicians on an acute care ward. Design/methods: Resident physicians rotating on a paediatric acute care ward participated in a prospective study. Immediately after an on-call night, they completed a confidential survey characterising their night on call, the adequacy of the sign-out they received, and where they went to get information they had not received during sign-out. Results: 158 of 196 (81%) potential surveys were collected. On 49/158 surveys (31%), residents indicated something happened while on call they were not adequately prepared for. In 40/49 instances residents did not receive information during sign-out that would have been helpful, and in 33/40 the situation could have been anticipated and discussed during sign-out. The quality of sign-out (assessed using a five-point Likert scale from 1 = inadequate to answer call questions to 5 = adequate to answer call questions) on the nights when something happened the resident was not adequately prepared for were significantly different than the nights they felt adequately prepared (mean (SD) score 3.58 (0.92) and 4.48 (0.70); p = 0.001). There were no significant differences in: how busy the nights were; numbers of patients on service at the beginning of the call shift; numbers of admissions during a call shift; numbers of transfers to an intensive care unit; whether residents were "cross-covering" or were members of the general ward team; or whether the resident had cared for the patient previously. Conclusion: Although sign-out between resident physicians is a frequent activity, there are many times when important information is not transmitted. Analysis of these "missed opportunities" can be used to help develop an educational programme for resident physicians on how to sign out more effectively. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency care medical service EMTREE MEDICAL INDEX TERMS article controlled study health survey human intensive care unit patient care physician EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008087169 MEDLINE PMID 18245212 (http://www.ncbi.nlm.nih.gov/pubmed/18245212) PUI L351262947 DOI 10.1136/qshc.2006.019273 FULL TEXT LINK http://dx.doi.org/10.1136/qshc.2006.019273 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 759 TITLE Pediatric critical care transport: Diagnostic uncertainty - No worries, resource limitation - Worry AUTHOR NAMES Kissoon N. AUTHOR ADDRESSES (Kissoon N.) Acute and Critical Care Programs, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. CORRESPONDENCE ADDRESS N. Kissoon, Acute and Critical Care Programs, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. SOURCE Pediatric Critical Care Medicine (2008) 9:1 (116-117). Date of Publication: January 2008 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS child care editorial hospital care human priority journal resource management uncertainty EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008025386 MEDLINE PMID 18185124 (http://www.ncbi.nlm.nih.gov/pubmed/18185124) PUI L351080862 DOI 10.1097/01.PCC.0000298649.43544.6C FULL TEXT LINK http://dx.doi.org/10.1097/01.PCC.0000298649.43544.6C COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 760 TITLE The influence of systemic hemodynamics and oxygen transport on cerebral oxygen saturation in neonates after the Norwood procedure AUTHOR NAMES Li J. Zhang G. Holtby H. Guerguerian A.-M. Cai S. Humpl T. Caldarone C.A. Redington A.N. Van Arsdell G.S. AUTHOR ADDRESSES (Li J., jia.li@sickkids.ca; Zhang G.; Holtby H.; Guerguerian A.-M.; Humpl T.; Caldarone C.A.; Redington A.N.; Van Arsdell G.S.) Heart Center, the Hospital for Sick Children, Toronto, Ont., Canada. (Cai S.) Data Center, Congenital Heart Surgeon's Society, Toronto, Ont., Canada. CORRESPONDENCE ADDRESS J. Li, Heart Center, the Hospital for Sick Children, Toronto, Ont., Canada. Email: jia.li@sickkids.ca SOURCE Journal of Thoracic and Cardiovascular Surgery (2008) 135:1 (83-90.e2). Date of Publication: January 2008 ISSN 0022-5223 BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Objectives: Ischemic brain injury is an important morbidity in neonates after the Norwood procedure. Its relationship to systemic hemodynamic oxygen transport is poorly understood. Methods: Sixteen neonates undergoing the Norwood procedure were studied. Continuous cerebral oxygen saturation was measured by near-infrared spectroscopy. Continuous oxygen consumption was measured by respiratory mass spectrometry. Pulmonary and systemic blood flow, systemic vascular resistance, oxygen delivery, and oxygen extraction ratio were derived with measurements of arterial, and superior vena cava and pulmonary venous gases and pressures at 2- to 4-hour intervals during the first 72 hours in the intensive care unit. Results: Mean cerebral oxygen saturation was 66% ± 12% before the operation, reduced to 51% ± 13% on arrival in the intensive care unit, and remained low during the first 8 hours; it increased to 56% ± 9% at 72 hours, still significantly lower than the preoperative level (P < .05). Postoperatively, cerebral oxygen saturation was closely and positively correlated with systemic arterial pressure, arterial oxygen saturation, and arterial oxygen tension and negatively with oxygen extraction ratio (P < .0001 for all). Cerebral oxygen saturation was moderately and positively correlated with systemic blood flow and oxygen delivery (P < .0001 for both). It was weakly and positively correlated with pulmonary blood flow (P = .001) and hemoglobin (P = .02) and negatively correlated with systemic vascular resistance (P = .003). It was not correlated with oxygen consumption (P > .05). Conclusions: Cerebral oxygen saturation decreased significantly in neonates during the early postoperative period after the Norwood procedure and was significantly influenced by systemic hemodynamic and metabolic events. As such, hemodynamic interventions to modify systemic oxygen transport may provide further opportunities to reduce the risk of cerebral ischemia and improve neurodevelopmental outcomes. © 2008 The American Association for Thoracic Surgery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia Norwood procedure EMTREE MEDICAL INDEX TERMS arterial oxygen saturation arterial oxygen tension arterial pressure artery diameter article brain injury brain oxygen consumption clinical article controlled study correlation analysis female hemodynamics human intensive care unit lung blood flow male mass spectrometry near infrared spectroscopy newborn outcome assessment oxygen delivery device oxygen saturation oxygen transport postoperative period preoperative evaluation priority journal pulmonary vein superior cava vein systemic circulation vascular resistance EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008005835 MEDLINE PMID 18179923 (http://www.ncbi.nlm.nih.gov/pubmed/18179923) PUI L351014119 DOI 10.1016/j.jtcvs.2007.07.036 FULL TEXT LINK http://dx.doi.org/10.1016/j.jtcvs.2007.07.036 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 761 TITLE National audit of critical care resources in South Africa - Transfer of critically ill patients AUTHOR NAMES Scribante J. Bhagwanjee S. AUTHOR ADDRESSES (Scribante J., juan.scribante@wits.ac.za; Bhagwanjee S.) Department of Anaesthesiology, University of the Witwatesrand, Johannesburg Hospital, Johannesburg, South Africa. CORRESPONDENCE ADDRESS J. Scribante, Department of Anaesthesiology, University of the Witwatersand, Johannesburg Hospital, Johannesburg, South Africa. Email: juan.scribante@wits.ac.za SOURCE South African Medical Journal (2007) 97:12 III (1323-1326). Date of Publication: December 2007 ISSN 0256-9574 BOOK PUBLISHER South African Medical Association, Private Bag X1, Pinelands, South Africa. ABSTRACT Objectives. To establish the efficacy of the current system of referral of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitais with appropriate facilities. Design and setting. A descriptive, non-interventive, observational study design was used. An audit of all public and private sector ICUs and HCUs in South Africa was undertaken. Results. A 100% sample was obtained; 77% of public and 16% of private hospitals have no IC/HC units. Spread of hospitals was disproportionate across provinces. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. In the private hospitals, the mean time to collect was less than an hour. In public hospitals without an ICU, the distance to an was 100 km or less for approximately 50% of hospitals, and less than 10% of these hospitals were more than 300 km away. For hospitals with units (public and private), the distance to an appropriate hospital was 100 km or less for approximately 60% of units while for 10% of hospitals the distance was greater than 300 km. For public hospitals without units the majority of patients were transferred by non-ICU transport. In some instances both public and private hospitals transferred ICU patients from one ICU to another ICU in non-ICU transport. Conclusion. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit critical illness intensive care patient transport EMTREE MEDICAL INDEX TERMS article controlled study critically ill patient descriptive research human intensive care unit observational study patient referral private hospital public hospital resource allocation South Africa EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008049961 MEDLINE PMID 18265914 (http://www.ncbi.nlm.nih.gov/pubmed/18265914) PUI L351166290 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 762 TITLE An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit. AUTHOR NAMES McFetridge B. Gillespie M. Goode D. Melby V. AUTHOR ADDRESSES (McFetridge B.; Gillespie M.; Goode D.; Melby V.) School of Nursing, University of Ulster, Magee Campus, Londonderry, UK. CORRESPONDENCE ADDRESS B. McFetridge, School of Nursing, University of Ulster, Magee Campus, Londonderry, UK. Email: b.mcfetridge@ulster.ac.uk SOURCE Nursing in critical care (2007) 12:6 (261-269). Date of Publication: 2007 Nov-Dec ISSN 1478-5153 (electronic) ABSTRACT The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit nursing staff patient transport public relations risk management EMTREE MEDICAL INDEX TERMS article attitude to health clinical trial human information processing interpersonal communication multicenter study nurse attitude organization and management patient care policy practice guideline United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 17983360 (http://www.ncbi.nlm.nih.gov/pubmed/17983360) PUI L350317928 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 763 TITLE Barriers to the optimal resuscitation of patients with severe sepsis? Transfer to a level I critical care center! AUTHOR NAMES Carlson D.E. Chiu W.C. Johnson S.B. Scalea T.M. AUTHOR ADDRESSES (Carlson D.E.; Chiu W.C.; Johnson S.B.; Scalea T.M.) R. Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, Baltimore, MD, United States. CORRESPONDENCE ADDRESS D. E. Carlson, R. Adams Cowley Shock Trauma Center, University of Maryland, School of Medicine, Baltimore, MD, United States. SOURCE Critical Care Medicine (2007) 35:11 (2644-2645). Date of Publication: November 2007 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit resuscitation sepsis EMTREE MEDICAL INDEX TERMS cardiovascular function central venous pressure clinical protocol critical illness early goal-directed therapy editorial emergency ward hemorrhagic shock intracranial pressure mortality nursing staff patient care patient monitoring priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2008114347 MEDLINE PMID 18075371 (http://www.ncbi.nlm.nih.gov/pubmed/18075371) PUI L351339032 DOI 10.1097/01.CCM.0000288080.93937.9D FULL TEXT LINK http://dx.doi.org/10.1097/01.CCM.0000288080.93937.9D COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 764 TITLE Intra-hospital transport of critical patients ORIGINAL (NON-ENGLISH) TITLE Transporte intra-hospitalar do paciente crítico AUTHOR NAMES Pereira Jr. G.A. De Carvalho J.B. Ponte Filho A.D. Malzone D.A. Pedersoli C.E. AUTHOR ADDRESSES (Pereira Jr. G.A., gersonapj@gmail.com.br; Pedersoli C.E.) Unidade de Emergência, Hospital Das Clínicas, USP, . (Pereira Jr. G.A., gersonapj@gmail.com.br) Emergências Médicas e Habilidades Cirúrgicas, Curso de Medicina, Universidade de Ribeirão Preto (UNAERP), . (De Carvalho J.B.) UNAERP, . (Ponte Filho A.D.) Hospital do Servidor Público Municipal de São Paulo, . (Malzone D.A.) Ginecologia, UNAERP, . (Pedersoli C.E.) Emergências Médicas e Atendimento Pré-hospitalar, Curso de Medicina, UNAERP, . (Pereira Jr. G.A., gersonapj@gmail.com.br) Rua Bernardino de Campos, 1000, CEP 14030-150 - Ribeirão Preto - SP. CORRESPONDENCE ADDRESS G. A. Pereira Jr., Rua Bernardino de Campos, 1000, CEP 14030-150 - Ribeirão Preto - SP. Email: gersonapj@gmail.com.br SOURCE Medicina (2007) 40:4 (500-508). Date of Publication: October/December 2007 ISSN 0076-6046 BOOK PUBLISHER Faculdade de Medicina de Ribeirao Preto - U.S.P., Monte Alegre, Ribeirao Preto, Brazil. ABSTRACT The medicine knowledge and development of new technologies for diagnoses and treatment of patients had permitted the longevity of healthy people and of those with acute or chronic illness. These technological advances are not well distributed, but there are clearly improvements on the management of patients in medical field leading to a lower mortality and a better quality of life. With these improvements, hospitals needed to increase the area of critical care settings. Patients have being beneficiated by these diagnose technologies, most of them including image, but to access them, they need to be transported out of a intensive care unit, needing to maintain the same level of monitorization. That is the great importance on transportation of a critical patient, and it has being neglected by most health professionals. The objective of this article is to make a reflection of the various moments, phases and care involving the intra-hospital transport, discussing its various aspects. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute disease (disease management) chronic disease (disease management) critically ill patient patient transport EMTREE MEDICAL INDEX TERMS conference paper endotracheal tube health practitioner human intensive care unit mortality nasogastric tube quality of life EMBASE CLASSIFICATIONS Internal Medicine (6) LANGUAGE OF ARTICLE Portuguese LANGUAGE OF SUMMARY English, Portuguese EMBASE ACCESSION NUMBER 2008251489 PUI L351722997 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 765 TITLE Challenges of pediatric medical transport in the 21st century health-care landscape AUTHOR NAMES Kunkel S.A. Sinkin R.A. AUTHOR ADDRESSES (Kunkel S.A.) University of Virginia-Pegasus Medical Transport Network, Charlottesville, VA, United States. (Sinkin R.A., ras9q@virginia.edu) Department of Pediatrics, University of Virginia, Charlottesville, VA, United States. (Sinkin R.A., ras9q@virginia.edu) Department of Neonatology, Neonatal ICU, Charlottesville, VA, United States. (Sinkin R.A., ras9q@virginia.edu) Virginia-Pegasus Medical Transport Network, Charlottesville, VA, United States. (Sinkin R.A., ras9q@virginia.edu) UVA-Pegasus Medical Transport Network, University of Virginia Medical Center, PO Box 800386, Charlottesville, VA 22908-0836, United States. CORRESPONDENCE ADDRESS R.A. Sinkin, UVA-Pegasus Medical Transport Network, University of Virginia Medical Center, PO Box 800386, Charlottesville, VA 22908-0836, United States. Email: ras9q@virginia.edu SOURCE Chest (2007) 132:4 (1113-1115). Date of Publication: October 2007 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians, 3300 Dundee Road, Northbrook, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS child health care editorial health care delivery human intensive care unit patient care priority journal EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007515930 MEDLINE PMID 17934111 (http://www.ncbi.nlm.nih.gov/pubmed/17934111) PUI L47620981 DOI 10.1378/chest.07-1427 FULL TEXT LINK http://dx.doi.org/10.1378/chest.07-1427 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 766 TITLE Inhaled nitric oxide therapy during the transport of neonates with persistent pulmonary hypertension or severe hypoxic respiratory failure AUTHOR NAMES Lowe C.G. Trautwein J.G. AUTHOR ADDRESSES (Lowe C.G., clowe@chla.usc.edu) Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States. (Trautwein J.G.) Pediatric Emergency Department, University Medical Center, University of Nevada School of Medicine, Las Vegas, NV, United States. CORRESPONDENCE ADDRESS C.G. Lowe, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States. Email: clowe@chla.usc.edu SOURCE European Journal of Pediatrics (2007) 166:10 (1025-1031). Date of Publication: October 2007 ISSN 0340-6199 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Our aim was to determine whether starting inhaled nitric oxide (iNO) on critically ill neonates with severe hypoxemic respiratory failure and/or persistent pulmonary hypertension (PPH), at a referring hospital at the start of transport, decreases the need for extracorporeal membrane oxygenation (ECMO), lessens the number of hospital days and improves survival in comparison with those patients who were started on iNO only at the receiving facility. The study was a retrospective review of 94 charts of neonates that had iNO initiated by the transport team at a referring hospital or only at the tertiary neonatal intensive care unit (NICU) of the receiving hospital. Data collected included demographics, mode of transport, total number of hospital days, days on inhaled nitric oxide and ECMO use. Of the 94 patients, 88 were included. Of these, 60 were started on iNO at the referring facility (Field-iNO) and 28 were started at the receiving NICU (CHLA-iNO). All patients survived transport to the receiving NICU. Death rates and ECMO use were similar in both groups. Overall, patients who died were younger and had lower birth weights and Apgar scores. For all surviving patients who did not require ECMO, the length of total hospital stay (median days 22 versus 38, P = 0.018), and the length of the hospital stay at the receiving hospital (median days 18 versus 29, P = 0.006), were significantly shorter for the Field-iNO patients than for the CHLA-iNO patients, respectively. Earlier initiation of iNO may decrease length of hospital stay in surviving neonates with PPH not requiring ECMO. © 2007 Springer-Verlag. EMTREE DRUG INDEX TERMS nitric oxide (drug therapy, inhalational drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn hypoxia (drug therapy) pulmonary hypertension (drug therapy) respiratory failure (drug therapy) EMTREE MEDICAL INDEX TERMS Apgar score article disease severity extracorporeal oxygenation hospitalization human infant mortality intensive care unit low birth weight patient transport priority journal survival rate therapy delay CAS REGISTRY NUMBERS nitric oxide (10102-43-9) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007418798 MEDLINE PMID 17205243 (http://www.ncbi.nlm.nih.gov/pubmed/17205243) PUI L47313066 DOI 10.1007/s00431-006-0374-y FULL TEXT LINK http://dx.doi.org/10.1007/s00431-006-0374-y COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 767 TITLE Transfer of emergency neurosurgical patients: when and how? ORIGINAL (NON-ENGLISH) TITLE Quand faut-il décider d'un transfert en milieu neurochirurgical spécialisé ? AUTHOR NAMES Bruder N. AUTHOR ADDRESSES (Bruder N., nicolas.bruder@ap-hm.fr) Pôle d'anesthésie-réanimation, CHU de la Timone-Adultes, 264, rue Saint-Pierre, 13385 Marseille, France. CORRESPONDENCE ADDRESS N. Bruder, Pôle d'anesthésie-réanimation, CHU de la Timone-Adultes, 264, rue Saint-Pierre, 13385 Marseille, France. Email: nicolas.bruder@ap-hm.fr SOURCE Annales Francaises d'Anesthesie et de Reanimation (2007) 26:10 (873-877). Date of Publication: October 2007 ISSN 0750-7658 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT The annual incidence of severe head injury lies between 9 and 25/100 000 inhabitants, depending on the criteria used for its definition. In most countries, the shortage in neurosurgical ICU beds makes it impossible to take in charge all patients with a severe brain injury. But the beneficial effect of a specialized neurosurgical ICU on outcome after brain injury has been demonstrated in several retrospective studies. Ideally, the best strategy is to admit the patients with a severe head injury directly in a neurosurgical centre. When this is not possible, the appropriate decision of a secondary transfer relies on the quality of the relationships between physicians in the community and the neurosurgical hospitals. Teleradiology is the best method to avoid unnecessary transportation or deleterious delays before transfer. In an era of decreasing medical budgets, technical improvements to enhance medical cooperation should be encouraged. © 2007 Elsevier Masson SAS. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neurosurgery EMTREE MEDICAL INDEX TERMS article brain injury budget head injury (epidemiology) human intensive care unit teleradiology EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 2007480895 MEDLINE PMID 17692495 (http://www.ncbi.nlm.nih.gov/pubmed/17692495) PUI L47503666 DOI 10.1016/j.annfar.2007.06.011 FULL TEXT LINK http://dx.doi.org/10.1016/j.annfar.2007.06.011 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 768 TITLE Pediatric Critical Care Interfacility Transport AUTHOR NAMES Horowitz R. Rozenfeld R.A. AUTHOR ADDRESSES (Horowitz R.; Rozenfeld R.A., rrozenfeld@northwestern.edu) Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. (Horowitz R.) Pediatric Emergency Medicine, Children's Memorial Hospital, Chicago, IL, United States. (Rozenfeld R.A., rrozenfeld@northwestern.edu) Pediatric Critical Care Medicine, Children's Memorial Hospital, Chicago, IL, United States. CORRESPONDENCE ADDRESS R.A. Rozenfeld, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States. Email: rrozenfeld@northwestern.edu SOURCE Clinical Pediatric Emergency Medicine (2007) 8:3 (190-202). Date of Publication: September 2007 ISSN 1522-8401 BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT Interfacility transport of critically ill pediatric patients requires coordination among referring physicians/institutions, receiving physicians/institutions, transport team personnel, and emergency medical services. Specialized transport teams can facilitate these transports as well as provide a unique service to the patients and their families. Providing critical care to patients in a transport environment is very different from providing this care in the intensive care unit or the emergency department. Transport personnel must be trained and equipped to provide this care in various environments, including ambulance, rotor wing, and fixed wing aircraft. This article reviews the process of setting up a pediatric critical care transport, team composition, equipment needs, personnel requirements, safety issues, and legal issues related to the interfacility transport of pediatric patients. © 2007 Elsevier Inc. All rights reserved. EMTREE DRUG INDEX TERMS amiodarone ampicillin antiarrhythmic agent antiasthmatic agent anticonvulsive agent antihypertensive agent antiinfective agent atropine bronchodilating agent ceftriaxone cimetidine dopamine fentanyl fosphenytoin sodium gentamicin hypnotic agent ketamine lidocaine lorazepam midazolam morphine narcotic agent narcotic analgesic agent neuromuscular blocking agent prostaglandin rocuronium sedative agent surfactant thiopental unindexed drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child care intensive care patient transport EMTREE MEDICAL INDEX TERMS accreditation air medical transport article child health care clinical protocol continuing education critically ill patient drug storage emergency health service health care policy human in service training informed consent legal liability medical device medical documentation medical record medicolegal aspect parental notification practice guideline safety telecommunication total quality management CAS REGISTRY NUMBERS amiodarone (1951-25-3, 19774-82-4, 62067-87-2) ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0) atropine (51-55-8, 55-48-1) ceftriaxone (73384-59-5, 74578-69-1) cimetidine (51481-61-9, 70059-30-2) dopamine (51-61-6, 62-31-7) fentanyl (437-38-7) fosphenytoin sodium (92134-98-0) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) ketamine (1867-66-9, 6740-88-1, 81771-21-3) lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9) lorazepam (846-49-1) midazolam (59467-70-8) morphine (52-26-6, 57-27-2) rocuronium (119302-91-9) thiopental (71-73-8, 76-75-5) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) Drug Literature Index (37) Forensic Science Abstracts (49) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007499468 PUI L47570812 DOI 10.1016/j.cpem.2007.07.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.cpem.2007.07.001 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 769 TITLE Medical complications of intra-hospital patient transports: implications for architectural design and research AUTHOR NAMES Ulrich R.S. Zhu X. AUTHOR ADDRESSES (Ulrich R.S.; Zhu X.) Roger S. Ulrich, PhD, 3137 TAMU, Texas A&M University, College Station, TX 77843-3137 (rulrich@tamu.edu) SOURCE HERD (2007) 1:1 (31-43). Date of Publication: 1 Sep 2007 ISSN 1937-5867 ABSTRACT Literature on healthcare architecture and evidence-based design has rarely considered explicitly that patient outcomes may be worsened by intra-hospital transport (IHT), which is defined as transport of patients within the hospital. The article focuses on the effects of IHTs on patient complications and outcomes, and the implications of such impacts for designing safer, better hospitals. A review of 22 scientific studies indicates that IHTs are subject to a wide range of complications, many of which occur frequently and have distinctly detrimental effects on patient stability and outcomes. The research suggests that higher patient acuity and longer transport durations are associated with more frequent and serious IHT-related complications and outcome effects. It appears no rigorous research has compared different hospital designs and layouts with respect to having possibly differential effects on transport-related complications and worsened outcomes. Nonetheless, certain design implications can be extracted from the existing research literature, including the importance of minimizing transport delays due to restricted space and congestion, and creating layouts that shorten IHT times for high-acuity patients. Limited evidence raises the possibility that elevator-dependent vertical building layouts may increase susceptibility to transport delays that worsen complications. The strong evidence indicating that IHTs trigger complications and worsen outcomes suggests a powerful justification for adopting acuity-adaptable rooms and care models that substantially reduce transports. A program of studies is outlined to address gaps in knowledge.Key WordsPatient transports, transports within hospitals, patient safety, evidence-based design, hospital design, healthcare architecture, intra-hospital transport complications, acuity-adaptable care, elevators, outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient safety EMTREE MEDICAL INDEX TERMS human patient transport research LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 21157716 (http://www.ncbi.nlm.nih.gov/pubmed/21157716) PUI L611460458 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 770 TITLE Smoked out: Emergency evacuation of an ICU AUTHOR NAMES Carey M.G. AUTHOR ADDRESSES (Carey M.G., mgcarey@buffalo.edu) School of Nursing, State University of New York, Buffalo. CORRESPONDENCE ADDRESS M.G. Carey, School of Nursing, State University of New York, Buffalo. Email: mgcarey@buffalo.edu SOURCE American Journal of Nursing (2007) 107:9 (54-57). Date of Publication: September 2007 ISSN 0002-936X BOOK PUBLISHER Lippincott Williams and Wilkins EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster planning fire intensive care unit patient transport EMTREE MEDICAL INDEX TERMS human methodology organization and management review LANGUAGE OF ARTICLE English MEDLINE PMID 17721151 (http://www.ncbi.nlm.nih.gov/pubmed/17721151) PUI L47329525 DOI 10.1097/01.NAJ.0000287511.31006.bd FULL TEXT LINK http://dx.doi.org/10.1097/01.NAJ.0000287511.31006.bd COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 771 TITLE Introduction of a liaison nurse role in a tertiary paediatric ICU AUTHOR NAMES Caffin C.L. Linton S. Pellegrini J. AUTHOR ADDRESSES (Caffin C.L., chelsea.caffin@rch.org.au; Linton S., sophie.linton@rch.org.au; Pellegrini J., juliet.pellegrini@rch.org.au) PICU Liaison Nurse, Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, 3052, Australia. CORRESPONDENCE ADDRESS C.L. Caffin, PICU Liaison Nurse, Intensive Care Unit, Royal Children's Hospital, Flemington Road, Parkville, 3052, Australia. Email: chelsea.caffin@rch.org.au SOURCE Intensive and Critical Care Nursing (2007) 23:4 (226-233). Date of Publication: August 2007 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone ABSTRACT Introduction: The Royal Children's Hospital in Melbourne is the only dedicated paediatric hospital in Victoria (population 5 million). The role of the PICU liaison nurse (LN) has been developed to bridge the gap between PICU and the wards within the hospital with the aim of reducing the number of readmissions to the PICU within 48 h of discharge. Results: The year of the PICU LN trial (July 2004-June 2005), 1388 patients were discharged from PICU. Sixty-seven patients had unplanned readmission within 48 h. This readmission rate (4.8%) is lower than the readmission rate (5.4%) during the year prior to the implementation of the PICU LN. Staff and parents were surveyed at the end of the 12-month trial to evaluate the introduction of the LN role. The response from the surveys was very positive, 98.5% of staff believed the PICU LN to be beneficial and to have made a valuable impact on PICU-ward transfers. Ninety-nine percent of surveyed parents agreed that the LN role is a good idea. Conclusion: The PICU LN role at RCH has shown many positive outcomes including improved communication, ward education, improved patient outcomes and decreased readmission rates to ICU. © 2006 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nurse nurse attitude patient care patient transport EMTREE MEDICAL INDEX TERMS adolescent adult article attitude to health Australia child evaluation study health personnel attitude hospital readmission human infant length of stay newborn nursing nursing evaluation research nursing methodology research nursing staff organization and management parent pediatric nursing preschool child psychological aspect statistics LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 17276065 (http://www.ncbi.nlm.nih.gov/pubmed/17276065) PUI L47029780 DOI 10.1016/j.iccn.2006.12.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2006.12.001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 772 TITLE Living in a Glasshouse... embracing care issues beyond ICU AUTHOR NAMES Leslie G.D. AUTHOR ADDRESSES (Leslie G.D.) SOURCE Australian Critical Care (2007) 20:3 (85-86). Date of Publication: August 2007 ISSN 1036-7314 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS Australia editorial human intensive care unit LANGUAGE OF ARTICLE English MEDLINE PMID 17627837 (http://www.ncbi.nlm.nih.gov/pubmed/17627837) PUI L47091540 DOI 10.1016/j.aucc.2007.06.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.aucc.2007.06.002 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 773 TITLE In-house growth-promoting transport system for Neisseria gonorrhoeae AUTHOR NAMES Sharma D. Sethi S. Das Mehta S. Sharma M. AUTHOR ADDRESSES (Sharma D.; Sethi S., sunilsethi10@hotmail.com; Sharma M.) Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. (Das Mehta S.) Department of Dermatology and Venerology, STD Polyclinic, Chandigarh, India. (Sethi S., sunilsethi10@hotmail.com) Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. CORRESPONDENCE ADDRESS S. Sethi, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. Email: sunilsethi10@hotmail.com SOURCE Journal of Clinical Microbiology (2007) 45:8 (2743-2744). Date of Publication: August 2007 ISSN 0095-1137 BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. ABSTRACT Eno powder (GlaxoSmithKline), an antacid preparation readily available over the counter, was used instead of a CO(2) generator for the growth of 15 strains of Neisseria gonorrhoeae obtained from men with urethritis. Due to its easy accessibility and low cost, Eno powder can be useful in developing countries for transporting clinical specimens from resource-poor peripheral labs to reference laboratories. Copyright © 2007, American Society for Microbiology. All Rights Reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antacid agent (drug analysis) EMTREE DRUG INDEX TERMS carbon dioxide eno powder unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial growth Neisseria gonorrhoeae EMTREE MEDICAL INDEX TERMS article cost developing country diagnostic accuracy laboratory diagnosis nonhuman priority journal strain identification transport kinetics urethritis (diagnosis, etiology) DRUG TRADE NAMES eno powder Glaxo SmithKline DRUG MANUFACTURERS Glaxo SmithKline DEVICE TRADE NAMES Bio-Bag Type C Becton Dickinson Gono-Pak Bbl JEMBEC Bbl DEVICE MANUFACTURERS Bbl Becton Dickinson CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007412582 MEDLINE PMID 17537947 (http://www.ncbi.nlm.nih.gov/pubmed/17537947) PUI L47295521 DOI 10.1128/JCM.00344-07 FULL TEXT LINK http://dx.doi.org/10.1128/JCM.00344-07 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 774 TITLE Incidence of complications in intrahospital transport of critically ill patients - Experience in an Austrian university hospital AUTHOR NAMES Lahner D. Nikolic A. Marhofer P. Koinig H. Germann P. Weinstabl C. Krenn C.G. AUTHOR ADDRESSES (Lahner D., daniel.lahner@meduniwien.ac.at; Nikolic A.; Marhofer P.; Koinig H.; Germann P.; Weinstabl C.; Krenn C.G.) Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria. (Lahner D., daniel.lahner@meduniwien.ac.at) Department of Anesthesiology and General Intensive Care, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. CORRESPONDENCE ADDRESS D. Lahner, Department of Anesthesiology and General Intensive Care, University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Email: daniel.lahner@meduniwien.ac.at SOURCE Wiener Klinische Wochenschrift (2007) 119:13-14 (412-416). Date of Publication: July 2007 ISSN 0043-5325 BOOK PUBLISHER Springer-Verlag Wien, Sachsenplatz 4-6, P.O. Box 89, Vienna, Austria. ABSTRACT BACKGROUND: During the past decade, considerable changes and advances have been made in intrahospital transport of critically ill patients. Despite the fact that intrahospital transport is nowadays regarded an extension of the intensive care continuum, it still poses a risk for the patient. MATERIALS AND METHODS: This prospective, observational study was designed to determine the occurrence rate of transport-related complications in the altered setting of intrahospital transports and to identify possible confounding sources of increased risk. In an eight-month period, adults and infants from anesthesiologic intensive care units were analyzed. RESULTS: A total of 226 patients underwent 452 intrahospital transports. The overall rate of critical incidents was low (4.2%) and no direct association between mortality and intrahospital transport was observed. In addition to the known risk factors of ventilatory support with positive end-expiratory pressure and requirement for catecholamine support, the necessity for intrahospital transport in the acute vs. elective situation was found to significantly increase the risk of complications. CONCLUSIONS: We conclude that advances in the management of intrahospital transport of critically ill patients have led to an overall decrease of complications. However, an undeniable risk remains, especially in relation to disease severity and the urgency of such transports. © 2007 Springer-Verlag. EMTREE DRUG INDEX TERMS catecholamine nitric oxide vasoactive agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bronchospasm (complication) heart arrest (complication) hypertension (complication) hypotension (complication) patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article artificial ventilation catheterization child controlled study critically ill patient extubation female human incidence intensive care unit major clinical study male mortality positive end expiratory pressure resuscitation risk factor university hospital CAS REGISTRY NUMBERS nitric oxide (10102-43-9) EMBASE CLASSIFICATIONS Internal Medicine (6) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2007432515 MEDLINE PMID 17671822 (http://www.ncbi.nlm.nih.gov/pubmed/17671822) PUI L47356171 DOI 10.1007/s00508-007-0813-4 FULL TEXT LINK http://dx.doi.org/10.1007/s00508-007-0813-4 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 775 TITLE Which children need to be transferred to the paediatric intensive care unit? AUTHOR NAMES Edwards E.D. Fardy C.H. AUTHOR ADDRESSES (Edwards E.D.; Fardy C.H.) SOURCE Paediatrics and Child Health (2007) 17:7 (295-299). Date of Publication: July 2007 ISSN 1751-7222 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT A paediatric intensive care service provides the necessary support, interventions and treatment for children who have critical illness or injury. The critically ill child has special medical needs and therefore requires care from medical and nursing staff trained in both paediatrics and intensive care. This is best provided in a service that conforms to agreed guidelines and standards. This review discusses the guidelines for admission to a paediatric intensive care unit (PICU), which must be modified and adapted to each hospital's policy. They are not meant to be all-inclusive, and it is recommended that professionals discuss each case with the tertiary centre as some hospitals have both PICU and high-dependency unit beds and can offer different types of service for the critically ill child. © 2007 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS article artificial ventilation assisted ventilation childhood injury consultation critical illness deterioration health care need hospital admission hospital bed hospital policy human intubation medical staff nursing staff practice guideline standard systematic review tertiary health care EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007320736 PUI L47017006 DOI 10.1016/j.paed.2007.04.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.paed.2007.04.002 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 776 TITLE Reverse transport of children from a tertiary pediatric hospital AUTHOR NAMES McPherson M.L. Jefferson L.S. Smith E.O. Sitler G.C. Graf J.M. AUTHOR ADDRESSES (McPherson M.L.; Jefferson L.S.; Smith E.O.; Graf J.M., jgraf@bcm.edu) Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States. (McPherson M.L.) Center for Pediatric Health Services Research, Texas Children's Hospital, Houston, TX, United States. (Sitler G.C.) Texas Children's Hospital, Houston, TX, United States. CORRESPONDENCE ADDRESS J.M. Graf, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States. Email: jgraf@bcm.edu SOURCE Air Medical Journal (2007) 26:4 (183-187). Date of Publication: July/August 2007 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Introduction: The purpose of this study was to determine the epidemiology and resources used and to study the potential savings of pediatric reverse transport patients. Methods: A case control study was performed with patients undergoing a reverse or outbound transport from a large, pediatric hospital. Twenty-five children undergoing reverse transport were compared with matched controls. Lengths of stay and costs were compared between the reverse transport and matched control patients. Results: Fifty-two percent of the reverse transport patients returned home, whereas 32% went home for end-of-life care and 16% went to other facilities. The average reverse transport was more than 400 miles and cost $6,064. The reverse transport of these patients did not save pediatric intensive care unit (PICU) days but did result in a shorter hospital stay compared with the matched controls (10 vs. 19 days, P = .03). Decreased utilization of bed days came from less use of intermediate care unit resources. Conclusions: Pediatric patients undergo reverse transports for a variety of reasons, often for end-of-life care. The ability to reverse transport pediatric patients may not save PICU bed days but may offer pediatric tertiary care hospitals a means to provide more intermediate care bed availability. © 2007 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health care health care cost patient transport EMTREE MEDICAL INDEX TERMS article child child care childhood mortality clinical article controlled study cost control emergency care female health care facility hospital based case control study hospital bed utilization hospitalization human infant intensive care unit length of stay male pediatric hospital priority journal resource allocation tertiary health care EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007305067 MEDLINE PMID 17603946 (http://www.ncbi.nlm.nih.gov/pubmed/17603946) PUI L46971873 DOI 10.1016/j.amj.2006.10.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2006.10.009 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 777 TITLE Timing of presentation of the first signs of vascular compromise dictates the salvage outcome of free flap transfers AUTHOR NAMES Chen K.-T. Mardini S. Chuang D.C.-C. Lin C.-H. Cheng M.-H. Lin Y.-T. Huang W.-C. Tsao C.-K. Wei F.-C. AUTHOR ADDRESSES (Wei F.-C., fcw2007@adm.cgmh.org.tw) Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Shing Street, Taoyuan, Taiwan. (Chen K.-T.; Mardini S.; Chuang D.C.-C.; Lin C.-H.; Cheng M.-H.; Lin Y.-T.; Huang W.-C.; Tsao C.-K.) CORRESPONDENCE ADDRESS F.-C. Wei, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Shing Street, Taoyuan, Taiwan. Email: fcw2007@adm.cgmh.org.tw SOURCE Plastic and Reconstructive Surgery (2007) 120:1 (187-195). Date of Publication: July 2007 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: Microsurgical free tissue transfer has become a reliable technique. Nevertheless, 5 to 25 percent of transferred flaps require re-exploration due to circulatory compromise. This study was conducted to evaluate the timing of occurrence of flap compromise following free tissue transfer, and its correlation with salvage outcome. METHODS: Between January of 2002 and June of 2003, 1142 free flap procedures were performed and 113 flaps (9.9 percent) received re-exploration due to compromise. All patients were cared for in the microsurgical intensive care unit for 5 days. Through a retrospective review, timing of presentation of compromise was identified and correlated with salvage outcome. RESULTS: Seventy-two flaps (63.7 percent) were completely salvaged and 23 (20.4 percent) were partially salvaged. Eighteen flaps (15.9 percent) failed completely. Ninety-three flaps (82.3 percent) presented with circulatory compromise within 24 hours; 108 (95.6 percent) presented with circulatory compromise within 72 hours, and 92 flaps (85.2 percent) were salvaged within this period. One out of the three flaps presenting with compromise 1 week postoperatively was salvaged. Flaps presenting with compromise upon admission to the microsurgical intensive care unit had significantly lower complete salvage rates as compared with those without immediate abnormal signs (40.9 percent versus 69.2 percent, p = 0.01). CONCLUSIONS: The time of presentation of flap compromise is a significant predictor of flap salvage outcome. Intensive flap monitoring at a special microsurgical intensive care unit by well-trained nurses and surgeons allows for early detection of vascular compromise, which leads to better outcomes. ©2007American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) free tissue graft vascular disease EMTREE MEDICAL INDEX TERMS adolescent adult aged article child controlled study female human human tissue intensive care unit male microsurgery priority journal retrospective study salvage therapy treatment outcome EMBASE CLASSIFICATIONS Dermatology and Venereology (13) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007301013 MEDLINE PMID 17572562 (http://www.ncbi.nlm.nih.gov/pubmed/17572562) PUI L46956049 DOI 10.1097/01.prs.0000264077.07779.50 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000264077.07779.50 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 778 TITLE Leaving critical care: facilitating a smooth transition. AUTHOR NAMES Boutilier S. AUTHOR ADDRESSES (Boutilier S.) University of South Florida, College of Nursing, Tampa, FL 33612, USA. CORRESPONDENCE ADDRESS S. Boutilier, University of South Florida, College of Nursing, Tampa, FL 33612, USA. SOURCE Dimensions of critical care nursing : DCCN (2007) 26:4 (137-142; quiz 143-144). Date of Publication: 2007 Jul-Aug ISSN 0730-4625 ABSTRACT Patient transfers from one area to another occur frequently within the inpatient healthcare environment. During transfers, nurses pass on information about patients to one another in a variety of ways. This article discusses the types of patient transfers, the problems that can occur throughout the transfer process, and strategies to decrease the identified problems. The perspectives of both the nursing staff and patients/families illustrate concerns related to patient transfers. The most important aspect of the patient transfer is systematically communicating necessary information to the receiving nurse in such a way that patient safety is not compromised and continuity of care is enhanced. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care interpersonal communication patient care patient care planning patient transport safety EMTREE MEDICAL INDEX TERMS attitude to health health personnel attitude health service human medical error (prevention) medical record methodology nurse attitude nursing staff organization and management psychological aspect review total quality management LANGUAGE OF ARTICLE English MEDLINE PMID 17577082 (http://www.ncbi.nlm.nih.gov/pubmed/17577082) PUI L47504577 DOI 10.1097/01.DCC.0000278762.46972.df FULL TEXT LINK http://dx.doi.org/10.1097/01.DCC.0000278762.46972.df COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 779 TITLE Technology Solutions for High-Risk Tasks in Critical Care AUTHOR NAMES Baptiste A. AUTHOR ADDRESSES (Baptiste A., andrea.baptiste@va.gov) Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL 33612, United States. CORRESPONDENCE ADDRESS A. Baptiste, Patient Safety Center of Inquiry, James A. Haley VAMC, Tampa, FL 33612, United States. Email: andrea.baptiste@va.gov SOURCE Critical Care Nursing Clinics of North America (2007) 19:2 (177-186). Date of Publication: June 2007 Safe Patient Handling, Book Series Title: ISSN 0899-5885 BOOK PUBLISHER W.B. Saunders ABSTRACT There are several high-risk nursing tasks in the critical care environment discussed in this article. These tasks include lateral transfers, repositioning patients up or side to side in bed, bed-to-chair or -wheelchair transfers, pericare of bariatric patients, toileting in bed, sustained limb holding for dressing wounds, and patient transport. Although many, if not all, of these tasks currently are performed manually, there are technological solutions available that undoubtedly can reduce the risks for caregiver and patient injuries. These solutions should be implemented in critical care to promote the safety of all involved in patient care. © 2007 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biomechanics (adverse drug reaction) biomedical technology assessment intensive care patient transport EMTREE MEDICAL INDEX TERMS bath bed rest body position daily life activity evidence based medicine human methodology nurse attitude nursing nursing evaluation research nursing staff occupational health organization and management review risk assessment risk factor safety skin care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 17512473 (http://www.ncbi.nlm.nih.gov/pubmed/17512473) PUI L46754778 DOI 10.1016/j.ccell.2007.02.011 FULL TEXT LINK http://dx.doi.org/10.1016/j.ccell.2007.02.011 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 780 TITLE Transfer surcharge AUTHOR NAMES Bekes C. AUTHOR ADDRESSES (Bekes C.) Cooper Health Systems, Camden, NJ, United States. CORRESPONDENCE ADDRESS C. Bekes, Cooper Health Systems, Camden, NJ, United States. SOURCE Critical Care Medicine (2007) 35:6 (1612-1613). Date of Publication: June 2007 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport reimbursement EMTREE MEDICAL INDEX TERMS cost benefit analysis editorial emergency ward financial management hospital admission human length of stay priority journal risk assessment EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007257431 MEDLINE PMID 17522534 (http://www.ncbi.nlm.nih.gov/pubmed/17522534) PUI L46809329 DOI 10.1097/01.CCM.0000266828.74601.46 FULL TEXT LINK http://dx.doi.org/10.1097/01.CCM.0000266828.74601.46 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 781 TITLE Casualty evacuations: Transport of the severely injured AUTHOR NAMES Richardson M.W. AUTHOR ADDRESSES (Richardson M.W., mark.richardson@lackland.af.mil) CORRESPONDENCE ADDRESS Email: mark.richardson@lackland.af.mil SOURCE Journal of Trauma - Injury, Infection and Critical Care (2007) 62:6 SUPPL. (S64-S65). Date of Publication: June 2007 ISSN 0022-5282 1529-8809 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) accident emergency health service EMTREE MEDICAL INDEX TERMS air medical transport conference paper critical illness human intensive care unit patient care patient transport priority journal resuscitation EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007285766 MEDLINE PMID 17556981 (http://www.ncbi.nlm.nih.gov/pubmed/17556981) PUI L46904338 DOI 10.1097/TA.0b013e318065adf3 FULL TEXT LINK http://dx.doi.org/10.1097/TA.0b013e318065adf3 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 782 TITLE Aeromedical evacuation of burn patients from Iraq AUTHOR NAMES Renz E.M. AUTHOR ADDRESSES (Renz E.M., evan.renz@amedd.army.mil) US Army, US Army Institute of Surgical Research, . CORRESPONDENCE ADDRESS E.M. Renz, US Army, US Army Institute of Surgical Research, . Email: evan.renz@amedd.army.mil SOURCE Journal of Trauma - Injury, Infection and Critical Care (2007) 62:6 SUPPL. (S74). Date of Publication: June 2007 ISSN 0022-5282 1529-8809 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport burn burn patient patient transport EMTREE MEDICAL INDEX TERMS air force conference paper Germany human injury severity intensive care unit Iraq lung injury priority journal thermal injury EMBASE CLASSIFICATIONS Surgery (9) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007285774 MEDLINE PMID 17556990 (http://www.ncbi.nlm.nih.gov/pubmed/17556990) PUI L46904346 DOI 10.1097/TA.0b013e318065af8f FULL TEXT LINK http://dx.doi.org/10.1097/TA.0b013e318065af8f COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 783 TITLE Surgical and intensive care needs of head-injured patients transferred to the University Hospital of the West Indies AUTHOR NAMES Harding-Goldson H.E. Crandon I.W. McDonald A.H. Augier R. Fearon-Boothe D. Rhoden A. Meeks-Aitken N. AUTHOR ADDRESSES (Harding-Goldson H.E., hyacinth.harding-goldson@uwimona.edu.jm; Crandon I.W.; McDonald A.H.; Augier R.; Fearon-Boothe D.; Rhoden A.; Meeks-Aitken N.) Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica. CORRESPONDENCE ADDRESS H.E. Harding-Goldson, Section of Anaesthesia and Intensive Care, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica. Email: hyacinth.harding-goldson@uwimona.edu.jm SOURCE West Indian Medical Journal (2007) 56:3 (230-233). Date of Publication: June 2007 ISSN 0043-3144 BOOK PUBLISHER University of the West Indies, Mona, Kingston 7, Jamaica. ABSTRACT A cross-sectional, descriptive study utilizing data collected in the 'Trauma Registry' of the Department of Surgery, Radiology, Anaesthesia and Intensive Care at the University Hospital of the West Indies (UHWI) was undertaken to document injury severity, surgical requirements and intensive care needs of head-injured patients transferred to the UHWI over a three-year period. Of 144 patients studied, the majority (71%) wereyoung males. Overall, injury tendedto be mild. Twenty-three patients (16.0%) had severe head injury and 27 patients (18.8%) were admitted to the intensive care unit. Concussion with (33%) or without (36%) skullfracture was the commonest neurological admission diagnosis. Associated non-neurological injuries in 33% were primarily fractures. Fifty-six patients (39%) re-quired surgical intervention. Craniotomies and open reduction and internal fixation of fractures were the commonest procedures. The majority ofpatients (79.2%) were discharged home; 56 (39%) made a good Glasgow outcome score recovery. Seventeen patients (11.8%) died in hospital. As most of the transferred patients with head injuries in this study had only mild injury, most commonly concussions, and their prognosis was good, we recommend that appropriate educational and training programmes and transfer policies be implemented to minimize inappropriate transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury (surgery) intensive care skull surgery EMTREE MEDICAL INDEX TERMS adolescent adult aged article brain contusion (surgery) brain hemorrhage (surgery) child clinical education concussion controlled study craniotomy cross-sectional study death descriptive research education program female Glasgow outcome scale hospital admission hospital discharge hospital policy human infant information processing injury severity intensive care unit major clinical study male open reduction (procedure) osteosynthesis patient transport prognosis skull fracture (surgery) traumatic brain injury (surgery) university hospital EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Otorhinolaryngology (11) Public Health, Social Medicine and Epidemiology (17) Orthopedic Surgery (33) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2007587417 MEDLINE PMID 18072402 (http://www.ncbi.nlm.nih.gov/pubmed/18072402) PUI L350200065 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 784 TITLE Unexpected Events during the Intrahospital Transport of Critically Ill Patients AUTHOR NAMES Papson J.P.N. Russell K.L. Taylor D.McD. AUTHOR ADDRESSES (Papson J.P.N., jonathan.papson@mh.org.au; Russell K.L.; Taylor D.McD.) Emergency Department, Royal Melbourne Hospital (JPNP, KLR, DMT), Vic., Australia. CORRESPONDENCE ADDRESS J.P.N. Papson, Emergency Department, Royal Melbourne Hospital (JPNP, KLR, DMT), Vic., Australia. Email: jonathan.papson@mh.org.au SOURCE Academic Emergency Medicine (2007) 14:6 (574-577). Date of Publication: June 2007 ISSN 1069-6563 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Objectives: To examine unexpected events (UEs) that occur during the intrahospital transport of critically ill emergency department patients. Methods: This was a prospective observational study of consecutive intrahospital transports between March 2003 and June 2004. The escorting emergency physician completed the data collection document either during or immediately after the transport. This document detailed equipment-related UEs, patient instability and invasive line-related UEs, whether the UEs required intervention, and whether the UEs were potentially life threatening (serious UEs). Results: Of 339 transports observed, 230 (67.9%; 95% confidence interval [CI] = 62.6% to 72.7%) were associated with 604 UEs. Overall, there was a median of 1.0 UE per transport (range, 0-16). There were 277 (45.9%; 95% CI = 41.8% to 49.9%) UEs related to equipment, 158 (26.2%; 95% CI = 22.7% to 29.9%) related to patient instability, 156 (25.8%; 95% CI = 22.4% to 29.6%) related to equipment lines, and 13 (2.2%, 95% CI = 1.2% to 3.8%) miscellaneous UEs. The most common UEs were oxygen saturation probe failures, lead and line tangles, hypotension, and the wearing off of sedation and/or paralysis. Most UEs (478 [79.1%]; 95% CI = 75.6% to 82.3%) required an intervention. Emergency physicians had a significantly lower UE rate than residents. Thirty serious UEs occurred; 5.0% (95% CI = 3.4% to 7.1%) of UEs and 8.9% (95% CI = 6.2% to 12.5%) of transports were associated with a serious UE. The most common were severe hypotension, decreasing consciousness requiring intubation, and increased intracranial pressure. Conclusions: Unexpected events during the intrahospital transport of critically ill patients from the emergency department are common and can be potentially life threatening. Transporting physician experience is associated with UE rate. Strict adherence to and review of existing transport guidelines is recommended. © 2007 Society for Academic Emergency Medicine. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital care intensive care EMTREE MEDICAL INDEX TERMS article confidence interval emergency human hypotension intracranial pressure intubation physician priority journal prospective study EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007239305 MEDLINE PMID 17535981 (http://www.ncbi.nlm.nih.gov/pubmed/17535981) PUI L46755596 DOI 10.1197/j.aem.2007.02.034 FULL TEXT LINK http://dx.doi.org/10.1197/j.aem.2007.02.034 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 785 TITLE Neurodevelopmental and growth outcomes of extremely low birth weight infants who are transferred from neonatal intensive care units to level I or II nurseries AUTHOR NAMES Lainwala S. Perritt R. Poole K. Vohr B. AUTHOR ADDRESSES (Lainwala S., slainwala@wihri.org; Vohr B.) Department of Pediatrics, Women and Infants Hospital, Providence, RI, United States. (Perritt R.; Poole K.) Statistical and Epidemiology Unit, RTI International, Research Triangle Park, NC, United States. (Lainwala S., slainwala@wihri.org) Department of Pediatrics, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, United States. CORRESPONDENCE ADDRESS S. Lainwala, Department of Pediatrics, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, United States. Email: slainwala@wihri.org SOURCE Pediatrics (2007) 119:5 (e1079-e1087). Date of Publication: May 2007 ISSN 0031-4005 0210-5721 (electronic) BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT OBJECTIVE. Transfer of clinically stable infants to level I and II nurseries alleviates demands on NICUs and allows better use of beds and resources. This study compared growth, neurodevelopmental impairments, postdischarge rehospitalization and deaths, and compliance for follow-up assessment at 18 to 22 months' corrected age of extremely low birth weight infants who transferred to level I and II nurseries with those who continued to receive care to discharge in a NICU. METHODS. A retrospective analysis of prospectively collected data from the National Institute of Child Health and Human Development Neonatal Research Network was performed. Between January 1998 and June 2002, 4896 infants born with birth weights of 401 to 1000 g and cared for in 19 National Institute of Child Health and Human Development Neonatal Research Network centers were included. The sample consisted of 4392 survivors who received continuing care in the NICU to discharge home and 504 infants who were transferred to level I and II nurseries before discharge home. Demographics, perinatal characteristics, growth, and neurodevelopmental impairments were compared. Bivariate and logistic regression analyses were performed. RESULTS. Transfer of infants to level I and II nurseries was associated significantly with white race, private insurance, outborn status, and lower neonatal morbidities and compliance for follow-up compared with the NICU group. After adjusting for known covariates, transfer to level I and II nurseries was not associated with neurodevelopmental impairments or death; however, it was associated with increased postdischarge rehospitalization. CONCLUSIONS. Extremely low birth weight infants who are transferred to level I and II nurseries have similar growth and neurodevelopmental outcomes to infants who are discharged from a NICU. They are, however, more likely to be readmitted to the hospital and are less compliant for follow-up. Establishment of consistent guidelines for comprehensive discharge planning for level I and II nurseries may improve follow-up compliance and reduce rehospitalization rates among these infants who are transferred. Copyright © 2007 by the American Academy of Pediatrics. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child growth extremely low birth weight EMTREE MEDICAL INDEX TERMS adolescent adult article birth weight bivariate analysis blindness brain disease cerebral palsy child care controlled study demography developmental disorder female follow up health insurance hearing impairment hospital discharge hospital readmission human infant major clinical study male mortality nervous system development newborn intensive care newborn morbidity nursery patient care patient compliance perinatal care priority journal retrospective study sepsis EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) Developmental Biology and Teratology (21) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007228390 MEDLINE PMID 17403821 (http://www.ncbi.nlm.nih.gov/pubmed/17403821) PUI L46715645 DOI 10.1542/peds.2006-0899 FULL TEXT LINK http://dx.doi.org/10.1542/peds.2006-0899 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 786 TITLE Defibrillator availability on rotor-wing critical care transports AUTHOR NAMES Frakes M.A. Neher S.W. AUTHOR ADDRESSES (Frakes M.A., mfrakes@harthosp.org) LIFE STAR, Hartford Hospital, Hartford, CT, United States. (Neher S.W.) Emergency Department, Middlesex Medical Center, Middletown, CT, United States. CORRESPONDENCE ADDRESS M.A. Frakes, LIFE STAR, Hartford Hospital, Hartford, CT, United States. Email: mfrakes@harthosp.org SOURCE Air Medical Journal (2007) 26:3 (144-146). Date of Publication: May/June 2007 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Introduction: Defibrillation is a time-critical and life-saving intervention for patients in ventricular fibrillation or ventricular tachycardia. The preparation of rotor-wing critical care transport teams to manage such arrhythmias out of the transport vehicle is unclear. Methods: A mail and telephone survey of 230 rotor-wing critical care transport programs. Results: Transport teams take a defibrillator to the patient's side on scene flights at 23.9% of programs, on interfacility flights at 48.3%, and after off-load at the receiving hospital at 43.1% of programs. Monitor style and utilization are associated with defibrillator deployment on scene flights, interfacility flights, and at offload. The site of patient origin does not affect transport team defibrillator availability on offload. Conclusions: It is not completely clear that defibrillators are immediately available during all phases of rotor-wing critical care transport. There are many opportunities for additional investigation. © 2007 Air Medical Journal Associates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport defibrillator intensive care EMTREE MEDICAL INDEX TERMS article defibrillation health program health survey heart arrest heart ventricle fibrillation heart ventricle tachycardia hospital human patient care postal mail priority journal telephone EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007197726 MEDLINE PMID 17467568 (http://www.ncbi.nlm.nih.gov/pubmed/17467568) PUI L46630334 DOI 10.1016/j.amj.2006.09.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2006.09.006 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 787 TITLE Bispectral index monitoring during intrahospital transport ORIGINAL (NON-ENGLISH) TITLE Monitorización del índice biespectral en el transporte intrahospitalario. AUTHOR NAMES Hernández-Gancedo C. Pestaña D. Criado A. AUTHOR ADDRESSES (Hernández-Gancedo C.; Pestaña D.; Criado A.) Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital General Universitario La Paz, Madrid. CORRESPONDENCE ADDRESS C. Hernández-Gancedo, Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital General Universitario La Paz, Madrid. Email: mhgancedo@hotmail.com SOURCE Revista española de anestesiología y reanimación (2007) 54:3 (169-172). Date of Publication: Mar 2007 ISSN 0034-9356 ABSTRACT BACKGROUND AND OBJECTIVE: Risk of morbidity and mortality increases for critically ill patients during transfers within the hospital. Such patients often require sedation, and suboptimal sedation is associated with hypertension, tachycardia, and ventilator dyssynchrony. The aim of this study was to assess level of sedation as indicated by monitoring of the bispectral (BIS) index during intrahospital transport of critical patients. PATIENTS AND METHODS: Thirty patients who required transport to the critical care unit within the hospital were studied prospectively. We recorded time in transport, the agent used for sedation and the dosage, the BIS index, mean arterial pressure (MAP), and heart rate before starting transport and upon arrival at the critical care unit. The data were recorded by an observer who was not assigned to patient care. RESULTS: The mean (SD) transport time was 13.9 (4.2) minutes. Midazolam was used in 26 patients and propofol in 4. Ten patients were given a bolus dose of cisatracurium before transfer started. Significant increases were observed in the BIS index (from 47 to 78, (P < .001), MAP (from 73 to 91 mmHg, P < .001), and heart rate (from 72 to 97 beats/min, P < .001) between the moment of starting transport and arrival at the critical care unit. Changes in the BIS index correlated significantly with changes in heart rate (r = 0.418, P = .024) but not with changes in MAP (r = 0.249, P = .19). CONCLUSIONS: Monitoring the BIS index during intrahospital transport of sedated, mechanically ventilated patients may be useful for detecting inadequate sedation. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hypnotic sedative agent (drug administration, drug therapy, pharmacology) EMTREE DRUG INDEX TERMS atracurium besilate (drug administration, drug therapy, pharmacology) cisatracurium drug derivative midazolam (drug administration, drug therapy, pharmacology) neuromuscular blocking agent (drug administration, drug therapy, pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) electroencephalography electromyography monitoring patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation blood pressure conscious sedation drug effect heart rate human intensive care intensive care unit methodology prospective study statistics time CAS REGISTRY NUMBERS atracurium (64228-79-1) cisatracurium (96946-41-7, 96946-42-8) midazolam (59467-70-8) LANGUAGE OF ARTICLE Spanish MEDLINE PMID 17436655 (http://www.ncbi.nlm.nih.gov/pubmed/17436655) PUI L46820956 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 788 TITLE Reconsidering the transfer of patients from the intensive care unit to the ward: A case study approach AUTHOR NAMES Wu C.-J. Coyer F. AUTHOR ADDRESSES (Wu C.-J., c3.wu@qut.edu.au; Coyer F.) School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia. (Wu C.-J., c3.wu@qut.edu.au) Intensive Care Unit/Coronary Care Unit, Mater Adult Hospital, Brisbane, QLD, Australia. CORRESPONDENCE ADDRESS C.-J. Wu, School of Nursing (N Block), Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia. Email: c3.wu@qut.edu.au SOURCE Nursing and Health Sciences (2007) 9:1 (48-53). Date of Publication: March 2007 ISSN 1441-0745 1442-2018 (electronic) BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT Evidence indicates that the poorly managed transfer of a patient from the intensive care unit (ICU) to the ward can lead to physical and psychological complications for the patient, and often require ICU readmission and rehospitalization. Reviewing this patient transfer process to improve the quality of care would be a positive step towards enhancing patients' recovery and providing skills to staff. The aim of this paper is to review case studies of transferring ICU patients to general wards in order to identify the shortcomings of this process. A literature review was conducted to evaluate current practices in the ICU transfer process. The results of this paper have clinical implications, suggest approaches to improve support for patients and their carers, and provide strategies to improve the transfer procedure. © 2007 The Authors; Journal Compilation © 2007 Blackwell Publishing Asia Pty Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical practice health care quality patient transport EMTREE MEDICAL INDEX TERMS caregiver case study coronary care unit critically ill patient hospital discharge hospital personnel hospital readmission human intensive care unit nursing care patient care practice guideline priority journal review teaching hospital EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007077263 MEDLINE PMID 17300545 (http://www.ncbi.nlm.nih.gov/pubmed/17300545) PUI L46218465 DOI 10.1111/j.1442-2018.2007.00294.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1442-2018.2007.00294.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 789 TITLE Lack of correlation in welfare check distribution and transport patterns in a rural critical care transport service AUTHOR NAMES Svenson J.E. O'Connor J.E. Lindsay M.B. AUTHOR ADDRESSES (Svenson J.E., jes@medicine.wisc.edu; Lindsay M.B.) Section of Emergency Medicine, University of Wisconsin, Madison, WI 53792, United States. (O'Connor J.E.) Med Flight, University of Wisconsin, Madison, WI 53792, United States. CORRESPONDENCE ADDRESS J.E. Svenson, Section of Emergency Medicine, University of Wisconsin, Madison, WI 53792, United States. Email: jes@medicine.wisc.edu SOURCE American Journal of Emergency Medicine (2007) 25:3 (345-347). Date of Publication: March 2007 ISSN 0735-6757 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Introduction: Understanding patterns of use of emergency medical services is important for planning adequate programs, budgets, and schedules. Understanding the factors associated with use of these services can help systems target high-risk populations or behaviors and allocate budgetary resources appropriately. Previous data have shown an association between the use of emergency health care use and distribution of welfare check distribution in both the United States and Canada. These data have limitations. In these studies, no attempt was made to investigate whether this increase in use was for particular types of complaints (medical or traumatic) or true outside of an urban community. The purpose of this study was to investigate whether there were similar monthly associations in patterns of use of a regional transport service for either medical or traumatic complaints. Methods: Med Flight is a regional aeromedical service operated by the University of Wisconsin. The service provides transport services to all hospitals and emergency medical services for critically ill or injured patients inside a radius of approximately 75 miles. The program transports approximately 1200 patients per year. Data for all transports for the years 1998-2004 were obtained. Daily numbers of transports were then compared for all patients and subsets of those with specifically traumatic or cardiac-related complaints. Results: There were 7756 transports during the study period: 34% of the transports were trauma related; 30% were cardiac related. There was a significant association between trauma-related flights and both month of the year (P < .0001) and day of the week (P < .001), but not for total or cardiac-related flights. There was no association between day or week of the month and transports. Conclusion: In contrast to previous studies, these findings show no association between use of a regional transport service and time of the month. Determinants of use of emergency services may differ between urban and nonurban areas. © 2007 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care patient transport EMTREE MEDICAL INDEX TERMS article correlation analysis disease association emergency care female health care distribution health care utilization heart disease high risk population human injury major clinical study male priority journal rural population urban population welfare EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007118412 MEDLINE PMID 17349912 (http://www.ncbi.nlm.nih.gov/pubmed/17349912) PUI L46356859 DOI 10.1016/j.ajem.2006.09.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajem.2006.09.003 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 790 TITLE Thirty-eight free fasciocutaneous flap transfers in acute burned-hand injuries AUTHOR NAMES Pan C.-H. Chuang S.-S. Yang J.-Y. AUTHOR ADDRESSES (Pan C.-H.; Chuang S.-S., sschuang@ms1.hinet.net; Yang J.-Y.) Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. CORRESPONDENCE ADDRESS S.-S. Chuang, Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. Email: sschuang@ms1.hinet.net SOURCE Burns (2007) 33:2 (230-235). Date of Publication: March 2007 ISSN 0305-4179 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT The benefits of free flap transfers in the acute burn injury are early wound closure, early mobility, reduced hospitalization, and possibly limb salvage. This retrospective study will attempt to provide principles to the use of free fasciocutaneous flap for the reconstruction of acute burned-hand injuries. Between 1995 and 2004, 5521 patients were admitted to the burn unit at Linkou Chang Gung Memorial Hospital. Of these, 38 patients (0.7%) patients received free fasciocutaneous flap transfers. Each patient's chart was reviewed the following data: age, gender, burn injury type, percentage of the burned area to total body surface area, flap type, operations prior to free flap coverage, the size and location of recipient area, timing of free flap coverage, operative time, duration of hospital stay, complications, flap survival and returning to work. All 38 free flaps survived and healed well. Three flaps with partial necrosis due to wound infections required subsequent debridement and skin grafting. Arterial thrombosis occurred in one patient and was salvaged successfully. Minimal donor-site morbidity with no intraoperative mortality was observed. Free fasciocutaneous flap transfer is a safe, efficacious one-stage reconstruction for acute burned-hands with satisfactory aesthetic and functional outcomes. Flap survival is not affected neither by the etiologies of burn nor the timing of free flap coverage. © 2006 Elsevier Ltd and ISBI. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (surgery) fasciocutaneous flap EMTREE MEDICAL INDEX TERMS adult artery thrombosis article body surface burn patient burn unit child debridement female gender hospital admission hospitalization human major clinical study male medical record morbidity operation duration patient satisfaction postoperative complication (complication) skin graft skin necrosis surgical mortality work wound healing wound infection EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007064976 MEDLINE PMID 17169493 (http://www.ncbi.nlm.nih.gov/pubmed/17169493) PUI L46186692 DOI 10.1016/j.burns.2006.06.022 FULL TEXT LINK http://dx.doi.org/10.1016/j.burns.2006.06.022 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 791 TITLE Pushing boundaries in paediatric intensive care: training as a paediatric retrieval nurse practitioner. AUTHOR NAMES Davies J. Lynch F. AUTHOR ADDRESSES (Davies J.; Lynch F.) South Thames Retrieval Service, PICU, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. CORRESPONDENCE ADDRESS J. Davies, South Thames Retrieval Service, PICU, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. Email: joanna.davies@gstt.nhs.uk SOURCE Nursing in critical care (2007) 12:2 (74-80). Date of Publication: 2007 Mar-Apr ISSN 1478-5153 (electronic) ABSTRACT Traditionally in the UK, the transportation of the critically ill child to a paediatric intensive care unit has been carried out by a medically led team of doctors and nurses. However, in countries such as the USA and Canada, appropriately trained nurse practitioners have proven to be competent in the transportation of these vulnerable children. This nurse-led team model has also been shown to be successful in the speciality of neonatal care in the UK. The impact of changes in the National Health Service (NHS) has led to an increased demand for the transportation of the child requiring paediatric intensive or high-dependency care, the lifting of restrictions on nursing practice and the reduction of doctors' hours in keeping with the European Working Time Directive. This has led to one NHS Trust in the UK developing the role of paediatric retrieval nurse practitioners (RNP): nurses who lead the retrieval team. The purpose of this article is to describe a pilot initiative to develop the role of RNPs. The comprehensive process of recruitment, training and assessment of competency will be detailed. Personal reflection on the project will also explore the pertinent nursing issues around; role impact and definition, conflict and change management, communication, legislation and personal and professional growth. Recommendations for future initiatives will also be explored. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nurse practitioner nursing education patient transport EMTREE MEDICAL INDEX TERMS child education human organization and management program development review United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 17883631 (http://www.ncbi.nlm.nih.gov/pubmed/17883631) PUI L350320515 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 792 TITLE Initial management of multiple-injury patients ORIGINAL (NON-ENGLISH) TITLE Die erstversorgung des polytraumatisierten patienten AUTHOR NAMES Adams H.A. Trentz O. AUTHOR ADDRESSES (Adams H.A.) Stabsstelle für Interdisziplinäre Notfall- und Katastrophenmedizin, Medizinische Hochschule Hannover, . (Trentz O.) Klinik für Unfallchirurgie, Universitätsspital Zürich, . CORRESPONDENCE ADDRESS H.A. Adams, Stabsstelle für Interdisziplinäre Notfall- und Katastrophenmedizin, Medizinische Hochschule Hannover, . SOURCE Anasthesiologie und Intensivmedizin (2007) 48:2 (73-92). Date of Publication: February 2007 ISSN 0170-5334 BOOK PUBLISHER DIOmed Verlags GmbH, Am Weichselgarten 30, Erlangen, Germany. ABSTRACT Multiple injury is a potentially life-threatening syndrome involving simultaneous injuries to various regions or organs with consecutive systemic dysfunctions. The most important risks are hypovolaemia and tissue hypoxia. The major tasks of the emergency physician are assessment of the patient and trauma mechanism (first view), a meticulous basic examination, preservation of gas exchange and the circulation, prevention of sequelae, prompt transport, timely alerting of the hospital and the establishment of a brief (indirect) anamnesis. Primarily, endotracheal intubation and controlled ventilation serve to secure oxygenation and the airways and analgesia only secondarily. After induction of anaesthesia, many seriously injured patients require no further analgesia or sedation, and the life-saving endocrine stress response must not be suppressed by inadequate application of anaesthetics, while in patients with clinical signs of insufficient anaesthesia a deepening of the anaesthesia is necessary. In patients with traumatic-haemorrhagic and haemorrhagic shock, rapid stabilization of the circulatory system through haemostasis and volume replacement must be attempted. Circulatory therapy should aim for an SAP > 90 mm Hg and an HR < 100/min, and an SAP > 120 mm Hg to achieve an adequate CPP in patients with craniocerebral trauma. In the event of uncontrolled bleeding, careful volume replacement with permissive hypotension is required, until surgical or interventional haemostasis can be established. In such cases, an SAP of about 70 - 80 mm Hg (or an MAP > 50 mm Hg) is desirable. In the emergency room, the responsible surgeon and anaesthesiologist should be provided with an oral and written report by the emergency physician, This is followed by a comprehensive examination of the patient by the specialists, the application of a high-flow central venous catheter und initial diagnostic imaging. During intrahospital transport, meticulous clinical and technical monitoring of the patient and protection against hypothermia are imperative. Urgent diagnostic procedures should be noted in writing and carried out without delay. The advantages and disadvantages of therapeutic measures must be carefully considered to ensure minimization of the traumatization. After admission to the intensive care unit, the patient should be systematically examined and assessed by the physician in charge at least once a day. A special emergency room is necessary not only for the primary care of multiple injury patients but also for other emergency patients. The equipment must be such as to permit the securement of vital functions and enable diagnostic and therapeutic interventions to be implemented, and a specialized emergency team must be available at all times. In the interest of the patient, interdisciplinary cooperation is imperative, and this is improved by the institution of a team coordinator. © Anästh Intensivmed. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) anesthetic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) multiple trauma (etiology) EMTREE MEDICAL INDEX TERMS analgesia anesthesia induction artificial ventilation central venous catheter diagnostic procedure emergency physician emergency ward endotracheal intubation head injury hemorrhagic shock human hypothermia hypovolemia hypoxemia oxygenation pathophysiology patient assessment primary medical care review risk assessment stress traumatic shock EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2007090492 PUI L46261882 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 793 TITLE Horizontal gene transfer in a polyclonal outbreak of carbapenem-resistant Acinetobacter baumannii AUTHOR NAMES Valenzuela J.K. Thomas L. Partridge S.R. Van Der Reijden T. Dijkshoorn L. Iredell J. AUTHOR ADDRESSES (Valenzuela J.K.; Thomas L.; Partridge S.R.; Iredell J., joni@icpmr.wsahs.nsw.gov.au) Centre for Infectious Diseases and Microbiology, University of Sydney, Sydney, NSW 2145, Australia. (Thomas L.) Institute for Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW 2145, Australia. (Van Der Reijden T.; Dijkshoorn L.) Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands. (Iredell J., joni@icpmr.wsahs.nsw.gov.au) Centre for Infectious Diseases and Microbiology, ICPMR Building, Westmead Hospital, Wentworthville, NSW 2145, Australia. CORRESPONDENCE ADDRESS J. Iredell, Centre for Infectious Diseases and Microbiology, ICPMR Building, Westmead Hospital, Wentworthville, NSW 2145, Australia. Email: joni@icpmr.wsahs.nsw.gov.au SOURCE Journal of Clinical Microbiology (2007) 45:2 (453-460). Date of Publication: February 2007 ISSN 0095-1137 BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. ABSTRACT In the last few years, phenotypically carbapenem resistant Acinetobacter strains have been identified throughout the world, including in many of the hospitals and intensive care units (ICUs) of Australia. Genotyping of Australian ICU outbreak-associated isolates by pulsed-field gel electrophoresis of whole genomic DNA indicated that different strains were cocirculating within one hospital. The carbapenem-resistant phenotype of these and other Australian isolates was found to be due to carbapenem-hydrolyzing activity associated with the presence of the bla(OXA-23) gene. In all resistant strains examined, the bla(OXA-23) gene was adjacent to the insertion sequence ISAba1 in a structure that has been found in Acinetobacter baumannii strains of a similar phenotype from around the world; bla(OXA-51)-like genes were also found in all A. baumannii strains but were not consistently associated with ISAba1, which is believed to provide the promoter required for expression of linked antibiotic resistance genes. Most isolates were also found to contain additional antibiotic resistance genes within the cassette arrays of class 1 integrons. The same cassette arrays, in addition to the ISAba1-bla (OXA-23) structure, were found within unrelated strains, but no common plasmid carrying these accessory genetic elements could be identified. It therefore appears that antibiotic resistance genes are readily exchanged between cocirculating strains in epidemics of phenotypically indistinguishable organisms. Epidemiological investigation of major outbreaks should include whole-genome typing as well as analysis of potentially transmissible resistance genes and their vehicles. Copyright © 2007, American Society for Microbiology. All Rights Reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carbapenem EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter baumannii antibiotic resistance epidemic horizontal gene transfer nucleotide sequence EMTREE MEDICAL INDEX TERMS antibiotic resistance gene article Australia bacterial gene bacterial genome bacterial strain bacterium isolate blaoxa 23 gene blaoxa 51 like gene drug hydrolysis human integron intensive care unit nonhuman phenotype priority journal pulsed field gel electrophoresis CAS REGISTRY NUMBERS carbapenem (83200-96-8) MOLECULAR SEQUENCE NUMBERS GENBANK (AF201828, AJ132105, AJ620678, AY288523, AY554200, AY795964, DQ029069, EF015496, EF015497, EF015498, EF015500) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007093590 MEDLINE PMID 17108068 (http://www.ncbi.nlm.nih.gov/pubmed/17108068) PUI L46272061 DOI 10.1128/JCM.01971-06 FULL TEXT LINK http://dx.doi.org/10.1128/JCM.01971-06 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 794 TITLE Doppler signal interpretation in free tissue transfer: A computer simulator for resident and nursing education AUTHOR NAMES Thornton B.P. Marek C. Stewart D.H. Vasconez H.C. AUTHOR ADDRESSES (Thornton B.P.) Kentucky Aesthetic and Plastic Surgery Institute, Lexington, KY, United States. (Marek C.) Plastic Surgery Associates, Lexington, KY, United States. (Stewart D.H.; Vasconez H.C.) Division of Plastic Surgery, University of Kentucky, Lexington, KY, United States. (Thornton B.P.) Norton Healthcare Pavilion, 315 East Broadway, Louisville, KY 40202, United States. CORRESPONDENCE ADDRESS B.P. Thornton, Norton Healthcare Pavilion, 315 East Broadway, Louisville, KY 40202, United States. SOURCE Journal of Reconstructive Microsurgery (2007) 23:2 (75-78). Date of Publication: February 2007 ISSN 0743-684X BOOK PUBLISHER Thieme Medical Publishers, Inc., 333 7th Avenue, New York, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) computer simulation free tissue graft nursing education residency education EMTREE MEDICAL INDEX TERMS edema graft perfusion human intensive care unit postoperative period priority journal reliability review training EMBASE CLASSIFICATIONS Surgery (9) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007136589 MEDLINE PMID 17330202 (http://www.ncbi.nlm.nih.gov/pubmed/17330202) PUI L46418449 DOI 10.1055/s-2007-970186 FULL TEXT LINK http://dx.doi.org/10.1055/s-2007-970186 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 795 TITLE Transferring critically ill patients out of hospital improves the standardized mortality ratio: A simulation study AUTHOR NAMES Kahn J.M. Kramer A.A. Rubenfeld G.D. AUTHOR ADDRESSES (Kahn J.M., jkahn@cceb.med.upenn.edu; Rubenfeld G.D.) Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA, United States. (Kramer A.A.) Cerner Corporation, Kansas City, MO, United States. (Kahn J.M., jkahn@cceb.med.upenn.edu) Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, School of Medicine, 3600 Spruce St, Philadelphia, PA 19104, United States. CORRESPONDENCE ADDRESS J.M. Kahn, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, School of Medicine, 3600 Spruce St, Philadelphia, PA 19104, United States. Email: jkahn@cceb.med.upenn.edu SOURCE Chest (2007) 131:1 (68-75). Date of Publication: January 2007 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians, 3300 Dundee Road, Northbrook, United States. ABSTRACT Background: Transferring critically ill patients to other acute care hospitals may artificially impact benchmarking measures. We sought to quantify the effect of out-of-hospital transfers on the standardized mortality ratio (SMR), an outcome-based measure of ICU performance. Methods: We performed a cohort study and Monte Carlo simulation using data from 85 ICUs participating in the acute physiology and chronic health evaluation (APACHE) clinical information system from 2002 to 2003. The SMR (observed divided by expected hospital mortality) was calculated for each ICU using APACHE FV risk adjustment. A set number of patients was randomly assigned to be transferred out alive rather than experience their original outcome. The SMR was recalculated, and the mean simulated SMR was compared to the original. Results: The mean (± SD) baseline SMR was 1.06 ± 0.19. In the simulation, increasing the number of transfers by 2% and 6% over baseline decreased the SMR by 0.10 ± 0.03 and 0.14 ± 0.03, respectively. At a 2% increase, 27 ICUs had a decrease in SMR of > 0.10, and two ICUs had a decrease in SMR of > 0.20. Transferring only one additional patient per month was enough to create a bias of > 0.1 in 27 ICUs. Conclusions: Increasing the number of acute care transfers by a small amount can significantly bias the SMR, leading to incorrect inference about ICU quality. Sensitivity to the variation in hospital discharge practices greatly limits the use of the SMR as a quality measure. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critically ill patient mortality patient transport EMTREE MEDICAL INDEX TERMS APACHE article cohort analysis health care quality hospital discharge human intensive care unit major clinical study Monte Carlo method outcome assessment priority journal EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007042265 MEDLINE PMID 17218558 (http://www.ncbi.nlm.nih.gov/pubmed/17218558) PUI L46122976 DOI 10.1378/chest.06-0741 FULL TEXT LINK http://dx.doi.org/10.1378/chest.06-0741 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 796 TITLE Post-resuscitation stabilization and transportation ORIGINAL (NON-ENGLISH) TITLE Estabilización posresucitación y transporte AUTHOR NAMES López-Herce Cid J. Canillo Álvarez A. Calvo Macías C. AUTHOR ADDRESSES (López-Herce Cid J., pielvi@ya.com; Canillo Álvarez A.) Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain. (Calvo Macías C.) Servicio de Críticos y Urgencias Pediátricas, Hospital Materno-Infantil de Málaga, Spain. (López-Herce Cid J., pielvi@ya.com) Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Dr. Castelo, 47, 28009 Madrid, Spain. CORRESPONDENCE ADDRESS J. López-Herce Cid, Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Dr. Castelo, 47, 28009 Madrid, Spain. Email: pielvi@ya.com SOURCE Anales de Pediatria (2006) 65:6 (578-585). Date of Publication: December 2006 ISSN 1695-4033 BOOK PUBLISHER Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain. ABSTRACT Cardiopulmonary resuscitation does not end with restoration of spontaneous circulation; rather, it must be continued with the application of all the measures that allow organ function to be maintained. The initial goal of hemodynamic treatment is to achieve normal blood pressure for the patient's age by means of fluids and/or vasoactive drugs. The aim of respiratory treatment is to normalize ventilation and oxygenation without causing further lung injury, avoiding hyperoxia and hyperventilation as well as hypoxia and hypercapnia. Neurological stabilization aims to reduce secondary brain damage, by avoiding hypertension and hypotension, maintaining normal ventilation and oxygenation, and treating hyperglycemia, agitation and seizures. Although no specific studies in children are available, data from adults have shown that early moderate hypothermia attenuates brain damage secondary to cardiorespiratory arrest, without increasing complications. After the arrest, the need for analgesia and/or sedation must be considered. The process of transportation to the pediatric intensive care unit (PICU) requires the following steps: stablizing the patient, checking for and stabilizing fractures and external wounds, ensuring a stable aiway and intravenous lines, assessing the need for nasogatric and bladder tubes, taking blood samples for analyses, contacting the PICU and informing the staff about the child's condition, choosing the optimal vehicle for transportation according to the child's condition and the distance, checking pediatric equipment and medications, selecting experienced staff and, finally, maintaining close surveillance and monitoring during transportation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport resuscitation EMTREE MEDICAL INDEX TERMS agitation analgesia blood pressure blood sampling brain damage (prevention) cardiopulmonary insufficiency hemodynamics human hypercapnia (prevention) hyperglycemia (therapy) hyperoxia hypertension (prevention) hyperventilation (prevention) hypotension (prevention) hypothermia hypoxia (prevention) intensive care unit lung injury lung ventilation neuroprotection oxygenation review sedation seizure (therapy) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2007044728 MEDLINE PMID 17340787 (http://www.ncbi.nlm.nih.gov/pubmed/17340787) PUI L46132818 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 797 TITLE Transfer of resistance to meropenem and other antibiotics from nosocomial Stenotrophomonas maltophilia strains to broad spectrum of recipient strains ORIGINAL (NON-ENGLISH) TITLE Transfer rezistencie na meropeném a ďalšie antibiotiká z nozokomiálnych kmeňov stenotrophomonas maltophilia na široké spektrum recipientných kmeňov AUTHOR NAMES Babálová M. Blahová J. Ježek P. Králiková K. Krčméry V. Menkyna R. AUTHOR ADDRESSES (Babálová M., marta.babalova@szu.sk; Blahová J.; Králiková K.; Krčméry V.; Menkyna R.) Národného Referenčného, Laboratória Pre Surveillance Antibiotickej Rezistencie, Katedry Chemoterapie Slovenskej Zdravotnickej Univerzity, Bratislave, Slovakia. (Ježek P.) Oddelenia Klinickej Mikrobiológie NsP Příbram, Czech Republic. (Babálová M., marta.babalova@szu.sk) Slovenská Zdravotnícka Univerzita, Limbová 14, 833 03 Bratislava 37, Slovakia. CORRESPONDENCE ADDRESS M. Babálová, Slovenská Zdravotnícka Univerzita, Limbová 14, 833 03 Bratislava 37, Slovakia. Email: marta.babalova@szu.sk SOURCE Lekarsky Obzor (2006) 55:9 (362-365). Date of Publication: 2006 ISSN 0457-4214 BOOK PUBLISHER Slovenska zdravotnicka univerzita, Limbova 12, , Slovakia. ABSTRACT Background: In several countries including Slovak Republic and Czech Republic, meropenem resistant bacteria begin to appear in increasing numbers in seriously ill hospitalized patients. Therefore, it is important to obtain information concerning the transferability of resistance to this maximally important and effective antibiotic. Set and Methods: We studied in mixed cultures of donor and recipient strains the transferability of resistance to meropenem and of other important antibiotics from two resistant strains of Stenotrophomonas maltophilia to an extended number of recipient strains including Pseudomonas aeruginosa and Proteus mirabilis. Donor strains were isolated in intensive care units of a large Regional Hospital in Příbram. Czech Republic. Results: Both strains transferred directly their resistance to meropenem and to other antibiotics to the recipient strains of P. mirabilis and P. aeruginosa. Nevertheless, the number of recipient strains, as well as the number of transferred determinants of resistance varied in individual pairs of donor and recipient strains. Thus, each donor strain transferred different elements of transferable antibiotic resistance. Conclusions: In the study a first case of a direct transfer of the determinant of meropenem to a set of recipient strains including P. aeruginosa was demonstrated. This fact points to the existence of a broad host range of transferred determinants of resistance. An important event of this process is the use of fairly extended set of recipient strains including those of P. aeruginosa. Results of this study demonstrate the unwanted situation that the genes of resistance to meropenem are mobilized for transfer also in hospitals of our region. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) meropenem EMTREE DRUG INDEX TERMS aztreonam cefalotin cefepime cefoperazone cefotaxime kanamycin rifampicin ticarcillin EMTREE MEDICAL INDEX TERMS antibiotic resistance article bacterial strain bacterium culture controlled study Czech Republic hospital infection intensive care unit nonhuman Proteus mirabilis Pseudomonas aeruginosa Stenotrophomonas maltophilia CAS REGISTRY NUMBERS aztreonam (78110-38-0) cefalotin (153-61-7, 58-71-9) cefepime (88040-23-7) cefoperazone (62893-19-0, 62893-20-3) cefotaxime (63527-52-6, 64485-93-4) kanamycin (11025-66-4, 61230-38-4, 8063-07-8) meropenem (96036-03-2) rifampicin (13292-46-1) ticarcillin (29457-07-6, 34787-01-4, 4697-14-7) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE Slovak LANGUAGE OF SUMMARY English, Slovak EMBASE ACCESSION NUMBER 2006611735 PUI L44912068 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 798 TITLE Horizontal transfer of Shiga toxin and antibiotic resistance genes among Escherichia coli strains in house fly (Diptera: Muscidae) gut AUTHOR NAMES Petridis M. Bagdasarian M. Waldor M.K. Walker E. AUTHOR ADDRESSES (Petridis M., mpetridi@jhsph.edu; Walker E.) Department of Entomology, Michigan State University, East Lansing, MI 48824, United States. (Petridis M., mpetridi@jhsph.edu; Bagdasarian M.; Walker E.) Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, United States. (Petridis M., mpetridi@jhsph.edu) Johns Hopkins University, Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Baltimore, MD 21205, United States. (Waldor M.K.) Division of Geographic Medicine and Infectious Diseases, New England Medical Center #233, 750 Washington St., Boston, MA 02111, United States. CORRESPONDENCE ADDRESS M. Petridis, Johns Hopkins University, Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Baltimore, MD 21205, United States. Email: mpetridi@jhsph.edu SOURCE Journal of Medical Entomology (2006) 43:2 (288-295). Date of Publication: 2006 ISSN 0022-2585 BOOK PUBLISHER Entomological Society of America ABSTRACT Whether the house fly, Musca domestica L., gut is a permissive environment for horizontal transfer of antibiotic resistance and virulence genes between strains of Escherichia coli is not known. House flies were immobilized and force fed suspensions of defined, donor strains of E. coli containing chloramphenicol resistance genes on a plasmid, or lysogenic, bacteriophage-born Shiga toxin gene stx1 (bacteriophage H-19B::Ap1). Recipient strains were E. coli lacking these mobile elements and genes but having rifampicin as a selectable marker. Plasmid transfer occurred at rates of 10(-2) per donor cell in the fly midgut and 10(-3) in the fly crop after 1 h of incubation postfeeding. Bacteriophage transfer rate was ≈10(-6) per donor cell without induction, but induction with mitomycin C increased rates of transfer to 10 (-2) per donor cell. These findings show that genes encoding antibiotic resistance or toxins will transfer horizontally among bacteria in the house fly gut via plasmid transfer or phage transduction. The house fly gut may provide a favorable environment for the evolution and emergence of pathogenic bacterial strains through acquisition of antibiotic resistance genes or virulence factors. © 2006 Entomological Society of America. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) verotoxin 1 EMTREE DRUG INDEX TERMS primer DNA rifampicin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance Escherichia coli horizontal gene transfer house fly EMTREE MEDICAL INDEX TERMS animal article bacterial count bacteriophage bacterium conjugation chemistry classification comparative study gastrointestinal tract genetic marker genetic transduction genetics methodology microbiology phenotype plasmid polymerase chain reaction CAS REGISTRY NUMBERS rifampicin (13292-46-1) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 16619613 (http://www.ncbi.nlm.nih.gov/pubmed/16619613) PUI L44743539 DOI 10.1603/0022-2585(2006)043[0288:HTOSTA]2.0.CO;2 FULL TEXT LINK http://dx.doi.org/10.1603/0022-2585(2006)043[0288:HTOSTA]2.0.CO;2 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 799 TITLE Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit AUTHOR NAMES Gillman L. Leslie G. Williams T. Fawcett K. Bell R. McGibbon V. AUTHOR ADDRESSES (Gillman L., Lucia.gillman@health.wa.gov.au; Leslie G.) Royal Perth Hospital, Edith Cowan University, Perth, WA 6001, Australia. (Williams T.) Centre for Nursing Evidence Based Practice, Department of Education and Research, Royal Perth Hospital, Perth, WA 6001, Australia. (Fawcett K.; Bell R.) Emergency Department, Royal Perth Hospital, Perth, WA 6001, Australia. (McGibbon V.) Intensive Care Unit, Royal Perth Hospital, Perth, WA 6001, Australia. CORRESPONDENCE ADDRESS L. Gillman, Royal Perth Hospital, Edith Cowan University, Perth, WA 6001, Australia. Email: Lucia.gillman@health.wa.gov.au SOURCE Emergency Medicine Journal (2006) 23:11 (858-861). Date of Publication: November 2006 ISSN 1472-0205 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Objectives: To determine the incidence and nature of adverse events and delay to patient transfer from emergency department to intensive care unit (ICU) in a metropolitan tertiary hospital. Method: A 6-month prospective observational study in conjunction with a retrospective chart audit on all emergency department patients admitted to ICU, including those admitted via theatre or after a computed tomography scan. Results: Equipment problems was the most common adverse event occurring in 9% of patient transfers (n = 290). Hypothermia events occurred in 7% of transfers, cardiovascular events in 6% of patient transfers, delays to transfer >20 min occurred in 38% of the prospectively audited cases, with 14% waiting > 1 h. One patient was found to have an incorrect patient identification band during a preoperative check. Conclusions: This study generally reported lower rates of adverse events than noted in previous studies involving critically ill transfers. The most significant finding was the application of an incorrect patient identification band and has prompted a review of practice. The establishment of benchmark indicators for adverse events and delays in transfer will be useful for future audits. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness intensive care patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article cardiovascular disease clinical audit controlled study disease course emergency ward human hypothermia intensive care unit major clinical study medical error patient identification priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006543536 MEDLINE PMID 17057138 (http://www.ncbi.nlm.nih.gov/pubmed/17057138) PUI L44696841 DOI 10.1136/emj.2006.037697 FULL TEXT LINK http://dx.doi.org/10.1136/emj.2006.037697 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 800 TITLE Determination of closest appropriate destination facility for air and critical care medical transportation AUTHOR NAMES Position Statement of the Air Medical Physician Association AUTHOR ADDRESSES (Position Statement of the Air Medical Physician Association) SOURCE Air Medical Journal (2006) 25:6 (276-277). Date of Publication: November/December 2006 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport patient care EMTREE MEDICAL INDEX TERMS article decision making emergency care health care facility intensive care patient transport physician policy priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006519129 MEDLINE PMID 17071417 (http://www.ncbi.nlm.nih.gov/pubmed/17071417) PUI L44615499 DOI 10.1016/j.amj.2006.09.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2006.09.005 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 801 TITLE Management of obese patients in the intensive care unit: technical aspects ORIGINAL (NON-ENGLISH) TITLE Prise en charge des patients obèses en réanimation : aspects techniques AUTHOR NAMES Clec'h C. Gonzalez F. Cohen Y. AUTHOR ADDRESSES (Clec'h C., christophe.clech@avc.aphp.fr; Gonzalez F.; Cohen Y.) Service de réanimation, hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny cedex, France. CORRESPONDENCE ADDRESS C. Clec'h, Service de réanimation, hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny cedex, France. Email: christophe.clech@avc.aphp.fr SOURCE Reanimation (2006) 15:6 (445-448). Date of Publication: Nov 2006 ISSN 1624-0693 ABSTRACT Anatomic patterns of obesity are responsible for various and potentially deleterious technical problems. Particularly, airway management, vascular access, monitoring, routine investigations, intrahospital transfers, as well as nursing and positioning can be challenging. A global therapeutic approach, which takes these technical problems into account is undoubtedly mandatory for improving the outcome of obese patients admitted to the intensive care unit. © 2006 Société de réanimation de langue française. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care obesity EMTREE MEDICAL INDEX TERMS human laboratory test nursing patient monitoring patient transport short survey vascular access EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 2006566248 PUI L44765316 DOI 10.1016/j.reaurg.2006.09.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.reaurg.2006.09.010 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 802 TITLE Utility of serial computed tomography imaging in pediatric patients with head trauma AUTHOR NAMES Durham S.R. Liu K.C. Selden N.R. AUTHOR ADDRESSES (Durham S.R., srd@hitchcock.org) Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, United States. (Liu K.C.; Selden N.R.) CORRESPONDENCE ADDRESS S.R. Durham, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03766, United States. Email: srd@hitchcock.org SOURCE Journal of Neurosurgery (2006) 105 PEDIATRICS:SUPPL. 5 (365-369). Date of Publication: November 2006 ISSN 0022-3085 0022-3085 (electronic) BOOK PUBLISHER American Association of Neurological Surgeons, 1224 West Main Street Suite 450, Charlottesville, United States. ABSTRACT Object. The purpose of this study was to evaluate the risk of progression of traumatic intracranial lesions in children by comparing initial and subsequent computed tomography (CT) scans. Reserving repeated CT imaging for patients who harbor higher-risk lesions may reduce overall radiation exposure, the need for sedative agents, and cost. Methods. The authors performed a retrospective cohort study in 268 patients younger than 18 years of age who underwent repeated CT scanning within 24 hours of their initial CT scanning procedure. The risk of progression between the initial and repeated CT scanning sessions and the need for delayed neurosurgical intervention were determined for each lesion type. In 54 patients (20.1%) the normal findings on the initial CT study did not change on subsequent imaging. In 61 (28.5%) of the 214 patients in whom abnormal findings were present on the initial scan, progression was demonstrated. Patients with epidural hematoma (EDH; odds ratio [OR] 12.29), subdural hematoma (SDH; OR 3.18), cerebral edema (OR 9.34), and intraparenchymal hemorrhage (IPH; OR 18.3) were found to be at a significantly increased risk for progression and to require delayed neurosurgical intervention (OR 11.91). No significantly increased risk was found for patients with subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), diffuse axonal injury (DAI), or skull fracture. Conclusions. Repeated CT imaging in children with high-risk lesions such as EDH, SDH, cerebral edema, and IPH is recommended. However, in children with low-risk lesions, such as SAH, IVH, DAI, and isolated skull fractures but no sign of clinical deterioration, repeated imaging may be less likely to alter the clinical management scheme. The limited benefits of undertaking repeated imaging in these patients should be weighed against the risks of radiation exposure, sedation, intrahospital transportation, and patient monitoring. EMTREE DRUG INDEX TERMS sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) traumatic brain injury EMTREE MEDICAL INDEX TERMS adolescent adult article axonal injury brain edema brain hemorrhage child computer assisted tomography controlled study epidural hematoma female head injury health care cost human infant major clinical study male medical assessment priority journal radiation exposure risk assessment skull fracture subarachnoid hemorrhage subdural hematoma EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Neurology and Neurosurgery (8) Radiology (14) Orthopedic Surgery (33) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006624256 MEDLINE PMID 17328259 (http://www.ncbi.nlm.nih.gov/pubmed/17328259) PUI L44954764 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 803 TITLE "Stay, just a little bit longer...". AUTHOR NAMES Leslie G.D. AUTHOR ADDRESSES (Leslie G.D.) CORRESPONDENCE ADDRESS G.D. Leslie, SOURCE Australian critical care : official journal of the Confederation of Australian Critical Care Nurses (2006) 19:4 (119). Date of Publication: Nov 2006 ISSN 1036-7314 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care delivery intensive care unit length of stay patient transport safety EMTREE MEDICAL INDEX TERMS Australia editorial health service hospital bed utilization hospital discharge human organization and management progressive patient care statistics LANGUAGE OF ARTICLE English MEDLINE PMID 17165489 (http://www.ncbi.nlm.nih.gov/pubmed/17165489) PUI L45004745 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 804 TITLE Assessment of the relationship between cerebral and splanchnic oxygen saturations measured by near-infrared spectroscopy and direct measurements of systemic haemodynamic variables and oxygen transport after the Norwood procedure AUTHOR NAMES Li J. Van Arsdell G.S. Zhang G. Cai S. Humpl T. Caldarone C.A. Holtby H. Redington A.N. AUTHOR ADDRESSES (Redington A.N., andrew.redington@sickkids.ca) Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8, Canada. (Li J.; Van Arsdell G.S.; Zhang G.; Cai S.; Humpl T.; Caldarone C.A.; Holtby H.; Redington A.N., andrew.redington@sickkids.ca) Cardiac Program, Hospital for Sick Children, Toronto, Ont., Canada. CORRESPONDENCE ADDRESS A.N. Redington, Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, Ont. M5G 1X8, Canada. Email: andrew.redington@sickkids.ca SOURCE Heart (2006) 92:11 (1678-1685). Date of Publication: November 2006 ISSN 1355-6037 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Objectives: To evaluate the clinical utility of near-infrared spectroscopic (NIRS) monitoring of cerebral (ScO(2)) and splanchnic (SsO (2)) oxygen saturations for estimation of systemic oxygen transport after the Norwood procedure. Methods: ScO(2) and SsO(2) were measured with NIRS cerebral and thoracolumbar probes (in humans). Respiratory mass spectrometry was used to measure systemic oxygen consumption (V̇O (2)). Arterial (SaO(2)), superior vena caval (SvO2) and pulmonary venous oxygen saturations were measured at 2 to 4 h intervals to derive pulmonary (Qp) and systemic blood flow (Qs), systemic oxygen delivery (DO(2)) and oxygen extraction ratio (ERO(2)). Mixed linear regression was used to test correlations. A study of 7 pigs after cardiopulmonary bypass (study 1) was followed by a study of 11 children after the Norwood procedure (study 2). Results: Study 1. ScO(2) moderately correlated with SvO(2), mean arterial pressure, Qs, DO(2) and ERO(2) (slope 0.30, 0.64. 2.30, 0.017 and -32.5, p < 0.0001) but not with SaO(2), arterial oxygen pressure (PaO(2)), haemoglobin and V̇O(2). Study 2. ScO(2) correlated well with SvO (2), SaO(2), PaO(2) and mean arterial pressure (slope 0.43, 0.61, 0.99 and 0.52, p < 0.0001) but not with haemoglobin (slope 0.24, p > 0.05). ScO(2) correlated weakly with V̇O(2) (slope -0.07, p = 0.05) and moderately with Qs, DO(2) and ERO(2) (slope 3.2, 0.03, -33.2, p < 0.0001). SsO(2) showed similar but weaker correlations. Conclusions: ScO(2) and SsO(2) may reflect the influence of haemodynamic variables and oxygen transport after the Norwood procedure. However, the interpretation of NIRS data, in terms of both absolute values and trends, is difficult to rely on clinically. EMTREE DRUG INDEX TERMS hemoglobin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart hemodynamics heart muscle oxygen consumption EMTREE MEDICAL INDEX TERMS animal experiment arterial oxygen saturation arterial oxygen tension article brain oxygen tension controlled study coronary care unit female human human experiment infant male mass spectrometry mean arterial pressure near infrared spectroscopy newborn nonhuman Norwood procedure oxygen consumption oxygen transport priority journal splanchnic blood flow superior cava vein systemic circulation CAS REGISTRY NUMBERS hemoglobin (9008-02-0) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006523381 MEDLINE PMID 16621884 (http://www.ncbi.nlm.nih.gov/pubmed/16621884) PUI L44629186 DOI 10.1136/hrt.2005.087270 FULL TEXT LINK http://dx.doi.org/10.1136/hrt.2005.087270 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 805 TITLE Is your patient ready for transport? Developing an ICU patient transport decision scorecard. AUTHOR NAMES Esmail R. Banack D. Cummings C. Duffett-Martin J. Rimmer K. Shultz J. Thurber T. Hulme T. AUTHOR ADDRESSES (Esmail R.; Banack D.; Cummings C.; Duffett-Martin J.; Rimmer K.; Shultz J.; Thurber T.; Hulme T.) Calgary Health Region, Foothills Medical Centre, AB. CORRESPONDENCE ADDRESS R. Esmail, Calgary Health Region, Foothills Medical Centre, AB. Email: rosmin.esmail@calgaryhealthregion.ca SOURCE Healthcare quarterly (Toronto, Ont.) (2006) 9 Spec No (80-86). Date of Publication: Oct 2006 ISSN 1710-2774 ABSTRACT Transport of patients from the intensive care unit (ICU) to another area of the hospital can pose serious risks if the patient has not been assessed prior to transport. Recently, the Department of Critical Care Medicine, Calgary Health Region, experienced two adverse events during transport. A subgroup of the Department's Patient Safety and Adverse Events team developed an ICU patient transport decision scorecard. This tool was tested through Plan-Do-Study-Act cycles and further revised using human factors principles. Staff, especially novice nurses, found the tool extremely useful in determining patient preparedness for transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making intensive care unit patient transport safety EMTREE MEDICAL INDEX TERMS article Canada health services research human organization and management program development LANGUAGE OF ARTICLE English MEDLINE PMID 17087174 (http://www.ncbi.nlm.nih.gov/pubmed/17087174) PUI L44983739 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 806 TITLE Reduction of musculoskeletal injuries in intensive care nurses using ceiling-mounted patient lifts. AUTHOR NAMES Silverwood S. Haddock M. AUTHOR ADDRESSES (Silverwood S.; Haddock M.) Richmond Health Services, British Columbia. CORRESPONDENCE ADDRESS S. Silverwood, Richmond Health Services, British Columbia. SOURCE Dynamics (Pembroke, Ont.) (2006) 17:3 (19-21). Date of Publication: 2006 Fall ISSN 1497-3715 ABSTRACT The musculoskeletal injury (MSI) rate in the Richmond Hospital Intensive Care Unit (ICU) increased significantly in 2000 and 2001 by 130%. As part of a quality initiative program, the problem was identified, assessed, and a plan was developed that involved the installation of ceiling-mounted patient lifts (CMPL) and the incorporation of a patient positioning sling. The evaluation process included a survey given to the ICU nursing staff prior to the implementation of the CMPL and repeated three, six, and 18 months after implementation. The survey included questions about discomfort, fatigue, and frustration levels before and after a 12-hour shift, as well as any medical interventions such as use of medications, physician visits, physiotherapy, and massage therapy for work-related issues. The use of the lifts contributed to lower scores in fatigue, pain and frustration in addition to a reduction in medical visits. The results also demonstrated a significant reduction in work-related time loss claims while promoting a positive workplace environment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biomechanics (adverse drug reaction) health personnel attitude musculoskeletal disease (epidemiology, etiology, prevention) nursing staff occupational disease (epidemiology, etiology, prevention) patient transport EMTREE MEDICAL INDEX TERMS absenteeism article bed rest bioengineering body position Canada (epidemiology) equipment design fatigue (etiology, prevention) frustration human intensive care job satisfaction longitudinal study methodology nurse attitude nursing nursing evaluation research nursing methodology research occupational health organization and management pain (etiology, prevention) psychological aspect workload workplace LANGUAGE OF ARTICLE English MEDLINE PMID 17009569 (http://www.ncbi.nlm.nih.gov/pubmed/17009569) PUI L44686699 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 807 TITLE Pretransport and posttransport characteristics and outcomes of neonates who were admitted to a cardiac intensive care unit AUTHOR NAMES Yeager S.B. Horbar J.D. Greco K.M. Duff J. Thiagarajan R.R. Laussen P.C. AUTHOR ADDRESSES (Yeager S.B., scott.yeager@vtmednet.org; Greco K.M.) Department of Pediatrics, University of Vermont, School of Medicine, Burlington, VT, United States. (Horbar J.D.) Center for Patient Safety in Neonatal Intensive Care, Vermont Oxford Network, Burlington, VT, United States. (Duff J.; Thiagarajan R.R.; Laussen P.C.) Department of Cardiology, Children's Hospital Boston, Boston, MA, United States. (Yeager S.B., scott.yeager@vtmednet.org) Division of Pediatric Cardiology, University of Vermont School of Medicine, FAHC Patrick 581, Burlington, VT 05401, United States. CORRESPONDENCE ADDRESS S.B. Yeager, Division of Pediatric Cardiology, University of Vermont School of Medicine, FAHC Patrick 581, Burlington, VT 05401, United States. Email: scott.yeager@vtmednet.org SOURCE Pediatrics (2006) 118:3 (1070-1077). Date of Publication: September 2006 ISSN 0031-4005 0210-5721 (electronic) BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT OBJECTIVE. The objective for this study was to characterize the impact and the safety of transporting neonates with known or suspected cardiac abnormalities. METHODS. We reviewed retrospectively the charts and computerized records of 192 admissions to a cardiac ICU in 2002. Patients were included when they were <28 days of age at admission and were transported from adjacent obstetric facilities (local N = 70) or other inpatient medical facilities (transport N = 122). Demographic, clinical, pharmacologic, laboratory, and diagnostic information was obtained before transport (when available) and within 3 hours of arrival. Arrival status was considered optimal when measured metabolic and clinical parameters all were within range. Outcome variables included days on ventilator, days in ICU, days in hospital, and death. RESULTS. Of local admissions, 31 (44%) patients had 61 suboptimal arrival values, including pH <7.25 (n = 11), saturation <70% (n = 12), and temperature <36°C (n = 9). There were 69 undocumented values in 39 patients. Of transported patients, 55 (45%) had 86 suboptimal arrival values, including pH <7.25 (n = 8), saturation <70% (n = 14), and temperature <36°C (n = 13). There were 98 undocumented values in 53 patients. No in-transport deaths or catastrophic events occurred. Local admissions were more likely to have a prenatal diagnosis of heart disease and had more complex disease and higher mortality. Other outcome parameters were not significantly different between the 2 groups. Low admission arterial saturation, pH, and core temperature were not correlated with adverse outcome measures. CONCLUSIONS. Although we did not encounter major transport complications, opportunities exist to optimize arrival status and improve surveillance and documentation. Copyright © 2006 by the American Academy of Pediatrics. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child hospitalization heart disease patient transport EMTREE MEDICAL INDEX TERMS article controlled study core temperature correlation analysis data analysis health survey human major clinical study mortality newborn newborn intensive care outcome assessment outcome variable oxygen saturation pH prenatal diagnosis priority journal statistical analysis terminal disease EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007030262 MEDLINE PMID 16951000 (http://www.ncbi.nlm.nih.gov/pubmed/16951000) PUI L46090048 DOI 10.1542/peds.2006-0719 FULL TEXT LINK http://dx.doi.org/10.1542/peds.2006-0719 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 808 TITLE A problem with delivering CPAP during patient transport [17] AUTHOR NAMES Sandby-Thomas M. AUTHOR ADDRESSES (Sandby-Thomas M., msandbythomas@btinternet.com) University Hospital of Wales, Cardiff CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS M. Sandby-Thomas, University Hospital of Wales, Cardiff CF14 4XN, United Kingdom. Email: msandbythomas@btinternet.com SOURCE Anaesthesia (2006) 61:8 (816-817). Date of Publication: August 2006 ISSN 0003-2409 1365-2044 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport positive end expiratory pressure EMTREE MEDICAL INDEX TERMS critically ill patient human intensive care unit letter medical device oxygen supply oxygenation radiology department tracheostomy ventilator wakefulness DEVICE TRADE NAMES Oxylog 2000 , United KingdomDrager DEVICE MANUFACTURERS (United Kingdom)Drager CAS REGISTRY NUMBERS oxygen (7782-44-7) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006328143 MEDLINE PMID 16867111 (http://www.ncbi.nlm.nih.gov/pubmed/16867111) PUI L44027429 DOI 10.1111/j.1365-2044.2006.04733.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2044.2006.04733.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 809 TITLE Intensive care and beyond: improving the transitional experiences for critically ill patients and their families AUTHOR NAMES Chaboyer W. AUTHOR ADDRESSES (Chaboyer W., W.Chaboyer@griffith.edu.au) Research Centre for Clinical Practice Innovation, Griffith University, Gold Coast Campus, Australia. CORRESPONDENCE ADDRESS W. Chaboyer, Research Centre for Clinical Practice Innovation, Griffith University, Gold Coast Campus, Australia. Email: W.Chaboyer@griffith.edu.au SOURCE Intensive and Critical Care Nursing (2006) 22:4 (187-193). Date of Publication: August 2006 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health critical illness family intensive care nurse patient transport EMTREE MEDICAL INDEX TERMS adaptive behavior aftercare anxiety (prevention) caregiver cost of illness editorial health personnel attitude human life event nurse attitude nursing organization and management patient care psychological aspect survivor total quality management LANGUAGE OF ARTICLE English MEDLINE PMID 16782338 (http://www.ncbi.nlm.nih.gov/pubmed/16782338) PUI L44103579 DOI 10.1016/j.iccn.2006.05.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2006.05.001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 810 TITLE Perceptions of critical care outreach within a network. AUTHOR NAMES Plowright C. Fraser J. Smith S. Buras-Rees S. Dennington L. King D. MacLellan C. Seymour P. Scott G. Brindle A. AUTHOR ADDRESSES (Plowright C.; Fraser J.; Smith S.; Buras-Rees S.; Dennington L.; King D.; MacLellan C.; Seymour P.; Scott G.; Brindle A.) Medway NHS Trust. CORRESPONDENCE ADDRESS C. Plowright, Medway NHS Trust. SOURCE Nursing times (2006) 102:29 (36-40). Date of Publication: 2006 Jul 18-24 ISSN 0954-7762 ABSTRACT AIM: The purpose of this study was to establish healthcare professionals' perceptions of critical care outreach. METHOD: A multi-site survey approach was used to collect qualitative data. RESULTS: Most respondents felt that outreach assisted with patient care by enabling the admission and smooth discharge to and from the critical care units and providing useful education and training that changed practice. Respondents also thought that the audits undertaken by the outreach teams benefited patient care. CONCLUSION: Overall, outreach was considered by healthcare professionals to enhance patient care and improve practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health personnel attitude intensive care nursing staff patient care patient transport EMTREE MEDICAL INDEX TERMS article education evaluation study general hospital health care quality human needs assessment nursing nursing education nursing methodology research organization and management psychological aspect public hospital public relations qualitative research questionnaire social support standard United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 16895249 (http://www.ncbi.nlm.nih.gov/pubmed/16895249) PUI L44303420 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 811 TITLE Impact of the reinforcement of a Methicillin-Resistant Staphylococcus aureus Control Programme: A 3-year evaluation by several indicators in a French University Hospital AUTHOR NAMES Eveillard M. Lancien E. De Lassence A. Branger C. Barnaud G. Benlolo J.-A. Joly-Guillou M.-L. AUTHOR ADDRESSES (Eveillard M., mathieu.eveillard@lmr.ap-hop-paris.fr; Lancien E.; Branger C.; Barnaud G.; Benlolo J.-A.; Joly-Guillou M.-L.) Department of Microbiology and Hygiene, Intensive Care Unit, Hôpital Louis Mourier AP-HP, 178 rue des Renouillers, Colombes F-92700, France. (De Lassence A.) Intensive Care Unit, Hôpital Louis Mourier AP-HP, 178 rue des Renouillers, Colombes F-92700, France. (Eveillard M., mathieu.eveillard@lmr.ap-hop-paris.fr) Department of Microbiology and Hygiene, Hôpital Louis Mourier (Assistance Publique - Hôpitaux de Paris), 178 rue des Renouillers, Colombes F-92700, France. CORRESPONDENCE ADDRESS M. Eveillard, Department of Microbiology and Hygiene, Hôpital Louis Mourier (Assistance Publique - Hôpitaux de Paris), 178 rue des Renouillers, Colombes F-92700, France. Email: mathieu.eveillard@lmr.ap-hop-paris.fr SOURCE European Journal of Epidemiology (2006) 21:7 (551-558). Date of Publication: July 2006 ISSN 0393-2990 1573-7284 (electronic) BOOK PUBLISHER Springer Netherlands, Van Godewijckstraat 30, Dordrecht, Netherlands. ABSTRACT Our objective was to evaluate the impact of the reinforcement of a methicillin-resistant Staphylococcus aureus (MRSA) control programme and to assess the impact of risk adjustment on the interpretation of data. A stepwise, retrospective analysis of 3-year prospectively collected data was performed in a 600-bed French teaching hospital in the Parisian area. A reinforcement of a pre-existing programme for limiting the spread of MRSA was implemented in 2002 and 2003 by increasing the frequency of the feedback of surveillance data, by using alcohol-based disinfectants, and by increasing patient screening. Different indicators were used to follow the change over time of MRSA transmission: the proportion of MRSA acquired in our hospital, the incidence of newly acquired MRSA/1,000 patient-days (PD) (incidence of newly acquired MRSA), the incidence of newly acquired MRSA isolated in at least one clinical specimen/1,000 PD (incidence of newly acquired clinical MRSA), and a risk-adjusted indicator, the incidence of newly acquired-MRSA isolated in at least one clinical specimen/1,000 PD of carriers identified at admission (incidence related to the risk of acquisition). The change over time of these indicators was studied with the chi-square test for trend. During the study, all indicators decreased significantly, with a mean drop of 0.07/1,000 PD for the incidence of newly acquired clinical MRSA, and a mean drop of 3.0/1,000 PD for the incidence related to the risk of acquisition. The proportion of MRSA acquired in our hospital decreased from 49.3% in 2002 to 24.1% in 2004. Concurrently, between 2002 and 2004, the number of patients screened on admission to hospital or at the time of intra-hospital transfer increased by 31% and the consumption of waterless alcohol-based hand disinfectants increased by 244%. The decreasing trend of all indicators emphasizes the effectiveness of the reinforcement of our MRSA control programme. From 2002 to 2004, the trend of the indicator related to the risk of acquisition over time is similar to those of other indicators. Further studies should be useful to assess if risk-adjustment is absolutely necessary when tracking rates within a single institution. © 2006 Springer Science+Business Media B.V. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alcohol derivative disinfectant agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) infection control methicillin resistant Staphylococcus aureus Staphylococcus infection (epidemiology, etiology, prevention) EMTREE MEDICAL INDEX TERMS article bacterial transmission bacterium carrier bacterium culture bacterium identification bacterium isolate bacterium isolation chi square test disinfection evaluation study France health program hospital admission hospital infection (etiology, prevention) human incidence nonhuman outcome assessment trend study university hospital EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006509075 MEDLINE PMID 16915525 (http://www.ncbi.nlm.nih.gov/pubmed/16915525) PUI L44578333 DOI 10.1007/s10654-006-9024-y FULL TEXT LINK http://dx.doi.org/10.1007/s10654-006-9024-y COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 812 TITLE Transporting critically ill patients: new opportunities for nurses. AUTHOR NAMES Mackintosh M. AUTHOR ADDRESSES (Mackintosh M.) Cardiothoracic Intensive Care, Freeman Hospital, Newcastle upon Tyne. CORRESPONDENCE ADDRESS M. Mackintosh, Cardiothoracic Intensive Care, Freeman Hospital, Newcastle upon Tyne. Email: magron169@onetel.com SOURCE Nursing standard (Royal College of Nursing (Great Britain) : 1987) (2006) 20:36 (46-48). Date of Publication: 2006 May 17-23 ISSN 0029-6570 ABSTRACT This article examines the inter-hospital and intra-hospital transport of critically ill patients in relation to recent guidelines and recommendations for the safe transfer of patients. The impact of new legislation on existing practice and the implications for developing new nursing roles are also discussed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS article human nurse attitude public health social change United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 16755893 (http://www.ncbi.nlm.nih.gov/pubmed/16755893) PUI L44068096 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 813 TITLE Efficacy of fentanyl analgesia for trauma in critical care transport AUTHOR NAMES Frakes M.A. Lord W.R. Kociszewski C. Wedel S.K. AUTHOR ADDRESSES (Frakes M.A., mfrakes@harthosp.org; Lord W.R.) LIFE STAR, Hartford Hospital, Hartford, CT 06102-5037, United States. (Frakes M.A., mfrakes@harthosp.org; Kociszewski C.; Wedel S.K.) Boston MedFlight, Boston, MA 01730, United States. CORRESPONDENCE ADDRESS M.A. Frakes, LIFE STAR, Hartford Hospital, Hartford, CT 06102-5037, United States. Email: mfrakes@harthosp.org SOURCE American Journal of Emergency Medicine (2006) 24:3 (286-289). Date of Publication: May 2006 ISSN 0735-6757 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Introduction: Pain relief is one of the most important interventions for out-of-hospital patient care providers. This paper documents the need for and benefits from the administration of fentanyl to trauma patients during critical care transport. Methods: We underwent a retrospective review of the transport charts of 100 trauma patients who received fentanyl analgesia during transport and who were able to use a numeric response scale to rate their pain from 0 to 10. Results: Mean initial pain report was 7.6 ± 2.2 units, relieved to 3.7 ± 2.8 units by a mean total fentanyl dose of 1.6 ± 0.8 μg/kg (P < .001). Neither initial pain level nor pain relief differed between male and female patients, but did differ between patients originating at the site of injury and those transferred between hospitals. Fentanyl dose correlated poorly with the magnitude of pain relief (r = 0.22), but a dose greater than 2 μg/kg provided more relief than lower doses (5.1 ± 2.1 vs 3.6 ± 2.4, P < .02). Conclusion: Fentanyl analgesia from these critical care transport teams provided significant pain relief to trauma patients. Pain reduction was greater for patients who received more than 2.0 μg/kg of fentanyl. © 2006 Elsevier Inc. All rights reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) analgesic agent (drug dose, drug therapy) fentanyl (drug dose, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) injury intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged analgesia article child correlation analysis drug efficacy drug megadose female hospital human low drug dose major clinical study male medical record review pain (drug therapy) pain assessment priority journal rating scale sex difference CAS REGISTRY NUMBERS fentanyl (437-38-7) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006195694 MEDLINE PMID 16635698 (http://www.ncbi.nlm.nih.gov/pubmed/16635698) PUI L43621844 DOI 10.1016/j.ajem.2005.11.021 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajem.2005.11.021 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 814 TITLE Clinical research and critical care transport: How to get started AUTHOR NAMES Thompson C.B. Panacek E.A. AUTHOR ADDRESSES (Thompson C.B., cbthompson@unmc.edu; Panacek E.A.) SOURCE Air Medical Journal (2006) 25:3 (107-111). Date of Publication: May/June 2006 ISSN 1067-991X 1532-6497 (electronic) BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical research intensive care EMTREE MEDICAL INDEX TERMS article clinical practice clinical protocol emergency care evidence based practice feasibility study human information processing medical decision making medical literature newborn care null hypothesis patient transport prediction priority journal publication reliability research ethics statistical analysis EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006204459 MEDLINE PMID 16679250 (http://www.ncbi.nlm.nih.gov/pubmed/16679250) PUI L43642211 DOI 10.1016/j.amj.2006.02.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2006.02.004 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 815 TITLE Practicing neonatology in a blackout: the University Hospital NICU in the midst of Hurricane Katrina: caring for children without power or water. AUTHOR NAMES Barkemeyer B.M. AUTHOR ADDRESSES (Barkemeyer B.M.) Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. CORRESPONDENCE ADDRESS B.M. Barkemeyer, Division of Neonatology, Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. Email: bbarke@lsuhsc.edu SOURCE Pediatrics (2006) 117:5 Pt 3 (S369-374). Date of Publication: May 2006 ISSN 1098-4275 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster neonatology newborn intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS article emergency health service high frequency ventilation human methodology newborn organization and management power supply telecommunication United States university hospital water supply LANGUAGE OF ARTICLE English MEDLINE PMID 16735267 (http://www.ncbi.nlm.nih.gov/pubmed/16735267) PUI L43809116 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 816 TITLE Sweating it out in a level III regional NICU: disaster preparation and lessons learned at the Ochsner Foundation Hospital. AUTHOR NAMES Ginsberg H.G. AUTHOR ADDRESSES (Ginsberg H.G.) Neonatal Intensive Care Unit, Alton Ochsner Foundation Hospital, New Orleans, LA 70121, USA. CORRESPONDENCE ADDRESS H.G. Ginsberg, Neonatal Intensive Care Unit, Alton Ochsner Foundation Hospital, New Orleans, LA 70121, USA. Email: hginsberg@ochsner.org SOURCE Pediatrics (2006) 117:5 Pt 3 (S375-380). Date of Publication: May 2006 ISSN 1098-4275 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster newborn intensive care patient care patient transport teaching hospital EMTREE MEDICAL INDEX TERMS article disaster planning emergency health service human methodology neonatology newborn organization and management power supply telecommunication United States water supply LANGUAGE OF ARTICLE English MEDLINE PMID 16735268 (http://www.ncbi.nlm.nih.gov/pubmed/16735268) PUI L43809117 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 817 TITLE Critical care transport teams: searching for evidence of effectiveness AUTHOR NAMES McDonald A.C. AUTHOR ADDRESSES (McDonald A.C.) Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont., Canada. (McDonald A.C.) Department of Emergency Services, Sunnybrook Women's College Health Sciences Centre, Toronto, Ont. M4N 3M5, Canada. CORRESPONDENCE ADDRESS A.C. McDonald, Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont., Canada. SOURCE Journal of Critical Care (2006) 21:1 (17-18). Date of Publication: Mar 2006 ISSN 0883-9441 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article government health care policy health care quality health service human intensive care unit length of stay mortality EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006189942 PUI L43606764 DOI 10.1016/j.jcrc.2005.12.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.jcrc.2005.12.009 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 818 TITLE National Consensus Conference. The rehabilitation management of traumatic brain injury patients during the acute phase: Criteria for referral and transfer from intensive care units to rehabilitative facilities (Modena June 20-21, 2000) AUTHOR NAMES Taricco M. De Tanti A. Boldrini P. Gatta G. AUTHOR ADDRESSES (Taricco M., mataari@tin.it) Functional Recovery and Rehabilitation Unit, Passirana di Rho (Milan), Italy. (De Tanti A.) Cardinal Ferrari Centre, Fontanellato (Parma), Italy. (Boldrini P.) Rehabilitation Unit, ULSS 9, Treviso, Italy. (Gatta G.) Rehabilitative Medicine Unit, Civil Hospital, Ravenna, Italy. (Taricco M., mataari@tin.it) U.O. Recupero e Rieducazione Funzionale, Azienda Ospedaliera G. Salvini, Via Settembrini 1, 20020 Passirana di Rho, Rho (Milano), Italy. CORRESPONDENCE ADDRESS M. Taricco, U.O. Recupero e Rieducazione Funzionale, Azienda Ospedaliera G. Salvini, Via Settembrini 1, 20020 Passirana di Rho, Rho (Milano), Italy. Email: mataari@tin.it SOURCE Europa Medicophysica (2006) 42:1 (73-84). Date of Publication: March 2006 ISSN 0014-2573 BOOK PUBLISHER Edizioni Minerva Medica S.p.A., Corso Bramante 83-85, Turin, Italy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) traumatic brain injury (rehabilitation) EMTREE MEDICAL INDEX TERMS conference paper disease classification human intensive care unit medical literature medical research EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) Rehabilitation and Physical Medicine (19) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006223892 MEDLINE PMID 16565689 (http://www.ncbi.nlm.nih.gov/pubmed/16565689) PUI L43700254 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 819 TITLE Pulmonary edema in meningococcal septicemia associated with reduced epithelial chloride transport AUTHOR NAMES Eisenhut M. Wallace H. Barton P. Gaillard E. Newland P. Diver M. Southern K.W. AUTHOR ADDRESSES (Eisenhut M., michael_eisenhut@yahoo.com; Wallace H.; Gaillard E.; Southern K.W.) Institute of Child Health, University of Liverpool, . (Southern K.W.) Paediatric Respiratory Medicine, Institute of Child Health, University of Liverpool, . (Barton P.; Newland P.) Royal Liverpool Children's NHS Trust, Alder Hey Hospital, . (Diver M.) Clinical Biochemistry, Royal Liverpool University Hospital, Liverpool, United Kingdom. (Eisenhut M., michael_eisenhut@yahoo.com) 5 Prestwood Crescent, Liverpool L14 2ED, United Kingdom. CORRESPONDENCE ADDRESS M. Eisenhut, 5 Prestwood Crescent, Liverpool L14 2ED, United Kingdom. Email: michael_eisenhut@yahoo.com SOURCE Pediatric Critical Care Medicine (2006) 7:2 (119-124). Date of Publication: March 2006 ISSN 1529-7535 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT Objectives: To test the hypothesis that meningococcal septicemia-related pulmonary edema is associated with a systemic abnormality of epithelial sodium and chloride transport and to investigate an association with hormones regulating Na(+) transport. Design: Prospective observational study. Setting: The 24-bed pediatric intensive care unit and pediatric wards of Royal Liverpool Children's Hospital. Patients: Consecutive children admitted to the pediatric intensive care unit and pediatric wards with a diagnosis of meningococcal septicemia and children (controls) with noninfectious critical illness receiving ventilatory support in the pediatric intensive care unit. Measurements and Main Results: We measured sweat and saliva electrolytes, renal electrolyte excretion, nasal potential difference, and aldosterone, thyroxine, and cortisol levels. Pulmonary edema was diagnosed by chest radiography and its severity quantified by calculation of ventilation index at admission and duration of mechanical ventilation. We recruited 17 patients with severe meningococcal septicemia (nine patients with pulmonary edema), 14 patients with mild meningococcal septicemia, and 20 controls. Sweat andsaliva Na(+) and Cl(-) concentrations and renal Na(+) excretion were significantly (p < .05) higher in patients with pulmonary edema compared with controls. Nasal potential difference and amiloride response in patients with pulmonary edema were not significantly different to controls, but response to a low Cl(-) solution was reduced in the nasal airway of patients with pulmonary edema (p < .05). Sweat and saliva chloride concentrations correlated significantly and better with ventilation index and duration of ventilation than sodium concentrations. Aldosterone, thyroxine, and cortisol levels were not significantly different between groups. Conclusions: We have confirmed that meningococcal septicemia-related pulmonary edema is associated with reduced systemic sodium and chloride transport. Features of reduced Cl (-) transport were most closely associated with markers of respiratory compromise, and this was supported by the reduced chloride channel function detected on nasal potential difference measurement. Copyright © 2006 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) chloride (endogenous compound) EMTREE DRUG INDEX TERMS aldosterone (endogenous compound) amiloride electrolyte (endogenous compound) hydrocortisone (endogenous compound) sodium ion (endogenous compound) thyroxine (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) chloride transport lung edema (diagnosis) meningococcosis (etiology) septicemia (etiology) EMTREE MEDICAL INDEX TERMS airway artificial ventilation clinical article controlled study critical illness disease association disease severity female hormonal regulation hospital admission human intensive care unit lung alveolus epithelium male potential difference preschool child priority journal prospective study quantitative analysis review saliva level sodium transport sweat thorax radiography treatment duration urinary excretion CAS REGISTRY NUMBERS aldosterone (52-39-1, 6251-69-0) amiloride (2016-88-8, 2609-46-3) chloride (16887-00-6) hydrocortisone (50-23-7) sodium ion (17341-25-2) thyroxine (7488-70-2) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) General Pathology and Pathological Anatomy (5) Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006163505 MEDLINE PMID 16446600 (http://www.ncbi.nlm.nih.gov/pubmed/16446600) PUI L43506385 DOI 10.1097/01.PCC.0000200944.98424.E0 FULL TEXT LINK http://dx.doi.org/10.1097/01.PCC.0000200944.98424.E0 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 820 TITLE The nursing role in ICU outreach: an international exploratory study. AUTHOR NAMES Endacott R. Chaboyer W. AUTHOR ADDRESSES (Endacott R.; Chaboyer W.) School of Nursing & Midwifery, La Trobe University, Victoria 3086, Australia. CORRESPONDENCE ADDRESS R. Endacott, School of Nursing & Midwifery, La Trobe University, Victoria 3086, Australia. Email: ruth.endacott@plymouth.ac.uk SOURCE Nursing in critical care (2006) 11:2 (94-102). Date of Publication: 2006 Mar-Apr ISSN 1362-1017 ABSTRACT It is widely acknowledged that many critically ill patients are managed outside of designated critical care units. One strategy adopted in Australia and England to assess and manage risk in these patients is the intensive care unit (ICU) outreach or liaison nurse service. This article examines how ICU outreach/liaison roles in Australia and England operate in the context of Manley's theoretical framework for advanced nursing practice. Descriptive case study design using semi-structured interviews and job descriptions as sources of evidence. Findings of interviews with six Australian ICU Liaison nurses are already published; this study replicated the Australian study with four ICU Consultant Nurses in England and mapped interview and job description data from both countries onto Manley's conceptual framework for advanced practice/consultant nurse. Four themes emerged from the English data: patient interventions, support for ward staff, liaison between ward and ICU staff and hospital-wide impact. The first three of these comprised the core service common to the roles in both countries. Manley's four subroles (expert practitioner, consultant, educator and researcher) were present across both countries. However, the interview and job description data demonstrated that there were lower expectations in Australia that the roles would lead to staff development and build capacity across the hospital system. Similarly, formal education for ward staff such as ALERT and CRiSP courses were more developed in UK. Our data demonstrate that the role undertaken in England and Australia is sufficiently comparable to use as a research intervention in international studies across the two countries. However, the macro service level differs. Job descriptions across both countries emphasized the need to influence hospital policy; however, the ICU consultant nurses in England might be considered better placed to achieve this through role title and access to the hospital executive. In both countries, the roles would benefit from systematic evaluation of the impact on outcomes. This is particularly important for longer-term integration of the role in the health services in both countries. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital subdivisions and components intensive care unit nurse nurse attitude patient transport public relations EMTREE MEDICAL INDEX TERMS aftercare article attitude to health Australia comparative study cultural factor education health personnel attitude human interpersonal communication model nursing methodology research nursing staff nursing theory organization and management psychological aspect questionnaire social support United Kingdom verbal communication work LANGUAGE OF ARTICLE English MEDLINE PMID 16555757 (http://www.ncbi.nlm.nih.gov/pubmed/16555757) PUI L43582522 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 821 TITLE Interfacility transportation of the critical care patient and its medical direction. AUTHOR ADDRESSES SOURCE Annals of emergency medicine (2006) 47:3 (305). Date of Publication: Mar 2006 ISSN 1097-6760 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS administrative personnel editorial human organization and management patient care practice guideline standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 16492517 (http://www.ncbi.nlm.nih.gov/pubmed/16492517) PUI L43464690 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 822 TITLE The support of severe respiratory failure beyond the hospital and during transportation AUTHOR NAMES Kashani K.B. Farmer J.C. AUTHOR ADDRESSES (Kashani K.B.) Division of Nephrology, University of Southern California, Los Angeles, CA, United States. (Farmer J.C., farmer.j@mayo.edu) Department of Critical Care Medicine, Program in Translational Immunovirology and Biodefense, Mayo Clinic, Rochester, MN, United States. CORRESPONDENCE ADDRESS J.C. Farmer, Department of Critical Care Medicine, Program in Translational Immunovirology and Biodefense, Mayo Clinic, Rochester, MN, United States. Email: farmer.j@mayo.edu SOURCE Current Opinion in Critical Care (2006) 12:1 (43-49). Date of Publication: February 2006 ISSN 1070-5295 1531-7072 (electronic) BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT Purpose of review: Given the number and variety of calamities in the past few years, providing support for critically ill and injured casualties has become a global priority. This article reviews and describes the challenges faced in providing critical care and respiratory support in an austere environment and during medical transport. The primary focus to be discussed is mechanical ventilation. Recent findings: The United States Air Force has developed a programme called the Critical Care Aeromedical Transport Teams. These teams provide dynamic and sophisticated critical care in austere environments, including during medical transport. The Critical Care Aeromedical Transport Teams programme provides a framework for the discussion of supporting respiratory failure in these settings. We will discuss the team concept of operations, the equipment assemblage, methods and techniques of intensive care unit patient care in this setting, and caveats and pitfalls as they pertain to respiratory failure, mechanical ventilation, and respiratory monitoring. Summary: The support of respiratory failure with mechanical ventilation during a disaster is complex and challenging. The key to success is pre-planning, flexibility, and portability. Programmes such as the Critical Care Aeromedical Transport Teams can be a useful model for the development of appropriate civil response capabilities in critical care for use during a disaster. © 2006 Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport artificial ventilation respiratory failure (therapy) EMTREE MEDICAL INDEX TERMS air force alarm monitor assisted ventilation disaster education program health care personnel human intensive care unit positive end expiratory pressure respiratory function review staff training systematic review United States ventilator EMBASE CLASSIFICATIONS Internal Medicine (6) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006196105 MEDLINE PMID 16394783 (http://www.ncbi.nlm.nih.gov/pubmed/16394783) PUI L43623920 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 823 TITLE Evacuation of trauma patients solely to Level 1 centers: Is the question patient or trauma center survival? AUTHOR NAMES Spira R.M. Reissman P. Goldberg S. Hersch M. Einav S. AUTHOR ADDRESSES (Spira R.M., traumaszmc@yahoo.com; Reissman P.; Goldberg S.) Department of General Surgery, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel. (Hersch M.; Einav S.) Intensive Care Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel. (Spira R.M., traumaszmc@yahoo.com; Reissman P.; Goldberg S.; Hersch M.; Einav S.) Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. CORRESPONDENCE ADDRESS R.M. Spira, Dept. of Surgery, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel. Email: traumaszmc@yahoo.com SOURCE Israel Medical Association Journal (2006) 8:2 (131-133). Date of Publication: February 2006 ISSN 1565-1088 BOOK PUBLISHER Israel Medical Association, 2 Twin Towers,11th Floor,35 Jabotinsky Street,PO Box 3566, Ramat Gan, Israel. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service injury (surgery) patient transport EMTREE MEDICAL INDEX TERMS accreditation article blood transfusion blunt trauma (surgery) disease severity health care delivery health care facility health care system hospital admission hospital care hospitalization human intensive care unit length of stay neurosurgery patient care penetrating trauma (surgery) rehabilitation medicine scoring system surgeon survival treatment planning EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Forensic Science Abstracts (49) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006093017 MEDLINE PMID 16544740 (http://www.ncbi.nlm.nih.gov/pubmed/16544740) PUI L43280134 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 824 TITLE Evacuation to a trauma center or a non-trauma center? Is there any doubt? AUTHOR NAMES Stein M. AUTHOR ADDRESSES (Stein M., mshtein@clalit.org.il) Department of Surgery, Rabin Medical Center, Trauma Services, Beilinson Campus, Petah Tiqva 49100, Israel. (Stein M., mshtein@clalit.org.il) Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. CORRESPONDENCE ADDRESS M. Stein, Trauma Services, Dept. of Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel. Email: mshtein@clalit.org.il SOURCE Israel Medical Association Journal (2006) 8:2 (134-136). Date of Publication: February 2006 ISSN 1565-1088 BOOK PUBLISHER Israel Medical Association, 2 Twin Towers,11th Floor,35 Jabotinsky Street,PO Box 3566, Ramat Gan, Israel. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service injury (surgery) patient transport EMTREE MEDICAL INDEX TERMS article clinical protocol emergency ward health care facility health care quality hospital admission hospital care hospital management human intensive care unit Israel operating room patient care register resuscitation traumatology victim EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Forensic Science Abstracts (49) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006093018 MEDLINE PMID 16544741 (http://www.ncbi.nlm.nih.gov/pubmed/16544741) PUI L43280135 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 825 TITLE Optimal equipment for medical transport of patients suffering cardiovascular diseases ORIGINAL (NON-ENGLISH) TITLE Équipement optimal pour un transport médicalisé en pathologie cardiovasculaire AUTHOR NAMES Sauval P. An K. AUTHOR ADDRESSES (Sauval P., patrick.sauval@nck.ap-hop-paris.fr; An K.) SAMU de Paris, SMUR Necker, 149 rue de Sèvres, 75015 Paris. CORRESPONDENCE ADDRESS P. Sauval, SAMU de Paris, SMUR Necker, 149 rue de Sèvres, 75015 Paris. Email: patrick.sauval@nck.ap-hop-paris.fr SOURCE Medecine Therapeutique - Cardio (2006) 2:1 (131-136). Date of Publication: Jan 2006 ISSN 1774-8747 ABSTRACT The French Society of Anesthesia and Intensive Care (SFAR) as well as SAMU de France have published recommendations for medical transportation. National rules have been established to regulate medical transportation standards. According to the guidelines, the medical personnel involved in the transport shall include a MD, a nurse and an ambulance driver. The recommended equipment to transfer patients with cardiovascular disease should provide monitoring, treatment or help for the diagnosis. In France, this type of transport is usually accomplished by SMUR. The equipment should allow for cardiopulmonary resuscitation. Thus, congestive heart failure, heart attack and pulmonary embolism frequently require means of artificial ventilation. The equipment involved in cardiovascular intensive care should improve diagnostic accuracy, monitoring and some emergency medical emergency actions. Many technological improvements have been added to this basic equipment such as biological analysis and in situ echocardiography. In the very near future, clinical data obtained on site from the patient will probably be directly transmitted to the receiving service in hospital, as already happens with pre-hospital ECG. The shared medical records can be consulted at the patient's bedside and the new data collected during transportation (either texts or images) could be added. The optimal use of equipment and the medical training of the personnel responsible for transportation are an invaluable aid in the response to secure cardiovascular emergencies, the primary cause of mortality and handicap. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) devices patient transport EMTREE MEDICAL INDEX TERMS artificial ventilation cardiovascular disease congestive heart failure diagnostic accuracy echocardiography emergency care heart infarction human intensive care unit lung embolism medical device medical education medical personnel medical record patient monitoring practice guideline resuscitation review EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2006192881 PUI L43616389 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 826 TITLE Establishing a rural emergency medical retrieval service AUTHOR NAMES Whitelaw A.S. Hsu R. Corfield A.R. Hearns S. AUTHOR ADDRESSES (Whitelaw A.S.; Hsu R.; Corfield A.R., alasdair.corfield@rah.scot.nhs.uk; Hearns S.) Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9PN, United Kingdom. CORRESPONDENCE ADDRESS A.R. Corfield, Department of Emergency Medicine, Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9PN, United Kingdom. Email: alasdair.corfield@rah.scot.nhs.uk SOURCE Emergency Medicine Journal (2006) 23:1 (76-78). Date of Publication: January 2006 ISSN 1472-0205 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT In 2004 the Argyll and Clyde health board established the Emergency Medical Retrieval Service to support its rural community hospitals. This article describes both why the service was established and its aims. This service covers a geographically extensive area, with approximately 85 000 people living in remote locations. Rural general practitioners in six community hospitals provide initial patient assessment and resuscitation. Providing emergency care and safe transfer of seriously ill and injured patients presenting to these community hospitals is a significant challenge. All parties involved felt that there was a need to provide a service to transport critically ill and injured patients from these remote locations to definitive care. The idea of the team is to bring the resuscitation room to the patient in the rural setting. With this aim and in order to implement the Intensive Care Society guidelines for the transport of critically ill patients, it was decided that consultants in Emergency Medicine and Anaesthetics with an interest in critical care would staff the service medically. This service is unique within the UK and the authors aim to report our findings from ongoing research and audit in future papers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service patient transport rural area EMTREE MEDICAL INDEX TERMS article general practitioner health care delivery intensive care unit patient assessment practice guideline priority journal resuscitation EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006018725 MEDLINE PMID 16373814 (http://www.ncbi.nlm.nih.gov/pubmed/16373814) PUI L43056375 DOI 10.1136/emj.2005.025528 FULL TEXT LINK http://dx.doi.org/10.1136/emj.2005.025528 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 827 TITLE Transfer of the hematopoietic stem cell transplant patient to the intensive care unit: Does it really matter? AUTHOR NAMES Naeem N. Reed M.D. Creger R.J. Youngner S.J. Lazarus H.M. AUTHOR ADDRESSES (Naeem N.; Creger R.J.; Lazarus H.M., hillard.lazarus@case.edu) Department of Medicine, Division of Hematology-Oncology, 11100 Euclid Avenue, Cleveland, OH 44106, United States. (Reed M.D.) Department of Pediatrics, Division of Pediatric Pharmacology and Critical Care, Cleveland, OH, United States. (Youngner S.J.) Department of Psychiatry, University Hospitals of Cleveland, Rainbow Babies and Childrens Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, United States. CORRESPONDENCE ADDRESS H.M. Lazarus, Department of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, United States. Email: hillard.lazarus@case.edu SOURCE Bone Marrow Transplantation (2006) 37:2 (119-133). Date of Publication: January 2006 ISSN 0268-3369 1476-5365 (electronic) BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT We critically reviewed published English language literature and concluded that from 1998 onward the survival of hematopoietic stem cell transplant (SCT) patients who experienced intensive care unit (ICU) transfer has improved. The factors associated with increased mortality during ICU stay included increased patient age, allogeneic transplant, intubation/mechanical ventilation, multiorgan system failure (MOSF), presumed/documented infection, graft-versus-host disease, and higher APACHE and O-PRISM score at ICU transfer. This encouraging outcome trend reflects evolving advances such as use of recombinant hematopoietic growth factors, use of mobilized blood cells rather than marrow, protective strategies for acute lung injury and early goal-directed therapy for sepsis syndrome. Patient selection bias (which patients were transferred and which were not sent to an ICU) also plays a role in ICU survival rates. New strategies to improve upon SCT patient outcome include use of a scoring system to predict mortality, better therapies for MOSF and integration of ICU components and multispecialist involvement earlier in the clinical course to prevent severe complications such as respiratory failure. SCT recipients comprise a heterogeneous group; to further advance this field, prospective multicenter trials involving larger populations from many centers are needed to reduce the biases of retrospective and single-center reports. © 2006 Nature Publishing Group. All rights reserved. EMTREE DRUG INDEX TERMS recombinant growth factor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) allogeneic hematopoietic stem cell transplantation intensive care patient care EMTREE MEDICAL INDEX TERMS acute lung injury (complication, prevention) age APACHE artificial ventilation blood cell cell motility disease course disease severity drug use graft versus host reaction (complication, etiology) human infection (complication, etiology) intensive care unit medical literature medical specialist mortality multiple organ failure (complication, etiology) outcomes research patient selection prediction priority journal prospective study retrospective study review scoring system sepsis (complication) survival rate EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Hematology (25) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006037171 MEDLINE PMID 16273112 (http://www.ncbi.nlm.nih.gov/pubmed/16273112) PUI L43108803 DOI 10.1038/sj.bmt.1705222 FULL TEXT LINK http://dx.doi.org/10.1038/sj.bmt.1705222 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 828 TITLE Performance of the faces anxiety scale in patients transferred from the ICU AUTHOR NAMES Gustad L.T. Chaboyer W. Wallis M. AUTHOR ADDRESSES (Gustad L.T., lise.tuset.gustad@rikshospitalet.no) Rikshospitalet University Hospital, Department of Anaesthesiology, Intensive Care Units, 0027 Oslo, Norway. (Chaboyer W.; Wallis M.) Griffith University, Research Centre for Clinical Practice Innovation, Gold Coast Health Service District, PMB50, Gold Coast, QLD 9726, Australia. CORRESPONDENCE ADDRESS L.T. Gustad, Rikshospitalet University Hospital, Department of Anaesthesiology, Intensive Care Units, 0027 Oslo, Norway. Email: lise.tuset.gustad@rikshospitalet.no SOURCE Intensive and Critical Care Nursing (2005) 21:6 (355-360). Date of Publication: December 2005 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone ABSTRACT Intensive Care Unit (ICU) patients are often not able to respond to long self-report instruments, therefore, in order to assess anxiety accurately, a short and easy to use measure is required. The Faces Anxiety Scale (FAS) developed by McKinley et al. [McKinley S, Coote K, Stein-Parbury J. Development and testing of a faces scale for the assessment of anxiety in critically ill patients. J Adv Nurs 2003;41(1):73-9.] has promised to be such an instrument. This study assessed the construct validity of the FAS against the well validated anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), in an ICU population ready for transfer to the ward. The study was a part of a larger study of transfer anxiety. The FAS showed good correlation with the anxiety sub-scale of the HADS which strengthened over time. The FAS was easy and quick to use and seemed to measure anxiety in ICU patients that were ready to move to the wards, however, further testing in a larger sample and with sicker ICU patients is required. © 2005 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety (diagnosis, etiology) critical illness facial expression patient transport psychological rating scale EMTREE MEDICAL INDEX TERMS adolescent adult aged article Australia classification comparative study female hospitalization human longitudinal study male methodology middle aged nonparametric test nursing assessment nursing evaluation research psychological aspect psychometry questionnaire standard teaching hospital validation study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 16102967 (http://www.ncbi.nlm.nih.gov/pubmed/16102967) PUI L41723000 DOI 10.1016/j.iccn.2005.06.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2005.06.006 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 829 TITLE Airway surface liquid and mucociliary transport. Can general anaesthesia affect their function? ORIGINAL (NON-ENGLISH) TITLE Płynna wyściółka dróg oddechowych i transport śluzowo-rzeskowy. Czy znieczulenie ogólne moze wpływać na ich funkcje? AUTHOR NAMES Smuszkiewicz P. Tyrakowski T. Drobnik L. AUTHOR ADDRESSES (Smuszkiewicz P.; Drobnik L.) Klinika Anestezjologii, Intensywnej Terapii i Leczenia Bólu AM, ul. Przybyszewskiego 49, 60-355 Poznań, Poland. (Tyrakowski T.) Zakład Patobiochemii i Chemii Klinicznej CM, Uniwersytetu im. M. Kopernika, Bydgoszczy, Poland. CORRESPONDENCE ADDRESS P. Smuszkiewicz, Klinika Anestezjologii, Intensywnej Terapii i Leczenia Bólu AM, ul. Przybyszewskiego 49, 60-355 Poznań, Poland. SOURCE Anestezjologia Intensywna Terapia (2005) 37:3 (200-206). Date of Publication: 2005 ISSN 0209-1712 ABSTRACT Mucus clearance is an important component of the lung's innate defence against disease, and the ability of the airways to clear mucus is strongly dependent on the volume of liquid on airway surfaces. Airway epithelium regulates ion concentration, volume and electric potential of the airways' surface liquid. Mucus hydration is determined by the volume of liquid present on airway surfaces, which in turn may be modified by active ion transport. The latter can be markedly compromised by various anaesthesia activities, such as decreased temperature and humidity of inspired gases and mechanical ventilation. Halothane, enflurane and isoflurane impair ciliary beat frequency and mucus transport by depressing chloride epithetial ion transport. Propofol increases calcium ion concentration, therefore preserving ciliary transport and mucus clearance and should be recommended for longer sedation in intensive care settings. Mechanical ventilation with large tidal volumes and high oxygen concentration leads to decreased fluid clearance in the lung, increases permeability for small particles and impairs Na-K-ATPase activity. In conclusion, general anaesthesia and mechanical ventilation impair the airway surface liquid function, and can contribute to the development of respiratory complications in the perioperative period. EMTREE DRUG INDEX TERMS adenosine triphosphatase (potassium sodium) (endogenous compound) calcium ion (endogenous compound) enflurane halothane isoflurane oxygen propofol EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) general anesthesia mucociliary transport EMTREE MEDICAL INDEX TERMS artificial ventilation concentration (parameters) enzyme activity human humidity intensive care unit ion transport mucociliary clearance mucus secretion postoperative period respiratory epithelium respiratory function respiratory tract disease (complication) review sedation CAS REGISTRY NUMBERS calcium ion (14127-61-8) enflurane (13838-16-9) halothane (151-67-7, 66524-48-9) isoflurane (26675-46-7) oxygen (7782-44-7) propofol (2078-54-8) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE Polish LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006093106 PUI L43280223 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 830 TITLE Does intermediate care minimize relocation stress for patients leaving the ICU? AUTHOR NAMES Beard H. AUTHOR ADDRESSES (Beard H.) High Dependency Unit, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk. CORRESPONDENCE ADDRESS H. Beard, High Dependency Unit, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk. Email: helen.beard@wsh.nhs.uk SOURCE Nursing in critical care (2005) 10:6 (272-278). Date of Publication: 2005 Nov-Dec ISSN 1362-1017 ABSTRACT Relocation stress is a phenomenon in which physical and psychological disturbances are experienced following transfer from one environment to another [Carpenito LJ. (2000). Nursing Diagnosis. Application to Clinical Practice, 8th edn]. The purpose of this review was to identify whether a period of intermediate care minimizes the problems associated with relocation stress after discharge from the intensive care unit (ICU) and before transfer to the ward. Methods of retrieving the literature involved identifying key terms, utilizing a range of databases and applying specific criteria in order to delineate the boundaries of the search. Using electronic and manual search methods, 11 studies were selected, both primary and secondary research. Following tabulation and critiquing of the studies, the findings of the review suggest that the factors which contribute towards relocation stress are the loss of one-to-one nursing, a reduction of visible monitoring equipment, lack of continuity of care and inadequate preparation of the patient for the transfer. The evidence also indicates that in order to minimize these factors, early planning and preparation of the patient for transfer are required, incorporating strategies of gradual reduction in nursing attention and monitoring equipment and the provision of information. Although the benefits of intermediate care are established as being advanced monitoring, appropriate nurse-to-patient ratio, heightened demonstration of expert knowledge and skill, there is no sufficient evidence to indicate a period of intermediate care that can ease the transition from the ICU to the ward. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care mental stress (etiology, prevention) patient transport EMTREE MEDICAL INDEX TERMS adaptive behavior attitude to health control fear health personnel attitude health service human monitoring nurse attitude nursing nursing research nursing staff organization and management patient care patient care planning patient education progressive patient care psychological aspect review risk factor workload LANGUAGE OF ARTICLE English MEDLINE PMID 16255334 (http://www.ncbi.nlm.nih.gov/pubmed/16255334) PUI L41849611 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 831 TITLE Risk factors of respiratory function deterioration after intrahospital transport in critically ill patients [2] ORIGINAL (NON-ENGLISH) TITLE Facteurs de risque d'aggravation respiratoire des patients de réanimation ventilés lors des transports intrahospitaliers AUTHOR NAMES Mohammedi I. Belkhouja K. Robert D. AUTHOR ADDRESSES (Mohammedi I., ismael.mohammedi@chu-lyon.fr; Belkhouja K.; Robert D.) Service de Réanimation, Pavillon N, Hôpital Edouard-Herriot, Place d'Arsonval, 69003 Lyon, France. CORRESPONDENCE ADDRESS I. Mohammedi, Service de Réanimation, Pavillon N, Hôpital Edouard-Herriot, Place d'Arsonval, 69003 Lyon, France. Email: ismael.mohammedi@chu-lyon.fr SOURCE Annales Francaises d'Anesthesie et de Reanimation (2005) 24:10 (1314-1315). Date of Publication: October 2005 ISSN 0750-7658 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport respiratory function EMTREE MEDICAL INDEX TERMS artificial ventilation critical illness hemodynamics hospitalization human letter prospective study resuscitation risk factor sedation EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2005467569 MEDLINE PMID 16019184 (http://www.ncbi.nlm.nih.gov/pubmed/16019184) PUI L41463423 DOI 10.1016/j.annfar.2005.05.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.annfar.2005.05.015 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 832 TITLE Widespread transfer of resistance genes between bacterial species in an intensive care unit: Implications for hospital epidemiology AUTHOR NAMES Al Naiemi N. Duim B. Savelkoul P.H.M. Spanjaard L. De Jonge E. Bart A. Vandenbroucke-Grauls C.M. De Jong M.D. AUTHOR ADDRESSES (Al Naiemi N.; Duim B., b.duim@amc.uva.nl; Spanjaard L.; Bart A.; Vandenbroucke-Grauls C.M.; De Jong M.D.) Academic Medical Center, Department of Medical Microbiology, Amsterdam, Netherlands. (De Jonge E.) Academic Medical Center, Department of Intensive Care, Amsterdam, Netherlands. (Savelkoul P.H.M.; Vandenbroucke-Grauls C.M.) VU University Medical Center, Medical Microbiology and Infection Control, Amsterdam, Netherlands. (Duim B., b.duim@amc.uva.nl) Academic Medical Center, Dept. of Medical Microbiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. (De Jong M.D.) Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam. CORRESPONDENCE ADDRESS B. Duim, Academic Medical Center, Dept. of Medical Microbiology, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. Email: b.duim@amc.uva.nl SOURCE Journal of Clinical Microbiology (2005) 43:9 (4862-4864). Date of Publication: September 2005 ISSN 0095-1137 BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. ABSTRACT A transferable plasmid encoding SHV-12 extended-spectrum β-lactamase, TEM-116, and aminoglycoside resistance was responsible for two sequential clonal outbreaks of Enterobacter cloacae and Acinetobacter baumannii bacteria. A similar plasmid was present among isolates of four different bacterial species. Recognition of plasmid transfer is crucial for control of outbreaks of multidrug-resistant nosocomial pathogens. Copyright © 2005, American Society for Microbiology. All Rights Reserved. EMTREE DRUG INDEX TERMS aminoglycoside (endogenous compound) beta lactamase (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance intensive care unit EMTREE MEDICAL INDEX TERMS Acinetobacter baumannii article bacterial strain Enterobacter cloacae epidemic gene gene transfer genetic resistance hospital infection human multidrug resistance nonhuman nucleotide sequence plasmid priority journal SHV 12 gene SHV 2 gene TEM 1 gene TEM 116 gene CAS REGISTRY NUMBERS beta lactamase (9073-60-3) MOLECULAR SEQUENCE NUMBERS GENBANK (AF550415, AY422214) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005415412 MEDLINE PMID 16145160 (http://www.ncbi.nlm.nih.gov/pubmed/16145160) PUI L41298296 DOI 10.1128/JCM.43.9.4862-4864.2005 FULL TEXT LINK http://dx.doi.org/10.1128/JCM.43.9.4862-4864.2005 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 833 TITLE Transfer of head-injured patients in Jamaica: Is there a problem? AUTHOR NAMES Crandon I.W. Harding H. McDonald A.H. Bruce C.A.R. Fearon-Boothe D. Rhoden A. Meeks-Aitken N. AUTHOR ADDRESSES (Crandon I.W., ivor.crandon@uwimona.edu.jm; Harding H.; McDonald A.H.; Bruce C.A.R.; Fearon-Boothe D.; Rhoden A.; Meeks-Aitken N.) Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica. CORRESPONDENCE ADDRESS I.W. Crandon, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica. Email: ivor.crandon@uwimona.edu.jm SOURCE West Indian Medical Journal (2005) 54:4 (220-224). Date of Publication: September 2005 ISSN 0043-3144 BOOK PUBLISHER University of the West Indies, Mona, Kingston 7, Jamaica. ABSTRACT Head-injured patients are often transferred to the University Hospital of the West Indies (UHWI) for tertiary care. There is no standardized, agreed protocol governing their transfer. During the three-year period January 1998 to December 2000, 144 head injured patients were transferred to the UHWI from other institutions. They were 70% male, had a mean age of 34 years and spent a mean of 13 days in hospital. Eighteen per cent were admitted to the Intensive Care Unit, where they spent a mean of nine days. On arrival, mean pulse rate was 92 ± 22 beats/minute, mean systolic blood pressure was 130 ± 27 mmHg and mean diastolic was 76 ± 19mmHg. Twenty-eight per cent of patients had a pulse rate above 100/min on arrival and 13.8% had systolic blood pressure below 60 mmHg. The Glasgow Coma Scale score was unrecorded at the referring institution in 70% of cases and by the receiving officers at the UHWI in 23% of cases. Intubation was done on only half of those who were eligible. Junior staff members initiated and carried out transfers whenever this was documented. The types of vehicles and monitoring equipment used could not be determined in most instances. Fifty-eight percent of patients had minor head injuries, 12%, severe injury and 33%, associated injuries requiring a variety of surgical procedures by multiple specialties. Most patients (80.6%) were discharged home but 11.8% died in hospital. Transfer of head-injured patients, many with multiple injuries is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardized protocol for the transfer of such patients in Jamaica. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury patient transport EMTREE MEDICAL INDEX TERMS adolescent adult article blood pressure measurement child clinical protocol female Glasgow coma scale health care policy hospital discharge hospitalization human institutional care intensive care unit intubation Jamaica length of stay major clinical study male mortality pulse rate standardization EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 2005544934 MEDLINE PMID 16312186 (http://www.ncbi.nlm.nih.gov/pubmed/16312186) PUI L41715657 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 834 TITLE Aeromedical evacuation and critical patient care ORIGINAL (NON-ENGLISH) TITLE Havadan tibbi tahliye ve kritik hasta bakimi AUTHOR NAMES Türkan H. Yilmaz S. Şener S. AUTHOR ADDRESSES (Türkan H.; Yilmaz S.; Şener S.) GATA Acil, Tip Anabilim Dali, Ankara, Turkey. (Türkan H.; Yilmaz S.; Şener S.) Gülhane Military, Medical Faculty, Department of Emergency Care, Ankara, Turkey. CORRESPONDENCE ADDRESS H. Türkan, Gülhane Military, Medical Faculty, Department of Emergency Care, Ankara, Turkey. SOURCE SENDROM (2005) 17:9 (47-57). Date of Publication: Sep 2005 ISSN 1016-5134 ABSTRACT Medical evacuation, especially aeromedical evacuation (AME) is arranged for safety and immediate transportation of injured or critically ill patient whose minutes and hours are seriously important. Although AME is easiness and significant time is gained by flight health crew and the patient, flight surgeons have to come to an agreement that disadvantages of AME should not exceed the advantages. Flight stressors (eg. vibration), physiological and pathological changes caused by altitude on patient should be taken into consideration and it should not to be forgotten to control the airway and to stabilize the hemodynamic parameters before the aircraft taken off. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS aircraft altitude aviation hemodynamics high risk patient human injury patient care review safety vibration EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE Turkish LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005490279 PUI L41545963 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 835 TITLE Intra-unit patient transports: Time, motion, and cost impact on hospital efficiency AUTHOR NAMES Hendrich A.L. Lee N. AUTHOR ADDRESSES (Hendrich A.L.) Clinical Excellence Operations, Ascension Health, St. Louis, MO, United States. (Lee N.) Rapid Modeling Corporation, Cincinnati, OH, United States. CORRESPONDENCE ADDRESS A.L. Hendrich, Clinical Excellence Operations, Ascension Health, St. Louis, MO, United States. SOURCE Nursing Economics (2005) 23:4 (157-164). Date of Publication: July/August 2005 ISSN 0746-1739 BOOK PUBLISHER Anthony J. Jannetti Inc. ABSTRACT ▶ This study of intra-hospital patient transfer analyzes the process, time, personnel, and cost of the transport procedure. ▶ Opportunities exist to increase the efficiency of the execution of this discrete process as well as gain overall system efficiency in terms of bed utilization and management. ▶ The study revealed only 12% effi ciency in the transfer process. ▶ Delays due to administrative requirements, unavailable resources, disruptions, and communication breakdown were cited as causes of the low productivity in the current process. ▶ Careful consideration for the three primary reasons for transfer - need for additional technology, need for higher skilled staff, and need for higher hours per patient day - offer the opportunity to rethink the drivers of transfer through technology planning, staff training, and staffing flexibility. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital management hospital personnel patient transport EMTREE MEDICAL INDEX TERMS article clinical competence communication disorder documentation education health care cost hospital bed capacity hospital bed utilization human information processing medical record nonbiological model nursing administration research organization and management patient care personnel management psychological aspect risk assessment standard system analysis task performance total quality management treatment outcome workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 16189980 (http://www.ncbi.nlm.nih.gov/pubmed/16189980) PUI L41555734 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 836 TITLE Intrahospital transport of a patient with acute exacerbation of chronic obstructive pulmonary disease under noninvasive ventilation [1] AUTHOR NAMES Kluge S. Baumann H.J. Kreymann G. AUTHOR ADDRESSES (Kluge S., skluge@uke.uni-hamburg.de; Baumann H.J.; Kreymann G.) Department of Medicine, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. CORRESPONDENCE ADDRESS S. Kluge, Department of Medicine, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. Email: skluge@uke.uni-hamburg.de SOURCE Intensive Care Medicine (2005) 31:6 (886). Date of Publication: June 2005 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) chronic obstructive lung disease lung ventilation patient transport EMTREE MEDICAL INDEX TERMS acute respiratory failure airway pressure blood gas analysis clinical feature disease exacerbation electrocardiography monitoring endotracheal intubation face mask heart catheterization heart ventriculography human intensive care unit length of stay letter non invasive measurement oxygen saturation patient monitoring pH measurement positive end expiratory pressure respiratory acidosis ST segment depression ventilator EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2005290995 MEDLINE PMID 15834706 (http://www.ncbi.nlm.nih.gov/pubmed/15834706) PUI L40897549 DOI 10.1007/s00134-005-2626-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-005-2626-0 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 837 TITLE The Zwolle global experience on primary percutaneous coronary intervention. AUTHOR NAMES De Luca G. Suryapranata H. de Boer M.J. AUTHOR ADDRESSES (De Luca G.; Suryapranata H.; de Boer M.J.) Department of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands. CORRESPONDENCE ADDRESS G. De Luca, Department of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands. Email: g.deluca@diagram-zwolle.nl SOURCE Italian heart journal : official journal of the Italian Federation of Cardiology (2005) 6:6 (453-458). Date of Publication: Jun 2005 ISSN 1129-471X ABSTRACT Timely restoration of antegrade blood flow in the infarct-related artery of patients with ST-segment elevation myocardial infarction (STEMI) results in myocardial salvage and improved survival. We describe the Zwolle approach with regard to prehospital phase, the first 15 min in hospital, initial pharmacological therapy, angiography, angioplasty, risk stratification, rehabilitation and secondary prevention. Confirmation of the diagnosis by 12-lead electrocardiography by either general practitioners or ambulance paramedics allows substantial reduction in the time-delay to first balloon inflation, as the hospital and the catheterization laboratory can be prepared in advance, and the emergency room and the coronary care unit with their unavoidable delays can be skipped on the way to acute angiography. In our setting all patients with STEMI are treated at the time of diagnosis (before or during transportation) with heparin (5000 IU) and aspirin (500 mg) intravenously, with additional oral bolus (300 mg) of clopidogrel and additional 5000 IU heparin at the time of angiography. Our attitude is that an optimal balloon angioplasty result should never be jeopardized just for somewhat lower rate of target vessel revascularization during the first year after the acute event. In particular, attention should be paid to side branches, which may be of more clinical relevance in this setting than with elective angioplasty. Additional mechanical devices, such as distal protection devices and/or thrombosuction, should be mostly used when relevant thrombotic material is visible, with concomitant higher risk of distal embolization, particularly in high-risk patients. Finally, the use of the Zwolle risk score may help to identify low-risk patients who could be safely discharged within 36-48 hours after primary angioplasty, with a significant reduction in the costs of hospitalization. EMTREE DRUG INDEX TERMS fibrinolytic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) fibrinolytic therapy heart infarction (therapy) patient transport transluminal coronary angioplasty EMTREE MEDICAL INDEX TERMS angiocardiography coronary care unit electrocardiography human methodology pathophysiology radiography review risk assessment standard time LANGUAGE OF ARTICLE English MEDLINE PMID 16008149 (http://www.ncbi.nlm.nih.gov/pubmed/16008149) PUI L41467212 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 838 TITLE Transitional care after the intensive care unit: current trends and future directions. AUTHOR NAMES Chaboyer W. James H. Kendall M. AUTHOR ADDRESSES (Chaboyer W.; James H.; Kendall M.) Research Centre for Clinical Practice Innovation, Griffith University, Gold Coast, Australia. CORRESPONDENCE ADDRESS W. Chaboyer, Research Centre for Clinical Practice Innovation, Griffith University, Gold Coast, Australia. SOURCE Critical care nurse (2005) 25:3 (16-18, 20-22, 24-26 passim; quiz 29). Date of Publication: Jun 2005 ISSN 0279-5442 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport progressive patient care EMTREE MEDICAL INDEX TERMS ambulatory care Australia forecasting hospital discharge human model needs assessment nurse nurse attitude nursing theory organization and management patient care psychological aspect review United Kingdom United States LANGUAGE OF ARTICLE English MEDLINE PMID 15946925 (http://www.ncbi.nlm.nih.gov/pubmed/15946925) PUI L41181031 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 839 TITLE Development and implementation of a protocol for transfers out of the pediatric intensive care unit. AUTHOR NAMES Van Waning N.R. Kleiber C. Freyenberger B. AUTHOR ADDRESSES (Van Waning N.R.; Kleiber C.; Freyenberger B.) University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. CORRESPONDENCE ADDRESS N.R. Van Waning, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA. SOURCE Critical care nurse (2005) 25:3 (50-55). Date of Publication: Jun 2005 ISSN 0279-5442 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical protocol intensive care patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS article attitude to health child child hospitalization evaluation study evidence based medicine family health care quality human interpersonal communication needs assessment nurse attitude nurse patient relationship nursing nursing evaluation research nursing methodology research organization and management patient education psychological aspect questionnaire standard teaching LANGUAGE OF ARTICLE English MEDLINE PMID 15946928 (http://www.ncbi.nlm.nih.gov/pubmed/15946928) PUI L41181034 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 840 TITLE "Two way transport" of neonates to the Pediatric Intensive Care Unit of the University Hospital Split ORIGINAL (NON-ENGLISH) TITLE Prijevoz novorocrossed d signenčadi "k sebi" jedinice Intenzivnog Liječenja djece Kliničke Bolnice Split AUTHOR NAMES Meštrović J. Polić B. Radonić M. Stričević L. Omazić A. Baraka K. Markić J. Stipančević H. Krželj V. Balarin L. AUTHOR ADDRESSES (Meštrović J., julije.mestrovic@st.htnet.hr; Polić B.; Stričević L.; Omazić A.) Jedinica Intenzivnog Lijecenja Djece, Klinika za Dječje Bolesti, Klinička Bolnica Split, Split, Croatia. (Radonić M.) Odjel za Pedijatriju, Opća Bolnica Dubrovnik, Croatia. (Baraka K.) Odjel za Neonatologiju, Opća Bolnica Zadar, Croatia. (Markić J.; Krželj V.; Balarin L.) Klinika za Dječje Bolesti, Klinička Bonica Split, Split, Croatia. (Stipančević H.) Institut Pomorske Medicine, HRM, Split, Croatia. (Meštrović J., julije.mestrovic@st.htnet.hr) Jedinica Intenzivog Lijecenja Djece, Klinika za Dječje Bolesti, KB Split, Spinčićeva 1, 21000 Split, Croatia. CORRESPONDENCE ADDRESS J. Meštrović, Jedinica Intenzivog Lijecenja Djece, Klinika za Dječje Bolesti, KB Split, Spinčićeva 1, 21000 Split, Croatia. Email: julije.mestrovic@st.htnet.hr SOURCE Paediatria Croatica (2005) 49:1 (25-29). Date of Publication: 2005 ISSN 1330-1403 BOOK PUBLISHER Children's Hospital Zagreb, Klaiceva 16, Zagreb, Croatia. ABSTRACT The best way to transport seriously ill neonates is by "two way transport". It means that the transport team from the referring hospital comes for the child to take over ongoing care. The treatment begins immediately, in the community hospital where the child was born, and the transport is arranged when the best possible conditions are achieved. We present the "two way transport" that links the Pediatric intensive care unit of the University hospital Split and the Air Force Base Divulje in Kaštela with Departments of Neonatology of General Hospital Dubrovnik and General Hospital Zadar. Over an eighteen months period, from February 2003, to August 2004, we transported fourteen neonates to the Pediatric Intensive Care Unit of the University Hospital Split. According to calculations of the Neonatal Therapeutic Intervention Scoring System (NTISS), estimated seriousness of their conditions was extremely high and life threatening. The clinical condition of the neonates remained without deterioration by the end of transport. Our system contributes to establishing and shaping "two way transport" in Croatia. EMTREE DRUG INDEX TERMS albumin antibiotic agent atropine diazepam dobutamine dopamine epinephrine fentanyl furosemide gluconate calcium glucose heparin naloxone phenobarbital (intravenous drug administration) prostaglandin E1 sodium chloride surfactant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport university hospital EMTREE MEDICAL INDEX TERMS article calculation childbirth clinical article community hospital Croatia disease severity female human male Neonatal Therapeutic Intervention Scoring System newborn patient care practice guideline scoring system CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) atropine (51-55-8, 55-48-1) diazepam (439-14-5) dobutamine (34368-04-2, 52663-81-7) dopamine (51-61-6, 62-31-7) fentanyl (437-38-7) furosemide (54-31-9) gluconate calcium (299-28-5) glucose (50-99-7, 84778-64-3) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) naloxone (357-08-4, 465-65-6) phenobarbital (50-06-6, 57-30-7, 8028-68-0) prostaglandin E1 (745-65-3) sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE unknown LANGUAGE OF SUMMARY English, unknown EMBASE ACCESSION NUMBER 2005197969 PUI L40592840 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 841 TITLE Tsunami disaster and infection: Beware what pathogens the transport delivers to your intensive care unit! AUTHOR NAMES Masur H. Murray P. AUTHOR ADDRESSES (Masur H.) Critical Care Medicine, National Institutes of Health, Bethesda, MD, United States. (Murray P.) Clinical Pathology, National Institutes of Health, Bethesda, MD, United States. CORRESPONDENCE ADDRESS H. Masur, Critical Care Medicine, National Institutes of Health, Bethesda, MD, United States. SOURCE Critical Care Medicine (2005) 33:5 (1179-1180). Date of Publication: May 2005 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE DRUG INDEX TERMS sea water EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster intensive care unit tsunami EMTREE MEDICAL INDEX TERMS Aeromonas chickenpox (epidemiology) diarrhea (etiology) editorial endemic disease (epidemiology) enteric virus Gram negative bacterium health care facility human influenza (epidemiology) Legionella measles (epidemiology) Mycobacterium marinum nonhuman priority journal Pseudomonas Salmonella Vibrio water contamination wound infection EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Environmental Health and Pollution Control (46) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2005212221 MEDLINE PMID 15891375 (http://www.ncbi.nlm.nih.gov/pubmed/15891375) PUI L40638218 DOI 10.1097/01.CCM.0000163271.78189.0F FULL TEXT LINK http://dx.doi.org/10.1097/01.CCM.0000163271.78189.0F COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 842 TITLE Geisinger checklist speeds transfer of heart attack patients. AUTHOR ADDRESSES SOURCE Performance improvement advisor (2005) 9:4 (40-42, 37). Date of Publication: Apr 2005 ISSN 1543-6160 ABSTRACT In cardiology, there is a saying that "time is muscle." The longer it takes to reopen a heart attack patient's blocked artery, the more damage is done to the heart muscle. Cardiologists and emergency department physicians at Geisinger Medical Center are working together to shorten the time that it takes for patients to receive angioplasty, thus saving more heart muscle. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) angioplasty coronary care unit heart infarction (therapy) patient transport EMTREE MEDICAL INDEX TERMS article human organization and management time United States LANGUAGE OF ARTICLE English MEDLINE PMID 15945291 (http://www.ncbi.nlm.nih.gov/pubmed/15945291) PUI L40889538 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 843 TITLE Adverse effect on a referral intensive care unit's performance of accepting patients transferred from another intensive care unit AUTHOR NAMES Combes A. Luyt C.-E. Trouillet J.-L. Chastre J. Gibert C. AUTHOR ADDRESSES (Combes A.; Luyt C.-E.; Trouillet J.-L.; Chastre J.; Gibert C.) Serv. de Reanimation Med., Hop. Pitie-Salpetriere, Paris, France. CORRESPONDENCE ADDRESS A. Combes, Serv. de Reanimation Med., Hop. Pitie-Salpetriere, Paris, France. SOURCE Critical Care Medicine (2005) 33:4 (705-710). Date of Publication: April 2005 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: To determine whether observed and predicted mortality for intensive care unit (ICU) transfer admissions is different from non-ICU transfer admissions and how that might affect ICU performance evaluation. Design, Setting, and Patients: We retrospectively analyzed the charts of 3,416 patients admitted to our tertiary referral ICU from January 1995 to December 2001 and evaluated the effect on our performance (based on the Simplified Acute Physiology Score II risk model) of accepting patients transferred from another hospital's ICU. Main Results: During the study period, 597 patients (17%) had been transferred from a non-ICU setting in another hospital (hospital transfer) and 408 (12%) from another hospital's ICU (ICU transfer). ICU mortality and standardized mortality ratios were significantly higher for ICU-transfer patients than for hospital-transfer or directly admitted patients: 34% vs. 23% vs. 17% (p < .0001) and 0.95 (95% confidence interval, 0.83-1.08), 0.82 (95% confidence interval, 0.71-0.95), and 0.62 (95% confidence interval, 0.55-0.68), respectively. ICU-transfer patients had 3.6-fold longer mean ICU stays and 1.9-fold longer durations of mechanical ventilation than directly admitted patients. Hospital-transfer (odds ratio = 1.89) and ICU-transfer patients (odds ratio = 2.41) had significantly higher mortality rates, even after adjustment for case mix and disease severity. Consequently, a benchmarking program adjusting only for these latter variables, but not admission source, would penalize our ICU by 39 excess deaths per 1,000 admissions as compared with another ICU admitting no transfer patients. Finally, patients transferred from the ward of another hospital had significantly higher mortality rates (odds ratio = 1.56) as compared with patients directly admitted from the ward of our hospital, confirming the "transfer effect" for this homogeneous patients' subgroup. Conclusions: Admission source remains a strong and independent predictor of ICU death, despite adjustment for case mix and disease severity at ICU admission. Specifically, accepting numerous ICU-transfer patients, for whom the probability of ICU death is the most underestimated by a system adjusting only for case mix and disease severity, can adversely affect the evaluation of referral centers' performance. Future benchmarking and profiling systems should evaluate and adequately account for the ICU-transfer factor to provide healthcare payers and consumers with more accurate and valid information on the true performance of referral centers. Copyright © 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital admission hospitalization intensive care unit patient referral EMTREE MEDICAL INDEX TERMS article artificial ventilation disease severity length of stay medical record mortality patient transport prediction priority journal retrospective study EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005169802 MEDLINE PMID 15818092 (http://www.ncbi.nlm.nih.gov/pubmed/15818092) PUI L40504375 DOI 10.1097/01.CCM.0000158518.32730.C5 FULL TEXT LINK http://dx.doi.org/10.1097/01.CCM.0000158518.32730.C5 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 844 TITLE Danish parents' experiences when their new born or critically ill small child is transferred to the PICU-a qualitative study. AUTHOR NAMES Hall E.O. AUTHOR ADDRESSES (Hall E.O.) Department of Nursing Science, Aarhus University, Aarhus, Denmark. CORRESPONDENCE ADDRESS E.O. Hall, Department of Nursing Science, Aarhus University, Aarhus, Denmark. Email: eh@nursingscience.au.dk SOURCE Nursing in critical care (2005) 10:2 (90-97). Date of Publication: 2005 Mar-Apr ISSN 1362-1017 ABSTRACT The aim of this study was to describe Danish parents' experiences when their newborn or small child was critically ill. Thirteen parents were interviewed. Data were analysed using qualitative content analysis. The child's transfer to the paediatric intensive care unit (PICU) meant either help or death for the parents. The back transfer was experienced as joy and despair. The parents had confidence in most nurses, and they were kind, helpful, informative and capable. Less capable and distressed nurses made the parents feel uncomfortable and insecure. Parents need help and support during their child's transfer to and from the PICU. Critical care nurses have to discuss the policy of family-centred care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care life event parent patient transport EMTREE MEDICAL INDEX TERMS adult article Denmark female human human relation infant male newborn nurse patient relationship psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 15839240 (http://www.ncbi.nlm.nih.gov/pubmed/15839240) PUI L40857178 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 845 TITLE Appropriate admissions to the appropriate unit: a decision tree approach. AUTHOR NAMES Matukaitis J. Stillman P. Wykpisz E. Ewen E. AUTHOR ADDRESSES (Matukaitis J.; Stillman P.; Wykpisz E.; Ewen E.) Patient Care Services, Critical Care, Newark, DE 19713, USA. CORRESPONDENCE ADDRESS J. Matukaitis, Patient Care Services, Critical Care, Newark, DE 19713, USA. Email: jmatukaitis@christianacare.org SOURCE American journal of medical quality : the official journal of the American College of Medical Quality (2005) 20:2 (90-97). Date of Publication: 2005 Mar-Apr ISSN 1062-8606 ABSTRACT An intermediate care decision tree tool was developed to meet the demand for intermediate care beds. Concurrently, a charging process was developed to support the acuity adaptable model of care, allowing the patient to remain in the same bed from admission to discharge, regardless of level of care required, adjusting nurse-to-patient ratios as acuity changes. Since beginning this pilot, 96% to 100% of the patients admitted to intermediate care from the emergency department met the criteria. Wait time from request to admission was reduced from 5.5 hours to 2.5 hours. A reduction in nursing costs was noted. The average number of patients waiting daily in the emergency department for an intermediate care bed has been reduced by approximately 80%. A significant difference in length of stay was not noted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision tree health economics hospital admission intensive care unit nursing home patient transport EMTREE MEDICAL INDEX TERMS economics human length of stay review statistics time LANGUAGE OF ARTICLE English MEDLINE PMID 15851387 (http://www.ncbi.nlm.nih.gov/pubmed/15851387) PUI L40596791 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 846 TITLE Transport ventilators: a guide for critical-care transportation, aeromedical & prehospital operations. AUTHOR NAMES DiLuigi K.J. AUTHOR ADDRESSES (DiLuigi K.J.) Temple University Hospital, Philadelphia, PA, USA. CORRESPONDENCE ADDRESS K.J. DiLuigi, Temple University Hospital, Philadelphia, PA, USA. SOURCE Emergency medical services (2005) 34:1 (67-70, 104). Date of Publication: Jan 2005 ISSN 0094-6575 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport emergency health service intensive care patient transport practice guideline ventilator EMTREE MEDICAL INDEX TERMS article human United States LANGUAGE OF ARTICLE English MEDLINE PMID 15743123 (http://www.ncbi.nlm.nih.gov/pubmed/15743123) PUI L40399465 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 847 TITLE The provision of sophisticated critical care beyond the hospital: Lessons from physiology and military experiences that apply to civil disaster medical response AUTHOR NAMES Grissom T.E. Farmer J.C. AUTHOR ADDRESSES (Grissom T.E.) Ctr. Sustainment Trauma Readiness S., Baltimore, MD, United States. (Grissom T.E.) R. A. Cowley Shock Trauma Center, Univ. of Maryland Medical Center, Baltimore, MD. (Farmer J.C.) Department of Medicine, Div. Pulmon. and Critical Care Med., Rochester, MN, United States. (Farmer J.C.) Prog. Translational I., Mayo Clinic, Rochester, MN, United States. CORRESPONDENCE ADDRESS T.E. Grissom, Ctr. Sustainment Trauma Readiness S., Baltimore, MD, United States. SOURCE Critical Care Medicine (2005) 33:1 SUPPL. (S13-S21). Date of Publication: January 2005 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: The provision of sophisticated medical care in an austere environment is challenging. During and after a mass casualty event, it is likely that critical care services will be needed beyond an intensive care unit (ICU) setting. The objective of this article is to explore existing ICU care systems such as military aeromedical transport that may be applicable to disaster medicine and to providing critical care outside of an ICU setting. Results: The U.S. Air Force Critical Care Aeromedical Transport (CCAT) Teams were developed in 1994 in response to an unmet military need for long-range air transport of critically ill and injured patients. This system has transported several thousand ICU patients and is an applicable model for the future development of extrahospital critical care capabilities needed during a disaster. We also discuss civilian aeromedical critical care systems, the types of medical devices used, and their applicability to disaster medical response. Conclusion: The U.S. Air Force CCAT Team program, as well as many civilian critical care air ambulance services, provides a workable starting point for the development of disaster medical critical care response capabilities for disaster medical systems. EMTREE DRUG INDEX TERMS antacid agent atropine chlorpromazine diazepam digoxin dimenhydrinate diphenhydramine dopamine epinephrine furosemide glucose glyceryl trinitrate haloperidol heparin isoprenaline morphine sulfate naloxone oxycodone plus paracetamol paracetamol pethidine phenytoin potassium chloride propranolol pseudoephedrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air medical transport army disaster intensive care patient transport EMTREE MEDICAL INDEX TERMS air force airplane crew devices electrocardiography monitoring human infusion system intensive care unit medical care medical device nurse paramedical personnel patient monitoring physician priority journal review United States ventilator CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) atropine (51-55-8, 55-48-1) chlorpromazine (50-53-3, 69-09-0) diazepam (439-14-5) digoxin (20830-75-5, 57285-89-9) dimenhydrinate (523-87-5) diphenhydramine (147-24-0, 58-73-1) dopamine (51-61-6, 62-31-7) furosemide (54-31-9) glucose (50-99-7, 84778-64-3) glyceryl trinitrate (55-63-0) haloperidol (52-86-8) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2) morphine sulfate (23095-84-3, 35764-55-7, 64-31-3) naloxone (357-08-4, 465-65-6) paracetamol (103-90-2) pethidine (28097-96-3, 50-13-5, 57-42-1) phenytoin (57-41-0, 630-93-3) potassium chloride (7447-40-7) propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6) pseudoephedrine (345-78-8, 7460-12-0, 90-82-4) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005037022 MEDLINE PMID 15640673 (http://www.ncbi.nlm.nih.gov/pubmed/15640673) PUI L40116593 DOI 10.1097/01.CCM.0000151063.85112.5A FULL TEXT LINK http://dx.doi.org/10.1097/01.CCM.0000151063.85112.5A COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 848 TITLE Barriers to screening infants for retinopathy of prematurity after discharge or transfer from a neonatal intensive care unit AUTHOR NAMES Attar M.A. Gates M.R. Iatrow A.M. Lang S.W. Bratton S.L. AUTHOR ADDRESSES (Attar M.A.; Gates M.R.; Iatrow A.M.; Lang S.W.; Bratton S.L.) Dept. of Pediat./Communic. Diseases, University of Michigan, Ann Arbor, MI, United States. (Attar M.A.) Mott Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0254, United States. CORRESPONDENCE ADDRESS M.A. Attar, Mott Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0254, United States. SOURCE Journal of Perinatology (2005) 25:1 (36-40). Date of Publication: January 2005 ISSN 0743-8346 BOOK PUBLISHER Nature Publishing Group, Houndmills, Basingstoke, Hampshire, United Kingdom. ABSTRACT Objective: To assess neonatal intensive care unit (NICU) practices affecting screening and follow-up for retinopathy of prematurity (ROP). Methods: Retrospective study of infants at risk for ROP, eligible for back transport, admitted to a regional NICU from January 1, 1999 until May 31, 2002. Patients failed to receive needed follow-up for ROP after discharge or transfer from a NICU, if we could not verify their ROP screening follow-up within 1 month. Results: A total of 74 infants were identified to need follow-up eye care. Infants who did not receive the follow-up care had greater mean gestational age (mean SD; 30.7±2.3 vs 29.6±2.5 weeks, p = 0.05) and birth weights (mean SD; 1581±366 vs 1360±508 g, p = 0.007), compared to infants who received the recommended care. Infants transported back to the community hospital were significantly more likely to miss follow-up eye care compared to infants discharged from the regional center (relative risk 2.81, 95% confidence interval (CI) (1.09 to 7.20)). Infants not screened for ROP in the NICU had greater risk for missing follow-up care compared to infants who had their first retinal examination in the NICU (relative risk 4.25, 95% CI (1.42 to 12.73)). Conclusions: Infants transferred back or discharged from the NICU before ROP screening represent a high-risk group for not receiving follow-up eye care. © 2005 Nature Publishing Group All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) retrolental fibroplasia (diagnosis) screening test EMTREE MEDICAL INDEX TERMS article birth weight community hospital confidence interval controlled study follow up gestational age high risk population hospital admission hospital discharge human infant major clinical study medical practice newborn intensive care patient transport risk assessment EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Ophthalmology (12) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005068995 MEDLINE PMID 15496873 (http://www.ncbi.nlm.nih.gov/pubmed/15496873) PUI L40207653 DOI 10.1038/sj.jp.7211203 FULL TEXT LINK http://dx.doi.org/10.1038/sj.jp.7211203 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 849 TITLE Respiratory critical care in emergency medicine: Non-invasive mechanical ventilation in urgencies, emergencies and sanitary transport. Indications and methodology ORIGINAL (NON-ENGLISH) TITLE Ventilación mecánica no invasiva en urgencias, emergencias y transporte sanitario. Indicaciones y metodología AUTHOR NAMES Esquinas Rodríguez A.M. González Díaz G. Ayuso Baptista F. Minaya García J.A. Artacho Ruiz R. Salguero Piedras M. Suero Méndez C. Del Campo E. Simó Gisbert J. Piera I Olives J. Ferre Jornet R. Llorente Rojo A.C. Folgado Pérez M.I. Pordomingo Rodríguez D. Cabriada Nuño V. AUTHOR ADDRESSES (Esquinas Rodríguez A.M., esquinas@ono.com; González Díaz G.; Ayuso Baptista F.; Minaya García J.A.; Artacho Ruiz R.; Salguero Piedras M.; Suero Méndez C.; Del Campo E.; Simó Gisbert J.; Piera I Olives J.; Ferre Jornet R.; Llorente Rojo A.C.; Folgado Pérez M.I.; Pordomingo Rodríguez D.; Cabriada Nuño V.) Unidad de Cuidados Intensivos, Hospitales Morales Meseguer, Murcia, Spain. (Esquinas Rodríguez A.M., esquinas@ono.com) Grupo de Ventilacion No Invasiva en Emergencias, Urgencias y Transporte Sanitario, Unidad de Cuidados Intensivos, Hospitales Morales Meseguer, Avda. Marques de los Velez, s/n, 30008 Murcia, Spain. CORRESPONDENCE ADDRESS A.M. Esquinas Rodríguez, Grupo de Ventilacion No Invasiva en Emergencias, Urgencias y Transporte Sanitario, Unidad de Cuidados Intensivos, Hospitales Morales Meseguer, Avda. Marques de los Velez, s/n, 30008 Murcia, Spain. Email: esquinas@ono.com SOURCE Puesta al Dia en Urgencias, Emergencias y Catastrofes (2005) 6:1 (33-44). Date of Publication: Jan 2005 ISSN 1576-0316 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute respiratory failure (therapy) artificial ventilation emergency treatment patient transport EMTREE MEDICAL INDEX TERMS asthma (therapy) chronic obstructive lung disease (therapy) critical illness emergency medicine face mask human oxygen therapy patient monitoring pneumonia positive end expiratory pressure practice guideline review treatment indication EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Internal Medicine (6) LANGUAGE OF ARTICLE Spanish EMBASE ACCESSION NUMBER 2005240191 PUI L40740242 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 850 TITLE Treatment of coronary heart disease. AUTHOR NAMES Stubbs J. Barrett D. AUTHOR ADDRESSES (Stubbs J.; Barrett D.) West Midlands South CHD Collaborative. CORRESPONDENCE ADDRESS J. Stubbs, West Midlands South CHD Collaborative. SOURCE Professional nurse (London, England) (2005) 20:5 (28-30). Date of Publication: Jan 2005 ISSN 0266-8130 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary artery disease (therapy) patient transport transluminal coronary angioplasty EMTREE MEDICAL INDEX TERMS article coronary care unit evaluation study health care policy health care quality health services research hospital admission hospital bed utilization human national health service organization organization and management patient care patient referral patient selection quality control time United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 15682993 (http://www.ncbi.nlm.nih.gov/pubmed/15682993) PUI L40282218 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 851 TITLE Recently published papers: Clunk-click every trip, smile, but don't stop for a drink on the way AUTHOR NAMES Stacey J. Venn R. AUTHOR ADDRESSES (Stacey J., jonathan_stacey@hotmail.com; Venn R.) Department of Critical Care, Worthing General Hospital, Lyndhurst Road, Worthing, United Kingdom. CORRESPONDENCE ADDRESS J. Stacey, Department of Critical Care, Worthing General Hospital, Lyndhurst Road, Worthing, United Kingdom. Email: jonathan_stacey@hotmail.com SOURCE Critical Care (2004) 8:6 (408-410). Date of Publication: December 2004 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd., 34 - 42 Cleveland Street, London, United Kingdom. ABSTRACT Reviews of the risks associated with intrahospital transfer and prolonged spinal immobilization made uncomfortable reading in August. Studies on the timing of tracheotomy and a potential role for exogenous surfactant will have done little to allay controversy. We are reminded of the neutrality of the Swiss, and gain valuable insight into prognostic tools in mechanically ventilated patients with cirrhotic liver disease. © 2004 BioMed Central Ltd. EMTREE DRUG INDEX TERMS artificial lung surfactant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport risk assessment EMTREE MEDICAL INDEX TERMS artificial ventilation hospital service human immobilization intensive care interpersonal communication liver cirrhosis medical decision making positive end expiratory pressure priority journal prognosis publication review spine stabilization Switzerland tracheotomy EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005022565 MEDLINE PMID 15566602 (http://www.ncbi.nlm.nih.gov/pubmed/15566602) PUI L40073666 DOI 10.1186/cc3002 FULL TEXT LINK http://dx.doi.org/10.1186/cc3002 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 852 TITLE Modalities for maternal transfer in the event of postpartum hemorrhage ORIGINAL (NON-ENGLISH) TITLE Modalités d'un transfert maternel dans le cadre d'une hémorragie post-partum AUTHOR NAMES Bagou G. AUTHOR ADDRESSES (Bagou G., gilles.bagou@chu-lyon.fr) SAMU Régional de Lyon, Hôpital Édouard-Herriot, 69437 Lyon Cedex 03, France. CORRESPONDENCE ADDRESS G. Bagou, SAMU Régional de Lyon, Hôpital Édouard-Herriot, 69437 Lyon Cedex 03, France. Email: gilles.bagou@chu-lyon.fr SOURCE Journal de Gynecologie Obstetrique et Biologie de la Reproduction (2004) 33:8 SUPPL. (4S89-4S92). Date of Publication: December 2004 ISSN 0368-2315 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT In the event of a postpartum bleeding, the decision to undertake a medical transfer should be made in concertation by the different physicians involved: the hospital that requests the transfer, the Emergency Medical and Mobile Service, the receiver. The choice of a health care provider depends on the health care facilities, the possibility to admit the patient and the time parameter. A transfer is contraindicated for patients with an unstable hemodynamic state and when hemostatic surgery is essential. During transportation, only cardiopulmonary techniques are allowed. Patient monitoring, anesthesia and resuscitation during the embolization process should be done by the critical care team in the hospital and not by emergency physicians and nurses. As a precaution, after the team has assessed the situation locally and before it worsens, a transfer, including intra uterine transfer, should be discussed and completed toward a health care facility equipped to provide rapid and varied emergency care. When postpartum bleeding occurs after an unexpected birth out of the hospital, rapid medical transportation toward a health care facility equipped to provide varied emergency care is required. The emergency care unit should be informed prior to the transfer. EMTREE DRUG INDEX TERMS sulprostone (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport postpartum hemorrhage (drug therapy, therapy) EMTREE MEDICAL INDEX TERMS anesthesia artificial embolization emergency health service health care facility hemodynamics hemostasis hospital intensive care unit medical decision making patient monitoring resuscitation review CAS REGISTRY NUMBERS sulprostone (60325-46-4, 96420-78-9) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2005008241 MEDLINE PMID 15577734 (http://www.ncbi.nlm.nih.gov/pubmed/15577734) PUI L40030207 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 853 TITLE Omissions and errors during oxygen therapy of hospitalized patients in a large city of Greece AUTHOR NAMES Brokalaki H. Matziou V. Zyga S. Kapella M. Tsaras K. Brokalaki E. Myrianthefs P. AUTHOR ADDRESSES (Brokalaki H., heropan@nurs.uoa.gr; Matziou V.; Tsaras K.) Nursing Faculty, Natl./Kapodistrian Univ. of Athens, 123 Papadiamandopoulou Str., GR-11528 Athens, Greece. (Zyga S.; Kapella M.) Hippokrateion Gen. Hosp. of Athens, Athens, Greece. (Brokalaki E.) Dermatology Clinic, Koln University, Koln, Germany. (Myrianthefs P.) KAT General Hospital, Athens, Greece. CORRESPONDENCE ADDRESS H. Brokalaki, Nursing Faculty, Natl./Kapodistrian Univ. of Athens, 123 Papadiamandopoulou Str., GR-11528 Athens, Greece. Email: heropan@nurs.uoa.gr SOURCE Intensive and Critical Care Nursing (2004) 20:6 (352-357). Date of Publication: December 2004 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone ABSTRACT Omissions and errors are commonly found concerning hospital oxygen use and the use of nebulizers. The aim of the study was to record oxygen use in seven hospitals located in a large district city of Greece. Another aim was to record the use of nebulizers in the same hospitals. We included 105 head nurses (HNs) working in seven hospitals of a large city district of Greece. Data were collected after interviewing each HN using a questionnaire and completing an anonymous data form. Data are expressed as percentages and analyzed using the chi-square test. We found that 41% of HN believed O(2) is a gas that improves patient's dyspnea. The majority of the nurses (88.6%) stated that there was no protocol for O(2) therapy in the departments in which they worked. We found that O(2) therapy was commonly started, modified, discontinued by nurses in the absence of a medical order. Oxygen therapy was commonly not guided by arterial blood gas (ABG) analysis. We also found that there are no guidelines to prevent O(2) therapy interruption during intra-hospital transportation, and that few measures were taken to prevent O(2) explosion. In 95.2% of the departments the nebulizers were filled with tap water and were not changed on a daily basis (81.2%). Our results indicate that educational programmes, nursing protocols and guidelines are becoming mandatory in our country in order to ensure the proper use of O(2) therapy and nebulizers. © 2004 Elsevier Ltd. All rights reserved. EMTREE DRUG INDEX TERMS oxygen (drug therapy) tap water EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical error oxygen therapy EMTREE MEDICAL INDEX TERMS article blood gas analysis chi square test clinical protocol data analysis disinfection dyspnea (drug therapy) education program Greece hospital department hospital patient human information processing instrument sterilization intensive care interview medical decision making medical record nebulizer nurse patient transport practice guideline questionnaire CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 15567676 (http://www.ncbi.nlm.nih.gov/pubmed/15567676) PUI L39618481 DOI 10.1016/j.iccn.2004.07.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.iccn.2004.07.003 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 854 TITLE Training and assessment of competency of trainees in the transfer of critically ill patients [3] AUTHOR NAMES Spencer C. Watkinson P. McCluskey A. AUTHOR ADDRESSES (Spencer C.; Watkinson P.; McCluskey A., amccluskey@mcmail.com) Stepping Hill Hospital, Stockport SK2 2JE, United Kingdom. CORRESPONDENCE ADDRESS C. Spencer, Stepping Hill Hospital, Stockport SK2 2JE, United Kingdom. SOURCE Anaesthesia (2004) 59:12 (1248). Date of Publication: December 2004 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS anesthesiology anesthesist artificial ventilation clinical audit competence continuing education critical illness education program experience human intensive care unit learning letter medical literature mortality patient transport practice guideline questionnaire safety staff training task performance time workplace EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2004521717 MEDLINE PMID 15549995 (http://www.ncbi.nlm.nih.gov/pubmed/15549995) PUI L39600171 DOI 10.1111/j.1365-2044.2004.04017.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2044.2004.04017.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 855 TITLE A four-year survey of transfers from Aarhus Hospital with accompanying anaesthesiology staff ORIGINAL (NON-ENGLISH) TITLE En fireårig prospektiv registrering af anæstesiledsagede transporter fra Århus Amtssygehus AUTHOR NAMES Christiansen A. Juelsgaard P. AUTHOR ADDRESSES (Christiansen A., aagchr@stofanet.dk) Nygade 24, 1. th., DK-8000 Århus C, Denmark. (Christiansen A., aagchr@stofanet.dk; Juelsgaard P.) Århus Universitetshospital, Århus Sygehus, Anæstesiologisk Afdeling, . CORRESPONDENCE ADDRESS A. Christiansen, Nygade 24, 1. th., DK-8000 Århus C, Denmark. Email: aagchr@stofanet.dk SOURCE Ugeskrift for Laeger (2004) 166:47 (4261-4264). Date of Publication: 15 Nov 2004 ISSN 0041-5782 BOOK PUBLISHER Almindelige Danske Laegeforening, Tromdhjemsgade 9, Copenhagen, Denmark. ABSTRACT Introduction: The growth in specialization and centralization of the Danish health care system has resulted in an increase in patient transfers of the critically ill over a greater distance. In Denmark, an anaesthesiology nurse and a resident traditionally accompany these transfers. There are only very limited national guidelines for the transfer of critically ill patients in Denmark. Materials and methods: In the period 1 January 1999-31 December 2002, transfers with accompanying staff from the Department of Anaesthesiology of Aarhus Hospital were registered regarding patients' background and transport data. Results: 284 transfers were registered. Throughout the observation period there was an increase in the ASA score (median of 3.4) (range 1-5) and number of transfers. 75% of the transfers were made from 3:00 to 8:00 p.m. or on weekends. The median transport time was 80 (range 25-660) min. In 22.2% of cases did an anaesthesiologist accompany the patient. A worsening of the patient's condition was observed in 7.5% of cases. Discussion: This research indicates an increase in the number and a worsening of condition in those requiring accompaniment by the staff of the Anaesthesiology Department. The workload is mostly outside the »daytime roster« hours, thus diminishing the transferring hospital's acute care resources. It is still »the most inexperienced physicians accompanying the sickest patients«. This research emphasizes the need for national recommendations for the transport of critically ill patients and formalized training within this area, as well as an increasing need for specially trained transfer and retrieval teams and mobile intensive care units. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesiology hospital personnel patient transport EMTREE MEDICAL INDEX TERMS anesthesist article critical illness Denmark health care system hospital cost human intensive care unit medical education medical society medical specialist nurse practice guideline residency education scoring system training workload EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE Danish LANGUAGE OF SUMMARY English, Danish EMBASE ACCESSION NUMBER 2004511428 MEDLINE PMID 15587359 (http://www.ncbi.nlm.nih.gov/pubmed/15587359) PUI L39572362 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 856 TITLE Surgical aspects of Operation Bali Assist: initial wound surgery on the tarmac and in flight. AUTHOR NAMES Read D. Ashford B. AUTHOR ADDRESSES (Read D.; Ashford B.) Department of Surgery, Royal Darwin Hospital, Darwin, NT, Australia. CORRESPONDENCE ADDRESS D. Read, Department of Surgery, Royal Darwin Hospital, Darwin, NT, Australia. Email: DavidJ.Read@nt.gov.au SOURCE ANZ journal of surgery (2004) 74:11 (986-991). Date of Publication: Nov 2004 ISSN 1445-1433 ABSTRACT BACKGROUND: The explosion of three bombs on 12 October 2002 in Kuta, Bali resulted in mass casualties akin to those seen in war. The aim of the present report is to describe the sequence of events of Operation Bali Assist including triage, resuscitation and initial wound surgery in Bali at Sanglah Hospital in the aeromedical staging facility (ASF), Denpasar airport and the evacuation to Darwin. METHODS: A descriptive report is provided of the event and includes; resuscitation, anaesthesia, initial burns surgery management including escharotomy and fasciotomy, head injury management and importance of supplies and medical records with a description of the evacuation to Darwin. RESULTS: Operation Bali Assist involved five C130 Hercules aircraft and aeromedical evacuation medical and nursing teams managing 66 casualties in the Denpasar area and their evacuation to Royal Darwin Hospital with ketamine the most useful anaesthetic agent and cling film the most useful burns dressing. Twelve procedures were performed at the ASF including seven escharotomies, three fasciotomies and two closed reductions. One escharotomy was performed in flight. DISCUSSION: The important lessons learnt from the exercise is the inclusion of a surgeon in the aeromedical evacuation team, the importance of debridement and delayed primary closure, the usefulness of cling film as a burns dressing and the importance of continuous assessment. Future disaster planning exercises need to consider a patient age mix that might be expected in a shopping mall, rather than the young adult encountered in Bali, a more familiar age mix for Australian Defence Force medical staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blast injury (surgery) burn (surgery) disaster patient transport terrorism EMTREE MEDICAL INDEX TERMS air medical transport anesthesia article Australia fascia (surgery) head injury (therapy) human Indonesia intensive care unit organization and management resuscitation LANGUAGE OF ARTICLE English MEDLINE PMID 15550089 (http://www.ncbi.nlm.nih.gov/pubmed/15550089) PUI L39702861 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 857 TITLE Fluoroquinolone resistance from a transferable plasmid in Acinetobacter calcoaceticus [3] AUTHOR NAMES Joshi S.G. Litake G.M. Ghole V.S. Niphadkar K.B. AUTHOR ADDRESSES (Joshi S.G., surejoshi@yahoo.com; Niphadkar K.B.) Department of Clinical Microbiology, King Edward Memorial Hospital, Pune, India. (Litake G.M.; Ghole V.S.) Molecular Biology Laboratory, Division of Biochemistry, University of Pune, Ganeshkhind Road, Pune, India. CORRESPONDENCE ADDRESS S.G. Joshi, Department of Clinical Microbiology, King Edward Memorial Hospital, Pune, India. Email: surejoshi@yahoo.com SOURCE Indian Journal of Pathology and Microbiology (2004) 47:4 (593-594). Date of Publication: October 2004 ISSN 0377-4929 BOOK PUBLISHER Indian Association of Pathologists and Microbiologists, Sector 32-A, Chandigarh, India. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) ciprofloxacin (drug comparison) lomefloxacin (drug comparison) norfloxacin (drug comparison) ofloxacin (drug comparison) pefloxacin (drug comparison) quinoline derived antiinfective agent (drug comparison) EMTREE DRUG INDEX TERMS antibiotic agent (drug comparison) beta lactam antibiotic (drug comparison) beta lactamase inhibitor (drug comparison) nalidixic acid (drug comparison) quinolone derivative (drug comparison) tetracycline (drug comparison) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Acinetobacter calcoaceticus antibiotic resistance EMTREE MEDICAL INDEX TERMS Acinetobacter bacterial infection (drug resistance, etiology) bacterial meningitis (drug resistance, etiology) bacterium isolation cerebrospinal fluid examination Escherichia coli Gram negative bacterium Gram positive bacterium intensive care unit Klebsiella pneumoniae letter minimum inhibitory concentration multidrug resistance nonhuman plasmid Staphylococcus aureus CAS REGISTRY NUMBERS ciprofloxacin (85721-33-1) lomefloxacin (98079-51-7) nalidixic acid (389-08-2) norfloxacin (70458-96-7) ofloxacin (82419-36-1) pefloxacin (70458-92-3) tetracycline (23843-90-5, 60-54-8, 64-75-5) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2006177699 MEDLINE PMID 16295408 (http://www.ncbi.nlm.nih.gov/pubmed/16295408) PUI L43568727 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 858 TITLE Use of a specialized transport team for intrahospital transport of critically ill patients. AUTHOR NAMES McLenon M. AUTHOR ADDRESSES (McLenon M.) Surgical Critical Care at Washington Hospital Center in Washington, DC, USA. CORRESPONDENCE ADDRESS M. McLenon, Surgical Critical Care at Washington Hospital Center in Washington, DC, USA. Email: macmel@cablespeed.com SOURCE Dimensions of critical care nursing : DCCN (2004) 23:5 (225-229). Date of Publication: 2004 Sep-Oct ISSN 0730-4625 ABSTRACT The transport of critically ill patients is challenging for nurses and patients alike. It is imperative that patient safety be the primary focus. The use of a specialized transport team can help to alleviate many of the adverse effects of the transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS critical illness (therapy) evidence based medicine human methodology monitoring nursing nursing assessment nursing evaluation research organization and management professional standard review LANGUAGE OF ARTICLE English MEDLINE PMID 15722846 (http://www.ncbi.nlm.nih.gov/pubmed/15722846) PUI L41893349 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 859 TITLE Reducing family members' anxiety and uncertainty in illness around transfer from intensive care: an intervention study. AUTHOR NAMES Mitchell M.L. Courtney M. AUTHOR ADDRESSES (Mitchell M.L.; Courtney M.) School of Nursing, Griffith University, Australia. CORRESPONDENCE ADDRESS M.L. Mitchell, School of Nursing, Griffith University, Australia. Email: marion.mitchell@griffith.edu.au SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (2004) 20:4 (223-231). Date of Publication: Aug 2004 ISSN 0964-3397 ABSTRACT INTRODUCTION: This intervention study examines anxiety and uncertainty in illness in families transferring from intensive care to a general ward. METHODS: The pre-test, post-test design purposively allocated family members to a control (n = 80) and intervention group (n = 82). The intervention group experienced a structured individualised transfer method whereas the control group received existing ad hoc transfer methods. Families were surveyed before and after transfer. RESULTS: Families' uncertainty was significantly related to their state anxiety (P < 0.000), the relationship to the patient (P = 0.022), and the unexpected nature of patients' admission (P < 0.000). Anxiety increased significantly with reduced social support (P = 0.002). Following transfer, anxiety reduced significantly for both groups whereas uncertainty reduced significantly for the intervention group (P = 0.03). CONCLUSION: Families at the time of transfer experience uncertainty and anxiety, which are significantly related in this study. The intervention significantly reduced uncertainty scores. When the family member was a parent, when admissions were unexpected, and those with fewer social supports represent potential 'at risk' groups whose adaptation to transfer may limit their coping ability. The structured individualised method of transfer is recommended with further research of ICU families to further examine the dimension of uncertainty and how it affects patient outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety (prevention) family patient transport publication social support EMTREE MEDICAL INDEX TERMS adolescent adult aged analysis of variance article Australia clinical trial controlled clinical trial controlled study female human intensive care unit male middle aged psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 15288876 (http://www.ncbi.nlm.nih.gov/pubmed/15288876) PUI L39321807 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 860 TITLE Intra-hospital transport of critically ill patients: Minimising risk AUTHOR NAMES Shirley P.J. Bion J.F. AUTHOR ADDRESSES (Shirley P.J.) Intensive Care Unit, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom. (Bion J.F., J.F.Bion@bham.ac.uk) Univ. Dept. Anaesthesia Intensive C., Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom. CORRESPONDENCE ADDRESS J.F. Bion, Univ. Dept. Anaesthesia Intensive C., Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom. Email: J.F.Bion@bham.ac.uk SOURCE Intensive Care Medicine (2004) 30:8 (1508-1510). Date of Publication: August 2004 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness hospital patient transport risk reduction EMTREE MEDICAL INDEX TERMS competence editorial health hazard human intensive care unit patient care professional practice risk assessment safety skill staff training EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2004354563 MEDLINE PMID 15197442 (http://www.ncbi.nlm.nih.gov/pubmed/15197442) PUI L39094949 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 861 TITLE Incidents relating to the intra-hospital transfer of critically ill patients: An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care AUTHOR NAMES Beckmann U. Gillies D.M. Berenholtz S.M. Wu A.W. Pronovost P. AUTHOR ADDRESSES (Beckmann U., mdub@alinga.newcastle.edu.au) Australian Incident Monitoring S., . (Pronovost P.) Agy. for Hlthcare. Res. and Quality, . (Berenholtz S.M.) Natl. Heart, Lung and Blood Inst., . (Beckmann U., mdub@alinga.newcastle.edu.au; Wu A.W.) Division of Anaesthesia, John Hunter Hospital, Newcastle Regional Mail Centre, Locked Bag 1, Newcastle, NSW 2300, Australia. (Gillies D.M.) Division of Surgery, John Hunter Hospital, Newcastle Regional Mail Centre, Locked Bag 1, Newcastle, NSW 2300, Australia. (Berenholtz S.M.; Pronovost P.) Dept. Anesth. and Critical Care Med., School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287-7294, United States. (Wu A.W.) Dept. of Hlth. Policy and Management, Johns Hopkins Bloomberg Sch. Pub. H., 624 North Wolfe Street, Baltimore, MD 21205, United States. CORRESPONDENCE ADDRESS U. Beckmann, Division of Anaesthesia, John Hunter Hospital, Newcastle Regional Mail Centre, Locked Bag 1, Newcastle, NSW 2300, Australia. Email: mdub@alinga.newcastle.edu.au SOURCE Intensive Care Medicine (2004) 30:8 (1579-1585). Date of Publication: August 2004 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Objective: Transportation of critically ill patients within the hospital poses important risks. We sought to identify causes, outcomes and contributing factors associated with intra-hospital transport. Design: Cross-sectional case review. Setting: Incident reports submitted to the Australian Incident Monitoring Study in Intensive Care (AIMS-ICU). Measurement and main results: Between 1993 and 1999, 176 reports were submitted describing 191 incidents. Seventy-five reports (39%) identified equipment problems, relating prominently to battery/power supply, transport ventilator and monitor function, access to patient elevators and intubation equipment. Hundred sixteen reports (61%) identified patient/staff management issues including poor communication, inadequate monitoring, incorrect set-up of equipment, artificial airway malpositioning and incorrect positioning of patients. Serious adverse outcomes occurred in 55 reports (31%) including major physiological derangement (15%), patient/relative dissatisfaction (7%), prolonged hospital stay (4%), physical/psychological injury (3%) and death (2%). Of 900 contributing factors identified, 46% were system-based and 54% human-based. Communication problems, inadequate protocols, in-servicing/training and equipment were prominent equipment-related incidents. Errors of problem recognition and judgement, failure to follow protocols, inadequate patient preparation, haste and inattention were common management-related incidents. Rechecking the patient and equipment, skilled assistance and prior experience were important factors limiting harm. Conclusions: Intra-hospital transport poses an important risk to ICU patients. The adequate provision of highly qualified staff, specially designed and well maintained equipment, as well as continuous monitoring are essential to avoid/mitigate these incidents. Professional societies and local units should adopt guidelines/protocols for intra-hospital transportation. Monitoring of incidents should aid in the continuous improvement in patient safety. © Springer-Verlag 2004. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness hospital care medical practice EMTREE MEDICAL INDEX TERMS clinical protocol death devices hospitalization human incidence injury intensive care unit interpersonal communication patient monitoring patient satisfaction patient transport physical disease power supply prevalence psychological aspect review skill ventilator EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004354573 MEDLINE PMID 14991102 (http://www.ncbi.nlm.nih.gov/pubmed/14991102) PUI L39094959 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 862 TITLE Intensive care within the context of military long-distance transport ORIGINAL (NON-ENGLISH) TITLE Intensivtherapie im militärischen langstreckentransport AUTHOR NAMES Hossfeld B. Rohowsky B. Rödig E. Lampl L. AUTHOR ADDRESSES (Hossfeld B., bjoern.hossfeld@extern.uni-ulm.de; Lampl L.) Bundeswehrkrankenhaus Ulm, Abt. Anasthesiol. und Intensivmed., . (Rohowsky B.) Lufttransportkommando Münster, . (Rödig E.) Luftwaffenamt, Abt. Luft-u. Raumfahrtmedizin, Fliegerarztlicher Dienst der Bw., . (Hossfeld B., bjoern.hossfeld@extern.uni-ulm.de) Abt. Anasthesiol. und Intensivmed., Bundeswehrkrankenhaus, 89070 Ulm, Germany. CORRESPONDENCE ADDRESS B. Hossfeld, Abt. Anasthesiol. und Intensivmed., Bundeswehrkrankenhaus, 89070 Ulm, Germany. Email: bjoern.hossfeld@extern.uni-ulm.de SOURCE Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie (2004) 39:5 (256-264). Date of Publication: May 2004 ISSN 0939-2661 BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. ABSTRACT Due to the changed task spectrum of the German Federal Armed Forces with participation in international deployments for UN and NATO the concept of Aeromedical Evacuation (MedEvac) gained a new quality for the Air Force as well as for the Medical Corps. The transport of mostly severely injured or critically ill patients requires both, medical equipment which has to be permanently adapted to the national standard, and qualified intensive-care-personnel. At present, the aircrafts used for such deployments are four C-160 Transall, one CL-601 Challenger and two Airbus A310, which, if necessary, can be equipped with one or more intensive-care "patient transportation units" (PTU). Contrary to the two other aircrafts, the CL-601 Challenger is only equipped for the intensive-care transport of one individual patient. The PTU corresponds to the technical equipment of the intensive care unit of a level-1-trauma centre and ensures an intensive-care therapy on highest level also during longer transportation. The work with this equipment, the characteristics of the long-distance air transport and the special situation of the military deployment causes special demands on the qualifications of the assigned personnel. Primarily planned for the repatriation of injured or ill soldiers, in the mean time, this concept is also essential for the medevac of civilian victims after mass casualties worldwide. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS air force aircraft army human military medicine practice guideline review United Nations victim EMBASE CLASSIFICATIONS Internal Medicine (6) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2004241871 MEDLINE PMID 15156416 (http://www.ncbi.nlm.nih.gov/pubmed/15156416) PUI L38720382 DOI 10.1055/s-2004-814463 FULL TEXT LINK http://dx.doi.org/10.1055/s-2004-814463 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 863 TITLE Perinatal transport: Problems in neonatal intensive care capacity AUTHOR NAMES Gill A.B. Bottomley L. Chatfield S. Wood C. AUTHOR ADDRESSES (Gill A.B., bryan.gill@leedsth.nhs.uk) Peter Congdon Neonatal Unit, Leeds General Infirmary, Leeds LS2 9NS, United Kingdom. (Gill A.B., bryan.gill@leedsth.nhs.uk; Bottomley L.) Peter Congdon Neonatal Unit, Leeds General Infirmary, Leeds, United Kingdom. (Chatfield S.) Neonatal Unit, Bradford Royal Infirmary, Bradford, United Kingdom. (Wood C.) Neonatal Unit, Hull Maternity Hospital, Hull, United Kingdom. CORRESPONDENCE ADDRESS A.B. Gill, Peter Congdon Neonatal Unit, Leeds General Infirmary, Leeds LS2 9NS, United Kingdom. Email: bryan.gill@leedsth.nhs.uk SOURCE Archives of Disease in Childhood: Fetal and Neonatal Edition (2004) 89:3 (F220-F223). Date of Publication: May 2004 ISSN 0003-9888 1359-2998 (electronic) BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT Objective: To assess the quantity and nature of transfers within the Yorkshire perinatal service, with the aim of identifying suitable outcome measures for the assessment of future service improvements. Design/Setting: Collection of data on perinatal transfers from all neonatal and maternity units located in the Yorkshire region of the United Kingdom from May to November 2000. Patients: Expectant mothers (in utero transfers) and neonates (ex utero transfers). Interventions: None Main Outcome Measures: Quantification of in utero and ex utero transfers; the reasons for and resources required to support transfers; the nature of each transfer (acute, specialist, non-acute, into or out of region). Results: In the period studied, there were 800 transfers (337 in utero; 463 ex utero); 306 transfers were "acute" (80% of transfers in utero), 214 because of specialist need, and 280 "non-acute". Some 37% of capacity transfers occurred from the two level 3 units in the region. Of 254 transfers out of the 14 neonatal units for intensive care, 44 (17.3%) were transferred to hospitals outside the normal neonatal commissioning boundaries. Conclusions: The study highlights a continuing apparent lack of capacity within the neonatal service in the Yorkshire region, resulting in considerable numbers of neonatal and maternal transfers. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport perinatal care EMTREE MEDICAL INDEX TERMS article human information processing maternal care outcomes research priority journal United Kingdom EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004195354 MEDLINE PMID 15102724 (http://www.ncbi.nlm.nih.gov/pubmed/15102724) PUI L38570150 DOI 10.1136/adc.2003.028159 FULL TEXT LINK http://dx.doi.org/10.1136/adc.2003.028159 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 864 TITLE Interhospital and intrahospital transport of the critically and injured ill patients ORIGINAL (NON-ENGLISH) TITLE Interhospitalni i intrahospitalni transport kriticno povredenih i obolelih. AUTHOR NAMES Filipović N. Surbatović M. Stanković N. Jovanović K. AUTHOR ADDRESSES (Filipović N.; Surbatović M.; Stanković N.; Jovanović K.) Vojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd. CORRESPONDENCE ADDRESS N. Filipović, Vojnomedicinska akademija, Klinika za anesteziologiju i intenzivnu terapiju, Beograd. Email: anes@EUnet.yu SOURCE Vojnosanitetski pregled. Military-medical and pharmaceutical review (2004) 61:3 (311-314). Date of Publication: 2004 May-Jun ISSN 0042-8450 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness injury patient transport EMTREE MEDICAL INDEX TERMS adolescent adult article human methodology middle aged monitoring LANGUAGE OF ARTICLE unknown MEDLINE PMID 15330305 (http://www.ncbi.nlm.nih.gov/pubmed/15330305) PUI L39680693 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 865 TITLE The safe transfer of care AUTHOR NAMES Sullivan E.E. AUTHOR ADDRESSES (Sullivan E.E., eesullivan@partners.org) PACU, Brigham and Women's Hospital, Boston, MA, United States. (Sullivan E.E., eesullivan@partners.org) 137 Tiffany Rd, Norwell, MA 02061, United States. CORRESPONDENCE ADDRESS E.E. Sullivan, 137 Tiffany Rd, Norwell, MA 02061, United States. Email: eesullivan@partners.org SOURCE Journal of Perianesthesia Nursing (2004) 19:2 (108-110). Date of Publication: April 2004 ISSN 1089-9472 BOOK PUBLISHER W.B. Saunders EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care patient transport EMTREE MEDICAL INDEX TERMS anamnesis anesthesia competence health care personnel human intensive care unit medical documentation medical information system medical practice medical record nursing operating room patient monitoring physical examination short survey standardization LANGUAGE OF ARTICLE English MEDLINE PMID 15069650 (http://www.ncbi.nlm.nih.gov/pubmed/15069650) PUI L38456675 DOI 10.1016/j.jopan.2004.01.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.jopan.2004.01.004 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 866 TITLE Guidelines for the transport of critically ill patients AUTHOR NAMES Gupta S. Bhagotra A. Gulati S. Sharma J. AUTHOR ADDRESSES (Gupta S.; Bhagotra A.; Gulati S.; Sharma J.) PG. Dept. Anaesth./Intensive Care, Govt. Medical College, Jammu J/K, India. CORRESPONDENCE ADDRESS S. Gupta, PG. Dept. Anaesth./Intensive Care, Govt. Medical College, Jammu J/K, India. SOURCE JK Science (2004) 6:2 (109-112). Date of Publication: April/June 2004 ISSN 0972-1177 BOOK PUBLISHER JK Science, Shiv Bhawan, Hari Market, P.O. Box 158, Jammu, India. EMTREE DRUG INDEX TERMS adenosine alfentanil aminophylline amiodarone atropine bicarbonate captopril cefotaxime dexamethasone diazepam digoxin dobutamine epinephrine etomidate flumazenil furosemide gluconate calcium heparin isoprenaline isosorbide dinitrate lidocaine magnesium sulfate methylprednisolone morphine noradrenalin phenobarbital propofol suxamethonium unindexed drug vecuronium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport practice guideline EMTREE MEDICAL INDEX TERMS article artificial ventilation blood pressure measurement breathing rate electrocardiography monitoring emergency treatment heart arrhythmia (complication) heart rate human hypotension (complication) hypoxia (complication) infusion system intensive care unit intracranial hypertension (complication) manpower medical decision making medical device medical documentation patient care patient monitoring resuscitation risk assessment safety teamwork treatment planning CAS REGISTRY NUMBERS adenosine (58-61-7) adrenalin (51-43-4, 55-31-2, 6912-68-1) alfentanil (69049-06-5, 71195-58-9) aminophylline (317-34-0) amiodarone (1951-25-3, 19774-82-4, 62067-87-2) atropine (51-55-8, 55-48-1) bicarbonate (144-55-8, 71-52-3) captopril (62571-86-2) cefotaxime (63527-52-6, 64485-93-4) dexamethasone (50-02-2) diazepam (439-14-5) digoxin (20830-75-5, 57285-89-9) dobutamine (34368-04-2, 52663-81-7) etomidate (15301-65-2, 33125-97-2, 51919-80-3) flumazenil (78755-81-4) furosemide (54-31-9) gluconate calcium (299-28-5) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2) isosorbide dinitrate (87-33-2) lidocaine (137-58-6, 24847-67-4, 56934-02-2, 73-78-9) magnesium sulfate (7487-88-9) methylprednisolone (6923-42-8, 83-43-2) morphine (52-26-6, 57-27-2) noradrenalin (1407-84-7, 51-41-2) phenobarbital (50-06-6, 57-30-7, 8028-68-0) propofol (2078-54-8) suxamethonium (306-40-1, 71-27-2) vecuronium (50700-72-6) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2004329046 PUI L39004378 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 867 TITLE Meeting patient and relatives' information needs upon transfer from an intensive care unit: The development and evaluation of an information booklet AUTHOR NAMES Paul F. Hendry C. Cabrelli L. AUTHOR ADDRESSES (Paul F., fiona.paul@tuht.scot.nhs.uk) Ninewells Hospital, Dundee, United Kingdom. (Hendry C.) School of Nursing and Midwifery, University of Dundee, Ninewells Hospital, Dundee, United Kingdom. (Cabrelli L.) Intensive Care Unit, Ninewells Hospital, Dundee, United Kingdom. (Paul F., fiona.paul@tuht.scot.nhs.uk) Ninewells Hospital, Dundee DD1 9SY, United Kingdom. CORRESPONDENCE ADDRESS F. Paul, Ninewells Hospital, Dundee DD1 9SY, United Kingdom. Email: fiona.paul@tuht.scot.nhs.uk SOURCE Journal of Clinical Nursing (2004) 13:3 (396-405). Date of Publication: March 2004 ISSN 0962-1067 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT Background. Transfer from the intensive care unit to a ward is associated with a significant degree of relocation stress for patients and relatives. This can be stressful for ward nurses due to the dependency levels of patients and the ensuing increased workload. Furthermore the patient may require care, not normally undertaken in that clinical area, e.g. tracheostomy care. Patients may forget the verbal information given to them at the time of transfer and often have limited or no memory of the intensive care unit experience. This can cause anxiety and compound the feelings of stress associated with transfer. Many patients suffer psychological and physiological problems after intensive care unit, which can affect their recovery and quality of life. Aims. The aim of the study was to develop an evidence-based information booklet for patients and relatives preparing for transfer from intensive care units. Design. This collaborative study used an exploratory design with elements of the action research cycle. The study, conducted in three phases, involved identifying patients' and relatives' information needs around the time of transfer; designing and developing an information booklet; and the introduction and evaluation of the booklet into practice. Methods. Semistructured interviews were used to elicit the views of patients and relatives regarding their information needs. Members of the multidisciplinary team were involved in identifying and reviewing booklet content. Results. Evaluation identified positive outcomes relating to patients' and relatives' satisfaction with the information and enhanced communication with other wards and health care professionals. The study also highlighted the need for more staff education in relation to patients and relatives needs when transferring to a ward. Conclusions. This study has demonstrated the value of providing patients and relatives with written information regarding transfer from intensive care units. Furthermore the study confirmed the feasibility and importance of including patients and relatives in the process of booklet development to ensure that their needs for information are being met. Relevance to clinical practice. Providing written information as part of a structured discharge plan is recommended. It provides patients and relatives with a resource that they can refer to at any time and that enhances verbal communication. The purpose of this information is to inform and empower patients so that they are better prepared for the transfer and recovery period. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care medical information system patient transport EMTREE MEDICAL INDEX TERMS clinical research evidence based medicine health practitioner human interpersonal communication interview outcomes research patient satisfaction relative review LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 15009342 (http://www.ncbi.nlm.nih.gov/pubmed/15009342) PUI L38470876 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 868 TITLE Putting cardiac surgery patients on the "fast track". AUTHOR NAMES Farley T. AUTHOR ADDRESSES (Farley T.) Duke University Health System, Durham, NC, USA. CORRESPONDENCE ADDRESS T. Farley, Duke University Health System, Durham, NC, USA. SOURCE Nursing (2004) 34:3 (19). Date of Publication: Mar 2004 ISSN 0360-4039 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart surgery intensive care unit patient selection patient transport EMTREE MEDICAL INDEX TERMS article human nursing nursing assessment organization and management policy practice guideline time LANGUAGE OF ARTICLE English MEDLINE PMID 15179997 (http://www.ncbi.nlm.nih.gov/pubmed/15179997) PUI L38753555 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 869 TITLE A practical tool to reduce medication errors during patient transfer from an intensive care unit AUTHOR NAMES Pronovost P. Hobson D.B. Earsing K. Lins E.S. Rinke M.L. Emery K. Berenholtz S.M. Lipsett P.A. Dorman T. AUTHOR ADDRESSES (Pronovost P., ppronovo@jhmi.edu; Hobson D.B.; Earsing K.; Lins E.S.; Rinke M.L.; Emery K.; Berenholtz S.M.; Lipsett P.A.; Dorman T.) Johns Hopkins Medical Institution, Johns Hopkins School of Medicine, 901 South Bond St., Baltimore, MD 21231, United States. CORRESPONDENCE ADDRESS P. Pronovost, Johns Hopkins Medical Institution, 901 South Bond St., Baltimore, MD 21231, United States. Email: ppronovo@jhmi.edu SOURCE Journal of Clinical Outcomes Management (2004) 11:1 (26-33). Date of Publication: Jan 2004 ISSN 1079-6533 ABSTRACT • Objective: To decrease medication errors that occur during the transfer of patients from a surgical intensive care unit (ICU) by institution of a computerized medication reconciliation tool. • Design: Prospective cohort study. Setting and participants: Patients admitted to a 16-bed surgical ICU in an academic medical center. • Measurement: Proportion of medical records with at least 1 error identified. Secondary outcomes included compliance with the tool and number of medication orders changed. • Results: Over the 1-year study period, 1455 medication reconciliation forms were completed. 636 medication orders were changed as a result of the medication form, and 299 (21%) individual patients required at least 1 change. An average of 12.2 orders were changed per week, affecting an average of 6 patients per week. There was a high rate of compliance with the form. • Conclusion: The implementation of a simple, inexpensive tool is associated with a decrease in medication errors that reach patients during transfer from a surgical ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) electronic medical record intensive care unit medication error patient transport EMTREE MEDICAL INDEX TERMS article cohort analysis computer system controlled study hospital admission human medical record outcomes research patient compliance prospective study surgical ward university hospital EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004245209 PUI L38735531 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 870 TITLE Air medical and critical care transport program down under AUTHOR ADDRESSES SOURCE Air Medical Journal (2004) 23:1 (16). Date of Publication: Jan 2004 ISSN 1067-991X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aerospace medicine intensive care patient transport EMTREE MEDICAL INDEX TERMS Australia competence e-mail education program human medical information New Zealand note organization and management paramedical personnel priority journal professional standard EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2004096367 PUI L38256473 DOI 10.1016/j.amj.2003.10.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.amj.2003.10.006 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 871 TITLE Guidelines for the inter- and intrahospital transport of critically ill patients AUTHOR NAMES Warren J. Fromm Jr. R.E. Orr R.A. Rotello L.C. Mathilda Horst H. AUTHOR ADDRESSES (Warren J.; Fromm Jr. R.E.; Orr R.A.; Rotello L.C.; Mathilda Horst H.) Amer. Coll. of Critical Care Med., . (Warren J.) Northwest Community Hospital, Arlington Heights, IL, United States. (Fromm Jr. R.E.) Baylor College of Medicine, Houston, TX, United States. (Orr R.A.) Children's Hospital of Pittsburgh, University of Pittsburgh, School of Medicine, Pittsburgh, PA. (Rotello L.C.) Suburban Hospital, Bethesda, MD, United States. (Mathilda Horst H.) Henry Ford Hospital, Detroit, MI, United States. CORRESPONDENCE ADDRESS J. Warren, Northwest Community Hospital, Arlington Heights, IL, United States. SOURCE Critical Care Medicine (2004) 32:1 (256-262). Date of Publication: January 2004 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: The development of practice guidelines for the conduct of intra- and interhospital transport of the critically ill patient. Data Source: Expert opinion and a search of Index Medicus from January 1986 through October 2001 provided the basis for these guidelines. A task force of experts in the field of patient transport provided personal experience and expert opinion. Study Selection and Data Extraction: Several prospective and clinical outcome studies were found. However, much of the published data comes from retrospective reviews and anecdotal reports. Experience and consensus opinion form the basis of much of these guidelines. Results of Data Synthesis: Each hospital should have a formalized plan for intra- and Interhospital transport that addresses a) pretransport coordination and communication; b) transport personnel; c) transport equipment; d) monitoring during transport; and e) documentation. The transport plan should be developed by a multidisciplinary team and should be evaluated and refined regularly using a standard quality improvement process. Conclusion: The transport of critically ill patients carries inherent risks. These guidelines promote measures to ensure safe patient transport. Although both intra- and interhospital transport must comply with regulations, we believe that patient safety is enhanced during transport by establishing an organized, efficient process supported by appropriate equipment and personnel. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS clinical observation experience health program hospital human interpersonal communication literature medical documentation medical information medical personnel medical society patient monitoring priority journal review risk assessment safety treatment outcome visuomotor coordination EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2004045839 MEDLINE PMID 14707589 (http://www.ncbi.nlm.nih.gov/pubmed/14707589) PUI L38125591 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 872 TITLE Top 10 ways to prepare for a pediatric critical care transport AUTHOR NAMES Shields R. AUTHOR ADDRESSES (Shields R., robert.shields@tch.harvard.edu) Critical Care Transport Team, Children's Hospital, Boston, MA, United States. (Shields R., robert.shields@tch.harvard.edu) 14 Morton Ave, Saugus, MA 01906, United States. CORRESPONDENCE ADDRESS R. Shields, 14 Morton Ave, Saugus, MA 01906, United States. Email: robert.shields@tch.harvard.edu SOURCE Journal of Emergency Nursing (2003) 29:6 (574-575). Date of Publication: December 2003 ISSN 0099-1767 BOOK PUBLISHER Mosby Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport pediatrics EMTREE MEDICAL INDEX TERMS airway conductance child environmental exposure human immobilization medical device medical record nasogastric tube note nursing patient care sedation splinting thermoregulation vascular patency LANGUAGE OF ARTICLE English MEDLINE PMID 14631349 (http://www.ncbi.nlm.nih.gov/pubmed/14631349) PUI L37541031 DOI 10.1016/S0099-1767(03)00347-7 FULL TEXT LINK http://dx.doi.org/10.1016/S0099-1767(03)00347-7 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 873 TITLE The transfer of capacities in cardiology: Is it the solution to coming difficulties in terms of medical demography that the French general hospitals will have to face in their departments of cardiology? ORIGINAL (NON-ENGLISH) TITLE Les transferts de compétence en cardiologie: La solution aux difficultés démographiques médicales à venir dans les services de cardiologie des hôpitaux généraux Français? AUTHOR NAMES Dujardin J.J. AUTHOR ADDRESSES (Dujardin J.J., jjacques.dujardin@ch-douai.fr) Sereviceece de Cardiologie, Centre Hospitalier de Douai, BP 740, 59507 Douai Cedex, France. CORRESPONDENCE ADDRESS J.J. Dujardin, Sereviceece de Cardiologie, Centre Hospitalier de Douai, BP 740, 59507 Douai Cedex, France. Email: jjacques.dujardin@ch-douai.fr SOURCE Annales de Cardiologie et d'Angeiologie (2003) 52:5 (282-284). Date of Publication: November 2003 ISSN 0003-3928 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiology demography France general hospital EMTREE MEDICAL INDEX TERMS Canada comparative study coronary care unit editorial human manpower nurse practitioner physician assistant United Kingdom United States EMBASE CLASSIFICATIONS Internal Medicine (6) Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2003464110 MEDLINE PMID 14714340 (http://www.ncbi.nlm.nih.gov/pubmed/14714340) PUI L37409054 DOI 10.1016/S0003-3928(03)00095-7 FULL TEXT LINK http://dx.doi.org/10.1016/S0003-3928(03)00095-7 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 874 TITLE Evacuation of the intensive care unit in case of danger ORIGINAL (NON-ENGLISH) TITLE Die räumung von intensivstationen im gefahrenfall AUTHOR NAMES Marx F. AUTHOR ADDRESSES (Marx F., dr.frank.marx@t-online.de) Rettungsdienst, Berufsfeuerwehr Duisburg, Wintgensstr. 111, D-47055 Duisburg, Germany. CORRESPONDENCE ADDRESS F. Marx, Rettungsdienst, Berufsfeuerwehr Duisburg, Wintgensstr. 111, D-47055 Duisburg, Germany. Email: dr.frank.marx@t-online.de SOURCE Journal fur Anasthesie und Intensivbehandlung (2003) 10:1 (181-182). Date of Publication: 2003 ISSN 0941-4223 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hazard intensive care unit patient transport EMTREE MEDICAL INDEX TERMS conference paper Germany medical documentation medical literature practice guideline ventilator EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 2003418857 PUI L37270979 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 875 TITLE The impact of early transfer bias in a growth study among neonatal intensive care units AUTHOR NAMES Olsen I.E. Richardson D.K. Schmid C.H. Ausman L.M. Dwyer J.T. AUTHOR ADDRESSES (Olsen I.E., olseni@email.chop.edu) Department of Nutrition, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02212, United States. (Ausman L.M.; Dwyer J.T.) Gerald J./Dorothy R. Friedman S., Tufts University, 153 Harrison Avenue, Boston, MA 02111, United States. (Richardson D.K.) Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States. (Richardson D.K.; Dwyer J.T.) Dept. Hlth. Plcy./Mgmt./Matern./C., Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02111, United States. (Schmid C.H.) Biostatistics Research Center, Division of Clinical Care Research, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, United States. (Schmid C.H.; Ausman L.M.; Dwyer J.T.) School of Medicine, Tufts University, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, United States. (Ausman L.M.; Dwyer J.T.) US Department of Agriculture, Hum. Nutr. Research Center on Aging, Tufts University, 153 Harrison Avenue, Boston, MA 02111, United States. (Dwyer J.T.) Frances Stern Nutrition Center, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, United States. (Olsen I.E., olseni@email.chop.edu) Children's Hospital of Philadelphia, Div. of Gastroenterol. and Nutrition, 3535 Market Street, Philadelphia, PA 19104, United States. CORRESPONDENCE ADDRESS I.E. Olsen, Children's Hospital of Philadelphia, Div. of Gastroenterol. and Nutrition, 3535 Market Street, Philadelphia, PA 19104, United States. Email: olseni@email.chop.edu SOURCE Journal of Clinical Epidemiology (2003) 56:10 (998-1005). Date of Publication: 1 Oct 2003 ISSN 0895-4356 BOOK PUBLISHER Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States. ABSTRACT Background and Objective: Transfer of infants between hospitals or their discharge home may bias comparisons of the performance across neonatal intensive care units (NICUs). This study attempts to show the potential size of transfer bias in the context of a large cohort study and describe strategies for minimizing this type of bias. Methods: To limit transfer bias in a neonatal growth study of extremely premature infants in six tertiary NICUs, we restricted eligibility to infants <30 weeks gestation at birth and substituted matched replacements for early transfers (infants transferred or discharged prior to day of life 16). Results: The restriction strategy was successful, reducing the overall early transfer rate from 16.4 to 3.6% and the range of transfer rates among individual NICUs from 0.6-32.7% to 0-11.0%. Replacement by matched substitutes had a much smaller effect because of the small number of early transfers and our inability to match on all factors distinguishing early transfers. Conclusion: Sampling strategies to minimize infants lost to follow-up were more successful than replacement strategies in limiting transfer bias in a NICU growth study. Although complete elimination of bias is likely impossible, valid studies require efforts to minimize, quantify, and test the effect of transfer bias. © 2003 Elsevier Inc. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) epidemiological data hospital discharge newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article cohort analysis controlled study follow up gestational age human newborn normal human prematurity priority journal procedures EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003418394 MEDLINE PMID 14568632 (http://www.ncbi.nlm.nih.gov/pubmed/14568632) PUI L37268088 DOI 10.1016/S0895-4356(03)00168-9 FULL TEXT LINK http://dx.doi.org/10.1016/S0895-4356(03)00168-9 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 876 TITLE Critical Care Nursing Expertise during Air Transport AUTHOR NAMES Topley D.K. Schmelz J. Henkenius-Kirschbaum J. Horvath K.J. AUTHOR ADDRESSES (Topley D.K.; Schmelz J.; Henkenius-Kirschbaum J.; Horvath K.J.) Wilford Hall Medical Center, 2200 Berquist Drive, Lackland Air Force Base, TX 78236, United States. CORRESPONDENCE ADDRESS D.K. Topley, Wilford Hall Medical Center, 2200 Berquist Drive, Lackland Air Force Base, TX 78236, United States. SOURCE Military Medicine (2003) 168:10 (822-826). Date of Publication: October 2003 ISSN 0026-4075 BOOK PUBLISHER Association of Military Surgeons of the US, 9320 Old Georgetown Road, Bethesda, United States. ABSTRACT The purpose of this study was to describe the practical knowledge possessed by registered nurses that are part of the Air Force's Critical Care Air Transport Team (CCATT) and distinguish salient features of CCATT knowledge to critical care nursing in the hospital. This research study used descriptive, exploratory methods. Twelve CCATT nurses, identified as experts, were included in the study. Data were collected using written narratives by each participant; group interviews in which nurses discussed the written narratives; and individual interviews. Data were analyzed using interpretive phenomenology. Four major themes developed from the data. The knowledge embedded in CCATT nursing included: preflight preparation, in-flight assessment and environment, characteristics of CCATT nurse, and hospital vs. in-flight nursing practice. CCATT nurses improvise and provide nursing care based on past experiences using a broad critical care knowledge base. This has led to the development of a unique body of knowledge for nursing care. The areas of assessment and preparation described by the CCATT nurses can serve as a template for the Air Force's CCATT training program and CCATT orientation checklists. This study also identified several topics for future research. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nursing patient transport EMTREE MEDICAL INDEX TERMS air force article comparative study hospital care human medical education nurse EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003428882 MEDLINE PMID 14620647 (http://www.ncbi.nlm.nih.gov/pubmed/14620647) PUI L37305321 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 877 TITLE Lack of clear channels of communication in patient transfer between care facilities leads to fragmentation in care AUTHOR ADDRESSES SOURCE International Journal for Quality in Health Care (2003) 15:5 (441). Date of Publication: October 2003 ISSN 1353-4505 BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care facility hospital management patient transport EMTREE MEDICAL INDEX TERMS case report community hospital hospital admission hospital discharge hospital personnel human infant intensive care unit note patient information priority journal staff training EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2003414787 MEDLINE PMID 14527988 (http://www.ncbi.nlm.nih.gov/pubmed/14527988) PUI L37259381 DOI 10.1093/intqhc/mzg072 FULL TEXT LINK http://dx.doi.org/10.1093/intqhc/mzg072 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 878 TITLE Understanding uncertainty and minimizing families' anxiety at the time of transfer from intensive care AUTHOR NAMES Mitchell M.L. Courtney M. Coyer F. AUTHOR ADDRESSES (Mitchell M.L., marion.mitchell@mailbox.gu.edu.au) School of Nursing, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia. (Courtney M.; Coyer F.) School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia. CORRESPONDENCE ADDRESS M. Mitchell, School of Nursing, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia. Email: marion.mitchell@mailbox.gu.edu.au SOURCE Nursing and Health Sciences (2003) 5:3 (207-217). Date of Publication: September 2003 ISSN 1441-0745 BOOK PUBLISHER Blackwell Publishing, 550 Swanston Street, Carlton South, Australia. ABSTRACT When general ward registered nurses (RN) receive patients from an intensive care unit (ICU) they report that much of their time in the initial phases revolves around meeting family needs (Farvis, 2002). Families experience anxiety when leaving the security of the close monitoring seen in ICU (Leith, 1999) and their anxiety reduces their ability to play a key role in the patient's recovery (McShane, 1991; Leske, 1992) as it can impair their decision-making (Cagan, 1988; Halm et al., 1993). By reducing a family's anxiety, they may be more able to cope with the necessary transition to a general ward and support the patient's recovery. A literature search from 1990 onwards was performed within the CINAHL, Medline and Cochrane databases using the key words: intensive care, family, General System Theory, uncertainty, anxiety and transfer. Further articles were retrieved from citation references from the Web of Science or through the reference lists of retrieved literature. Library catalogues were searched using the same key words for books and book chapters. von Bertalanffy's General System Theory provides a framework for understanding the importance of family in a critical illness situation. Critical illness permits little or no time to adapt, thus reducing the family's ability to cope with the situation. Transfer out of ICU is a significant anxiety-producing event for families. Uncertainty in illness is reported in other illness situations to reduce family's adaptation to illness events, but has not been researched with an ICU cohort of families. Seven out of the top 10 needs of ICU families are information needs, highlighting the importance of communication regarding progress and future plans. Nurses require an increased awareness that transfer anxiety exists for families and to be knowledgable about ways to reduce its occurrence. Research is required to evaluate the efficacy of interventions to reduce anxiety for families and examine the level of uncertainty in illness in this cohort. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety family counseling intensive care unit patient transport EMTREE MEDICAL INDEX TERMS adaptive behavior awareness book clinical research Cochrane Library cohort analysis convalescence coping behavior critical illness experience human interpersonal communication medical decision making medical information medical literature Medline nurse attitude nursing staff patient monitoring priority journal review theory time treatment planning ward EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003349180 MEDLINE PMID 12877722 (http://www.ncbi.nlm.nih.gov/pubmed/12877722) PUI L37045796 DOI 10.1046/j.1442-2018.2003.00155.x FULL TEXT LINK http://dx.doi.org/10.1046/j.1442-2018.2003.00155.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 879 TITLE Interfacility transport of patients admitted to the ICU: Perceived needs of family members AUTHOR NAMES Perez L. Alexander D. Wise L. AUTHOR ADDRESSES (Perez L.; Alexander D.; Wise L.) Life Flight Med. Transport Program, Stanford Hospital and Clinics, 300 Pasteur Dr., Stanford, CA 94305, United States. CORRESPONDENCE ADDRESS L. Perez, Life Flight Medical Transport, Stanford Hospital and Clinics, 300 Pasteur Dr., Stanford, CA 94305, United States. SOURCE Air Medical Journal (2003) 22:5 (44-48). Date of Publication: September/October 2003 ISSN 1067-991X BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Introduction: Limited research has been published regarding the needs of immediate family members with respect to the transport of critically ill loved ones. Furthermore, very little information exists on transport teams members' perception of the needs of the family members. Methods: During a 9-month period, a 25-item questionnaire was given to family members of adult patients who were transported by air or ground. All patients were admitted into an adult intensive care unit at a major university teaching hospital. Family members were asked to rank the relative importance of each item with regard to informational or situational needs. The identical questionnaire was given to the critical care transport teams employed by the hospital. The team members were asked to indicate what they thought the family members ranked as important. Results: Forty-two of 100 family members (42%) returned the questionnaire by mail. All 13 (100%) critical care transport team members completed surveys as well. Statistical comparisons indicated that family members and team members differed significantly on 13 of 25 items. Team members generally underestimated the importance of these items to family members. Conclusion: These findings suggest that, in this sample, transporting crew members often misperceived family members informational and situational needs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care delivery health care facility EMTREE MEDICAL INDEX TERMS article clinical research controlled study critical illness family health care need health survey hospital admission human intensive care intensive care unit medical information patient transport publication questionnaire teaching hospital university hospital EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003392996 MEDLINE PMID 14671773 (http://www.ncbi.nlm.nih.gov/pubmed/14671773) PUI L37185018 DOI 10.1016/S1067-991X(03)00026-9 FULL TEXT LINK http://dx.doi.org/10.1016/S1067-991X(03)00026-9 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 880 TITLE Trauma care systems in France AUTHOR NAMES Masmejean E.H. Faye A. Alnot J.-Y. Mignon A.F. AUTHOR ADDRESSES (Masmejean E.H., emmanuel.masmejean@hop.egp.ap-hop-paris.fr) Orthopaedics/Traumatology - Hand/U., Georges Pompidou European Hospital, 20 rue Leblanc, 75908 Paris Cedex 18, France. (Faye A.) Department of Emergency Surgery, HEGP, Paris, France. (Alnot J.-Y.) Dept. Orthoped. Surg./Traumatology, Bichat Hospital, Paris, France. (Mignon A.F.) Department of Anaesthesiology, Cochin Hospital, Paris, France. CORRESPONDENCE ADDRESS E.H. Masmejean, Orthopaedics/Traumatology - Hand/U., Georges Pompidou European Hospital, 20 rue Leblanc, 75908 Paris Cedex 18, France. Email: emmanuel.masmejean@hop.egp.ap-hop-paris.fr SOURCE Injury (2003) 34:9 (669-673). Date of Publication: September 2003 ISSN 0020-1383 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT The French Republic includes approximatively 60 millions inhabitants for almost 550,000 km(2). Prehospital management is organised at departement level (96). This management involves a regulatory system initiated from a unique phone number (15 national). The medical regulator sends either first-aid providers or a medical team. On-site care is highly developed and prehospital medically assisted care is really the first phase of the treatment of the injured. The team ensures that the victim is in the best condition for transport and participates in monitoring. Intra-hospital care begins either in an emergency room, with a physician qualified in Emergency Medecine, or in a recovery room, with a surgical intensive-care team. There is no specialisation in trauma in France. All specialist surgeons treat those aspects of trauma pathology that concern them. All surgeons operate on trauma patients and with regard to the organ concerned: digestive, orthopaedic,.... The challenge nervertheless remains that of maintaining facilities at a sufficient level to deal with everyday pathology, known for the seriousness of its consequences in both human and financial terms, within an increasingly sparse hospital infrastructure. Suggestions are emerging in response to these preoccupations. Organisation at the European level of hand emergency units (FESUM) is a targeted exemple. © 2003 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care system injury EMTREE MEDICAL INDEX TERMS convalescence demography disaster emergency ward finance first aid France geography hand surgery health care health care planning health center health service health status hospital hospital department hospital management hospital organization human intensive care medical education medical specialist medical staff organ outpatient paramedical disciplines patient care patient monitoring primary health care priority journal recovery room responsibility review surgeon telecommunication traffic accident traumatology EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) Forensic Science Abstracts (49) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003340759 MEDLINE PMID 12951291 (http://www.ncbi.nlm.nih.gov/pubmed/12951291) PUI L37013639 DOI 10.1016/S0020-1383(03)00146-3 FULL TEXT LINK http://dx.doi.org/10.1016/S0020-1383(03)00146-3 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 881 TITLE Study reveals benchmarking flaws of many report cards, quality rankings. AUTHOR ADDRESSES SOURCE Healthcare benchmarks and quality improvement (2003) 10:8 (85-88). Date of Publication: Aug 2003 ISSN 1541-1052 ABSTRACT Transferred patients have 38% longer ICU stays and 41% longer hospital stays. Many databases used for report cards are administrative, not clinical. Active awards are seen as more valid than passive ones. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality hospital patient transport quality control EMTREE MEDICAL INDEX TERMS article awards and prizes hospitalization human information dissemination intensive care unit organization and management standard statistics United States utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 12901317 (http://www.ncbi.nlm.nih.gov/pubmed/12901317) PUI L37015811 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 882 TITLE Towards better care: An exploration of some barriers and solutions to research transfer in the intensive care unit AUTHOR NAMES Angus D.C. AUTHOR ADDRESSES (Angus D.C., angusdc@ccm.upmc.edu) Clin. Res., Invest.,/Syst. M., Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States. (Angus D.C., angusdc@ccm.upmc.edu) Scaife Hall, Critical Care Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, United States. CORRESPONDENCE ADDRESS D.C. Angus, Scaife Hall, Critical Care Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, United States. Email: angusdc@ccm.upmc.edu SOURCE Current Opinion in Critical Care (2003) 9:4 (306-307). Date of Publication: August 2003 ISSN 1070-5295 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit EMTREE MEDICAL INDEX TERMS artificial ventilation critical illness editorial geriatric patient human patient care pneumonia (complication) research respiratory distress (therapy) ventilator associated pneumonia (complication) EMBASE CLASSIFICATIONS Internal Medicine (6) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Gerontology and Geriatrics (20) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2003312539 MEDLINE PMID 12883286 (http://www.ncbi.nlm.nih.gov/pubmed/12883286) PUI L36930375 DOI 10.1097/00075198-200308000-00009 FULL TEXT LINK http://dx.doi.org/10.1097/00075198-200308000-00009 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 883 TITLE Can protocolised-weaning developed in the United States transfer to the United Kingdom context: A discussion AUTHOR NAMES Blackwood B. AUTHOR ADDRESSES (Blackwood B., b.blackwood@qub.ac.uk) The Queen's University of Belfast, School of Nursing/Midwifery, 50 Elmwood Avenue, Belfast BT9 6AZ, United Kingdom. CORRESPONDENCE ADDRESS B. Blackwood, The Queen's University of Belfast, School of Nursing/Midwifery, 50 Elmwood Avenue, Belfast BT9 6AZ, United Kingdom. Email: b.blackwood@qub.ac.uk SOURCE Intensive and Critical Care Nursing (2003) 19:4 (215-225). Date of Publication: August 2003 ISSN 0964-3397 BOOK PUBLISHER Churchill Livingstone ABSTRACT Weaning patients from mechanical ventilation using standardised protocols has been demonstrated to be safe and effective in reducing mechanical ventilation time, intensive care unit (ICU) stay and costs. Studies supporting this have all been conducted in the United States of America and weaning protocols are not widely used in the United Kingdom. With such a strong scientific evidence-base for protocolised-weaning, it is unclear why the introduction of evidence-based practice in this area is so low in the UK. There may be a number of reasons for this. First, it may be that the evidence is considered not to apply to different settings, particularly between the USA and UK where there are many differences in health care cultures. Second, it is suggested that the strength of evidence is not the only factor to account for when trying to introduce research evidence into practice [Qual. Health Care 7 (1998) 149]. The context or environment into which the research is to be implemented and how the implementation process is facilitated are equally important factors to be considered. Kitson et al. [Qual. Health Care 7 (1998) 149] argue that the interplay between the three factors of evidence, context and facilitation, enable the successful implementation of evidence-based practice. This discussion paper explores the factors that influence the introduction of weaning protocols. The discussion is structured around the three core elements from Kitson et al.'s conceptual framework and it draws upon examples of UK and USA contextual differences from Northern Ireland (NI) and Virginia (VA). © 2003 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation clinical protocol EMTREE MEDICAL INDEX TERMS article clinical practice cultural factor evidence based medicine health care cost health care system hospitalization human intensive care unit medical research risk assessment standardization United Kingdom United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 12915111 (http://www.ncbi.nlm.nih.gov/pubmed/12915111) PUI L37069904 DOI 10.1016/S0964-3397(03)00053-3 FULL TEXT LINK http://dx.doi.org/10.1016/S0964-3397(03)00053-3 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 884 TITLE A review of emergency department fluid resuscitation of burn patients transferred to a regional, verified burn center AUTHOR NAMES Hagstrom M. Wirth G.A. Evans G.R.D. Ikeda C.J. AUTHOR ADDRESSES (Hagstrom M.; Wirth G.A.; Evans G.R.D.) Univ. CA Irvine Med. Ctr. Burn Ctr., San Francisco, CA, United States. (Ikeda C.J.) St. Francis Memorial Hospital, San Francisco, CA, United States. (Evans G.R.D.) Division of Plastic Surgery, University of California, 101 The City Drive, Orange, CA 92868, United States. CORRESPONDENCE ADDRESS G.R.D. Evans, Division of Plastic Surgery, University of California, 101 The City Drive, Orange, CA 92868, United States. SOURCE Annals of Plastic Surgery (2003) 51:2 (173-176). Date of Publication: 1 Aug 2003 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT The purpose of this study was to examine the adequacy of burn patient fluid resuscitation in relationship to the American Burn Association formula before arrival at a regional burn center. Further substratification of the data was undertaken to compare total burn surface area and fluid volume resuscitation as evaluated from the primary hospital's emergency department staff vs. the burn intensive care unit staff. The charts of all patients admitted to the burn center during 1 year were reviewed retrospectively. Data were compiled to calculate the time of injury, time of arrival in the referring emergency room, time in transit to the burn unit, and time of arrival in the burn unit. The total number of patients evaluated in the study was 41. Patients who were not referred from outside hospitals or who had incomplete charts were excluded. The average time from initial burn to transfer to the burn intensive care unit was 6.26 hours (range, 0.5-96 hours). The average total body surface area (TBSA) evaluated by the referring emergency department staff was 23.9% (range, 5-70%) compared with the burn intensive care unit staff evaluation average of 17.8% (range, 2-55%). Using the referring emergency department staff TBSA percentage, evaluation of the data revealed that only 23% of patients fell within the accepted range using the American Burn Association formula. Furthermore, 30% of patients were overresuscitated whereas 47% were underresuscitated. Of the overresuscitated patients, 1 patient was critically overresuscitated. In the group of underresuscitated patients, five were critically underresuscitated. Thirty-three percent of the patients' TBSA had a more than 50% discrepancy between the burn unit and the emergency department calculations. The authors conclude that better educating providers referring patients to regional burn centers can make a marked improvement in the overall care of burn patients. More important, early communication with the referring burn staff has been encouraged. Early communication permits review of estimated TBSA burn evaluations and permits cooperative calculations and optimal delivery of early fluid resuscitation. Burn center practitioners can improve care of patients before arrival by appropriately guiding the referring physician. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (therapy) emergency treatment fluid therapy EMTREE MEDICAL INDEX TERMS adolescent adult aged body surface calculation child clinical article controlled study critical illness data analysis emergency health service evaluation study hospital admission hospital personnel human infant intensive care unit patient care patient referral physician priority journal review time EMBASE CLASSIFICATIONS Surgery (9) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003317001 MEDLINE PMID 12897521 (http://www.ncbi.nlm.nih.gov/pubmed/12897521) PUI L36944486 DOI 10.1097/01.SAP.0000058494.24203.99 FULL TEXT LINK http://dx.doi.org/10.1097/01.SAP.0000058494.24203.99 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 885 TITLE Transport services under stress: Patient air transfers due to industrial action in Christchurch AUTHOR NAMES Dzendrowskyj P. Bowie D. Shaw G. AUTHOR ADDRESSES (Dzendrowskyj P., peter.Dzendrowskyj@middlemore.co.nz; Bowie D.; Shaw G.) Intensive Care Unit, Christchurch Hospital, Christchurch, New Zealand. (Dzendrowskyj P., peter.Dzendrowskyj@middlemore.co.nz) Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand. CORRESPONDENCE ADDRESS P. Dzendrowskyj, Intensive Care Unit, Middlemore Hospital, Auckland, New Zealand. Email: peter.Dzendrowskyj@middlemore.co.nz SOURCE New Zealand Medical Journal (2003) 116:1177. Date of Publication: 11 Jul 2003 ISSN 1175-8716 1175-8716 (electronic) BOOK PUBLISHER New Zealand Medical Association, 26 The Terrace, P.O. Box 156, Wellington, New Zealand. ABSTRACT Aims: On 2 and 3 December 2001, widespread industrial action by nursing staff in the five public hospitals in Christchurch resulted in a minimal number of nurses being available for inpatient care. The major hospital affected was Christchurch Public Hospital. Mass transfer of patients (and relatives) occurred, by road to local, private nursing homes, and by air to hospitals throughout New Zealand. This caused disruption at both a local and national level. This paper discusses the process by which air transfers took place and the lessons learnt from the experience. Methods: The reduction of inpatient numbers in this tertiary referral hospital was necessary in anticipation of a full withdrawal of labour by the nursing staff. All patients identified as potentially transferable were individually assessed as to the risk of remaining in an understaffed hospital versus that of transfer. The Intensive Care Unit (ICU) coordinated the triage of patients and organised air transfers. All elective work was suspended. Following strike action, all patients transferred were returned to Christchurch as rapidly as possible. Results: Eighty four patients were identified for air transfer. Eight were unfit for transfer and, of the remainder, 43 were transferred with their relatives in a six-day period before the industrial action began. This required the services of all medical air transport facilities within New Zealand, placing the aeromedical retrieval services under considerable stress. The hospital was reduced to 20% capacity at strike commencement (from 650 beds to 148). Intensivists performed nursing duties in the ICU. Conclusions: Two days of strike action resulted in 15 days of local and national disruption. Central coordination of all aero-medical transfer services, hospital teams, ambulance and social services was essential. The provision of 'family packages' was useful in assisting with the marked disruption experienced by patients and relatives. © NZMA. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital management patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article aviation female health care delivery health care facility hospital personnel hospital service human intensive care intensive care unit major clinical study male New Zealand nursing staff risk assessment trade union EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005440177 MEDLINE PMID 12861311 (http://www.ncbi.nlm.nih.gov/pubmed/12861311) PUI L41387002 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 886 TITLE Transferred patients hurt referral hospitals' quality ratings. AUTHOR NAMES Levenson D. AUTHOR ADDRESSES (Levenson D.) CORRESPONDENCE ADDRESS D. Levenson, SOURCE Report on medical guidelines & outcomes research (2003) 14:12 (1-2, 5). Date of Publication: 27 Jun 2003 ISSN 1050-5636 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality hospital mortality patient transport EMTREE MEDICAL INDEX TERMS accreditation APACHE article comparative study human intensive care unit quality control statistics United States LANGUAGE OF ARTICLE English MEDLINE PMID 12903638 (http://www.ncbi.nlm.nih.gov/pubmed/12903638) PUI L37015817 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 887 TITLE Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures. AUTHOR NAMES Rosenberg A.L. Hofer T.P. Strachan C. Watts C.M. Hayward R.A. AUTHOR ADDRESSES (Rosenberg A.L.; Hofer T.P.; Strachan C.; Watts C.M.; Hayward R.A.) University of Michigan and the Department of Veterans Affairs Health Services Research & Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48109-0048, USA. CORRESPONDENCE ADDRESS A.L. Rosenberg, University of Michigan and the Department of Veterans Affairs Health Services Research & Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48109-0048, USA. Email: arosen@umich.edu SOURCE Annals of internal medicine (2003) 138:11 (882-890). Date of Publication: 3 Jun 2003 ISSN 1539-3704 (electronic) ABSTRACT BACKGROUND: Common methods of benchmarking clinical performance rarely, if ever, account for admission source and, in particular, the effect of a patient being transferred from one medical center to another. Small biases in comparisons of observed versus expected deaths can substantially affect how high-quality institutions compare with peer hospitals. With the most sophisticated and validated set of case-mix measures available for patients, the intensive care unit is an ideal setting in which to study the effect of a patient's being transferred from another hospital. OBJECTIVE: To determine the extent of bias in benchmarking outcomes when performance measures do not account for transfer patients' greater severity of illness. DESIGN: Prospectively developed cohort study. SETTING: Medical intensive care unit (MICU) at a tertiary care university hospital. PATIENTS: 4579 consecutive admissions for 4208 patients from 1 January 1994 to 1 April 1998. MEASUREMENTS: MICU and hospital lengths of stay, MICU readmission, and hospital mortality rates. RESULTS: Compared with directly admitted patients, MICU patients transferred from another hospital had significantly higher Acute Physiology Scores at the time of admission and discharge (P = 0.001). Even after full adjustment for case mix and severity of illness, transfer patients had a 38% longer MICU stay (95% CI, 32% to 45%), a 41% longer hospital stay (CI, 34% to 50%), and a 2.2 times greater odds of hospital mortality (CI, 1.7 to 2.8) than directly admitted patients. With identical efficiency and quality, a referral hospital with a 25% MICU transfer rate compared with another with a 0% transfer rate would be penalized by 14 excess deaths per 1000 admissions when a benchmarking program adjusts only for case mix and severity of illness and not for the source of admission. CONCLUSIONS: In a setting with the most thorough diagnostic-based, case-mix adjustment and the most physiologically precise severity-of-illness information, accepting transfer patients can adversely affect efficiency and quality benchmarks. Benchmarking and profiling efforts beyond intensive care units must also recognize and account for this phenomenon; otherwise, referral centers may have an incentive to refuse care for patients who could benefit from being transferred to their facility. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness outcome assessment patient transport quality control university hospital EMTREE MEDICAL INDEX TERMS adolescent adult aged APACHE article diagnosis related group epidemiology female hospital readmission hospitalization human intensive care unit length of stay male middle aged mortality prospective study standard LANGUAGE OF ARTICLE English MEDLINE PMID 12779298 (http://www.ncbi.nlm.nih.gov/pubmed/12779298) PUI L36686481 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 888 TITLE Summaries for patients. Accepting critically ill transfer patients. AUTHOR ADDRESSES SOURCE Annals of internal medicine (2003) 138:11 (I42). Date of Publication: 3 Jun 2003 ISSN 1539-3704 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness outcome assessment patient transport quality control university hospital EMTREE MEDICAL INDEX TERMS adolescent adult aged article epidemiology female hospital readmission human intensive care unit length of stay male middle aged mortality patient education prospective study standard LANGUAGE OF ARTICLE English MEDLINE PMID 12779311 (http://www.ncbi.nlm.nih.gov/pubmed/12779311) PUI L36686492 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 889 TITLE Utilization, reliability, and clinical impact of point-of-care testing during critical care transport: Six years of experience AUTHOR NAMES Gruszecki A.C. Hortin G. Lam J. Kahler D. Smith D. Vines J. Lancaster L. Daly T.M. Robinson C.A. Hardy R.W. AUTHOR ADDRESSES (Gruszecki A.C.; Daly T.M.; Robinson C.A.; Hardy R.W., rhardy@path.uab.edu) Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, United States. (Hortin G.) Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD 20892, United States. (Lam J.) Depts. of Med., Pathol., and Surgery, Gene Therapy Center, University of Alabama at Birmingham, Birmingham, AL 35233, United States. (Kahler D.; Smith D.; Vines J.; Lancaster L.) Dept. of Critical Care Transport, University of Alabama at Birmingham, Birmingham, AL 35233, United States. (Hardy R.W., rhardy@path.uab.edu) Dept. of Pathol./Laboratory Medicine, University of Alabama at Birmingham, WP230, 619 South 19th St., Birmingham, AL 35233, United States. CORRESPONDENCE ADDRESS R.W. Hardy, Dept. of Pathol./Laboratory Medicine, University of Alabama at Birmingham, WP230, 619 South 19th St., Birmingham, AL 35233, United States. Email: rhardy@path.uab.edu SOURCE Clinical Chemistry (2003) 49:6 (1017-1019). Date of Publication: 1 Jun 2003 ISSN 0009-9147 BOOK PUBLISHER American Association for Clinical Chemistry Inc., 2101 L Street NW, Suite 202, Washington, United States. EMTREE DRUG INDEX TERMS glucose (endogenous compound) hemoglobin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care laboratory test patient transport point of care testing EMTREE MEDICAL INDEX TERMS adolescent adult aged article blood gas analysis child electrolyte balance glucose blood level health care cost health care quality hemoglobin determination human major clinical study newborn oxygen blood level DEVICE TRADE NAMES i_STAT i STAT DEVICE MANUFACTURERS i STAT CAS REGISTRY NUMBERS glucose (50-99-7, 84778-64-3) hemoglobin (9008-02-0) EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2003215417 MEDLINE PMID 12766018 (http://www.ncbi.nlm.nih.gov/pubmed/12766018) PUI L36623501 DOI 10.1373/49.6.1017 FULL TEXT LINK http://dx.doi.org/10.1373/49.6.1017 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 890 TITLE Global presence: USAF aeromedical evacuation and critical care air transport. AUTHOR NAMES Pierce P.F. Evers K.G. AUTHOR ADDRESSES (Pierce P.F.; Evers K.G.) University of Michigan School of Nursing, 400 North Ingalls Ann Arbor, MI 48109, USA. CORRESPONDENCE ADDRESS P.F. Pierce, University of Michigan School of Nursing, 400 North Ingalls Ann Arbor, MI 48109, USA. Email: pfpierce@umich.edu SOURCE Critical care nursing clinics of North America (2003) 15:2 (221-231). Date of Publication: Jun 2003 ISSN 0899-5885 ABSTRACT Flight nursing, whether as an AE nurse or as a CCAT team member, is a demanding profession that extracts tremendous energy, competes with family and recreational time, and sets high expectations. On reflection, however, most crewmembers claim it is the most rewarding experience in their professional life. The opportunity to be a part of history, to provide care and transport to American servicemen and women in times of extreme need, and to accomplish the mission safely despite the circumstances and personal cost is an unparalleled experience and one that hold tremendous pride. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aerospace medicine health intensive care military nursing patient transport EMTREE MEDICAL INDEX TERMS education human nurse attitude organization organization and management patient care review United States LANGUAGE OF ARTICLE English MEDLINE PMID 12755188 (http://www.ncbi.nlm.nih.gov/pubmed/12755188) PUI L36680360 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 891 TITLE Horizontal gene transfer-emerging multidrug resistance in hospital bacteria AUTHOR NAMES Dzidic S. Bedekovic V. AUTHOR ADDRESSES (Dzidic S., dzidic@rudjer.irb.hr) Institute Rudjer Boskovic, Department of Molecular Genetics, Bijenicka c54, 1002, Zagreb, Croatia. (Bedekovic V.) Zagreb School of Medicine, Department of Otolaryngology, Univ. Hospital Sestre Milosrdnice, Zagreb, Croatia. CORRESPONDENCE ADDRESS S. Dzidic, Institute Rudjer Boskovic, Department of Molecular Genetics, Bijenicka c54, 1002, Zagreb, Croatia. Email: dzidic@rudjer.irb.hr SOURCE Acta Pharmacologica Sinica (2003) 24:6 (519-526). Date of Publication: 1 Jun 2003 ISSN 1671-4083 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT The frequency and spectrum of antibiotic resistant infections have increased worldwide during the past few decades. This increase has been attributed to a combination of microbial characteristics, the selective pressure of antimicrobial use, and social and technical changes that enhance the transmission of resistant organisms. The resistance is acquired by mutational change or by the acquisition of resistance-encoding genetic material which is transfered from another bacteria. The spread of antibiotic resistance genes may be causally related to the overuse of antibiotics in human health care and in animal feeds, increased use of invasive devices and procedures, a greater number of susceptible hosts, and lapses in infection control practices leading to increased transmission of resistant organisms. The resistance gene sequences are integrated by recombination into several classes of naturally occurring gene expression cassettes and disseminated within the microbial population by horizontal gene transfer mechanisms: transformation, conjugation or transduction. In the hospital, widespread use of antimicrobials in the intensive care units (ICU) and for immunocompromised patients has resulted in the selection of multidrug-resistant organisms. Methicilin-resistant Staphylococci, vancomycin resistant Enterococci and extended-spectrum beta-lactamase (ESBL) producing Gram negative bacilli are identified as major problem in nosocomial infections. Recent surveillance studies have demonstrated trend towards more seriously ill patients suffering from multidrug-resistant nosocomial infections. Emergence of multiresistant bacteria and spread of resistance genes should enforce the aplication of strict prevention strategies, including changes in antibiotic treatment regimens, hygiene measures, infection prevention and control of horizontal nosocomial transmission of organisms. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antiinfective agent EMTREE DRUG INDEX TERMS beta lactamase (endogenous compound) vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance horizontal gene transfer hospital infection (epidemiology, etiology, prevention) multidrug resistance EMTREE MEDICAL INDEX TERMS animal food antibiotic therapy article bacterial gene bacterial mutation bacterial transmission conjugation critical illness device infection Enterococcus epidemiological data gene cassette gene expression gene sequence genetic code genetic transduction genetic transformation Gram negative bacterium health care hospital hygiene host susceptibility human immune deficiency infection control intensive care unit methicillin resistant Staphylococcus aureus nonhuman prevalence prophylaxis social aspect CAS REGISTRY NUMBERS beta lactamase (9073-60-3) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Internal Medicine (6) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003239362 MEDLINE PMID 12791177 (http://www.ncbi.nlm.nih.gov/pubmed/12791177) PUI L36713503 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 892 TITLE An accident of intra-hospital transport ORIGINAL (NON-ENGLISH) TITLE Un accident de transport intrahospitalier AUTHOR NAMES Sicot C. Baranger D. AUTHOR ADDRESSES (Sicot C., csicot@lesoumedical.fr; Baranger D.) Le Sou-Médical, 130, rue du Faubourg-Saint-Denis, 75466 Paris Cedex 10, France. CORRESPONDENCE ADDRESS C. Sicot, Le Sou-Médical, 130, rue du Faubourg-Saint-Denis, 75466 Paris Cedex 10, France. Email: csicot@lesoumedical.fr SOURCE Reanimation (2003) 12:3 (268-270). Date of Publication: May 2003 ISSN 1624-0693 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) accident patient transport EMTREE MEDICAL INDEX TERMS court decision making hospital hospital management human intensive care law law suit legal liability safety short survey EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Forensic Science Abstracts (49) Surgery (9) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2003259196 PUI L36775632 DOI 10.1016/S1624-0693(03)00053-7 FULL TEXT LINK http://dx.doi.org/10.1016/S1624-0693(03)00053-7 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 893 TITLE Out of the box: Group rethinks ECMO transport for girl's sake AUTHOR NAMES Valdez B. AUTHOR ADDRESSES (Valdez B.) Mercy Air Services, Inc., Fontana, CA, United States. CORRESPONDENCE ADDRESS B. Valdez, Mercy Air Services, Inc., Fontana, CA, United States. SOURCE Air Medical Journal (2003) 22:3 (22-24). Date of Publication: May/June 2003 ISSN 1067-991X BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) extracorporeal oxygenation patient transport EMTREE MEDICAL INDEX TERMS airplane pilot case report female fever flight heart disease heart muscle necrosis heart transplantation helicopter hospital admission human intensive care unit medical device medical personnel note pediatric hospital preschool child risk assessment survival thorax surgery EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Cardiovascular Diseases and Cardiovascular Surgery (18) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2003234630 MEDLINE PMID 12748527 (http://www.ncbi.nlm.nih.gov/pubmed/12748527) PUI L36700625 DOI 10.1016/S1067-991X(03)70003-0 FULL TEXT LINK http://dx.doi.org/10.1016/S1067-991X(03)70003-0 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 894 TITLE Minimum standards for intrahospital transport of critically ill patients. AUTHOR ADDRESSES SOURCE Emergency medicine (Fremantle, W.A.) (2003) 15:2 (202-204). Date of Publication: Apr 2003 ISSN 1035-6851 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service emergency treatment intensive care patient transport EMTREE MEDICAL INDEX TERMS article critical illness (therapy) documentation health care quality human personnel management practice guideline rescue personnel standard LANGUAGE OF ARTICLE English MEDLINE PMID 12675634 (http://www.ncbi.nlm.nih.gov/pubmed/12675634) PUI L37079372 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 895 TITLE Impact of the "Doctor-Heli" system for emergency and critical care medicine in otolaryngology AUTHOR NAMES Okami K. Miyamoto T. Onuki J. Iida M. Takahashi M. Yamamoto I. Nakagawa Y. Inokuchi S. AUTHOR ADDRESSES (Okami K.; Miyamoto T.; Onuki J.; Iida M.; Takahashi M.) Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan. (Yamamoto I.; Nakagawa Y.; Inokuchi S.) Ctr. of Emergency/Critical Care Med., Tokai University Hospital, Isehara, Japan. CORRESPONDENCE ADDRESS K. Okami, Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan. SOURCE Journal of Otolaryngology of Japan (2003) 106:1 (17-20). Date of Publication: 2003 ISSN 0030-6622 BOOK PUBLISHER Oto-Rhino-Laryngological Society of Japan Inc., 23-14, 3-Chome Takanawa, Minato-ku, Tokyo, Japan. ABSTRACT We reported the "Doctor-Heli" (medical service helicopter) system at the center of emergency and critical care medicine at Tokai University Hospital. From October 1999 to March 2001, the service had transported 485 patients, shortening the time to critical care and improving patient-prognosis. We report a case of cervical and laryngeal trauma occurring during a suicide attempt successfully treated thanks to the rapid start of critical care enabled by use of the helicopter. The service has proven its utility in otolaryngology and head and neck surgery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article cervical spine injury helicopter human larynx injury prognosis suicide EMBASE CLASSIFICATIONS Otorhinolaryngology (11) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY English, Japanese EMBASE ACCESSION NUMBER 2003077218 MEDLINE PMID 12647319 (http://www.ncbi.nlm.nih.gov/pubmed/12647319) PUI L36205608 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 896 TITLE Transfer from ward to PICU: a standard. AUTHOR NAMES Heward Y. AUTHOR ADDRESSES (Heward Y.) Birmingham Children's Hospital NHS Trust. CORRESPONDENCE ADDRESS Y. Heward, Birmingham Children's Hospital NHS Trust. SOURCE Paediatric nursing (2003) 15:1 (XI-XIII). Date of Publication: Feb 2003 ISSN 0962-9513 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality intensive care patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS article child human nursing nursing evaluation research organization and management practice guideline standard United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 12655957 (http://www.ncbi.nlm.nih.gov/pubmed/12655957) PUI L36473047 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 897 TITLE Delays in transfer to the ICU: A preventable adverse event? AUTHOR NAMES Kaboli P.J. Rosenthal G.E. AUTHOR ADDRESSES (Kaboli P.J.; Rosenthal G.E.) Department of Internal Medicine, Univ. of Iowa College of Medicine, Iowa City Vet. Aff. Medical Center, Iowa City, IA, United States. CORRESPONDENCE ADDRESS P.J. Kaboli, Department of Internal Medicine, Univ. of Iowa College of Medicine, Iowa City Vet. Aff. Medical Center, Iowa City, IA, United States. SOURCE Journal of General Internal Medicine (2003) 18:2 (155-156). Date of Publication: 1 Feb 2003 ISSN 0884-8734 BOOK PUBLISHER Springer New York LLC, 233 Springer Street, New York, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit EMTREE MEDICAL INDEX TERMS cardiopulmonary arrest clinical practice death disease exacerbation disease severity editorial hospital admission human nursing staff patient care patient monitoring risk treatment outcome ward EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2003100297 MEDLINE PMID 12542592 (http://www.ncbi.nlm.nih.gov/pubmed/12542592) PUI L36278954 DOI 10.1046/j.1525-1497.2003.21217.x FULL TEXT LINK http://dx.doi.org/10.1046/j.1525-1497.2003.21217.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 898 TITLE Critical-care transport team improves care. AUTHOR ADDRESSES SOURCE ED management : the monthly update on emergency department management (2003) 15:1 (6-7). Date of Publication: Jan 2003 ISSN 1044-9167 ABSTRACT A critical-care transport team can prevent adverse outcomes, improve patient flow, and reduce delays. The team carries equipment and medications that can save a patient's life. Emergency department (ED) nurses can remain in the department, instead of having to transport patients for diagnostic tests. Transport nurses assist with resuscitations of trauma patients in the ED. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service health care quality intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS article cost control human legal liability organization and management standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 12515110 (http://www.ncbi.nlm.nih.gov/pubmed/12515110) PUI L36480490 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 899 TITLE Transportable versus fixed platform CT scanners: Comparison of costs AUTHOR NAMES Mayo-Smith W.W. Rhea J.T. Smith W.J. Cobb C.M. Gareen I.F. Dorfman G.S. AUTHOR ADDRESSES (Mayo-Smith W.W., wmayo-smith@lifespan.org; Smith W.J.; Cobb C.M.; Dorfman G.S.) Department of Radiology, Rhode Island Hospital, Brown University School of Medicine, 593 Eddy St, Providence, RI 02903, United States. (Gareen I.F.) Center for Statistical Sciences, Brown University, Providence, RI, United States. (Rhea J.T.) CORRESPONDENCE ADDRESS W.W. Mayo-Smith, Department of Radiology, Rhode Island Hospital, Brown University School of Medicine, 593 Eddy St, Providence, RI 02903, United States. Email: wmayo-smith@lifespan.org SOURCE Radiology (2003) 226:1 (63-68). Date of Publication: 1 Jan 2003 ISSN 0033-8419 BOOK PUBLISHER Radiological Society of North America Inc., 820 Jorie Boulevard, Oak Brook, United States. ABSTRACT PURPOSE: To compare the aggregate hospital technical costs of a transportable computed tomographic (CT) scanner used to image patients in an intensive care unit with those of a fixed platform CT scanner in the radiology department. MATERIALS AND METHODS: Direct fixed costs (ie, machine and service contract costs) and direct variable costs (ie, personnel costs) were calculated. Indirect costs, including space costs and departmental overhead, were calculated. Total costs were calculated as the sum of indirect, direct fixed, and direct variable costs. Personnel costs were calculated from time-motion analyses involving 95 patients who underwent brain CT with either a transportable (n = 51) or a fixed platform (n = 44) CT scanner. Costs per examination were calculated by using both low- and high-examination-volume models and compared with use of the Wilcoxon rank sum test. RESULTS: The total cost per examination for the transportable scanner ranged from $108.98 to $167.20 for the high- and low-volume models. Total cost per examination for the fixed platform scanner ranged from $75.24 to $112.39 for the highand low-volume models. For the transportable scanner, direct fixed, variable, and overhead costs were $87.05, $70.73, and $9.42 per examination, respectively, with the low-volume model. The corresponding costs for the fixed platform scanner were $46.66, $55.69, and $10.04, respectively. CONCLUSION: The technical cost of using an in-hospital transportable CT scanner is higher than that of using a fixed platform scanner. © RSNA, 2002. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) computed tomography scanner cost effectiveness analysis EMTREE MEDICAL INDEX TERMS article comparative study health care personnel health economics hospital cost intensive care unit priority journal radiologist radiology department socioeconomics DEVICE TRADE NAMES Tomoscan M , United StatesPhilips DEVICE MANUFACTURERS (United States)Philips EMBASE CLASSIFICATIONS Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2003062454 MEDLINE PMID 12511669 (http://www.ncbi.nlm.nih.gov/pubmed/12511669) PUI L36163908 DOI 10.1148/radiol.2261012047 FULL TEXT LINK http://dx.doi.org/10.1148/radiol.2261012047 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 900 TITLE Reducing anxiety in patients and families discharged from ICU. AUTHOR NAMES Choate K. Stewart M. AUTHOR ADDRESSES (Choate K.; Stewart M.) Alfred Hospital, Victoria. CORRESPONDENCE ADDRESS K. Choate, Alfred Hospital, Victoria. SOURCE Australian nursing journal (July 1993) (2002) 10:5 (29). Date of Publication: Nov 2002 ISSN 1320-3185 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety (prevention) hospital discharge intensive care unit nurse patient relationship patient transport EMTREE MEDICAL INDEX TERMS article Australia family human human relation psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 12503383 (http://www.ncbi.nlm.nih.gov/pubmed/12503383) PUI L35534986 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 901 TITLE Clinical evaluation of the Life Support for Trauma and Transport (LSTAT™) platform AUTHOR NAMES Johnson K. Pearce F. Westenskow D. Ogden L.L. Farnsworth S. Peterson S. White J. Slade T. AUTHOR ADDRESSES (Johnson K., kjohnson@remi.med.utah.edu; Ogden L.L.; Farnsworth S.; Peterson S.; White J.; Slade T.) Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, United States. (Pearce F.) Department of Resuscitative Medicine, Division of Military Casualty Research, Walter Reed Army Institute of Research, Silver Spring, MD, United States. (Westenskow D.) Departments of Biomedical Engineering and Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, United States. CORRESPONDENCE ADDRESS K. Johnson, Department of Anesthesiology, Univ. of Utah School of Medicine, Salt Lake City, UT, United States. Email: kjohnson@remi.med.utah.edu SOURCE Critical Care (2002) 6:5 (439-446). Date of Publication: October 2002 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd., 34 - 42 Cleveland Street, London, United Kingdom. ABSTRACT Introduction. The Life Support for Trauma and Transport (LSTAT™) is a self-contained, stretcher-based miniature intensive care unit designed by the United States Army to provide care for critically injured patients during transport and in remote settings where resources are limited. The LSTAT contains conventional medical equipment that has been integrated into one platform and reduced in size to fit within the dimensional envelope of a North Atlantic Treaty Organization (NATO) stretcher. This study evaluated the clinical utility of the LSTAT in simulated and real clinical environments. Our hypothesis was that the LSTAT would be equivalent to conventional equipment in detecting and treating life-threatening problems. Methods. Thirty-one anesthesiologists and recovery room nurses compared the LSTAT with conventional monitors while managing four simulated critical events. The time required to reach a diagnosis and treatment was recorded for each simulation. Subsequently, 10 consenting adult patients were placed on the LSTAT after surgery for postoperative care in the recovery room. Questionnaires about aspects of LSTAT functionality were completed by nine nurses who cared for the patients placed on the LSTAT. Results. In all of the simulations, there was no clinically significant difference in the time to diagnosis or treatment between the LSTAT and conventional equipment. All clinicians reported that they were able to manage the simulated patients properly with the LSTAT. Nursing staff reported that the LSTAT provided adequate equipment to care for the patients monitored during recovery from surgery and were able to detect critical changes in vital signs in a timely manner. Discussion. Preliminary evaluation of the LSTAT in simulated and postoperative environments demonstrated that the LSTAT provided appropriate equipment to detect and manage critical events in patient care. Further work in assessing LSTAT functionality in a higher-acuity environment is warranted. EMTREE DRUG INDEX TERMS furosemide (drug therapy) glyceryl trinitrate (sublingual drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness hospital equipment patient transport EMTREE MEDICAL INDEX TERMS anesthesist article artificial ventilation blood transfusion cardioversion controlled study equipment design heart disease (diagnosis, drug therapy, therapy) human hypothesis intensive care intensive care unit intravenous drug administration lung disease (diagnosis, drug therapy, therapy) medical device monitoring nursing staff oxygen therapy patient care patient monitoring pericardiocentesis postoperative care priority journal questionnaire thorax drainage United States DEVICE TRADE NAMES LSTAT , United StatesIntegrated Medical Systems Model Narkomed AV2+ , United StatesDrager Model Propaq Encore , United StatesProtocol Systems Inc Resuscitation Circuit Model , United StatesVital Signs DEVICE MANUFACTURERS (United States)Drager (United States)Hewlett Packard (United States)Integrated Medical Systems (United States)Protocol Systems Inc (United States)Vital Signs CAS REGISTRY NUMBERS furosemide (54-31-9) glyceryl trinitrate (55-63-0) EMBASE CLASSIFICATIONS Internal Medicine (6) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002351591 MEDLINE PMID 12398785 (http://www.ncbi.nlm.nih.gov/pubmed/12398785) PUI L35106286 DOI 10.1186/cc1538 FULL TEXT LINK http://dx.doi.org/10.1186/cc1538 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 902 TITLE Effects of intra-hospital transport of severely head injured patients on the parameters of cerebral perfusion ORIGINAL (NON-ENGLISH) TITLE Effets des transferts intra-hospitaliers de patients traumatisés crâniens graves sur les paramètres de perfusion cérébrale. AUTHOR NAMES Yeguiayan J.M. Lenfant F. Rapenne T. Bouyssou H. Freysz M. AUTHOR ADDRESSES (Yeguiayan J.M.; Lenfant F.; Rapenne T.; Bouyssou H.; Freysz M.) CORRESPONDENCE ADDRESS J.M. Yeguiayan, SOURCE Canadian journal of anaesthesia = Journal canadien d'anesthésie (2002) 49:8 (890-891). Date of Publication: Oct 2002 ISSN 0832-610X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury patient transport EMTREE MEDICAL INDEX TERMS brain circulation hemodynamics human intracranial pressure letter pathophysiology prospective study time LANGUAGE OF ARTICLE French MEDLINE PMID 12374730 (http://www.ncbi.nlm.nih.gov/pubmed/12374730) PUI L35553631 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 903 TITLE Fractional inspired oxygen on transport ventilators: An important determinant of volume delivery during assist control ventilation with high resistive load [1] AUTHOR NAMES Breton L. Minaret G. Aboab J. Richard J.-C. Guerin C. AUTHOR ADDRESSES (Breton L.; Minaret G.; Aboab J.; Richard J.-C.; Guerin C.) Medical Intensive Care Unit, Rouen University Hospital, 1, Rue de Germont, 76000 Rouen, France. CORRESPONDENCE ADDRESS J.-C. Richard, Medical Intensive Care Unit, Rouen University Hospital, 1, Rue de Germont, 76000 Rouen, France. Email: jrichard@invivo.edu SOURCE Intensive Care Medicine (2002) 28:8 (1181-1182). Date of Publication: 2002 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assisted ventilation EMTREE MEDICAL INDEX TERMS airway pressure airway resistance clinical practice devices intensive care unit letter positive end expiratory pressure tidal volume ventilator EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2002319996 MEDLINE PMID 12400512 (http://www.ncbi.nlm.nih.gov/pubmed/12400512) PUI L34985249 DOI 10.1007/s00134-002-1390-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-002-1390-7 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 904 TITLE A method of transporting critical care mass casualties. AUTHOR NAMES Hudson T.L. Weichart T. AUTHOR ADDRESSES (Hudson T.L.; Weichart T.) United States Army Nurse Corp, White House Medical Unit, Washington, DC, USA. CORRESPONDENCE ADDRESS T.L. Hudson, United States Army Nurse Corp, White House Medical Unit, Washington, DC, USA. SOURCE Disaster management & response : DMR : an official publication of the Emergency Nurses Association (2002) (26-28). Date of Publication: Sep 2002 ISSN 1540-2487 ABSTRACT The use of a self-contained transport platform can aid in the efforts to care for mass casualty victims. The platform is equipped with critical care equipment and has the capabilities of documenting care electronically. It has been used in a number of different settings and has allowed health care personnel to provide more efficient, individualized care to a larger number of victims. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster intensive care patient transport EMTREE MEDICAL INDEX TERMS article bed documentation human methodology military medicine United States LANGUAGE OF ARTICLE English MEDLINE PMID 12685464 (http://www.ncbi.nlm.nih.gov/pubmed/12685464) PUI L36660484 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 905 TITLE Evacuation of intensive care patients: Will it never be necessary? ORIGINAL (NON-ENGLISH) TITLE Zeitkritischer transport von intensiv-patienten: Ausgeschlossen!? AUTHOR NAMES Blazejak J. Gretenkort P. AUTHOR ADDRESSES (Blazejak J.; Gretenkort P.) SOURCE Journal fur Anasthesie und Intensivbehandlung (2002) 9:1 (97-98). Date of Publication: 2002 ISSN 0941-4223 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) disaster intensive care patient transport EMTREE MEDICAL INDEX TERMS conference paper human intensive care unit neurotraumatology newborn intensive care patient monitoring traumatology EMBASE CLASSIFICATIONS Internal Medicine (6) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 2002287105 PUI L34875257 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 906 TITLE Transport of intensive care patients by helicopter ORIGINAL (NON-ENGLISH) TITLE Intensivtransport von patienten per helikopter AUTHOR NAMES Pöschl G. Röder G. Kemetzhofer P. Pointinger H. AUTHOR ADDRESSES (Pöschl G.; Röder G.; Kemetzhofer P.; Pointinger H.) SOURCE Wiener Klinische Wochenschrift (2002) 114:10-11 A (36-38). Date of Publication: 14 Jun 2002 ISSN 0043-5325 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS health care quality helicopter patient care short survey EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 2002213647 PUI L34632809 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 907 TITLE Evaluation of ventilators used during transport of ICU patients - A bench study AUTHOR NAMES Zanetta G. Robert D. Guérin C. AUTHOR ADDRESSES (Zanetta G.; Robert D.; Guérin C., claude.guerin@chu-lyon.fr) Service de Réanimation Médicale et Assistance Respiratoire, Hôpital de la Croix Rousse, 103 grande rue de la Croix-Rousse, 69004 Lyon, France. CORRESPONDENCE ADDRESS C. Guérin, Serv. de Reani. Med./Assist. Resp., Hopital de la Croix Rousse, 103 grande rue de la Croix-Rousse, 69004 Lyon, France. Email: claude.guerin@chu-lyon.fr SOURCE Intensive Care Medicine (2002) 28:4 (443-451). Date of Publication: 2002 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Objectives: To evaluate portable ventilators. Design and settings: Bench study. Materials and methods: Five portable ventilators used for transporting ICU patients [Osiris 1, (ventilator a), Osiris 2, (ventilator b), Oxylog 1000, (ventilator c), Oxylog 2000, (ventilator d), AXR1a, (ventilator e)] and three ICU ventilators which can be used for this purpose [Horus, (ventilator f), T-Bird, (ventilator g), and SV 300, (ventilator h)] were compared using a test lung regarding: 1) their capability to maintain set tidal volumes (V(T)) of 300 ml, 500 ml, and 800 ml under a normal condition A [resistance (R) 5 cmH(2)O/l/s and compliance (C) 100 ml/cmH(2)0] and two abnormal conditions B (R 20-C 30) and C (R 50-C 100); 2) trapped volume (expired V(T) relative to inspired V(T) at 0.7 s, 1 s, and 1.4 s), an estimate of the expiratory resistance of both circuit and valve; and 3) the triggering system assessed from the measurements of Δt, ΔP for two inspiratory efforts at a PEEP of 0 cmH(2)0 and 5 cmH(2)0 in ventilators b, d, f, g, and h. Flow and airway pressure were measured with an independent physiologic recording system. Results: 1) V(T). For ventilators a-h, the mean±SD changes of a set V(T) of 300 ml were -2.6±0.2%, -9.7±0.2%, 0±0%, -6.1±0.2%, 1.0±0.3%, -2.1±1.7%, 0.3±0%, and -1.3±0.1% (P<0.001), respectively, during condition B relative to A. Similar results were obtained for a V(T) of 500 ml and 800 ml and during condition C relative to A; 2) Trapped volume. For ventilators a-h, trapped volume averaged 1±1%, 20±0%, 30±0.4%, 20±1%, 1±0%, 19±0%, 15±0%, and 14±0% at 0.7 s (P<0.001) and 0.6±0%, 5±0%, 0.5±0%, 0±0%%, 0±0%, 0.6±0%, 0±0%, and 0±0% at 1.4 s (P=NS); and 3) the triggering system of Oxylog 2000 was poor whereas it was of good quality for Horus, T-Bird, SV 300, and Osiris 2. Conclusions: The small portable ventilators presently investigated varied between each other and were less accurate than ICU ventilators. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ventilator EMTREE MEDICAL INDEX TERMS accuracy airway pressure article breathing comparative study intensive care unit lung compliance lung resistance respiratory airflow tidal volume DEVICE TRADE NAMES AXR1a , Francebio ms Horus , FranceTaema Osiris 1 , FranceTaema Osiris 2 , FranceTaema Oxylog 1000 , GermanyDrager Oxylog 2000 , GermanyDrager SV 300 , GermanySiemens T-Bird , United StatesBird DEVICE MANUFACTURERS (France)bio ms (United States)Bird (Germany)Drager (Germany)Siemens (France)Taema EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002144353 MEDLINE PMID 11967599 (http://www.ncbi.nlm.nih.gov/pubmed/11967599) PUI L34328029 DOI 10.1007/s00134-002-1242-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00134-002-1242-5 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 908 TITLE Intensive care transfers AUTHOR NAMES Hopkins P. Wolff A.H. AUTHOR ADDRESSES (Hopkins P.) Department of Infectious Diseases, Hammersmith Hospital, London, United Kingdom. (Wolff A.H., ahwolff@47mvr.com) Barnet Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS A.H. Wolff, Intensive Care, Barnet Hospital, London, United Kingdom. Email: ahwolff@47mvr.com SOURCE Critical Care (2002) 6:2 (123-124). Date of Publication: 2002 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd., 34 - 42 Cleveland Street, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS controlled study critical illness developed country developing country health care delivery health care financing health care planning health economics health service health survey hospital bed capacity human information processing intensive care unit law morbidity mortality note patient monitoring priority journal register EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2002134959 MEDLINE PMID 11983037 (http://www.ncbi.nlm.nih.gov/pubmed/11983037) PUI L34296340 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 909 TITLE Oxygen saturation during transfer [3] AUTHOR NAMES Wilson C. Webber S. AUTHOR ADDRESSES (Wilson C.) Anaesthetics Department, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, United Kingdom. (Webber S.) Royal Hallamshire Hospital, Sheffield, United Kingdom. CORRESPONDENCE ADDRESS C. Wilson, Anaesthetics Department, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, United Kingdom. SOURCE Paediatric Anaesthesia (2002) 12:3 (288). Date of Publication: 2002 ISSN 1155-5645 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) oxygen saturation patient transport EMTREE MEDICAL INDEX TERMS anesthesia breathing cost benefit analysis diagnostic procedure face mask human institutional care intensive care unit letter oxygenation postoperative period priority journal recovery room EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2002121746 MEDLINE PMID 11903949 (http://www.ncbi.nlm.nih.gov/pubmed/11903949) PUI L34264453 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 910 TITLE Transport of the mechanically ventilated neonate. AUTHOR NAMES Bowen S.L. AUTHOR ADDRESSES (Bowen S.L.) All Children's Hospital, St. Petersburg, FL 33731-8920, USA. CORRESPONDENCE ADDRESS S.L. Bowen, All Children's Hospital, St. Petersburg, FL 33731-8920, USA. Email: bowens@allkids.org SOURCE Respiratory care clinics of North America (2002) 8:1 (67-82). Date of Publication: Mar 2002 ISSN 1078-5337 ABSTRACT Although the primary focus of this article is on interhospital transport, some of the same basic transport principles and management techniques apply to intrahospital transport. The level of care provided during interhospital and intrahospital transport should be based on the neonate's diagnosis, clinical status, anticipated problems, and local, state, and national standards and regulations. The transport team should have policies and procedures to direct their practice. Documentation of the transport process should be initiated with the referral call and continued until the completion of transport. Planning and anticipation of problems are essential, as is care of the family. The transport team should evaluate each neonate's individual response to the transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation neonatal respiratory distress syndrome (therapy) patient transport EMTREE MEDICAL INDEX TERMS critical illness (therapy) devices female human male methodology monitoring mortality newborn newborn intensive care review risk assessment risk factor sensitivity and specificity standard survival rate United States ventilator LANGUAGE OF ARTICLE English MEDLINE PMID 12184658 (http://www.ncbi.nlm.nih.gov/pubmed/12184658) PUI L35526317 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 911 TITLE Relocation stress in critical care: a review of the literature. AUTHOR NAMES McKinney A.A. Melby V. AUTHOR ADDRESSES (McKinney A.A.; Melby V.) Intensive Care Unit, Belfast City Hospital Trust, Lisburn Rd, Belfast, Northern Ireland. CORRESPONDENCE ADDRESS A.A. McKinney, Intensive Care Unit, Belfast City Hospital Trust, Lisburn Rd, Belfast, Northern Ireland. Email: aidinmckinney@hotmail.com SOURCE Journal of clinical nursing (2002) 11:2 (149-157). Date of Publication: Mar 2002 ISSN 0962-1067 ABSTRACT 1. Transfer to the ward following a period in intensive care may cause stress for patients. 2. A review of the literature reveals that this phenomenon has been described in a number of different ways, such as transfer stress, transfer anxiety, translocation syndrome and, more recently, relocation stress. 3. This paper reviews the various concepts before arriving at a more operational definition of the phenomenon. 4. It attempts to reveal what causes this phenomenon and to what extent it exists. 5. Patients' responses to transfer are identified and the physical and psychological problems that have been associated with discharge from intensive care are discussed. 6. Lists of interventions that the literature suggests may reduce or prevent this phenomenon from occurring are reviewed. 7. Recommendations for practice development and further research are made. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care mental stress (etiology) EMTREE MEDICAL INDEX TERMS adaptive behavior female human intensive care unit male nurse attitude nursing nursing assessment patient transport psychological aspect review risk assessment risk factor sensitivity and specificity LANGUAGE OF ARTICLE English MEDLINE PMID 11903714 (http://www.ncbi.nlm.nih.gov/pubmed/11903714) PUI L35640538 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 912 TITLE Evaluation of critically ill patients for transfer to long-term acute-care facilities. AUTHOR NAMES Lusk R. O'Bryan L. AUTHOR ADDRESSES (Lusk R.; O'Bryan L.) Hospital Division of Kindred Healthcare, Inc. CORRESPONDENCE ADDRESS R. Lusk, Hospital Division of Kindred Healthcare, Inc. SOURCE Lippincott's case management : managing the process of patient care (2002) 7:1 (24-26). Date of Publication: 2002 Jan-Feb ISSN 1529-7764 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) case management critical illness intensive care unit nursing home patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation classification economics human long term care organization and management patient selection time utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 11840055 (http://www.ncbi.nlm.nih.gov/pubmed/11840055) PUI L35579820 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 913 TITLE Intrahospital transport of critically ill patients [3] AUTHOR NAMES Shirley P.J. Stott S.A. AUTHOR ADDRESSES (Shirley P.J.; Stott S.A.) Dept. of Anaesthesia/Intensive Care, Aberdeen Royal Infirmary, Aberdeen, United Kingdom. CORRESPONDENCE ADDRESS P.J. Shirley, Dept. of Anaesthesia/Intensive Care, Aberdeen Royal Infirmary, Aberdeen, United Kingdom. SOURCE Anaesthesia and Intensive Care (2001) 29:6 (669). Date of Publication: 2001 ISSN 0310-057X BOOK PUBLISHER Australian Society of Anaesthetists, P.O. Box 600, Edgecliff, Australia. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS clinical audit consultation controlled study hospital equipment human intensive care letter major clinical study medical staff organization practice guideline publishing United Kingdom EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2001435804 MEDLINE PMID 11771616 (http://www.ncbi.nlm.nih.gov/pubmed/11771616) PUI L33138628 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 914 TITLE Intensive care air transport: The sky is the limit; or is it? AUTHOR NAMES Chang D.-M. AUTHOR ADDRESSES (Chang D.-M.) Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. (Chang D.-M.) Department of Internal Medicine, 325 Cheng-Kung Rd., Sec. 2, Neihu 114, Taipei, Taiwan. CORRESPONDENCE ADDRESS T.A. Dillard, Pulmonary/Critical Care Section, Medical College of Georgia, Augusta, GA, United States. SOURCE Critical Care Medicine (2001) 29:11 (2227-2230). Date of Publication: 2001 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS aircraft artificial ventilation atmospheric pressure blood gas analysis editorial hemodynamic monitoring human hypoxemia (complication) lung injury (therapy) nonhuman priority journal respiratory distress syndrome (therapy) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2001405351 MEDLINE PMID 11700432 (http://www.ncbi.nlm.nih.gov/pubmed/11700432) PUI L33063559 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 915 TITLE Information sought on faxed report [5] AUTHOR NAMES DePompeo D. AUTHOR ADDRESSES (DePompeo D.) The Valley Hospital, Ridgewood, NJ, United States. CORRESPONDENCE ADDRESS D. DePompeo, The Valley Hospital, Ridgewood, NJ, United States. SOURCE Journal of Emergency Nursing (2001) 27:6 (532). Date of Publication: 2001 ISSN 0099-1767 BOOK PUBLISHER Mosby Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward fax hospital management information processing medical record patient transport public relations EMTREE MEDICAL INDEX TERMS emergency health service health care personnel hospital admission hospital subdivisions and components human information system intensive care unit letter standard LANGUAGE OF ARTICLE English MEDLINE PMID 11712004 (http://www.ncbi.nlm.nih.gov/pubmed/11712004) PUI L33150121 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 916 TITLE Providing continuity of care for patients transferred from ICU. AUTHOR NAMES Haines S. Crocker C. Leducq M. AUTHOR ADDRESSES (Haines S.; Crocker C.; Leducq M.) Nottingham City Hospital NHS Trust. CORRESPONDENCE ADDRESS S. Haines, Nottingham City Hospital NHS Trust. SOURCE Professional nurse (London, England) (2001) 17:1 (17-21). Date of Publication: Sep 2001 ISSN 0266-8130 ABSTRACT Patients requiring treatments previously only undertaken in critical care units are now being nursed in other ward areas. A study was carried out to determine the difficulties that are faced by ward nurses caring for this highly dependent patient group. Staff and patient stress were problems experienced and there was a call for closer liaison between ICU and ward staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health intensive care nursing staff patient care EMTREE MEDICAL INDEX TERMS article burnout female human male nurse patient relationship organization and management patient transport psychological aspect workload LANGUAGE OF ARTICLE English MEDLINE PMID 12030140 (http://www.ncbi.nlm.nih.gov/pubmed/12030140) PUI L35600064 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 917 TITLE Intrahospital transport of critically ill patients: Complications and difficulties AUTHOR NAMES Lovell M.A. Mudaliar M.Y. Klineberg P.L. AUTHOR ADDRESSES (Lovell M.A.; Mudaliar M.Y.; Klineberg P.L.) Anaesthetic Department, Westmead Hospital, Westmead, NSW 2203, Australia. CORRESPONDENCE ADDRESS M.A. Lovell, Anaesthetic Department, Westmead Hospital, Westmead, NSW 2203, Australia. SOURCE Anaesthesia and Intensive Care (2001) 29:4 (400-405). Date of Publication: 2001 ISSN 0310-057X BOOK PUBLISHER Australian Society of Anaesthetists, P.O. Box 600, Edgecliff, Australia. ABSTRACT An audit of 97 intrahospital transports of critically ill patients was undertaken within Westmead Hospital. The aims of this audit were to assess all factors that may lead to problems during intrahospital transports. At the completion of a transport medical staff were asked to provide information about their patient and their treatment, as well as any difficulties they may have encountered. Overall, 62% of transports reported some difficulty or complication. Of these, 31% were patient-related and 45% were related to equipment or the transport environment. (15% encountered problems in both areas). Many of the difficulties were preventable with adequate pre-transport communication and planning. Other problems were directly related to the increased severity of illness in these patients. EMTREE DRUG INDEX TERMS antihypertensive agent bicarbonate inotropic agent insulin muscle relaxant agent nimodipine sedative agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article Australia cardiovascular disease (complication) central nervous system disease (complication) clinical audit complication (complication) controlled study disease severity drug infusion environmental factor female health care planning human interpersonal communication major clinical study male medical device medical staff patient care patient monitoring respiratory tract disease (complication) ventilator CAS REGISTRY NUMBERS bicarbonate (144-55-8, 71-52-3) insulin (9004-10-8) muscle relaxant agent (9008-44-0) nimodipine (66085-59-4) EMBASE CLASSIFICATIONS Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2001282087 MEDLINE PMID 11512652 (http://www.ncbi.nlm.nih.gov/pubmed/11512652) PUI L32734393 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 918 TITLE From unit to unit: Danish nurses' experiences of transfer of a small child to and from an intensive care unit. AUTHOR NAMES Hall E.O. AUTHOR ADDRESSES (Hall E.O.) Institute of Nursing Science, Faculty of Health Sciences, University of Aarhus, Denmark. CORRESPONDENCE ADDRESS E.O. Hall, Institute of Nursing Science, Faculty of Health Sciences, University of Aarhus, Denmark. Email: eh@nursingscience.au.dk SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (2001) 17:4 (196-205). Date of Publication: Aug 2001 ISSN 0964-3397 ABSTRACT In this study, Danish nurses' lived experience of transfer of a small child to and from the intensive care unit was explored. While there has been considerable research that has addressed transfer from the parents' perspective, little literature was found which addressed the transfer of small children from the nurses' perspective. A convenience sample of 19 nurses was interviewed once. Data were analysed following Spiegelberg's and Van Manen's phenomenological methodologies. Four themes emerged: being accountable; being supportive to the parents; being with the child; and experiencing safety and insecurity. Seven subthemes expanded and clarified the meaning of these themes. The study provides a thematic interpretation of how Danish nurses experience in-hospital transfers. Overall, the nurses were responsible to the transferred patient, the unhappy and worried parents, for technical procedures and the hospital team 'at home' on their own unit. However, responsibilities did not always include their colleagues on the receiving unit. It is recommended that transfer experiences be discussed more in clinical nursing, and that this explorative study needs to be followed by more studies exploring nurses' experiences of transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care newborn intensive care patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS adult article Denmark female human infant middle aged newborn nurse preschool child psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 11868727 (http://www.ncbi.nlm.nih.gov/pubmed/11868727) PUI L35583582 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 919 TITLE French and foreign recommendations for the practice of anaesthesia and intensive care ORIGINAL (NON-ENGLISH) TITLE Recommandations françaises et étrangères sur la pratique de l'anesthésie-réanimation AUTHOR NAMES Otteni J.C. Desmonts J.M. Haberer J.P. AUTHOR ADDRESSES (Otteni J.C.; Desmonts J.M.; Haberer J.P.) Serv. d'Anesthesie-Reanimation Chir., Hopitaux Universitaires Strasbourg, Hopital de Hautepierre, 67098 Strasbourg Cedex, France. CORRESPONDENCE ADDRESS J.C. Otteni, Serv. d'Anesthesie-Reanimation Chir., Hopitaux Universitaires Strasbourg, Hopital de Hautepierre, 67098 Strasbourg Cedex, France. SOURCE Annales Francaises d'Anesthesie et de Reanimation (2001) 20:6 (537-548). Date of Publication: 2001 ISSN 0750-7658 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT This article reviews the development of Standards, Recommendations and Guidelines for practice in anaesthesiology in France and other countries. The French society for anaesthesia and intensive care (Sfar) has published, since 1989, 11 basic Standards: 1) Recommendations for the monitoring of patients during anaesthesia (June 1989, amended on January 1994) [APSF Newsletter, Summer 1990, page 22]; 2) Recommendations for postanaesthesia monitoring and care (September 1990); 3) Recommendations for preanaesthesia care (September 1991); 4) Recommendations for anaesthetic apparatus and checking before use (January 1994); 5) Recommendations for the equipment of anaesthesia working places (January 1995); 6) Recommendations for the tasks of the nurse anaesthetist (January 1995); 7) Recommendations for hygiene standards in anaesthesia practice (December 1997); 8) Recommendations for outpatient anaesthesia (September 1990); 9) Recommendations for the practice of obstetrical analgesia (September 1992); 10) Recommendations for interhospital physician-accompanied transfers (December 1992); 11) Recommendations for intrahospital physician-accompanied transfers (February 1994). Additionally the Sfar produced or coproduced 9 Experts' conferences, 15 Consensus conferences and 5 Guidelines for clinical practice. © 2001 Éditions scientifiques et médicales Elsevier SAS. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia intensive care EMTREE MEDICAL INDEX TERMS anesthetic equipment anesthetic recovery France health care organization health care quality hospital hygiene nurse obstetric anesthesia outpatient care patient monitoring patient transport practice guideline premedication review EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2001234788 MEDLINE PMID 11471501 (http://www.ncbi.nlm.nih.gov/pubmed/11471501) PUI L32606066 DOI 10.1016/S0750-7658(01)00412-9 FULL TEXT LINK http://dx.doi.org/10.1016/S0750-7658(01)00412-9 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 920 TITLE The evolutionary process of Medical Emergency Team (MET) implementation: Reduction in unanticipated ICU transfers AUTHOR NAMES Salamonson Y. Kariyawasam A. Van Heere B. O'Connor C. AUTHOR ADDRESSES (Salamonson Y.; Kariyawasam A.; Van Heere B.; O'Connor C.) ICU/CCU Department, Campbelltown Hospital, P.O. Box 149, Campbelltown 2560, NSW, Australia. (Salamonson Y.) Division of Nursing, Faculty of Health, University of Western Sydney Macarthur,, P.O. Box 555, Campbelltown 2560, NSW, Australia. CORRESPONDENCE ADDRESS Y. Salamonson, ICU/CCU Department, Campbelltown Hospital, P.O. Box 149, Campbelltown 2560, NSW, Australia. SOURCE Resuscitation (2001) 49:2 (135-141). Date of Publication: 2001 ISSN 0300-9572 BOOK PUBLISHER Elsevier Ireland Ltd, P.O. Box 85, Limerick, Ireland. ABSTRACT Objectives: To determine whether the introduction of the Medical Emergency Team (MET) system designed to provide immediate help for seriously ill patients: (i) changed the pattern of ICU patient transfers from the wards; and (ii) improved hospital survival rates. Methods: Prospective information on MET calls and unanticipated ICU transfers was collected for 3 years in a suburban metropolitan hospital. Results: A 3-year review of MET showed the number of MET calls doubled in the second and third year and the team was activated for more than just the most extremely ill patients. Whilst the frequency of calls for cardiopulmonary arrest remained constant (n=16), increased use of the MET resulted in the proportion of calls for cardiopulmonary arrest dropping from 30% in year 1 to 13% in year 3. A slight decrease in the percentage of in-hospital deaths (0.74% in year 1 to 0.65% in year 3) was also demonstrated. The incidence of cardiopulmonary arrest per hospital admission also decreased slightly (0.08-0.07%). Although the overall number of ICU transfers remained constant, more seriously ill patients were transferred to ICU via the MET system. This was accompanied by a significant fall in unanticipated ICU transfers. Whilst the reduction in hospital deaths was encouraging, this study could not demonstrate whether the slight improvement in hospital survival rate over the 3 years was due to the MET system. Conclusion: More information is needed to demonstrate that the MET system improves patient survival. The study also highlights the importance of taking proactive measures, which should include providing in-service education on the benefits of early identification and treatment of patients who are at risk of acute deterioration, raising awareness and changing attitudes in hospitals when introducing system such as the MET. © 2001 Elsevier Science Ireland Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article cardiopulmonary arrest clinical article controlled study deterioration early diagnosis evolution first aid hospital admission human medical education medical personnel mortality normal human priority journal survival rate ward EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, Portuguese EMBASE ACCESSION NUMBER 2001203946 MEDLINE PMID 11382518 (http://www.ncbi.nlm.nih.gov/pubmed/11382518) PUI L32520925 DOI 10.1016/S0300-9572(00)00353-1 FULL TEXT LINK http://dx.doi.org/10.1016/S0300-9572(00)00353-1 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 921 TITLE Intensive care. Critical coverage of ICU discharge deaths. AUTHOR NAMES Mulholand H. AUTHOR ADDRESSES (Mulholand H.) CORRESPONDENCE ADDRESS H. Mulholand, SOURCE Nursing times (2001) 97:23 (10). Date of Publication: 2001 Jun 7-13 ISSN 0954-7762 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care unit mortality patient transport EMTREE MEDICAL INDEX TERMS article health services research human length of stay manpower national health service needs assessment standard United Kingdom (epidemiology) utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 11954277 (http://www.ncbi.nlm.nih.gov/pubmed/11954277) PUI L35668183 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 922 TITLE Transfer anxiety: preparing to leave intensive care. AUTHOR NAMES Coyle M.A. AUTHOR ADDRESSES (Coyle M.A.) Altnagelvin Hospital, Londonderry, Northern Ireland, UK. CORRESPONDENCE ADDRESS M.A. Coyle, Altnagelvin Hospital, Londonderry, Northern Ireland, UK. Email: wilmin6@yahoo.com SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (2001) 17:3 (138-143). Date of Publication: Jun 2001 ISSN 0964-3397 ABSTRACT There is much literature to substantiate the inadvertent emotional and psychological trauma associated with critical care areas. However, alongside this, there is a growing body of knowledge to show that these intense and specialized areas are actually perceived as secure, safe and familiar environments by some patients and family members. Transfer from the intensive care unit is not always perceived in a positive light and often the transition is dreaded by both the patient and his family. The evidence would suggest that discharge from specialized care environments can actually be as traumatic as admission. This phenomenon has become known as transfer anxiety, relocation anxiety, or translocation anxiety. There is the possibility that transfer may induce stress or distress in some patients, especially when routines, environments and/or invasive monitoring procedures are altered or ceased without prior knowledge, preparation or adequate explanation. If healthcare personnel fail to identify and meet the psychological needs of patients and families relocating from these areas, the detrimental effects may extend far beyond discharge from ICU. For relocating patients, transfer from the ICU can be presented as a positive step. However, treatment to minimize transfer anxiety will only be successful when all healthcare personnel recognize and react positively to the psychological factors that affect patients adversely. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety (etiology) critical illness intensive care unit patient transport EMTREE MEDICAL INDEX TERMS hospital discharge human methodology psychological aspect review risk factor standard LANGUAGE OF ARTICLE English MEDLINE PMID 11868684 (http://www.ncbi.nlm.nih.gov/pubmed/11868684) PUI L35482328 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 923 TITLE Expertenforum der DGAI: Hemodynamic active drugs in critical care medicine - Glossar, calculation of hemodynamics and oxygen transport ORIGINAL (NON-ENGLISH) TITLE Glossar und berechnungen von hämodynamik und sauerstofftransport AUTHOR NAMES Burchardi H. AUTHOR ADDRESSES (Burchardi H.) Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Univ.-Klinikum Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. CORRESPONDENCE ADDRESS H. Burchardi, Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Univ.-Klinikum Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. SOURCE Intensivmedizin und Notfallmedizin (2001) 38:3 (216-220). Date of Publication: 2001 ISSN 0175-3851 EMTREE DRUG INDEX TERMS acetylcysteine arachidonic acid beta adrenergic receptor corticosteroid corticotropin cyclic GMP endothelin 1 gamma interferon glyceryl trinitrate indocyanine green interleukin 1 isosorbide 2 nitrate lipopolysaccharide messenger RNA n(g) nitroarginine methyl ester nitric oxide nitric oxide synthase nitroprusside sodium nonsteroid antiinflammatory agent phosphodiesterase phospholipase phospholipase A2 prostacyclin derivative prostaglandin E1 prostaglandin E2 prostaglandin synthase thrombocyte activating factor tumor necrosis factor tumor necrosis factor antibody unindexed drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness EMTREE MEDICAL INDEX TERMS article calculation cardiovascular system hemodynamic monitoring nomenclature oxygen transport CAS REGISTRY NUMBERS acetylcysteine (616-91-1) arachidonic acid (506-32-1, 6610-25-9, 7771-44-0) corticotropin (11136-52-0, 9002-60-2, 9061-27-2) cyclic GMP (7665-99-8) gamma interferon (82115-62-6) glyceryl trinitrate (55-63-0) indocyanine green (3599-32-4) isosorbide 2 nitrate (16106-20-0) n(g) nitroarginine methyl ester (50903-99-6) nitric oxide synthase (125978-95-2) nitric oxide (10102-43-9) nitroprusside sodium (14402-89-2, 15078-28-1) phospholipase A2 (9001-84-7) phospholipase (9013-93-8) prostaglandin E1 (745-65-3) prostaglandin E2 (363-24-6) prostaglandin synthase (39391-18-9, 59763-19-8, 9055-65-6) thrombocyte activating factor (64176-80-3, 65154-06-5) EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Drug Literature Index (37) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 2001161946 PUI L32390956 DOI 10.1007/s003900170087 FULL TEXT LINK http://dx.doi.org/10.1007/s003900170087 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 924 TITLE Innovation and change: can you afford not to? AUTHOR NAMES Melia M.C. Bieniek R. Passauer M.B. AUTHOR ADDRESSES (Melia M.C.; Bieniek R.; Passauer M.B.) Saint Vincent Health Center, Erie, PA, USA. CORRESPONDENCE ADDRESS M.C. Melia, Saint Vincent Health Center, Erie, PA, USA. SOURCE The Journal of cardiovascular management : the official journal of the American College of Cardiovascular Administrators (2001) 12:3 (16-19). Date of Publication: 2001 May-Jun ISSN 1053-5330 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit health care delivery organization patient transport EMTREE MEDICAL INDEX TERMS article commercial phenomena creativity hospital bed capacity human organization and management United States LANGUAGE OF ARTICLE English MEDLINE PMID 11392901 (http://www.ncbi.nlm.nih.gov/pubmed/11392901) PUI L33487530 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 925 TITLE The unusual transfer of the "Spanish model" of organ donation to the United Kingdom ORIGINAL (NON-ENGLISH) TITLE La insólita traslación del "modelo español" de donación de órganos al Reino Unido. AUTHOR NAMES Matesanz R. AUTHOR ADDRESSES (Matesanz R.) CORRESPONDENCE ADDRESS R. Matesanz, SOURCE Nefrología : publicación oficial de la Sociedad Española Nefrologia (2001) 21:2 (99-103). Date of Publication: 2001 Mar-Apr ISSN 0211-6995 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) donor hospital personnel international cooperation transplantation EMTREE MEDICAL INDEX TERMS cultural anthropology economics editorial hospital bed capacity human intensive care unit kidney transplantation organization and management psychological aspect public health public opinion Spain standard statistics theoretical model traffic accident United Kingdom utilization review LANGUAGE OF ARTICLE Spanish MEDLINE PMID 11464661 (http://www.ncbi.nlm.nih.gov/pubmed/11464661) PUI L33505523 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 926 TITLE Paediatric intensive care transfers (multiple letters) AUTHOR NAMES Murphy P.J. Jenkins I. Fraser J. Marriage S. Griffiths R. Smith H. AUTHOR ADDRESSES (Murphy P.J.; Jenkins I.; Fraser J.; Marriage S.; Griffiths R.; Smith H.) Royal Hospital for Sick Children, Bristol BS2 8BJ, United Kingdom. CORRESPONDENCE ADDRESS P.J. Murphy, Royal Hospital for Sick Children, Bristol BS2 8BJ, United Kingdom. SOURCE Anaesthesia (2001) 56:1 (83-84). Date of Publication: 2001 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport pediatrics EMTREE MEDICAL INDEX TERMS airway obstruction (therapy) anesthesia induction anesthesist child care cooperation critical illness emergency medicine epiglottitis health care availability human intubation letter medical education resource management resuscitation safety standard EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Otorhinolaryngology (11) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2001046640 MEDLINE PMID 11167443 (http://www.ncbi.nlm.nih.gov/pubmed/11167443) PUI L32111880 DOI 10.1046/j.1365-2044.2001.01840-2.x FULL TEXT LINK http://dx.doi.org/10.1046/j.1365-2044.2001.01840-2.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 927 TITLE Bed availability and transfer of critically ill patients AUTHOR NAMES Dobb G.J. AUTHOR ADDRESSES (Dobb G.J.) Royal Perth Hospital, University Department of Medicine, University of Western Australia, Perth, WA, Australia. CORRESPONDENCE ADDRESS G.J. Dobb, Royal Perth Hospital, University Department of Medicine, University of Western Australia, Perth, WA, Australia. Email: geofdobb@rph.health.wa.gov.au SOURCE Medical Journal of Australia (2001) 174:3 (114-115). Date of Publication: 5 Feb 2001 ISSN 0025-729X BOOK PUBLISHER Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road, Pyrmont, Australia. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness (disease management) hospital bed EMTREE MEDICAL INDEX TERMS editorial health care availability health care cost high risk patient hospital bed capacity human intensive care intensive care unit patient transport EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2001064630 MEDLINE PMID 11247611 (http://www.ncbi.nlm.nih.gov/pubmed/11247611) PUI L32149353 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 928 TITLE Risks associated with peri-operative use of alpha(2)-adrenoceptor agonists AUTHOR NAMES Quintin L. Ghignone M. AUTHOR ADDRESSES (Quintin L.) Cardiovascular Anesthesia, CHU Nord, St Etienne, France. (Quintin L.) Department of Physiology, School of Medicine, Lyon, France. (Ghignone M.) Columbia Hospital, W Palm Beach, FL, United States. CORRESPONDENCE ADDRESS L. Quintin, Cardiovascular Anesthesia, CHU Nord, St. Etienne, France. SOURCE Bailliere's Best Practice and Research in Clinical Anaesthesiology (2000) 14:2 (347-368). Date of Publication: 2000 ISSN 1521-6896 ABSTRACT Experimentally, α(2)-agonists keep intact the reactivity of the circulatory system to hypotension or hypovolaemia. These findings have been reproduced in humans outside the anaesthesia/critical care setting. Within the anaesthesia/critical care setting, no studies directly tackle the problem of circulatory reactivity to hypotension. Poor circulatory tolerance (hypotension, bradycardia and low cardiac output) to systemic α(2)-agonists has been reported in the anaesthetic setting. In contrast, however, most reports in the literature suggest good tolerance. This discrepancy may be a function of the intravascular volume status, the dosage of the anaesthetic/sedative agents co-administered or the specific opiate used. The opinion of the authors is that (a) the administration of α(2)-agonists should be restricted to hypertensive/coronary patients or patients presenting to or recovering from minor or major surgery in whom a high benefit-to-risk ratio is expected, (b) appropriate volume loading before the induction of anaesthesia or intra-hospital transport should be considered, and (c) a reduction in anaesthetic/sedative and vasopressor requirements should be considered. Key studies are lacking. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alpha 2 adrenergic receptor stimulating agent (adverse drug reaction, clinical trial, drug administration, drug comparison, drug dose, drug interaction, drug therapy, epidural drug administration, intracisternal drug administration, intradermal drug administration, intravenous drug administration, oral drug administration, pharmacokinetics, pharmacology) hypertensive agent (adverse drug reaction, drug combination, drug dose, drug interaction, drug therapy, intravenous drug administration) vasoactive agent (adverse drug reaction, drug dose, drug interaction, drug therapy, intravenous drug administration) EMTREE DRUG INDEX TERMS adrenergic receptor blocking agent (adverse drug reaction) alfentanil (drug comparison, drug dose, drug therapy) atropine (adverse drug reaction, drug dose, drug interaction, drug therapy) beta adrenergic receptor blocking agent (adverse drug reaction, drug therapy) cholinergic receptor blocking agent (drug therapy) clonidine (adverse drug reaction, clinical trial, drug administration, drug comparison, drug dose, drug interaction, drug therapy, epidural drug administration, intracisternal drug administration, intradermal drug administration, intravenous drug administration, oral drug administration, pharmacokinetics, pharmacology) dexmedetomidine (adverse drug reaction, drug administration, drug comparison, intramuscular drug administration, intravenous drug administration) diltiazem (adverse drug reaction, drug therapy) ephedrine (drug interaction, drug therapy) fentanyl (adverse drug reaction, drug comparison, drug dose) hexamethonium (adverse drug reaction) isoflurane (drug combination, drug therapy) isoprenaline (drug dose, drug interaction, drug therapy, intravenous drug administration) ketanserin (drug comparison) midazolam (drug therapy) mivazerol (adverse drug reaction, clinical trial, drug comparison, drug therapy) morphine (drug therapy) neuroleptic agent (drug therapy) opiate derivative (drug combination, drug comparison, drug dose, drug interaction, drug therapy) phenoxybenzamine (drug therapy) phenylephrine (adverse drug reaction, drug interaction, drug therapy) propofol (drug therapy) propranolol (adverse drug reaction, drug combination, drug therapy) remifentanil (drug combination, drug dose, drug therapy) reserpine (drug combination, drug therapy) unindexed drug EMTREE MEDICAL INDEX TERMS anesthesia anesthesia induction bradycardia (drug therapy, side effect) clinical trial dose response drug absorption drug antagonism drug effect drug inhibition drug potentiation drug tolerance drug use forward heart failure (drug therapy, side effect) human hypertension (drug therapy) hypotension (drug therapy, side effect) hypovolemia intensive care ischemic heart disease (drug therapy) meta analysis nonhuman perioperative period priority journal review sedation surgical risk CAS REGISTRY NUMBERS alfentanil (69049-06-5, 71195-58-9) atropine (51-55-8, 55-48-1) clonidine (4205-90-7, 4205-91-8, 57066-25-8) dexmedetomidine (113775-47-6) diltiazem (33286-22-5, 42399-41-7) ephedrine (299-42-3, 50-98-6) fentanyl (437-38-7) hexamethonium (60-26-4) isoflurane (26675-46-7) isoprenaline (299-95-6, 51-30-9, 6700-39-6, 7683-59-2) ketanserin (74050-98-9) midazolam (59467-70-8) mivazerol (125472-02-8) morphine (52-26-6, 57-27-2) phenoxybenzamine (59-96-1, 63-92-3) phenylephrine (532-38-7, 59-42-7, 61-76-7) propofol (2078-54-8) propranolol (13013-17-7, 318-98-9, 3506-09-0, 4199-09-1, 525-66-6) remifentanil (132539-07-2) reserpine (50-55-5, 8001-95-4) EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Clinical and Experimental Pharmacology (30) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000408909 PUI L30843335 DOI 10.1053/bean.2000.0088 FULL TEXT LINK http://dx.doi.org/10.1053/bean.2000.0088 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 929 TITLE Protocol for intensive care transport ORIGINAL (NON-ENGLISH) TITLE Intensivtransport-protokoll: Empfehlung der DIVI und des bayerischen staatsministeriums des innern AUTHOR NAMES Moecke Hp. Anding K. AUTHOR ADDRESSES (Moecke Hp.; Anding K.) Institut fur Notfallmedizin, Rubenkamp 148, D-22291 Hamburg, Germany. CORRESPONDENCE ADDRESS Hp. Moecke, Institut fur Notfallmedizin, Rubenkamp 148, D-22291 Hamburg, Germany. SOURCE Anasthesiologie und Intensivmedizin (2000) 41:10 (789-792). Date of Publication: 2000 ISSN 0170-5334 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS clinical protocol Germany human intensive care short survey EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 2000388301 PUI L30812214 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 930 TITLE Protocol for transport of patients requiring intensive care ORIGINAL (NON-ENGLISH) TITLE Intensivtransport-Protokoll AUTHOR NAMES Moecke H. AUTHOR ADDRESSES (Moecke H.) Institut fur Notfallmedizin, Rubenkamp 148, 22291 Hamburg, Germany. CORRESPONDENCE ADDRESS H. Moecke, Institut fur Notfallmedizin, Rubenkamp 148, 22291 Hamburg, Germany. SOURCE Notfall Medizin (2000) 26:9 (414-417). Date of Publication: 2000 ISSN 0341-2903 ABSTRACT In recent years, appreciably greater demands have been made on both the medical and documentation-related aspects of the transport of patients requiring intensive care. For a controlled transfer between the respective departments and hospitals involved, all the details of the transport need to be entered in a protocol. In order to ensure uniform standards, the DIVI (German interdisciplinary organisation for intensive care and emergency medicine) and the Bavarium Ministry for Internal Affairs have now drawn up protocol recommendations, which will be discussed in detail. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS clinical protocol documentation emergency medicine human intensive care interhospital cooperation medical decision making short survey EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2000367317 PUI L30775952 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 931 TITLE Specific characteristics of the ventilator-supported patients during intrahospital or interhospital transports (monitoring-alarms) ORIGINAL (NON-ENGLISH) TITLE Les specificites des alarmes et du monitorage des malades ventiles pendant un transport intra- ou interhospitalier AUTHOR NAMES Dureuil B. Roupie É. AUTHOR ADDRESSES (Dureuil B.) Département d'Anesthésie-réanimation Chirurgicale, Hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen. (Roupie É.) Service d'Accueil et d'Urgence, Hôpital Henri-Mondor, 51, ave. Marechalde-Lattre-de-T., 94010 Créteil, France. CORRESPONDENCE ADDRESS B. Dureuil, Dept. Anesth.-Reanimat. Chirurgicale, Hopital Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France. SOURCE Reanimation Urgences (2000) 9:6 (477-480). Date of Publication: 2000 ISSN 1164-6756 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation EMTREE MEDICAL INDEX TERMS article capnometry human medical device patient monitoring patient transport pulse oximetry spirometry DEVICE TRADE NAMES AXR1a , Francebio ms Babylog 2000 , GermanyDrager Bird AVS Bird Evita 2 Dura , GermanyDrager Medumat , Germanyweinmann industry NPB 740 , United StatesNellcor Puritan Bennett Osiris , FranceTaema Oxylog 2000 , GermanyDrager DEVICE MANUFACTURERS (France)bio ms Bird (Germany)Drager (United States)Nellcor Puritan Bennett (France)Taema (Germany)weinmann industry EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Internal Medicine (6) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2000367616 PUI L30776259 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 932 TITLE Specific characteristics of neonates receiving mechanical ventilation during intrahospital or interhospital transports (monitoring-alarms) ORIGINAL (NON-ENGLISH) TITLE Les specificites des alarmes et du monitorage des nouveau-nes ventiles pendant un transport intraou interhospitalier AUTHOR NAMES Rozé J.C. AUTHOR ADDRESSES (Rozé J.C.) Service de Réanimation Néonatale et Pédiatique, Hôpital Mère-Enfant, Hôtel-Dieu, 44035 Nantes cedex, France. CORRESPONDENCE ADDRESS J.C. Roze, Svc. Reanimation Neonatale Pedia., Hopital Mere-Enfant, CHU de Nantes, 44035 Nantes Cedex, France. SOURCE Reanimation Urgences (2000) 9:6 (481-482). Date of Publication: 2000 ISSN 1164-6756 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation neonatal respiratory distress syndrome (therapy) EMTREE MEDICAL INDEX TERMS article end tidal carbon dioxide tension human newborn patient monitoring patient transport pulse oximetry respiratory distress syndrome (therapy) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 2000367617 PUI L30776260 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 933 TITLE Paediatric intensive care transfers: 1 AUTHOR NAMES Kenny M. Peters M. Harmer M. AUTHOR ADDRESSES (Kenny M.; Peters M.; Harmer M.) Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS M. Harmer, Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. SOURCE Anaesthesia (2000) 55:10 (1025). Date of Publication: 2000 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE DRUG INDEX TERMS benzodiazepine (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute epiglottitis (therapy) intensive care EMTREE MEDICAL INDEX TERMS artificial ventilation child child care critical illness febrile convulsion (drug therapy, therapy) head injury hospital admission human length of stay letter medical practice paralysis patient referral patient transport resuscitation sedation CAS REGISTRY NUMBERS benzodiazepine (12794-10-4) EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Otorhinolaryngology (11) Neurology and Neurosurgery (8) Drug Literature Index (37) Epilepsy Abstracts (50) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000373435 MEDLINE PMID 11228660 (http://www.ncbi.nlm.nih.gov/pubmed/11228660) PUI L30784189 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 934 TITLE Paediatric intensive care transfers: 2 AUTHOR NAMES Gudgeon J. Harmer M. AUTHOR ADDRESSES (Gudgeon J.; Harmer M.) Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS M. Harmer, Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. SOURCE Anaesthesia (2000) 55:10 ([d]1025-1026). Date of Publication: 2000 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care obstructive airway disease (therapy) EMTREE MEDICAL INDEX TERMS child child care competence critical illness health care personnel human letter mental stress patient monitoring patient referral patient transport pediatric anesthesia respiratory tract intubation resuscitation teamwork wellbeing EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000373436 MEDLINE PMID 11012501 (http://www.ncbi.nlm.nih.gov/pubmed/11012501) PUI L30784190 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 935 TITLE Paediatric intensive care transfers 3 AUTHOR NAMES Jones K.J. Harmer M. AUTHOR ADDRESSES (Jones K.J.; Harmer M.) Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS M. Harmer, Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. SOURCE Anaesthesia (2000) 55:10 (1026). Date of Publication: 2000 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child care intensive care patient transport EMTREE MEDICAL INDEX TERMS anesthesist centralization epiglottitis extubation hospital management human letter paralysis pediatric anesthesia sedation EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) Health Policy, Economics and Management (36) Otorhinolaryngology (11) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000373437 MEDLINE PMID 11012502 (http://www.ncbi.nlm.nih.gov/pubmed/11012502) PUI L30784191 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 936 TITLE When the family asks, 'what happened?'. AUTHOR NAMES Erlen J.A. AUTHOR ADDRESSES (Erlen J.A.) Department of Health Promotion and Development, Center for Research in Chronic Disorders, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. CORRESPONDENCE ADDRESS J.A. Erlen, Department of Health Promotion and Development, Center for Research in Chronic Disorders, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. Email: jae001@pitt.edu SOURCE Orthopaedic nursing / National Association of Orthopaedic Nurses (2000) 19:6 (68-71). Date of Publication: 2000 Nov-Dec ISSN 0744-6020 ABSTRACT Because of the high level of acuity of hospitalized patients, untoward events can and do occur. Very often, nurses develop a caring relationship with the families of these patients. As a result, the family may approach the nurse about this negative turn of events. The questions that the family raises may create an ethical dilemma for the nurse. The nurse may wonder how to respond, feel powerless and "caught in the middle," and experience moral distress because of constraints in the health care system. This article discusses the ethical perspective of caring and the "nurse in the middle" phenomenon. Several strategies to help nurses manage this issue include consulting with a mentor, consulting with the institutional ethics committee, and promoting an ethical climate within the health care setting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) family human relation interpersonal communication medical ethics nursing staff patient transport EMTREE MEDICAL INDEX TERMS empathy human intensive care unit professional standard psychological aspect review LANGUAGE OF ARTICLE English MEDLINE PMID 11899312 (http://www.ncbi.nlm.nih.gov/pubmed/11899312) PUI L35639249 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 937 TITLE Mobile computerized tomography scanning in the neurosurgery intensive care unit: Increase in patient safety and reduction of staff workload AUTHOR NAMES Gunnarsson T. Theodorsson A. Karlsson P. Fridriksson S. Bostrom S. Persliden J. Johansson I. Hillman J. AUTHOR ADDRESSES (Gunnarsson T.; Theodorsson A.; Karlsson P.; Fridriksson S.; Bostrom S.; Persliden J.; Johansson I.; Hillman J.) Department of Neurosurgery, University Hospital, 581 85 Linkoping, Sweden. CORRESPONDENCE ADDRESS T. Gunnarsson, Department of Neurosurgery, University Hospital, 581 85 Linkoping, Sweden. Email: Thorsteinn.Gunnarsson@lio.se SOURCE Journal of Neurosurgery (2000) 93:3 (432-436). Date of Publication: 2000 ISSN 0022-3085 BOOK PUBLISHER American Association of Neurological Surgeons, 1224 West Main Street Suite 450, Charlottesville, United States. ABSTRACT Object. Transportation of unstable neurosurgical patients involves risks that may lead to further deterioration and secondary brain injury from perturbations in physiological parameters. Mobile computerized tomography (CT) head scanning in the neurosurgery intensive care (NICU) is a new technique that minimizes the need to transport unstable patients. The authors have been using this device since June 1997 and have developed their own method of scanning such patients. Methods. The scanning procedure and radiation safety measures are described. The complications that occurred in 89 patients during transportation and conventional head CT scanning at the Department of Radiology were studied prospectively. These complications were compared with the ones that occurred during mobile CT scanning in 50 patients in the NICU. The duration of the procedures was recorded, and an estimation of the staff workload was made. Two patient groups, defined as high- and medium-risk cases, were studied. Medical and/or technical complications occurred during conventional CT scanning in 25% and 20% of the patients in the high- and medium-risk groups, respectively. During mobile CT scanning complications occurred in 4.3% of the high-risk group and 0% of the medium-risk group. Mobile CT scanning also took significantly less time, and the estimated personnel cost was reduced. Conclusions. Mobile CT scanning in the NICU is safe. It minimizes the risk of physiological deterioration and technical mishaps linked to intrahospital transport, which may aggravate secondary brain injury. The time that patients have to remain outside the controlled environment of the NICU is minimized, and the staff's workload is decreased. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) computer assisted tomography intensive care EMTREE MEDICAL INDEX TERMS article clinical trial devices heart arrhythmia (complication) hospital personnel human intracranial hypertension (complication) major clinical study priority journal radiation dose safety seizure (complication) time workload DEVICE TRADE NAMES Tomoscan M , NetherlandsPhilips DEVICE MANUFACTURERS (Netherlands)Philips EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000314821 MEDLINE PMID 10969941 (http://www.ncbi.nlm.nih.gov/pubmed/10969941) PUI L30677206 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 938 TITLE New organisational concepts: Intensive-care transport helicopter ORIGINAL (NON-ENGLISH) TITLE Neue organisatorische versorgungskonzepte: Der intensivtransporthubschrauber AUTHOR NAMES Huf R. Weninger E. AUTHOR ADDRESSES (Huf R.; Weninger E.) Chirurgische Klinik, Klin. Univ. Munchen - Grosshadern, Marchioninistrasse 15, 81377 Munchen, Germany. CORRESPONDENCE ADDRESS R. Huf, Chirurgische Klinik, Klin. Univ. Munchen - Grosshadern, Marchioninistrasse 15, 81377 Munchen, Germany. SOURCE Notarzt (2000) 16:4 (130-132). Date of Publication: 2000 ISSN 0177-2309 ABSTRACT Airborne intensive-care transport is a new and safe link in the rescue chain, as explained below. The incidence rate of cases where such airborne transport is required at the relevant sites justified the cost and effort involved. Continued safety and quality of such transport can be maintained only if the entire personnel involved is highly trained to a maximum possible degree of efficiency, whereas medicotechnical equipment must be absolutely update in accordance with present-day quality standards of intensive-care medicine. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) helicopter patient transport EMTREE MEDICAL INDEX TERMS article emergency health service health care quality human intensive care EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2000299968 PUI L30649838 DOI 10.1055/s-2000-3808 FULL TEXT LINK http://dx.doi.org/10.1055/s-2000-3808 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 939 TITLE The traveling intensive care unit patient: Road trips AUTHOR NAMES Braxton C.C. Reilly P.M. Schwab C.W. AUTHOR ADDRESSES (Braxton C.C.; Reilly P.M.; Schwab C.W.) Div. of Traumatol./Surg. Crit. Care, Department of Surgery, Hosp. of University of Pennsylvania, 3440 Market Street, Philadelphia, PA 19104-3335, United States. (Braxton C.C.; Reilly P.M.; Schwab C.W.) CORRESPONDENCE ADDRESS C.W. Schwab, Div. of Traumatol./Surg. Crit. Care, Department of Surgery, Hosp. of University of Pennsylvania, 3440 Market Street, Philadelphia, PA 19104-3335, United States. SOURCE Surgical Clinics of North America (2000) 80:3 (949-956). Date of Publication: 2000 ISSN 0039-6109 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Transport of critically ill or injured patients in the hospital is a necessary part of ICU care. Although the overall severity of misadventures occurring during patient transfer is minimal, potential complications risk patient deterioration in settings that may not be equipped to handle cardiovascular, respiratory, or neurologic emergencies safely. The critical care team should provide the same level of monitoring and care to the transported patient outside the ICU as he or she receives the unit. Each hospital should have a system that meets acceptable standards for safe transfer of the ICU patient, which minimizes risk and maximizes diagnostic and treatment yield. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS artificial ventilation clinical examination human hypoxia intensive care intracranial hypertension patient monitoring planning priority journal review risk assessment EMBASE CLASSIFICATIONS Surgery (9) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000215396 MEDLINE PMID 10897272 (http://www.ncbi.nlm.nih.gov/pubmed/10897272) PUI L30396982 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 940 TITLE Paediatric intensive care transfers AUTHOR NAMES Griffiths R. Smith H. Harmer M. AUTHOR ADDRESSES (Griffiths R.; Smith H.; Harmer M.) Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. CORRESPONDENCE ADDRESS M. Harmer, Department of Anaesthetics, University of Wales, College of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom. SOURCE Anaesthesia (2000) 55:6 (610). Date of Publication: 2000 ISSN 0003-2409 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport pediatrics EMTREE MEDICAL INDEX TERMS child critical illness human intensive care letter patient care resuscitation safety EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000198066 MEDLINE PMID 10866756 (http://www.ncbi.nlm.nih.gov/pubmed/10866756) PUI L30345055 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 941 TITLE Resident training in pediatric critical care transport medicine: A survey of pediatric residency programs AUTHOR NAMES Fazio R.F. Wheeler D.S. Poss W.B. AUTHOR ADDRESSES (Fazio R.F., wmacal@snd10.med.navy.mil; Wheeler D.S.; Poss W.B.) Depts. of Pediat. and Clin. Invest., Naval Medical Center San Diego, San Diego, CA, United States. (Fazio R.F., wmacal@snd10.med.navy.mil) Clinical Investigation Department, Medical Editing Division, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-1005, United States. CORRESPONDENCE ADDRESS R.F. Fazio, Clinical Investigation Department, Medical Editing Division, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134-1005, United States. Email: wmacal@snd10.med.navy.mil SOURCE Pediatric Emergency Care (2000) 16:3 (166-169). Date of Publication: June 2000 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: The Accreditation Council for Graduate Medical Education (ACGME) Program Requirement for Pediatrics includes specific objectives that pediatric residents participate in both the pre-hospital care of acutely ill or injured patients and the stabilization and transport of patients to critical care areas. Previously, residents were often included as the physician component for many pediatric critical care transport teams. Subsequent regionalization of transport services and development of nurse- only transport teams prompted us to determine the current level of resident participation in pediatric critical care transport as well as how individual residency programs were meeting the educational objectives. Methods: A questionnaire was mailed to each pediatric residency program listed in the 1996-1997 GME Directory. Information was obtained regarding the size of the hospital and the residency program, the presence of a pediatric critical care transport team, the number of annual transports, and transport team leader. In addition, the use of pediatric residents for transports was ascertained, as well as their specific role, training requirements, and method of evaluation. Results: Data were received from 138 programs for a return rate of 65%. Eighty percent of programs offered a pediatric critical care transport service. Nurse-led teams were used for 51% of NICU and 44% of PICU transports. Of the 82 NICU and 84 PICU teams that used residents, the majority used them as team leaders (60% and 70%, respectively) with only the minority requiring that they be at the PL-3 year or greater. The training and/or certification required for resident participation in transports varied among programs, with 85% requiring completion of a NICU or PICU rotation, and 94% requiring NRP or PALS certification. Programs that did not allow resident participation provided exposure to Transport Medicine by various mechanisms, including lectures and emergency department (ED) rotations. Conclusion: Pediatric resident participation in critical care transport varies widely among pediatric critical care transport teams. The degree to which residents participate in the transport team would appear to have diminished in comparison to previous studies. Transport teams often use other resources, such as nurses, fellows, or attendings, to lead their transport teams. Pediatric resident exposure to and participation in Transport Medicine varies among programs, as do the methods used to prepare residents for their experience. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) residency education EMTREE MEDICAL INDEX TERMS article education program intensive care pediatrics questionnaire EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000219076 MEDLINE PMID 10888453 (http://www.ncbi.nlm.nih.gov/pubmed/10888453) PUI L30407978 DOI 10.1097/00006565-200006000-00007 FULL TEXT LINK http://dx.doi.org/10.1097/00006565-200006000-00007 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 942 TITLE Discharge from intensive care: a view from the ward. AUTHOR NAMES Whittaker J. Ball C. AUTHOR ADDRESSES (Whittaker J.; Ball C.) Intensive Care Unit, The London Hospital, Barts and the London NHS Trust, UK. CORRESPONDENCE ADDRESS J. Whittaker, Intensive Care Unit, The London Hospital, Barts and the London NHS Trust, UK. SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (2000) 16:3 (135-143). Date of Publication: Jun 2000 ISSN 0964-3397 ABSTRACT Relocation stress is a common phenomenon in patients discharged from an intensive care unit (ICU) to a ward. A variety of nursing interventions, initiated by intensive care nurses, have been introduced following research in this area. Ward nurses are ideally situated to minimize stress in this patient population, yet their contribution has not been considered. The aim of this study was to identify the experience of the ward nursing staff when receiving a patient from the ICU. An exploratory pilot study was conducted over a 6-month period. The sample group comprised nursing staff in two wards, who regularly received ICU patients. Data collection methods were triangulated and involved the use of open-ended questionnaires and semi-structured interviews. Thirty-six questionnaires were sent, yielding a 36.1% (n = 13) response rate. Seven staff of various grades were interviewed. Data analysis was undertaken using Burnard's (1991) Thematic Content Analysis. Four major categories were identified in the analysis of the data. These were emotions; problems; communication; and interventions. However, the experience of ward staff receiving patients from intensive care differed according to grade. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health personnel attitude hospital discharge intensive care nursing staff patient transport EMTREE MEDICAL INDEX TERMS adaptive behavior article attitude to health education human in service training needs assessment nursing education nursing methodology research peer group pilot study psychological aspect public relations questionnaire workload LANGUAGE OF ARTICLE English MEDLINE PMID 10859622 (http://www.ncbi.nlm.nih.gov/pubmed/10859622) PUI L35584569 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 943 TITLE The critical care research network: A partnership in community-based research and research transfer AUTHOR NAMES Keenan S.P. Martin C.M. Kossuth J.D. Eberhard J. Sibbald W.J. AUTHOR ADDRESSES (Keenan S.P.; Martin C.M.; Kossuth J.D.; Eberhard J.; Sibbald W.J.) Richard Ivey Critical Care Trauma C., Victoria Campus, London Health Sciences Centre, London, Ont., Canada. (Keenan S.P.) Ctr. Hlth. Eval. and Outcome Sci., St. Paul's Hospital 620-B, 1081 Burrad St, Vancouver, BC V6Z 1Y6, Canada. (Keenan S.P.; Martin C.M.; Sibbald W.J.) Critical Care Research Network, London, Ont., Canada. CORRESPONDENCE ADDRESS S.P. Keenan, Ctr. for Health Eval./Outcome Sci., St. Paul's Hospital, 1081 Burrad St, Vancouver, BC V6Z 1Y6, Canada. SOURCE Journal of Evaluation in Clinical Practice (2000) 6:1 (15-22). Date of Publication: 2000 ISSN 1356-1294 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT The objectives of this study were to present a short history of the Critical Care Research Network (CCR-Net), describe its approach to health services research and to summarize completed and current research projects. In doing this, we explored the question is this research network accomplishing its goals? We reviewed the medical literature to identify studies on similar types of Networks and also the evidence supporting the methodology used by CCR-Net to conduct research using MEDLINE, HEALTHSTAR, CINAHL and the keywords network and health care or healthcare, benchmarking and health care or healthcare, and research transfer or research utilization. We also reviewed the bibliographies of retrieved articles and our personal files. In addition, we summarized the results of studies conducted by CCR-Net and outlined those currently in progress. A review of the literature identified studies on two similar networks that appeared to be succeeding. In addition, the literature was also supportive of the general process used by CCR-Net, although the level of evidence varied. Finally, the studies conducted to date within CCR-Net follow the suggested methodology. At the time of this preliminary communication CCR-Net appears to have adopted a valid approach to health services research within the area of Critical Care Medicine. Further direct evidence is required and appropriate studies are planned. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) community medicine intensive care EMTREE MEDICAL INDEX TERMS article clinical research critical illness evidence based medicine health service human medical assessment medical literature priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000121885 MEDLINE PMID 10807020 (http://www.ncbi.nlm.nih.gov/pubmed/10807020) PUI L30182752 DOI 10.1046/j.1365-2753.2000.00214.x FULL TEXT LINK http://dx.doi.org/10.1046/j.1365-2753.2000.00214.x COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 944 TITLE Chest pain: current concepts and implications for critical care transport. AUTHOR NAMES Lowell M.J. AUTHOR ADDRESSES (Lowell M.J.) CORRESPONDENCE ADDRESS M.J. Lowell, SOURCE Air medical journal (2000) 19:2 (50-54). Date of Publication: 2000 Apr-Jun ISSN 1067-991X EMTREE DRUG INDEX TERMS anticoagulant agent (drug administration) antithrombocytic agent (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport thorax pain (diagnosis, drug therapy, etiology) EMTREE MEDICAL INDEX TERMS air medical transport aortic rupture (complication) article dissecting aneurysm (complication) esophagus perforation (complication) heart muscle ischemia (complication) human lung embolism (complication) methodology pneumothorax (complication) LANGUAGE OF ARTICLE English MEDLINE PMID 11010377 (http://www.ncbi.nlm.nih.gov/pubmed/11010377) PUI L31356852 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 945 TITLE Initial management and diagnostic strategy of severely head-injured patients ORIGINAL (NON-ENGLISH) TITLE Prise en charge du traumatise cranien grave dans les 24 premieres heures. Reanimation et strategie diagnostique initiales AUTHOR NAMES Ricard-Hibon A. Marty J. AUTHOR ADDRESSES (Ricard-Hibon A.; Marty J.) Serv. d'Anesthesie-reanimation-smur, Hop. Beaujon, 100, bd Gen.-L., Clichy, France. CORRESPONDENCE ADDRESS A. Ricard-Hibon, Serv. d'Anesthesie-Reanimation-Smur, Hopital Beaujon, 100, bd du General-Leclerc, 92110 Clichy, France. SOURCE Annales Francaises d'Anesthesie et de Reanimation (2000) 19:4 (286-295). Date of Publication: April 2000 ISSN 0750-7658 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT Limitation of secondary insults after severe head injury is a permanent concern during the early phase of head trauma management. The objectives are to maintain mean arterial pressure between 80 and 100 mmHg, to avoid hypoxaemia, and to maintain arterial PCO(2) near to 35 mmHg. Volume loading can be necessary to improve arterial pressure, and is carried out with isotonic critalloid (NaCl 9‰) or colloids, with the exclusion of all hypotonic solutions (Ringer lactate or glucose). The use of catecholamines is reserved for patients with unstable haemodynamics despite an adequate volume loading. The rapid sequence induction is recommended for endotracheal intubation and is followed by continuous analgesia-sedation to keep patient- ventilator dysynchrony, but without compromising haemodynamic objectives. Mannitol is used in case of life-threatening intracranial hypertension. Conversely, specific treatment of intracranial hypertension, especially hypocapnia, is not recommended. Initial diagnostic procedures include cerebral tomodensitometry (TDM). However, TDM may be delayed in case of haemorrhage, which requires a rapid treatment. Intrahospital transport for additional explorations risks secondary insults, and thus requires close monitoring to detect and treat in due time all adverse events. This monitoring includes invasive arterial blood pressure assessment, use of continuous capnography and repeated arterial blood gas measurements. The usefulness of transcranial Doppler for initial management of head-trauma patients needs further evaluation. (C) 2000 Editions scientifiques et medicales Elsevier SAS. EMTREE DRUG INDEX TERMS catecholamine mannitol EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury (diagnosis) injury scale EMTREE MEDICAL INDEX TERMS analgesia arterial carbon dioxide tension article blood gas analysis blood pressure monitoring blood volume capnometry colloid crystalloid endotracheal intubation hemodynamics human hypoxemia (prevention) mean arterial pressure radiodensitometry sedation CAS REGISTRY NUMBERS mannitol (69-65-8, 87-78-5) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 2000173465 MEDLINE PMID 10836116 (http://www.ncbi.nlm.nih.gov/pubmed/10836116) PUI L30263764 DOI 10.1016/S0750-7658(99)00149-5 FULL TEXT LINK http://dx.doi.org/10.1016/S0750-7658(99)00149-5 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 946 TITLE Improving outcomes and reducing costs in intensive care. AUTHOR ADDRESSES SOURCE Report on medical guidelines & outcomes research (2000) 11:4 (7-10, 12). Date of Publication: 17 Feb 2000 ISSN 1050-5636 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost control intensive care intensive care unit length of stay patient transport EMTREE MEDICAL INDEX TERMS article drug cost economics emergency health service health care quality human organization and management patient care planning time treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 11768410 (http://www.ncbi.nlm.nih.gov/pubmed/11768410) PUI L33568525 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 947 TITLE Bedside procedures: Solutions to the pitfalls of intrahospital transport AUTHOR NAMES Haupt M.T. Rehm C.G. AUTHOR ADDRESSES (Haupt M.T.) Department of Medicine, Critical Care Medicine Service, Oregon Health Sciences University, Portland, OR, United States. (Rehm C.G.) Department of Surgery, Critical Care Medicine Service, Oregon Health Sciences University, Portland, OR, United States. CORRESPONDENCE ADDRESS M.T. Haupt, Department of Medicine, Critical Care Medicine Service, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201-3098, United States. SOURCE Critical Care Clinics (2000) 16:1 (1-6). Date of Publication: 2000 ISSN 0749-0704 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The technology to perform diagnostic and therapeutic procedures at the bedside continues to advance. Because of documented hazards and the expense of intrahospital transport, the bedside is becoming an appealing site for procedures that are more commonly performed in radiologic, bronchoscopic, other procedural suites, and the operating room. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS arterial oxygen saturation bronchoscopy critical illness intensive care monitoring patient care priority journal pulse oximetry review vascular access EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000033897 MEDLINE PMID 10650497 (http://www.ncbi.nlm.nih.gov/pubmed/10650497) PUI L30048854 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 948 TITLE If hospital policy jeopardizes a patient. AUTHOR NAMES Johnson L.J. AUTHOR ADDRESSES (Johnson L.J.) CORRESPONDENCE ADDRESS L.J. Johnson, SOURCE Medical economics (2000) 77:1 (165, 168). Date of Publication: 10 Jan 2000 ISSN 0025-7206 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport policy EMTREE MEDICAL INDEX TERMS article human malpractice organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 10787864 (http://www.ncbi.nlm.nih.gov/pubmed/10787864) PUI L31297112 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 949 TITLE Practical realization of a patient accompanying concept in anesthesia and intensive care ORIGINAL (NON-ENGLISH) TITLE Praktische umsetzung eines patientenbegleitenden arbeitsplatzkonzeptes fur anasthesie und intensivmedizin AUTHOR NAMES Holst D. Rudolph P. Wendt M. AUTHOR ADDRESSES (Holst D., holst@mail.uni-greifswald.de) Klin. Anasthesiologie I., Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 23c, 17489 Greifswald, Germany. (Rudolph P.; Wendt M.) CORRESPONDENCE ADDRESS D. Holst, Klin. fur Anasthesiol./Intensivmed., Ernst-Moritz-Arndt-Universitat, Friedrich-Loeffler-Strasse 23c, 17489 Greifswald, Germany. Email: holst@mail.uni-greifswald.de SOURCE Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie (2000) 35:1 (25-29). Date of Publication: January 2000 ISSN 0939-2661 BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. ABSTRACT Our current concept of stationary workplaces results in an interruption in patient monitoring and treatment. Because transfers are invariably associated with a reduction or interruption in the monitoring and treatment chain, an endangerment to critically-ill patients, as well as a significant increase in the mortality rates, can result. Design: In the new construction of the Cardiac Clinic, the previous concept of immobile anesthesia and intensive care workstations has been completely abandoned. The complete treatment workstation, including monitoring and fluid management, is set up on a bedside cart which accompanies the patients uninterrUptedly - from anesthesia administration, to the operating room, to the ICU or recovery room, as well as during elective or emergency interventions outside the ICU. Transport times and complications from 995 transports (ASA III and IV) were analysed and compared with 880 transports with the conventional system. Results: During all intrahospital transfers with the mobile workplace, there were no complications resulting from faulty operation or accidental adjustment of the perfusors, or from disconnecting the monitoring,-, respiration-, or infusion lines. On the whole, there were fewer cases of circulatory instability during transport, since infusion treatment and medication could be administered without interruption. All hemodynamic parameters were recorded during transport, as were cardiac minute output and right- and left-atrial filling pressures. The mobile workplace system allows for the shortest possible transport and exchange times - 13.5 rain, as compared to 42.5 min with the conventional system. The reconnection of monitoring equipment with zeroing, adjustment of the alarm limits, as well as exchanging perfusors and infusomats before and after transport is eliminated entirely. Conclusion: This mobile workplace, in which all components of the anesthesiological and intensive care workstations are integrated, guarantees the highest possible level of patient safety, since nothing has to be disconnected until the patient is transferred to a normal-care ward. In addition to the improved ergonomic design of the nurse's and doctor's workplace, substantial savings can also be made. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia complication intensive care EMTREE MEDICAL INDEX TERMS anesthetic recovery article critical illness hemodynamic monitoring human major clinical study patient monitoring EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2000066388 MEDLINE PMID 10689519 (http://www.ncbi.nlm.nih.gov/pubmed/10689519) PUI L30097371 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 950 TITLE Perinatal transport practices: A survey of inborn versus outborn very preterm infants admitted to European neonatal intensive care units AUTHOR NAMES Kollée L.A.A. Chabernaud J.-L. Van Reempts P. Debauche C. Zeitlin J. AUTHOR ADDRESSES (Kollée L.A.A.; Chabernaud J.-L.; Van Reempts P.; Debauche C.; Zeitlin J.) SOURCE Prenatal and Neonatal Medicine (1999) 4:SUPPL. 1 (61-72). Date of Publication: 1999 ISSN 1359-8635 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport perinatal care prematurity EMTREE MEDICAL INDEX TERMS article Europe gestational age health care policy hospital admission human infant intensive care unit newborn patient referral priority journal EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000080350 PUI L30118265 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 951 TITLE Blood flow does not limit peritoneal transport AUTHOR NAMES Flessner M.F. Lofthouse J. AUTHOR ADDRESSES (Flessner M.F.; Lofthouse J.) Nephrology Unit, Department of Medicine, Univ. of Rochester Medical Center, Rochester, NY, United States. (Flessner M.F.) Univ. of Rochester Medical Center, Box 675, 601 Elmwood Avenue, Rochester, NY 14642, United States. CORRESPONDENCE ADDRESS M.F. Flessner, Box 675, University Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States. SOURCE Peritoneal Dialysis International (1999) 19:SUPPL. 2 (S102-S105). Date of Publication: 1999 ISSN 0896-8608 BOOK PUBLISHER Multimed Inc., 66 Martin Street, Milton, Canada. ABSTRACT Objective: We investigated the assumption that blood flow to the microvessels underlying the peritoneum does not limit solute or water exchange between the blood and the dialysis fluid. Design: Small plastic chambers were affixed to the serosal side of the liver, cecum, stomach, and abdominal wall of anesthetized rats. Solutions that contained labeled solutes or that were made hypertonic were placed into the chambers, which restricted the area of transfer across the tissue to the base of the chamber and which permitted calculation of mass or water transfer rates on the basis of area. The local blood flow was monitored continuously with a laser Doppler flowmeter during three periods of observation: control, after 50%-70% reduction of the blood flow, and postmortem. Results: Urea transfer across all serosa, except for the liver, showed no difference in mean mass transfer coefficient (cm/min) between control (0.0038-0.0046) and after 70% flow reduction (0.0037-0.0040), but demonstrated a significant decrease with blood flow equal to zero (0.0020). These tissues demonstrated small but insignificant decreases in osmotic water flow into the chamber (0.7-0.9 μL/min/cm(2) under control conditions versus 0.4-0.7 μL/min/cm(2) with reduced blood flow). The liver demonstrated limitations in water and solute transport with a 70% decrease in blood flow. Conclusion: Because the liver makes up a small part of the peritoneal area, we conclude that large drops in blood flow do not limit overall solute or water transfer across the peritoneum during dialysis, and therefore acute peritoneal dialysis may be an appropriate modality for ICU patients in shock and renal failure. EMTREE DRUG INDEX TERMS dialysis fluid urea (endogenous compound) water (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood flow peritoneal cavity water transport EMTREE MEDICAL INDEX TERMS abdominal wall animal experiment blood cecum conference paper controlled study Doppler flowmeter intensive care unit kidney failure (therapy) liver microvasculature nonhuman osmosis peritoneal dialysis priority journal rat shock (therapy) stomach water flow CAS REGISTRY NUMBERS urea (57-13-6) water (7732-18-5) EMBASE CLASSIFICATIONS Urology and Nephrology (28) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2000010931 MEDLINE PMID 10406502 (http://www.ncbi.nlm.nih.gov/pubmed/10406502) PUI L30015460 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 952 TITLE Variations in the organization of obstetric and neonatal intensive care in Europe AUTHOR NAMES Papiernik E. Zeitlin J. Milligan D.W.A. Carrapato M.R.G. Van Reempts P. Gadzinowski J. Mazela J. Cabero L. Roura I. Di Renzo G.C. Moessinger A. Kollée L.A.A. Künzel W. Velebil P. AUTHOR ADDRESSES (Papiernik E.; Zeitlin J.; Milligan D.W.A.; Carrapato M.R.G.; Van Reempts P.; Gadzinowski J.; Mazela J.; Cabero L.; Roura I.; Di Renzo G.C.; Moessinger A.; Kollée L.A.A.; Künzel W.; Velebil P.) SOURCE Prenatal and Neonatal Medicine (1999) 4:SUPPL. 1 (73-87). Date of Publication: 1999 ISSN 1359-8635 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport perinatal care EMTREE MEDICAL INDEX TERMS adult birth rate Europe health care organization high risk patient human newborn practice guideline priority journal review EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000080351 PUI L30118266 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 953 TITLE Recommendations for intra-hospital transport of the severely head injured patient AUTHOR NAMES Ferdinande P. AUTHOR ADDRESSES (Ferdinande P.) European Society Intensive Care Med., Avenue Joseph Wybran 40, 1070 Brussels, Belgium. CORRESPONDENCE ADDRESS P. Ferdinande, European Society Intensive Care Med., Avenue Joseph Wybran 40, 1070 Brussels, Belgium. Email: esicm@pophost.eunet.be SOURCE Intensive Care Medicine (1999) 25:12 (1441-1443). Date of Publication: 1999 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury (disease management) patient transport EMTREE MEDICAL INDEX TERMS human note practice guideline EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2000015348 MEDLINE PMID 10660856 (http://www.ncbi.nlm.nih.gov/pubmed/10660856) PUI L30021175 DOI 10.1007/s001340051096 FULL TEXT LINK http://dx.doi.org/10.1007/s001340051096 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 954 TITLE Intrahospital transport of critically ill patients AUTHOR NAMES Waydhas C. AUTHOR ADDRESSES (Waydhas C., christian.waydhas@uni-essen.de) Klin. Poliklin. F. Unfallchirurgie, University Hospital, University of Essen, Essen, Germany. (Waydhas C., christian.waydhas@uni-essen.de) Klin. Poliklin. F. Unfallchirurgie, University Hospital, University of Essen, Hufelandstr. 55, 45147 Essen, Germany. CORRESPONDENCE ADDRESS C. Waydhas, Klin./Poliklinik fur Unfallchirurgie, University Hospital, University of Essen, Hufelandstr. 55, 45147 Essen, Germany. Email: christian.waydhas@uni-essen.de SOURCE Critical Care (1999) 3:5 (R83-R89). Date of Publication: 1999 ISSN 1364-8535 BOOK PUBLISHER BioMed Central Ltd., 34 - 42 Cleveland Street, London, United Kingdom. ABSTRACT Background: This review on the current literature of the intrahospital transport of critically ill patients addresses type and incidence of adverse effects, risk factors and risk assessment, and the available information on efficiency and cost-effectiveness of transferring such patients for diagnostic or therapeutic interventions within hospital. Methods and guidelines to prevent or reduce potential hazards and complications are provided. Methods: A Medline search was performed using the terms 'critical illness', 'transport of patients', 'patient transfer', 'critical care', 'monitoring' and 'intrahospital transport', and all information concerning the intrahospital transport of patients was considered. Results: Adverse effects may occur in up to 70% of transports. They include a change in heart rate, arterial hypotension and hypertension, increased intracranial pressure, arrhythmias, cardiac arrest and a change in respiratory rate, hypocapnia and hypercapnia, and significant hypoxaemia. No transport-related deaths have been reported. In up to one-third of cases mishaps during transport were equipment related. A long-term deterioration of respiratory function was observed in 12% of cases. Patient-related risk indicators were found to be a high Therapeutic Intervention Severity Score, mechanical ventilation, ventilation with positive end-expiratory pressure and high injury severity score. Patients' age, duration of transport, destination of transport, Acute Physiology and Chronic Health Evaluation II score, personnel accompanying the patient and other factors were not found to correlate with an increased rate of complications. Transports for diagnostic procedures resulted in a change in patient management in 40-50% of cases, indicating a good risk:benefit ratio. Conclusions: To prevent adverse effects of intrahospital transports, guidelines concerning the organization of transports, the personnel, equipment and monitoring should be followed. In particular, the presence of a critical care physician during transport, proper equipment to monitor vital functions and to treat such disturbances immediately, and close control of the patient's ventilation appear to be of major importance. It appears useful to use specifically constructed carts including standard intensive care unit ventilators in a selected group of patients. To further reduce the rate of inadvertent mishaps resulting from transports, alternative diagnostic modalities or techniques and performing surgical procedures in the intensive care unit should be considered. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS clinical protocol disease severity emergency health service human patient monitoring priority journal review risk assessment EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999363756 MEDLINE PMID 11094486 (http://www.ncbi.nlm.nih.gov/pubmed/11094486) PUI L29488975 DOI 10.1186/cc362 FULL TEXT LINK http://dx.doi.org/10.1186/cc362 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 955 TITLE Ethics in action. A nurse on a critical care unit has promised her terminally ill patient that she will care for him until the end. AUTHOR NAMES Haddad A. AUTHOR ADDRESSES (Haddad A.) School of Pharmacy and Allied Health Professions, Creighton University, Omaha, USA. CORRESPONDENCE ADDRESS A. Haddad, School of Pharmacy and Allied Health Professions, Creighton University, Omaha, USA. SOURCE RN (1999) 62:11 (21-24). Date of Publication: Nov 1999 ISSN 0033-7021 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care medical ethics nurse patient relationship patient transport terminal care EMTREE MEDICAL INDEX TERMS article Death and Euthanasia human professional-patient relationship psychological aspect recumbency LANGUAGE OF ARTICLE English MEDLINE PMID 10640126 (http://www.ncbi.nlm.nih.gov/pubmed/10640126) PUI L31277851 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 956 TITLE Logistic adaptation of intra hospital transport of adults ARDS ORIGINAL (NON-ENGLISH) TITLE Adaptation logistique du transport intrahospitalier de l'adulte en syndrome de detresse respiratoire aigue (SDRA) AUTHOR NAMES Corcelle P. Bernardin G. Mattéi M. AUTHOR ADDRESSES (Corcelle P.; Bernardin G.; Mattéi M.) Serv. de reanimation medicale, CHU, hôpital de l'Archet 1, BP 3079, 06202 Nice Cedex 3, France. CORRESPONDENCE ADDRESS P. Corcelle, Service de Reanimation Medicale, CHU, Hopital de l'Archet 1, BP 3079, 06202 Nice Cedex 3, France. SOURCE RBM - Revue Europeenne de Technologie Biomedicale (1999) 21:7 (148-152). Date of Publication: Oct 1999 ISSN 0222-0776 ABSTRACT Patients with ARDS must be displaced under safety conditions equivalent to those prevailing within the ICU; we have attempted to elaborate an autonomous, compact unit allowing patient transport under these conditions while easing the task of each of the care providers. This concept of transportation is applied in the clinical setting by means of a basket stretcher - carrying the patient - over which is adapted a mobile table carrying the treatment and monitoring equipment; the whole combination is installed on a cot. Once the patient is positioned in the basket stretcher/table unit, the majority of investigations (CT scanning in particular) can be conducted without any additional manipulation, with the same standards of monitoring and care as those provided in the ICU. Handling of the unit during transport only requires translational movements, which makes work easier for the nursing staff, stretcher-bearers and radiology technicians. The ultimate goal is to achieve a simple system allowing each ICU to elaborate its own set-up in view of applying this concept. Created for ARDS, our system can easily be applied to all patients in intensive care for whom such drastic requirements (especially regarding ventilation) are not always necessary. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adult respiratory distress syndrome EMTREE MEDICAL INDEX TERMS article computer assisted tomography hospital care human intensive care unit patient care patient transport EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 1999381531 PUI L29513619 DOI 10.1016/S0222-0776(00)88264-4 FULL TEXT LINK http://dx.doi.org/10.1016/S0222-0776(00)88264-4 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 957 TITLE The intra-hospital transport of patients with increased intracranial pressure ORIGINAL (NON-ENGLISH) TITLE Der innerklinische transport von patienten mit erhohtem intrakraniellen druck AUTHOR NAMES Marx G. Leuwer M. Piepenbrock S. Rueckoldt H. AUTHOR ADDRESSES (Marx G.; Leuwer M.; Piepenbrock S.; Rueckoldt H.) Zentrum für Anaesthesiologie, Abteilung II, Medizinische Hochschule Hannover, . CORRESPONDENCE ADDRESS G. Marx, Zentrum fur Anaesthesiologie, Abteilung II, Medizinische Hochschule Hannover, Hannover, Germany. SOURCE Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, Supplement (1999) 34:1 (S58-S61). Date of Publication: September 1999 ISSN 1430-7790 BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury intracranial hypertension EMTREE MEDICAL INDEX TERMS article artificial ventilation hospital care human patient care patient monitoring patient transport EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 1999354096 MEDLINE PMID 10542912 (http://www.ncbi.nlm.nih.gov/pubmed/10542912) PUI L29476758 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 958 TITLE Complications of intrahospital transport of the critically ill patients: Fact or fiction? ORIGINAL (NON-ENGLISH) TITLE Das transporttrauma: Fakt oder Fiktion? AUTHOR NAMES Zettl R. Waydhas C. Ruchholtz S. Zintl B. Schweiberer L. AUTHOR ADDRESSES (Zettl R.; Waydhas C.; Ruchholtz S.; Zintl B.; Schweiberer L.) Chir. Klinik Klinikum Innenstadt, Ludwig-Maximilians-Univ. M., . CORRESPONDENCE ADDRESS R. Zettl, Chir. Klinik Klinikum Innenstadt, Ludwig-Maximilians-Univ. Munchen, Munchen, Germany. SOURCE Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, Supplement (1999) 34:1 (S62-S65). Date of Publication: September 1999 ISSN 1430-7790 BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation hospital care human intensive care patient care EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 1999354097 MEDLINE PMID 10542913 (http://www.ncbi.nlm.nih.gov/pubmed/10542913) PUI L29476759 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 959 TITLE Comparison of commercial Amies transport systems with in-house Amies medium for recovery of Neisseria gonorrhoeae AUTHOR NAMES Thompson D.S. French S.A. AUTHOR ADDRESSES (Thompson D.S., thompsond@health.moh.gov.on.ca) Orillia Public Health Laboratory, 750 Memorial Ave., Orillia, Ont. L3V 6K5, Canada. (French S.A.) CORRESPONDENCE ADDRESS D.S. Thompson, Orillia Public Health Laboratory, 750 Memorial Ave., Orillia, Ont. L3V 6K5, Canada. Email: thompsond@health.moh.gov.on.ca SOURCE Journal of Clinical Microbiology (1999) 37:9 (3020-3021). Date of Publication: 1999 ISSN 0095-1137 BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. ABSTRACT Microbiologists are still encumbered by the variable performance of Amies charcoal transport medium in recovery of Neisseria gonorrhoeae. The objective of this study was to evaluate and select a good quality commercial system to replace our in-house preparation. We adsorbed 0.1 ml of a suspension from 30 gonococcal isolates onto each swab type and replaced the swab into the transport medium. We plated the swabs to New York City medium at 0, 24, 48, 72, and 96 h. We compared the survival of each isolate in the commercial Amies transport systems with that in our in-house Amies transport medium. The best recovery was observed with Copan transport systems. Some systems are inadequate and unacceptable for culture of gonococci. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Neisseria gonorrhoeae EMTREE MEDICAL INDEX TERMS article bacterium culture bacterium isolate culture medium intermethod comparison nonhuman priority journal quality control transport medium DEVICE TRADE NAMES CultureSwab 1006607A , United StatesDifco Culturette N7KA020 , United StatesBecton Dickinson NCS 7F26A , CanadaStarplex PHL 1390/2058/5028 , CanadaPublic Health Labs Starswab 7G17A , CanadaStarplex Transwab 97G28 , United KingdomMedical Wire and Equipment Transystem 7029 , ItalyCopan Transystem 7073 , ItalyCopan Transystem 7323 , ItalyCopan DEVICE MANUFACTURERS (United States)Becton Dickinson (Italy)Copan (United States)Difco (United Kingdom)Medical Wire and Equipment (Canada)Public Health Labs (Canada)Starplex EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999291368 MEDLINE PMID 10449495 (http://www.ncbi.nlm.nih.gov/pubmed/10449495) PUI L29391930 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 960 TITLE Preparing parents for their child's transfer from the PICU to the pediatric floor. AUTHOR NAMES Bouvé L.R. Rozmus C.L. Giordano P. AUTHOR ADDRESSES (Bouvé L.R.; Rozmus C.L.; Giordano P.) School of Nursing, Georgia Southwestern State University, Americus 31709, USA. CORRESPONDENCE ADDRESS L.R. Bouvé, School of Nursing, Georgia Southwestern State University, Americus 31709, USA. SOURCE Applied nursing research : ANR (1999) 12:3 (114-120). Date of Publication: Aug 1999 ISSN 0897-1897 ABSTRACT The experimental study described here was conducted to examine a nursing intervention intended to diminish the anxiety level of parents of children being transferred from a pediatric intensive care unit (PICU) to a general pediatric floor. The convenience sample included 50 parents of patients in a PICU at a southeastern U.S. tertiary medical center. The sample was randomly assigned to control and experimental groups. All subjects' anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) 24 to 48 hours prior to the child's impending transfer. The experimental group subsequently was given a transfer-preparation letter along with a verbal explanation. Finally, both groups were retested using the STAI immediately prior to the child's transfer. After controlling for trait anxiety, the analysis of covariant results showed significantly lower anxiety levels among the subjects who received the transfer-preparation letter than among those who did not, F(1,47) = 18.65, p < .0005. The study concludes that effective transfer preparation can significantly reduce the anxiety experienced by parents who are facing the imminent transfer of their child out of the PICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety (diagnosis, etiology, prevention) child hospitalization intensive care parent patient transport EMTREE MEDICAL INDEX TERMS adolescent adult article clinical trial controlled clinical trial controlled study education female human male methodology middle aged nursing nursing evaluation research pediatric nursing psychological aspect questionnaire randomized controlled trial teaching LANGUAGE OF ARTICLE English MEDLINE PMID 10457621 (http://www.ncbi.nlm.nih.gov/pubmed/10457621) PUI L129455071 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 961 TITLE Avoid COBRA's fangs. The Emergency Medical Treatment & Active Labor Act: legislating appropriate critical care transports. AUTHOR NAMES Maggiore W.A. AUTHOR ADDRESSES (Maggiore W.A.) CORRESPONDENCE ADDRESS W.A. Maggiore, SOURCE JEMS : a journal of emergency medical services (1999) 24:8 (66-74, 76). Date of Publication: Aug 1999 ISSN 0197-2510 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service patient transport EMTREE MEDICAL INDEX TERMS article female human intensive care labor law legal aspect legal liability physical examination practice guideline pregnancy United States LANGUAGE OF ARTICLE English MEDLINE PMID 10557814 (http://www.ncbi.nlm.nih.gov/pubmed/10557814) PUI L129464313 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 962 TITLE Regional protocols for the transfer and treatment of patients with head injury ORIGINAL (NON-ENGLISH) TITLE I protocolli regionali di trasferimento ed il trattamento del trauma cranico: L'Esperienza della Romagna AUTHOR NAMES Servadei F. Veronesi V. Giuliani G. Giardini E. Chieregato A. AUTHOR ADDRESSES (Servadei F.; Veronesi V.; Giuliani G.; Giardini E.; Chieregato A.) Div. Neurochirur. Funz. Traumatol., Ospedale Maurizio Bufalini, 47023 Cesena, Italy. CORRESPONDENCE ADDRESS F. Servadei, Div. Neurochirur. Funz. Traumatol., Ospedale Maurizio Bufalini, 47023 Cesena, Italy. Email: fservade@ausl-cesena.emr.it SOURCE Rivista Medica (1999) 5:1-2 (29-34). Date of Publication: 1999 ISSN 1127-6339 ABSTRACT Concentrating head injured patients in a hospital with neurosurgery and intensive care units has been confirmed in literature reports and recently by Italian guidelines. A regional trauma system with head injuries treated at the Bufalini Hospital in Cesena was analysed. The epidemiological aspects were investigated and existing resources identified. Although epidemiological findings disclosed the need for admission to intensive care units for 180- 220 patients, only half the patients with severe head injury were admitted to hospitals with specialist wards. A transfer protocol is proposed correlated with the transmission of CT scans which offers the best possible treatment for patients with head injury. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury (diagnosis, epidemiology) EMTREE MEDICAL INDEX TERMS article clinical protocol computer assisted tomography hospital admission human intensive care unit major clinical study nervous system injury (diagnosis, epidemiology) neuroradiology neurotraumatology patient transport practice guideline EMBASE CLASSIFICATIONS Radiology (14) Public Health, Social Medicine and Epidemiology (17) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE Italian LANGUAGE OF SUMMARY English, Italian EMBASE ACCESSION NUMBER 1999195946 PUI L29258655 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 963 TITLE Intrahospital transport of critically ill children - Should we pay attention? AUTHOR NAMES Venkataraman S.T. AUTHOR ADDRESSES (Venkataraman S.T.) Pediatric Critical Care, Children's Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA, United States. CORRESPONDENCE ADDRESS S.T. Venkataraman, Pediatric Critical Care, Children's Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA, United States. SOURCE Critical Care Medicine (1999) 27:4 (694-695). Date of Publication: 1999 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS artificial ventilation child critical illness disease severity editorial end tidal carbon dioxide tension human intensive care unit intermethod comparison medical literature medical staff priority journal risk assessment tidal volume EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1999165136 MEDLINE PMID 10321655 (http://www.ncbi.nlm.nih.gov/pubmed/10321655) PUI L29218199 DOI 10.1097/00003246-199904000-00016 FULL TEXT LINK http://dx.doi.org/10.1097/00003246-199904000-00016 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 964 TITLE Patients' and family members' perceptions of transfer from intensive care AUTHOR NAMES Leith B.A. AUTHOR ADDRESSES (Leith B.A.) Montreal Neurological Hospital, Intensive Care Unit, 3801 University St, Montreal, Que. H3A 2B4, Canada. CORRESPONDENCE ADDRESS B.A. Leith, Montreal Neurological Hospital, Intensive Care Unit, 3801 University St, Montreal, Que. H3A 2B4, Canada. SOURCE Heart and Lung: Journal of Acute and Critical Care (1999) 28:3 (210-218). Date of Publication: 1999 ISSN 0147-9563 BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT OBJECTIVE: To describe patients' and family members' perceptions of transfer from an intensive care unit (ICU). DESIGN: Qualitative component of a descriptive, cross-sectional survey. SETTING: Two university-affiliated tertiary care centres in western Canada. PARTICIPANTS: Fifty-three patients and 35 family members who had been transferred from a medical ICU within the previous 48 hours. MEASURES: Content analysis of responses to 3 open-ended questions relating to transfer from the ICU. RESULTS: Patients and family members had 3 major responses of transfer from the ICU: positive, neutral or ambivalent, and negative. Although some patients and family members perceived the transfer from the ICU as a sign of progress, many individuals expressed concern about the sudden and dramatic change in the level of care after transfer. CONCLUSION: Patients and family members perceived the transfer from the ICU as a significant and sometimes negative event. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) comprehension intensive care EMTREE MEDICAL INDEX TERMS article family human morbidity patient education priority journal EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999181425 MEDLINE PMID 10330217 (http://www.ncbi.nlm.nih.gov/pubmed/10330217) PUI L29239349 DOI 10.1016/S0147-9563(99)70061-0 FULL TEXT LINK http://dx.doi.org/10.1016/S0147-9563(99)70061-0 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 965 TITLE Use of flexible intermediate and intensive care to reduce multiple transfers of patients. AUTHOR NAMES Besserman E. Teres D. Logan A. Brennan M. Cleaves S. Bayly R. Brochis D. Nemeth B. Grare J. Ngo D. AUTHOR ADDRESSES (Besserman E.; Teres D.; Logan A.; Brennan M.; Cleaves S.; Bayly R.; Brochis D.; Nemeth B.; Grare J.; Ngo D.) Department of Critical Care, Muhlenberg Regional Medical Center, Plainfield, NJ, USA. CORRESPONDENCE ADDRESS E. Besserman, Department of Critical Care, Muhlenberg Regional Medical Center, Plainfield, NJ, USA. SOURCE American journal of critical care : an official publication, American Association of Critical-Care Nurses (1999) 8:3 (170-179). Date of Publication: May 1999 ISSN 1062-3264 ABSTRACT OBJECTIVE: To test an alternative flexible approach to traditional fixed intermediate and intensive care to minimize transfers of patients. METHODS: Patients admitted to a 28-bed nursing unit with intermediate care potential and a 12-bed intensive care unit at a 300-bed teaching community hospital were studied. The group included 524 patients with a discharge diagnosis code for mechanical ventilation. During eight 3-week cycles, 1073 transfers of patients were tabulated. A plan-do-study-act method was used to improve weaning from mechanical ventilation and reduce the number of inappropriate days in intensive care. Admissions and transfers to the 2 units for all patients during the eight 3-week cycles were compared over time. Length of stay and mortality were noted for all patients treated with conventional and noninvasive ventilation. RESULTS: Direct admissions to the flexible intermediate unit increased with no overall change in admissions to the intensive care unit. Fewer patients needed conventional ventilation, and more in both units were treated with noninvasive ventilation. The median number of transfers per patient treated with mechanical ventilation decreased from 1.94 to 1.20. Length of stay and mortality also decreased among such patients. Some cost savings were attributable to the decrease in the number of transfers. Transfers out of the hospital directly from the intensive care unit increased from 2.24% to 4.43%. CONCLUSIONS: In a community teaching hospital, flexible care policies decreased the number of in-hospital transfers of patients treated with mechanical ventilation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation community hospital human length of stay methodology mortality organization and management teaching hospital United States LANGUAGE OF ARTICLE English MEDLINE PMID 10228658 (http://www.ncbi.nlm.nih.gov/pubmed/10228658) PUI L129420494 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 966 TITLE Critical care of the burn patient AUTHOR NAMES Love R. Nguyen T.T. AUTHOR ADDRESSES (Love R.; Nguyen T.T.) Warner Ave, Fountain Valley, CA 92708, United States. CORRESPONDENCE ADDRESS T.T. Nguyen, Warner Ave, Fountain Valley, CA 92708, United States. SOURCE Seminars in Anesthesia (1999) 18:1 (87-98). Date of Publication: 1999 ISSN 0277-0326 ABSTRACT Comprehensive care of bum patients requires attention to details throughout the acute phase of the patient's recovery to maximize survival. Team efforts by surgeons, anesthesiologists, nurses, scientists, and a vast array of therapists are making productive and social lives possible for many of these bum victims. Overall, advances in the treatment of initial injuries and their complications as well as new surgical techniques for closing wounds and reducing scar tissue have increased burn patient's chances, not only of survival but also of recovery and readjustment into society. However, many problems still need to be solved, such as inhalation injury, hypermetabolism with muscle wasting, and severe bum scarring. New therapies, such as percussive ventilators, growth hormone, and newer methods of covering wounds, will ultimately lead to further improvements in survival and functional outcome. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (surgery) intensive care patient transport EMTREE MEDICAL INDEX TERMS compartment syndrome (complication) epidemiological data fasciotomy hypermetabolism (complication) metabolic rate mortality multiple organ failure patient care practice guideline priority journal resuscitation review thermal injury wound care EMBASE CLASSIFICATIONS Anesthesiology (24) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999109520 PUI L29142602 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 967 TITLE Intrahospital transport of critically ill children AUTHOR NAMES Paret G. Ben Abraham R. Yativ O. Vardi A. Barzilay Z. AUTHOR ADDRESSES (Paret G.; Ben Abraham R.; Yativ O.; Vardi A.; Barzilay Z.) Dept. of Pediatric Intensive Care and of Anesthesiology, Sheba Medical Center, Tel Hashomer. CORRESPONDENCE ADDRESS G. Paret, Dept. of Pediatric Intensive Care and of Anesthesiology, Sheba Medical Center, Tel Hashomer. SOURCE Harefuah (1999) 136:8 (609-611, 659). Date of Publication: 15 Apr 1999 ISSN 0017-7768 ABSTRACT Prospective evaluation of intrahospital transportation of 33 critically ill children to and from the pediatric intensive care unit was conducted over the course of a month. Factors contributing to risk of transport were assessed. There were 33 children (25 boys and 8 girls), 3 days to 15 years of age. Reasons for admission included: disease and trauma in 19, and status post operation in 11. The pretransport PRISM score was 4.84. 22 children (66.6%) were being mechanically ventilated and 10 (30.3%) were being treated with amines. Transport time ranged from 8-150 minutes. 15 of the transports (45.4%) were urgent and a special intensive care team escorted 22 (66.6%). Equipment mishaps and physiological deterioration occurred in 12 (36.3%) and 11 (30.3%) of the cases, respectively. The use of amines, mechanical ventilation, longer transport time and high PRISM score were all associated with physiological deterioration on transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child hospitalization critical illness patient transport EMTREE MEDICAL INDEX TERMS adolescent article child female human infant injury male newborn postoperative complication preschool child LANGUAGE OF ARTICLE Hebrew MEDLINE PMID 10955068 (http://www.ncbi.nlm.nih.gov/pubmed/10955068) PUI L31363989 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 968 TITLE Factors that contribute to complications during intrahospital transport of the critically ill. AUTHOR NAMES Doring B.L. Kerr M.E. Lovasik D.A. Thayer T. AUTHOR ADDRESSES (Doring B.L.; Kerr M.E.; Lovasik D.A.; Thayer T.) Vanderbilt University Medical Center, USA. CORRESPONDENCE ADDRESS B.L. Doring, Vanderbilt University Medical Center, USA. SOURCE The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses (1999) 31:2 (80-86). Date of Publication: Apr 1999 ISSN 0888-0395 ABSTRACT Transporting patients from the protective environment of the intensive care (ICU) unit to other areas of the hospital has become increasingly common since high technologic testing has become an integral part of health care assessment. The hazards of moving critically ill patients by ambulance or air transport are well recognized and standards of care have been developed based on delineation of these risks. Despite the existing evidence of hazards of interhospital hospital transport, less attention has been given to the potential hazards associated with the intrahospital transport of critically ill patients. A high incidence of serious hemodynamic or respiratory alteration is associated with the intrahospital transport of critically ill patients. In one third of critically ill intrahospital transports, technical mishaps (eg, i.v. disconnects, which could potentially lead to deleterious physiologic outcomes) may occur. As patient acuity increases, there is a greater risk of hemodynamic instability. The purpose of this study was to further investigate the patient complications during transportation to and from the ICU to a diagnostic or treatment site. The sample consisted of thirty-five critically ill patients from the Neuro/Trauma ICU who required continuous physiological monitoring and had an arterial catheter in place. The systemic blood pressure, heart rate and peripheral oxygen saturation were monitored at nine time points throughout the transport process. The incidence of defined technical mishaps that occurred when the patient was off the unit were also recorded. Transport factors examined included the length of time spent off the unit and the number and level of personnel accompanying the patient. A within-subject repeat measure design was used to examine the physiologic changes and mishaps that occurred. Results indicate that while the majority of patients experienced some physiologic responses as a result of transport, the responses were not of sufficient magnitude to be classified as a deleterious. Twenty-three technical mishaps, which included inadvertent ventilator and electrocardiogram disconnects, power failures, interruption of medication administration and disconnection of drainage devices were observed. Factors related to these occurrences of technical mishaps were the number of intravenous solutions and infusion pumps and the time spent outside of the ICU environment. EMTREE DRUG INDEX TERMS oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article factor analysis female hospital human intubation male metabolism middle aged standard CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE English MEDLINE PMID 14964607 (http://www.ncbi.nlm.nih.gov/pubmed/14964607) PUI L38309264 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 969 TITLE A comparison of manual and mechanical ventilation during pediatric transport AUTHOR NAMES Dockery W.K. Futterman C. Keller S.R. Sheridan M.J. Akl B.F. AUTHOR ADDRESSES (Dockery W.K.) Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, VA, United States. (Dockery W.K.; Futterman C.; Keller S.R.) Dept. of Pediatric Critical Care, Inova Fairfax Hospital for Children, Falls Church, VA, United States. (Akl B.F.) Department of Pediatrics and Surgery, Inova Fairfax Hospital for Children, Falls Church, VA, United States. (Sheridan M.J.) Institute of Research and Education, Inova Health System, Falls Church, VA, United States. CORRESPONDENCE ADDRESS W.K. Dockery, Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, VA, United States. SOURCE Critical Care Medicine (1999) 27:4 (802-806). Date of Publication: April 1999 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: To compare the amount of variability in ventilation during intrahospital transport of intubated pediatric patients ventilated either manually or with a transport ventilator. Design: Prospective, randomized study. Setting: Tertiary, multidisciplinary, pediatric intensive care unit. Patients: Forty-nine pediatric postoperative heart patients who required transport while still intubated. Interventions: Patients were randomized to receive either manual ventilation during transport or ventilation by a portable mechanical ventilator. Baseline ventilatory and hemodynamic parameters were recorded before and during transport. Before and after arterial blood gases were also obtained. All other aspects of care were identical. Measurements and Main Results: There was a statistically significant greater amount of variation in ventilation during transport with manual technique as opposed to the mechanical ventilator. A Student's t-test on pre- to post-blood gas differences showed a significantly lower PetCO(2) (p = .02) in the manually ventilated patients when compared with the mechanically ventilated patients. Values for PCO(2) were higher, but only marginally significant (p = .08). Repeated measures analysis of variance using these same pre- and post blood gas values confirmed the significant decrease in PetCO(2) (p = .05). Minute to minute variation in PetCO(2) during transport was greater and the mean values significantly lower in the manually ventilated group (p < .05). Hemodynamic data were remarkably stable when examined both before and after transport and on a minute to minute basis during transport. Conclusions: Manual ventilation during intrahospital transport results in greater fluctuation of ventilatory parameters from an established baseline than does use of a transport ventilator. No clinically significant changes in status occurred during the brief period of transport studied. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation patient transport EMTREE MEDICAL INDEX TERMS adolescent airway pressure arterial gas article carbon dioxide tension central venous pressure child clinical article congenital heart malformation controlled study critical illness end tidal carbon dioxide tension endotracheal intubation hemodynamic parameters human infant intensive care intermethod comparison mean arterial pressure newborn patient monitoring postoperative care priority journal risk assessment ventilator EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999165153 MEDLINE PMID 10321673 (http://www.ncbi.nlm.nih.gov/pubmed/10321673) PUI L29218216 DOI 10.1097/00003246-199904000-00040 FULL TEXT LINK http://dx.doi.org/10.1097/00003246-199904000-00040 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 970 TITLE Intrahospital transport of critically ill patients ORIGINAL (NON-ENGLISH) TITLE Transporte intrahospitalario del paciente critico AUTHOR NAMES Reig Valero R. Belenguer Muncharaz A. Bisbal Andrés E. Abizanda Campos R. Carregui Tusón R. Pesqueira Alonso E.E. AUTHOR ADDRESSES (Reig Valero R.; Belenguer Muncharaz A.; Bisbal Andrés E.; Abizanda Campos R.; Carregui Tusón R.; Pesqueira Alonso E.E.) Servei de Medicina Intensiva, Hospital General de Castelló, Castelló, Spain. (Abizanda Campos R.) Servei Med. Intensiva Hosp. Gen. C., Avda Benicàssim, s/n, 12004 Castelló, Spain. CORRESPONDENCE ADDRESS R. Abizanda Campos, Servei de Medicina Intensiva, Hospital General de Castello, Avda. Benicassim s-n, 12004 Castello, Spain. SOURCE Medicina Intensiva (1999) 23:3 (120-126). Date of Publication: Mar 1999 ISSN 0210-5691 ABSTRACT The assisted intrahospital transport of critically ill patients is a common attending procedure which represents an additional risk derived from leaving the security room - the ICU - and also because patients are left to unpreventable factors associated with portable equipment and the not always easy intrahospital communications. The frequency of this type of displacements is justified by the potential benefits derived from diagnostic or therapeutic tests which cannot be performed at patient's bedside. Therefore, an action strategy should be established in order to guarantee that the patient overcomes the potential risks. The problems related to intrahospital communications (both horizontally and vertically) with the necessary equipment, with the necessary personnel and their qualifications, and with monitoring of patients during the whole process are reviewed. Finally, a systematic, detailed action programme leading to solve the reported problems is provided. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical practice critical illness patient transport EMTREE MEDICAL INDEX TERMS devices diagnostic test human intensive care unit interpersonal communication patient monitoring personnel review EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY Spanish, English EMBASE ACCESSION NUMBER 1999153457 PUI L29201783 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 971 TITLE Development of a pediatric critical care transport team: Experience at a military medical center AUTHOR NAMES Wheeler D.S. Sperring J.L. Vaux K.K. Poss W.B. AUTHOR ADDRESSES (Wheeler D.S.; Sperring J.L.; Vaux K.K.; Poss W.B.) Depts. of Pediat. and Clin. Research, Naval Medical Center San Diego, San Diego, CA, United States. CORRESPONDENCE ADDRESS W.B. Poss, Dept. of Pediatr. and Clinic. Res., Naval Medical Center San Diego, San Diego, CA, United States. SOURCE Military Medicine (1999) 164:3 (188-193). Date of Publication: March 1999 ISSN 0026-4075 BOOK PUBLISHER Association of Military Surgeons of the US, 9320 Old Georgetown Road, Bethesda, United States. ABSTRACT Introduction: A pediatric critical care transport program was initiated and organized at Naval Medical Center San Diego in January 1994. The primary goal of the program was to formally train military pediatric residents in the early stabilization and transport of the critically ill neonatal and pediatric patient. It was also felt that such a program would generate significant cost savings to the Department of Defense. We present the statistics, training protocol, and the cost savings. In addition, we surveyed previous residents who had been involved with this program to determine its perceived benefit. Methods: In the first phase of this project, the pediatric critical care transport program database from January 1994 to December 1997 was reviewed. The number and types of transports were recorded. Next, we determined cost savings for the transport program for fiscal year 1996-1998 (the period for which fiscal data were available). In the second phase of this project, we sent surveys to the 23 graduating residents who had participated in the pediatric critical care transport program. The survey sought to determine the perceived value of the transport training experience and the degree to which that training is now being used. All investigators were blinded to the responses. Statistical analysis consisted of determining the percentage of each response. Results: During the 4-year period reviewed, 404 transports were performed (198 neonatal and 206 pediatric). During fiscal year 1996-1998, there was a cost avoidance of $1,962 per transport. In the second phase, 91% of the surveys were returned and analyzed. The majority of residents were practicing in overseas or isolated communities. All respondents rated their experience in the pediatric critical care transport program as worthwhile and educational, and they complemented their training in the neonatal and pediatric intensive care units. Seventy-one percent of the respondents had transported a critically ill neonate or child to another facility within the last year. Conclusions: In summary, we report our experience with the development of a pediatric critical care transport program. The Program was developed to provide military pediatric residents instruction and experience in the stabilization and transport of critically ill children. In addition, we were able to demonstrate a significant cost avoidance. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health care EMTREE MEDICAL INDEX TERMS article child critical illness health care cost human military medicine newborn newborn intensive care patient transport EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999102746 MEDLINE PMID 10091491 (http://www.ncbi.nlm.nih.gov/pubmed/10091491) PUI L29133712 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 972 TITLE Critical care transport: Outcome evaluation after interfacility transfer and hospitalization AUTHOR NAMES Selevan J.S. Fields W.W. Chen W. Petitti D.B. Wolde-Tsadik G. AUTHOR ADDRESSES (Selevan J.S.; Fields W.W.; Chen W.; Petitti D.B.; Wolde-Tsadik G.) S. California Permanente Med. Grp., 393 East Walnut Street, Pasadena, CA 91188, United States. CORRESPONDENCE ADDRESS J.S. Selevan, S. California Permanente Med. Grp., 393 East Walnut Street, Pasadena, CA 91188, United States. SOURCE Annals of Emergency Medicine (1999) 33:1 (33-43). Date of Publication: 1999 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Study objective: To test the hypothesis that interfacility transfer is not associated with increased mortality, duration of stay, or readmission within 7 days. Methods: We matched 3,298 patients who were hospitalized for chest pain or related complaints in Kaiser Permanente medical centers after transfer from the emergency department of a non-plan hospital (transported patients) with 3,298 patients of the same gender and age (±5 years) and with the same principal diagnosis who were hospitalized within 6 months without transfer in the same Kaiser Permanente medica center (directly admitted patients). Patients were compared in terms of outcome measures: in-hospital deaths, continued care in another facility, readmission within 7 days, in- patient length of stay (LOS), and LOS in special care units. Results: The adjusted odds ratios for in-hospital mortality and readmission within 7 days were 1.0 (95% confidence interval, .8 to 1.4) and .9 (95% confidence interval, .7 to 1.2), respectively. The adjusted mean difference in LOS was - .1 days (95% confidence interval, -.2 to .1). Transported and directly admitted cardiac patients were also compared for all examined outcome measures at each of 10 medical centers. At a few medical centers, we observed significant difference in LOS, special care LOS, and continued care in another facility. However, all these differences were small, and most were probably random errors. Conclusion: Conservative patient selection criteria, pretransfer stabilization, and the use of appropriate equipment and medical personnel have resulted in the interfacility transfer program's achieving its goal of transferring high-risk patients without adverse impact on clinical outcomes or resource use. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart arrhythmia (diagnosis) hospitalization intensive care treatment outcome EMTREE MEDICAL INDEX TERMS article conservative treatment disease severity heart failure (diagnosis) heart muscle ischemia (diagnosis) high risk population human major clinical study medical care medical personnel mortality myocardial disease (diagnosis) patient transport priority journal thorax pain (diagnosis) EMBASE CLASSIFICATIONS Internal Medicine (6) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1999022214 MEDLINE PMID 9867884 (http://www.ncbi.nlm.nih.gov/pubmed/9867884) PUI L29028777 DOI 10.1016/S0196-0644(99)70414-2 FULL TEXT LINK http://dx.doi.org/10.1016/S0196-0644(99)70414-2 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 973 TITLE Secondary insults during intrahospital transport of neurosurgical intensive care patients AUTHOR NAMES Bekar A. Ipekoglu Z. Türeyen K. Bilgin H. Korfali G. Korfali E. AUTHOR ADDRESSES (Bekar A.; Ipekoglu Z.; Türeyen K.; Korfali E.) Department of Neurosurgery, Uludag University, Bursa, Turkey. (Bilgin H.; Korfali G.) Dept. of Anesth. and Reanimation, Uludag University, Bursa, Turkey. (Bekar A.) Department of Neurosurgery, Uludag University, School of Medicine, TR-Görükle, Bursa, Turkey. CORRESPONDENCE ADDRESS A. Bekar, Department of Neurosurgery, Uludag University, School of Medicine, TR-Gorukle, Bursa, Turkey. SOURCE Neurosurgical Review (1998) 21:2-3 (98-101). Date of Publication: 1998 ISSN 0344-5607 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Secondary insults occurring after injury have been prospectively assessed in seven head-injured patients who required intrahospital transfer to a computerized tomography unit for re-evaluation of their brain injury. During transportation the intracranial pressure, blood pressure, and arterial blood gases were monitored. A significant increase in intracranial pressure was observed during transport (p < 0.01). The conclusion is that patients should be ventilated and have appropriate sedation and analgesia. This could provide some protection against secondary insults. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) head injury (complication) EMTREE MEDICAL INDEX TERMS article human injury scale intensive care intracranial pressure patient transport priority journal surgical patient Turkey (republic) EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998412650 MEDLINE PMID 9795941 (http://www.ncbi.nlm.nih.gov/pubmed/9795941) PUI L28552704 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 974 TITLE Does optimizing oxygen transport improve outcome in intensive care patients? AUTHOR NAMES Brazzi L. Gattinoni L. AUTHOR ADDRESSES (Brazzi L.) Department of Anaesthesia, University of Milan, Milan, Italy. (Gattinoni L.) Department of Anaesthesia, Ospedale Maggiore Policlinico, IRCCS, Milan, Italy. (Brazzi L.) Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy. CORRESPONDENCE ADDRESS L. Brazzi, Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy. SOURCE British Journal of Anaesthesia (1998) 81:SUPPL. 1 (46-49). Date of Publication: 1998 ISSN 0007-0912 BOOK PUBLISHER Oxford University Press, Great Clarendon Street, Oxford, United Kingdom. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) oxygen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hemodynamics intensive care oxygen transport EMTREE MEDICAL INDEX TERMS conference paper critical illness human oxygen consumption priority journal treatment outcome CAS REGISTRY NUMBERS oxygen (7782-44-7) EMBASE CLASSIFICATIONS Internal Medicine (6) Anesthesiology (24) Hematology (25) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1998419191 MEDLINE PMID 10318988 (http://www.ncbi.nlm.nih.gov/pubmed/10318988) PUI L28561304 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 975 TITLE The outcome of patients with upper airway obstruction transported to a regional paediatric intensive care unit AUTHOR NAMES Durward A.D. Nicoll S.J.B. Oliver J. Tibby S.M. Murdoch I.A. AUTHOR ADDRESSES (Durward A.D.; Nicoll S.J.B.; Oliver J.; Tibby S.M., s.tibby@umds.ac.uk; Murdoch I.A.) Dept. of Paediatric Intensive Care, Guy's Tower, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom. CORRESPONDENCE ADDRESS S.M. Tibby, Dept. of Paediatric Intensive Care, Guy's Tower, Guy's Hospital, St Thomas Street, London SE1 9RT, United Kingdom. Email: s.tibby@umds.ac.uk SOURCE European Journal of Pediatrics (1998) 157:11 (907-911). Date of Publication: 1998 ISSN 0340-6199 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT The diagnoses, transfer, management and outcome of patients with upper airway obstruction (UAO) admitted from district general hospitals (DGH) to a regional paediatric intensive care unit were retrospectively reviewed over a 3.5-year period. Sixty-seven patient episodes were analysed. Fifty-two cases (78%) underwent tracheal intubation prior to transport with a low morbidity for both procedures. The most common diagnosis was viral croup (n = 34, 51%) with a median duration of intubation of 5 days, with subglottic stenosis being the next most common category (n = 10, 15%), median duration of intubation 7 days. Inhaled budesonide was used prior to intubation in 12 (35%) of those with croup, and inhaled bronchodilators in 28%, possibly reflecting diagnostic uncertainty. Patients with croup treated with budesonide were significantly less likely to require intubation (P = 0.04). The re-intubation rate for patients with viral croup was uncomfortably high at 16% (4/25) despite the routine use of prednisolone throughout the intubation period. Successful extubation of patients with viral croup could not be predicted by age (P = 0.31), length of intubation (P = 0.94), endotracheal tube size, (P = 0.60) abnormalities on the chest X-ray (P = 1.0), or presence of secondary bacterial infection (P = 0.23). Conclusion. Although viral croup remains the most common diagnostic category presenting at the DGH level with severe UAO, a wide range of other diagnoses is seen. Despite clear evidence of benefit, steroid administration to children presenting at the DGH with viral croup has not become routine practice. Once intubated, no reliable predictors of successful extubation were found amongst this patient group. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) bronchodilating agent (drug therapy) EMTREE DRUG INDEX TERMS budesonide (drug therapy) ipratropium bromide (drug therapy) prednisolone (drug therapy) salbutamol (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport public hospital upper respiratory tract obstruction (diagnosis, etiology, therapy) EMTREE MEDICAL INDEX TERMS article bacterial infection (diagnosis) child croup (diagnosis, drug therapy) endotracheal intubation extubation human infant inhalational drug administration intravenous drug administration major clinical study newborn oral drug administration priority journal subglottic stenosis (diagnosis) thorax radiography treatment outcome CAS REGISTRY NUMBERS budesonide (51333-22-3) ipratropium bromide (22254-24-6) prednisolone (50-24-8) salbutamol (18559-94-9) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Otorhinolaryngology (11) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998374591 MEDLINE PMID 9835435 (http://www.ncbi.nlm.nih.gov/pubmed/9835435) PUI L28506551 DOI 10.1007/s004310050965 FULL TEXT LINK http://dx.doi.org/10.1007/s004310050965 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 976 TITLE Predictors of respiratory function deterioration after transfer of critically ill patients AUTHOR NAMES Marx G. Vangerow B. Hecker H. Leuwer M. Jankowski M. Piepenbrock S. Rueckoldt H. AUTHOR ADDRESSES (Marx G., marx.gernot@mh-hannover.de; Vangerow B.; Leuwer M.; Jankowski M.; Piepenbrock S.; Rueckoldt H.) Department of Anaesthesia, Hannover Medical School, D-30625 Hannover, Germany. (Hecker H.) Department of Biometry, Hannover Medical School, D-30625 Hannover, Germany. CORRESPONDENCE ADDRESS G. Marx, Department of Anaesthesia, Hannover Medical School, D-30625 Hannover, Germany. Email: marx.gernot@mh-hannover.de SOURCE Intensive Care Medicine (1998) 24:11 (1157-1162). Date of Publication: 1998 ISSN 0342-4642 BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Objectives: Critically ill patients are often transferred due to the growing number of diagnostic procedures required to be performed outside the intensive care unit. These transfers have proved to be very critical. The aim of this study was to evaluate predictors for the deterioration of respiratory function in critically ill patients after transfer. Design: Prospective, clinical, observational study. Setting: 1800-bed university teaching hospital. Subjects: 98 mechanically ventilated patients were investigated during transfer. Measurement and main results: Before transfer, all patients were classified according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Therapeutic Intervention Scoring System (TISS). Haemodynamics and arterial blood gases were measured at 11 different times. Arterial oxgen tension (PaO(2)), fractional inspired oxygen (FIO(2)), PaO(2)/FIO(2) ratio, lowest PaO(2)/FIO(2) ratio, minimal PaO(2) and maximal FIO(2), APACHE II score, TISS before transfer, age and duration of transfer were analysed as potential predictors for deterioration of respiratory function after transfer. Variables were analysed using Classification and Regression Trees and Clustering by Response. In 54 transports (55%) there was a decrease in the PaO(2)/FIO(2) ratio, and a decrease of more than 20% from baseline was noted in 23 of the transferred patients (24%). Age > 43 years and FIO(2) > 0.5 were identified as predictors for respiratory deterioration. Conclusions: Our predictors were able to indicate deterioration after transfer correctly in 20 of 22 patients (91%), combined with a false-positive rate in 17 of 49 (35%). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation critical illness lung function patient transport EMTREE MEDICAL INDEX TERMS adolescent adult age aged arterial oxygen saturation article blood gas analysis deterioration female hemodynamics human intensive care unit major clinical study male scoring system EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998404016 MEDLINE PMID 9876978 (http://www.ncbi.nlm.nih.gov/pubmed/9876978) PUI L28542930 DOI 10.1007/s001340050739 FULL TEXT LINK http://dx.doi.org/10.1007/s001340050739 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 977 TITLE Provision of intensive care for children. Effective transport systems are essential. AUTHOR NAMES Berry A. AUTHOR ADDRESSES (Berry A.) CORRESPONDENCE ADDRESS A. Berry, SOURCE BMJ (Clinical research ed.) (1998) 317:7168 (1320; author reply 1321). Date of Publication: 7 Nov 1998 ISSN 0959-8138 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS child human note standard United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 9804736 (http://www.ncbi.nlm.nih.gov/pubmed/9804736) PUI L128189590 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 978 TITLE Dilemma in the ICU. AUTHOR NAMES Dean K. AUTHOR ADDRESSES (Dean K.) CORRESPONDENCE ADDRESS K. Dean, SOURCE The Florida nurse (1998) 46:7 (27-28). Date of Publication: Sep 1998 ISSN 0015-4199 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial heart pacemaker intensive care malpractice nursing staff patient transport EMTREE MEDICAL INDEX TERMS article case report clinical competence devices fatality human legal aspect legal liability United States LANGUAGE OF ARTICLE English MEDLINE PMID 10614323 (http://www.ncbi.nlm.nih.gov/pubmed/10614323) PUI L31275127 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 979 TITLE Haiti critical care air transport team mission AUTHOR NAMES Topley D. AUTHOR ADDRESSES (Topley D.) USAF, NC, 8210 Parkland Hills Dr., San Antonio, TX 78250, United States. CORRESPONDENCE ADDRESS D. Topley, USAF, NC, 8210 Parkland Hills Dr., San Antonio, TX 78250, United States. SOURCE Aviation Space and Environmental Medicine (1998) 69:7 (705-706). Date of Publication: 1998 ISSN 0095-6562 BOOK PUBLISHER Aerospace Medical Association, 320 S. Henry Street, Alexandria, United States. ABSTRACT Critical care air transport delivers quality care to critically ill patients. It supports the wartime and peacetime missions of the USAF. Nurses practicing in this environment represent a unique voice of clinical care in the aeromedical evacuation field. This role expands nursing practice beyond the typical critical care environment that is hospital based. Critical care nurses can meet the challenges of working within the aeromedical environment through additional education and training. Critical care air transport provides a specialized service that meets health care demands for these special patients. I am proud to be a vital part of the CCATT at Wilford Hall Medical Center and in the forefront of program development. We are medically ready to serve in contingencies and humanitarian missions. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) dopamine ketamine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS aerospace medicine aircraft article artificial ventilation aviation blood vessel catheterization case report gunshot injury (therapy) Haiti human intravenous drug administration male medical personnel nursing patient monitoring resuscitation traumatology treatment outcome CAS REGISTRY NUMBERS dopamine (51-61-6, 62-31-7) ketamine (1867-66-9, 6740-88-1, 81771-21-3) EMBASE CLASSIFICATIONS Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998234344 MEDLINE PMID 9681382 (http://www.ncbi.nlm.nih.gov/pubmed/9681382) PUI L28322020 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 980 TITLE Spread of vancomycin-resistant enterococci: why did it happen in the United States? AUTHOR NAMES Martone W.J. AUTHOR ADDRESSES (Martone W.J.) National Foundation for Infectious Diseases, Bethesda, MD 20814, USA. CORRESPONDENCE ADDRESS W.J. Martone, National Foundation for Infectious Diseases, Bethesda, MD 20814, USA. Email: wjmartone@aol.com SOURCE Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America (1998) 19:8 (539-545). Date of Publication: Aug 1998 ISSN 0899-823X ABSTRACT The question of why vancomycin-resistant enterococci (VRE) became epidemic in the United States can be answered on at least three basic levels: (1) molecular and genetic, (2) factors affecting host-microbe interactions, and (3) epidemiological. This article will address the epidemiological issues and seek to defend the assertion that, once VRE had evolved, its spread throughout hospitals in the United States was all but assured. Nosocomial VRE outbreaks were reported first in the mid- and late-1980s. Since that time, scientific reports of VRE have increased over 20-fold. Among hospitals participating in the National Nosocomial Infection Surveillance System from 1989 to 1997, the percentage of enterococci reported as resistant to vancomycin increased from 0.4% to 23.2% in intensive-care settings and from 0.3% to 15.4% in non-intensive-care settings. Factors leading to the spread of VRE in US hospitals include (1) antimicrobial pressure, (2) sub-optimal clinical laboratory recognition and reporting, (3) unrecognized "silent" carriage and prolonged fecal carriage, (4) environmental contamination and survival, (5) intrahospital and interhospital transfer of colonized patients, (6) introduction of unrecognized carriers from community settings such as nursing homes, and (7) inadequate compliance with hand washing and barrier precautions. Guidelines developed by the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee address each of these factors. The impact of these guidelines on the spread of VRE within individual institutions has been variable, and the overall impact of the guidelines nationally is unknown. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antiinfective agent (drug therapy) vancomycin (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic resistance bacterial infection (drug therapy, epidemiology) cross infection (drug therapy, epidemiology) Enterococcus EMTREE MEDICAL INDEX TERMS disease carrier disease transmission drug effect growth, development and aging heterozygote hospital human infection control methodology review standard statistics United States (epidemiology) CAS REGISTRY NUMBERS vancomycin (1404-90-6, 1404-93-9) LANGUAGE OF ARTICLE English MEDLINE PMID 9758052 (http://www.ncbi.nlm.nih.gov/pubmed/9758052) PUI L129363515 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 981 TITLE An international Critical Care Air Transport flight: intervening in the Korean airline crash. AUTHOR NAMES Topley D. AUTHOR ADDRESSES (Topley D.) CORRESPONDENCE ADDRESS D. Topley, SOURCE Aviation, space, and environmental medicine (1998) 69:8 (806-807). Date of Publication: Aug 1998 ISSN 0095-6562 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aerospace medicine aircraft accident military nursing EMTREE MEDICAL INDEX TERMS article disaster emergency Guam human intensive care international cooperation Korea patient care preventive health service United States LANGUAGE OF ARTICLE English MEDLINE PMID 9715973 (http://www.ncbi.nlm.nih.gov/pubmed/9715973) PUI L128300153 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 982 TITLE Patients' outcomes: intrahospital transportation and monitoring of critically ill patients by a specially trained ICU nursing staff. AUTHOR NAMES Stearley H.E. AUTHOR ADDRESSES (Stearley H.E.) University of Missouri Hospitals and Clinics, Columbia, USA. CORRESPONDENCE ADDRESS H.E. Stearley, University of Missouri Hospitals and Clinics, Columbia, USA. SOURCE American journal of critical care : an official publication, American Association of Critical-Care Nurses (1998) 7:4 (282-287). Date of Publication: Jul 1998 ISSN 1062-3264 ABSTRACT BACKGROUND: Intrahospital transportation of critically ill patients can contribute to patients' morbidity and mortality. OBJECTIVE: To determine adverse outcomes associated with intrahospital transportation of critically ill patients by a specially trained nursing transport team. METHODS: Monitoring and intervention data were collected for 237 instances of transportation of patients between a hospital's ICUs and radiology suites. These results were compared with the results of national studies on complication rates associated with intrahospital transportation of patients. RESULTS: The patients moved by the specially trained transport team has a 15.5% overall complication rate, with 10.2% minor, 2.5% moderate (compensated for with medications), and 2.8% severe complications that did not respond to intervention. No medications of therapies were delayed, and only 2 patients (0.8%) had decompensation that required the examinations to be aborted. Reported national complication rates for intrahospital transportation of patients are as high as 75%; the complications include adverse events such as delayed administration of medications, significant changes in vital signs, dislodgment of artificial airways and i.v. catheters, and cardiopulmonary arrest. CONCLUSION: Use of a specially trained ICU transport team can substantially reduce the rate of adverse outcomes generated by the transportation of critically ill patients for specialized radiological procedures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care nursing staff outcome assessment patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article child critical illness female human infant intensive care unit male middle aged nursing preschool child LANGUAGE OF ARTICLE English MEDLINE PMID 9656042 (http://www.ncbi.nlm.nih.gov/pubmed/9656042) PUI L128286197 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 983 TITLE Ventilator-associated pneumonia after transport from intensive care units - A real risk AUTHOR NAMES Kollef M.H. AUTHOR ADDRESSES (Kollef M.H.) Department of Medicine, Pulmonary and Critical Care Division, Washington Univ. School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, United States. CORRESPONDENCE ADDRESS M.H. Kollef, Department of Medicine, Pulmonary and Critical Care Division, Washington Univ. School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, United States. SOURCE Cardiology Review (1998) 15:3 (41-43). Date of Publication: 1998 ISSN 1092-6607 ABSTRACT To assess whether transporting patients out of the intensive care unit setting is a risk factor for the development of ventilator-associated pneumonia, we conducted a prospective cohort study of 521 patients admitted to an intensive care unit who required mechanical ventilation for longer than 12 hours. Among the 273 mechanically ventilated patients transported out of the unit, ventilator-associated pneumonia developed in 24.2% compared with 4.4% of the 248 patients not transported. Multivariate analysis demonstrated that previous transport out of the intensive care unit was independently associated with the development of ventilator-associated pneumonia. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport pneumonia (complication, epidemiology) ventilator EMTREE MEDICAL INDEX TERMS article artificial ventilation aspiration pneumonia (complication, epidemiology) cohort analysis controlled study disease association female hospital infection (complication, epidemiology) human major clinical study male multivariate analysis risk factor EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998172626 PUI L28236941 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 984 TITLE Intrahospital transport of the critically ill adult: a research review and implications. AUTHOR NAMES Caruana M. Culp K. AUTHOR ADDRESSES (Caruana M.; Culp K.) University of Iowa Hospitals and Clinics, Iowa City, USA. CORRESPONDENCE ADDRESS M. Caruana, University of Iowa Hospitals and Clinics, Iowa City, USA. SOURCE Dimensions of critical care nursing : DCCN (1998) 17:3 (146-156). Date of Publication: 1998 May-Jun ISSN 0730-4625 ABSTRACT Transporting the critically ill adult from the relative stability of the critical care environment to a testing site or new area is a nursing responsibility. Yet current research about the risks and benefits of intrahospital transport is at times conflicting. This article provides an analysis of available research on the critical elements involved in intrahospital transport and suggests recommendations for clinical practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS algorithm human methodology organization and management public relations review LANGUAGE OF ARTICLE English MEDLINE PMID 9633345 (http://www.ncbi.nlm.nih.gov/pubmed/9633345) PUI L129362547 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 985 TITLE The Ontario Health Care Evaluation Network and the Critical Care Research Network as vehicles for research transfer AUTHOR NAMES Sibbald W.J. Kossuth J.D. AUTHOR ADDRESSES (Sibbald W.J.; Kossuth J.D.) CORRESPONDENCE ADDRESS W.J. Sibbald, London Health Sciences Centre, University of Western Ontario, London, Ont., Canada. SOURCE Medical Decision Making (1998) 18:1 (9-16). Date of Publication: 1998 ISSN 0272-989X BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Facilitating the successful and consistent use of research results to support health care decisions is a formidable task. Barriers to effectively transferring the results of research into the decision-making process have been created between practitioners and researchers, who traditionally have worked in isolation from each other. The need for them to work cooperatively to break down these barriers is paramount as changes within the health care environment increase. The Ontario Health Care Evaluation Network (OHCEN) and the Critical Care Research Network (CCR-Net) have attempted to address these concerns by bringing together teams of researchers, practitioners, and administrative personnel with the purpose of equipping them with tools to meet oncoming health care challenges. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decision making health care research EMTREE MEDICAL INDEX TERMS conference paper diffusion education evidence based medicine information science Internet meta analysis EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998028259 MEDLINE PMID 9456201 (http://www.ncbi.nlm.nih.gov/pubmed/9456201) PUI L28041633 DOI 10.1177/0272989X9801800103 FULL TEXT LINK http://dx.doi.org/10.1177/0272989X9801800103 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 986 TITLE Streamlined critical care transport on the shore. AUTHOR NAMES Parks K. AUTHOR ADDRESSES (Parks K.) Critical Care Services, Shore Health System, Easton, MD, USA. CORRESPONDENCE ADDRESS K. Parks, Critical Care Services, Shore Health System, Easton, MD, USA. SOURCE Nursing spectrum (D.C./Baltimore metro ed.) (1998) 8:1 (8). Date of Publication: 12 Jan 1998 ISSN 1098-9153 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article human United States LANGUAGE OF ARTICLE English MEDLINE PMID 9469098 (http://www.ncbi.nlm.nih.gov/pubmed/9469098) PUI L128226114 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 987 TITLE Critical care transport team can reduce risks, boost bottom line. AUTHOR ADDRESSES SOURCE ED management : the monthly update on emergency department management (1998) 10:1 (8-11). Date of Publication: Jan 1998 ISSN 1044-9167 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service patient transport EMTREE MEDICAL INDEX TERMS article economics financial management intensive care legal aspect legal liability organization and management patient care rescue personnel risk management standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 10176035 (http://www.ncbi.nlm.nih.gov/pubmed/10176035) PUI L128227120 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 988 TITLE French mobile intensive care units and inhaled nitric oxide treated patients ORIGINAL (NON-ENGLISH) TITLE Utilisation du monoxyde d'azote chez l'adulte dans les unites mobiles hospitalieres lors des transports secondaires medicalises en france AUTHOR NAMES Leclerc J. Vallet B. Goldstein P. AUTHOR ADDRESSES (Leclerc J.; Vallet B.) Dept. d'Anesthesie Reanimation C., CHKU, Hopital Claude Huriez, Place de Verdun, 59037 Lille Cedex. (Leclerc J.; Goldstein P.) SAMU Régional Centre 15, CHRU, 5 avenue Oscar Lambret, 59037 Lille Cedex. CORRESPONDENCE ADDRESS J. Leclerc, DARC, 2, HCHPV, 59037 Lille Cedex, France. SOURCE JEUR (1997) 10:3 (130-134). Date of Publication: 1997 ISSN 0993-9857 ABSTRACT Mobile intensive care units (MICU) could be more and more often required to take care of patients treated with inhaled nitric oxide (NO) during their secondary mission (ambulance transport from an hospital to an other one). During those inter- or extra-hospital transfers from an intensive care unit, it's mandatory to proceed with the dispensing of inhaled NO in order to avoid a sudden weaning. Theoretical and practical knowledge concerning the medical use of NO is essential for the medical team of the mobile intensive care units. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) nitric oxide (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS adult respiratory distress syndrome (drug therapy) drug indication human hypoxemia (drug therapy) inhalational drug administration priority journal pulmonary hypertension (drug therapy) review CAS REGISTRY NUMBERS nitric oxide (10102-43-9) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Drug Literature Index (37) Internal Medicine (6) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 1997341707 PUI L27473905 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 989 TITLE The Munich intensive care transport system. Patient transport and intensive care conditions ORIGINAL (NON-ENGLISH) TITLE Das Münchner Intensiv-Transport-System. Patiententransport und Intensivbedingungen. AUTHOR NAMES Huf R. Weninger E. Schildberg F.W. Peter K. AUTHOR ADDRESSES (Huf R.; Weninger E.; Schildberg F.W.; Peter K.) Chirurgische Klinik und Poliklinik, Universität München, Klinikum Grosshadern. CORRESPONDENCE ADDRESS R. Huf, Chirurgische Klinik und Poliklinik, Universität München, Klinikum Grosshadern. SOURCE Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress (1997) 114 (1398-1400). Date of Publication: 1997 ISSN 0942-2854 ABSTRACT In November 1990 a new program for transporting critically ill patients by a 24-h specialized intensive care transportation system at the Munich Hospital Grosshadern was established. All medical equipment similar to that in the ICU allows invasive and non-invasive monitoring, drug administration, and a sophisticated respiratory therapy, provided by a Siemens Servo 300 ventilator. Even extracorporal lung augmentation (ECLA) and cardiac pump assistance by special mobile devices are possible during the transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport preventive health service EMTREE MEDICAL INDEX TERMS aircraft article cost economics equipment design Germany heart assist device hospital service human monitoring ventilator LANGUAGE OF ARTICLE German MEDLINE PMID 9574441 (http://www.ncbi.nlm.nih.gov/pubmed/9574441) PUI L128250672 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 990 TITLE Audit of neonatal intensive care transport - Closing the loop AUTHOR NAMES Leslie A.J. Stephenson T.J. AUTHOR ADDRESSES (Leslie A.J.) Departments of Neonatal Medicine, City Hospital, Queen's Medical Centre, Nottingham. (Stephenson T.J.) Department of Child Health, University Hospital, Nottingham, United Kingdom. (Leslie A.J.) Neonatal Emergency Transport Service, Department of Neonatal Medicine, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom. CORRESPONDENCE ADDRESS A.J. Leslie, Neonatal Emergency Transport Service, Dept. of Neonatal Med. and Surgery, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom. SOURCE Acta Paediatrica, International Journal of Paediatrics (1997) 86:11 (1253-1256). Date of Publication: 1997 ISSN 0803-5253 BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT To audit the effectiveness of changes in transport arrangements, data on babies ventilated during transfer into a neonatal unit were compared between two periods. During the first period, August 1991-February 1993, an ad hoc transport team operated. Transport practice was changed in 1993 by forming a nine-person nursing transport team, improving training and upgrading monitoring. The second audit period was January 1994-July 1995. The groups were not significantly different for birthweight, gestation or levels of ventilation. Physiological variables were assessed with a 'transport score'. Improved scores for temperature and pH were achieved on completion of transfer in 1994-95 compared to 1991-93. Stabilizing prior to transfer took longer in the 1994-95 period. No serious deteriorations occurred in transit in the 1994-95 period, three in 1991-93. Audit facilitates identification of problems in transport. Staff, education and equipment changes were associated with improved audited outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation blood pH medical personnel patient monitoring priority journal scoring system temperature training EMBASE CLASSIFICATIONS Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997369030 MEDLINE PMID 9401523 (http://www.ncbi.nlm.nih.gov/pubmed/9401523) PUI L27509442 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 991 TITLE Reports by the German Interdisciplinary Group of Intensive Care and Emergency Medicine. New recommendations for medical qualifications in transport of intensive care patients ORIGINAL (NON-ENGLISH) TITLE Mitteilungen aus der DIVI (Deutsche Interdisziplinäre Vereinigung für Intensive- und Notfallmedizin). Neue Empfehlungen zur ärztlichen Qualifikation bei Intensivtransporten. AUTHOR ADDRESSES SOURCE Zentralblatt für Neurochirurgie (1997) 58:2 (95). Date of Publication: 1997 ISSN 0044-4251 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS article curriculum education Germany human medical education LANGUAGE OF ARTICLE German MEDLINE PMID 9334129 (http://www.ncbi.nlm.nih.gov/pubmed/9334129) PUI L127292516 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 992 TITLE Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia AUTHOR NAMES Kollef M.H. Von Harz B. Prentice D. Shapiro S.D. Silver P. John R.S. Trovillion E. AUTHOR ADDRESSES (Kollef M.H.; Von Harz B.; Prentice D.; Shapiro S.D.; Silver P.; John R.S.; Trovillion E.) Pulmonary and Critical Care Division, Washington Univ. School of Medicine, Box 8052, 660 S Euclid Ave., St. Louis, MO 63110, United States. CORRESPONDENCE ADDRESS M.H. Kollef, Pulmonary and Critical Care Division, Washington Univ. School of Medicine, Box 8052, 660 S Euclid Ave., St. Louis, MO 63110, United States. SOURCE Chest (1997) 112:3 (765-773). Date of Publication: 1997 ISSN 0012-3692 BOOK PUBLISHER American College of Chest Physicians, 3300 Dundee Road, Northbrook, United States. ABSTRACT Study objective: To determine whether patient transport out of the ICU is associated with an increased risk of developing ventilator-associated pneumonia. Design: Prospective cohort study. Setting: ICUs of Barnes-Jewish Hospital, a university-affiliated teaching hospital. Patients: Five hundred twenty-one ICU patients requiring mechanical ventilation for >12 h. Intervention: Prospective patient surveillance and data collection. Measurements and results: The primary outcome measure was the development of ventilator-associated pneumonia. A total of 273 (52.4%) mechanically ventilated patients required at least one transport out of the ICU while 248 (47.6%) patients did not undergo transport. Sixty-six (24.2%) of the transported patients developed ventilator-associated pneumonia compared with 11 (4.4%) patients in the group not undergoing transport (relative risk=5.5; 95% confidence interval [CI]=2.9 to 10.1; p<0.001). Multiple logistic regression analysis demonstrated that a preceding episode of transport out of the ICU was independently associated with the development of ventilator- associated pneumonia (adjusted odds ratio=3.8; 95% CI=2.6 to 5.5; p<0.001). Other variables independently associated with the development of ventilator- associated pneumonia included reintubation, presence of a tracheostomy, administration of aerosols, and male gender. Conclusions: We conclude that patient transport out of the ICU is associated with an increased risk for the development of ventilator-associated pneumonia. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation hospital infection (complication, etiology) pneumonia (complication, etiology) EMTREE MEDICAL INDEX TERMS adolescent adult aged article controlled study female human infection risk intensive care unit major clinical study male patient transport priority journal risk assessment risk factor EMBASE CLASSIFICATIONS Internal Medicine (6) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997295034 MEDLINE PMID 9315813 (http://www.ncbi.nlm.nih.gov/pubmed/9315813) PUI L27410716 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 993 TITLE Intrahospital transport of patients with increased intracranial pressure ORIGINAL (NON-ENGLISH) TITLE Innerklinische Transporte von Patienten mit erhohtem intrakraniellem Druck AUTHOR NAMES Engelhardt W. AUTHOR ADDRESSES (Engelhardt W.) Klinik für Anaesthesiologie, Universität Würzburg, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany. CORRESPONDENCE ADDRESS W. Engelhardt, Klinik fur Anaesthesiologie, Universitat Wurzburg, Josef-Schneider-Strasse 2, D-97080 Wurzburg, Germany. SOURCE Anasthesiologie und Intensivmedizin (1997) 38:7-8 (385). Date of Publication: 1997 ISSN 0171-1814 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain injury (diagnosis) intracranial hypertension (diagnosis) intracranial pressure patient transport EMTREE MEDICAL INDEX TERMS conference paper human intensive care EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 1997250483 PUI L27347962 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 994 TITLE Clinical assessment and measurement of oxygen transport in the critical care setting AUTHOR NAMES Breen D. Bihari D. AUTHOR ADDRESSES (Breen D.; Bihari D., d.bihari@unsw.edu.au) Department of Intensive Care, St. George Hospital, Gray Street, Sydney, NSW 2217, Australia. CORRESPONDENCE ADDRESS D. Bihari, Department of Intensive Care, St George Hospital, Gray Street, Sydney, NSW 2217, Australia. Email: d.bihari@unsw.edu.au SOURCE Transfusion Science (1997) 18:3 (437-445). Date of Publication: September 1997 ISSN 0955-3886 BOOK PUBLISHER Elsevier Ltd, Langford Lane, Kidlington, Oxford, United Kingdom. ABSTRACT Adequate delivery of oxygen to the tissues is an important factor both in the initial resuscitation of the shocked patient and subsequently in the development of multiple organ failure. The advent of the pulmonary artery catheter has facilitated the calculation of global measurements of oxygen transport at the bedside. Calculated oxygen delivery in fact represents arterial oxygen dispatch rather than actual oxygen delivery to the respiring tissues. Considerable controversy still surrounds the issue of resuscitation of critically ill patients to predetermined goals for oxygen delivery and consumption. More recently interest has arisen in other measures of oxygen transport, in particular regional techniques such as the gastric tonometer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness oxygen transport EMTREE MEDICAL INDEX TERMS catheter human intensive care measurement multiple organ failure nonhuman oxygen consumption pulmonary artery resuscitation review shock tissue oxygenation tonometry EMBASE CLASSIFICATIONS Physiology (2) Anesthesiology (24) Hematology (25) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997356152 MEDLINE PMID 10175157 (http://www.ncbi.nlm.nih.gov/pubmed/10175157) PUI L27492854 DOI 10.1016/S0955-3886(97)00042-8 FULL TEXT LINK http://dx.doi.org/10.1016/S0955-3886(97)00042-8 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 995 TITLE Monitoring the critically ill during transport AUTHOR NAMES Parke T.J. Rimmer M.E. AUTHOR ADDRESSES (Parke T.J.; Rimmer M.E.) Dept. Anaesthetics Intensive Care, Royal Berkshire Hospital, Reading, United Kingdom. CORRESPONDENCE ADDRESS T.J. Parke, Dept. Anaesthetics Intensive Care, Royal Berkshire Hospital, Reading, United Kingdom. SOURCE Care of the Critically Ill (1997) 13:4 (150-152,154). Date of Publication: 1997 ISSN 0266-0970 ABSTRACT Critically ill patients frequently need to be transported. Dedicated teams can transfer seriously ill patients between hospitals without deterioration in their condition. However, patients on the intensive care unit also require transport to the radiology department, or to the operating theatre, without the benefit of such specialised teams. This article will discuss the danger of transporting critically ill patients. The need for patient monitoring will then be considered. Finally, the different types of monitors available will be examined. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient monitoring patient transport EMTREE MEDICAL INDEX TERMS ambulatory monitoring intensive care unit short survey EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997241409 PUI L27336939 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 996 TITLE Emergency medical care for spectators attending National Football League games. AUTHOR NAMES Roberts D.M. Blackwell T.H. Marx J.A. AUTHOR ADDRESSES (Roberts D.M.; Blackwell T.H.; Marx J.A.) Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232, USA. CORRESPONDENCE ADDRESS D.M. Roberts, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28232, USA. SOURCE Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors (1997) 1:3 (149-155). Date of Publication: 1997 Jul-Sep ISSN 1090-3127 ABSTRACT OBJECTIVE: To analyze medical care facilities and resources available for spectators attending football games in the current National Football League (NFL) stadiums. METHODS: A prospective, structured questionnaire regarding facilities, transportation, medications and equipment, personnel configuration, compensation, and communications was mailed to all 28 NFL organizations. Those falling to respond were interviewed by telephone using the identical questionnaire. Data were compiled using Lotus 1-2-3. RESULTS: Data were collected from all 28 NFL organizations. Because two teams use the same stadium, results were calculated for 27 facilities (n = 27). The number of stadium first aid rooms ranges from 1 to 7, with an average of 2.4 +/- 1.3 rooms per stadium (+/- 1 SD) and these vary in size from 120 to 2,000 square feet, with a mean of 434 +/- 377 square feet. Each room is equipped with an average of 3.3 +/- 2.9 stretchers (or tables), with telephones being present in 91% and sinks in 88% of all rooms. To provide contractual EMS coverage, stadiums use standard EMS system designs, including private (n = 19), fire department-based (n = 7), municipal (city/county) (n = 5), volunteer (n = 4), and hospital (n = 3). Nine stadiums employ more than one type of provider. All stadiums have a minimum of one ambulance dedicated on-site for spectators, with a range of 1 to 7, and a mean of 2.9 +/- 1.4. Golf carts are used for intrafacility patient transportation in 17 stadiums, with a range of 1 to 6, and a mean of 2.5 +/- 1.3. Advanced Cardiac Life Support (ACLS) medications and equipment are present in all NFL stadiums and are provided by the private EMS company (n = 16), stadium (n = 10), fire EMS (n = 7), hospitals (n = 4), municipal EMS (n = 2), and the local NFL organization (n = 1). Several facilities have more than one provider of ACLS medications and equipment. The majority of stadiums dispense acetaminophen (n = 25) and aspirin (n = 24). Some dispense antacids (n = 7) and antihistamines (n = 6). The average stadium staffs 8 EMT-Bs, 7 EMT-Ps, 3 registered nurses, and 2 physicians. Nine stadiums pay a predesignated fee per game to an agency to provide emergency care to spectators. Medical personnel are compensated by an hourly rate (n = 15), a fixed rate per event (n = 9), overtime wages (n = 3), or volunteerism (n = 4). Four NFL organizations pay their medical personnel by more than one type of compensation. Courtesy seats are provided to physicians and nurses in 1 stadium and to just physicians in 8 stadiums, with a range of 2 to 6 and a mean of 3.3 +/- 1.3. All stadiums use two-way radios for the communication and coordination of medical care in the stadium. Additionally, 20 use fixed telephones in the first aid rooms, 3 use cellular telephones, and 2 incorporate a pager system to dispatch personnel within the stadium. CONCLUSION: A wide variety of system designs, facilities, and personnel configurations are used to provide emergency medical care for spectators attending NFL games. This information may be useful for assisting those individuals responsible for organizing stadium medical coverage. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) construction work and architectural phenomena emergency health service first aid football EMTREE MEDICAL INDEX TERMS article history human organization and management prospective study questionnaire standard statistics United States LANGUAGE OF ARTICLE English MEDLINE PMID 9709358 (http://www.ncbi.nlm.nih.gov/pubmed/9709358) PUI L128298924 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 997 TITLE Inhibition of ion transport in septic rat heart: (133)Cs(+) as an NMR active K(+) analog AUTHOR NAMES Schornack P.A. Song S.-K. Hotchkiss R. Ackerman J.J.H. AUTHOR ADDRESSES (Schornack P.A.; Song S.-K.; Ackerman J.J.H.) Department of Chemistry, Washington University, St. Louis 63130. (Song S.-K.; Hotchkiss R.) Department of Anesthesiology, Washington University, School of Medicine, St. Louis, MO 63110, United States. (Song S.-K.; Ackerman J.J.H.) Department of Medicine, Washington University, School of Medicine, St. Louis, MO 63110, United States. (Ackerman J.J.H.) Departments of Radiology, Washington University, School of Medicine, St. Louis, MO 63110, United States. CORRESPONDENCE ADDRESS J.J.H. Ackerman, Dept. of Chemistry, Campus Box 1134, Washington University, One Brookings Dr., St. Louis, MO 63130-4899, United States. SOURCE American Journal of Physiology - Cell Physiology (1997) 272:5 41-5 (C1635-C1641). Date of Publication: 1997 ISSN 0363-6143 BOOK PUBLISHER American Physiological Society, 9650 Rockville Pike, Bethesda, United States. ABSTRACT Sepsis, the systemic response to severe infection, and the resulting multiorgan failure it induces are major contributors to intensive care unit morbidity and mortality. A number of abnormalities in ion transport processes and intracellular free Na(+) ([Na(+)](i)) and K(+) ([K(+)](i)) concentrations have been reported to occur during sepsis/endotoxemia. An effect of sepsis on the Na(+)K(+)-ATPase may be an important contribution to changes in intracellular ion balance and the resultant pathophysiology of the disorder. The purpose of this study was to examine the effect of sepsis on the Na(+)- K(+)-ATPase in the isolated perfused rat heart using (133)Cs(+) nuclear magnetic resonance (NMR). Cs(+) is a K(+) analog, and (133)Cs-NMR offers the opportunity to examine Na(+)-K(+)-ATPase activity in the intact organ via tracer kinetics. Sepsis was induced in halothane-anesthetized male Sprague- Dawley rats using the cecal ligation and perforation (CLP) model. Twenty- four to thirty-six hours after surgery, hearts from CLP or shamoperated rats were perfused with Krebs-Henseleit buffer containing 1.25 mM Cs(+). The influx rate constant for Cs(+) was decreased by 24% in septic rat hearts, i.e., 0.25 ± 0.08 (SD) mini(-1) for controls and 0.19 ± 0.04 (SD) min(-1) for septic animals (P = 0.003). There was no difference for Cs(+) efflux [0.005 ± 0.001 (SD) min(-1) for controls and 0.005 ± 0.002 (SD) min(-1) for septic animals; P = 0.8]. These results are consistent with an inhibition of the Na(+)-K(+)- ATPase pump during sepsis/endotoxemia. A decrease in the activity of the Na(+)-K(+)-ATPase pump may be responsible for or contribute to the changes in [Na(+)](i) and [K(+)](i) during the disorder. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cesium potassium ion EMTREE DRUG INDEX TERMS adenosine triphosphatase (potassium sodium) sodium ion EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) ion transport sepsis EMTREE MEDICAL INDEX TERMS animal experiment animal model article cell membrane transport controlled study enzyme activity heart muscle perfusion intensive care unit male multiple organ failure nonhuman nuclear magnetic resonance priority journal rat CAS REGISTRY NUMBERS cesium (7440-46-2) potassium ion (24203-36-9) sodium ion (17341-25-2) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997177944 MEDLINE PMID 9176155 (http://www.ncbi.nlm.nih.gov/pubmed/9176155) PUI L27250401 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 998 TITLE Interhospital and intrahospital transfer of the critically ill patient. AUTHOR NAMES Tan T.K. AUTHOR ADDRESSES (Tan T.K.) Department of Anaesthesia Glasgow Royal Infirmary, United Kingdom. CORRESPONDENCE ADDRESS T.K. Tan, Department of Anaesthesia Glasgow Royal Infirmary, United Kingdom. SOURCE Singapore medical journal (1997) 38:6 (244-248). Date of Publication: Jun 1997 ISSN 0037-5675 ABSTRACT AIM: This paper highlights hazards involved in moving critically ill patients between locations, discusses minimalisation of risks involved and the advantages of specialist teams. METHOD: This is a systematic review. RESULTS AND CONCLUSIONS: Critically ill patients are moved within the hospital because of the need for surgical procedures or to have fixed facilities investigations performed. Interhospital movement of patients is necessary for specialised care available elsewhere. This has increased with centralisation of specialist services. This paper adopts a practical approach to the transfer process. It establishes the goals of conducting a safe transfer, highlights the deleterious effects of moving an ill patient, the risks and pitfalls of a transfer, and how to minimise them. Attention is drawn to the need for proper resuscitation and stabilisation of a patient before transport. The quality and outcome of the transfer depend on the experience of the transferring team and on adequate monitoring facilities. The benefits of a specialist transfer team is suggested. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient care patient transport EMTREE MEDICAL INDEX TERMS human monitoring practice guideline resuscitation review risk factor standard LANGUAGE OF ARTICLE English MEDLINE PMID 9294336 (http://www.ncbi.nlm.nih.gov/pubmed/9294336) PUI L127300410 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 999 TITLE Transfer of adults between intensive care units in the United Kingdom: Postal survey AUTHOR NAMES Mackenzie P.A. Smith E.A. Wallace P.G.M. AUTHOR ADDRESSES (Mackenzie P.A.; Wallace P.G.M.) Directorate of Anaesthesia, Western Infirmary, Glasgow G11 6NT, United Kingdom. (Smith E.A.) Glasgow Roy. Infirm. Univ. NHS Trust, Glasgow G4 0SF, United Kingdom. CORRESPONDENCE ADDRESS P.A. Mackenzie, Directorate of Anaesthesia, Western Infirmary, Glasgow G11 6NT, United Kingdom. SOURCE British Medical Journal (1997) 314:7092 (1455-1456). Date of Publication: 1997 ISSN 0959-8146 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article human patient satisfaction priority journal United Kingdom EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1997147391 MEDLINE PMID 9167562 (http://www.ncbi.nlm.nih.gov/pubmed/9167562) PUI L27207936 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1000 TITLE Bed shortages. Regional intensive care unit transfer teams are needed. AUTHOR NAMES Wallace P.G. Lawler P.G. AUTHOR ADDRESSES (Wallace P.G.; Lawler P.G.) CORRESPONDENCE ADDRESS P.G. Wallace, SOURCE BMJ (Clinical research ed.) (1997) 314:7077 (369). Date of Publication: 1 Feb 1997 ISSN 0959-8138 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital bed utilization intensive care EMTREE MEDICAL INDEX TERMS human letter patient transport LANGUAGE OF ARTICLE English MEDLINE PMID 9040339 (http://www.ncbi.nlm.nih.gov/pubmed/9040339) PUI L127229734 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1001 TITLE Critically ill children: the case for short-term care in general intensive care units. AUTHOR NAMES Bennett J. AUTHOR ADDRESSES (Bennett J.) Clinical Nurse Specialist IUC, Kettering General NHS Trust, Northamptonshire, UK. CORRESPONDENCE ADDRESS J. Bennett, Clinical Nurse Specialist IUC, Kettering General NHS Trust, Northamptonshire, UK. SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (1997) 13:1 (53-57). Date of Publication: Feb 1997 ISSN 0964-3397 ABSTRACT This paper contests the claim that all children should be nursed in paediatric intensive care units (PICUs). Although there is an undoubted need for prolonged care to be undertaken within PICUs, they are a scarce resource and many children's critical illness is of short duration. Following a discussion on the negative aspects of transferring a critically ill child this paper then establishes how a general intensive care unit (GICU) can maintain-awareness and standards which make it a safe environment for children with a short-term critical illness, as well as contribute towards future management and practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child hospitalization intensive care length of stay patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS child education health care organization human organization and management psychological aspect review LANGUAGE OF ARTICLE English MEDLINE PMID 9095883 (http://www.ncbi.nlm.nih.gov/pubmed/9095883) PUI L127248521 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1002 TITLE Collaboration between a referring hospital and a tertiary care center in improving the transfer process for cardiac patients. AUTHOR NAMES Sivaram C.A. Jarolim D. Nasser A. AUTHOR ADDRESSES (Sivaram C.A.; Jarolim D.; Nasser A.) Section of Cardiology, Department of Veterans Affairs Medical Center, Oklahoma City 73104-5018, USA. CORRESPONDENCE ADDRESS C.A. Sivaram, Section of Cardiology, Department of Veterans Affairs Medical Center, Oklahoma City 73104-5018, USA. SOURCE The Joint Commission journal on quality improvement (1996) 22:12 (795-800). Date of Publication: Dec 1996 ISSN 1070-3241 ABSTRACT BACKGROUND: Transfer of cardiac patients between hospitals is a complex process with many implications for quality of care. In the case of heart disease, specialized procedures such as coronary angioplasty, coronary bypass surgery, and valve replacement or repair require the performance of cardiac catheterization and coronary arteriography in a catheterization laboratory, as well as the availability of cardiac surgical services. The Department of Veterans Affairs Medical Center (DVAMC) at Muskogee, Oklahoma, transfers most cardiac patients requiring specialized diagnostic procedures and advanced cardiac care to DVAMC at Oklahoma City, Oklahoma. Concerns about the inefficiency of the transfer process led to the launch of a quality improvement project in late 1992. CHANGES IN THE TRANSFER PROCESS: Greater emphasis was placed on medical aspects compared to administrative aspects of transfer, and ready access to the physicians at DVAMC at Oklahoma City was provided. RESULTS: The time from request for transfer to the actual transfer decreased. Before the quality improvement project, only 33% of transfers of cardiac patients were completed within 24 hours-versus 78% in 1993 and 1994, 89% in 1995, and 84% in the first half of 1996. In addition, DVAMC-Muskogee physician satisfaction regarding services at DVAMC-Oklahoma City improved. CONCLUSION: Ongoing discussion between the cardiology team at the accepting hospital and physicians at the referring hospital expanded the continuum of care to both hospitals. Priority of transfers could be upgraded at any time without unduly jeopardizing patient safety or increasing resource utilization at the receiving center. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit health care quality heart disease (therapy) patient transport public relations EMTREE MEDICAL INDEX TERMS article human organization organization and management public hospital standard time management United States university hospital LANGUAGE OF ARTICLE English MEDLINE PMID 8986561 (http://www.ncbi.nlm.nih.gov/pubmed/8986561) PUI L127203264 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1003 TITLE Analysis of 200 critically ill children transported to and from a Pediatric Intensive Care Unit ORIGINAL (NON-ENGLISH) TITLE Valoracion de 200 traslados de ninos criticos en una Unidad de Cuidados Intensivos Pediatricos AUTHOR NAMES Rubio Quiñones F. Hernández González A. Quintero Otero S. Pérez Ruiz J. Ruiz Ruiz C. Seidel A. Fernández O'Dogherty S. Pantoja Rosso S. AUTHOR ADDRESSES (Rubio Quiñones F.; Hernández González A.; Quintero Otero S.; Pérez Ruiz J.; Ruiz Ruiz C.; Seidel A.; Fernández O'Dogherty S.; Pantoja Rosso S.) U. Cuidados Intensivos Pediatricos, Servicio de Pediat. Hosp., Universitario Puerta del Mar, Cádiz, Spain. (Rubio Quiñones F.) U.C.I., Pediatría Hospital, Universitario Puerta del Mar, Avda Ana de Viya. 21, 11009 Cádiz, Spain. CORRESPONDENCE ADDRESS F. Rubio Quinones, U.C.I. de Pediatria, Hospital Univ. Puerta del Mar, Servicio de Pediatria, Avda. Ana de Viya, 21, 11009 Cadiz, Spain. SOURCE Anales Espanoles de Pediatria (1996) 45:3 (249-252). Date of Publication: 1996 ISSN 0302-4342 BOOK PUBLISHER Ediciones Doyma, S.L., Travesera de Gracia 17-21, Barcelona, Spain. ABSTRACT Background: Pediatric intensive care units have developed as treatment areas with a concentration of specialized equipment and personnel. Critically ill children often need to be moved to and from these critical care areas for diagnostic or therapeutic procedures. Such transport may pose additional risk to the critically ill patient. Patients and methods: In order to assess the problems encountered in our transport process, a prospective study was performed. A questionnaire was undertaken to evaluate the transport of critically ill children hospitalized in the Pediatric Intensive Care Unit of the Hospital Universitario Prerta del Mar from Cadiz over an eleven month period. Results: Two hundred children transported were evaluated. Forty-seven (23.5%) were interhospital transported patients and one hundred fifty-three (76.5%) were intrahospital transported patients. The most common type of intrahospital transport involves transfers between the operating room and the intensive care unit (73 patients, 36.5%). Deterioration in respiratory, cardiovascular and other physiological systems was registered in twenty-two patients (11%). One hundred four equipment-related mishaps were noted in eighty-six patients (43%) during the transport process. Dislodgement of intravenous catheters, loss of oxygen supply, endotracheal tube problems and equipment malfunction were the most common mishaps noted. Conclusions: Our results would suggest that more training regarding the transport of the critically ill child are needed in our area. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness intensive care patient transport EMTREE MEDICAL INDEX TERMS article child human major clinical study questionnaire Spain EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 1996323270 MEDLINE PMID 9019963 (http://www.ncbi.nlm.nih.gov/pubmed/9019963) PUI L26353930 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1004 TITLE Transportation on long distance of baby ventilated by Babylog 2 with Babymix. Study of system to reduce fluid's consummation ORIGINAL (NON-ENGLISH) TITLE Transport sur de longues distances de nourrissons ventiles Babylog 2® avec Babymix®. Etude d'un systeme pour economiser les fluides AUTHOR NAMES Rosenthal J.M. Perie J.L. Cadet E. Hertogh C. Lavaud J. AUTHOR ADDRESSES (Rosenthal J.M.) Maternité, Guadeloupe, France. (Perie J.L.) Service des Urgences-Samu 97-1, Guadeloupe, France. (Cadet E.) Serv. de Reanimation Neonatale, CHU Pap Abymes, Guadeloupe, France. (Hertogh C.) UFR STAPS, Antilles, Guyane, France. (Lavaud J.) Smur Pédiatrique, Hopital Necker-Enfants-Malades, 149, rue de Sèvres, 75005 Paris, France. CORRESPONDENCE ADDRESS J.M. Rosenthal, Maternite, CHU, Pap Abymes, Guadeloupe. SOURCE Urgences Medicales (1996) 15:4 (163-168). Date of Publication: 1996 ISSN 0923-2524 ABSTRACT Each year, around 20 children are carried under mechanical ventilation from Guadeloupe to Europe. Flight time is around 8 hours for 7200 km distance on a regular carrier line. These children are transferred for complementary investigation, impossible to do Guadeloupe or for long durable hospitalization. Care continuities have to be assured during transportation, especially for oxygenotherapy. In wanting to increase Babylog 2 respiratory autonomy equipped with Babymix on long distances, we had studied a new possibility of utilisation of the respirator. We reduced medical air consummation for babies ventilated with FiO(2) inferior to 0.60. In this method, the FiO(2) marked on Babymix is not the FiO(2) wanted. We used a simple formula to adapt the FiO(2) (FiO(2) marked = 2 (FiO(2) wanted - 0,105). We gave to the children their real needs. These are the case results of five children under artificial ventilation from Pointe-a-Pitre to Paris. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation intensive care unit oxygen therapy patient transport EMTREE MEDICAL INDEX TERMS article clinical article emergency medicine France human infant newborn EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English, French EMBASE ACCESSION NUMBER 1996328646 PUI L26359757 DOI 10.1016/0923-2524(96)82413-1 FULL TEXT LINK http://dx.doi.org/10.1016/0923-2524(96)82413-1 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1005 TITLE Air force helicopters for transport of intensive care patients AUTHOR NAMES Mittermair H.G. AUTHOR ADDRESSES (Mittermair H.G.) Austrian Air Force, 4063 Horsching, Austria. CORRESPONDENCE ADDRESS H.G. Mittermair, Austrian Air Force, 4063 Horsching, Austria. SOURCE Acta Anaesthesiologica Scandinavica, Supplement (1996) 40:109 (113-114). Date of Publication: 1996 ISSN 0515-2720 BOOK PUBLISHER Blackwell Munksgaard, 1 Rosenorns Alle, P.O. Box 227, Copenhagen V, Denmark. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) helicopter intensive care unit traffic and transport EMTREE MEDICAL INDEX TERMS air force conference paper intensive care priority journal EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1996296984 MEDLINE PMID 8901972 (http://www.ncbi.nlm.nih.gov/pubmed/8901972) PUI L26323118 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1006 TITLE Oxygen transport and oxygen metabolism in shock and critical illness: Invasive and noninvasive monitoring of circulatory dysfunction and shock AUTHOR NAMES Shoemaker W.C. AUTHOR ADDRESSES (Shoemaker W.C.) Department of Surgery, LAC-USC Medical Center, 1200 North State Street, Los Angeles, CA 90033, United States. CORRESPONDENCE ADDRESS W.C. Shoemaker, Department of Surgery, LAC-USC Medical Center, 1200 North State Street, Los Angeles, CA 90033, United States. SOURCE Critical Care Clinics (1996) 12:4 (939-969). Date of Publication: 1996 ISSN 0749-0704 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The common underlying physiologic problem in shock is low flow from hypovolemia or maldistributed microcirculatory flow from uneven vasoconstriction, leading to inadequate tissue perfusion (hypoxia), often in the face of increased metabolic demands. Noninvasive monitoring, which was found to provide similar information to that of invasive monitoring, was used in the earliest period of time shortly after admission to the emergency department to provide objective physiologic criteria as therapeutic goals for each of the three major circulatory components: cardiac, pulmonary, and tissue perfusion functions. A clinical algorithm or branch-chain decision tree for high-risk surgical patients was developed from decision rules based on survivor and nonsurvivor patterns, outcome predictors, prospective controlled clinical trials of the oxygen delivery/oxygen consumption (DO(2)/VO(2)) concept, and the DO(2)/VO(2) responses of a wide variety of therapeutic agents. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alpha adrenergic receptor blocking agent (drug therapy, pharmacology) inotropic agent (drug dose, drug therapy, pharmacology) phosphodiesterase inhibitor (drug dose, drug therapy, pharmacology) vasodilator agent (drug therapy, pharmacology) EMTREE DRUG INDEX TERMS amrinone (drug dose, drug therapy, pharmacology) dobutamine (drug dose, drug therapy, pharmacology) dopamine (drug therapy, pharmacology) epinephrine (drug therapy, pharmacology) glyceryl trinitrate (drug therapy, pharmacology) hydralazine (drug therapy, pharmacology) labetalol (drug therapy, pharmacology) milrinone (drug dose, drug therapy, pharmacology) nitroprusside sodium (drug therapy, pharmacology) noradrenalin (drug therapy, pharmacology) prostaglandin E1 (drug therapy, pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) oxygen transport shock (complication, diagnosis, drug therapy, therapy) EMTREE MEDICAL INDEX TERMS algorithm clinical trial controlled clinical trial controlled study critical illness fluid therapy heart output hemodynamic monitoring high risk patient human hypotension intensive care unit major clinical study medical decision making multiple organ failure oxygen consumption patient monitoring postoperative complication priority journal randomized controlled trial resuscitation review septic shock (complication, diagnosis, drug therapy, therapy) surgical patient thermodilution tissue perfusion CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) amrinone (60719-84-8) dobutamine (34368-04-2, 52663-81-7) dopamine (51-61-6, 62-31-7) glyceryl trinitrate (55-63-0) hydralazine (304-20-1, 86-54-4) labetalol (32780-64-6, 36894-69-6) milrinone (78415-72-2) nitroprusside sodium (14402-89-2, 15078-28-1) noradrenalin (1407-84-7, 51-41-2) prostaglandin E1 (745-65-3) EMBASE CLASSIFICATIONS Surgery (9) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996323026 MEDLINE PMID 8902378 (http://www.ncbi.nlm.nih.gov/pubmed/8902378) PUI L26353424 DOI 10.1016/S0749-0704(05)70286-4 FULL TEXT LINK http://dx.doi.org/10.1016/S0749-0704(05)70286-4 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 1007 TITLE Risk factors associated with vancomycin-resistant Enterococcus faecium infection or colonization in 145 matched case patients and control patients AUTHOR NAMES Riley L.W. AUTHOR ADDRESSES (Riley L.W.) Division of International Medicine, Cornell University Medical College, 1300 York Avenue, New York, NY 10021, United States. CORRESPONDENCE ADDRESS L.W. Riley, Division of International Medicine, Cornell University Medical College, 1300 York Avenue, New York, NY 10021, United States. SOURCE Clinical Infectious Diseases (1996) 23:4 (767-772). Date of Publication: 1996 ISSN 1058-4838 BOOK PUBLISHER University of Chicago Press, 1427 E. 60th Street, Chicago, United States. ABSTRACT Risk factors and mortality associated with vancomycin-resistant Enterococcus faecium (VREF) infection or colonization were examined at a tertiary care hospital by comparing 145 patients who had VREF isolates (cases) to 145 patients with vancomycin-susceptible Enterococcus faecium (VSEF) isolates (controls). The number of deaths per 100 person-days of hospitalization after diagnosis did not differ significantly between VREF patients (1.2) and VSEF patients (0.8). Multivariate analyses found that the duration of hospitalization (≤7 days), intrahospital transfer between floors, use of antimicrobials (i.e., vancomycin and third-generation cephalosporins), and duration of vancomycin use (≤7 days) was independently associated with VREF infection or colonization. This study, which has a large sample size, confirms some earlier observations regarding risks for VREF infection or colonization and identifies factors that may be potentially exploited to develop interventional strategies for the control of this emerging nosocomial problem. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cephalosporin derivative vancomycin EMTREE DRUG INDEX TERMS cefotaxime ceftazidime ceftriaxone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Enterococcus faecalis hospital infection Streptococcus infection EMTREE MEDICAL INDEX TERMS adolescent adult aged antibiotic resistance article bacterial colonization bacterium isolation child controlled study female hospitalization human infant major clinical study male mortality priority journal risk factor CAS REGISTRY NUMBERS cefotaxime (63527-52-6, 64485-93-4) ceftazidime (72558-82-8) ceftriaxone (73384-59-5, 74578-69-1) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996303794 MEDLINE PMID 8909842 (http://www.ncbi.nlm.nih.gov/pubmed/8909842) PUI L26331122 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1008 TITLE Erratum: The 1995 update of recommendations for a standard technique for measuring the single-breath carbon monoxide diffusing capacity (transfer factor) (American Journal of Respiratory Critical Care Medicine (1996) 154 (265-266)) AUTHOR NAMES Rosenberg E. AUTHOR ADDRESSES (Rosenberg E.) Department of Physiology/Biophysics, College of Medicine, Howard University, Washington, DC, United States. CORRESPONDENCE ADDRESS E. Rosenberg, Department of Physiology/Biophysics, College of Medicine, Howard University, Washington, DC, United States. SOURCE American Journal of Respiratory and Critical Care Medicine (1996) 154:3 I (827-828). Date of Publication: 1996 ISSN 1073-449X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum priority journal EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1996300253 PUI L26327313 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1009 TITLE Haematological patients transferred to the intensive care unit: what ICU nurses need to know. AUTHOR NAMES Hollis H. AUTHOR ADDRESSES (Hollis H.) CORRESPONDENCE ADDRESS H. Hollis, SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (1996) 12:5 (272-276). Date of Publication: Oct 1996 ISSN 0964-3397 ABSTRACT This article will consider the nursing care and treatment required by haematology patients when transferred to an intensive care unit (ICU). Background information on types of haematological malignancies, treatment for and survival from these diseases will be presented. This will be followed by considering some of the complications that may lead to admission to ICU including tumour lysis syndrome, infections, disseminated intravascular coagulation and haemorrhage and the side-effects of treatment itself. Specialist needs of these patients when in an ICU will be addressed and the patients' experience of the disease will be discussed to enable ICU nurses to offer the best standard of care possible for such patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hematologic disease (complication) intensive care patient transport EMTREE MEDICAL INDEX TERMS classification health service human nursing review self help LANGUAGE OF ARTICLE English MEDLINE PMID 8938080 (http://www.ncbi.nlm.nih.gov/pubmed/8938080) PUI L126306825 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1010 TITLE Re: Intrahospital transportation. AUTHOR NAMES Elliott M. AUTHOR ADDRESSES (Elliott M.) CORRESPONDENCE ADDRESS M. Elliott, SOURCE Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (1996) 12:5 (311). Date of Publication: Oct 1996 ISSN 0964-3397 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care oxygen therapy patient transport EMTREE MEDICAL INDEX TERMS clinical protocol human letter methodology LANGUAGE OF ARTICLE English MEDLINE PMID 8938087 (http://www.ncbi.nlm.nih.gov/pubmed/8938087) PUI L126306832 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1011 TITLE Allocation of scarce resources: ethical challenges, clinical realities. AUTHOR NAMES Terry P. Rushton C.H. AUTHOR ADDRESSES (Terry P.; Rushton C.H.) Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Johns Hopkins University, Baltimore, Md. USA. CORRESPONDENCE ADDRESS P. Terry, Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma and Allergy Center, Johns Hopkins University, Baltimore, Md. USA. SOURCE American journal of critical care : an official publication, American Association of Critical-Care Nurses (1996) 5:5 (326-330). Date of Publication: Sep 1996 ISSN 1062-3264 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care organization intensive care unit medical ethics patient transport EMTREE MEDICAL INDEX TERMS article artificial ventilation case report chronic obstructive lung disease (complication) human male nurse patient relationship nursing organization and management patient advocacy policy respiratory failure (etiology, therapy) LANGUAGE OF ARTICLE English MEDLINE PMID 8870855 (http://www.ncbi.nlm.nih.gov/pubmed/8870855) PUI L127188880 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1012 TITLE Alterations of end-tidal carbon dioxide during the intrahospital transport of children AUTHOR NAMES Tobias J.D. Lynch A. Garrett J. AUTHOR ADDRESSES (Tobias J.D.) Depts. of Child Hlth. and Anesth., University of Missouri, Columbia, MO, United States. (Lynch A.) Division of Pediatric Critical Care, Vanderbilt University, Nashville, TN, United States. (Garrett J.) Division of Pediatric Critical Care, Sunrise Children's Hospital, Las Vegas, NV, United States. (Tobias J.D.) University of Missouri, Department of Child Health, M658 Health Sciences Center, One Hospital Drive, Columbia, MO 65212, United States. CORRESPONDENCE ADDRESS J.D. Tobias, Department of Child Health, M658 Health Sciences Center, University of Missouri, One Hospital Drive, Columbia, MO 65212, United States. SOURCE Pediatric Emergency Care (1996) 12:4 (249-251). Date of Publication: August 1996 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: To determine the effect of manual ventilation during intrahospital transport on end-tidal carbon dioxide concentrations in children. Design: Prospective study in children who required tracheal intubation and mechanical ventilation/hyperventilation to maintain an arterial partial pressure of CO(2) (PaCO(2)) of 25 to 30 torr for control of intracranial pressure. Setting: Pediatric intensive care unit. Intervention: During patient transport with manual ventilation, end-tidal CO(2) was monitored with a side-streaming aspirating, infrared device. The person responsible for manual ventilation was informed of the current ventilator settings and the need to maintain a PaCO(2) of 25 to 30 torr, but was not allowed to see the end-tidal CO(2) monitor. Results: The study population included 12 patients ranging in age from seven months to 14 years (average age 6.9 years) and in weight from 6.5 to 57 kg (average weight 28.9 kg). A total of 1716 end-tidal CO(2) values were recorded during 286 minutes of monitoring. Five hundred and thirty-one (31%) of the readings were in the intended range of 25 to 30 torr. Four hundred (23%) were less than 20 torr, 665 (39%) were in the 20 to 24 torr range, and 119 (6.3%) were greater than 30 torr. Only five were greater than 40 torr. Conclusions: Unintentional hyperventilation occurs during the intrahospital transport of children. End- tidal CO(2) values less than 25 torr were noted 62% of the time. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) end tidal carbon dioxide tension hyperventilation (complication) EMTREE MEDICAL INDEX TERMS adolescent article artificial ventilation child clinical article endotracheal intubation human infant intracranial pressure patient transport EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996306631 MEDLINE PMID 8858645 (http://www.ncbi.nlm.nih.gov/pubmed/8858645) PUI L26334105 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1013 TITLE An outbreak of multiply-resistant Klebsiella pneumoniae in the Grampian region of Scotland AUTHOR NAMES Hobson R.P. MacKenzie F.M. Gould I.M. AUTHOR ADDRESSES (Hobson R.P.; MacKenzie F.M.; Gould I.M.) Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, United Kingdom. CORRESPONDENCE ADDRESS I.M. Gould, Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, United Kingdom. SOURCE Journal of Hospital Infection (1996) 33:4 (249-262). Date of Publication: August 1996 ISSN 0195-6701 BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT A predominantly hospital-based outbreak of multiply-resistant Klebsiella pneumoniae capsular type K(2) (MRK) expressing expanded spectrum β-lactamase (ESBL) activity and fully sensitive only to the carbapenems and amikacin is described. The organism was isolated from 283 patients between March 1992 and September 1995. The outbreak started in the intensive care unit (ICU) of a major acute hospital and spread through surgical wards, a medical ward, a geriatric unit in a separate hospital and various other local hospitals. Environmental screening revealed extensive ward contamination. The decline of the outbreak after the spring of 1995 coincided with the re-emphasis of standard infection control procedures and the launch of a works programme aimed at addressing underlying sites of environmental contamination. Of the 283 cases, 166 (59.0%) were detected through a specially instigated case finding programme. The MRK caused 11 cases of septicaemia, two postoperative intra-abdominal abscesses, one case of postoperative meningitis, 102 cases of urinary tract infection and 28 wound infections and was isolated from the respiratory tracts of five patients with ventilator associated pneumonia. The difficulty in controlling the outbreak is ascribed to heavy environmental contamination, frequent inter- and intra-hospital patient transfers and prolonged carriage of the outbreak strain. EMTREE DRUG INDEX TERMS amikacin (drug therapy) antibiotic agent (drug therapy) beta lactamase (endogenous compound) carbapenem derivative (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital infection (drug resistance, drug therapy, etiology) EMTREE MEDICAL INDEX TERMS abdominal abscess (complication, epidemiology, etiology) antibiotic resistance article assisted ventilation bacterium contamination case finding enzyme activity geriatric hospital human infection control intensive care Klebsiella pneumoniae major clinical study meningitis (complication, epidemiology, etiology) patient transport pneumonia (complication, epidemiology, etiology) postoperative complication respiratory system screening septicemia (epidemiology, etiology) surgical ward United Kingdom urinary tract infection (epidemiology, etiology) wound infection (epidemiology, etiology) CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) beta lactamase (9073-60-3) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996263717 MEDLINE PMID 8864938 (http://www.ncbi.nlm.nih.gov/pubmed/8864938) PUI L26285364 DOI 10.1016/S0195-6701(96)90011-0 FULL TEXT LINK http://dx.doi.org/10.1016/S0195-6701(96)90011-0 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1014 TITLE Is today's workplace conception still up-to-date? New management concepts for anesthesia and intensive care medicine ORIGINAL (NON-ENGLISH) TITLE IST UNSER ARBEITSPLATZ-KONZEPT HEUTE NOCH ZEITGERECHT? NEUE ABLAUFKONZEPTE IN DER ANASTHESIOLOGIE UND INTENSIVMEDIZIN AUTHOR NAMES Holst D. Guth G. Wendt M. AUTHOR ADDRESSES (Holst D.; Guth G.; Wendt M.) Klin. F. Anasthesiologie I., Klinikum Karlsburg, Ernst-Moritz-Arndt-Univ. Greifswald, . (Holst D.) Klin. F. Anasthesiologie I., Klinikum Karlsburg, Greifswalder Straße 11, D-17495 Karlsburg, Germany. CORRESPONDENCE ADDRESS D. Holst, Klin. fur Anaesthesiol./Intensivmed., Klinikum Karlsburg, Ernst-Moritz-Arndt-Universitat, Greifswalder Strasse 11, D-17495 Karlsburg, Germany. SOURCE Anasthesiologie und Intensivmedizin (1996) 37:6 (322-327). Date of Publication: 1996 ISSN 0170-5334 ABSTRACT The continuous care of patients from emergency, diagnostic and operative units up to the ICU is being provided by the department of anesthesiology. Still our present work concept is in contradiction to the necessary continuous care for critically ill patients. Transports between stationary working places in theatre, the ICU or diagnostic centres unevitably go along with interruption of monitoring and therapy: and leads towards a considerable endangering of critically ill patients and a significant rise of mortality. With a new monitoring- and therapy-place concept a steady monitoring and fluid management is ensured. On a small bedside car the complete side system of an intensive ward/operative bedplace as monitoring, fluid management, suction also for thorax drains as well as a manual emergency artificial respiration system with O(2)-supply will be integrated. This car serves already as monitoring for the induction of the narcosis, accompanied the patients to the operating room and postoperatively to the intensive ward without the necessity of a disconnection. The whole monitoring accompanied the patient for a possible reintervention or for diagnostic measure in hospital. In addition to the considerable saving of time by transports (for instance operating room - intensive care unit) and the guarantee of a steady monitoring of the patient, the costs of this car system are in the region of only one-third of today's usual wall-fixed or ceiling-fixed medium supply. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia intensive care patient transport quality control work environment EMTREE MEDICAL INDEX TERMS anesthesiological procedure hospital cost human patient monitoring short survey workplace EMBASE CLASSIFICATIONS Anesthesiology (24) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 1996196000 PUI L26200273 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1015 TITLE A study of newborn infants with severe heart defects. Longer transportation did not increase the risks ORIGINAL (NON-ENGLISH) TITLE Studie av nyfödda med allvarliga hjärtfel. Längre transporter ökade inte riskerna. AUTHOR NAMES Hellström-Westas L. Hanséus K. Klette H. Lundström N.R. Svenningsen N. AUTHOR ADDRESSES (Hellström-Westas L.; Hanséus K.; Klette H.; Lundström N.R.; Svenningsen N.) Barn-och ungdomsmedicinska kliniken, Lasarettet. CORRESPONDENCE ADDRESS L. Hellström-Westas, Barn-och ungdomsmedicinska kliniken, Lasarettet. SOURCE Läkartidningen (1996) 93:18 (1734, 1739-1740). Date of Publication: 1 May 1996 ISSN 0023-7205 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart malformation (complication, surgery) patient transport EMTREE MEDICAL INDEX TERMS air medical transport article comparative study coronary care unit female hospital management human male newborn newborn intensive care organization and management risk factor statistics Sweden LANGUAGE OF ARTICLE Swedish MEDLINE PMID 8667791 (http://www.ncbi.nlm.nih.gov/pubmed/8667791) PUI L126236098 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1016 TITLE Nurses' patient transfer report. Concept for the determination of the nursing transfer status at a surgical intensive care unit ORIGINAL (NON-ENGLISH) TITLE Der pflegerische Verlegungsbericht. Konzept Zur Erhebung des pflegerischen Verlegungsstatus auf einer operativen Intensivstation. AUTHOR NAMES Hofmann-Rösener V.M. Furth P. AUTHOR ADDRESSES (Hofmann-Rösener V.M.; Furth P.) CORRESPONDENCE ADDRESS V.M. Hofmann-Rösener, SOURCE Krankenpflege Journal (1996) 34:4 (125-127). Date of Publication: Apr 1996 ISSN 0174-108X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient care planning patient transport EMTREE MEDICAL INDEX TERMS article health status human public relations LANGUAGE OF ARTICLE German MEDLINE PMID 8716052 (http://www.ncbi.nlm.nih.gov/pubmed/8716052) PUI L126268410 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1017 TITLE Influence of referring physicians on interventions by a pediatric and neonatal critical care transport team AUTHOR NAMES Kronick J.B. Frewen T.C. Kissoon N. Lee R. Sommerauer J.F. Reid W.D. Casier S. Boyle K. AUTHOR ADDRESSES (Kronick J.B.; Frewen T.C.; Kissoon N.; Lee R.; Sommerauer J.F.; Reid W.D.; Casier S.; Boyle K.) Paediatric Critical Care Unit, Child Health Research Institute, University of Western Ontario, London, Ont., Canada. (Kissoon N.) Wolfson Children's Hospital, Howard Bldg., 820 Prudential Drive, Jacksonville, FL 32207, United States. CORRESPONDENCE ADDRESS N. Kissoon, Wolfson Children's Hospital, Howard Bldg, 820 Prudential Drive, Jacksonville, FL 32207, United States. SOURCE Pediatric Emergency Care (1996) 12:2 (73-77). Date of Publication: April 1996 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT The objective of this study was to determine the influence of: a) pediatrician versus nonpediatrician referrals on a transport team's therapeutic interventions and b) referring physician's year of graduation on interventions performed by the transport team. From November 1987 through December 1989 we prospectively compared the therapeutic interventions performed by the critical care transport team on newborns and pediatric patients with the referring physician's specialty and year of graduation. The transport team (critical care physician [PL3 or greater], registered respiratory therapist, critical care nurse), recorded all therapeutic interventions, including both procedural and pharmacologic, for 213 newborn and 149 consecutive pediatric transports. Referring physicians were categorized as pediatricians and nonpediatricians. Data were analyzed by analysis of variance, χ(2), or linear regression. All patients were admitted to either the pediatric or the neonatal intensive care unit, and over 80% of both age groups received assisted ventilation. Newborns referred by nonpediatricians required significantly more procedural interventions (2.64 vs 1.91, P = 0.016) than those referred by pediatricians. The opposite relationship was observed among pediatric patients in that children referred by pediatricians received more frequent intervention (P = 0.008) than those referred by nonpediatricians. There was a significant inverse relationship between the referring physician's year of medical school graduation and the number of therapeutic interventions (total interventions = 6.17 - 0.040 x graduation year, P = 0.01) and procedural interventions (procedural interventions = 3.54 - 0.024 x graduation year, P = 0.01). We found that the referring physicians' medical training affected the number of interventions their patients received. Similarly, patients were likely to receive more interventions if the referral physician's training was not recent. These data have educational implications and support the concepts of continuing medical education, recertification, and maintenance of skills among physicians providing care to critically ill newborns and pediatric patients. EMTREE DRUG INDEX TERMS antibiotic agent anticonvulsive agent atropine bicarbonate inotropic agent morphine pancuronium respiratory tract agent vasodilator agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care pediatrics EMTREE MEDICAL INDEX TERMS article artificial ventilation child clinical audit clinical trial diagnosis related group health care delivery human intubation major clinical study medical education newborn patient referral patient transport pediatrician prospective study resuscitation vascular access CAS REGISTRY NUMBERS atropine (51-55-8, 55-48-1) bicarbonate (144-55-8, 71-52-3) morphine (52-26-6, 57-27-2) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996127483 MEDLINE PMID 8859911 (http://www.ncbi.nlm.nih.gov/pubmed/8859911) PUI L26123822 DOI 10.1097/00006565-199604000-00001 FULL TEXT LINK http://dx.doi.org/10.1097/00006565-199604000-00001 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1018 TITLE Air transport of obstetric critical care patients to tertiary centers AUTHOR NAMES Elliott J.P. Foley M.R. Young L. Balazs K.T. Meiner L. AUTHOR ADDRESSES (Elliott J.P.; Foley M.R.; Young L.; Balazs K.T.; Meiner L.) Phoenix Perinatal Associates, Division of Maternal-Fetal Medicine, Good Samaritan Reg. Medical Center, Phoenix, AZ, United States. (Elliott J.P.) Phoenix Perinatal Associates, 1111 East McDowell Road, Phoenix, AZ 85006, United States. CORRESPONDENCE ADDRESS J.P. Elliott, Phoenix Perinatal Associates, 1111 East McDowell Road, Phoenix, AZ 85006, United States. SOURCE Journal of Reproductive Medicine for the Obstetrician and Gynecologist (1996) 41:3 (171-174). Date of Publication: 1996 ISSN 0024-7758 BOOK PUBLISHER Journal of Reproductive Medicine Inc., 8342 Olive Boulevard, P.O. Box 12425, St. Louis, United States. ABSTRACT OBJECTIVE: To evaluate critical care diagnoses and their frequency in an air transport situation. STUDY DESIGN: A retrospective review was done of all obstetric air transports performed by Samaritan AirEvac to tertiary hospitals in Phoenix, Arizona, from January 1, 1990, to August 31, 1991. RESULTS: In the 20-month study period, 1,541 maternal transports were performed. Critical care diagnoses were found in 360 (23.4%) of the patients. The following categories were used: hypertensive crisis, 188/360 (52%); hemorrhage, 131/360 (36%); trauma, 21/360 (6%); and respiratory compromise, 11/360 (3%). CONCLUSION: Critical care diagnoses represented about 25% of all obstetric air transports in this study. Our transport team is made up of an obstetric flight nurse and another team member (adult trauma nurse, neonatal flight nurse, flight respiratory therapist or flight paramedic). Skill in both obstetric diagnosis and management and in critical care is necessary in these situations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) obstetric procedure EMTREE MEDICAL INDEX TERMS article aviation female human intensive care major clinical study priority journal teaching hospital EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996087120 MEDLINE PMID 8778415 (http://www.ncbi.nlm.nih.gov/pubmed/8778415) PUI L26087663 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1019 TITLE Molecular epidemiology of Klebsiella pneumoniae producing SHV-5 β- lactamase: Parallel outbreaks due to multiple plasmid transfer AUTHOR NAMES Prodinger W.M. Fille M. Bauernfeind A. Stemplinger I. Amann S. Pfausler B. Lass-Flori C. Dierich M.P. AUTHOR ADDRESSES (Prodinger W.M.; Fille M.; Bauernfeind A.; Stemplinger I.; Amann S.; Pfausler B.; Lass-Flori C.; Dierich M.P.) Institut fur Hygiene, University of Innsbruck, Fritz-Pregl-Str. 3, A-6020 Innsbruck, Austria. CORRESPONDENCE ADDRESS W.M. Prodinger, Institut fur Hygiene, University of Innsbruck, Fritz-Pregl-Str. 3, A-6020 Innsbruck, Austria. SOURCE Journal of Clinical Microbiology (1996) 34:3 (564-568). Date of Publication: 1996 ISSN 0095-1137 BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. ABSTRACT Over a period of 22 months, 32 patients treated in three independent intensive care units of the Innsbruck University Hospital were infected with extended-spectrum β-lactamase-producing members of the family Enterobacteriaceae (30 Klebsiella pneumoniae isolates, 1 Klebsiella oxytoca isolate, and 1 Escherichia coli isolate). As confirmed by sequencing of a bla gene PCR fragment, all isolates expressed the SHV-5-type β-lactamase. Genomic fingerprinting of epidemic strains with XbaI and pulsed-field gel electrophoresis grouped 20 of 21 isolates from ward A into two consecutive clusters which included 1 of 3 ward B isolates. All six K. pneumoniae isolates from ward C formed a third cluster. Stool isolates of asymptomatic patients and environmental isolates belonged to these clusters as well. Additionally, 2,6110 routine K. pneumoniae isolates from the surrounding provinces (population, 900,000) were screened for SHV-5 production. Only one of six nonepidemic isolates producing SHV-5 β-lactamase was matched with the outbreak strains by genomic fingerprinting. Plasmid fingerprinting, however, revealed the epidemic spread of a predominant R-plasmid, with a size of approximately 80 kb, associated with 29 of the 30 K. pneumoniae isolates. This plasmid was also present in the single K. oxytoca and E. coli isolates from ward C and in three nonepidemic isolates producing SHV-5. Our results underline that strain typing exclusively on the genomic level can be misleading in the epidemiological investigation of plasmid-encoded extended- spectrum β-lactamases. Our evidence for multiple events of R-plasmid transfer between species of the family Enterobacteriaceae in this nosocomial outbreak stresses the need for plasmid typing, especially because SHV-5 β- lactamase seems to be regionally spread predominantly via plasmid transfer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) beta lactamase EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) gene transfer Gram negative infection (diagnosis) Klebsiella pneumoniae EMTREE MEDICAL INDEX TERMS article clinical article controlled study epidemic hospital infection (diagnosis) human intensive care unit priority journal R factor CAS REGISTRY NUMBERS beta lactamase (9073-60-3) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996060487 MEDLINE PMID 8904415 (http://www.ncbi.nlm.nih.gov/pubmed/8904415) PUI L26065776 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1020 TITLE Pediatric and neonatal critical care transport: A comparison of therapeutic interventions AUTHOR NAMES Kronick J.B. Frewen T.C. Kissoon N. Lee R. Sommerauer J.F. Reid W.D. Casier S. Boyle K. AUTHOR ADDRESSES (Kissoon N.) Wolfson Children's Hospital, Howard Bldg., 820 Prudential Drive, Jacksonville, FL 32207, United States. (Kronick J.B.; Frewen T.C.; Lee R.; Sommerauer J.F.; Reid W.D.; Casier S.; Boyle K.) CORRESPONDENCE ADDRESS N. Kissoon, Wolfson Children's Hospital, Howard Bldg., 820 Prudential Drive, Jacksonville, FL 32207, United States. SOURCE Pediatric Emergency Care (1996) 12:1 (23-26). Date of Publication: February 1996 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objective: To compare the therapeutic interventions provided to newborn and pediatric patients by a dedicated combined neonatal pediatric critical care transport team. Method: From November 1987 through December 1989 we prospectively compared the number of therapeutic interventions performed by the critical care transport team on newborns and pediatric patients. The transport team (critical care physician [PL3 or greater], pediatric respiratory therapist, critical care nurse), recorded all therapeutic interventions, including both procedural and pharmacologic, for 213 newborn and 149 pediatric consecutive transports. Data were analyzed by analysis of variance or χ(2) statistic. Results: All patients were admitted to either the pediatric or the neonatal intensive care unit, and over 80% of both age groups received assisted ventilation. Newborns commonly suffered from respiratory diseases (159/213), while pediatric patients suffered from respiratory (52/149), central nervous system (28/149), and traumatic conditions (37/149). Airway maintenance procedural interventions (intubation, ventilation) were the commonest in both groups, although more frequent in neonates. Neonates received antibiotics and morphine (P < 0.05) while pediatric patients received anticonvulsants and respiratory drugs (P < 0.05) more frequently. Newborns received significantly more interventions than pediatric patients (average 3.56 vs 2.93, P < 0.05). Newborns also received significantly more procedural interventions (2.06 vs 1.36, P = < 0.05) including intubation (34.7% vs 15.4%, P < 0.05) and the initiation of mechanical ventilation (38% vs 22%, P < 0.05). Conclusions: Overall, newborns received more interventions, including intubation, and ventilation from the transport team than did pediatric patients. Our data suggest that combined pediatric neonatal transport teams should be prepared to intervene in a wide range of conditions from preterm respiratory distress to the multiply traumatized adolescent. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article critical illness emergency treatment medical staff paramedical personnel pediatrics EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996078372 MEDLINE PMID 8677174 (http://www.ncbi.nlm.nih.gov/pubmed/8677174) PUI L26073557 DOI 10.1097/00006565-199602000-00007 FULL TEXT LINK http://dx.doi.org/10.1097/00006565-199602000-00007 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1021 TITLE Impact of specialised paediatric retrieval teams. Intensive care provided by local hospitals should be improved. AUTHOR NAMES Raffles A. AUTHOR ADDRESSES (Raffles A.) CORRESPONDENCE ADDRESS A. Raffles, SOURCE BMJ (Clinical research ed.) (1996) 312:7023 (120; author reply 121). Date of Publication: 13 Jan 1996 ISSN 0959-8138 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health care intensive care patient transport EMTREE MEDICAL INDEX TERMS child human note patient care preschool child standard United Kingdom LANGUAGE OF ARTICLE English MEDLINE PMID 8555903 (http://www.ncbi.nlm.nih.gov/pubmed/8555903) PUI L126200262 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1022 TITLE Fast Track recovery after aortocoronary bypass surgery: early extubation and intensive care unit transfer. AUTHOR NAMES Jesurum J.T. Alexander W.A. Anderson J.J. Houston S. AUTHOR ADDRESSES (Jesurum J.T.; Alexander W.A.; Anderson J.J.; Houston S.) CORRESPONDENCE ADDRESS J.T. Jesurum, SOURCE Seminars in perioperative nursing (1996) 5:1 (12-22). Date of Publication: Jan 1996 ISSN 1056-8670 ABSTRACT Fast Track is a practical method of delivering care to aortocoronary bypass (ACB) patients with minimal risks to the patients or their care providers. A prospective study designed by an interdisciplinary practice team will evaluate the effects of an accelerated recovery program on clinical and financial outcomes of ACB patients. Essential components of the accelerated recovery program include early extubation, accelerated activity, and appropriate patient selection. Preliminary results on early extubation are discussed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary artery bypass graft endotracheal intubation intensive care patient transport postanesthesia nursing progressive patient care EMTREE MEDICAL INDEX TERMS article clinical pathway human nursing organization and management outcome assessment prospective study time LANGUAGE OF ARTICLE English MEDLINE PMID 8696284 (http://www.ncbi.nlm.nih.gov/pubmed/8696284) PUI L126257256 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1023 TITLE Mobile paediatric intensive care: The ethos of transfering critically ill children AUTHOR NAMES Britto J. Nadel S. Levin M. Habibi P. AUTHOR ADDRESSES (Britto J.; Nadel S.; Levin M.; Habibi P.) St Mary's Hospital, Paddington, London, United Kingdom. CORRESPONDENCE ADDRESS J. Britto, St Mary's Hospital, Paddington, London, United Kingdom. SOURCE Care of the Critically Ill (1995) 11:6 (235-238). Date of Publication: 1995 ISSN 0266-0970 ABSTRACT Specialised paediatric mobile intensive care teams (MICT) can rapidly deliver intensive care to critically ill children awaiting transfer. Involvement by the MICT in the patient's management begins at the time of the initial request for transfer. The level of therapy and monitoring that the child receives from the MICT, at the referring hospital, during the period of stabilisation and transport should be similar to that of a paediatric intensive care unit. The ethos of mobile intensive care not only ensures minimal transport related morbidity and mortality but a decrease in the severity of illness during transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health critical illness emergency medicine patient transport EMTREE MEDICAL INDEX TERMS artificial ventilation blood pressure monitoring endotracheal intubation human intensive care morbidity mortality patient care patient referral short survey EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1995364469 PUI L25357621 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1024 TITLE Parental perceptions of infant transfer from an NICU to a community nursery: implications for research and practice. AUTHOR NAMES Page J. Lunyk-Child O. AUTHOR ADDRESSES (Page J.; Lunyk-Child O.) CORRESPONDENCE ADDRESS J. Page, SOURCE Neonatal network : NN (1995) 14:8 (69-71). Date of Publication: Dec 1995 ISSN 0730-0832 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health newborn intensive care parent patient transport EMTREE MEDICAL INDEX TERMS human newborn newborn nursing nursing research psychological aspect review LANGUAGE OF ARTICLE English MEDLINE PMID 8552019 (http://www.ncbi.nlm.nih.gov/pubmed/8552019) PUI L126200719 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1025 TITLE Clinical aspects of mucociliary transport in anesthesia and intensive-care medicine AUTHOR NAMES Konrad F. AUTHOR ADDRESSES (Konrad F.) Abteilung Anasthesie Intensivmedizin, Kreiskrankenhaus Sigmaringen, Akadem Lehrkrankenhaus Univ Tubingen, Postfach 240, 72488 Sigmaringen, Germany. CORRESPONDENCE ADDRESS F. Konrad, Abteilung Anasthesie Intensivmedizin, Kreiskrankenhaus Sigmaringen, Akadem Lehrkrankenhaus Univ Tubingen, Postfach 240, 72488 Sigmaringen, Germany. SOURCE Applied Cardiopulmonary Pathophysiology (1995) 5:4 (249-255). Date of Publication: 1995 ISSN 0920-5268 ABSTRACT Because it is in direct contact with the environment, the respiratory system is exposed to the continuous action of harmful substances. The mucociliary escalator of the lungs is an important protective transport system by means of which inhaled particles and microorganisms are removed from the tracheobronchial system. Ventilated patients in the intensive-care unit (ICU) frequently have impaired mucus transport, which is associated with the development of retention of secretion and nosocomial pneumonia. Reduced mucociliary clearance is often caused by multiple factors. Previous chronic cigarette smoking or pre-existing chronic bronchitis, suction-induced lesions of the mucus membrane, ventilation with high oxygen concentrations, colonization by potentially pathogenic microorganisms, infection with respiratory viruses, release of inflammatory mediators and inadequate humidification of the inspired gases combine to form a formidable potential insult to the mucociliary clearance mechanism. Beta-mimetics and theophylline, in particular, have a favorable effect on mucociliary transport, whereas the effect of mucolytic agents is controversial. EMTREE DRUG INDEX TERMS beta adrenergic receptor stimulating agent (pharmacology) theophylline (pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia intensive care mucociliary transport respiratory system EMTREE MEDICAL INDEX TERMS article artificial ventilation bacterial colonization chronic bronchitis cigarette smoking environment hospital infection (complication, etiology) human humidifier inhalation membrane damage (etiology) mucociliary clearance oxygen concentration pneumonia (complication, etiology) priority journal respiratory mucosa suction tracheobronchial tree CAS REGISTRY NUMBERS theophylline (58-55-9, 5967-84-0, 8055-07-0, 8061-56-1, 99007-19-9) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Drug Literature Index (37) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1996075499 PUI L26070960 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1026 TITLE Monitoring of O2 transport and tissue oxygenation in paediatric critical care. AUTHOR NAMES Hüttemann E. Reinhart K. AUTHOR ADDRESSES (Hüttemann E.; Reinhart K.) Department of Anesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University Jena, Germany. CORRESPONDENCE ADDRESS E. Hüttemann, Department of Anesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University Jena, Germany. SOURCE Paediatric anaesthesia (1995) 5:5 (281-286). Date of Publication: 1995 ISSN 1155-5645 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care monitoring oxygen consumption EMTREE MEDICAL INDEX TERMS adult blood child human infant newborn review tissue distribution CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE English MEDLINE PMID 7489468 (http://www.ncbi.nlm.nih.gov/pubmed/7489468) PUI L126187121 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1027 TITLE Transfer anxiety in patients with myocardial infarction. AUTHOR NAMES Jenkins D.A. Rogers H. AUTHOR ADDRESSES (Jenkins D.A.; Rogers H.) CORRESPONDENCE ADDRESS D.A. Jenkins, SOURCE British journal of nursing (Mark Allen Publishing) (1995) 4:21 (1248-1252). Date of Publication: 1995 Nov 23-Dec 13 ISSN 0966-0461 ABSTRACT When patients are transferred from a coronary care unit to a general ward they often experience transfer anxiety. A structured pre-transfer teaching programme is suggested as a tool which may improve patient care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety heart infarction patient education patient transport EMTREE MEDICAL INDEX TERMS article coronary care unit human nursing psychological aspect psychological model LANGUAGE OF ARTICLE English MEDLINE PMID 8574101 (http://www.ncbi.nlm.nih.gov/pubmed/8574101) PUI L126207671 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1028 TITLE Intrahospital transport of critically ill pediatric patients AUTHOR NAMES Wallen E. Venkataraman S.T. Grosso M.J. Kiene K. Orr R.A. AUTHOR ADDRESSES (Wallen E.; Venkataraman S.T.; Grosso M.J.; Kiene K.; Orr R.A.) Children's Hospital of Pittsburgh, 3705, Fifth Avenue at Desoto Street, Pittsburgh, PA 15213, United States. CORRESPONDENCE ADDRESS S.T. Venkataraman, Children's Hospital of Pittsburgh, 3705, Fifth Avenue at Desoto Street, Pittsburgh, PA 15213, United States. SOURCE Critical Care Medicine (1995) 23:9 (1588-1595). Date of Publication: 1995 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Objectives: To determine the frequency of adverse events during intrahospital transport; to determine the requirement of therapeutic interventions during transport; to test the hypothesis that adverse events that occur during intrahospital transport are due to the transport process itself; and to determine the factors that predict the occurrence of adverse events and the requirement of major therapeutic interventions during transport. Design: A two-phase study in which data were prospectively collected. In phase I, we examined the occurrence rate of adverse events, the requirement for therapeutic interventions, and the factors that predicted adverse events and the requirement of therapeutic interventions. In phase II, we tested the hypothesis that adverse events during transport were due to the transport process itself. Setting: A 250-bed university children's hospital with a 50-bed intensive care unit (ICU). Patients: Phase I of the study consisted of one hundred and eighty intrahospital transports in 139 patients. These transports included patients who were transferred: a) to the ICU from the operating room, emergency department, or the general ward; b) from the ICU to the operating room; and c) from the ICU for diagnostic or therapeutic procedures. Phase II of the study consisted of 89 transports in 85 patients. Interventions: None. Measurements and Main Results: Vital signs and oxygen saturation were measured before and during transport. In phase I, there were no adverse events in 23.9% of transports. There was a significant change in at least one physiologic variable in 71.7% of transports, and at least one equipment-related mishap in 10% of transports. At least one major intervention was performed in 13.9% of transports in response to physiologic deterioration or an equipment-related mishap. There were no arrests or deaths during transport. The requirement for a major procedure was 34.4% in mechanically ventilated patients vs. 9.5% in nonventilated patients. Logistic regression analysis showed that both pretransport Therapeutic Intervention Scoring System and the duration of transport were significantly associated with the requirement of a major intervention and physiologic deterioration, while only the duration of transport was associated with an equipment- related event. The age of the patient and the number of escorts accompanying the transport did not affect the frequency of adverse events. Before transport in phase II study patients, no patient became hypothermic, the changes in physiologic variables were always <20%, and there was no change ≥5% in oxygen saturation. Hypothermia occurred in 11.2% of transports. A ≥20% change in heart rate (15.7%), blood pressure (21.3%), and respiratory rate (23.6%) was seen only during transport. A ≥5% change in oxygen saturation (5.6%) was seen only during transport. Conclusions: Serious physiologic deterioration occurs during intrahospital transport of critically ill children. Severity of illness and the duration of transport are associated with the occurrence of adverse events during transport. The team composition and equipment required on transport must be commensurate with the pretransport severity of illness and the anticipated duration of transport. EMTREE DRUG INDEX TERMS carbon dioxide (endogenous compound) neuromuscular blocking agent oxygen (endogenous compound) sedative agent vasoactive agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness hospital EMTREE MEDICAL INDEX TERMS article artificial ventilation human intubation major clinical study oxygen saturation patient transport priority journal CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) oxygen (7782-44-7) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1995272515 MEDLINE PMID 7664562 (http://www.ncbi.nlm.nih.gov/pubmed/7664562) PUI L25269903 DOI 10.1097/00003246-199509000-00020 FULL TEXT LINK http://dx.doi.org/10.1097/00003246-199509000-00020 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1029 TITLE Critical care transport: an evolving role in EMS. AUTHOR NAMES Celia M. Paluck J.N. Smith R.L. AUTHOR ADDRESSES (Celia M.; Paluck J.N.; Smith R.L.) R Adams Cowley Shock Trauma Center, Baltimore, MD, USA. CORRESPONDENCE ADDRESS M. Celia, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA. SOURCE JEMS : a journal of emergency medical services (1995) 20:8 (90-94). Date of Publication: Aug 1995 ISSN 0197-2510 ABSTRACT Critical care transport (CCT). It is defined as the movement of critically ill patients from facilities where the patients' needs exceed available resources to places that meet their needs, while maintaining a specialized level of care. And it is a specialty that is becoming increasingly common in today's managed care environment--an environment that emphasizes putting people in network hospitals. It is also becoming a viable career move for paramedics wishing to upgrade their skills and education. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service intensive care patient transport EMTREE MEDICAL INDEX TERMS article continuing education health services research human legal liability role playing United States LANGUAGE OF ARTICLE English MEDLINE PMID 10144803 (http://www.ncbi.nlm.nih.gov/pubmed/10144803) PUI L125105429 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1030 TITLE Intrahospital transportation of critical patients ORIGINAL (NON-ENGLISH) TITLE Transporte intrahospitalario en pacientes críticos. AUTHOR NAMES Martínez Magro M.L. Lozano Quintana M.J. López Castillo M.T. Cuenca Solanas M. AUTHOR ADDRESSES (Martínez Magro M.L.; Lozano Quintana M.J.; López Castillo M.T.; Cuenca Solanas M.) CORRESPONDENCE ADDRESS M.L. Martínez Magro, SOURCE Enfermería intensiva / Sociedad Española de Enfermería Intensiva y Unidades Coronarias (1995) 6:3 (111-116). Date of Publication: 1995 Jul-Sep ISSN 1130-2399 ABSTRACT Critically ill patients often need to be transferred for a short period of time for diagnostical or therapeutical reasons to other areas outside the intensive care unit which are less safe than their own unit and suppose a potential risk of deterioration in the patient's status. We analyse prospectively the intrahospitalary transfer in 50 patients and study the hemodynamic, ventilatory and neurological variations before and after the transfer. 93.7% of our patients were transferred for diagnostical reasons, basically to the radiodiagnosis service (85.4% for TAC performance), only 6.25% were transferred for therapeutical reasons, all of them to the operating theatre. All the patients included in the study were subjected to: -mechanic ventilation, electrocardiographic monitoring (ECG), invasive arterial monitoring (TA), monitoring of arterial saturation of O2 using pulsioximetry, drugs infusion through volumetric bombs and intracraneal pressure monitoring through intra-ventricular catheter (in 18 cases). The intrahospitalary transfer was performed with: -Portable ventilator, ECG monitoring, TA, PIC and pulsioximetry. Before and after the transfer different parameters were registered: -Inspiratory fraction of O2 (FiO2), TA, cardiac frequency, PIC, arterial gasometry (pH, PAO2, PACO2). There were no complications in any of the cases, the gasometric alterations were due to the change of respiratory parameters for the transfer (increase of the FiO2 and prophylactic ventilation in all the cases). We recommend: -Use of the portable ventilator, volumetric bombs, hemodynamic monitoring and uninterrupted pulsioximetry and the presence of qualified staff (doctor and ICU nurse) during the transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article blood gas analysis hemodynamics human methodology monitoring LANGUAGE OF ARTICLE Spanish MEDLINE PMID 7493286 (http://www.ncbi.nlm.nih.gov/pubmed/7493286) PUI L126182663 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1031 TITLE Cooperative efforts between tertiary-care centers and outlying hospitals boost imaging services and transfer technologies. AUTHOR NAMES Ripley R.C. AUTHOR ADDRESSES (Ripley R.C.) Cardiology Group of Middle Tennesse, Nashville, USA. CORRESPONDENCE ADDRESS R.C. Ripley, Cardiology Group of Middle Tennesse, Nashville, USA. SOURCE The Journal of cardiovascular management : the official journal of the American College of Cardiovascular Administrators (1995) 6:3 (24-26). Date of Publication: 1995 May-Jun ISSN 1053-5330 ABSTRACT Information maintained in the medical record is becoming computerized and is thus accessible to real-time retrieval and correlation. The potential for digital images lies not only in greater diagnostic power, but in the ability to telecommunicate and share the images with all physicians managing the patient, regardless of geographic location. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit technology telemedicine EMTREE MEDICAL INDEX TERMS article cardiovascular disease (therapy) health care quality health insurance heart catheterization hospital human multihospital system patient care standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 10143351 (http://www.ncbi.nlm.nih.gov/pubmed/10143351) PUI L125089111 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1032 TITLE Secondary systemic insults to the brain ORIGINAL (NON-ENGLISH) TITLE CONCEPT D'AGRESSION CEREBRALE SECONDAIRE D'ORIGINE SYSTEMIQUE (ACSOS) AUTHOR NAMES Moeschler O. Boulard G. Ravussin P. AUTHOR ADDRESSES (Moeschler O.; Boulard G.; Ravussin P.) Service d'Anesthesiologie, Centre Hospitalier Univ. Vaudois, 1011 Lausanne, Switzerland. CORRESPONDENCE ADDRESS O. Moeschler, Service d'Anesthesiologie, Centre Hospitalier Univ. Vaudois, 1011 Lausanne, Switzerland. SOURCE Annales Francaises d'Anesthesie et de Reanimation (1995) 14:1 (114-121). Date of Publication: 1995 ISSN 0750-7658 BOOK PUBLISHER Elsevier Masson SAS, 62 rue Camille Desmoulins, Issy les Moulineaux Cedex, France. ABSTRACT The prevention and treatment of secondary insults to the brain of systemic origin in severely head injured patients remain of utmost importance. Head injury remains the leading cause of traumatic death, being responsible for 50-60% of fatalities. Head-injured patients not only suffer from the primary injury at the time of trauma, but also from the secondary, largely ischaemic, brain damage that occurs later. Some of these insults are of extracranial origin (or systemic), such as arterial hypotension, hypoxaemia, hypercarbia and anaemia. Their impact on mortality and morbidity is extremely high and requires greater efforts in improving the care of head-injured patients. Systemic insults occur either before the patient reaches hospital or during interfaculty transfer or, in a surprisingly large number of cases, within hospital during emergency procedures, intrahospital transport or during their stay in intensive care units. Hypoxaemia, although quite easy to treat, is still common. This calls for better and earlier protection of the airway, more systematic administration of oxygen to trauma patients and wider use of pulse oximetry. Arterial hypotension has even more dramatic consequences in severe head injury. Recent studies indicate that short episodes of hypotension may induce severe brain ischaemia, that will be present even after complete systemic haemodynamic restoration. The treatment of hypotensive episodes should be immediate and agressive. In some circumstances, restoration of an adequate cerebral perfusion pressure may not be obtained sufficiently rapidly with fluids alone and may require early use of vasopressors. Optimal haemodynamic resuscitation of the trauma patient with haemorrhagic hypotension and severe head injury remains a special challenge. Hypertonic saline, with or without additional colloids, could be beneficial, especially in the prehospital setting. Numerous experimental and a few recent clinical studies are promising but need further clinical investigations. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hypertensive agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain injury (complication, drug therapy, prevention, therapy) brain ischemia (complication, drug therapy, prevention, therapy) colloid head injury EMTREE MEDICAL INDEX TERMS bleeding (complication, therapy) complication conference paper drug therapy hemodynamics human hypotension (complication, drug therapy, therapy) intensive care therapy EMBASE CLASSIFICATIONS Surgery (9) Neurology and Neurosurgery (8) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) Drug Literature Index (37) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 1995089370 MEDLINE PMID 7677275 (http://www.ncbi.nlm.nih.gov/pubmed/7677275) PUI L25087968 DOI 10.1016/S0750-7658(05)80159-5 FULL TEXT LINK http://dx.doi.org/10.1016/S0750-7658(05)80159-5 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1033 TITLE Transferable resistance to β-lactams in a nosocomial strain of Xanthomonas maltophilia [1] AUTHOR NAMES Hupkova M. Blahova J. Kralikova J. Kremery V. AUTHOR ADDRESSES (Hupkova M.; Blahova J.; Kralikova J.; Kremery V.) Preventive/Clinical Medicine Inst., Limbova 14, 83301 Bratislava, Slovakia. CORRESPONDENCE ADDRESS M. Hupkova, Preventive/Clinical Medicine Inst., Limbova 14, 83301 Bratislava, Slovakia. SOURCE Antimicrobial Agents and Chemotherapy (1995) 39:4 (1011-1012). Date of Publication: 1995 ISSN 0066-4804 BOOK PUBLISHER American Society for Microbiology, 1752 N Street N.W., Washington, United States. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) aztreonam (pharmacology) beta lactam antibiotic (pharmacology) cefotaxime (pharmacology) ceftazidime (pharmacology) imipenem (pharmacology) EMTREE DRUG INDEX TERMS amikacin (pharmacology) carbenicillin (pharmacology) clavulanic acid (pharmacology) kanamycin (pharmacology) ofloxacin (pharmacology) rifampicin (pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) Stenotrophomonas maltophilia EMTREE MEDICAL INDEX TERMS antibiotic resistance antibiotic sensitivity bacterium isolation bacterium transduction Escherichia coli hospital infection (etiology) human human cell intensive care unit letter priority journal Proteus mirabilis quantitative diagnosis CAS REGISTRY NUMBERS amikacin (37517-28-5, 39831-55-5) aztreonam (78110-38-0) carbenicillin (17230-86-3, 4697-36-3, 4800-94-6) cefotaxime (63527-52-6, 64485-93-4) ceftazidime (72558-82-8) clavulanic acid (58001-44-8) imipenem (64221-86-9) kanamycin (11025-66-4, 61230-38-4, 8063-07-8) ofloxacin (82419-36-1) rifampicin (13292-46-1) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Clinical and Experimental Pharmacology (30) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1995111144 MEDLINE PMID 7785971 (http://www.ncbi.nlm.nih.gov/pubmed/7785971) PUI L25109734 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1034 TITLE Intrahospital transport of neuro ICU patients. AUTHOR NAMES Kalisch B.J. Kalisch P.A. Burns S.M. Kocan M.J. Prendergast V. AUTHOR ADDRESSES (Kalisch B.J.; Kalisch P.A.; Burns S.M.; Kocan M.J.; Prendergast V.) University of Michigan School of Nursing, Ann Arbor 48109, USA. CORRESPONDENCE ADDRESS B.J. Kalisch, University of Michigan School of Nursing, Ann Arbor 48109, USA. SOURCE The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses (1995) 27:2 (69-77). Date of Publication: Apr 1995 ISSN 0888-0395 ABSTRACT Neuroscience intensive care unit (NICU) patients are frequently transported out of the critical care environment for diagnostic and interventional procedures. Four hundred and seventy-one such transports from seventeen clinical centers were studied to identify the characteristics of intrahospital transport. Data collected included the destination and duration of transport, number and type of personnel involved, changes in monitoring and treatment during transport, adverse patient responses and the impact on patients left in the unit. Differences between transports characterized as elective or emergent in nature were noted. Results validate that intrahospital transport of NICU patients is both time and labor intensive. The study also suggests that the optimal process for safe and efficient transport is yet to be designed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) central nervous system disease intensive care patient care patient transport EMTREE MEDICAL INDEX TERMS article devices emergency human intensive care unit monitoring nursing statistics time LANGUAGE OF ARTICLE English MEDLINE PMID 7622953 (http://www.ncbi.nlm.nih.gov/pubmed/7622953) PUI L125093321 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1035 TITLE How to transfer a postoperative patient to the intensive care unit. Strategies for documentation, evaluation, and management. AUTHOR NAMES Nearman H.S. Popple C.G. AUTHOR ADDRESSES (Nearman H.S.; Popple C.G.) University Hospitals of Cleveland, USA. CORRESPONDENCE ADDRESS H.S. Nearman, University Hospitals of Cleveland, USA. SOURCE The Journal of critical illness (1995) 10:4 (275-280). Date of Publication: Apr 1995 ISSN 1040-0257 ABSTRACT Postoperative intensive care is often required for patients who have underlying cardiac or respiratory dysfunction, who undergo major surgery, or who experience major perioperative complications. The initial report should list the patient's intravenous lines, catheters, and surgical drains or tubes, as well as whether ventilation is needed; this allows the intensive care unit (ICU) staff to set up appropriate equipment. On the patient's arrival in the ICU, document the medical history, anesthetics given, surgery performed, and intraoperative events. Perform an organ system review with ongoing assessment at 15-minute intervals. Residual effects of anesthetic agents can include respiratory depression, hypotension, and bradycardia. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport postoperative care EMTREE MEDICAL INDEX TERMS human medical record monitoring nursing organization and management postoperative complication review LANGUAGE OF ARTICLE English MEDLINE PMID 10150500 (http://www.ncbi.nlm.nih.gov/pubmed/10150500) PUI L125085188 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1036 TITLE Audit of neonatal intensive care transport [5] AUTHOR NAMES Whitfield J.M. AUTHOR ADDRESSES (Whitfield J.M.) Neonatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. CORRESPONDENCE ADDRESS J.M. Whitfield, Neonatology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. SOURCE Archives of Disease in Childhood (1995) 72:1 (98). Date of Publication: 1995 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS clinical audit human letter newborn priority journal EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1995043612 MEDLINE PMID 7717754 (http://www.ncbi.nlm.nih.gov/pubmed/7717754) PUI L25042313 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1037 TITLE Audit of neonatal intensive care transport [3] AUTHOR NAMES Whitfield J.M. AUTHOR ADDRESSES (Whitfield J.M.) Baylor College Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. CORRESPONDENCE ADDRESS J.M. Whitfield, Baylor College Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. SOURCE Archives of Disease in Childhood (1995) 72:1 SUPPL. (F79-F80). Date of Publication: 1995 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS clinical audit human letter priority journal EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1995043634 MEDLINE PMID 7743294 (http://www.ncbi.nlm.nih.gov/pubmed/7743294) PUI L25042335 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1038 TITLE Intrahospital transportation of critically ill children ORIGINAL (NON-ENGLISH) TITLE Traslado intrahospitalario del niño críticamente enfermo. AUTHOR NAMES Cruzado García M.D. Rubio Quiñones F. Cruzado García M.J. Ignacio García E. Mateo Sánchez J.I. AUTHOR ADDRESSES (Cruzado García M.D.; Rubio Quiñones F.; Cruzado García M.J.; Ignacio García E.; Mateo Sánchez J.I.) CORRESPONDENCE ADDRESS M.D. Cruzado García, SOURCE Enfermería intensiva / Sociedad Española de Enfermería Intensiva y Unidades Coronarias (1995) 6:1 (20-24). Date of Publication: 1995 Jan-Mar ISSN 1130-2399 ABSTRACT The intrahospital transport of a critically ill child is always a risky procedure. While it is being done, some complications which can worsen their initial situation may appear, so the benefits that this transport can provide must outweigh the possible risks. Preparing the patient and succeeding in performing a safe transport need the use of the proper equipment and human resources. Its degree of complexity and preparation must be proportional to the situation of instability of the patient and to the probability of increasing such instability, which implies performing a careful evaluation of the child and its real and potential needs previously. We also state some general ideas about the way of preparing and performing this kind of intrahospital transport in its different stages. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article child human LANGUAGE OF ARTICLE Spanish MEDLINE PMID 7493271 (http://www.ncbi.nlm.nih.gov/pubmed/7493271) PUI L126182724 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1039 TITLE Interruption of oxygen therapy during intrahospital transport of non-ICU patients: Elimination of a common problem through caregiver education AUTHOR NAMES Stubbs C.R. Crogan K.J. Pierson D.J. AUTHOR ADDRESSES (Stubbs C.R.; Crogan K.J.; Pierson D.J.) Respiratory Care Department, 325 Ninth Avenue, Seattle, WA 98104, United States. CORRESPONDENCE ADDRESS C.R. Stubbs, Respiratory Care Department, 325 Ninth Avenue, Seattle, WA 98104, United States. SOURCE Respiratory Care (1994) 39:10 (968-972). Date of Publication: 1994 ISSN 0098-9142 BOOK PUBLISHER Daedalus Enterprises Inc., 9425 North MacArthur Blvd, Suite 100, Irving, United States. ABSTRACT BACKGROUND: Hospital inpatients frequently leave their rooms for diagnostic procedures and for other reasons. For some, interruption of oxygen therapy during transport could lead to serious complications. In our institution, non-ICU patient transport is done mainly by nonclinical personnel from an independent transport service. MATERIALS AND METHODS: We reviewed respiratory care department and transport service records for 5 arbitrarily selected days to determine the number of non-ICU patients receiving O(2) therapy, the number of times these patients were transported, and the number of occasions on which O(2) was used during the transport. We then interviewed the primary nurse for each patient transported without O(2) and reviewed the charts of those patients to determine whether this practice was consistent with the therapy as it had been ordered. After our initial investigation showed a high rate of transport without prescribed O(2), we sent memoranda to all nursing units describing proper procedures for transport of patients for whom O(2) had been ordered. We then repeated the audit. Because the second audit showed the need, we conducted education sessions with all nursing personnel on the affected units and posted guidelines for O(2) use during transport. A third audit was then conducted. In addition, we performed a telephone survey of respiratory care department managers to learn the patient-transport practices in all hospitals in our state with more than 200 beds, using a structured questionnaire. RESULTS: During the initial 125 patient-days of O(2) therapy, O(2) accompanied patients on only 30 of 55 transports (55%). After distribution of memoranda, O(2) use increased to 28 of 35 transports (80%) during 82 patient-days. The second educational effort resulted in O(2) use with all 35 transports (100%) performed during 99 patient-days. Survey results from 24 hospitals with 225-680 beds showed that 11 (46%) had separate transport services and that decisions on O(2) use during patient transport were generally made by nursing staff. Although respiratory care departments supplied the O(2) equipment, their personnel were involved in non-ICU transports in only 5/24 hospitals. CONCLUSIONS: Patients receiving O(2) therapy on acute-care wards are often transported to other areas of the hospital without O(2). This potentially dangerous practice can be corrected by respiratory care practitioners through educational efforts targeted toward those responsible for administering O(2) therapy in non-ICU hospital areas. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) nursing education oxygen therapy patient transport respiratory care EMTREE MEDICAL INDEX TERMS article caregiver clinical audit human nursing staff questionnaire United States EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1994338396 MEDLINE PMID 10146115 (http://www.ncbi.nlm.nih.gov/pubmed/10146115) PUI L24329090 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1040 TITLE Intrahospitalary transport of children in critical conditions ORIGINAL (NON-ENGLISH) TITLE TRANSPORTE INTRAHOSPITALARIO DE NINOS CRITICOS AUTHOR NAMES Rubio Quinones F. Cruzado Garcia M.D. AUTHOR ADDRESSES (Rubio Quinones F.; Cruzado Garcia M.D.) Unidad de Cuidados Intens. Pediatr., Hospital Univ. 'Puerta del Mar', Ana de Viya 21, 11009 Cadiz, Spain. CORRESPONDENCE ADDRESS F. Rubio Quinones, Unidad de Cuidados Intens. Pediatr., Hospital Univ. 'Puerta del Mar', Ana de Viya 21, 11009 Cadiz, Spain. SOURCE Revista Espanola de Pediatria (1994) 50:299 (399-403). Date of Publication: 1994 ISSN 0034-947X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child hospitalization patient transport EMTREE MEDICAL INDEX TERMS disease severity human review EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE Spanish EMBASE ACCESSION NUMBER 1994320782 PUI L24320090 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1041 TITLE The transport of neonates to an intensive care unit. AUTHOR NAMES Pieper C.H. Smith J. Kirsten G.F. Malan P. AUTHOR ADDRESSES (Pieper C.H.; Smith J.; Kirsten G.F.; Malan P.) Department of Paediatrics and Child Health, Tygerberg Hospital, W. Cape. CORRESPONDENCE ADDRESS C.H. Pieper, Department of Paediatrics and Child Health, Tygerberg Hospital, W. Cape. SOURCE South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (1994) 84:11 Suppl (801-803). Date of Publication: Nov 1994 ISSN 0256-9574 ABSTRACT OBJECTIVE: To describe the mode of transport, the type of patient transferred and outcome as defined by death or discharge from hospital. DESIGN: A retrospective study was done of all neonates transferred from outside the designated drainage area of the hospital. SETTING: The study was done at the level 3 Neonatal Intensive Care Unit at Tygerberg Hospital for the period January-September 1992. PARTICIPANTS: From a total of 58 infants 52 were enrolled; they originated over a vast area of the western and northern Cape Province. MAIN OUTCOME MEASURES: Reasons for transfer, mode of transport and survival were measured. RESULTS: None of the infants died during transport. In total 11 (21%) of the 52 died. Categorising outcome according to transport method showed 100% survival of babies transported by fixed-wing aircraft, 94% survival if transport was by helicopter, and 70% survival if transported by ambulance. The non-survivors had a higher mean gestational age (P < 0.05) than the survivors and included 8 (73%) with asphyxia-related meconium aspiration syndrome. When the primary referral diagnosis was considered, 8 (27%) of 29 infants with respiratory failure of any cause, and 2 (28%) of those with neurological problems, died. All the infants transported because of a surgical emergency survived. CONCLUSION: These results show a high survival rate in transported infants, with the highest mortality in the asphyxia-related meconium aspiration syndrome and the infants transported by ambulance. The preponderance of infants with meconium aspiration syndrome might reflect the standard of perinatal care provided in the outlying regions of the western and northern Cape. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article cause of death human infant mortality methodology newborn retrospective study standard LANGUAGE OF ARTICLE English MEDLINE PMID 8914542 (http://www.ncbi.nlm.nih.gov/pubmed/8914542) PUI L127192960 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1042 TITLE A new dimension of the PACU: the dilemma of the ICU overflow patient. AUTHOR NAMES Johannes M.S. AUTHOR ADDRESSES (Johannes M.S.) CORRESPONDENCE ADDRESS M.S. Johannes, SOURCE Journal of post anesthesia nursing (1994) 9:5 (297-300). Date of Publication: Oct 1994 ISSN 0883-9433 ABSTRACT With the increase in the number of critically ill patients needing extended periods of time in the ICU and the subsequent shortage of ICU beds, hospitals have examined ways to use the PACU as an alternative for the short-term critically ill patient. This article identifies common problems encountered by the PACU staff, and the author suggests criteria for establishing and implementing guidelines for successful integration of these short-term critically ill patients without losing sight of the PACU's goals and compromising patient care. The criteria for establishing guidelines were based on the personal experience of the author in developing a program for ICU overflow patients, as well as from experiences of other PACU nurses working in PACUs where successful guidelines currently are used. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital bed capacity intensive care intensive care unit patient transport postanesthesia nursing recovery room EMTREE MEDICAL INDEX TERMS article clinical protocol human methodology LANGUAGE OF ARTICLE English MEDLINE PMID 7807407 (http://www.ncbi.nlm.nih.gov/pubmed/7807407) PUI L125022060 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1043 TITLE Paediatric intensive care transport AUTHOR NAMES Macrae D.J. AUTHOR ADDRESSES (Macrae D.J.) Paediatric Intensive Care Units, Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, United Kingdom. CORRESPONDENCE ADDRESS D.J. Macrae, Paediatric Intensive Care Units, Hospital for Sick Children, Great Ormond Street, London WC1N 3JH, United Kingdom. SOURCE Archives of Disease in Childhood (1994) 71:2 (175-178). Date of Publication: 1994 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS patient transport pediatrics priority journal short survey United Kingdom EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1994261117 MEDLINE PMID 7944547 (http://www.ncbi.nlm.nih.gov/pubmed/7944547) PUI L24261130 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1044 TITLE Audit of neonatal intensive care transport AUTHOR NAMES Leslie A.J. Stephenson T.J. AUTHOR ADDRESSES (Leslie A.J.; Stephenson T.J.) Dept. of Neonatal Medicine/Surgery, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom. CORRESPONDENCE ADDRESS A.J. Leslie, Dept. of Neonatal Medicine/Surgery, City Hospital, Hucknall Road, Nottingham NG5 1PB, United Kingdom. SOURCE Archives of Disease in Childhood (1994) 71:1 SUPPL. (F61-F66). Date of Publication: 1994 ISSN 0003-9888 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article clinical audit human newborn priority journal EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1994234395 MEDLINE PMID 7605415 (http://www.ncbi.nlm.nih.gov/pubmed/7605415) PUI L24238554 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1045 TITLE Mothers of chronically ill neonates and primary nurses in the NICU: transfer of care. AUTHOR NAMES Scharer K. Brooks G. AUTHOR ADDRESSES (Scharer K.; Brooks G.) CORRESPONDENCE ADDRESS K. Scharer, SOURCE Neonatal network : NN (1994) 13:5 (37-47). Date of Publication: Aug 1994 ISSN 0730-0832 ABSTRACT The purpose of this study was to explore the relationship between nurse and mother during the ill neonate's hospitalization and examine how this relationship influenced the mother's parenting of her infant during the hospitalization. Using qualitative methods, we separately interviewed ten mothers and nine primary nurses about their relationships, their views on each other, and the mothers' infant care. The tape-recorded interviews were transcribed verbatim, themes were extracted, and categories were developed for coding the data. As issues emerged, they were further explored in follow-up interviews. We identified four stages in the process of transferring the care of the infant from nurse to mother. The mother-nurse relationships were influenced by both the nurses' and the mothers' typical interactional patterns. Nurses had definite ideas about who was an "ideal" mother. To the mothers, the nurses' competence and caring attitude toward their infants were most important. The process by which the nurse and mother interact to provide care for the infant and alter their roles during the course of the hospitalization is linked to various factors and aspects of the nurse-mother relationship. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child parent relation chronic disease human relation mother newborn nursing nursing staff primary health care EMTREE MEDICAL INDEX TERMS adult article human methodology newborn newborn intensive care nursing nursing methodology research psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 7854261 (http://www.ncbi.nlm.nih.gov/pubmed/7854261) PUI L125030693 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1046 TITLE Hospital delays compound patient and transport delays AUTHOR NAMES Lenfant C. AUTHOR ADDRESSES (Lenfant C.) NIH, Bldg 31, Berthesda, MD 20892, United States. CORRESPONDENCE ADDRESS C. Armstrong, NIH, Bldg 31, Berthesda, MD 20892, United States. SOURCE Journal of the American Medical Association (1994) 271:10 (738). Date of Publication: 1994 ISSN 0098-7484 EMTREE DRUG INDEX TERMS fibrinolytic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital patient transport EMTREE MEDICAL INDEX TERMS acute heart infarction (diagnosis, drug therapy) coronary care unit electrocardiogram emergency medicine emergency ward fibrinolytic therapy human note priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Cardiovascular Diseases and Cardiovascular Surgery (18) Health Policy, Economics and Management (36) Drug Literature Index (37) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1994079001 PUI L24074510 DOI 10.1001/jama.271.10.738 FULL TEXT LINK http://dx.doi.org/10.1001/jama.271.10.738 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1047 TITLE A strategy for decreasing anxiety of ICU transfer patients and their families. AUTHOR NAMES Maillet R.J. Pata I. Grossman S. AUTHOR ADDRESSES (Maillet R.J.; Pata I.; Grossman S.) CORRESPONDENCE ADDRESS R.J. Maillet, SOURCE NursingConnections (1993) 6:4 (5-8). Date of Publication: 1993 Winter ISSN 0895-2809 ABSTRACT With the growing number of clients transferred out of the intensive care units (ICUs) following increasingly shorter stays, time constraints have become a barrier to effective teaching. Written information that is readily available to clients helps resolve this problem. A pamphlet (in Spanish and English) was developed to ease the move for patients, families, and critical care and medical nurses from a medical ICU (MICU) to a general floor. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety (prevention) family intensive care patient education patient transport EMTREE MEDICAL INDEX TERMS article human nursing psychological aspect publication LANGUAGE OF ARTICLE English MEDLINE PMID 8133938 (http://www.ncbi.nlm.nih.gov/pubmed/8133938) PUI L24879280 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1048 TITLE Transporting critically ill patients. American College of Critical Care Medicine, Society of Critical Care Medicine, and American Association of Critical-Care Nurses. AUTHOR ADDRESSES SOURCE Health devices (1993) 22:12 (590-591). Date of Publication: Dec 1993 ISSN 0046-7022 ABSTRACT Guidelines for transporting critically ill patients were published simultaneously in the June 1993 issue of Critical Care Medicine (21[6]:931-7) and the May 1993 issue of the American Journal of Critical Care (2[3]:189-95). Developed by a task force composed of members from the American College of Critical Care Medicine, the Society of Critical Care Medicine, and the American Association of Critical-Care Nurses (AACN), these guidelines, summarized below, outline the reasons and requirements for transporting patients, including the personnel who should be involved and the equipment (including monitors) that should accompany the patient. The task force's recommendations are consistent with ECRI's previous recommendations, also summarized below, but are more comprehensive and stringent in some respects and provide additional details. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article critical illness human practice guideline standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 8113073 (http://www.ncbi.nlm.nih.gov/pubmed/8113073) PUI L24876696 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1049 TITLE Critical care pediatrician-led aeromedical transports: Physician interventions and predictiveness of outcome AUTHOR NAMES Strauss R.H. Rooney B. AUTHOR ADDRESSES (Strauss R.H.; Rooney B.) 1836 South Avenue, La Crosse, WI 54606, United States. CORRESPONDENCE ADDRESS R.H. Strauss, 1836 South Avenue, La Crosse, WI 54606, United States. SOURCE Pediatric Emergency Care (1993) 9:5 (270-274). Date of Publication: 1993 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT This article reviews the one-year experience (March 28, 1987 to March 27, 1988) of the pediatric transport service of the University of Wisconsin Hospital and Clinics (UWHC). The UWHC pediatric transport team consisted of a critical care flight nurse and a pediatric critical care attending physician or fellow. The aims of the study were to: 1) determine the types and number of interventions performed by the physicians to gauge the need for physician presence on transport: and 2) determine which variables (severity of illness scores, age, gender, distance from hospital) recorded at the time of the referral telephone call best predicted outcome of the patient. There were 109 children transported by helicopter during the one-year study period. Thirty percent of the patients (43% of trauma patients and 22% of medical patients) had no interventions at all, 18% of medical patients and 10% of trauma patients were intubated, and 9% of medical patients and no trauma patients had central venous catheters inserted. Multivariate modeling determined that among medical patients, outcome could be accurately predicted only 38% of the time if telephone PRISM (Pediatric Risk of Mortality) scores were determined. Among trauma patients, if gender, age, distance from UWHC, and telephone PRISM scores were known, outcome could be predicted 74% of the time. Unless studies show the benefit of pediatrician-accompanied transport, transports could probably be done without critical care pediatricians. Severity of illness scoring at this time is probably not sufficiently accurate to warrant its use for deciding the appropriateness of transport of pediatric patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport pediatrician EMTREE MEDICAL INDEX TERMS age article central venous catheter child disease severity female gender helicopter human infant injury (epidemiology, therapy) intubation major clinical study male mortality resuscitation telephone EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1993306391 MEDLINE PMID 8247931 (http://www.ncbi.nlm.nih.gov/pubmed/8247931) PUI L23306377 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1050 TITLE Continuing evolution of regionalized perinatal care: Community hospital neonatal convalescent care AUTHOR NAMES Pittard III W.B. Geddes K.M. Ebeling M. Hulsey T.C. AUTHOR ADDRESSES (Pittard III W.B.; Geddes K.M.; Ebeling M.; Hulsey T.C.) Department of Pediatrics, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425-3313, United States. CORRESPONDENCE ADDRESS W.B. Pittard III, Department of Pediatrics, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC 29425-3313, United States. SOURCE Southern Medical Journal (1993) 86:8 (903-907). Date of Publication: 1993 ISSN 0038-4348 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT We describe the convalescent care of 169 back-transported (to community hospitals) and 285 eligible but not back-transported very low birth weight (VLBW) infants. Eligible infants who were not back transported to a level I or II community hospital were transferred to a level II nursery within the Medical University of South Carolina (MUSC) for convalescent care. Study infants were admitted to the neonatal intensive care unit (NICU) at MUSC from July 1985 through June 1989. They were admitted after maternal transport to MUSC for imminent delivery (N = 159), out-born community delivery (N = 55), or in-born MUSC delivery (N = 240). The mean ± SD birth weight and gestational age and the NICU admission diagnoses for the back-transported and non-back-transported neonates were similar. The mean ± SD weight of neonates at the time they were back transported was significantly greater than the weight of neonates at the time of intrahospital transfer. In contrast, the discharge weight to home and total days hospitalized were significantly less in the back-transported infants. Five back-transported neonates (3%) and 12 non-back-transported neonates (4%) were readmitted to the NICU. The back- transported infants used more than 3,800 bed days at community hospitals that would otherwise have been spent in the regional center, thus facilitating increased parental and primary physician involvement in their care. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport perinatal care EMTREE MEDICAL INDEX TERMS article community hospital convalescence cost benefit analysis human major clinical study newborn newborn intensive care priority journal regionalization very low birth weight (therapy) EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1993246393 MEDLINE PMID 8351551 (http://www.ncbi.nlm.nih.gov/pubmed/8351551) PUI L23246379 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1051 TITLE Transfer of critical patients to hospitals ORIGINAL (NON-ENGLISH) TITLE TRANSFERENCIA DE PACIENTES CRITICOS A HOSPITALES AUTHOR NAMES Alvarez J.A. Ibarguren M.C. Corral A. Taboada M. Freire M. AUTHOR ADDRESSES (Alvarez J.A.; Ibarguren M.C.; Corral A.; Taboada M.; Freire M.) Servicio Especial de Urgencias, INSALUD, C/Lope de Rueda, 43, 28009 Madrid, Spain. CORRESPONDENCE ADDRESS J.A. Alvarez, Servicio Especial de Urgencias, INSALUD, C/Lope de Rueda, 43, 28009 Madrid, Spain. SOURCE Medicina Intensiva (1993) 17:3 (148-153). Date of Publication: 1993 ISSN 0210-5691 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 1993139267 PUI L23139253 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1052 TITLE Transfer out of critical care: Freedom or fear? AUTHOR NAMES Saarmann L. AUTHOR ADDRESSES (Saarmann L.) School of Nursing, San Diego State University, San Diego, CA, United States. CORRESPONDENCE ADDRESS L. Saarmann, School of Nursing, San Diego State University, San Diego, CA, United States. SOURCE Critical Care Nursing Quarterly (1993) 16:1 (78-85). Date of Publication: 1993 ISSN 0887-9303 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety intensive care patient attitude EMTREE MEDICAL INDEX TERMS coping behavior human nurse patient relationship patient transport review separation anxiety (etiology) stress EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Psychiatry (32) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1993119155 MEDLINE PMID 8504366 (http://www.ncbi.nlm.nih.gov/pubmed/8504366) PUI L23119155 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1053 TITLE The organization of a pediatric critical care transport program AUTHOR NAMES Pon S. Notterman D.A. AUTHOR ADDRESSES (Pon S.; Notterman D.A.) New York Hospital, 525 East 68th Street, New York, NY 10021, United States. CORRESPONDENCE ADDRESS S. Pon, New York Hospital, 525 East 68th Street, New York, NY 10021, United States. SOURCE Pediatric Clinics of North America (1993) 40:2 (241-261). Date of Publication: 1993 ISSN 0031-3955 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Highly specialized pediatric critical care centers have matured significantly over the past two decades; however, access to this care is limited to tertiary care facilities and constrained by geography. With the advances of transport medicine, great distances can be spanned to bring critical care to the patient and provide effective treatment and safe transport systems where specialized care was previously unavailable. A patchwork of diverse transport systems perform pediatric transports with significant differences in the level of pediatric critical care. The optimal transport system has yet to be fully defined, but many successful systems share fundamental elements of organization. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport pediatrics EMTREE MEDICAL INDEX TERMS finance health care personnel medical device medical education organization priority journal responsibility review telecommunication EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1993111302 MEDLINE PMID 8451080 (http://www.ncbi.nlm.nih.gov/pubmed/8451080) PUI L23111302 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1054 TITLE Ins and outs of intrafacility transfers. AUTHOR NAMES Colborn C. Schulman E. Casper M. AUTHOR ADDRESSES (Colborn C.; Schulman E.; Casper M.) CORRESPONDENCE ADDRESS C. Colborn, SOURCE Contemporary longterm care (1993) 16:5 (28, 95). Date of Publication: May 1993 ISSN 8750-9652 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) nursing home patient advocacy patient transport EMTREE MEDICAL INDEX TERMS article health care facility legal aspect organization and management progressive patient care standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 10129659 (http://www.ncbi.nlm.nih.gov/pubmed/10129659) PUI L23936639 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1055 TITLE Transfer of a patient with a ventricular assist device to a non-critical care area AUTHOR NAMES Reedy J.E. AUTHOR ADDRESSES (Reedy J.E.) Dept. of Surgery, Saint Louis University Hospital, 3635 Vista Avenue at Grand Blvd., St. Louis, MO 63110-0250, United States. CORRESPONDENCE ADDRESS J.E. Reedy, Dept. of Surgery, Saint Louis University Hospital, 3635 Vista Avenue at Grand Blvd., St. Louis, MO 63110-0250, United States. SOURCE Heart and Lung: Journal of Critical Care (1993) 22:1 (71-76). Date of Publication: 1993 ISSN 0147-9563 BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Ventricular assist device (VAD) support has traditionally been associated with critically ill patients. Indeed, a VAD is inserted as the last hope for patients with cardiogenic shock who are unresponsive to conventional therapy. However, many patients bridged to potential cardiac transplantation are no longer critically ill after hemodynamic stabilization is achieved with VAD support. The focus of this article is to provide guidelines established for the transfer and provision of quality nursing care for patients with a VAD on a general cardiothoracic nursing floor. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) assisted circulation patient transport EMTREE MEDICAL INDEX TERMS article coronary care unit critical illness health care cost nursing patient education priority journal staff training EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1993046658 MEDLINE PMID 8420859 (http://www.ncbi.nlm.nih.gov/pubmed/8420859) PUI L23046658 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1056 TITLE Improving the patient transfer process at Bellin Hospital. AUTHOR ADDRESSES SOURCE The Quality letter for healthcare leaders (1993) 5:1 (4-5). Date of Publication: Feb 1993 ISSN 1047-5311 ABSTRACT Project: To facilitate timely and efficient transfers of patients on the cardiac service. Principals: Nursing staff from the intensive care (ICU), intermediate care (IMCU), and step down units. Process Improvement Method: VALUE PLUS+, a scientific, problem-solving model developed at Bellin that requires statistical thinking. Timeline: March 1990-August 1991. Key Findings or Improvements: Mid-morning, early afternoon, and early evening are the ideal times for patient transfers; late morning and mid-to-late afternoon transfers should be avoided. Unit staff can plan transfers for preferable times by predicting the number of transfers from ICU and IMCU, based on a percentage of the previous day's census. Results: The number of process steps to transfer a patient was reduced from 21 to 13. 80 percent of transfers now occur during three designated time periods. The role of transport staff has been expanded to free up nursing time. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit health care quality patient transport volunteer EMTREE MEDICAL INDEX TERMS article hospital bed capacity nonbiological model organization organization and management personnel management problem solving standard statistics United States LANGUAGE OF ARTICLE English MEDLINE PMID 10125550 (http://www.ncbi.nlm.nih.gov/pubmed/10125550) PUI L23894221 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1057 TITLE Paediatric inter-facility transport: The parents' perspective AUTHOR NAMES Macnab A.J. AUTHOR ADDRESSES (Macnab A.J.) Paediatric Transport Programme, Paediatric Critical Care Unit, British Columbia's Children's Hosp., 4480 Oak Street, Vancouver, BC V6H 3V4, Canada. CORRESPONDENCE ADDRESS A.J. Macnab, Paediatric Transport Programme, Paediatric Critical Care Unit, British Columbia's Children's Hosp., 4480 Oak Street, Vancouver, BC V6H 3V4, Canada. SOURCE Social Work in Health Care (1992) 17:3 (21-30). Date of Publication: 1992 ISSN 0098-1389 BOOK PUBLISHER Haworth Press Inc., 10 Alice Street, Binghamton, United States. ABSTRACT A telephone survey was conducted to evaluate the impact on families of inter-facility paediatric transport to a tertiary care centre. The 54 families who responded were almost unanimous in their appreciation of the transport service and the expertise of the attendants. However, many experienced problems, including finances, child care, travel arrangements and accommodation. Most problems were encountered by those who did not accompany the child in the transport vehicle, lived at a distance so that they could not commute and did not use hospital accommodation. Further research is suggested to assess the extent of the problems families face and to determine appropriate solutions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care facility parent patient transport pediatric hospital social work EMTREE MEDICAL INDEX TERMS article child care child parent relation family life health care system hospitalization human intensive care unit major clinical study questionnaire stress travel EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992370433 MEDLINE PMID 1465713 (http://www.ncbi.nlm.nih.gov/pubmed/1465713) PUI L22370415 DOI 10.1300/J010v17n03_02 FULL TEXT LINK http://dx.doi.org/10.1300/J010v17n03_02 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1058 TITLE An audit of a paediatric intensive care transfer unit AUTHOR NAMES Robb H.M. Hallworth D. Skeoch C.H. Levy C. AUTHOR ADDRESSES (Robb H.M.; Hallworth D.; Skeoch C.H.; Levy C.) Consultant in Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom. CORRESPONDENCE ADDRESS H.M. Robb, Consultant in Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow, United Kingdom. SOURCE British Journal of Intensive Care (1992) 2:8 (371+374-376+378-379). Date of Publication: 1992 ISSN 0961-7930 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical audit intensive care unit workload EMTREE MEDICAL INDEX TERMS article hospital management medical staff pediatric hospital United Kingdom EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1993146703 PUI L23146689 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1059 TITLE Hemodynamic changes, hydromineral metabolism and oxygen transport during mechanical ventilation ORIGINAL (NON-ENGLISH) TITLE REPERCUSIONES HEMODINAMICAS, METABOLISMO HIDROMINERAL Y TRANSPORTE DE OXIGENO DURANTE LA VENTILACION MECANICA AUTHOR NAMES Nicolas Franco S. Gomez Rubi J.A. Gonzalez Diaz G. AUTHOR ADDRESSES (Nicolas Franco S.; Gomez Rubi J.A.; Gonzalez Diaz G.) Servicio de Medicina Intensiva, Hosp. Univ. 'Virgen de la Arrixaca, Ctra. Madrid Cartagena s/n, El Palmar, Spain. CORRESPONDENCE ADDRESS S. Nicolas Franco, Servicio de Medicina Intensiva, Hosp. Univ. 'Virgen de la Arrixaca, Ctra. Madrid Cartagena s/n, El Palmar, Spain. SOURCE Medicina Intensiva (1992) 16:8 (438-445). Date of Publication: 1992 ISSN 0210-5691 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation hemodynamics intensive care unit EMTREE MEDICAL INDEX TERMS conference paper hormone release oxygen consumption EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE Spanish LANGUAGE OF SUMMARY English, Spanish EMBASE ACCESSION NUMBER 1993149508 PUI L23149494 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1060 TITLE Optimization of the blood for oxygen transport and tissue perfusion in critical care AUTHOR NAMES Wardrop C.A.J. Holland B.M. Jacobs S. Jones J.G. AUTHOR ADDRESSES (Wardrop C.A.J.; Holland B.M.; Jacobs S.; Jones J.G.) Department of Haematology, University Wales College of Medicine, Heath Park, Cardiff CF4 4XN, United Kingdom. CORRESPONDENCE ADDRESS C.A.J. Wardrop, Department of Haematology, University Wales College of Medicine, Heath Park, Cardiff CF4 4XN, United Kingdom. SOURCE Postgraduate Medical Journal (1992) 68:SUPPL. 2 (S2-S6). Date of Publication: 1992 ISSN 0032-5473 BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. ABSTRACT In present practice, patients in intensive care are managed with subnormal haematocrit values and oligovolaemia. Optimization of the blood for oxygen transport in preterm infants in intensive care yields major benefits in their prognosis. A rational basis is described for this optimization in terms of the circulating blood volume and haematocrit, represented by circulating red cell volume (mass). Extrapolation of these lessons in haematological management is proposed for adult patients in critical care, so as to reduce dependence on respiratory support and minimize clinical complications and costs. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) oxygen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) blood volume intensive care oxygen transport tissue perfusion EMTREE MEDICAL INDEX TERMS assisted ventilation conference paper erythrocyte volume hematocrit human newborn intensive care prematurity priority journal CAS REGISTRY NUMBERS oxygen (7782-44-7) EMBASE CLASSIFICATIONS Anesthesiology (24) Hematology (25) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992298085 MEDLINE PMID 1461866 (http://www.ncbi.nlm.nih.gov/pubmed/1461866) PUI L22298067 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1061 TITLE The problems of intrahospital transfer of patients with trauma and one solution: the "Trauma Transfer Backpack". AUTHOR NAMES Nayduch D. Sullivan S.L. AUTHOR ADDRESSES (Nayduch D.; Sullivan S.L.) CORRESPONDENCE ADDRESS D. Nayduch, SOURCE Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association (1992) 18:5 (383-389). Date of Publication: Oct 1992 ISSN 0099-1767 ABSTRACT With long stays for computed tomographic scans and x-ray exams and long trips to ICUs, patients with trauma may need extra fluids, drugs, or equipment outside the emergency department. Putting everything in a backpack saves time, leaves the nurse's hands free, and does not take up room on the stretcher. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) long term care multiple trauma patient transport EMTREE MEDICAL INDEX TERMS article devices human nursing organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 1474732 (http://www.ncbi.nlm.nih.gov/pubmed/1474732) PUI L23849222 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1062 TITLE Pressure support ventilation: Technology transfer from the intensive care unit to the operating room AUTHOR NAMES Pearl R.G. Rosenthal M.H. AUTHOR ADDRESSES (Pearl R.G.; Rosenthal M.H.) Department of Anesthesia, Stanford University Medical Center, Stanford, CA 94305-5123, United States. CORRESPONDENCE ADDRESS R.G. Pearl, Department of Anesthesia, Stanford University Medical Center, Stanford, CA 94305-5123, United States. SOURCE Anesthesia and Analgesia (1992) 75:2 (161-163). Date of Publication: 1992 ISSN 0003-2999 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit operating room patient transport positive end expiratory pressure EMTREE MEDICAL INDEX TERMS editorial human priority journal technology EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1992240915 MEDLINE PMID 1632528 (http://www.ncbi.nlm.nih.gov/pubmed/1632528) PUI L22240914 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1063 TITLE Intrahospital transport of critically ill, mechanically ventilated patients AUTHOR NAMES Branson R.D. AUTHOR ADDRESSES (Branson R.D.) Dept of Surgery, University of Cincinnati, Medical Center, 231 Bethesda Ave, Cincinnati, OH 45267-0550, United States. CORRESPONDENCE ADDRESS R.D. Branson, Dept of Surgery, University of Cincinnati, Medical Center, 231 Bethesda Ave, Cincinnati, OH 45267-0550, United States. SOURCE Respiratory Care (1992) 37:7 (775-795). Date of Publication: 1992 ISSN 0098-9142 BOOK PUBLISHER Daedalus Enterprises Inc., 9425 North MacArthur Blvd, Suite 100, Irving, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation critical illness patient transport EMTREE MEDICAL INDEX TERMS conference paper human intensive care unit EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1992230688 MEDLINE PMID 10145673 (http://www.ncbi.nlm.nih.gov/pubmed/10145673) PUI L22230687 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1064 TITLE Primary care of patients with myocardial infarction AUTHOR NAMES Obayashi K. AUTHOR ADDRESSES (Obayashi K.) CORRESPONDENCE ADDRESS K. Obayashi, SOURCE Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine (1992) 81:8 (1208-1212). Date of Publication: 10 Aug 1992 ISSN 0021-5384 EMTREE DRUG INDEX TERMS diazepam (drug administration) glyceryl trinitrate (drug administration) tissue plasminogen activator (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service heart infarction (prevention, therapy) patient transport EMTREE MEDICAL INDEX TERMS article coronary care unit fibrinolytic therapy heart arrhythmia (prevention, therapy) human oxygen therapy CAS REGISTRY NUMBERS diazepam (439-14-5) glyceryl trinitrate (55-63-0) tissue plasminogen activator (105913-11-9) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 1431460 (http://www.ncbi.nlm.nih.gov/pubmed/1431460) PUI L22974771 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1065 TITLE Intrahospital transport of critically ill patients AUTHOR NAMES Venkataraman S.T. Orr R.A. AUTHOR ADDRESSES (Venkataraman S.T.; Orr R.A.) 3705 Fifth Avenue, Pittsburgh, PA 15213, United States. CORRESPONDENCE ADDRESS S.T. Venkataraman, 3705 Fifth Avenue, Pittsburgh, PA 15213, United States. SOURCE Critical Care Clinics (1992) 8:3 (525-531). Date of Publication: 1992 ISSN 0749-0704 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Intrahospital transport of critically ill patients must be considered as part of the critical care continuum. The level of care provided must be commensurate with the severity of illness. These transfers are intensive in terms of utilization of personnel and resources. Advance preparation and optimal coordination of the transport process go a long way toward safer transfers of the critically ill. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS organization review technology EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992220372 MEDLINE PMID 1638440 (http://www.ncbi.nlm.nih.gov/pubmed/1638440) PUI L22220371 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1066 TITLE Emergency transport of critically ill children [3] AUTHOR NAMES Thomas D. Henning R. AUTHOR ADDRESSES (Thomas D.; Henning R.) Flinders Medical Centre, Bedford Park, SA 5042, Australia. CORRESPONDENCE ADDRESS D. Thomas, Flinders Medical Centre, Bedford Park, SA 5042, Australia. SOURCE Medical Journal of Australia (1992) 157:1 (66-67). Date of Publication: 1992 ISSN 0025-729X BOOK PUBLISHER Australasian Medical Publishing Co. Ltd, Level 2, 26-32 Pyrmont Bridge Road, Pyrmont, Australia. EMTREE DRUG INDEX TERMS aminophylline (adverse drug reaction, drug therapy) dexamethasone (drug therapy) diazepam (drug administration, drug therapy) epinephrine (adverse drug reaction, drug therapy) phenytoin (adverse drug reaction, drug administration, drug therapy) salbutamol (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child critical illness emergency patient transport EMTREE MEDICAL INDEX TERMS age asthma (drug therapy) bronchitis (drug therapy) cardiotoxicity (side effect) croup (drug therapy, etiology) disease classification drug efficacy endotracheal intubation epileptic state (drug therapy) heart arrhythmia (side effect) inhalational drug administration intensive care unit interpersonal communication intravenous drug administration letter lung dysplasia (drug therapy) meningitis (drug therapy) oxygen therapy pallor (side effect) patient monitoring priority journal rectal drug administration shock (drug therapy) CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) aminophylline (317-34-0) dexamethasone (50-02-2) diazepam (439-14-5) phenytoin (57-41-0, 630-93-3) salbutamol (18559-94-9) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Drug Literature Index (37) Adverse Reactions Titles (38) Epilepsy Abstracts (50) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1992210536 MEDLINE PMID 1640897 (http://www.ncbi.nlm.nih.gov/pubmed/1640897) PUI L22210535 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1067 TITLE Back transporting infants from neonatal intensive care units to community hospitals for recovery care: Effect on total hospital charges AUTHOR NAMES Phibbs C.S. Mortensen L. AUTHOR ADDRESSES (Phibbs C.S.; Mortensen L.) Center for Health Care Evaluation, Veterans Affairs Medical Center, 795 Willow Rd, Menlo Park, CA 94025, United States. CORRESPONDENCE ADDRESS C.S. Phibbs, Center for Health Care Evaluation, Veterans Affairs Medical Center, 795 Willow Rd, Menlo Park, CA 94025, United States. SOURCE Pediatrics (1992) 90:1 PART 1 (22-26). Date of Publication: 1992 ISSN 0031-4005 BOOK PUBLISHER American Academy of Pediatrics, 141 Northwest Point Blvd, P.O. Box 927, Elk Grove Village, United States. ABSTRACT Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small- sample bias. Data were collected for all back transports from a NICU to non- tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU. When the charges for the back transport are subtracted (mean = $1603), the average net savings are $4,600. These savings are even larger ($6163) for neonates who stayed at the community hospital for more than 7 days. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) community hospital hospital cost newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article controlled study cost effectiveness analysis female hospitalization human infant length of stay major clinical study male newborn patient referral priority journal EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992196226 MEDLINE PMID 1614772 (http://www.ncbi.nlm.nih.gov/pubmed/1614772) PUI L22196225 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1068 TITLE A cart to provide high frequency jet ventilation during transport of neonates AUTHOR NAMES Scuderi J. Elton C.B. Elton D.R. AUTHOR ADDRESSES (Scuderi J.; Elton C.B.; Elton D.R.) 3207 Berkley Forest Dr, Columbia, SC 29209-4111, United States. CORRESPONDENCE ADDRESS D.R. Elton, 3207 Berkley Forest Dr, Columbia, SC 29209-4111, United States. SOURCE Respiratory Care (1992) 37:2 (129-136). Date of Publication: 1992 ISSN 0098-9142 BOOK PUBLISHER Daedalus Enterprises Inc., 9425 North MacArthur Blvd, Suite 100, Irving, United States. ABSTRACT We report the evaluation of a cart we created to provide high frequency jet ventilation (HFJV) to neonates during intrahospital or interhospital transport. DESCRIPTION: The cart carries a conventional ventilator, jet ventilator (JV), incubator, gas blender, 3 E cylinders of oxygen and 2 of air, uninterruptible electric power supply (UPS), 2 syringe infusion pumps, cardiac monitor, and oximeter. EVALUATION METHODS: To determine the available operating time of the ventilators, we ran tests with 60% and 100% oxygen, high and low ventilator settings, 2.5-mm and 3.5-mm endotracheal tubes, and lung simulator set for low and high time constants. With five different combinations of these variables, the system was run to exhaustion of its gas supply. To determine the operating time limit of the UPS, we used it to operate the JV until the low-battery alarm sounded. RESULTS: The UPS always provided electrical power for at least 2 hours. In no case did a single cylinder of oxygen fail to power the system for less than 20 min. Because the cart carries 3 cylinders of oxygen and 2 of air, under the conditions tested a minimum of 60 min of continuous operation, using 100% oxygen, should be available during those portions of transports when the system is away from hospital and ambulance bulk power sources and is dependent on its own UPS and E cylinders of gas. EXPERIENCE: We have used the cart on two occasions to transport a 30-week gestational age, 1-kg, HFJV-dependent infant, first from ICU to surgery, then to another hospital for cardiac catheterization. Total transport time was 3 hours; there were no problems. The cart has also been used to transport three patients between hospitals during ECMO, without HFJV. CONCLUSIONS: Our HFJV transport system is adequate to transport an HFJV- dependent infant during the 30 to 60 minutes that may elapse when the cart is away from ambulance or hospital sources of electricity and gas. Available operating time with an HFJV transport system should be estimated conservatively; when an infant is dependent on HFJV, it would be well to have aircraft backup in case of ambulance breakdown or other contingencies. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) devices jet ventilation EMTREE MEDICAL INDEX TERMS article human newborn EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992169444 MEDLINE PMID 10145616 (http://www.ncbi.nlm.nih.gov/pubmed/10145616) PUI L22169443 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1069 TITLE Intrahospital transport: A framework for assessment AUTHOR NAMES Fought S.G. Nemeth L. AUTHOR ADDRESSES (Fought S.G.; Nemeth L.) Department of Physiological Nursing, Harborview Medical Center, University of Washington, Seattle, WA, United States. CORRESPONDENCE ADDRESS S.G. Fought, Department of Physiological Nursing, Harborview Medical Center, University of Washington, Seattle, WA, United States. SOURCE Critical Care Nursing Quarterly (1992) 15:1 (87-90). Date of Publication: 1992 ISSN 0887-9303 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness patient transport EMTREE MEDICAL INDEX TERMS article education program emergency medicine health care manpower health care quality human medical assessment paramedical education patient monitoring risk factor EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1992168576 MEDLINE PMID 1568160 (http://www.ncbi.nlm.nih.gov/pubmed/1568160) PUI L22168575 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1070 TITLE Patient dumping by specialized care facilities: compliance efforts riddled with uncertainties. AUTHOR NAMES Brown L.C. Paine S.J. AUTHOR ADDRESSES (Brown L.C.; Paine S.J.) CORRESPONDENCE ADDRESS L.C. Brown, SOURCE HealthSpan (1992) 9:6 (3-7). Date of Publication: Jun 1992 ISSN 0883-0452 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service patient transport EMTREE MEDICAL INDEX TERMS article government health care delivery intensive care unit legal aspect physician attitude public relations United States LANGUAGE OF ARTICLE English MEDLINE PMID 10119737 (http://www.ncbi.nlm.nih.gov/pubmed/10119737) PUI L22952523 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1071 TITLE Variables predicting the need for a pediatric critical care transport team AUTHOR NAMES McCloskey K.A. Faries G. King W.D. Orr R.A. Plouff R.T. AUTHOR ADDRESSES (McCloskey K.A.; Faries G.; King W.D.; Orr R.A.; Plouff R.T.) Children's Hospital of Alabama, 1600 Seventh Avenue, South, Birmingham, AL 35233 CORRESPONDENCE ADDRESS Children's Hospital of Alabama, 1600 Seventh Avenue, South, Birmingham, AL 35233 SOURCE Pediatric Emergency Care (1992) 8:1 (1-3). Date of Publication: 1992 ISSN 0749-5161 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT To determine when a pediatric critical care transport team is required to transport a patient to a referral center, this cross-sectional study evaluated 369 consecutive pediatric transports by stepwise multiple logistic regression analysis of six variables: age, vital signs, seizure activity, current endotracheal intubation, respiratory distress, and respiratory diagnosis. Models were developed for three outcome variables: 1) Major procedures were required in 8.9% of cases. The predicted probability of needing a major procedure was increased for intubated patients (probability of 12.9%), patients <1 year of age with unstable vital signs (12.9%), and patients meeting both these criteria (23.2%). 2) A posttransport assessment of need for a physician on the team was positive in 43% of cases. The probability of needing a physician was increased for intubated patients (probability of 68.8%), patients <1 year of age with unstable vital signs (58.7%), and patients meeting both these criteria (79.9%). 3) Category 1 drugs, ie, medications requiring ICU monitoring, were used in 19% of transports. The probability of this occurring was increased for intubated patients with stable vital signs (probability of 24.7%) and for intubated patients with unstable vital signs (41.4%). None of the other pretransport variables, alone or in pairs, was a significant predictor of any of the three outcome variables. The data indicate that intubation, age, and vital sign status can be used in predicting whether a transport team is needed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service patient transport EMTREE MEDICAL INDEX TERMS age article childhood endotracheal intubation human infant prediction EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992088294 MEDLINE PMID 1603682 (http://www.ncbi.nlm.nih.gov/pubmed/1603682) PUI L22088293 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1072 TITLE Development and implications of an interdisciplinary quality assurance monitor on unplanned transfers into the intensive care units. AUTHOR NAMES Posa P.J. Yonkee D.E. Fields W.L. AUTHOR ADDRESSES (Posa P.J.; Yonkee D.E.; Fields W.L.) CORRESPONDENCE ADDRESS P.J. Posa, SOURCE Journal of nursing care quality (1992) 6:2 (51-55). Date of Publication: Jan 1992 ISSN 1057-3631 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care quality intensive care unit patient care patient transport EMTREE MEDICAL INDEX TERMS article human information processing medical record methodology organization and management standard LANGUAGE OF ARTICLE English MEDLINE PMID 1728330 (http://www.ncbi.nlm.nih.gov/pubmed/1728330) PUI L22876434 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1073 TITLE Critical care transport of a cardiac infant: a case study. AUTHOR NAMES Demmons L.L. McGreevy T. AUTHOR ADDRESSES (Demmons L.L.; McGreevy T.) CORRESPONDENCE ADDRESS L.L. Demmons, SOURCE Neonatal network : NN (1991) 10:4 (39-44). Date of Publication: Dec 1991 ISSN 0730-0832 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) congenital heart malformation (therapy) intensive care patient transport EMTREE MEDICAL INDEX TERMS article case report human incubator male multiple malformation syndrome (therapy) newborn nursing LANGUAGE OF ARTICLE English MEDLINE PMID 1766425 (http://www.ncbi.nlm.nih.gov/pubmed/1766425) PUI L22880738 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1074 TITLE Elective intrahospital admissions versus acute interhospital transfers to a surgical intensive care unit: Cost and outcome prediction AUTHOR NAMES Borlase B.C. Baxter J.K. Kenney P.R. Forse R.A. Benotti P.N. Blackburn G.L. AUTHOR ADDRESSES (Borlase B.C.; Baxter J.K.; Kenney P.R.; Forse R.A.; Benotti P.N.; Blackburn G.L.) General Surgery/Critical Care, New England Deaconess Hospital, 110 Francis St., Boston, MA 02215, United States. CORRESPONDENCE ADDRESS B.C. Borlase, General Surgery/Critical Care, New England Deaconess Hospital, 110 Francis St., Boston, MA 02215, United States. SOURCE Journal of Trauma (1991) 31:7 (915-919). Date of Publication: 1991 ISSN 0022-5282 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT After a decade of intense fiscal scrutiny, appropriate utilization of intensive care resources remains controversial. In particular, the financial impact of patients transferred to a tertiary surgical intensive care unit (SICU) from a community hospital (interhospital) is unknown, especially when compared with elective (intrahospital) SICU admissions admitted from the tertiary center itself. We prospectively studied outcome and costs in 82 consecutive tertiary SICU admissions. Half were transferred acutely from community hospitals and half were transferred from within the hospital or postoperatively. Severity of illness (APACHE II) was scored on day 1, at the same time of the day (9:00-10:00 AM) and by one attending surgeon (BCB). Acute transfer patients had a significantly elevated mortality (36%) when compared with elective admissions (12%) (p < 0.05). When stratified by APACHE II score, acute transfers had twice the mortality for equivalent APACHE II scores (p < 0.05). Acute transfer patients with APACHE II scores greater than 19 had an 89% mortality; those nonsurvivors cost $128,652 each. From these results we conclude the following: (1) Acute transfer patients have a significantly elevated mortality when compared with elective intrahospital admissions with equivalent APACHE II day-1 scores; (2) patients transferred acutely to tertiary SICUs are significantly more costly, irrespective of outcome; (3) admission source (elective vs. acute transfer) should be seriously considered when evaluating patient outcome and cost in a SICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost intensive care unit prediction EMTREE MEDICAL INDEX TERMS conference paper controlled study human human tissue major clinical study mortality priority journal scoring system survival EMBASE CLASSIFICATIONS Surgery (9) Orthopedic Surgery (33) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1992119189 MEDLINE PMID 2072429 (http://www.ncbi.nlm.nih.gov/pubmed/2072429) PUI L22119188 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1075 TITLE Medication use during neonatal and pediatric critical care transport AUTHOR NAMES Sumpton J.E. Kronick J.B. AUTHOR ADDRESSES (Sumpton J.E.; Kronick J.B.) Department of Pediatrics, Children's Hospital of Western Ont., 800 Commissioners Road East, London, Ont., N6C 2V5 CORRESPONDENCE ADDRESS Department of Pediatrics, Children's Hospital of Western Ont., 800 Commissioners Road East, London, Ont., N6C 2V5 SOURCE Canadian Journal of Hospital Pharmacy (1991) 44:3 (153-156). Date of Publication: 1991 ISSN 0008-4123 BOOK PUBLISHER Canadian Society of Hospital Pharmacists, 30 Concourse Gate, Unit 3, Ottawa, Canada. ABSTRACT The Pediatric Critical Care Unit (PCCU) at the Children's Hospital of Western Ontario provides a transport service and team (critical care physician, critical care nurse, respiratory therapist) which transports critically ill newborns, infants, and children. The purpose of this study was to identify the medications used during transport and to determine age-related differences. Results of a prospective study of all drugs administered by the transport team to 174 patients during their stabilization and transport from November 1, 1987 through October 31, 1988 are presented. One hundred and twenty-one (69.5%) patients received at least one medication. The most frequently administered medications were antibiotics (38.5% of patients), followed by morphine (27.0%), anticonvulsants (23.6%), neuromuscular blockers (14.4%), respiratory drugs (11.5%), inotropes (10.9%), and sedatives (7.5%). Miscellaneous medications were administered to 48.8% of patients. The use of different classes of drugs varied with age; anticonvulsants were most frequently administered to children, sedatives and respiratory medications to infants, and antibiotics and miscellaneous medications to newborns. The wide range of medications used may reflect the diversity of diseases causing critical illness which reinforces that transport teams must have access to and knowledge of a variety of medications. The formulary of medications taken by the critical care transport team is included. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) aminophylline antibiotic agent anticonvulsive agent epinephrine inotropic agent morphine neuromuscular blocking agent salbutamol sedative agent EMTREE DRUG INDEX TERMS ampicillin atropine diazepam gentamicin lorazepam pancuronium paracetamol phenobarbital phenytoin suxamethonium thiopental EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) drug use emergency medicine patient transport EMTREE MEDICAL INDEX TERMS article child human intensive care newborn CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) aminophylline (317-34-0) ampicillin (69-52-3, 69-53-4, 7177-48-2, 74083-13-9, 94586-58-0) atropine (51-55-8, 55-48-1) diazepam (439-14-5) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) lorazepam (846-49-1) morphine (52-26-6, 57-27-2) paracetamol (103-90-2) phenobarbital (50-06-6, 57-30-7, 8028-68-0) phenytoin (57-41-0, 630-93-3) salbutamol (18559-94-9) suxamethonium (306-40-1, 71-27-2) thiopental (71-73-8, 76-75-5) EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 1991264533 MEDLINE PMID 10112743 (http://www.ncbi.nlm.nih.gov/pubmed/10112743) PUI L21263839 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1076 TITLE No duty to admit emergency patient when intensive care unit is full. AUTHOR ADDRESSES SOURCE Journal of health and hospital law : a publication of the American Academy of Hospital Attorneys of the American Hospital Association (1991) 24:10 (322). Date of Publication: Oct 1991 ISSN 1046-4360 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care malpractice patient transport EMTREE MEDICAL INDEX TERMS article hospital bed utilization human infant legal aspect United States LANGUAGE OF ARTICLE English MEDLINE PMID 10183531 (http://www.ncbi.nlm.nih.gov/pubmed/10183531) PUI L21875120 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1077 TITLE Intrahospital transport of critically ill adults: potential physiologic changes and nursing implications. AUTHOR NAMES Tice P. AUTHOR ADDRESSES (Tice P.) CORRESPONDENCE ADDRESS P. Tice, SOURCE Focus on critical care / American Association of Critical-Care Nurses (1991) 18:5 (424-428). Date of Publication: Oct 1991 ISSN 0736-3605 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) critical illness heart lung patient transport EMTREE MEDICAL INDEX TERMS article hemodynamics human intracranial pressure nursing care oxygen consumption physiology LANGUAGE OF ARTICLE English MEDLINE PMID 1936370 (http://www.ncbi.nlm.nih.gov/pubmed/1936370) PUI L21872710 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1078 TITLE The relation between oxygen transport and consumption can be upset in intensive care patients ORIGINAL (NON-ENGLISH) TITLE Relationen syrgastransport och-konsumtion kan rubbas hos intensivvårdspatienter. AUTHOR NAMES Lind L. Skoog G. Mälstam J. AUTHOR ADDRESSES (Lind L.; Skoog G.; Mälstam J.) Samtliga vid anestesikliniken, länssjukhuset Gävle. CORRESPONDENCE ADDRESS L. Lind, Samtliga vid anestesikliniken, länssjukhuset Gävle. SOURCE Läkartidningen (1991) 88:35 (2751-2753). Date of Publication: 28 Aug 1991 ISSN 0023-7205 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care oxygen consumption EMTREE MEDICAL INDEX TERMS article cardiogenic shock (therapy) human metabolism physiology prognosis respiratory failure (therapy) septic shock (therapy) shock (therapy) traumatic shock (therapy) CAS REGISTRY NUMBERS oxygen (7782-44-7) LANGUAGE OF ARTICLE Swedish MEDLINE PMID 1895823 (http://www.ncbi.nlm.nih.gov/pubmed/1895823) PUI L21864677 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1079 TITLE Safe intraclinical transfer of intensive-care patients - A concept to avoid monitoring and treatment gaps ORIGINAL (NON-ENGLISH) TITLE DER SICHERE INNERKLINISCHE TRANSPORT VON INTENSIVPATIENTEN. EIN KONZEPT ZUR VERMEIDUNG VON UBERWACHUNGS- UND THERAPIELUCKEN AUTHOR NAMES Schirmer U. Heinrich H. Siebeneich H. Vandermeersch E. AUTHOR ADDRESSES (Schirmer U.; Heinrich H.; Siebeneich H.; Vandermeersch E.) Universitatsklinik fur Anasthesiologie, Klinikum der Universitat Ulm, Steinhovelstrasse 9, D-7900 Ulm CORRESPONDENCE ADDRESS Universitatsklinik fur Anasthesiologie, Klinikum der Universitat Ulm, Steinhovelstrasse 9, D-7900 Ulm SOURCE Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie (1991) 26:2 (112-115). Date of Publication: 1991 ISSN 0939-2661 BOOK PUBLISHER Georg Thieme Verlag, Rudigerstrasse 14, Stuttgart, Germany. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport risk factor EMTREE MEDICAL INDEX TERMS article EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1991191683 MEDLINE PMID 1873411 (http://www.ncbi.nlm.nih.gov/pubmed/1873411) PUI L21192371 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1080 TITLE Total materials flow control system: intra-hospital transport service control system. AUTHOR NAMES Watanabe M. Yoshizawa M. AUTHOR ADDRESSES (Watanabe M.; Yoshizawa M.) St. Marianna University School of Medicine. CORRESPONDENCE ADDRESS M. Watanabe, St. Marianna University School of Medicine. SOURCE Japan-hospitals : the journal of the Japan Hospital Association (1991) 10 (49-52). Date of Publication: Jul 1991 ISSN 0910-1004 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) automation hospital equipment hospital management EMTREE MEDICAL INDEX TERMS article Japan medical record methodology public relations LANGUAGE OF ARTICLE English MEDLINE PMID 10111644 (http://www.ncbi.nlm.nih.gov/pubmed/10111644) PUI L21844403 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1081 TITLE Critical care transport: aircraft and medicine. AUTHOR NAMES Powell D.G. AUTHOR ADDRESSES (Powell D.G.) Foothills Provincial General Hospital, Calgary. CORRESPONDENCE ADDRESS D.G. Powell, Foothills Provincial General Hospital, Calgary. SOURCE Dimensions in health service (1991) 68:4 (17-18, 33). Date of Publication: May 1991 ISSN 0317-7645 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aircraft intensive care patient transport EMTREE MEDICAL INDEX TERMS article Canada cost benefit analysis economics human organization and management standard LANGUAGE OF ARTICLE English MEDLINE PMID 1905652 (http://www.ncbi.nlm.nih.gov/pubmed/1905652) PUI L21841494 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1082 TITLE Critical care transport. AUTHOR NAMES Bock-Laudenslager C. Johnson L.M. AUTHOR ADDRESSES (Bock-Laudenslager C.; Johnson L.M.) CORRESPONDENCE ADDRESS C. Bock-Laudenslager, SOURCE Focus on critical care / American Association of Critical-Care Nurses (1991) 18:2 (109). Date of Publication: Apr 1991 ISSN 0736-3605 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital department intensive care patient transport EMTREE MEDICAL INDEX TERMS human letter methodology organization and management United States LANGUAGE OF ARTICLE English MEDLINE PMID 2022281 (http://www.ncbi.nlm.nih.gov/pubmed/2022281) PUI L21821412 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1083 TITLE Mothers' perceptions of their neonates' in-hospital transfers from a neonatal intensive-care unit. AUTHOR NAMES Kolotylo C.J. Parker N.I. Chapman J.S. AUTHOR ADDRESSES (Kolotylo C.J.; Parker N.I.; Chapman J.S.) McMaster University, Hamilton, Ontario, Canada. CORRESPONDENCE ADDRESS C.J. Kolotylo, McMaster University, Hamilton, Ontario, Canada. SOURCE Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG (1991) 20:2 (146-153). Date of Publication: 1991 Mar-Apr ISSN 0884-2175 ABSTRACT This study explored mothers' perceptions of their neonates' in-hospital transfers from a neonatal intensive-care unit. A convenience sample of 15 mothers was selected, and the researchers interviewed each mother once within a week after her neonate's transfer. Three themes emerged from the data: (1) the mothers expressed feelings of relief accompanied by concern, fear of the unknown, and feelings of alienation; (2) the mothers depended on familiar things and people; and (3) the mothers experienced feelings of helplessness. The mothers' perceptions of their preparation for transfer and continuity of care were mainly negative. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) attitude to health mental stress (etiology) mother newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS article control fear female human interview male newborn nursing psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 2030452 (http://www.ncbi.nlm.nih.gov/pubmed/2030452) PUI L21826059 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1084 TITLE Critical care transportation medicine: New concepts in pretransport stabilization of the critically ill patient AUTHOR NAMES Crippen D. AUTHOR ADDRESSES (Crippen D.) Department of Critical Care, St Francis Medical Center, Pittsburgh, PA 15201 CORRESPONDENCE ADDRESS Department of Critical Care, St Francis Medical Center, Pittsburgh, PA 15201 SOURCE American Journal of Emergency Medicine (1990) 8:6 (551-554). Date of Publication: 1990 ISSN 0735-6757 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Regionalization of health care for trauma has become commonplace, and the same concept for critically ill medical/surgical patients is developing. Recent evidence suggests that current stabilization measures used by transport teams can be inadequate for this critically ill patient population. In trauma, speed has been considered a necessity to get the patient to a facility which cannot be carried out to the field, eg, an operating room. For acute medical illnesses, critical care transport teams can bring intensive care technology to the patient. Accumulating evidence supports the premise that speed of transport is not as important as stabilization before transport, knowledge of hemodynamics during transport, and early use of critical care monitoring systems. Other reports identify the need for initial evaluation and stabilization of critically ill patients by physicians at the critical care level of expertise. Accordingly, critical care transportation teams have evolved, creating new notions of pretransport stabilization not applicable to previous transport systems. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency ward hemodynamics patient transport EMTREE MEDICAL INDEX TERMS human risk factor short survey EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1991016340 MEDLINE PMID 2222604 (http://www.ncbi.nlm.nih.gov/pubmed/2222604) PUI L21016340 DOI 10.1016/0735-6757(90)90163-T FULL TEXT LINK http://dx.doi.org/10.1016/0735-6757(90)90163-T COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1085 TITLE Critical care transport AUTHOR NAMES Fromm Jr. R.E. AUTHOR ADDRESSES (Fromm Jr. R.E.) Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX CORRESPONDENCE ADDRESS Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX SOURCE Problems in Critical Care (1990) 4:4 (ix). Date of Publication: 1990 ISSN 0889-4701 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency intensive care patient transport EMTREE MEDICAL INDEX TERMS editorial nonhuman priority journal EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1991003243 PUI L21003243 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1086 TITLE Issues in critical care transport AUTHOR NAMES Fromm Jr. R.E. Cronin L.A. AUTHOR ADDRESSES (Fromm Jr. R.E.; Cronin L.A.) MS B101, Methodist Hospital, 6565 Fannin, Houston, TX 77030, United States. CORRESPONDENCE ADDRESS R.E. Fromm Jr., MS B101, Methodist Hospital, 6565 Fannin, Houston, TX 77030, United States. SOURCE Problems in Critical Care (1990) 4:4 (439-446). Date of Publication: 1990 ISSN 0889-4701 ABSTRACT Hospital closures, changes in reimbursement, and advances in diagnostics and therapeutics have led to an increase in the number of critically ill patients transported. Despite years of evolution in transport systems, many issues remain. The importance of medical direction and control is generally recognized but issues of appropriate use and reimbursement persist. Although data from ground transport systems is limited, safety remains a paramount issue in both ground and air transport activities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency intensive care patient transport EMTREE MEDICAL INDEX TERMS devices female human male priority journal review risk factor EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1991003244 PUI L21003244 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1087 TITLE Intrahospital transport of critically ill patients AUTHOR NAMES Link J. Krause H. Wagner W. Papadopoulos G. AUTHOR ADDRESSES (Link J.; Krause H.; Wagner W.; Papadopoulos G.) FU Klinikum Steglitz, Klinik fur Anaesthesiologie, Operative Intensivmedizin, Hindenburgdamm 30, D-1000 Berlin 45, Germany. CORRESPONDENCE ADDRESS J. Link, FU Klinikum Steglitz, Klinik fur Anaesthesiologie, Operative Intensivmedizin, Hindenburgdamm 30, D-1000 Berlin 45, Germany. SOURCE Critical Care Medicine (1990) 18:12 (1427-1429). Date of Publication: 1990 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Severe complications sometimes occur in critically ill patients during intrahospital transport. Possible causes may be inadequate ventilation, insufficient monitoring, interrupted application of vasoactive drugs, or disconnections and accidental extubation. We constructed a transport unit equipped with a respiratory; capnometer; monitor to measure ECG, arterial and intracranial pressures, and temperature; and two syringe pumps that can be connected easily to the patient's bed. Gas is supplied by cylinders with oxygen and air. Electrical power is supplied by two accumulators connected to recharger and transformer devices that deliver 220 V (110 V). Since this transfer unit was introduced, we have had no unanticipated problems during intrahospital ICU patient transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hemodynamic monitoring intensive care patient transport vasodilatation EMTREE MEDICAL INDEX TERMS article extubation human priority journal risk factor EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1991028000 MEDLINE PMID 2245620 (http://www.ncbi.nlm.nih.gov/pubmed/2245620) PUI L21028000 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1088 TITLE The practicability of a transportable haemoglobin measuring system in routine operative and intensive medical care ORIGINAL (NON-ENGLISH) TITLE ZUR ANWENDBARKEIT EINES TRANSPORTABLEN HAMOGLOBINMESSSYSTEMS IM OPERATIVEN UND INTENSIVMEDIZINISCHEN ROUTINEBETRIEB AUTHOR NAMES Polasek J. Taeger K. AUTHOR ADDRESSES (Polasek J.; Taeger K.) Institut fur Anasthesiologie, Ludwig-Maximilians-Universitat, Innenstadt-Kliniken, Nussbaumstrasse 20, D-8000 Munchen CORRESPONDENCE ADDRESS Institut fur Anasthesiologie, Ludwig-Maximilians-Universitat, Innenstadt-Kliniken, Nussbaumstrasse 20, D-8000 Munchen SOURCE Anasthesiologie und Intensivmedizin (1990) 31:9 (268-270). Date of Publication: 1990 ISSN 0170-5334 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hemoglobin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care oximeter EMTREE MEDICAL INDEX TERMS article methodology nonhuman CAS REGISTRY NUMBERS hemoglobin (9008-02-0) EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990316445 PUI L20310534 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1089 TITLE Effect of in-house transport on murine plasma corticosterone concentration and blood lymphocyte populations. AUTHOR NAMES Drozdowicz C.K. Bowman T.A. Webb M.L. Lang C.M. AUTHOR ADDRESSES (Drozdowicz C.K.; Bowman T.A.; Webb M.L.; Lang C.M.) Department of Comparative Medicine, College of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033. CORRESPONDENCE ADDRESS C.K. Drozdowicz, Department of Comparative Medicine, College of Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033. SOURCE American journal of veterinary research (1990) 51:11 (1841-1846). Date of Publication: Nov 1990 ISSN 0002-9645 ABSTRACT The effect of in-house transport on plasma corticosterone concentration and blood lymphocyte populations of laboratory mice was investigated. Mice were transported within a research facility at 0900 hours in a pattern designed to simulate that commonly used by investigators prior to experimental manipulation. Plasma corticosterone concentration and WBC count were determined at 0.25, 2, 4, 8, 12, and 24 hours after transport. A significant (P less than 0.05) increase in plasma corticosterone concentration was seen in mice immediately after transport. The normal circadian rhythm of plasma corticosterone concentration was altered for the subsequent 24-hour period. Corresponding significant (P less than 0.05) decreases in total WBC numbers, lymphocyte count, and thymus gland weight were observed. The decrease in total blood lymphocyte numbers at 4 hours was reflected in B- and T-lymphocyte populations. The subsequent acute increase in plasma corticosterone concentration was associated with alterations in the cellular components of the immune system. Results of the study indicated that routine in-house transport of laboratory mice should be considered a stressful stimulus. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) corticosterone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) laboratory diagnosis lymphocyte EMTREE MEDICAL INDEX TERMS animal animal disease article Bagg albino mouse blood circadian rhythm histology leukocyte count male methodology mouse organ size thymus traffic and transport CAS REGISTRY NUMBERS corticosterone (50-22-6) LANGUAGE OF ARTICLE English MEDLINE PMID 2240810 (http://www.ncbi.nlm.nih.gov/pubmed/2240810) PUI L20886144 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1090 TITLE A dedicated helicopter-based ITU has all the advantages AUTHOR NAMES Bristow A. Evans I. AUTHOR ADDRESSES (Bristow A.; Evans I.) St Bartholomew's Hospital, London EC1A 7BE CORRESPONDENCE ADDRESS St Bartholomew's Hospital, London EC1A 7BE SOURCE British Journal of Hospital Medicine (1990) 44:2 (91). Date of Publication: 1990 ISSN 0007-1064 BOOK PUBLISHER MA Healthcare Ltd, Dulwich Road, London, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS human letter EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1990281548 MEDLINE PMID 2207488 (http://www.ncbi.nlm.nih.gov/pubmed/2207488) PUI L20275654 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1091 TITLE Early 'step-down' transfer of low-risk patients with chest pain. A controlled interventional trial AUTHOR NAMES Weingarten S. Ermann B. Bolus R. Riedinger M.S. Rubin H. Green A. Karns K. Ellrodt A.G. AUTHOR ADDRESSES (Weingarten S.; Ermann B.; Bolus R.; Riedinger M.S.; Rubin H.; Green A.; Karns K.; Ellrodt A.G.) Southern California, Permanente Medical Group, Dept. of Internal Medicine, 5601 De Soto Avenue, Woodland Hills, CA 91365-4084, United States. CORRESPONDENCE ADDRESS S. Weingarten, Southern California, Permanente Medical Group, Dept. of Internal Medicine, 5601 De Soto Avenue, Woodland Hills, CA 91365-4084, United States. SOURCE Annals of Internal Medicine (1990) 113:4 (283-289). Date of Publication: 1990 ISSN 0003-4819 BOOK PUBLISHER American College of Physicians, 190 N. Indenpence Mall West, Philadelphia, United States. ABSTRACT Objective: To determine whether providing private practitioners with triage criteria for their low-risk chest pain patients would safely enhance bed utilization efficiency in coronary and intermediate care units. Design: Prospective, controlled, interventional trial using an alternate month study design. Setting: A large teaching community hospital. Patients: Cohort of 404 low-risk patients with chest pain for whom a diagnosis of myocardial infarction has been excluded and who have not sustained complications, required interventions, or developed unstable comorbidity. Interventions: During intervention months, private practitioners caring for low-risk patients in the coronary and intermediate care units were contacted 24 hours after admission. Physicians were informed that the transfer of low-risk patients to nonmonitored beds could probably be done safely, based on the results of a pilot study. The practitioner had the option of agreeing to or deferring patient transfer. During control months, physicians were not contacted in this way. Measurements and Main Results: Use of the triage criteria by private practitioners reduced lengths of stay of the intermediate and coronary care units by 36% and 53%, respectively. Bed availability increased by 744 intermediate and 372 coronary care unit bed-days per year. Charges decreased by $2.6 million per year and profits improved by $390000 per year. There were no significant differences in complications between control and intervention patients and in no case (95% CI, 0% to 1.6%) did the triage criteria adversely affect quality of care. Conclusions: The early transfer triage criteria may be a safe and efficacious decision aid for improving bed utilization in intermediate and coronary care units. In addition, this study shows the feasibility of and potential benefits from applying practice guidelines at a community hospital. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit thorax pain EMTREE MEDICAL INDEX TERMS article clinical trial controlled clinical trial controlled study cost economic aspect education general practitioner hospital bed utilization human medical education priority journal prospective study EMBASE CLASSIFICATIONS Internal Medicine (6) Cardiovascular Diseases and Cardiovascular Surgery (18) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990260221 MEDLINE PMID 2115754 (http://www.ncbi.nlm.nih.gov/pubmed/2115754) PUI L20254355 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 1092 TITLE Three or more rib fractures as an indicator for transfer to a Level I trauma center: A population-based study AUTHOR NAMES Lee R.B. Bass S.M. Morris Jr. J.A. MacKenzie E.J. AUTHOR ADDRESSES (Lee R.B.; Bass S.M.; Morris Jr. J.A.; MacKenzie E.J.) Division of Trauma, Vanderbilt University, School of Medicine, Nashville, TN 37232-3755, United States. CORRESPONDENCE ADDRESS J.A. Morris Jr., Division of Trauma, Vanderbilt University, School of Medicine, Nashville, TN 37232-3755, United States. SOURCE Journal of Trauma (1990) 30:6 (689-694). Date of Publication: 1990 ISSN 0022-5282 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT The presence of major chest wall injury is an indication for transfer to a Level I trauma center. We hypothesized that the presence of three or more rib fractures on initial chest X-ray would identify a small subgroup of patients with a high probability of requiring trauma center care. All trauma discharges in Maryland between 1984 and 1986 (N = 105,683) were reviewed. Patients were divided by the presence of rib fractures (no rib fractures, 1-2 fractures, 3+ fractures) and age in years (0-13, 14-64, 65+). Results: The presence of three or more rib fractures in the pediatric age group was rare and precluded further evaluation. When comparing patients with 1-2 rib fractures versus 3 or more rib fractures, significant differences were found in mortality, mean Injury Severity Score, mean hospital stay and mean number of ICU days (p < 0.001). The significant differences occurred in all age groups 14 years old and older. The presence of three of more rib fractures increased the relative risk of splenic injury (6.2) and liver injury (3.6) but did not predict the presence of aortic injury. Conclusion: The presence of 3 or more rib fractures identifies a small subgroup of patients (2.4%) likely to require tertiary care. This triage tool is useful in all patients over the age of 14 years. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) age hospital bed utilization intensive care unit length of stay liver injury rib fracture spleen injury thorax injury (therapy) EMTREE MEDICAL INDEX TERMS adolescent adult aged child conference paper economic aspect fatality female human infant major clinical study male organization and management priority journal EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990198340 MEDLINE PMID 2352298 (http://www.ncbi.nlm.nih.gov/pubmed/2352298) PUI L20197982 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1093 TITLE Mishaps during transport from the intensive care unit AUTHOR NAMES Smith I. Fleming S. Cernaianu A. AUTHOR ADDRESSES (Smith I.; Fleming S.; Cernaianu A.) Div. of Critical Care Med., Department of Anesthesia, Cooper Hosp./Univ. Med. Cent., Three Cooper Plaza, Camden, NJ 08103, United States. CORRESPONDENCE ADDRESS I. Smith, Div. of Critical Care Med., Department of Anesthesia, Cooper Hosp./Univ. Med. Cent., Three Cooper Plaza, Camden, NJ 08103, United States. SOURCE Critical Care Medicine (1990) 18:3 (278-281). Date of Publication: 1990 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT We undertook a prospective study of 125 intrahospital patient transports from the ICU in an attempt to identify any factors that could influence the occurrence of mishaps. One third of the transports sustained at least one mishap. Therapeutic intervention scoring system class IV transports had the highest rate of mishaps (35%). We found no relationship of occurrence of mishaps to severity of illness (Acute Physiology and Chronic Health Evaluation, APACHE II), number of lines, monitoring and support modalities, and time out of the ICU. Transports for elective procedures had more mishaps (60%) than occurred for emergencies (40%). Most mishaps occurred either during the procedure, on transports to CT scan, or while waiting at the destination. The numbers and types of escorts as defined by our ICU policy and physician attendance on transport did not clearly reduce mishap risk. Morbidity and mortality were not affected by mishaps. Although certain trends did emerge, no clearly defined predictive factor could be identified. Further study into transport mishaps is warranted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) diagnostic error intensive care unit patient transport risk factor EMTREE MEDICAL INDEX TERMS article catheterization education electrocardiogram human major clinical study priority journal tracheostomy EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990087199 MEDLINE PMID 2302952 (http://www.ncbi.nlm.nih.gov/pubmed/2302952) PUI L20086855 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1094 TITLE Critical care transport: A trauma perspective AUTHOR NAMES Grande C.M. AUTHOR ADDRESSES (Grande C.M.) Department of Anesthesiology, Maryland Institute for Emergency Medical Services Systems, 22 South Greene Street, Baltimore, MD 21201-1595 CORRESPONDENCE ADDRESS Department of Anesthesiology, Maryland Institute for Emergency Medical Services Systems, 22 South Greene Street, Baltimore, MD 21201-1595 SOURCE Critical Care Clinics (1990) 6:1 (165-183). Date of Publication: 1990 ISSN 0749-0704 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The realm of CCT is a challenging one, an arena open to advances in skills and technology that will improve the patient's ultimate outcome as well as provide that patient with the best possible conditions for transfer. Considering the background of skills and knowledge and anesthesiologist possesses, he or she is a 'natural' for this subspecialty. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn heart disease injury intensive care patient transport EMTREE MEDICAL INDEX TERMS anemia conference paper helicopter human hypoxia methodology organization and management physiology EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) Forensic Science Abstracts (49) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990084148 MEDLINE PMID 2404546 (http://www.ncbi.nlm.nih.gov/pubmed/2404546) PUI L20083804 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1095 TITLE From ICU to rehabilitation: a checklist to ease the transition for the spinal cord injured. AUTHOR NAMES Swarczinski C. Graham P. AUTHOR ADDRESSES (Swarczinski C.; Graham P.) Southeastern Michigan Spinal Cord Injury System, Rehabilitation Institute, Detroit 48201. CORRESPONDENCE ADDRESS C. Swarczinski, Southeastern Michigan Spinal Cord Injury System, Rehabilitation Institute, Detroit 48201. SOURCE The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses (1990) 22:2 (89-91). Date of Publication: Apr 1990 ISSN 0888-0395 ABSTRACT Spinal cord injuries are devastating. The injured person faces many unknowns including surgical procedures, hospitalization and rehabilitation. Frequently, the transition from acute care to rehabilitation is frightening. In the intensive care unit (ICU), the patient receives one-to-one nursing care and develops trust, but then may feel abandoned when faced with rehabilitation. In order to facilitate readiness for rehabilitation, coordinators of the Southeastern Michigan Spinal Cord Injury System proposed a checklist of activities designed to meet individual patient and family needs. Coordinators assess the patient within 24 hours of admission to the spinal ICU. The physiatrist is notified of the admission and recommends initial therapies as appropriate. The patient is followed through the acute phase and preparations are made for rehabilitation. A checklist format has been developed to coordinate the transfer. This article describes the checklist and its use at our institution. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical record patient care patient transport primary health care spinal cord injury (rehabilitation) EMTREE MEDICAL INDEX TERMS adaptive behavior article human intensive care nursing nursing assessment patient education psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 2139687 (http://www.ncbi.nlm.nih.gov/pubmed/2139687) PUI L20824614 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1096 TITLE Critical care air transportation of the severely injured: Does long distance transport adversely affect survival? AUTHOR NAMES Valenzuela T.D. Criss E.A. Copass M.K. Luna G.K. Rice C.L. AUTHOR ADDRESSES (Valenzuela T.D.; Criss E.A.; Copass M.K.; Luna G.K.; Rice C.L.) Section of Emergency Medicine, Arizona Health Science Center, 1501 North Campbell Avenue, Tucson, AZ 85724, United States. CORRESPONDENCE ADDRESS T.D. Valenzuela, Section of Emergency Medicine, Arizona Health Science Center, 1501 North Campbell Avenue, Tucson, AZ 85724, United States. SOURCE Annals of Emergency Medicine (1990) 19:2 (169-172). Date of Publication: 1990 ISSN 0196-0644 BOOK PUBLISHER Mosby Inc., 11830 Westline Industrial Drive, St. Louis, United States. ABSTRACT Civilian aeromedical transportation systems, both fixed and rotary wing, have proliferated since the middle 1970s. However, outcome data substantiating the benefit of these services have been slow in coming. From February 22, 1982, through March 5, 1984, Airlift Northwest transported 118 trauma patients (aged 15 years and older) an average distance of 340 miles (range, 100 to 800 miles) with fixed-wing aircraft. The in-hospital mortality for this group was 19% compared with 18% for a comparable group of trauma patients who were ground-transported from within the city limits of Seattle, Washington. The two groups did not differ significantly in age, Injury Severity Score, or Glasgow Coma Score. These results suggest that some part of the clinical benefit of a regional trauma center may be extended up to 800 miles with no increase in transport-related mortality. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air transportation coma resuscitation EMTREE MEDICAL INDEX TERMS aircraft article fatality human injury methodology organization and management priority journal EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990058186 MEDLINE PMID 2301795 (http://www.ncbi.nlm.nih.gov/pubmed/2301795) PUI L20057842 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1097 TITLE Secondary insults during intrahospital transport of head-injured patients AUTHOR NAMES Andrews P.J.D. Piper I.R. Dearden N.M. Miller J.D. AUTHOR ADDRESSES (Andrews P.J.D.; Piper I.R.; Dearden N.M.; Miller J.D.) Dept. Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2UX, United Kingdom. CORRESPONDENCE ADDRESS P.J.D. Andrews, Dept. Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2UX, United Kingdom. SOURCE Lancet (1990) 335:8685 (327-330). Date of Publication: 1990 ISSN 0140-6736 BOOK PUBLISHER Elsevier Limited, 32 Jamestown Road, London, United Kingdom. ABSTRACT Secondary pathophysiological insults occurring after injury have been prospectively assessed in 50 head-injured patients who required intrahospital transfer. 35 patients were transported from the intensive care unit (ICU) and 15 from the accident and emergency department. Physiological variables were recorded every minute in the four hours before transfer (ICU group only), during the move, and for four hours afterwards. Pretransfer insults were predictive of further insults during and after transport. There was significant correlation between increased frequency of insults post-transfer (compared with pre-transfer) and high injury severity score. A greater proportion of the patients transported from the emergency department had secondary injuries post-transfer. Adequate resuscitation before moving the patient, especially in patients with multiple injury, is important. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) brain ischemia coma head injury patient transport EMTREE MEDICAL INDEX TERMS article clinical article human priority journal EMBASE CLASSIFICATIONS Neurology and Neurosurgery (8) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990051611 MEDLINE PMID 1967776 (http://www.ncbi.nlm.nih.gov/pubmed/1967776) PUI L20051267 DOI 10.1016/0140-6736(90)90614-B FULL TEXT LINK http://dx.doi.org/10.1016/0140-6736(90)90614-B COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1098 TITLE Secondary transportation of intensive care patients in Switzerland ORIGINAL (NON-ENGLISH) TITLE SEKUNDARTRANSPORTE VON INTENSIVPATIENTEN IN DER SCHWEIZ AUTHOR NAMES Frutiger A. AUTHOR ADDRESSES (Frutiger A.) Interdisziplinare Intensivst., Kantonsspital Chur, CH-7000 Chur, Switzerland. CORRESPONDENCE ADDRESS A. Frutiger, Interdisziplinare Intensivst., Kantonsspital Chur, CH-7000 Chur, Switzerland. SOURCE Schweizerische Medizinische Wochenschrift (1990) 120:6 (159-163). Date of Publication: 1990 ISSN 0036-7672 BOOK PUBLISHER Schwabe A.G. Verlag, Steinentorstrasse 13, Basel, Switzerland. ABSTRACT This study addresses the frequency and circumstances of secondary transportation of intensive care patients in Switzerland by evaluation of a questionnaire sent to all recognized intensive care units. Surprisingly many critically ill (roughly speaking two full ICUs with 8 patients) are transferred daily between Swiss hospitals, which amounts of about 6000 transfers per year. Pediatric cases make up 1/4 of the transfers and follow a rather common pattern, since pediatric units prefer to pick up their patients in the primary hospital with their own personnel and also to transfer them later in the same way. For adult patients no common pattern is recognizable except as regards admissions, which are usually performed by the primary hospital's facilities. We suspect a considerable degree of improvisation around secondary transfers of adults. Well trained personnel, suitable ambulances, good communication and a reasonable degree of monitoring are desirable. Non invasive monitoring techniques are considered mandatory or at least helpful by most of the answering units, whereas invasive monitoring was generally judged superfluous. The large number of secondary patient transfers and their only moderately standardized organization patterns make further research desirable. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS conference paper organization and management patient monitoring priority journal Switzerland EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 1990048434 MEDLINE PMID 2305226 (http://www.ncbi.nlm.nih.gov/pubmed/2305226) PUI L20048090 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1099 TITLE Intrahospital transport of critically ill patients ORIGINAL (NON-ENGLISH) TITLE DER SPITALINTERNE TRANSPORT IM GROSSEN SPITAL AUTHOR NAMES Roth F. AUTHOR ADDRESSES (Roth F.) Abteilung fur Intensivbehandl., Inselspital, CH-3010 Bern, Switzerland. CORRESPONDENCE ADDRESS F. Roth, Abteilung fur Intensivbehandl., Inselspital, CH-3010 Bern, Switzerland. SOURCE Schweizerische Medizinische Wochenschrift (1990) 120:6 (164-169). Date of Publication: 1990 ISSN 0036-7672 BOOK PUBLISHER Schwabe A.G. Verlag, Steinentorstrasse 13, Basel, Switzerland. ABSTRACT In July 1989 an enquiry was conducted among all intensive care units with more than 6 beds regarding their experience of intrahospital transport of critically ill patients. The results are presented and commented on. The study then deals with some of the specific problems which arise when critically ill patients have to be moved within the hospital. Recent publications and our own experience concerning transport of ventilator-dependent patients suggest that there should at least be monitoring of expiratory volumes. Ventilation of the patient by portable mechanical ventilator has proven superior to manual ventilation since mechanical ventilation is more consistent and therefore fewer hemodynamic complications are to be expected. A simple device is described involving suction (by means of an injector run on oxygen) and an oxygen delivery system including an outlet into which the respirator can be plugged direct. A small shelf which can be easily attached to the bed has proven helpful during transport. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation intensive care unit patient transport EMTREE MEDICAL INDEX TERMS conference paper organization and management patient monitoring priority journal Switzerland EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1990048435 MEDLINE PMID 2305227 (http://www.ncbi.nlm.nih.gov/pubmed/2305227) PUI L20048091 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1100 TITLE Rapid transfer to the coronary unit of patients with acute myocardial infarct. Justification of the necessity and action measures ORIGINAL (NON-ENGLISH) TITLE El traslado rápido a la unidad coronaria de los enfermos con infarto agudo de miocardio. Justificación de su necesidad y medidas de actuación. AUTHOR NAMES Gausí Gené C. AUTHOR ADDRESSES (Gausí Gené C.) Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona. CORRESPONDENCE ADDRESS C. Gausí Gené, Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona. SOURCE Medicina clínica (1990) 94:7 (259-261). Date of Publication: 24 Feb 1990 ISSN 0025-7753 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart infarction (therapy) patient transport EMTREE MEDICAL INDEX TERMS coronary care unit human note time LANGUAGE OF ARTICLE Spanish MEDLINE PMID 2325488 (http://www.ncbi.nlm.nih.gov/pubmed/2325488) PUI L20753384 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1101 TITLE Law and the emergency nurse. Orders on admitted patients held in the emergency department. AUTHOR NAMES George J.E. Quattrone M.S. AUTHOR ADDRESSES (George J.E.; Quattrone M.S.) CORRESPONDENCE ADDRESS J.E. George, SOURCE Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association (1990) 16:1 (43). Date of Publication: 1990 Jan-Feb ISSN 0099-1767 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical protocol coronary care unit emergency health service patient transport EMTREE MEDICAL INDEX TERMS article hospital bed utilization human legal aspect nursing care standard United States LANGUAGE OF ARTICLE English MEDLINE PMID 2406495 (http://www.ncbi.nlm.nih.gov/pubmed/2406495) PUI L20811408 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1102 TITLE Intrahospital transport of seriously ill or injured children. AUTHOR NAMES Tompkins J.M. AUTHOR ADDRESSES (Tompkins J.M.) CORRESPONDENCE ADDRESS J.M. Tompkins, SOURCE Pediatric nursing (1990) 16:1 (51-53). Date of Publication: 1990 Jan-Feb ISSN 0097-9805 ABSTRACT Critically ill children are frequently subject to transfer between hospitals or even between units in hospitals. Safety is an important concern for the ensuing transport in order to minimize risk and maximize efficiency. Nurses should give careful consideration to many aspects of the intrahospital transport when planning the move. Principles outlined in this article can be included in critical care educational programs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) clinical protocol patient transport pediatric nursing EMTREE MEDICAL INDEX TERMS article child human organization and management patient care LANGUAGE OF ARTICLE English MEDLINE PMID 2359624 (http://www.ncbi.nlm.nih.gov/pubmed/2359624) PUI L20839805 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1103 TITLE Effect of opposite changes in cardiac output and arterial PO(2) on the relationship between mixed venous PO(2) and oxygen transport AUTHOR NAMES Carlile P.V. Gray B.A. AUTHOR ADDRESSES (Carlile P.V.; Gray B.A.) Pulmonary Disease and Critical Care Medicine Section, Veterans Administration Medical Center, Oklahoma City, OK CORRESPONDENCE ADDRESS Pulmonary Disease and Critical Care Medicine Section, Veterans Administration Medical Center, Oklahoma City, OK SOURCE American Review of Respiratory Disease (1989) 140:4 (891-898). Date of Publication: 1989 ISSN 0003-0805 BOOK PUBLISHER American Lung Association, 16 Broadway Fl 4, New York, United States. ABSTRACT We examined the relationship between changes in systemic oxygen transport (SO(2)T) and mixed venous PO(2) (Pv̄(O2)) in nine critically ill patients with acute respiratory failure and analyzed the effect of like and opposite changes in cardiac output (CO) and arterial PO(2) (Pa(O2)) on this relationship. Paired measurements of oxygen consumption (V̇O(2)), SO(2)T, and Pv̄(O2) were obtained before and after changes in the level of positive end-expiratory pressure (PEEP) equal to or more than 5 cm H(2)O. V̇O(2) was measured with a rebreathing circuit adapted to a volume ventilator, and SO(2)T was calculated from thermodilution CO, Pa(O2), Sa(O2), and hemoglobin. In eight studies, CO and Pa(O2) changed in the same direction, and the absolute change in SO(2)T averaged 48 ± 38 ml/min/m(2). In 12 studies, CO and Pa(O2) changed in opposite directions, and the absolute change in SO(2)T averaged 78 ± 69 ml/min/m(2). When Pa(O2) and CO changed in the same direction, Pv̄(O2) increased on the higher level of SO(2)T (average difference 3.0 ± 3.7 mm Hg, p < 0.05) and there was a strong positive correlation between the difference in SO(2)T on lower and higher levels of PEEP and the difference in Pv̄(O2) (r = 0.83). When Pa(O2) and CO changed in opposite directions, Pv̄(O2) was unchanged on the higher level of SO(2)T, and there was no correlation between the difference in SO(2)T on lower and higher levels of PEEP and the difference in Pv̄(O2) (r = -0.45). V̇O(2) was not different at the lower and higher levels of PEEP and the difference in Pv̄O(2) (r = -0.45). V̇O(2) was not different at the lower and higher levels of SO(2)T in both groups, indicating that V̇O(2) was not transport-limited in these patients. We conclude that unidirectional changes in CO and Pa(O2) produced like changes in Pv̄(O2), whereas the relationship between SO(2)T and Pv̄(O2) is inconsistent when opposite changes in CO and Pa(O2) occur. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acute respiratory failure arterial oxygen tension heart output oxygen transport EMTREE MEDICAL INDEX TERMS artificial ventilation human hypoxemia intensive care unit oxygen consumption positive end expiratory pressure priority journal venous oxygen tension EMBASE CLASSIFICATIONS Physiology (2) Internal Medicine (6) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1989259529 MEDLINE PMID 2508523 (http://www.ncbi.nlm.nih.gov/pubmed/2508523) PUI L19259483 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1104 TITLE Maintaining continuity of care: transferring patients from the CCU. AUTHOR NAMES Appel-Hardin S.J. AUTHOR ADDRESSES (Appel-Hardin S.J.) CORRESPONDENCE ADDRESS S.J. Appel-Hardin, SOURCE Critical care nurse (1989) 9:9 (92-94). Date of Publication: Oct 1989 ISSN 0279-5442 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit medical record patient care patient transport primary health care EMTREE MEDICAL INDEX TERMS article human interpersonal communication LANGUAGE OF ARTICLE English MEDLINE PMID 2805770 (http://www.ncbi.nlm.nih.gov/pubmed/2805770) PUI L19512422 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1105 TITLE Front-page coverage. AUTHOR NAMES Stephens B. AUTHOR ADDRESSES (Stephens B.) CORRESPONDENCE ADDRESS B. Stephens, SOURCE Profiles in healthcare marketing (1989) :36 (46-49). Date of Publication: Oct 1989 ISSN 1040-7480 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport public relations publication EMTREE MEDICAL INDEX TERMS article hospital bed capacity intensive care unit United States utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 10295710 (http://www.ncbi.nlm.nih.gov/pubmed/10295710) PUI L19493550 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1106 TITLE Transportation of very low birthweight infants in 1986 AUTHOR NAMES Cull A.B. Darlow B.A. Knight D.B. AUTHOR ADDRESSES (Cull A.B.; Darlow B.A.; Knight D.B.) Christchurch School of Medicine, Christchurch CORRESPONDENCE ADDRESS Christchurch School of Medicine, Christchurch SOURCE New Zealand Medical Journal (1989) 102:869 (275-277). Date of Publication: 1989 ISSN 0028-8446 BOOK PUBLISHER New Zealand Medical Association, 26 The Terrace, P.O. Box 156, Wellington, New Zealand. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit low birth weight patient transport EMTREE MEDICAL INDEX TERMS clinical article human infant EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1989221921 MEDLINE PMID 2733902 (http://www.ncbi.nlm.nih.gov/pubmed/2733902) PUI L19221879 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1107 TITLE Role of the oncology nurse when the patient with cancer is transferred to the critical care unit. AUTHOR NAMES Griffin J.P. Comley C. AUTHOR ADDRESSES (Griffin J.P.; Comley C.) CORRESPONDENCE ADDRESS J.P. Griffin, SOURCE Oncology nursing forum (1989) 16:5 (703-707). Date of Publication: 1989 Sep-Oct ISSN 0190-535X ABSTRACT Patients with cancer can become critically ill from treatment-related complications or from progressive disease. The oncology nurse can positively influence the care of the patient and family during and after transfer to the Intensive Care Unit (ICU) by maintaining a strong advocacy role. Patient and family education can prevent or alleviate many of the psychological discomforts precipitated by critical illness. Open communication between the oncology and critical care staff can ease discussion about ethical issues. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit oncology nursing patient transport EMTREE MEDICAL INDEX TERMS article family human mental stress nursing patient advocacy patient education LANGUAGE OF ARTICLE English MEDLINE PMID 2780406 (http://www.ncbi.nlm.nih.gov/pubmed/2780406) PUI L19483684 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1108 TITLE Criteria predicting bad outcome before transfer to a critical care unit AUTHOR NAMES Badlissi A. Baigelman W. Beiser A. Gannon D. Goldiron J. AUTHOR ADDRESSES (Badlissi A.; Baigelman W.; Beiser A.; Gannon D.; Goldiron J.) Pulmonary Medicine Unit, Waterbury Hospital, Waterbury, CT CORRESPONDENCE ADDRESS Pulmonary Medicine Unit, Waterbury Hospital, Waterbury, CT SOURCE Journal of Critical Care (1989) 4:2 (78-82). Date of Publication: 1989 ISSN 0883-9441 ABSTRACT The charts of 225 hospitalized patients who were transferred into a critical care unit were reviewed to variables that might be useful for identifying a bad outcome by the time of discharge of 6-month follow-up. An age of more than 65 years, the pre-hospital admission function status, the presence of hypotension, and respiratory decompensation individually correlated well with a bad outcome. Combinations of these variables were capable of identifying individuals who were almost certain to have a bad outcome. We conclude that charts and nomograms can be created applying simple and readily available objective data that will permit physicians with triage responsibility for critical care units to limit access for some patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hemodynamic monitoring intensive care unit risk factor EMTREE MEDICAL INDEX TERMS age human hypotension major clinical study mortality EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1989146463 PUI L19146421 DOI 10.1016/0883-9441(89)90121-4 FULL TEXT LINK http://dx.doi.org/10.1016/0883-9441(89)90121-4 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1109 TITLE Comparison of neonatal mortality rates between transports to tertiary and intermediate neonatal intensive care units. AUTHOR NAMES Chan L.S. Vogt J.F. Winters L. AUTHOR ADDRESSES (Chan L.S.; Vogt J.F.; Winters L.) Department of Pediatrics, School of Medicine, University of Southern California, Los Angeles 90033. CORRESPONDENCE ADDRESS L.S. Chan, Department of Pediatrics, School of Medicine, University of Southern California, Los Angeles 90033. SOURCE Journal of perinatology : official journal of the California Perinatal Association (1989) 9:2 (141-146). Date of Publication: Jun 1989 ISSN 0743-8346 ABSTRACT The differential of neonatal mortality rates between infant transports to tertiary and to intermediate neonatal intensive care units (NICUs) was examined based on 8,391 one-time infant transports from community hospitals to tertiary or intermediate NICUs in Southern California in the three-year period 1981-1983. Among the demographic, birth and delivery, and diagnostic characteristics studied, nine were identified to be related significantly to the higher neonatal mortality rate among transports to tertiary NICUs: birthweight, gestational age, necessity of intubation, multiple clinical conditions, presence of cardiac, neurologic, and genitourinary problems, anomalies, and syndromes. Adjusting for differences in the number of cases with necessity of intubation and the presence of the five clinical problems reduced the neonatal mortality ratio of tertiary to intermediate NICUs from 1:56 to 1:01, while adjustment for birthweight and gestational age differences reduced the ratio from 1.56 to 1.54. This analysis indicates that the difference of neonatal mortality between the two levels of NICUs can be explained to a larger extent by the higher proportion of infants requiring intubation with serious clinical problems. Birthweight and gestational age played only a minor role in this respect. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) infant mortality newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS Apgar score article birth weight classification comparative study congenital malformation gestational age heart disease (complication) human intubation neurologic disease (complication) newborn syndrome urogenital system LANGUAGE OF ARTICLE English MEDLINE PMID 2738723 (http://www.ncbi.nlm.nih.gov/pubmed/2738723) PUI L19443397 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1110 TITLE A turnaround tale. AUTHOR NAMES Murphy B. AUTHOR ADDRESSES (Murphy B.) CORRESPONDENCE ADDRESS B. Murphy, SOURCE The American journal of nursing (1989) 89:6 (810). Date of Publication: Jun 1989 ISSN 0002-936X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospice intensive care unit patient transport EMTREE MEDICAL INDEX TERMS letter organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 2729365 (http://www.ncbi.nlm.nih.gov/pubmed/2729365) PUI L19437139 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1111 TITLE Need for ICU transfer questioned. AUTHOR NAMES Alexander B. AUTHOR ADDRESSES (Alexander B.) CORRESPONDENCE ADDRESS B. Alexander, SOURCE Oncology nursing forum (1989) 16:3 (316). Date of Publication: 1989 May-Jun ISSN 0190-535X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care oncology nursing patient transport EMTREE MEDICAL INDEX TERMS education human note psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 2734212 (http://www.ncbi.nlm.nih.gov/pubmed/2734212) PUI L19438165 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1112 TITLE Training and development of the ICU nurse for critical care transport. AUTHOR NAMES Dyer L.L. AUTHOR ADDRESSES (Dyer L.L.) CORRESPONDENCE ADDRESS L.L. Dyer, SOURCE Critical care nurse (1989) 9:4 (74-80). Date of Publication: Apr 1989 ISSN 0279-5442 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) in service training intensive care nursing staff patient transport EMTREE MEDICAL INDEX TERMS article education human United States university hospital LANGUAGE OF ARTICLE English MEDLINE PMID 2582812 (http://www.ncbi.nlm.nih.gov/pubmed/2582812) PUI L19515878 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1113 TITLE Changes in homeostatic parameters during transportation of patients from the operating room to the resuscitation and intensive care unit ORIGINAL (NON-ENGLISH) TITLE Izmenenie nekotorykh pokazateleǐ gomeostaza v period transportirovki bol'nykh iz operatsionnoǐ v otdelenie reanimatsii i intensivnoǐ terapii. AUTHOR NAMES Gochashvili N.D. Grishchenko M.N. AUTHOR ADDRESSES (Gochashvili N.D.; Grishchenko M.N.) CORRESPONDENCE ADDRESS N.D. Gochashvili, SOURCE Anesteziologiia i reanimatologiia (1989) :2 (19-21). Date of Publication: 1989 Mar-Apr ISSN 0201-7563 ABSTRACT Oxygen balance, acid-base balance, systolic and diastolic blood pressure, heart rate, central and peripheral temperature have been investigated in patients after abdominal, thoracic and vascular surgery during transportation from the operation room into an intensive care unit, using different respiratory techniques and inhaled mixture composition. It has been shown that spontaneous respiration leads to the onset of arterial hypoxemia, which is more pronounced in patients after thoracic surgery. Inhalation of vapourized O2 through nasal catheters during transportation reduces the incidence and degree of arterial hypoxemia. Assisted lung ventilation with O2 prevents the onset of arterial hypoxemia during transportation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) homeostasis intensive care unit operating room patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article female human male middle aged LANGUAGE OF ARTICLE Russian MEDLINE PMID 2742180 (http://www.ncbi.nlm.nih.gov/pubmed/2742180) PUI L19450871 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1114 TITLE Nursing frontiers. Critical care in the air. AUTHOR NAMES Guest J.L. AUTHOR ADDRESSES (Guest J.L.) CORRESPONDENCE ADDRESS J.L. Guest, SOURCE Journal of Christian nursing : a quarterly publication of Nurses Christian Fellowship (1989) 6:2 (17-21). Date of Publication: 1989 Spring ISSN 0743-2550 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aerospace medicine intensive care patient transport EMTREE MEDICAL INDEX TERMS aircraft article human LANGUAGE OF ARTICLE English MEDLINE PMID 2926644 (http://www.ncbi.nlm.nih.gov/pubmed/2926644) PUI L19392315 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1115 TITLE Use of mobile coronary care unit by patients with myocardial infarction AUTHOR NAMES Galimidi J. Tamir A. Egoz N. AUTHOR ADDRESSES (Galimidi J.; Tamir A.; Egoz N.) CORRESPONDENCE ADDRESS J. Galimidi, SOURCE Harefuah (1989) 116:4 (199-202). Date of Publication: 15 Feb 1989 ISSN 0017-7768 ABSTRACT 140 consecutive patients with MI, all those admitted during 1 month to 3 general hospitals in Haifa, were interviewed and their records reviewed. Only 17.3% had been transferred by a mobile coronary care unit (MCCU). The rates of utilization were lower among residents of the Mount Carmel area and among those hospitalized in Carmel Hospital. Those of European origin used MCCU less than those of Asian-African origin. The rate of usage was inversely related to the level of education. Multivariate analysis showed that the continent of origin explained the largest proportion of the variance. Age of patient and day of week were not of significance. Patients who had had a previous coronary event used the MCCU more than those had not. Only 13% referred to hospitals by physicians in the community were transferred by MCCU, in contrast to 33% of those referred by Magen David Adom stations. 67% of the patients had prior knowledge of the MCCU, but this was not associated with rate of usage. We conclude that the use of the MCCU in the Haifa area is not consistent with its original objectives. The reasons are both patient- and service-related. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart infarction patient transport preventive health service EMTREE MEDICAL INDEX TERMS Africa article Asia ethnology Europe hospitalization human Israel socioeconomics utilization review LANGUAGE OF ARTICLE Hebrew MEDLINE PMID 2731787 (http://www.ncbi.nlm.nih.gov/pubmed/2731787) PUI L19448717 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1116 TITLE Intraclinical transport of intensive care patients ORIGINAL (NON-ENGLISH) TITLE INNERKLINISCHER TRANSPORT VON INTENSIVPATIENTEN: ERSTE ERFAHRUNGEN AUTHOR NAMES Pehl S. Claus S. Brost F. Jantzen J.-P. Dick W. AUTHOR ADDRESSES (Pehl S.; Claus S.; Brost F.; Jantzen J.-P.; Dick W.) Klinik fur Anasthesiologie der Johannes-Gutenberg-Universitat, D-6500 Mainz CORRESPONDENCE ADDRESS Klinik fur Anasthesiologie der Johannes-Gutenberg-Universitat, D-6500 Mainz SOURCE Notfall Medizin (1988) 14:11 (949-954). Date of Publication: 1988 ISSN 0341-2903 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS high risk patient human organization organization and management EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 1988276863 PUI L18276859 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1117 TITLE Risk, cost, and benefit of transporting ICU patients for special studies AUTHOR NAMES Indeck M. Peterson S. Smith J. Brotman S. AUTHOR ADDRESSES (Indeck M.; Peterson S.; Smith J.; Brotman S.) Department of Trauma Surgery, Geisinger Medical Center, Danville, PA 17822 CORRESPONDENCE ADDRESS Department of Trauma Surgery, Geisinger Medical Center, Danville, PA 17822 SOURCE Journal of Trauma (1988) 28:7 (1020-1025). Date of Publication: 1988 ISSN 0022-5282 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Prospective evaluation of 103 consecutive transports for diagnostic studies of 56 patients out of the Shock Trauma Unit over a 3-month period was done to document physiologic changes, the cost of each transport, and to assess whether the information gained was utilized to change patient management. Of the 56 patients, 36 (65%) were males and 20 (35%) were females with an age range of 14-82 years (mean, 48 years). The Apache II score ranged from 3-49 (mean, 19.4). There were seven types of diagnostic studies: CT of the head (28), CT of abdomen (35), CT of chest (four), angiography (nine), ventilation/perfusion scan (three), tomography (seven) and miscellaneous studies (15). The average trip time was 81 minutes, a range of 15-210, requiring an average of 3.3 personnel per trip. Ninety-four transported patients had ventilatory support, 26 had PA lines, and 26 transports required three or more IV infusion pumps. Sixty-eight per cent of all transports experienced serious physiologic changes of 5 minutes' duration defined as BP systolic or diastolic ± 20 mm Hg (40%), pulse ± 20 beats/minute (21%), ventilatory rate ± 5/minute (20%), O(2) saturation decrease by 5% or more (17%). There was a total of 113 serious changes requiring an increase in support of the patient during the transport. There were no significant differences when comparing diagnosis of patient or types of studies to the number of changes in the physiologic parameters, nor were there significant differences within a physiologic parameter when comparing patient types or diagnostic studies. Twenty-five of the transports resulted in a change in patient management within 48 hours. However, no diagnostic study produced a significantly greater number of management changes. The average transport cost per patient was $465.00. Transportation of patients from the ICU resulted in a large number of physiologic changes, each requiring changes in support, therefore suggesting a need for the preservation of equally intensive monitoring and care of these patients during transports. The indications for diagnostic studies must be weighed against a 76% chance that the result will not alter the patient's management. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cardiopulmonary hemodynamics computer assisted tomography cost hospital intensive care lung ventilation nuclear magnetic resonance patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged complication computer analysis diagnosis economic aspect female human major clinical study male organization and management priority journal EMBASE CLASSIFICATIONS Surgery (9) Health Policy, Economics and Management (36) Forensic Science Abstracts (49) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1988204540 MEDLINE PMID 3135417 (http://www.ncbi.nlm.nih.gov/pubmed/3135417) PUI L18204540 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1118 TITLE The child requiring critical care transport. AUTHOR NAMES McCloskey K.A. AUTHOR ADDRESSES (McCloskey K.A.) CORRESPONDENCE ADDRESS K.A. McCloskey, SOURCE Pediatric emergency care (1988) 4:3 (230-231). Date of Publication: Sep 1988 ISSN 0749-5161 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS aircraft child human letter organization and management patient care planning LANGUAGE OF ARTICLE English MEDLINE PMID 3186534 (http://www.ncbi.nlm.nih.gov/pubmed/3186534) PUI L18819097 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1119 TITLE Physician-accompanied transport of surgical intensive care patients AUTHOR NAMES Girotti M.J. Pagliarello G. Todd T.R. Demajo W. Cain J. Walker P. Patterson A. AUTHOR ADDRESSES (Girotti M.J.; Pagliarello G.; Todd T.R.; Demajo W.; Cain J.; Walker P.; Patterson A.) Surgical Intensive Care Research Group, Department of Surgery, Toronto General Hospital, Toronto, Ont. M5G 2C4 CORRESPONDENCE ADDRESS Surgical Intensive Care Research Group, Department of Surgery, Toronto General Hospital, Toronto, Ont. M5G 2C4 SOURCE Canadian Journal of Anaesthesia (1988) 35:3 I (303-308). Date of Publication: 1988 ISSN 0832-610X BOOK PUBLISHER Canadian Anaesthetists' Society, 1 Eglinton Avenue East, Suite 208, Toronto, Canada. ABSTRACT During a one-year period, 107 critically ill adult patients were transferred by a physician-accompanied transport system (PATS). Most patients required both tracheal intubation (82 per cent) and mechanical ventilation (71 per cent), while continuous vasopressor support was required in 27 per cent of transfers. Patients were classified as either potential organ donors (n = 21) or nondonor patients (n = 86). Nondonor patients had a mean time of patient transfer documented from the initial telephone contact to final arrival of the patient in the ICU of 345 ± 221 min (range 65-1350 min); the mean time the patients were out-of-hospital was 73 ± 58 min (range 5-330 min); the average distance travelled by the patient and PATS was 342 ± 692 km (range 1-4000 km). Ultimate nonsurvivors of ICU admission (36 per cent) had shorter out-of-hospital times, shorter travel distances, and increased interventional support, as assessed by the Therapeutic Intervention Scoring System applied over the telephone and prior to departure at the referring hospital. Significant interventions were undertaken by PATS in 23 per cent of the nondonor patients prior to departure. During the transport process, there was at least a seven per cent morbidity (arrhythmia, hypotension, and vehicular difficulties) and a 0.9 mortality rate. We conclude that PATS offered significant advantages to this patient population through its ability to maintain acceptable morbidity and mortality rates while transferring patients over long distances and for prolonged periods of time. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit organ donor survival EMTREE MEDICAL INDEX TERMS blunt trauma fatality human mortality organization and management review sepsis EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY French, English EMBASE ACCESSION NUMBER 1988132062 MEDLINE PMID 3383322 (http://www.ncbi.nlm.nih.gov/pubmed/3383322) PUI L18132062 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1120 TITLE Nursing interventions: caring for parents of a newborn transferred to a regional intensive care nursery--a challenge for low risk obstetric specialists. AUTHOR NAMES Weingarten C.T. AUTHOR ADDRESSES (Weingarten C.T.) College of Nursing, Villanova University, PA 19085-1690. CORRESPONDENCE ADDRESS C.T. Weingarten, College of Nursing, Villanova University, PA 19085-1690. SOURCE Journal of perinatology : official journal of the California Perinatal Association (1988) 8:3 (271-275). Date of Publication: 1988 Summer ISSN 0743-8346 ABSTRACT Parents of infants transferred to a regional NICU have unique needs for support when the mother remains in the hospital of birth. Suddenly in a high risk situation and faced with family separation, these parents may display intense grief and crisis reactions related to their infant's status and transfer. The high risk interventions they require are frequently incongruent with the wellness orientation of staff specializing in care of the low risk clients. Nevertheless, low risk specialists have a critical role in assisting parents through this difficult transition to parenthood. Effective strategies are based upon: understanding that at some point infants requiring transfer to a regional NICU will be born; advance planning to prepare staff to assist parents during this type of crisis; establishing an ongoing relationship with staff from the regional NICU; and identification of crisis support networks available to parents and to staff within the low risk setting. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mother newborn intensive care obstetrical nursing EMTREE MEDICAL INDEX TERMS article crisis intervention female grief human methodology mother child relation newborn patient care planning patient transport psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 3225670 (http://www.ncbi.nlm.nih.gov/pubmed/3225670) PUI L19375639 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1121 TITLE Medical directors of critical care air transport services. AUTHOR NAMES White J.D. AUTHOR ADDRESSES (White J.D.) CORRESPONDENCE ADDRESS J.D. White, SOURCE Critical care medicine (1988) 16:5 (570-571). Date of Publication: May 1988 ISSN 0090-3493 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS aircraft letter organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 3359799 (http://www.ncbi.nlm.nih.gov/pubmed/3359799) PUI L18747261 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1122 TITLE Critical care helicopter service: evaluation of prehospital utilization in trauma care. AUTHOR NAMES Kazarian K.K. AUTHOR ADDRESSES (Kazarian K.K.) CORRESPONDENCE ADDRESS K.K. Kazarian, SOURCE Connecticut medicine (1988) 52:5 (317). Date of Publication: May 1988 ISSN 0010-6178 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aircraft emergency health service patient transport EMTREE MEDICAL INDEX TERMS human letter utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 3402215 (http://www.ncbi.nlm.nih.gov/pubmed/3402215) PUI L18779435 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1123 TITLE Critical care helicopter service. Evaluation of prehospital utilization in trauma care. AUTHOR NAMES Schwartz R.J. Jacobs L.M. AUTHOR ADDRESSES (Schwartz R.J.; Jacobs L.M.) CORRESPONDENCE ADDRESS R.J. Schwartz, SOURCE Connecticut medicine (1988) 52:4 (203-208). Date of Publication: Apr 1988 ISSN 0010-6178 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aircraft emergency health service patient transport EMTREE MEDICAL INDEX TERMS adolescent adult aged article child female human male middle aged traffic accident United States LANGUAGE OF ARTICLE English MEDLINE PMID 3370977 (http://www.ncbi.nlm.nih.gov/pubmed/3370977) PUI L18760938 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1124 TITLE Risks in intrahospital transport. AUTHOR NAMES Wright I. Rogers P.N. Ridley S. AUTHOR ADDRESSES (Wright I.; Rogers P.N.; Ridley S.) CORRESPONDENCE ADDRESS I. Wright, SOURCE Annals of internal medicine (1988) 108:4 (638). Date of Publication: Apr 1988 ISSN 0003-4819 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS human intensive care letter methodology LANGUAGE OF ARTICLE English MEDLINE PMID 3348578 (http://www.ncbi.nlm.nih.gov/pubmed/3348578) PUI L18731248 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1125 TITLE Written policy and patient transport from the intensive care unit. AUTHOR NAMES Smith I.U. Fleming S. Bekes C.E. AUTHOR ADDRESSES (Smith I.U.; Fleming S.; Bekes C.E.) CORRESPONDENCE ADDRESS I.U. Smith, SOURCE Critical care medicine (1987) 15:12 (1162). Date of Publication: Dec 1987 ISSN 0090-3493 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit management patient transport EMTREE MEDICAL INDEX TERMS accident prevention human letter organization and management standard LANGUAGE OF ARTICLE English MEDLINE PMID 3677771 (http://www.ncbi.nlm.nih.gov/pubmed/3677771) PUI L18672002 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1126 TITLE Medical directors of critical care air transport services AUTHOR NAMES Poulton T.J. Kisicki P.A. AUTHOR ADDRESSES (Poulton T.J.; Kisicki P.A.) Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68131 CORRESPONDENCE ADDRESS Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68131 SOURCE Critical Care Medicine (1987) 15:8 (784-785). Date of Publication: 1987 ISSN 0090-3493 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Since 1975, the number of hospital-based, air medical transport services in the United States has increased from under ten to over 100. Since approximately 70% of flights in the typical flight program transport a critical patient between hospitals, we expected critical care specialists to be involved in the medical direction of many flight programs. To determine how many are directing such programs, we designed a survey of the qualifications, specialties, and aeromedical and critical care training of those medical directors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) air transportation critical illness organization patient transport EMTREE MEDICAL INDEX TERMS clinical article human organization and management EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1988055669 MEDLINE PMID 3608535 (http://www.ncbi.nlm.nih.gov/pubmed/3608535) PUI L18055669 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1127 TITLE Complications of intrahospital transport in critically ill patients AUTHOR NAMES Braman S.S. Dunn S.M. Amico C.A. Millman R.P. AUTHOR ADDRESSES (Braman S.S.; Dunn S.M.; Amico C.A.; Millman R.P.) Rhode Island Hospital, Division of Pulmonary and Critical Care Medicine, Providence, RI 02903 CORRESPONDENCE ADDRESS Rhode Island Hospital, Division of Pulmonary and Critical Care Medicine, Providence, RI 02903 SOURCE Annals of Internal Medicine (1987) 107:4 (469-473). Date of Publication: 1987 ISSN 0003-4819 BOOK PUBLISHER American College of Physicians, 190 N. Indenpence Mall West, Philadelphia, United States. ABSTRACT To determine the frequency of hemodynamic and respiratory complications during movement within the hospital, we conducted a prospective study involving 36 critically ill, ventilator-dependent patients who needed procedures done outside the intensive care unit. During the first 20 transports, patients received ventilation through a manual resuscitation bag. Arterial blood gas measurements showed frequent changes from baseline with alterations in P(CO(2)) (> 10 torr) or pH (> 0.05) occurring on 14 occasions. In a subsequent study, 16 patients received ventilation during transit with the aid of a portable mechanical ventilator. Although 6 patients showed changes in arterial blood gas values, mean changes in P(CO(2)) and pH were significantly less than in the group that received manual ventilatory support (p < 0.01). Hemodynamic complications of hypotension and cardiac arrhythmia showed a significant correlation with disturbances in arterial blood gases (p < 0.05). Although limited by the lack of a control period, this study shows that the transport of critically ill patients may result in severe hemodynamic complications; it also suggests that these complications might be prevented by more careful monitoring of ventilation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital transport system ventilator EMTREE MEDICAL INDEX TERMS cardiovascular system clinical article human intensive care therapy EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1987217260 MEDLINE PMID 3477105 (http://www.ncbi.nlm.nih.gov/pubmed/3477105) PUI L17149760 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1128 TITLE An organizational system for critical care transport AUTHOR NAMES Hackel A. AUTHOR ADDRESSES (Hackel A.) Department of Anesthesia, Stanford University School of Medicine, Stanford, CA CORRESPONDENCE ADDRESS Department of Anesthesia, Stanford University School of Medicine, Stanford, CA SOURCE International Anesthesiology Clinics (1987) 25:2 (1-13). Date of Publication: 1987 ISSN 0020-5907 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS human LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1987178501 MEDLINE PMID 3610342 (http://www.ncbi.nlm.nih.gov/pubmed/3610342) PUI L17111001 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1129 TITLE Reducing in-house transfers improves cost effectiveness. AUTHOR NAMES Deines E. Stevens B. AUTHOR ADDRESSES (Deines E.; Stevens B.) CORRESPONDENCE ADDRESS E. Deines, SOURCE Nursing management (1987) 18:9 (54-57). Date of Publication: Sep 1987 ISSN 0744-6314 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport EMTREE MEDICAL INDEX TERMS article cost cost benefit analysis economics human productivity task performance time LANGUAGE OF ARTICLE English MEDLINE PMID 3114689 (http://www.ncbi.nlm.nih.gov/pubmed/3114689) PUI L17784567 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1130 TITLE Early recanalization in acute myocardial infarction: the role of the community hospital AUTHOR NAMES Aziz D.A. Landau E. Gotsman M. Reisin L.H. AUTHOR ADDRESSES (Aziz D.A.; Landau E.; Gotsman M.; Reisin L.H.) CORRESPONDENCE ADDRESS D.A. Aziz, SOURCE Harefuah (1987) 112:12 (592-593). Date of Publication: 15 Jun 1987 ISSN 0017-7768 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) streptokinase (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) community hospital coronary care unit heart infarction (therapy) hospital patient transport EMTREE MEDICAL INDEX TERMS article heart catheterization human percutaneous transluminal angioplasty time CAS REGISTRY NUMBERS streptokinase (9002-01-1) LANGUAGE OF ARTICLE Hebrew MEDLINE PMID 2962913 (http://www.ncbi.nlm.nih.gov/pubmed/2962913) PUI L18694239 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1131 TITLE Critical care transport. AUTHOR ADDRESSES SOURCE International anesthesiology clinics (1987) 25:2 (1-173). Date of Publication: 1987 Summer ISSN 0020-5907 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS article human LANGUAGE OF ARTICLE English MEDLINE PMID 3610343 (http://www.ncbi.nlm.nih.gov/pubmed/3610343) PUI L17780018 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1132 TITLE A pressure-limited critical care ventilator AUTHOR NAMES Morris A.H. Myers L. AUTHOR ADDRESSES (Morris A.H.; Myers L.) Pulmonary Division, LDS Hospital, Salt Lake City, UT 84143 CORRESPONDENCE ADDRESS Pulmonary Division, LDS Hospital, Salt Lake City, UT 84143 SOURCE Respiratory Care (1987) 32:3 (172-177). Date of Publication: 1987 ISSN 0020-1324 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation patient transport ventilator EMTREE MEDICAL INDEX TERMS devices nonhuman peak expiratory flow preliminary communication pressure respiratory system therapy EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1987097228 MEDLINE PMID 10315728 (http://www.ncbi.nlm.nih.gov/pubmed/10315728) PUI L17029728 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1133 TITLE Easing the transfer from CCU. AUTHOR NAMES Craney J.M. Greck D.L. AUTHOR ADDRESSES (Craney J.M.; Greck D.L.) CORRESPONDENCE ADDRESS J.M. Craney, SOURCE The American journal of nursing (1987) 87:5 (618-619). Date of Publication: May 1987 ISSN 0002-936X EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) information processing medical record nursing patient transport EMTREE MEDICAL INDEX TERMS article coronary care unit human organization and management progressive patient care LANGUAGE OF ARTICLE English MEDLINE PMID 3646837 (http://www.ncbi.nlm.nih.gov/pubmed/3646837) PUI L17730337 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1134 TITLE Transfer stress in patients after myocardial infarction. AUTHOR NAMES Schactman M. AUTHOR ADDRESSES (Schactman M.) CORRESPONDENCE ADDRESS M. Schactman, SOURCE Focus on critical care / American Association of Critical-Care Nurses (1987) 14:2 (34-37). Date of Publication: Apr 1987 ISSN 0736-3605 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart infarction mental stress patient transport EMTREE MEDICAL INDEX TERMS article coronary care unit human progressive patient care psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 3646146 (http://www.ncbi.nlm.nih.gov/pubmed/3646146) PUI L17733767 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1135 TITLE Genetic and biochemical study of allelic variants of hypoxanthine phosphoribosyl transferase in house mice AUTHOR NAMES Bochkarev M.N. Kulbakina N.A. Zakiyan S.M. AUTHOR ADDRESSES (Bochkarev M.N.; Kulbakina N.A.; Zakiyan S.M.) Institute of Cytology and Genetics, Academy of Sciences of the USSR, Siberian Branch, Novosibirsk CORRESPONDENCE ADDRESS Institute of Cytology and Genetics, Academy of Sciences of the USSR, Siberian Branch, Novosibirsk SOURCE Doklady Biological Sciences (1986) 288:1-6 (304-306). Date of Publication: 1986 ISSN 0012-4966 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hypoxanthine phosphoribosyltransferase EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) allele genetic polymorphism EMTREE MEDICAL INDEX TERMS animal cell heredity mouse nonhuman CAS REGISTRY NUMBERS hypoxanthine phosphoribosyltransferase (9016-12-0) EMBASE CLASSIFICATIONS Human Genetics (22) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1987050650 PUI L17218795 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1136 TITLE Conditions for transportation to specialized burn units ORIGINAL (NON-ENGLISH) TITLE Podmínky transportu na specializované popáleninové pracoviste. AUTHOR NAMES Königová R. Klimes J. AUTHOR ADDRESSES (Königová R.; Klimes J.) CORRESPONDENCE ADDRESS R. Königová, SOURCE Rozhledy v chirurgii : mesícník Ceskoslovenské chirurgické spolecnosti (1986) 65:12 (797-801). Date of Publication: Dec 1986 ISSN 0035-9351 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (diagnosis, therapy) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article human LANGUAGE OF ARTICLE Czech MEDLINE PMID 3810320 (http://www.ncbi.nlm.nih.gov/pubmed/3810320) PUI L17688094 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1137 TITLE Emergency Nurses Association/National Flight Nurses Association joint position paper: staffing of critical care air medical transport services. AUTHOR ADDRESSES SOURCE Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association (1986) 12:6 (16A-19A). Date of Publication: 1986 Nov-Dec ISSN 0099-1767 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service patient transport personnel management EMTREE MEDICAL INDEX TERMS article human manpower nursing organization United States LANGUAGE OF ARTICLE English MEDLINE PMID 3540400 (http://www.ncbi.nlm.nih.gov/pubmed/3540400) PUI L17671213 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1138 TITLE Transfer to a public hospital. A prospective study of 467 patients AUTHOR NAMES Schiff R.L. Ansell D.A. Schlosser J.E. AUTHOR ADDRESSES (Schiff R.L.; Ansell D.A.; Schlosser J.E.) Division of General Medicine, Department of Medicine, Cook County Hospital, Chicago, IL 60612 CORRESPONDENCE ADDRESS Division of General Medicine, Department of Medicine, Cook County Hospital, Chicago, IL 60612 SOURCE New England Journal of Medicine (1986) 314:9 (552-557). Date of Publication: 1986 ISSN 0028-4793 ABSTRACT In recent years there has been a dramatic increase in the number of patients transferred to public hospitals in the United States. We prospectively studied 467 medical and surgical patients who were transferred from the emergency departments of other hospitals in the Chicago area to Cook County Hospital and subsequently admitted. Eighty-nine percent of the transferred patients were black or Hispanic, and 81 percent were unemployed. Most (87 percent) were transferred because they lacked adequate medical insurance. Only 6 percent of the patients had given written informed consent for transfer. Twenty-two percent required admission to an intensive care unit, usually within 24 hours of arrival. Twenty-four percent were in an unstable clinical condition at the transferring hospital. The proportion of transferred medical-service patients who died was 9.4 percent, which was significantly higher than the proportion of medical-service patients who were not transferred (3.8 percent, P < 0.01). There was no significant difference in the proportion of deaths on the surgical service between patients who were transferred and those who were not (1.5 vs. 2.4 percent). We conclude that patients are transferred to public hospitals predominantly for economic reasons, in spite of the fact that many of them are in an unstable condition at the time of transfer. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) admission ethics health insurance health status intensive care unit patient referral public hospital EMTREE MEDICAL INDEX TERMS economic aspect ethnic group human organization and management priority journal prospective study psychological aspect social aspect social structure therapy United States EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1986117124 MEDLINE PMID 3945293 (http://www.ncbi.nlm.nih.gov/pubmed/3945293) PUI L16128063 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1139 TITLE Monitoring of serum pseudocholinesterase and transferrin in intensive care patients ORIGINAL (NON-ENGLISH) TITLE Monitoraggio della pseudo-colinesterasi serica e della transferrina in pazienti di rianimazione. AUTHOR NAMES Cantoni A. Pizzola A. AUTHOR ADDRESSES (Cantoni A.; Pizzola A.) CORRESPONDENCE ADDRESS A. Cantoni, SOURCE Minerva anestesiologica (1986) 52:1-2 (51-57). Date of Publication: 1986 Jan-Feb ISSN 0375-9393 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cholinesterase transferrin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS adolescent adult aged article blood female human male metabolism middle aged monitoring prognosis retrospective study CAS REGISTRY NUMBERS cholinesterase (9001-08-5) transferrin (82030-93-1) LANGUAGE OF ARTICLE Italian MEDLINE PMID 3736913 (http://www.ncbi.nlm.nih.gov/pubmed/3736913) PUI L16737201 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1140 TITLE Transfer anxiety and the MI patient. AUTHOR NAMES Miracle V.A. AUTHOR ADDRESSES (Miracle V.A.) CORRESPONDENCE ADDRESS V.A. Miracle, SOURCE Kentucky nurse (1986) 34:1 (15-16). Date of Publication: 1986 Jan-Feb ISSN 0742-8367 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety heart infarction progressive patient care EMTREE MEDICAL INDEX TERMS article coronary care unit human nurse patient relationship nursing psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 3633006 (http://www.ncbi.nlm.nih.gov/pubmed/3633006) PUI L16670572 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1141 TITLE Oxygen lung transfer under respirator during anaesthesia and intensive care ORIGINAL (NON-ENGLISH) TITLE TRANSFERT PULMONAIRE DE L'OXYGENE SOUS RESPIRATEUR EN ANESTHESIE ET EN REANIMATION AUTHOR NAMES Gay R. Horellou M.F. Gobeaux R. AUTHOR ADDRESSES (Gay R.; Horellou M.F.; Gobeaux R.) Service de Reanimation Medicale, Hopital Universitaire Dupuytren, 87042 Limoges Cedex CORRESPONDENCE ADDRESS Service de Reanimation Medicale, Hopital Universitaire Dupuytren, 87042 Limoges Cedex SOURCE Clinical Respiratory Physiology (1985) 21:3 (257-261). Date of Publication: 1985 ISSN 0272-7587 ABSTRACT The resistance of the passage of oxygen from air to blood is estimated in measuring P(A - a)O(2). This index varies with FIO(2). P(a/A)O(2), the index proposed by GILBERT and KEIGHLEY [18], expresses PaO(2) as a percentage of PAO(2). This index would be independent of FIO(2). Two groups are studied. Patients of the first group (n = 22) are artificially ventilated in intensive care for severe parenchymal lesion. Those of the second group (n = 25) have no notable history of pulmonary disease and are anaesthetized and hooked up to a respirator for surgery. Blood gases are measured and the transfer indices calculated for increasing FIO(2) (0.4, 0.6, 0.8 and 1). Under conditions of anaesthesia, the effect of thermic decrease on PaCO(2) is dampened by maintaining a constant PACO(2) during measurement. P(a/A)O(2) does not vary significantly as a function of FIO(2) in the intensive care group, whereas the results observed in the anaesthetized patients are substantially dispersed. Factors which are susceptible to affect oxygen transfer as well as the effects of FIO(2) increase are discussed. P(a/A)O(2) stability observed in intensive care is probably related to the predominant effect of venous admixture, which is hardly affected by variations in FIO(2). In anaesthesia, resistance to the transfer of oxygen appears to be linked mainly to changes in the distribution of the ventilation/perfusion ratio (reduction in CRF; pharmacological effect of oxygen on pulmonary vascular reactivity). These phenomena lead to alveolar instability and a variable shunt effect. It appears that P(a/A)O(2) is a useful index for determining oxygen transfer at different concentrations of oxygen in the case of parenchymal injury, if ever the haemodynamic state is relatively stable. On the other hand, the use of this index in functional pulmonary affection is much more delicate. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alfadolone acetate alfaxalone althesin pancuronium bromide EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anesthesia artificial ventilation drug therapy gas exchange lung ventilation perfusion ratio oxygen transport EMTREE MEDICAL INDEX TERMS blood and hemopoietic system blood gas central nervous system clinical article human priority journal respiratory system therapy DRUG TRADE NAMES althesin CAS REGISTRY NUMBERS alfadolone acetate (23930-37-2) alfaxalone (23930-19-0) althesin (8067-82-1) pancuronium bromide (15500-66-0) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Anesthesiology (24) Clinical and Experimental Pharmacology (30) Drug Literature Index (37) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1985144809 PUI L15094809 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1142 TITLE Immediate problems met in intensive care and transportation of neonates under 1500 g born outside of a maternity hospital. Study of results over four years ORIGINAL (NON-ENGLISH) TITLE PROBLEMES IMMEDIATS POSES PAR LA RENAIMATION ET LE TRANSPORT DESENFANTS DE MOINS DE 1500 GRAMMES NES HORS MATERNITE. ETUDE DES RESULTATS SUR UNE PERIODE DE QUATRE ANS AUTHOR NAMES Herve C. Gaillard M. Huguenard P. AUTHOR ADDRESSES (Herve C.; Gaillard M.; Huguenard P.) Service d'Aide Medicale Urgente du Val-de Marne (SAMU 94), Hopital Henri Mondor, 94010 Creteil CORRESPONDENCE ADDRESS Service d'Aide Medicale Urgente du Val-de Marne (SAMU 94), Hopital Henri Mondor, 94010 Creteil SOURCE Annales de Pediatrie (1985) 32:3 BIS (257-261). Date of Publication: 1985 ISSN 0066-2097 ABSTRACT Analysis of 12 unexpected deliveries of infants under 1500 g at birth which occurred over four years in the Val-de-Marne district exemplifies the significance of emergency medical care. Mortality rate is 30% and is significantly higher (with an up to three-fold increase) in deliveries of infants under 1250 g. Furthermore, six children had residual neurologic impairment, severe in three, with a follow up ranging from six months to four years. Comparison with studies on small-for-dates or premature infants confirms the importance of the first moments of life for these hypotrophic, high risk neonates in whom the chief secondary disorders are enterocolitis and patent ductus arteriosus, more prevalent in our series. These problems seem to be related, mainly, to hypothermia and non-optimal conditions at delivery and explain the discrepancies in mortality rates between these different series. However, improvement in the prognosis for these infants should not rely on optimization of management which is already very thorough and very rapid on the spot, but rather on information of mothers and routine monitoring of pregnancies, which will avoid increasing the risk in these already high-risk infants. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care transport EMTREE MEDICAL INDEX TERMS case report epidemiology geographic distribution human hypothermia low birth weight mortality newborn organization and management pregnancy prevention risk factor therapy EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1985109254 PUI L15109254 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1143 TITLE Transferring the terminally ill AUTHOR NAMES Vernon M.S. Klectner H. Vinciguerra V. AUTHOR ADDRESSES (Vernon M.S.; Klectner H.; Vinciguerra V.) East Carolina University, School of Medicine, Greenville, NC 27835-1846 CORRESPONDENCE ADDRESS East Carolina University, School of Medicine, Greenville, NC 27835-1846 SOURCE New England Journal of Medicine (1985) 312:7 (440-442). Date of Publication: 1985 ISSN 0028-4793 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) terminal care EMTREE MEDICAL INDEX TERMS editorial human intensive care unit patient transport priority journal psychological aspect therapy EMBASE CLASSIFICATIONS Anesthesiology (24) Health Policy, Economics and Management (36) Public Health, Social Medicine and Epidemiology (17) Gerontology and Geriatrics (20) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1985080148 MEDLINE PMID 3969099 (http://www.ncbi.nlm.nih.gov/pubmed/3969099) PUI L15130148 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1144 TITLE Unconvinced of value of antenatal transfer to level 3 intensive care units. AUTHOR NAMES Sepkowitz S. AUTHOR ADDRESSES (Sepkowitz S.) CORRESPONDENCE ADDRESS S. Sepkowitz, SOURCE Pediatrics (1985) 75:4 (801-802). Date of Publication: Apr 1985 ISSN 0031-4005 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) infant mortality newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS human letter newborn statistics LANGUAGE OF ARTICLE English MEDLINE PMID 3982913 (http://www.ncbi.nlm.nih.gov/pubmed/3982913) PUI L15654989 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1145 TITLE Immediate problems posed in the intensive care and transportation of children weighing less than 1,500 grams born outside of a maternity center. Study of results over a period of 4 years ORIGINAL (NON-ENGLISH) TITLE Problèmes immédiats posés par la réanimation et le transport des enfants de moins de 1 500 grammes nés hors maternité. Etude des résultats sur une période de quatre ans. AUTHOR NAMES Hervé C. Gaillard M. Huguenard P. AUTHOR ADDRESSES (Hervé C.; Gaillard M.; Huguenard P.) CORRESPONDENCE ADDRESS C. Hervé, SOURCE Annales de pédiatrie (1985) 32:3 Pt 2 (257-261). Date of Publication: 25 Mar 1985 ISSN 0066-2097 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) home delivery intensive care low birth weight obstetric delivery patient transport EMTREE MEDICAL INDEX TERMS article birth weight comparative study female France human infant mortality male mortality newborn prematurity (prevention) small for date infant LANGUAGE OF ARTICLE French MEDLINE PMID 4004034 (http://www.ncbi.nlm.nih.gov/pubmed/4004034) PUI L15681475 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1146 TITLE Military neonatal transport and intensive care - Effective and cost effective AUTHOR NAMES Bell R.E. Yoder B.A. Ackerman Jr. N.B. AUTHOR ADDRESSES (Bell R.E.; Yoder B.A.; Ackerman Jr. N.B.) Neonatology Service, Division of Maternal Child Care, Wilford Hall USAF Medical Center, Lackland AF Base, San Antonio, TX 78236 CORRESPONDENCE ADDRESS Neonatology Service, Division of Maternal Child Care, Wilford Hall USAF Medical Center, Lackland AF Base, San Antonio, TX 78236 SOURCE Military Medicine (1984) 149:3 (143-145). Date of Publication: 1984 ISSN 0026-4075 ABSTRACT Medical support of dependents of active duty military members is a major priority in the Military Health Care System. There are two important questions to be considered in evaluating the military health care delivery system for premature infants: Is the mortality and morbidity of preterm newborns similar to that in major civilian centers; and is the expense of military transport and neonatal care cost effective when compared with civilian transport and care. To answer these two questions, we reviewed the medical records of all preterm newborns cared for at Wilford Hall USAF Medical Center (WHMC) from July 1979 thru July 1982. Costs of newborn care and transport were determined for both WHMC and civilian Newborn Intensive Care Units (NICU) in our referral area. Our results show: that mortality of preterm newborns at WHMC compares favorably with that reported in other series; and the duration of hospitalization beyond which it is cost effective to transport these infants to WHMC is 18 days. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost intensive care military medicine newborn care patient transport EMTREE MEDICAL INDEX TERMS economic aspect human organization and management short survey therapy EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1985072839 MEDLINE PMID 6425731 (http://www.ncbi.nlm.nih.gov/pubmed/6425731) PUI L15172839 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1147 TITLE When should a child with febrile purpura be transferred to an intensive care unit? ORIGINAL (NON-ENGLISH) TITLE QUAND FAUT-IL TRANSFERER EN REANIMATION UN ENFANT PRESENTANT UN PURPURA FEBRILE? AUTHOR NAMES Devictor D. AUTHOR ADDRESSES (Devictor D.) Unite de Reanimation Pediatrique, Hopital de Bicetre, 94270 Le Kremlin Bicetre CORRESPONDENCE ADDRESS Unite de Reanimation Pediatrique, Hopital de Bicetre, 94270 Le Kremlin Bicetre SOURCE Revue de Pediatrie (1984) 20:8 (383-387). Date of Publication: 1984 ISSN 0035-1644 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health care fulminating purpura intensive care EMTREE MEDICAL INDEX TERMS cardiovascular system child human infection priority journal purpura septic shock short survey therapy EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Anesthesiology (24) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1985239744 PUI L15240194 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1148 TITLE Implementation of exempt status for an inpatient psychiatric unit AUTHOR NAMES Hutzler N.P. AUTHOR ADDRESSES (Hutzler N.P.) Medical Records at St. Joseph's Hospital, Parkersburg, WV CORRESPONDENCE ADDRESS Medical Records at St. Joseph's Hospital, Parkersburg, WV SOURCE Journal of the American Medical Record Association (1984) 55:7 (29-31). Date of Publication: 1984 ISSN 0273-9976 ABSTRACT PPS regulations are redefining the way that intrahospital transfers are handled when those transfers involve 'exempt' units. The author describes procedures which proved to be successful in meeting criteria for exempt psychiatric units. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical record prospective pricing psychiatric department EMTREE MEDICAL INDEX TERMS economic aspect methodology nonhuman organization and management short survey EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Psychiatry (32) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1984207433 MEDLINE PMID 10310702 (http://www.ncbi.nlm.nih.gov/pubmed/10310702) PUI L14032486 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1149 TITLE Implementing an ICU transfer tool. AUTHOR NAMES Coleman B. AUTHOR ADDRESSES (Coleman B.) CORRESPONDENCE ADDRESS B. Coleman, SOURCE Dimensions of critical care nursing : DCCN (1984) 3:6 (352-361). Date of Publication: 1984 Nov-Dec ISSN 0730-4625 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital discharge intensive care unit medical record EMTREE MEDICAL INDEX TERMS aged article case report female human male patient care preschool child LANGUAGE OF ARTICLE English MEDLINE PMID 6568156 (http://www.ncbi.nlm.nih.gov/pubmed/6568156) PUI L14810386 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1150 TITLE Organization and delivery of medical care in group and mass thermal injuries ORIGINAL (NON-ENGLISH) TITLE Organizatsiia i provedenie meditsinskoi pomoshchi pri gruppovykh i massovykh termicheskikh porazheniiakh. AUTHOR NAMES Povstianoi N.E. Polishchuk S.A. AUTHOR ADDRESSES (Povstianoi N.E.; Polishchuk S.A.) CORRESPONDENCE ADDRESS N.E. Povstianoi, SOURCE Klinicheskaia khirurgiia (1983) :3 (36-40). Date of Publication: Mar 1983 ISSN 0023-2130 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article human organization and management Ukraine LANGUAGE OF ARTICLE Russian MEDLINE PMID 6855082 (http://www.ncbi.nlm.nih.gov/pubmed/6855082) PUI L13678502 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1151 TITLE Minimizing stress-of-transfer responses. AUTHOR NAMES Poe C.M. AUTHOR ADDRESSES (Poe C.M.) CORRESPONDENCE ADDRESS C.M. Poe, SOURCE Dimensions of critical care nursing : DCCN (1982) 1:6 (364, 366-373). Date of Publication: 1982 Nov-Dec ISSN 0730-4625 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) heart infarction mental stress (prevention) patient education progressive patient care EMTREE MEDICAL INDEX TERMS article coronary care unit fear human psychological aspect LANGUAGE OF ARTICLE English MEDLINE PMID 6923818 (http://www.ncbi.nlm.nih.gov/pubmed/6923818) PUI L13620114 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1152 TITLE The responsibilities of first aid at the scene of an accident and during transport. Viewpoints on intensive care AUTHOR NAMES Wickstrom I. AUTHOR ADDRESSES (Wickstrom I.) Anestesiklin., Sahlgrenska Sjukhuset, 413 45 Goteborg CORRESPONDENCE ADDRESS Anestesiklin., Sahlgrenska Sjukhuset, 413 45 Goteborg SOURCE Opuscula Medica, Supplement (1982) 26:58 (17-19). Date of Publication: 1982 ISSN 0473-1018 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) first aid injury intensive care EMTREE MEDICAL INDEX TERMS therapy EMBASE CLASSIFICATIONS Rehabilitation and Physical Medicine (19) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE Swedish EMBASE ACCESSION NUMBER 1982180611 PUI L12094705 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1153 TITLE The physiological basis of critical care nursing. Diffusion and transportation of respiratory gases AUTHOR NAMES Kim Y.Y. AUTHOR ADDRESSES (Kim Y.Y.) CORRESPONDENCE ADDRESS Y.Y. Kim, SOURCE Taehan kanho. The Korean nurse (1981) 20:5 (51-54). Date of Publication: 31 Dec 1981 ISSN 0047-3618 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carbon dioxide oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breathing EMTREE MEDICAL INDEX TERMS article blood human intensive care pressure CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) oxygen (7782-44-7) LANGUAGE OF ARTICLE Korean MEDLINE PMID 6798300 (http://www.ncbi.nlm.nih.gov/pubmed/6798300) PUI L12596872 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1154 TITLE Newborn transport in metropolitan Sydney: Experience with a newborn intensive care unit based regional transport service AUTHOR NAMES Barr P.A. Suthers J.A. Leslie G.I. AUTHOR ADDRESSES (Barr P.A.; Suthers J.A.; Leslie G.I.) Newborn Intens. Care Unit, Roy. North Shore Hosp., St Leonards, NSW 2065 CORRESPONDENCE ADDRESS Newborn Intens. Care Unit, Roy. North Shore Hosp., St Leonards, NSW 2065 SOURCE Australian Paediatric Journal (1981) 17:2 (95-99). Date of Publication: 1981 ISSN 0004-993X ABSTRACT The effect of skilled transport on the condition of 100 infants referred for intensive care and the factors affecting their survival were analysed. Infants with respiratory failure who were not moribound showed significant increases in pH (P < 0.01) and arterial/alveolar PO(2) ratio (P < 0.001) with assisted ventilation. Less severely ill infants were transported without significant change in pH and blood gas status. Hypoxaemia (17%), hyperoxaemia (24%) and hyperglycaemia (14%) were not uncommon on admission to the newborn intensive care unit. Survival rate did not decrease significantly with decreasing birth weight or gestation. Factors significantly more common in infants who died were one minute Apgar score 0-3 (P < 0.05), and pH < 7.25 (P < 0.05) and PaCO(2) > 60 mmHg (P < 0.005) on admission to the NICU. Infants mechanically ventilated before transport did not have a significantly higher mortality rate than those ventilated after admission, though moribound infants and those with untreated early onset bacterial pneumonia had high mortality rates. Pre-transfer events were responsible for the death of 8 (38%) of the 21 infants who died and perhaps contributed to the death from intraventricular haemorrhage of a further 5 infants (24%). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation brain ventricle hemorrhage newborn intensive care patient transport respiratory failure EMTREE MEDICAL INDEX TERMS central nervous system diagnosis geographic distribution methodology newborn respiratory system short survey therapy EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Forensic Science Abstracts (49) Public Health, Social Medicine and Epidemiology (17) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1981235068 MEDLINE PMID 7305777 (http://www.ncbi.nlm.nih.gov/pubmed/7305777) PUI L11011068 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1155 TITLE Transporting the critically burned patient. AUTHOR NAMES Trunkey D.D. AUTHOR ADDRESSES (Trunkey D.D.) CORRESPONDENCE ADDRESS D.D. Trunkey, SOURCE Topics in emergency medicine (1981) 3:3 (21-24). Date of Publication: Oct 1981 ISSN 0164-2340 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (therapy) intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article classification human organization United States LANGUAGE OF ARTICLE English MEDLINE PMID 10253308 (http://www.ncbi.nlm.nih.gov/pubmed/10253308) PUI L11648820 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1156 TITLE Airborne intensive care. AUTHOR NAMES Griffin M. AUTHOR ADDRESSES (Griffin M.) CORRESPONDENCE ADDRESS M. Griffin, SOURCE Nursing times (1981) 77:38 (1022-1023). Date of Publication: 1981 Sep 16-22 ISSN 0954-7762 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMTREE MEDICAL INDEX TERMS aerospace medicine article case report female France human Ireland traffic accident LANGUAGE OF ARTICLE English MEDLINE PMID 6912511 (http://www.ncbi.nlm.nih.gov/pubmed/6912511) PUI L11636447 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1157 TITLE A comparison of inborn versus transferred neonates admitted to a special care unit. AUTHOR NAMES Easa D. Ash K. Boychuk R.B. Light M.J. LaBarre M. AUTHOR ADDRESSES (Easa D.; Ash K.; Boychuk R.B.; Light M.J.; LaBarre M.) CORRESPONDENCE ADDRESS D. Easa, SOURCE Hawaii medical journal (1981) 40:7 (175-177). Date of Publication: Jul 1981 ISSN 0017-8594 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child care infant mortality intensive care unit newborn disease (complication) EMTREE MEDICAL INDEX TERMS article birth weight comparative study human lung disease (epidemiology) newborn retrospective study standard United States utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 7263214 (http://www.ncbi.nlm.nih.gov/pubmed/7263214) PUI L11634203 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1158 TITLE Neonatal intensive care in Sweden AUTHOR NAMES Tunell R. Palme C. Sandberg K. AUTHOR ADDRESSES (Tunell R.; Palme C.; Sandberg K.) Barnmed. Klin., Huddinge Sjukh., S-141 86 Huddinge CORRESPONDENCE ADDRESS Barnmed. Klin., Huddinge Sjukh., S-141 86 Huddinge SOURCE Lakartidningen (1981) 78:5 (331-342). Date of Publication: 1981 ISSN 0023-7205 ABSTRACT Results of a retrospective survey of transports from a neonatal ward to a neonatal intensive care unit are presented. The authors see a need for centralisation of neonatal intensive care. The structure of the portable incubator should be improved, while the child must be in optimal condition at the time of transport. A comparison was executed between the results of intensive care transports from a ward located 10 km from a neonatal intensive care unit, and from a department in the same hospital as the intensive care unit. Short transport within one and the same hospital seems to be as hazardous as a journey of many miles by ambulance. The survival rate and rate of complications in a population of 89 very low birth weight infants below 1,000 g were studied. Meticulous control of vital functions during transportation is necessary to avoid complications in transit. A portable incubator suitable for Swedish ambulances and specially designed for transport of neonatal intensive care cases is presented. Experience of this device hitherto indicates that it is feasible to transport babies with very severe respiratory insufficiency under controlled conditions without hazard to the quality of care in transit. A review is presented of the modes of long distance air transport of sick neonates. The article describes the problems which arise both when the arrangements are made and during the actual journeys. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn intensive care patient transport EMTREE MEDICAL INDEX TERMS geographic distribution newborn Sweden therapy EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE Swedish LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1981112621 MEDLINE PMID 6937726 (http://www.ncbi.nlm.nih.gov/pubmed/6937726) PUI L11144408 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1159 TITLE The transfer summary--an essential link. AUTHOR NAMES DiCiancia P. AUTHOR ADDRESSES (DiCiancia P.) CORRESPONDENCE ADDRESS P. DiCiancia, SOURCE Supervisor nurse (1981) 12:4 (36-37). Date of Publication: Apr 1981 ISSN 0039-5870 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) medical record progressive patient care EMTREE MEDICAL INDEX TERMS article coronary care unit interpersonal communication organization and management LANGUAGE OF ARTICLE English MEDLINE PMID 6908179 (http://www.ncbi.nlm.nih.gov/pubmed/6908179) PUI L11572341 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1160 TITLE NICU: intensive education and infant transport capabilities optimize service of Boise's St. Luke's Hospital neonatal IC unit. AUTHOR NAMES Graalman N.M. AUTHOR ADDRESSES (Graalman N.M.) CORRESPONDENCE ADDRESS N.M. Graalman, SOURCE Hospital forum (1981) 24:2 (55-56). Date of Publication: 1981 Mar-Apr ISSN 0018-5663 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health care planning intensive care unit nursery perinatology EMTREE MEDICAL INDEX TERMS article hospital bed capacity human newborn newborn disease organization and management progressive patient care United States LANGUAGE OF ARTICLE English MEDLINE PMID 10250100 (http://www.ncbi.nlm.nih.gov/pubmed/10250100) PUI L11554651 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1161 TITLE Oxygenation for the transport of newborn infants with respiratory disorders ORIGINAL (NON-ENGLISH) TITLE Oxigeniációs rendszer légzési zavarban szenvedö újszülöttek szállítására. AUTHOR NAMES Rubecz I. Tóth G. Varga P. Vincellér M. Farbaky I. AUTHOR ADDRESSES (Rubecz I.; Tóth G.; Varga P.; Vincellér M.; Farbaky I.) CORRESPONDENCE ADDRESS I. Rubecz, SOURCE Orvosi hetilap (1980) 121:50 (3065-3067). Date of Publication: 14 Dec 1980 ISSN 0030-6002 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) neonatal respiratory distress syndrome (therapy) oxygen therapy EMTREE MEDICAL INDEX TERMS article devices human incubator intensive care unit newborn patient transport LANGUAGE OF ARTICLE Hungarian MEDLINE PMID 7220024 (http://www.ncbi.nlm.nih.gov/pubmed/7220024) PUI L11580719 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1162 TITLE Regional integration of intensive care and transport of severely ill newborns AUTHOR NAMES Hager-Malecka B. Grzywna W. Norska-Borowka I. AUTHOR ADDRESSES (Hager-Malecka B.; Grzywna W.; Norska-Borowka I.) Klin. Ped. IP SLAM Zabrze CORRESPONDENCE ADDRESS Klin. Ped. IP SLAM Zabrze SOURCE Pediatria Polska (1980) 55:8 (979-985). Date of Publication: 1980 ISSN 0031-3939 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine newborn intensive care transport EMTREE MEDICAL INDEX TERMS geographic distribution newborn short survey therapy EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE Polish LANGUAGE OF SUMMARY English, Russian EMBASE ACCESSION NUMBER 1981009243 MEDLINE PMID 7432833 (http://www.ncbi.nlm.nih.gov/pubmed/7432833) PUI L11233024 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1163 TITLE The course of patients with suspected myocardial infarction. The identification of low-risk patients for early transfer from intensive care AUTHOR NAMES Mulley A.G. Thibault G.E. Hughes R.A. AUTHOR ADDRESSES (Mulley A.G.; Thibault G.E.; Hughes R.A.) Med. Practices Eval. Unit, Massachusetts Gen. Hosp., Boston, Mass. 02114 CORRESPONDENCE ADDRESS Med. Practices Eval. Unit, Massachusetts Gen. Hosp., Boston, Mass. 02114 SOURCE New England Journal of Medicine (1980) 302:17 (943-948). Date of Publication: 1980 ISSN 0028-4793 ABSTRACT The hospital course of all patients admitted to a medical intensive-care unit (ICU) with suspected myocardial infarction was reviewed to test the feasibility of identifying patients suitable for earlier transfer from the ICU. Three hundred sixty patients admitted after presentation with uncomplicated chest pain could be stratified into 3 risk groups within 24 hr of admission to the ICU. One hundred sixty-eight patients (47%), who were without major complications, elevation of total serum creatine phosphokinase, or electrocardiographic evidence of transmural infarction during the first day, could be designated 'low-risk' patients. Three per cent of the low-risk patients subsequently met clinical criteria for infarction, 2% had late complications in the ICU, and none died. Rates of infarction, late complications in the ICU, and mortality in the hospital were significantly higher for patients at intermediate and high risk. Identification of low-risk patients for whom early transfer may be routinely indicated is feasible and could reduce by 55% the total number of days that such patients spend in the ICU. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart infarction EMTREE MEDICAL INDEX TERMS heart major clinical study methodology therapy EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1980129002 MEDLINE PMID 7360201 (http://www.ncbi.nlm.nih.gov/pubmed/7360201) PUI L10096599 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1164 TITLE Coronary emergencies. II. Transport to an intensive care unit ORIGINAL (NON-ENGLISH) TITLE II-LE TRANSPORT DES URGENCES CORONARIENNES DANS LES UNITES DE SOINS INTENSIFS AUTHOR NAMES Cara M. Poisvert M. Galinski R. AUTHOR ADDRESSES (Cara M.; Poisvert M.; Galinski R.) SOURCE Concours Medical (1980) 102:3 (241-242). Date of Publication: 1980 ISSN 0010-5309 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency medicine heart infarction intensive care ischemic heart disease EMTREE MEDICAL INDEX TERMS diagnosis heart short survey EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE French EMBASE ACCESSION NUMBER 1980097246 PUI L10128026 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1165 TITLE Referral of mothers and infants for intensive care AUTHOR NAMES Blake A.M. Pollitzer M.J. Reynolds E.O.R. AUTHOR ADDRESSES (Blake A.M.; Pollitzer M.J.; Reynolds E.O.R.) Dept. Paed., Univ. Coll. Hosp., London WC1E 6BT CORRESPONDENCE ADDRESS Dept. Paed., Univ. Coll. Hosp., London WC1E 6BT SOURCE British Medical Journal (1979) 2:6187 (414-416). Date of Publication: 1979 ISSN 0959-8146 ABSTRACT During 1975-7, 96 monthers were referred to University College Hospital for delivery from 39 other hospitals other hispitals because their pregnancies were considered to be at very high risk. One hundred of the 111 infants born to the 96 mothers weighed 2500 g or less and 60 weighed 1500 g or less. A high proportion of the infants developed serious illnesses necessitating intensive care. The birth-weight-specific neonatal mortality rates of the infants were much lower than those of infants born in England and Wales as a whole and were also lower than those of the 370 infants transported to this hospital for intensive care after delivery elsewhere. Whenever possible mothers with very high-risk pregnancies should be referred for delivery to centres with full facilities for the intensive care of the mother, fetus, and newborn infant. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) high risk pregnancy intensive care obstetrics patient transport EMTREE MEDICAL INDEX TERMS fetus major clinical study newborn normal human pregnancy prevention therapy EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Pediatrics and Pediatric Surgery (7) Anesthesiology (24) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1979243072 MEDLINE PMID 486967 (http://www.ncbi.nlm.nih.gov/pubmed/486967) PUI L9241655 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1166 TITLE Critical care unit transfer: Reducing patient stress through nursing interventions AUTHOR NAMES Schwartz L.P. Brenner Z.R. AUTHOR ADDRESSES (Schwartz L.P.; Brenner Z.R.) Sch. Nurs., Univ. Rochester, N.Y. CORRESPONDENCE ADDRESS Sch. Nurs., Univ. Rochester, N.Y. SOURCE Heart and Lung: Journal of Acute and Critical Care (1979) 8:3 (540-546). Date of Publication: 1979 ISSN 0147-9563 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit intensive care nursing patient care stress EMTREE MEDICAL INDEX TERMS cardiovascular system psychological aspect short survey therapy EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) Public Health, Social Medicine and Epidemiology (17) Neurology and Neurosurgery (8) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1980221284 MEDLINE PMID 254678 (http://www.ncbi.nlm.nih.gov/pubmed/254678) PUI L10000084 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1167 TITLE Who pays the bill for neonatal intensive care? AUTHOR NAMES McCarthy J.T. Koops B.L. Honeyfield P.R. Butterfield L.J. AUTHOR ADDRESSES (McCarthy J.T.; Koops B.L.; Honeyfield P.R.; Butterfield L.J.) Dept. Perinatol., Child. Hosp., Denver, Colo. 80218 CORRESPONDENCE ADDRESS Dept. Perinatol., Child. Hosp., Denver, Colo. 80218 SOURCE Journal of Pediatrics (1979) 95:5 I (755-762). Date of Publication: 1979 ISSN 0022-3476 ABSTRACT The Children's Hospital Newborn Emergency Service conducted 174 transports to the Newborn Center during a four-month period in 1976. The transport charge directly related to the distance between the referring hospital and the NBC. Two years after the NBC discharged the last study infant, 150 of 174 accounts had been paid in full. Insurance paid 85%, families paid 4%, and the hospital wrote off 11% of all hospital charges. The Children's Hospital referred 2% of all hospital charges to a bill collection agency. One hundred-forty-four infants (84%) survived and 27 (16%) died. The mean charge per day for survivors was $338; the mean charge per day for nonsurvivors was $607. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost intensive care newborn mortality patient transport EMTREE MEDICAL INDEX TERMS economic aspect geographic distribution newborn therapy EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Health Policy, Economics and Management (36) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1980009019 MEDLINE PMID 490247 (http://www.ncbi.nlm.nih.gov/pubmed/490247) PUI L10228540 DOI 10.1016/S0022-3476(79)80731-3 FULL TEXT LINK http://dx.doi.org/10.1016/S0022-3476(79)80731-3 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1168 TITLE Manually transferred contamination and its prevention in surgical intensive care ORIGINAL (NON-ENGLISH) TITLE LA CONTAMINATION MANUPORTEE ET SA PREVENTION EN REANIMATION CHIRURGICALE RESUME AUTHOR NAMES Picard J.M. Hartemann Ph. Blech M.F. Jacob F. AUTHOR ADDRESSES (Picard J.M.; Hartemann Ph.; Blech M.F.; Jacob F.) SOURCE Annales de l'Anesthesiologie Francaise (1979) 20:6-7 (517). Date of Publication: 1979 ISSN 0003-4061 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hand washing infection intensive care EMTREE MEDICAL INDEX TERMS prevention EMBASE CLASSIFICATIONS Anesthesiology (24) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1980083696 MEDLINE PMID 44964 (http://www.ncbi.nlm.nih.gov/pubmed/44964) PUI L10177495 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 1169 TITLE Transport problems of intensive care patients ORIGINAL (NON-ENGLISH) TITLE TRANSPORTPROBLEME BEI KRITISCHEN INTENSIVBEHANDLUNGSPATIENTEN AUTHOR NAMES Hess F.A. Roth F. AUTHOR ADDRESSES (Hess F.A.; Roth F.) Abt. Reanimat. Intensivbehandl., Univ. Bern CORRESPONDENCE ADDRESS Abt. Reanimat. Intensivbehandl., Univ. Bern SOURCE Intensivbehandlung (1979) 4:1 (1-7). Date of Publication: 1979 ISSN 0341-3063 ABSTRACT The transport of an intensive care patient brings up several special problems: First of all those of ventilation, then those of monitoring and eventually supporting circulation. A nonbreathing valve combined with a controllable flow of fresh gas allows a satisfactory constancy of respiratory minutevolume. Also pressure-operated respirators are suitable for such transports. The administration of an adequate air-oxygen mixture is discussed. With an Ambu-PEEP-valve, PEEP may be maintained satisfactorily. During an operation, patients with serious respiratory problems should be ventilated on the same respirator as before. Thoracic drainage needs a maintenance of suction during transport only in special situations. For sure suction is not necessary in patients on IPPV. Transportable ECG-monitors are available already for years, also battery-operated pacemakers and defibrillators. A direct monitoring of blood pressure is possible without any special expense. Modern compact monitors, which can be driven on batteries, bring the great advantage of monitoring a patient through operation, transport and postoperative follow-up by the same apparatus. An inverter delivering 220 V AC keeps infusion pumps working during transport, but there are also battery-operated pumps available today. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care patient transport EMBASE CLASSIFICATIONS Anesthesiology (24) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1979232154 PUI L9230876 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1170 TITLE Myocardial infarct stress-of-transfer inventory: Development of a research tool AUTHOR NAMES Minckley B.B. Burrows D. Ehrat K. AUTHOR ADDRESSES (Minckley B.B.; Burrows D.; Ehrat K.) Stanford Univ. Sch. Nurs., Palo Alto, Calif. CORRESPONDENCE ADDRESS Stanford Univ. Sch. Nurs., Palo Alto, Calif. SOURCE Nursing Research (1979) 28:1 (4-10). Date of Publication: 1979 ISSN 0029-6562 ABSTRACT The Myocardial Infarct Stress-of-Transfer Inventory is a set of measures composed of grouped variables related to patients' perceptions of external support, perceived attitudes and behaviors, and physiological (cardiovascular and autonomic) responses commonly assessed by nurses in typical hospital settings. These measures were designed to evaluate changes in patients' status as a result of transfer from the coronary care unit to a general care ward at the time the patient is presumably out of danger. Direction of change of all parameters is a measure of patient response to transfer as well as a measure of effectiveness of nursing care. The tool consists of observational and nurse questionnaire data collected and averaged for pre- and posttransfer items. Of 48 total items of the tool, 20 are designated 'change scores'. Interrater reliability was obtained for 20 percent of the tests with 80 percent agreement. A score of less than 22 is associated with poor transfer outcome; a score of more than 25 is associated with better-than-expected transfer outcome. Midrange from 22 to 25 is the average total score expectation for change as a result of transfer. The instrument was tested on 177 transfers of patients in six hospital settings in five western states (Arizona, Montana, Nevada, Utah and Washington). The six hospital populations were found to be homogeneous as to patient age, sex, race, diagnosis, and patterns of nursing care. Individual total scores for the tool ranged from 18 to 27 with a mean of 23.175 and S.D. of 1.754. Change scores were adjusted to accommodate the influence of prescores on postscores for the behavioral variables. Factor analysis indicated 17 factors in the tool with eigen values greater than 1.00. Significant findings were: 1) Cardiovascular signs and symptoms are unstable and arrhythmias are likely to occur in the two-hour period following transfer. Nursing care needs to accommodate this finding. 2) Nurses equated patient acceptance of disconnection of the Cardiac monitor with patient 'readiness for transfer'. 3) Because family visits had significant effect on patients, sometimes negative, sometimes positive families should be taught how to visit the patient in order to avoid negative effects. 4) Nursing care plans are associated with patients who are out of danger and are usually not available or not written for patients who are critically ill. 5) The tool proved easy to use. It may lend itself to evaluation of other transfer situations such as transfer from hospital to nursing home. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart infarction nursing EMTREE MEDICAL INDEX TERMS heart methodology psychological aspect therapy EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1979108551 MEDLINE PMID 252703 (http://www.ncbi.nlm.nih.gov/pubmed/252703) PUI L9108284 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1171 TITLE Effectiveness of neonatal transport AUTHOR NAMES Modanlou H.D. Dorchester W.L. AUTHOR ADDRESSES (Modanlou H.D.; Dorchester W.L.) UCIMiller Children's Hospital, Long Beach, United States. SOURCE Journal of Pediatrics (1979) 94:4 (682-683). Date of Publication: 1 Apr 1979 ISSN 1097-6833 (electronic) 0022-3476 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn care patient transport EMTREE MEDICAL INDEX TERMS birth weight human length of stay letter morbidity mortality rate neonatal intensive care unit newborn newborn mortality priority journal EMBASE CLASSIFICATIONS Anesthesiology (24) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170624364 MEDLINE PMID 430326 (http://www.ncbi.nlm.nih.gov/pubmed/430326) PUI L618126701 DOI 10.1016/S0022-3476(79)80064-5 FULL TEXT LINK http://dx.doi.org/10.1016/S0022-3476(79)80064-5 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 1172 TITLE Reply AUTHOR NAMES Chance G.W. Cunningham K. AUTHOR ADDRESSES (Chance G.W.) Division of NeonatologyThe Hospital for Sick Children, Toronto, Canada. (Cunningham K.) Division of Bio-Statistics The Hospital for Sick Children, Toronto, Canada. SOURCE Journal of Pediatrics (1979) 94:4 (683-684). Date of Publication: 1 Apr 1979 ISSN 1097-6833 (electronic) 0022-3476 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) low birth weight patient transport perinatal care EMTREE MEDICAL INDEX TERMS gestational age hospitalization human length of stay letter neonatal intensive care unit patient referral priority journal probability prognosis rectal temperature small for date infant statistical analysis EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Public Health, Social Medicine and Epidemiology (17) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170624128 PUI L618126276 DOI 10.1016/S0022-3476(79)80066-9 FULL TEXT LINK http://dx.doi.org/10.1016/S0022-3476(79)80066-9 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 1173 TITLE Transfer of the newborn at risk to a neonatal intensive care unit. ORIGINAL (NON-ENGLISH) TITLE TRASPORTO DEL NEONATO A RISCHIO AD UNA UNITA NEONATALE DI TERAPIA INTENSIVA AUTHOR NAMES Minoli I. Calciolari G. Cherubini P. AUTHOR ADDRESSES (Minoli I.; Calciolari G.; Cherubini P.) Unita Neonatale Ter. Intens., Ist. Osp. Prov. Matern., Milano CORRESPONDENCE ADDRESS Unita Neonatale Ter. Intens., Ist. Osp. Prov. Matern., Milano SOURCE Minerva Pediatrica (1978) 30:14 (1131-1136). Date of Publication: 1978 ISSN 0026-4946 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) high risk newborn intensive care perinatal morbidity transport EMTREE MEDICAL INDEX TERMS methodology newborn pregnancy therapy EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Public Health, Social Medicine and Epidemiology (17) Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE Italian LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1978403463 MEDLINE PMID 672855 (http://www.ncbi.nlm.nih.gov/pubmed/672855) PUI L8397852 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1174 TITLE Endogenous inhibitors of glutathione S-transferases in house flies AUTHOR NAMES Motoyama N. Kulkarni A.P. Hodgson E. Dauterman W.C. AUTHOR ADDRESSES (Motoyama N.; Kulkarni A.P.; Hodgson E.; Dauterman W.C.) Toxicol. Progr., Dept. Entomol., North Carolina State Univ., Raleigh, N.C. 27607 CORRESPONDENCE ADDRESS Toxicol. Progr., Dept. Entomol., North Carolina State Univ., Raleigh, N.C. 27607 SOURCE Pesticide Biochemistry and Physiology (1978) 9:3 (255-262). Date of Publication: 1978 ISSN 0048-3575 EMTREE DRUG INDEX TERMS (MAJOR FOCUS) 1,2 dichloro 4 nitrobenzene 1,4 benzoquinone 1,4 dimethoxybenzene 2,5 dihydroxybenzoquinone anthracene derivative aromatic compound catechol epinephrine glutathione glutathione transferase hydroquinone mequinol monophenol monooxygenase naphthalene derivative para cresol pentachlorophenol phenol pyrogallol resorcinol tetroquinone ubiquinone EMTREE DRUG INDEX TERMS unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) enzyme inhibition EMTREE MEDICAL INDEX TERMS animal experiment arthropod drug comparison house fly in vitro study DRUG MANUFACTURERS (United States)Aldrich (United States)Baker (United States)chem. procurement lab. (United States)eastman organic chem (United States)Fisher (United States)Valeant (United States)Sigma CAS REGISTRY NUMBERS 1,2 dichloro 4 nitrobenzene (99-54-7) 1,4 benzoquinone (106-51-4) 1,4 dimethoxybenzene (150-78-7) 2,5 dihydroxybenzoquinone (615-94-1) adrenalin (51-43-4, 55-31-2, 6912-68-1) catechol (120-80-9) glutathione transferase (50812-37-8) glutathione (70-18-8) hydroquinone (123-31-9) mequinol (150-76-5) monophenol monooxygenase (9002-10-2) para cresol (106-44-5) pentachlorophenol (87-86-5) phenol (108-95-2, 3229-70-7) pyrogallol (87-66-1) resorcinol (108-46-3) tetroquinone (319-89-1) ubiquinone (1339-63-5) EMBASE CLASSIFICATIONS Clinical and Experimental Pharmacology (30) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1979075696 PUI L9075507 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1175 TITLE Transportation of severely ill neonates to an intensive care unit (experience with 55 cases) ORIGINAL (NON-ENGLISH) TITLE TRANSPORTE DE RECEM-NASCIDOS GRAVES: EXPERIENCIA DE 55 CASOS AUTHOR NAMES Grajwer L.A. Ruffier J. Genes L. Ruffier C. AUTHOR ADDRESSES (Grajwer L.A.; Ruffier J.; Genes L.; Ruffier C.) Serv. Pediat., Policlin. Botafogo, Rio de Janeiro CORRESPONDENCE ADDRESS Serv. Pediat., Policlin. Botafogo, Rio de Janeiro SOURCE Jornal de Pediatria (1978) 45:3 (187-190). Date of Publication: 1978 ISSN 0021-7557 ABSTRACT During a six-month period, 55 newborns were transported to an intensive care unit. 56% had respiratory problems such as hyaline membrane disease and transient tachypnea of the newborn. About half of the newborns were hypo or hyperthermic at the referring hospitals. There was an improvement of the thermal balance during transport. The viability of the transport system and the lack of equipment in the referring hospitals are discussed in the paper. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care newborn EMTREE MEDICAL INDEX TERMS case report therapy EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE Portuguese LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1979075971 PUI L9075782 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1176 TITLE Mobile critical care unit safeguards lives during transfers AUTHOR NAMES Tinker A.J. Birnbaum M.L. Burns L.A. AUTHOR ADDRESSES (Tinker A.J.; Birnbaum M.L.; Burns L.A.) Univ. Hosp., Madison, Wis. CORRESPONDENCE ADDRESS Univ. Hosp., Madison, Wis. SOURCE Hospitals (1978) 52:18 (79-85). Date of Publication: 1978 ISSN 0018-5973 ABSTRACT Providing access to high-quality critical care services for patients in small or remote hospitals is an important problem faced by many hospitals in this country. In an effort to meet the needs of critically ill patients who might be saved if they could be safely transported from their community hospitals to a large medical center with more specialized care capabilities, the University of Wisconsin Hospitals, Madison, designed a Mobile Critical Care Unit. The details of the unit's construction and of the program's operation are presented herein. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service mobile clinic transport EMTREE MEDICAL INDEX TERMS economic aspect therapy United States EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1979045021 MEDLINE PMID 680670 (http://www.ncbi.nlm.nih.gov/pubmed/680670) PUI L9044839 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1177 TITLE Transport of neonates for intensive care AUTHOR NAMES Ryan M.E. AUTHOR ADDRESSES (Ryan M.E.) Dept. Ped., Geisinger Med. Cent., Danville, Pa. 17821 CORRESPONDENCE ADDRESS Dept. Ped., Geisinger Med. Cent., Danville, Pa. 17821 SOURCE Journal of the American Osteopathic Association (1978) 78:2 (103-109). Date of Publication: 1978 ISSN 0098-6151 LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1979091323 MEDLINE PMID 711521 (http://www.ncbi.nlm.nih.gov/pubmed/711521) PUI L9091102 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1178 TITLE Control of heart rate during movement in acute myocardial infarction AUTHOR NAMES Devlin J.E. Mulholland H.C. Kelly M.J.H. AUTHOR ADDRESSES (Devlin J.E.; Mulholland H.C.; Kelly M.J.H.) Card. Dept., Roy. Victoria Hosp., Belfast CORRESPONDENCE ADDRESS Card. Dept., Roy. Victoria Hosp., Belfast SOURCE European Journal of Cardiology (1978) 7:2-3 (147-156). Date of Publication: 1978 ISSN 0301-4711 ABSTRACT Among patients with acute myocardial infarction and a normal heart rate and blood pressure, a high incidence of sympathetic overactivity was recorded during transport. The combined administration of atropine and sotalol had no significant effect on the mean maximum heart rate on movement. However, this drug combination prevented excessive slowing of the heart rate. Sotalol caused a significant reduction in the mean maximum heart rate on movement. The side-effects were minimal. 10% of patients who received sotalol required atropine for the correction of bradyarrhythmia. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) atropine sotalol EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adrenergic system blood pressure coronary care unit drug mixture drug therapy heart infarction heart rate patient transport transport EMTREE MEDICAL INDEX TERMS cardiovascular system heart major clinical study therapy CAS REGISTRY NUMBERS atropine (51-55-8, 55-48-1) sotalol (3930-20-9, 80456-07-1, 959-24-0) EMBASE CLASSIFICATIONS Drug Literature Index (37) Cardiovascular Diseases and Cardiovascular Surgery (18) Internal Medicine (6) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978370914 MEDLINE PMID 352700 (http://www.ncbi.nlm.nih.gov/pubmed/352700) PUI L8366842 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1179 TITLE Utilizing the nurse-patient relationship to reduce stress on transfer out of the coronary care unit AUTHOR NAMES Brenner Z.R. AUTHOR ADDRESSES (Brenner Z.R.) Univ. Rochester, N.Y. CORRESPONDENCE ADDRESS Univ. Rochester, N.Y. SOURCE Abstracts of Hospital Management Studies (1978) 14:3 (18507 SC). Date of Publication: 1978 ABSTRACT This study investigated what effect the establishment of a relationship between a general medical nurse and a myocardial infarction patient might have on the stress experienced on transfer out of the coronary care unit. A post-test only control group was used. Twenty English-speaking patients who had been directly admitted to the coronary care unit, had confirmed myocardial infarctions, had family members available, and had no previous history of psychiatric therapy were randomly assigned to either the control or experimental group. The level of the patient's psychosocial stress the evening of transfer was evaluated by means of a questionnaire administered to the patient, a family member and the nurse caring for the patient. The patient questionnaire also included items for reporting physiological symptoms. The patient's chart was examined for information on physiological complications and documentation by the professional staff of behavioral manifestations of stress and physiological status during recuperation. The responses of the patient, family and nurse supported the hypothesis that patients in the experimental group would be less stressed on transfer out of the coronary care unit. Patient-reported levels of physical symptoms the evening of transfer were identical for both groups, but experimental patients experienced fewer physiological symptoms within 24 hours of transfer and from that time until discharge. The experimental patients also exhibited fewer behavioral manifestations of stress and had shorter hospital stays with fewer physiological complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit nurse patient relationship EMTREE MEDICAL INDEX TERMS clinical trial controlled study human psychological aspect randomized controlled trial EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978324308 PUI L8320744 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1180 TITLE Nurse-family interaction to reduce patient stress during transfer from the coronary care unit AUTHOR NAMES Schwartz L.P. AUTHOR ADDRESSES (Schwartz L.P.) Univ. Rochester, N.Y. CORRESPONDENCE ADDRESS Univ. Rochester, N.Y. SOURCE Abstracts of Hospital Management Studies (1978) 14:3 (18532 SC). Date of Publication: 1978 ABSTRACT Twenty patients hospitalized with acute myocardial infarction were studied to determine the effects of a family-centered nursing approach on reducing patient stress associated with CCU transfer and the incidence of cardiovascular complications. Three nurse-family interactions provided the family with information about CCU transfer and encouraged family members to offer emotional support to the patient. A comparison group was also used. Six dependent variables measured the effect of the nurse-family intervention. The instrument used was equally divided between psychosocial and physiological measures of patient stress. The psychosocial portion consisted of questionnaires administered to the patient, a family member, and a staff nurse. The physiological portion consisted of 1) cardiovasuclar complaints as reported on the patient questionnaire, 2) cardiovascular complications as recorded in the hospital record within 24 hours of transfer, and 3) cardiovascular complications as recorded in the patient's chart for the remainder of the hospitalization. Findings indicated that, overall, experimental patients scored lower than control patients on 1) self reported patient stress, 2) family reported patient stress, 3) cardiovascular complications with 24 hours of transfer and 4) cardiovasuclar complications during the remainder of the hospitalization. Of these, only the difference in the family evaluated patient stress was statistically significant. There was no difference found between experimental and control patients for 1) patient reported cardiovascular complaints and 2) patient stress as reported by the staff nurse. Additional findings revealed no alteration in feelings of anger, but anxiety, depression, and fear were reduced in patients who received the experimental intervention. These patients were also more likely to comply with physicians' orders, had fewer readmissions to CCU, spent fewer days hospitalized on the general medical unit, and had fewer acute cardiovasuclar readmissions during the first three months. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit nurse patient attitude stress EMTREE MEDICAL INDEX TERMS psychological aspect EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978324310 PUI L8320746 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1181 TITLE The effects of telemetry in reducing anxiety for myocardial infarction patients after coronary care unit transfer AUTHOR NAMES Van De Zande G.A. AUTHOR ADDRESSES (Van De Zande G.A.) Univ. Rochester, N.Y. CORRESPONDENCE ADDRESS Univ. Rochester, N.Y. SOURCE Abstracts of Hospital Management Studies (1978) 14:3 (18534 SC). Date of Publication: 1978 ABSTRACT The purpose of this study was to test the theoretical hypothesis that telemetry reduces anxiety for myocardial infarction patients after transfer from the coronary care unit. The sample consisted of 45 myocardial infarction patients at two city hospitals. Twenty patients were transferred on telemetry and 25 patients were transferred not on telemetry. The dependent variables utilized to test the study hypothesis were the scores on the Multiple Affect Adjective Check List the day after transfer, scores on the anxiety about care questionnaire, difficulty in sleeping scores, the amount of sleeping medication, tranquilizers, and analygesics for chest pain, and the number of complaints of chest pain. It was hypothesized that patients on telemetry would have lower scores on each of these variables. Statistically significant results in the predicted direction were obtained for the anxiety about care scores, the difficulty in sleeping scores, and the amount of tranquilizers received. An exploratory analysis of the quantitative data showed that patients over 60 years of age tended to have more difficulty in sleeping than patients under 60, and that female patients tended to report higher anxiety levels than males. Telemetry patients, as compared to non-telemetry patients, were more likely to see transfer as a positive step in their recovery. Patients transferred to a small cardiac telemetry unit were more likely to feel secure in their environment. Qualitative data, separated into six categories of concerns, showed that the majority of the patients reacted positively to the coronary care unit and to the nursing care, but expressed indifference to the presence of the monitors. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anxiety coronary care unit nursing patient attitude telemetry EMTREE MEDICAL INDEX TERMS psychological aspect therapy EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978324311 PUI L8320747 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1182 TITLE Does a photograph of a newborn about to be transferred to an intensive care center promote mother-infant bonding? AUTHOR NAMES Kopelman A.E. Simeonsson R.J. Smaldone A. Gilbert L. AUTHOR ADDRESSES (Kopelman A.E.; Simeonsson R.J.; Smaldone A.; Gilbert L.) Dept. Ped., Univ. Rochester Sch. Med. Dent., Rochester, N.Y. 14642 CORRESPONDENCE ADDRESS Dept. Ped., Univ. Rochester Sch. Med. Dent., Rochester, N.Y. 14642 SOURCE Clinical Pediatrics (1978) 17:1 (15-16). Date of Publication: 1978 ISSN 0009-9228 ABSTRACT The first days following birth are now looked upon as a 'sensitive period' in which mother-infant bonding most readily occurs. Separation of a mother from her infant at that time may interfere with this process, so that the mother-infant attachment may subsequently be achieved imperfectly or even not at all. This preliminary communication describes the experiences with the use of an infant photograph, presented to the mother at the time of neonatal transfer, as a simple measure to help her deal with the psychologic process of bonding during a time of crisis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care mother child relation newborn EMTREE MEDICAL INDEX TERMS major clinical study methodology therapy EMBASE CLASSIFICATIONS Psychiatry (32) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978275871 MEDLINE PMID 618695 (http://www.ncbi.nlm.nih.gov/pubmed/618695) PUI L8273117 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1183 TITLE Neonatal transport, 1976. AUTHOR NAMES McCaffree M.A. AUTHOR ADDRESSES (McCaffree M.A.) CORRESPONDENCE ADDRESS M.A. McCaffree, SOURCE The Journal of the Oklahoma State Medical Association (1978) 71:1 (10-14). Date of Publication: Jan 1978 ISSN 0030-1876 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn disease (therapy) patient transport EMTREE MEDICAL INDEX TERMS aircraft article car human intensive care unit newborn patient care United States LANGUAGE OF ARTICLE English MEDLINE PMID 621596 (http://www.ncbi.nlm.nih.gov/pubmed/621596) PUI L8663673 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1184 TITLE The Maryland State Intensive Care Neonatal Program (MSICNP), part 2: role of the Maryland State police Aviation Division. AUTHOR NAMES Mazzi E. Gutberlet R. Phillips J.A. AUTHOR ADDRESSES (Mazzi E.; Gutberlet R.; Phillips J.A.) CORRESPONDENCE ADDRESS E. Mazzi, SOURCE Maryland state medical journal (1977) 26:12 (48-50). Date of Publication: Dec 1977 ISSN 0025-4363 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aircraft intensive care unit newborn disease (therapy) patient transport EMTREE MEDICAL INDEX TERMS article health care planning human methodology newborn United States LANGUAGE OF ARTICLE English MEDLINE PMID 926862 (http://www.ncbi.nlm.nih.gov/pubmed/926862) PUI L8642663 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1185 TITLE Intra hospital transfer: effects on chronically ill psychogeriatric patients AUTHOR NAMES Raasoch J. Willmuth R. Thomson L. Hyde R. AUTHOR ADDRESSES (Raasoch J.; Willmuth R.; Thomson L.; Hyde R.) Vermont State Hosp., Waterbury, Vt. CORRESPONDENCE ADDRESS Vermont State Hosp., Waterbury, Vt. SOURCE Journal of the American Geriatrics Society (1977) 25:6 (281-284). Date of Publication: 1977 ISSN 0002-8614 ABSTRACT Since the Vermont State Hospital was approaching a major transition period, it was decided to study systematically the effects of intraunit and interunit transfer on its psychogeriatric patients. Ten patients were assessed by means of 4 standardized measures in the intraunit study, specifically investigating the effects of integrating wards previously devoted either to chronic or to acute psychiatric illness. Twenty five patients from a specialized geriatric unit were evaluated, by separate investigators, with respect to changes occurring as a result of their transfer to regional mixed units. The critical incident log, the problem classification form, and the clinical global impression showed some changes, for which there were several possible explanations. None of the changes was as dramatic as predicted by staff members holding divergent views prior to the study. The optimists predicted a 'blossoming' of the psychogeriatric patients in the mixed, regional units, whereas the pessimists prophesied dire consequences. The group of patients studied was not completely homogeneous with respect to the effect of transfer. Clinical assessment after transfer could be relied on to detect improvement in some of these psychogeriatric patients and deterioration in others. Some understanding of the complexity of the multifactor determinants of change developed along with increased cooperation among the investigators and the nursing staff. A middle ground of mutual respect for fresh ideas and an appreciation for years of experience was reached. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) chronic disease gerontopsychiatry hospital patient transfer EMTREE MEDICAL INDEX TERMS age diagnosis major clinical study EMBASE CLASSIFICATIONS Gerontology and Geriatrics (20) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Psychiatry (32) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978104287 MEDLINE PMID 864175 (http://www.ncbi.nlm.nih.gov/pubmed/864175) PUI L8103720 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1186 TITLE Transfer of the cardiac patient ORIGINAL (NON-ENGLISH) TITLE Le transfert du malade cardiaque. AUTHOR NAMES Lethbridge B. Somboon O. Shea H.L. AUTHOR ADDRESSES (Lethbridge B.; Somboon O.; Shea H.L.) CORRESPONDENCE ADDRESS B. Lethbridge, SOURCE L' Infirmière canadienne (1977) 19:7 (16-18). Date of Publication: Jul 1977 ISSN 0019-9605 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adaptive behavior heart disease progressive patient care EMTREE MEDICAL INDEX TERMS article hospital subdivisions and components human intensive care unit nursing LANGUAGE OF ARTICLE French MEDLINE PMID 586204 (http://www.ncbi.nlm.nih.gov/pubmed/586204) PUI L7547879 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1187 TITLE The transfer of patients from the I.C.U. AUTHOR NAMES Sombun O. AUTHOR ADDRESSES (Sombun O.) CORRESPONDENCE ADDRESS O. Sombun, SOURCE Thai journal of nursing (1977) 26:3 (225-231). Date of Publication: Jul 1977 ISSN 0125-0078 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart infarction patient transport progressive patient care EMTREE MEDICAL INDEX TERMS article human nursing LANGUAGE OF ARTICLE Thai MEDLINE PMID 252825 (http://www.ncbi.nlm.nih.gov/pubmed/252825) PUI L9505864 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1188 TITLE Where is the borderline between the work of physicians and nurses? Questions of responsibility, salary and education often unsolved in transfer of duties ORIGINAL (NON-ENGLISH) TITLE Ansvars-, löne- och utbildningsfrågor ofta olösta vid överföring av uppgifter AUTHOR NAMES Karlsson Y. AUTHOR ADDRESSES (Karlsson Y.) CORRESPONDENCE ADDRESS Y. Karlsson, SOURCE Nordisk medicin (1977) 92:5 (136-138). Date of Publication: May 1977 ISSN 0029-1420 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health economics nurse nursing education EMTREE MEDICAL INDEX TERMS article diabetes mellitus human human relation hypertension injection intensive care unit nurse anesthetist nursing prescription Sweden utilization review vaccination LANGUAGE OF ARTICLE Swedish MEDLINE PMID 866099 (http://www.ncbi.nlm.nih.gov/pubmed/866099) PUI L7528665 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1189 TITLE Transport of high risk neonates. Part II: Short term intensive care and stabilization of the sick infant. AUTHOR NAMES Ramamurthy R.S. Yeh T.F. Pildes R.S. AUTHOR ADDRESSES (Ramamurthy R.S.; Yeh T.F.; Pildes R.S.) CORRESPONDENCE ADDRESS R.S. Ramamurthy, SOURCE IMJ. Illinois medical journal (1976) 150:6 (601-604). Date of Publication: Dec 1976 ISSN 0019-2120 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service newborn disease (therapy) patient transport EMTREE MEDICAL INDEX TERMS article human infant intensive care unit newborn time LANGUAGE OF ARTICLE English MEDLINE PMID 12098 (http://www.ncbi.nlm.nih.gov/pubmed/12098) PUI L7472022 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1190 TITLE The ecology of adaptation to a new environment AUTHOR NAMES Lawton M.P. Patnaik B. Kleban M.H. AUTHOR ADDRESSES (Lawton M.P.; Patnaik B.; Kleban M.H.) Philadelphia Geriat. Cent., Philadelphia, Pa. 19141 CORRESPONDENCE ADDRESS Philadelphia Geriat. Cent., Philadelphia, Pa. 19141 SOURCE International Journal of Aging and Human Development (1976) 7:1 (15-26). Date of Publication: 1976 ISSN 0091-4150 ABSTRACT The intrainstitutional room transfer of 48 elderly residents was studied by direct behavior mapping techniques. Data were obtained on the physical location, body position, and behavior of both residents and staff on a large number of tours of residential floors preceding and following the move. About half of the hypotheses suggesting that greater passivity and restriction in social space would occur following the move were supported. These responses were seen as adaptive in allowing the individual to comprehend the new environment prior to moving out more actively. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adaptation institutionalization EMTREE MEDICAL INDEX TERMS age classification EMBASE CLASSIFICATIONS Gerontology and Geriatrics (20) Anatomy, Anthropology, Embryology and Histology (1) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1977117336 MEDLINE PMID 1279029 (http://www.ncbi.nlm.nih.gov/pubmed/1279029) PUI L7117284 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1191 TITLE The present state of the regionalization of intensive care and the transport system for high risk newborn babies in Japan (Japanese) AUTHOR NAMES Ishizuka Y. Hashimoto T. Fujii T. AUTHOR ADDRESSES (Ishizuka Y.; Hashimoto T.; Fujii T.) Dept. Ped., II Tokyo Nat. Hosp., Tokyo CORRESPONDENCE ADDRESS Dept. Ped., II Tokyo Nat. Hosp., Tokyo SOURCE Acta Neonatologica Japonica (1976) 12:4 (451-458). Date of Publication: 1976 ISSN 0029-0386 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMTREE MEDICAL INDEX TERMS history statistics therapy EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE Japanese EMBASE ACCESSION NUMBER 1978020068 PUI L8019729 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1192 TITLE A new transparent insulating gown for the surgical neonate AUTHOR NAMES Hobbs J.F. Eidelman A.I. MacKuanying N. AUTHOR ADDRESSES (Hobbs J.F.; Eidelman A.I.; MacKuanying N.) Div. Neonatol., Dept. Ped., Hosp. Albert Einstein Coll. Med., Bronx, N.Y. 10461 CORRESPONDENCE ADDRESS Div. Neonatol., Dept. Ped., Hosp. Albert Einstein Coll. Med., Bronx, N.Y. 10461 SOURCE Journal of Pediatric Surgery (1976) 11:3 (455-460). Date of Publication: 1976 ISSN 0022-3468 ABSTRACT A single layer infant gown of transparent polyethylene was designed to provide insulation with accessability. Initial testing was done in the delivery room, a hazardous environment for the unprotected infant. Subsequently, additional infants were studied during intra hospital transport, diagnostic radiologic testing, and operative procedures. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) homeostasis newborn EMTREE MEDICAL INDEX TERMS methodology therapy EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1977116513 MEDLINE PMID 957071 (http://www.ncbi.nlm.nih.gov/pubmed/957071) PUI L7116461 DOI 10.1016/S0022-3468(76)80203-5 FULL TEXT LINK http://dx.doi.org/10.1016/S0022-3468(76)80203-5 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1193 TITLE Intensive care in obstetrics and gynecology; indications for the transfer to the intensive care unit ORIGINAL (NON-ENGLISH) TITLE INTENSIV THERAPIE IN GEBURTSHILFE UND GYNAKOLOGIE; INDIKATIONEN ZUR VERLEGUNG AUF INTENSIV STATIONEN AUTHOR NAMES Grumbrecht C. Hohlweg Majert P. Klose R. Wochele E. AUTHOR ADDRESSES (Grumbrecht C.; Hohlweg Majert P.; Klose R.; Wochele E.) Frauenklin., Fak. Klin. Med., Univ. Heidelberg, Mannheim CORRESPONDENCE ADDRESS Frauenklin., Fak. Klin. Med., Univ. Heidelberg, Mannheim SOURCE Fortschritte der Medizin (1976) 94:27 (1447-1450). Date of Publication: 1976 ISSN 0015-8178 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) gynecology intensive care obstetrics EMTREE MEDICAL INDEX TERMS diagnosis major clinical study therapy EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 1977152807 MEDLINE PMID 971890 (http://www.ncbi.nlm.nih.gov/pubmed/971890) PUI L7152668 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1194 TITLE The effects of patient preparation on reducing anxiety in patients transferred from a coronary care unit AUTHOR NAMES Sicard J. AUTHOR ADDRESSES (Sicard J.) Univ. Rochester, N.Y. 14627 CORRESPONDENCE ADDRESS Univ. Rochester, N.Y. 14627 SOURCE Abstracts of Hospital Management Studies (1976) 13:2 (16052 NU:103p). Date of Publication: 1976 ABSTRACT Study investigated the effect of patient preparation on level of anxiety and use of pain and sleeping medications and tranquilizers in a sample of coronary care patients transferred from an acute care setting to a convalescent unit. Fourteen patients meeting study criteria were randomly assigned to either an experimental group or control group. The experimental group received daily teaching sessions regarding their illness while the control group received only routine preparations for transfer. Anxiety scores were determined and compared from questionnaires administered before and after the transfer. Results show a significant relationship between preparation of the patient and decreased anxiety and use of tranquilizers at 0.05 level of significance using the one tail t test. Findings also show relationship between frequency of sleeping disturbances and patient preparation was in direction predicted, although not statistically significant. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit patient care EMTREE MEDICAL INDEX TERMS clinical trial controlled study human major clinical study methodology randomized controlled trial therapy EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1978011616 PUI L8011511 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1195 TITLE Indicators and periods of transfer of sick newborn infants and premature infants from maternity homes into specialized wards of pediatric hospitals ORIGINAL (NON-ENGLISH) TITLE Pokazaniia i sroki perevoda iz rodil'nykh domov zabolevshikh novorozhdennykh i nedonoshennykh detei v spetsializirovannye otdeleniia (palaty) detskikh bol'nits AUTHOR NAMES Balashova V.G. AUTHOR ADDRESSES (Balashova V.G.) CORRESPONDENCE ADDRESS V.G. Balashova, SOURCE Feldsher i akusherka (1976) 41:9 (5-6). Date of Publication: Sep 1976 ISSN 0014-9772 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) newborn disease nursery patient transport prematurity EMTREE MEDICAL INDEX TERMS article hospital human intensive care unit newborn USSR LANGUAGE OF ARTICLE Russian MEDLINE PMID 1050297 (http://www.ncbi.nlm.nih.gov/pubmed/1050297) PUI L7471482 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1196 TITLE Retransfer of convalescent infants from newborn intensive care to community intermediate care nurseries. AUTHOR NAMES Leake R.D. Loew A.D. Oh W. AUTHOR ADDRESSES (Leake R.D.; Loew A.D.; Oh W.) CORRESPONDENCE ADDRESS R.D. Leake, SOURCE Clinical pediatrics (1976) 15:3 (293-294). Date of Publication: Mar 1976 ISSN 0009-9228 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health care patient transport EMTREE MEDICAL INDEX TERMS article community hospital convalescence cross infection (therapy) human intensive care unit newborn newborn disease (therapy) nursery nursing salmonellosis (therapy) United States LANGUAGE OF ARTICLE English MEDLINE PMID 1253510 (http://www.ncbi.nlm.nih.gov/pubmed/1253510) PUI L6527543 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1197 TITLE Organization, transport, admission and permanent control of the severely sick child ORIGINAL (NON-ENGLISH) TITLE Organizacija transporta, prijema i stalne kontrole tesko obolelog deteta. AUTHOR NAMES Pavlović P. Ugoci S. Janković S. AUTHOR ADDRESSES (Pavlović P.; Ugoci S.; Janković S.) CORRESPONDENCE ADDRESS P. Pavlović, SOURCE Narodno zdravlje (1976) 32:3-4 (186-190). Date of Publication: 1976 Mar-Apr ISSN 0027-8025 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child hospitalization monitoring patient transport EMTREE MEDICAL INDEX TERMS age article child hemorrhagic shock (therapy) human injury (therapy) intensive care unit organization and management respiratory failure (therapy) Yugoslavia LANGUAGE OF ARTICLE Serbian MEDLINE PMID 1029787 (http://www.ncbi.nlm.nih.gov/pubmed/1029787) PUI L7557406 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1198 TITLE Neonatal ICU transport--a life-saver. AUTHOR ADDRESSES SOURCE RN (1975) 38:12 (ICU14-15). Date of Publication: Dec 1975 ISSN 0033-7021 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit newborn disease (therapy) patient transport EMTREE MEDICAL INDEX TERMS article human newborn United States LANGUAGE OF ARTICLE English MEDLINE PMID 1043113 (http://www.ncbi.nlm.nih.gov/pubmed/1043113) PUI L6483088 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1199 TITLE Practical experience in the transport of newborn infants at risk by means of a mobile intensive care unit ORIGINAL (NON-ENGLISH) TITLE PRAKTISCHE ERFAHRUNGEN MIT DEM INTENSIVPFLEGE TRANSPORT VON FRUH- UND NEUGEBORENEN BEI VITALER GEFAHRDUNG AUTHOR NAMES Lemburg P. Enayat U. Renner K. Volberg B. AUTHOR ADDRESSES (Lemburg P.; Enayat U.; Renner K.; Volberg B.) Abt. Pad. Intensivmed., Univ. Kinderklin., Dusseldorf CORRESPONDENCE ADDRESS Abt. Pad. Intensivmed., Univ. Kinderklin., Dusseldorf SOURCE Wiener Klinische Wochenschrift (1975) 87:15 (468-474). Date of Publication: 1975 ISSN 0043-5325 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE German EMBASE ACCESSION NUMBER 1976113918 MEDLINE PMID 1226753 (http://www.ncbi.nlm.nih.gov/pubmed/1226753) PUI L6113857 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1200 TITLE Transport of "high-risk" newborn infants. (Apropos of 159 emergency calls by the SAMU 94-Service d'Aide Médicale Urgente-Emergency Health Service) ORIGINAL (NON-ENGLISH) TITLE Transport des nouveau-nes "a haut risque" (a propos de 159 interventions médicales urgentes régulée par le SAMU 94) AUTHOR NAMES Scheyer M. Iannascoli F. Brioude R. Canet J. AUTHOR ADDRESSES (Scheyer M.; Iannascoli F.; Brioude R.; Canet J.) CORRESPONDENCE ADDRESS M. Scheyer, SOURCE Annales de l'anesthésiologie française (1975) 16 Spec No 1 (130-134). Date of Publication: 1975 ISSN 0003-4061 ABSTRACT Analysis of our experience confirms in the domain of the newborn the fundamental notion of the Emergency medical call. The EMC has two objectives: 1--Emergency treatment before the patient is moved, and the correction of failing vital functions by a medical team skilled in problems of neonates. 2--Transportation of the neonate in a stable condition, to the Intensive Care unit. The quality of such transportation depends closely upon the quality of the medical care given and upon organisation. It can only be carried out in the context of a system coordinated by a "coordinating physician" (e.g. SAMU 94). This coordinating physician has responsibility for logistics, telephone coordination, and application of the call procedure as rapidly as possible. From a logistical point of view, only coordination between:--SAMU-SMUR;--Medical team of the Intensive care unit;--Requesting service make possible the provision and quality of continuous supplies of oxygen, warmth, sugar - all under aseptic conditions, indispensable to the quality of survival of the neonate. In addition, we feel it essential--that the delay before the call is answered be as brief as possible;--that the call should be dealt with by a mixed team, including at least one physician experienced in neonatal problems;--that the choice of vehicle used for transportation should be better adapted to the situation. This choice is the responsibility of the coordinating physician, who should base his decisions on two fundamental requirements:--rapidity of dealing with the call;--personal safety of those involved. This without losing sight of--Prevention of perinatal problems lies part with the detection of high risk pregnancies, with the aim of arranging delivery in specialised "mother and baby" centres where close collaboration between obstetrician and paediatrician is assured.--The development of transportation of the "high-risk" neonate, which is so costly in manpower and equipment, depends closely upon general concepts of health care in France, which should be aimed at:--the prevention of prematury;--the detection of high risk pregnancies;--the development of mother and baby centres. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency health service newborn disease (therapy) patient transport EMTREE MEDICAL INDEX TERMS article child health care emergency female France human intensive care unit newborn nursery pregnancy pregnancy complication (therapy) LANGUAGE OF ARTICLE French MEDLINE PMID 2070 (http://www.ncbi.nlm.nih.gov/pubmed/2070) PUI L6498679 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1201 TITLE Letter: Transport of infants for intensive care. AUTHOR ADDRESSES SOURCE British medical journal (1975) 4:5993 (408). Date of Publication: 15 Nov 1975 ISSN 0007-1447 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child health care intensive care unit EMTREE MEDICAL INDEX TERMS article human newborn newborn disease (therapy) LANGUAGE OF ARTICLE English MEDLINE PMID 1192098 (http://www.ncbi.nlm.nih.gov/pubmed/1192098) PUI L6474580 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1202 TITLE Movement of criticall ill patients within hospital. AUTHOR NAMES Waddell G. AUTHOR ADDRESSES (Waddell G.) CORRESPONDENCE ADDRESS G. Waddell, SOURCE British medical journal (1975) 2:5968 (417-419). Date of Publication: 24 May 1975 ISSN 0007-1447 ABSTRACT Critically ill patients were observed during routine movement inside the hospital to and from the intensive therapy unit. One patient a month suffered major cardiorespiratory collapse or death as a direct result of movement. Renewed bleeding of a pelvic fracture, cardiac arrhythmia, cardiac embarrassment due to a haemothorax, and cardiovascular decompensation were seen. It was difficult to continue treatment during movement, especially maintaining an airway or providing adequate intermittent positive pressure ventilation. Seventy postoperative patients suffered few ill effects on being moved. Greater awareness of the dangers of moving critically ill patients within hospital is needed. Thorough preparation for the move and adequate maintenance of treatment during movement requires the skill of experienced medical staff. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital intensive care unit patient transport EMTREE MEDICAL INDEX TERMS acute disease aged airway obstruction (epidemiology) article bleeding (epidemiology) child female heart arrest (etiology) heart arrhythmia (etiology) human intermittent positive pressure ventilation male middle aged mortality traction therapy wound drainage LANGUAGE OF ARTICLE English MEDLINE PMID 1092402 (http://www.ncbi.nlm.nih.gov/pubmed/1092402) PUI L5508288 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1203 TITLE Neonatal Intensive Care Center, Maine Medical Center: who and how to transfer AUTHOR NAMES Hallett G.W. AUTHOR ADDRESSES (Hallett G.W.) 22 Bramhall St., Portland, Me. 04102 CORRESPONDENCE ADDRESS 22 Bramhall St., Portland, Me. 04102 SOURCE Journal of the Maine Medical Association (1974) 65:8 (183). Date of Publication: 1974 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care newborn EMBASE CLASSIFICATIONS Pediatrics and Pediatric Surgery (7) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1975111081 PUI L5111002 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1204 TITLE Organization for patient movement at Fitzsimons General Hospital, Denver, Colorado AUTHOR NAMES Soriano Jr F.M. AUTHOR ADDRESSES (Soriano Jr F.M.) Baylor Univ., Waco, Tex. CORRESPONDENCE ADDRESS Baylor Univ., Waco, Tex. SOURCE Abstracts of Hospital Management Studies (1974) 10:3 (11291:101p.). Date of Publication: 1974 ABSTRACT The purpose of this study was to define the air evacuation problem at Fitzsimons General Hospital and develop the best system of organization for patient movement. Data was collected through unstructured interviews of air evacuation personnel and others in various position levels in the hospital. Review of the literature revealed significant lack of material in the area of organization for patient movement. Time study of the patient movement activity for air evacuation was conducted. Work load and performance data were analyzed. The premise was that an organization with a sound organizational structure and centralized control of its resources would facilitate coordination, cooperation, and communication among its members, and would result in a more efficient and effective enterprise. Emphasis was on the concept that patient movement is a part of total patient care and a medical function that should be performed and supervised by medically trained personnel. It was recommended that: (1) the Air Evacuation Section and the Ambulance Section be consolidated into a centralized 'Patient Movement Activity' under the organizaion and operational control of the Nursing Department; (2) there be continuing medical training and cross training of all personnel of the activity including the ambulance drivers and the registrar trained air evacuation enlisted personnel; (3) consideration be given to the future addition of a centralized intrahospital patient transport service organized under the proposed Patient Movement Activity because of its nurse timesaving feature and more efficient utilization of orderlies and porters. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) economic aspect EMTREE MEDICAL INDEX TERMS outpatient care EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1974206159 PUI L4206048 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1205 TITLE The observed and expressed nursing needs of fifteen myocardial infarction patients following transfer from a coronary care unit AUTHOR NAMES McNeely E.R. AUTHOR ADDRESSES (McNeely E.R.) Univ. Toronto CORRESPONDENCE ADDRESS Univ. Toronto SOURCE Abstracts of Hospital Management Studies (1973) 10:2 (10686 NU: 94p). Date of Publication: 1973 ABSTRACT A study was made of the observed and expressed nursing needs of 15 myocardial infarction patients following their transfer from a coronary care unit to a general care unit in 2 metropolitan general hospitals. Data were collected from medical records, direct observation, and interviews with patients and their families. Study findings showed the 7 most frequently observed and expressed physical needs, the 7 most frequently occurring psychological needs, and the needs most frequently expressed by the families. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit economic aspect heart infarction hospital patient nursing psychology EMTREE MEDICAL INDEX TERMS general hospital hospital teaching hospital university hospital EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1974131929 PUI L4131846 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1206 TITLE Prehospital care and transport in acute myocardial infarction AUTHOR NAMES Grace W.J. AUTHOR ADDRESSES (Grace W.J.) Dept. Med., St Vincent's Hosp., New York, N.Y. CORRESPONDENCE ADDRESS Dept. Med., St Vincent's Hosp., New York, N.Y. SOURCE CHEST (1973) 63:4 (469-472). Date of Publication: 1973 ISSN 0012-3692 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit heart infarction EMTREE MEDICAL INDEX TERMS therapy EMBASE CLASSIFICATIONS Cardiovascular Diseases and Cardiovascular Surgery (18) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1974143446 MEDLINE PMID 4695341 (http://www.ncbi.nlm.nih.gov/pubmed/4695341) PUI L4143362 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1207 TITLE The effects of ward change on patients' psychopathology and behaviour: a failure to replicate AUTHOR NAMES Hoffmann H. Nickles L.A. AUTHOR ADDRESSES (Hoffmann H.; Nickles L.A.) Willmar State Hosp., Willmar, Minn. CORRESPONDENCE ADDRESS Willmar State Hosp., Willmar, Minn. SOURCE Journal of Clinical Psychology (1973) 29:1 (97). Date of Publication: 1973 ISSN 0021-9762 ABSTRACT 33 psychiatric patients were rated by three nursing staff members on psychiatric symptoms and ward behavior 1 mth prior to and 6 mth after a transfer from a general assignment type ward to a geographic unit system. Changes in psychopathology as noted by other researchers in retests after 3 mth could not be found in this study, which used retests completed 6 mth after patients' transfers. This indicates that immediate or shortterm effects from intrahospital transfer tend not to be maintained over a longer period of time. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) behavior nursing staff psychiatry EMTREE MEDICAL INDEX TERMS methodology EMBASE CLASSIFICATIONS Psychiatry (32) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1974109309 MEDLINE PMID 4683403 (http://www.ncbi.nlm.nih.gov/pubmed/4683403) PUI L4109233 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 1208 TITLE Transport of pregnant patients with severe forms of late toxicosis to specialized resuscitation departments ORIGINAL (NON-ENGLISH) TITLE Transportirovka bol'nykh s tiazhelymi formami poznego toksikoza beremennykh v spetsializirovannye reanimatsionnye otdeleniia AUTHOR NAMES Manevich L.E. Kaverina K.P. Khlestova R.A. Blinkin A.I. AUTHOR ADDRESSES (Manevich L.E.; Kaverina K.P.; Khlestova R.A.; Blinkin A.I.) CORRESPONDENCE ADDRESS L.E. Manevich, SOURCE Voprosy okhrany materinstva i detstva (1973) 18:4 (85-89). Date of Publication: 1973 ISSN 0042-8825 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency patient transport preeclampsia (therapy) resuscitation EMTREE MEDICAL INDEX TERMS acute disease article female human intensive care unit pregnancy Russian Federation LANGUAGE OF ARTICLE Russian MEDLINE PMID 4802937 (http://www.ncbi.nlm.nih.gov/pubmed/4802937) PUI L5450806 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1209 TITLE Materials transportation AUTHOR NAMES Jones R. Pisinski E. AUTHOR ADDRESSES (Jones R.; Pisinski E.) Commun. Syst. Found., Ltd., Ann Arbor, Mich. 48105 CORRESPONDENCE ADDRESS Commun. Syst. Found., Ltd., Ann Arbor, Mich. 48105 SOURCE Abstracts of Hospital Management Studies (1973) 10:2 (10488 PU:34p). Date of Publication: 1973 ABSTRACT This study analyzed the intrahospital transportation system (delivery of items such as linen and pharmaceuticals), projected cart requirements, and defined routes carts should follow during material delivery in a hospital that was expanding from 207 to 315 beds. The study also examined ways to adapt the transportation system to team nursing. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) hospital linen EMTREE DRUG INDEX TERMS unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) economic aspect hospital management materials handling nurse teamwork transport EMTREE MEDICAL INDEX TERMS general hospital home for the aged hospital mental health center mental hospital nursing home public hospital teaching hospital university hospital EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 1974132053 PUI L4131970 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1210 TITLE Diagnostic criteria for admission to or transfer from the intensive care unit--description of patients treatment in the ICU AUTHOR NAMES Urukami H. AUTHOR ADDRESSES (Urukami H.) CORRESPONDENCE ADDRESS H. Urukami, SOURCE [Kango gijutsu] : [Nursing technique] (1973) 19:8 (132-137). Date of Publication: Aug 1973 ISSN 0449-752X EMTREE MEDICAL INDEX TERMS article diagnosis intensive care unit prognosis progressive patient care LANGUAGE OF ARTICLE Japanese MEDLINE PMID 4489950 (http://www.ncbi.nlm.nih.gov/pubmed/4489950) PUI L93411193 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1211 TITLE Early transportable combination-apparatus for oxygen supply and suction device ORIGINAL (NON-ENGLISH) TITLE Ein leicht transportables Kombinationsgerät für Sauerstoffzufuhr und Absaugevorrichtung. AUTHOR NAMES Wietelmann H. Klaucke D. AUTHOR ADDRESSES (Wietelmann H.; Klaucke D.) CORRESPONDENCE ADDRESS H. Wietelmann, SOURCE Zeitschrift für praktische Anästhesie, Wiederbelebung und Intensivtherapie (1973) 8:3 (186-187). Date of Publication: Jun 1973 ISSN 0300-8789 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial ventilation catheterization oxygen therapy EMTREE MEDICAL INDEX TERMS article bronchus devices human intensive care unit intubation secretion (process) ventilator LANGUAGE OF ARTICLE German MEDLINE PMID 4520415 (http://www.ncbi.nlm.nih.gov/pubmed/4520415) PUI L4445796 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1212 TITLE The transfer process: an area of concern for the CCU nurse. AUTHOR NAMES Shannon V.J. AUTHOR ADDRESSES (Shannon V.J.) CORRESPONDENCE ADDRESS V.J. Shannon, SOURCE Heart & lung : the journal of critical care (1973) 2:3 (364-367). Date of Publication: 1973 May-Jun ISSN 0147-9563 EMTREE MEDICAL INDEX TERMS adaptive behavior article coronary care unit nurse patient relationship progressive patient care LANGUAGE OF ARTICLE English MEDLINE PMID 4488728 (http://www.ncbi.nlm.nih.gov/pubmed/4488728) PUI L93367696 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1213 TITLE Transferable resistance to gentamycin. II. Transmission and linkage of the resistance character ORIGINAL (NON-ENGLISH) TITLE Resistance transferable a la gentamicine. II. Transmission et liaisons du caractere de resistance AUTHOR NAMES Witchitz J.L. Chabbert Y.A. AUTHOR ADDRESSES (Witchitz J.L.; Chabbert Y.A.) Lab. Cent., Hop. Claude Bernard, Paris. CORRESPONDENCE ADDRESS Lab. Cent., Hop. Claude Bernard, Paris. SOURCE Annales de l'Institut Pasteur (1972) 122:3 (367-378). Date of Publication: 1972 ISSN 0020-2444 ABSTRACT Transferable gentamycin resistance (Gk) was studied in 26 strains belonging to 7 bacterial species: E. coli, Enterobacter aerogenes, K. pneumoniae, Citrobacter, P. mirabilis, Providencia and Pseudomonas aeruginosa, isolated in an intensive care unit between November 1969 and December 1970. All these strains were also resistant to ampicillin (A), chloramphenicol (C), sulfonamides (Su) and in some cases other agents as well. The strains transferred at least the resistance pattern ACSuGk to E. coli K12. Phage P1Kc transduces the complete pattern ACSuGk from K12 to suitable K12 recipients. The resistance marker Gk was first observed in November 1969 and ACSu R factors seem to be rare in previous studies. These observations may be explained by in vivo transfer of a single R factor between different bacterial species. Such transfer may have occurred in the liquid of a peritoneal dialysis performed in one of the first patients. Transferable resistance to gentamycin may thus have become widely distributed as the result of in vivo transfer of a single R factor between different bacterial species. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) gentamicin EMTREE DRUG INDEX TERMS ampicillin chloramphenicol kanamycin marker sulfonamide EMTREE MEDICAL INDEX TERMS bacteriophage Citrobacter disinfection Enterobacter aerogenes Escherichia coli Gram negative bacterium hospital infection in vitro study intensive care unit Klebsiella pneumoniae liquid Mirabilis patient peritoneal dialysis Providencia Pseudomonas aeruginosa R factor recipient species LANGUAGE OF ARTICLE French LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008442639 PUI L292053558 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1214 TITLE Transfer of newborns with respiratory distress syndrome from obstetrical to paediatric wards for intensive care ORIGINAL (NON-ENGLISH) TITLE Beitrag zum Problem der Uberführung deprimierter Neugeborener aus geburtshilflicher Sofortreanaimation in preanimation in pädiatrische Langzeitreanimation. AUTHOR NAMES Koenen F.W. Schnell U.C. AUTHOR ADDRESSES (Koenen F.W.; Schnell U.C.) CORRESPONDENCE ADDRESS F.W. Koenen, SOURCE Zeitschrift für praktische Anästhesie, Wiederbelebung und Intensivtherapie (1972) 7:6 (378-382). Date of Publication: Dec 1972 ISSN 0300-8789 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hospital department intensive care unit neonatal respiratory distress syndrome (therapy) patient transport EMTREE MEDICAL INDEX TERMS article emergency health service German Federal Republic human incubator long term care newborn procedures resuscitation ventilator LANGUAGE OF ARTICLE German MEDLINE PMID 4631278 (http://www.ncbi.nlm.nih.gov/pubmed/4631278) PUI L93304767 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1215 TITLE Value of helicopter evacuations in pediatric practice in the region of Lyons. Analysis of 40 cases in emergency and intensive care units of Desgenettes army instruction hospital ORIGINAL (NON-ENGLISH) TITLE Interêt des évacuations par hélicoptere en pratique pédiatrique dans la région Lyonnaise. Analyse de 40 observations réunies ar le service d'Urgence et de Soins Intensifs de l'Hôpital d'Instruction des Armées Desgenettes. AUTHOR NAMES Giroud M. Morlat C. Buffat J.J. Calamai M. AUTHOR ADDRESSES (Giroud M.; Morlat C.; Buffat J.J.; Calamai M.) CORRESPONDENCE ADDRESS M. Giroud, SOURCE Pédiatrie (1972) 27:7 (783-788). Date of Publication: 1972 Oct-Nov ISSN 0031-4021 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) aircraft patient transport pediatrics EMTREE MEDICAL INDEX TERMS article child emergency health service France human infant intensive care unit military medicine newborn preschool child teaching hospital LANGUAGE OF ARTICLE French MEDLINE PMID 4659978 (http://www.ncbi.nlm.nih.gov/pubmed/4659978) PUI L93350873 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1216 TITLE The recently burned patient. (Appraisal of the seriousness. 1st therapeutic measures. Transport) ORIGINAL (NON-ENGLISH) TITLE Le brulé récent. (Appréciation de la gravité. Premiers gestes thérapeutiques. Transport. AUTHOR NAMES Aubert P. Aubert M. Saizy R. Stern A. Apoil A. Gaudy J.H. Coloigner M. AUTHOR ADDRESSES (Aubert P.; Aubert M.; Saizy R.; Stern A.; Apoil A.; Gaudy J.H.; Coloigner M.) CORRESPONDENCE ADDRESS P. Aubert, SOURCE Anesthésie, analgésie, réanimation (1971) 28:6 (1109-1125). Date of Publication: 1971 Nov-Dec ISSN 0003-3014 EMTREE DRUG INDEX TERMS dextran (drug therapy) glucose (drug therapy) plasma substitute (drug therapy) sodium chloride (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (therapy) first aid patient transport EMTREE MEDICAL INDEX TERMS age article blood pressure measurement catheterization diuresis electrolyte balance human infusion intensive care unit metabolism nursing resuscitation CAS REGISTRY NUMBERS dextran (87915-38-6, 9014-78-2) glucose (50-99-7, 84778-64-3) sodium chloride (7647-14-5) LANGUAGE OF ARTICLE French MEDLINE PMID 5154085 (http://www.ncbi.nlm.nih.gov/pubmed/5154085) PUI L92516057 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1217 TITLE Emergency care and evacuation of the severely burned ORIGINAL (NON-ENGLISH) TITLE Soins d'urgence et évacuation des brûlés graves. AUTHOR NAMES Monteil R. AUTHOR ADDRESSES (Monteil R.) CORRESPONDENCE ADDRESS R. Monteil, SOURCE Thérapie (1971) 26:2 (291-298). Date of Publication: 1971 Mar-Apr ISSN 0040-5957 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) burn (therapy) emergency health service patient transport EMTREE MEDICAL INDEX TERMS acute disease article human infusion intensive care unit resuscitation LANGUAGE OF ARTICLE French MEDLINE PMID 5574553 (http://www.ncbi.nlm.nih.gov/pubmed/5574553) PUI L91383788 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1218 TITLE So-called transportable thoracic radiography and its importance in the intensive therapy ORIGINAL (NON-ENGLISH) TITLE Die sogenannte transportable Thoraxaufnahme und ihre Bedeutung in der Intensivtherapie. AUTHOR NAMES Birzle H. Meroth O. Zix R. AUTHOR ADDRESSES (Birzle H.; Meroth O.; Zix R.) CORRESPONDENCE ADDRESS H. Birzle, SOURCE Zeitschrift für praktische Anästhesie und Wiederbelebung (1971) 6:1 (7-12). Date of Publication: Feb 1971 ISSN 0044-3387 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) intensive care unit thorax radiography EMTREE MEDICAL INDEX TERMS accident article devices human injury lung embolism (diagnosis) radiography radiology time LANGUAGE OF ARTICLE German MEDLINE PMID 4255683 (http://www.ncbi.nlm.nih.gov/pubmed/4255683) PUI L91475347 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1219 TITLE Air transportation of high-risk infants utilizing a flying intensive-care nursery. AUTHOR NAMES Shepard K.S. AUTHOR ADDRESSES (Shepard K.S.) CORRESPONDENCE ADDRESS K.S. Shepard, SOURCE The Journal of pediatrics (1970) 77:1 (148-149). Date of Publication: Jul 1970 ISSN 0022-3476 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) child care emergency health service intensive care unit patient transport EMTREE MEDICAL INDEX TERMS article human infant LANGUAGE OF ARTICLE English MEDLINE PMID 5450278 (http://www.ncbi.nlm.nih.gov/pubmed/5450278) PUI L90438027 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1220 TITLE The induction process. A method of choice in intrainstitutional transfer. AUTHOR NAMES Muzekari L.H. AUTHOR ADDRESSES (Muzekari L.H.) CORRESPONDENCE ADDRESS L.H. Muzekari, SOURCE The Journal of nervous and mental disease (1970) 150:6 (419-422). Date of Publication: Jun 1970 ISSN 0022-3018 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) group therapy mental hospital therapeutic community EMTREE MEDICAL INDEX TERMS article human United States LANGUAGE OF ARTICLE English MEDLINE PMID 5444882 (http://www.ncbi.nlm.nih.gov/pubmed/5444882) PUI L90379971 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1221 TITLE Respiratory distress syndrome. an emergency air ground transport system for newborn infants AUTHOR NAMES Arp L.J. Dillon R.E. Long M.T. Boatwright C.X. AUTHOR ADDRESSES (Arp L.J.; Dillon R.E.; Long M.T.; Boatwright C.X.) Div. of Engin. Fundament, Virginia Polytechn. Lnst, Blacksburg, VA, United States. CORRESPONDENCE ADDRESS L.J. Arp, Div. of Engin. Fundament, Virginia Polytechn. Lnst, Blacksburg, VA, United States. SOURCE Ohio St.Med.J. (1969) 65:7 (703-706). Date of Publication: 1969 ABSTRACT Described is an emergency air ground transport system which has been used successfully to transport newborn infants with respiratory distress syndrome to the Roanoke Memorial Hospitals at Roanoke, Virginia. The special equipment which has been developed for ventilating the distressed newborn will not be available commercially for about one year. In an effort to make this equipment available immediately to physicians and the distressed infants, the Virginia Polytechnic Institute at Blacksburg, Virginia, has established an emergency air ground transport system. A twin engine airplane equipped with special respiratory support equipment will be available to physicians who may wish to transfer respiratory distress cases to the Intensive Care Nursery at the Roanoke Memorial Hospitals. EMTREE DRUG INDEX TERMS hyalin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) emergency newborn respiratory distress syndrome EMTREE MEDICAL INDEX TERMS aircraft assisted ventilation emergency medicine hospital hyaline membrane disease infant intensive care intensive care unit membrane newborn intensive care nursery physician respiratory distress twins United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008464068 PUI L290061167 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1222 TITLE Transfer from a coronary care unit. Some adverse responses AUTHOR NAMES Klein R.F. Kliner V. Zipes D.P. AUTHOR ADDRESSES (Klein R.F.; Kliner V.; Zipes D.P.) Dept. of Med., Duke Univ. Med. Cent., Durham, NC, United States. () CORRESPONDENCE ADDRESS R.F. Klein, Dept. of Med., Duke Univ. Med. Cent., Durham, NC, United States. SOURCE Archives of Internal Medicine (1968) 122:2 (104-108). Date of Publication: 1968 ISSN 0003-9926 ABSTRACT A series of 14 patients with myocardial infarction hospitalized on a Coronary Care Unit and then transferred to a general medical ward were studied by clinical observation and measurement of urinary catecholamine excretion. Emotional changes were frequent and correlated temporally with urinary catecholamine changes at the time of transfer. The incidence of cardiovascular complications was reduced in patients prepared for transfer and followed by a nurse and physician throughout their hospitalization. The findings reaffirm the importance of continuity of care in the treatment of patients with myocardial infarction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) coronary care unit EMTREE MEDICAL INDEX TERMS cardiovascular disease catecholamine excretion catecholamine urine level clinical observation heart arrhythmia heart infarction hospitalization nurse patient patient care physician ward LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008926616 PUI L289109467 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 1223 TITLE Transferring cardiac patients stirs communications problems. AUTHOR NAMES Mary George Sister AUTHOR ADDRESSES (Mary George Sister) CORRESPONDENCE ADDRESS Mary George Sister, SOURCE Chart (1967) 64:10 (309-312). Date of Publication: Dec 1967 ISSN 0069-2778 EMTREE MEDICAL INDEX TERMS article human relation intensive care unit interpersonal communication nursing LANGUAGE OF ARTICLE English MEDLINE PMID 5183742 (http://www.ncbi.nlm.nih.gov/pubmed/5183742) PUI L88036815 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1224 TITLE The transferring phenomena influences on nurse and patient. AUTHOR NAMES Mary George Sister AUTHOR ADDRESSES (Mary George Sister) CORRESPONDENCE ADDRESS Mary George Sister, SOURCE Hospital management (1967) 104:4 (92 passim). Date of Publication: Oct 1967 ISSN 0018-5744 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) nurse patient relationship nursing EMTREE MEDICAL INDEX TERMS article human relation intensive care unit LANGUAGE OF ARTICLE English MEDLINE PMID 6082626 (http://www.ncbi.nlm.nih.gov/pubmed/6082626) PUI L88035263 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 1225 TITLE Mechanization of intrahospital transport of stretcher patients in field condition. AUTHOR NAMES Turovskii B.I. AUTHOR ADDRESSES (Turovskii B.I.) CORRESPONDENCE ADDRESS B.I. Turovskii, SOURCE Voenno-meditsinskiǐ zhurnal (1960) 3 (23-24). Date of Publication: Mar 1960 ISSN 0026-9050 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient transport TRANSPORT OF WOUNDED EMTREE MEDICAL INDEX TERMS article LANGUAGE OF ARTICLE Russian MEDLINE PMID 13778763 (http://www.ncbi.nlm.nih.gov/pubmed/13778763) PUI L80397171 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record.