Morse JM, et al. A prospective study to identify the fall-prone patient. Soc Sci Med. 1989;28(1):81-6.
The objective of this study was to validate the Morse Scale in predicting patient risk of falling. The introduction and methods sections describe the instrument, which was derived from previous work by Morse and colleagues analyzing characteristics of patients prone to falls (Morse JM, et al. Characteristics of the fall-prone patient. Gerontologist. 1987;27:516.)
A search of PubMed: (diabetes OR diabetic) AND inpatients AND (diet OR food service) AND patient satisfaction
retrieved the following study comparing use of the two diet plans for diabetic inpatients
Curll M, et al. Menu selection, glycaemic control and satisfaction with standard and patient-controlled consistent carbohydrate meal plans in hospitalised patients with diabetes. Qual Saf Health Care. 2010 Aug;19(4):355-9.
This is a comparative study; the abstract does not indicate whether or not patients are randomized. Compares levels of patient satisfaction, rates of hypoglycemia, and level of clinician oversight.
Using the related articles feature in PubMed retrieved these additional papers:
Bhattacharyya A, et al. In-patient management of diabetes mellitus and patient satisfaction. Diabet Med. 2002 May;19(5):412-6. Erratum in: Diabet Med. 2002 Sep;19(9):797.
Gosmanov AR, Umpierrez GE. Medical nutrition therapy in hospitalized patients with diabetes. Curr Diab Rep. 2012 Feb;12(1):93-100. doi: 10.1007/s11892-011-0236-5. Review
Swift CS, Boucher JL. Nutrition therapy for the hospitalized patient with diabetes.
Endocr Pract. 2006 Jul-Aug;12 Suppl 3:61-7.
Curll M, et al. Menu selection, glycaemic control and satisfaction with standard and patient-controlled consistent carbohydrate meal plans in hospitalised patients with diabetes. Qual Saf Health Care. 2010 Aug;19(4):355-9. doi: 10.1136/qshc.2008.027441.
Bottom line: There is some lower level evidence that remifentanil may be associated with a lower seizure threshold.
Search methods: Searched EMBASE and Medline using these concepts:
remifentanil AND electroconvulsive therapy
Applied filters for RCT and systematic reviews
Search results:
REVIEWS OF EVIDENCE:
Remifentanil: A review of its use in electroconvulsive therapy
Chen S.T.
Journal of ECT 2011 27:4 (323-327)
Review includes study (Sullivan et al.) that documented effect of remifentanil on seizure threshold (lowered threshold and results in lower rise in threshold than comparison group.) This was a very small (n=24) retrospective study.
Effects of general anesthetic agents in adults receiving electroconvulsive therapy: A systematic review
Hooten W.M. and Rasmussen K.G.
Journal of ECT 2008 24:3 (208-223)
RCTS:
Effects of remifentanil on convulsion duration and hemodynamic responses during electroconvulsive therapy: A double-blind, randomized clinical trial
Nasseri K., Arasteh M.T., Maroufi A. and Shami S.
Journal of ECT 2009 25:3 (170-173)
Propofol versus propofol-remifentanil combination anaesthesia in electroconvulsive therapy: Effects on seizure duration and hemodynamics
Algül A., Şen H., Ateş M.A., Yen T., Özkan S., Durmaz O., Erbinç S., Daǧli G. and Çetin M.
Klinik Psikofarmakoloji Bulteni 2009 19:SUPPL. 1 (S153-S154)
Remifentanil supplementation of propofol during electroconvulsive therapy: Effect on seizure duration and cardiovascular stability
Vishne T., Aronov S., Amiaz R., Etchin A. and Grunhaus L.
Journal of ECT 2005 21:4 (235-238)
Effects of remifentanil and alfentanil on seizure duration, stimulus amplitudes and recovery parameters during ECT
Akcaboy Z.N., Akcaboy E.Y., Yigitbasi B., Bayam G., Dikmen B., Gocus N. and Dilbaz N.
Acta Anaesthesiologica Scandinavica 2005 49:8 (1068-1071)
Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy
Smith D.L., Angst M.S., Brock-Utne J.G. and DeBattista C.
Acta Anaesthesiologica Scandinavica 2003 47:9 (1064-1066)
The effect of remifentanil on seizure duration and acute hemodynamic responses to electroconvulsive therapy
Recart A., Rawal S., White P.F., Byerly S. and Thornton L.
Anesthesia and Analgesia 2003 96:4 (1047-1050)
Bottom line: There is evidence that associates capnography with improved detection of respiratory depression during procedural sedation and in management of mechanical ventilation.
PubMed search: (capnography OR end tidal carbon dioxide) AND sedation AND (emergency department OR intensive care OR critical care) AND humans[mesh]
Includes prospective studies, a systematic review and some lower quality comparative studies.
Higher quality study (Randomized controlled trial and prospective studies)
Proehl J, et al. J Emerg Nurs. 2011 Nov;37(6):533-6. Emergency Nursing Resource: the use of capnography during procedural sedation/analgesia in the emergency department.
Systematic review describes evidence from research studies, meta-analyses, systematic
reviews, and existing guidelines. Rates evidence using Appraisal of Guidelines Research & Evaluation methodology.
Deitch K, et al. Ann Emerg Med. 2010 Mar;55(3):258-64. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial.
Patients (n=132) in the ED who received propofol sedation received standard monitoring plus capnography and were randomized so that physicians administering care either had access to capnography readings or were blinded to capnography readings. RESULTS: Hypoxia was observed in 17 of 68 (25%) subjects with capnography and 27 of 64 (42%) with blinded capnography (P=.035; difference 17%; 95% confidence interval 1.3% to 33%). Capnography identified all cases of hypoxia before onset (sensitivity 100%; specificity 64%), with the median time from capnographic evidence of respiratory depression to hypoxia 60 seconds (range 5 to 240 seconds)
Burton JH, et al. Acad Emerg Med. 2006 May;13(5):500-4. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?
60 patients (enrollment stopped after review of 20 acute respiratory events) underwent capnographic monitoring while under procedural sedation. Abnormal end tidal CO2 findings were documented in 36 patients (60%). Abnormal ETCO2 findings were documented before changes in SpO2 or clinically observed hypoventilation in 14 patients (70%) with acute respiratory events.
PubMed: (capnography OR end tidal carbon dioxide) AND mechanical ventilation AND (emergency department OR intensive care OR critical care) AND humans[mesh]
Filters: Systematic reviews
Walsh BK, Crotwell DN, Restrepo RD. Capnography/Capnometry during mechanical ventilation: 2011. Respir Care. 2011 Apr;56(4):503-9.
Applied GRADE criteria to 200+ identified studies and guidelines. Includes several recommendations for use of capnography in monitoring patients on mechanical ventilation.
Recent study of deeply sedated patients compares protocol of hourly assessment alone versus the protocol plus daily sedation interruption. There was nodifference in time to extubation, ICU length of stay, hospital LOS, rate of delirium, or accidental extubation. Daily interruption may not be beneficial over hourly monitoring alone.
RCT of 430 critically ill, mechanically ventilated adults in 16 tertiary care medical and surgical ICUs. All patients received continuous opioid and/or benzodiazepine infusions and were randomized to protocolized sedation (n = 209) (control) or to protocolized sedation plus daily sedation interruption. Protocolized sedation involved nurses using standardized scales to assess sedation needs hourly and titrate infusions.
RESULTS: For interruption group v. control group:
DIFFERENCES BETWEEN THE GROUPS FOR THESE VARIABLES
Reviewed JKN 4/14
Handouts for patients or family members are available through MedlinePlus.
At the bottom of the Palliative Care and Hospice care pages there are links to patient handouts.
Actual instructions will vary by patient, and specific sets of instructions might also be available through the Krames materials on EMR. You might try a keyword search for palliative in the Krames tool to see what it retrieves.
Nothing in CINAHL or PubMed searches really addressed what to cover in discharge instructions with patients going to palliative care or hospice.
Searched with combinations of these concepts: (Palliative care or hospice), (discharge instructions or patient education
A search of CINAHL for (MM “Personnel Staffing and Scheduling”) AND ((breaks OR meal* OR rest)) retrieves articles discussing how to ensure breaks, as well as articles on effect of work breaks on quality of care. Below are article identified as more relevant to the question of how to facilitate break times.
Rest break guidelines needed to clarify shifts confusion. Harrison M; Nursing Standard. 2009; 23(41): 32-3.
Managers forum. Ensuring meal breaks.Detail Only Available Rietow N; Ingalls J; Kuell D; Proehl JA; Zimmermann PG; JEN: Journal of Emergency Nursing, 2003 Oct; 29 (5): 465-7, 495-502
One-hour, off-unit meal breaks. Stefancyk AL; American Journal of Nursing, 2009 Jan; 109 (1): 64-6.
Penalties for missed breaks, lunch. OR Manager, 2001 Jul; 17 (7): 6.
Reorganize staff to address mealtime challenges. Senior Care Management, 2005 Jun; 8 (6): 69-70.
Rest break guidelines needed to clarify shifts confusion… Gerry Bolger and Annabel Morris (features June 3). Harrison M. Nursing Standard, 2009 Jun 17-23; 23 (41): 32-3.
The rules of rest and relaxation: minimizing fatigue to increase patient safety. Joint Commission Perspectives on Patient Safety, 2007 May; 7 (5): 1, 3-4, 8 (journal article) ISSN: 1534-5181
Work force management. Work breaks and patient safety.Detail Only Available Cavorous CA; Suby C; Journal of Clinical Systems Management, 2005 Jan-Feb; 7 (1-2): 7 (journal article)
Breaks are not a privilege, they are an employment right. Lester J; Nursing Standard. 2008; 23(1): 33.
Evidence Matters 