Click here for a PubMed search on direct intra-articular antibiotic infusion
What are guidelines for care of the catheter inserted for Direct Intra-articular Antibiotic infusion?
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How to gauge readiness to apply for ANCC Magnet designation
Do any ICUs in the United States use arteriovenous fistulae in implementing continous renal replacement therapy (CRRT)?
The AACN Procedure Manual for Critical Care, 6th ed., 2011, states that although surgically created AV fistulas had been used in the past for CRRT, they are not recommended for CRRT access because of increased rates of injury, bleeding and infection (p. 1023), and the manual references National Kidney Foundation: KDOQI clinical practice guidelines for vascular access: update 2006, Am J Kidney Dis. 2006; 48:S176-S307.
The manual also references Uchino S, et al. Continuous renal replacement therapy: a worldwide practice survey. Intensive Care Med. 2007;33:1563-70.
Of a cohort of 1006 ICU patients treated with CRRT at 54 ICUs in 23 countries, Table 2 (p. 1566) shows that only 1 patient (0.1%) had continuous arteriovenous hemodialysis as the mode for RCCT.
A search of PubMed for continuous renal replacement therapy and access did not identify any studies published in the United States that specifically described using AVF for the access.
Does screening inpatients for delirium affect hospital length of stay?
Bottom line: There are no published experimental studies evaluating the effect of screening inpatients for delirium on the hospital length of stay.
Summary:
Length of stay: A search of Joanna Briggs and of PubMed and CINAHL using combinations of these concepts–delirium, inpatients, screening, length of stay, outcomes–did not identify any studies of the impact of screening for delirium on length of stay. There were observational studies documenting that delirium in the hospital is associated with increased length of stay. See Han (2011), Saravay (2004) and reviews in the PubMed search. None of these report on effect of screening on length of stay.
Delirium Screening and Assessment. In: Joanna Briggs JBIConnect
PubMed: delirium[mesh] AND (inpatients OR hospitalized patients) AND screening AND length of stay
Clinical outcomes: None of the papers identifed in the searches describe studies assessing effect of screening for delirium on other clinical outcomes, such as mortality or readmission. Again, there are observational studies documenting the effect of delirium on these outcomes, i.e., Uthamalingam (2011), Gonzalez (2009) in the search below.
PubMed: (“delirium/diagnosis”[mesh] OR “delirium/prevention and control”[mesh]) AND (inpatients OR hospitalized patients) AND screening AND (outcomes OR mortality OR readmission)
What is published related to patient room environmental design?
What is the best practice regarding effects of patient location, specifically patient grouping, on patient and nursing satisfaction?
A search of CINAHL on the concepts of patient and nursing satisfaction and grouping assignment produced these results on care assignments and satisfaction of nurses and patients.
Duffield, Christine. Staffing, skill mix and the model of care. Journal of clinical nursing 2010 vol:19 iss:15-16 pg:2242 -2251
Hurst, Keith. UK ward design: patient dependency, nursing workload, staffing and quality-an observational study. International journal of nursing studies 2008 vol:45 iss:3 pg:370 -381
Adams, Ann, Staffing in acute hospital wards: part 1. The relationship between number of nurses and ward organizational environment. Journal of nursing management 2003 vol:11 iss:5 pg:287 -292
Mohamed, A H, Using the job characteristics model to compare patient care assignment methods of nurses. Eastern Mediterranean health journal 2004 vol:10 iss:3 pg:389 -405
What are the benefits and risks of ultrafiltration in managing patients with decompensated heart failure and is there evidence of this procedure being performed on a cardiac step down unit?
DynaMed includes information about ultrafiltration in the Acute Heart Failure article.
For the outcome of readmission rate:
DynaMed references ACC/AHA 2009 practice guideline recommending use in patients with refractory congestion. Evidence suggests that ultrafiltration may be associated with reduction in hospital readmission. For a summary of evidence, in the DynaMed article, use links on left side of page – Treatment section>Other management>ultrafiltration. For details of the evidence, including cited studies see 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults.
For the outcome of length of stay:
A search of PubMed’s Clinical Queries (Therapy filter, heart failure AND length of stay AND ultrafiltration) retrieved 2 RCTs (Hanna, 2012 and Costanzo, 2005) that included length of stay as an outcome. Both studies reported evidence that ultrafiltration may be associated with reduction in length of stay. See individual studies for details on population size and other aspects of the methodology.
For the outcome of kidney function:
Revising the PubMed Clinical Queries to Therapy/narrow filter, heart failure AND ultrafiltration AND (kidney function OR renal function OR creatinine) Retrieves studies and reviews discussing kidney function. If there are other actual markers that would be used to measure renal function, those can be added to the Clinical Query.
Use in cardiac step down units:
Searches of PubMed (“step down” OR “progressive care”) AND ultrafiltration AND heart failure and CINAHL (step down OR progressive care) AND heart failure, did not identify any studies specifically discussing ultrafiltration on step down units.
For risks PubMed Clinical Queries for Therapy/Broad filter, heart failure AND (adverse effects OR risk) AND ultrafiltration. There are reviews of evidence by Freda (2011) and Dandamudi (2011) and a retrospective analysis (Flythe, 2011) of data from an RCT to examine morbidity and mortality. These results include systematic reviews as well.
Evidence Matters 