Journal of critical care
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Journal of critical care · Aug 2015
Barriers and supportive conditions to improve quality of care for critically ill patients: A team approach to quality improvement.
Despite the fact that Quality Improvement (QI) teams are widespread tools for improving performance in medical settings, little is known about what makes teams effective and successful. The goal of this study was to identify barriers and supportive conditions for QI teams to implement an effective and successful QI project to improve quality of care. ⋯ Using a grounded theory-based qualitative approach, we identified a framework of conditions supportive of QI-related change, which can help project initiators to create environments that are supportive of change.
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Journal of critical care · Aug 2015
ReviewEarly mobilization in the critical care unit: A review of adult and pediatric literature.
Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. ⋯ Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.
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Journal of critical care · Aug 2015
Multicenter Study Observational StudySerum melatonin levels are associated with mortality in severe septic patients.
Melatonin in septic patients has been scarcely explored and only in studies of small sample size (maximum 20 patients). Thus, the objective of this study was to determine whether serum melatonin levels are associated with severity, oxidant and inflammatory state, and mortality in a large series of septic patients. ⋯ The novel finding of our study was that serum melatonin levels are associated with mortality in septic patients.
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Journal of critical care · Aug 2015
Clinical TrialPrehospital oral chlorhexidine does not reduce the rate of ventilator-associated pneumonia among critically ill trauma patients: A prospective concurrent-control study.
The purpose of the study was to test the hypothesis that prehospital oral chlorhexidine administered to intubated trauma patients will decrease the Clinical Pulmonary Infection Score (CPIS) during the first 2 days of hospitalization. ⋯ The prehospital administration of oral chlorhexidine does not reduce the CPIS score over the first 48 hours of admission for intubated trauma patients. Further study should explore other prehospital strategies of reducing complications of critical illness.
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Journal of critical care · Aug 2015
Observational StudyRisk factors for fluconazole-resistant invasive candidiasis in intensive care unit patients: An analysis from the China Survey of Candidiasis study.
To assess the risk factors for invasive Candida infection (ICI) caused by fluconazole-resistant (Flu-R) Candida species in intensive care unit (ICU) patients. ⋯ As many as 41% of ICI patients were infected with Flu-R Candida, and the main risk factor was longer ICU stay before onset of ICI, implying that caution should be exercised when treating patients who have been long stayed in ICU with fluconazole as the first-line drug before testing isolates for drug sensitivity.