American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Case Reports
Acute mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter.
Mediastinitis is a complication generally associated with thoracic surgery. Its occurrence after placement of a central venous catheter is uncommon, and only a few cases have been reported. ⋯ The signs and symptoms, diagnosis, and treatment of this unusual complication are described. This complication should be included in the differential diagnosis of mediastinitis in patients with a central venous catheter in place who have not had thoracic surgery.
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The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple, validated survey instrument for measuring sleep quality in intensive care patients. Although both patients and nurses can complete the RCSQ, interrater reliability and agreement have not been fully evaluated. ⋯ Patient-nurse interrater reliability on the RCSQ was "slight" to "moderate," with nurses tending to overestimate patients' perceived sleep quality.
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Biography Historical Article
Clinical research: together, stronger, bolder.
Clinical inquiry is the ongoing process of questioning and evaluating practice, providing informed practice based on best-available data, and innovating practice though research. It is about noticing subtle differences at the bedside and asking "what if" questions. Critically ill patients and their families require care that is based on our best-available evidence. ⋯ In critical care, clinical research should be conducted in the same manner as we practice, collaboratively within multidisciplinary teams. Our core value of the primacy of patient and family, our spirit of inquiry, and our passion for innovation centers our practice. During this year's Distinguished Research Lecture, Martha Curley describes how together, we can build stronger, bolder clinical research.
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Although there is widespread acceptance that hospital discharge planning should begin at hospital admission, early discharge planning is usually delayed for clinically unstable patients in intensive care units. ⋯ The results provide a preliminary indication that staff in intensive care units may contribute to the early identification of patients' postacute care needs. The results also help to identify methods to study the discharge planning process within intensive care units.
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Randomized Controlled Trial
Impact of a nutritional formula enriched in fish oil and micronutrients on pressure ulcers in critical care patients.
Pressure ulcers are an important source of morbidity and suffering for patients and a formidable burden on caregivers. ⋯ Administration of a feeding formula enriched with fish oil was associated with decreased progression of pressure ulcers and a decrease in blood concentrations of C-reactive protein.