American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Observational Study
Using simulation to investigate the impact of hours worked on task performance in an intensive care unit.
Past studies have indicated a positive correlation between shift length and the rate of medical errors. In situ simulation is an innovative way to study issues in quality of care. ⋯ Critical care nurses take significantly less time to complete tasks at the end of their shift than at the beginning. This, coupled with a lack of change in accuracy of task completion over time, suggests that nursing performance of simple tasks may improve over the course of a 12-hour shift. Simulation can be an effective means to address some quality improvement issues.
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Extracorporeal membrane oxygenation (ECMO) is used for critically ill patients when conventional treatments for cardiac or respiratory failure are unsuccessful. ⋯ Patients with respiratory indications for ECMO experienced better survival than did cardiac patients. Increasing age was associated with poor outcome. Complications, regardless of ECMO indication, were common and associated with poor outcome.
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Vitamin D has immunomodulating properties. ⋯ Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.