Critical care : the official journal of the Critical Care Forum
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Critical care nurses are vulnerable to depression, which not only lead to poor well-being and increased turnover intention, but also affect their working performances and organizational productivity as well. Work related factors are important drivers of depressive symptoms. However, the non-liner and multi-directional relationships between job demands-resources and depressive symptoms in critical care nurses has not been adequately analyzed. Understanding these relationships would be helpful for reducing depression, increasing nurses' well-being and retain healthcare forces. ⋯ There was a rather strong interconnectedness between depressive symptoms and job demands-resources. Fatigue, motor, and appetite were core depressive symptoms of critical care nurses. Close attention to those symptoms could help recognize depression in critical care nurses. Supervisor support, work meaning, and co-worker support played vital roles as job resources in reducing depression, while negative impact of long average working hours per week were more contagious. Resilience, as personal resources, could help mediate the associations between job demands-resources and depression. In clinical practice, it's recommended for nursing managers to (1) encourage critical care nurses to find their "meaning in work", (2) implement resilience enhancing programs for nurse, (3) build and maintain meaningful relationships with nurses and support them in daily work, and (4) create a harmonious and dedicated working environment where co-workers are willing to help and support each other. Improvements in those modifiable aspects could help reduce risk and prevent exacerbations of depressive symptoms in critical care nurses.
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Observational Study
The association of capillary refill time and return of spontaneous circulation during out-of-hospital cardiac arrest: an observational study.
Microcirculatory alterations are predictive of poor outcomes in patients with shock and after cardiac arrest in animal models. However, microcirculatory alterations during human cardiac arrest have not yet been studied. ⋯ During out-of-hospital cardiac arrest, shorter CRT-F, but not CRT-E, is associated with a higher chance of any ROSC.
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Observational Study
Prehospital lactate analysis in suspected sepsis improves detection of patients with increased mortality risk: an observational study.
Rapid, adequate treatment is crucial to reduce mortality in sepsis. Risk stratification scores used at emergency departments (ED) are limited in detecting all septic patients with increased mortality risk. We assessed whether the addition of prehospital lactate analysis to clinical risk stratification tools improves detection of patients with increased risk for rapid deterioration and death in sepsis. ⋯ The addition of a prehospital lactate level > 3 mmol/l improved early recognition of individuals with increased mortality risk in a cohort with suspected sepsis admitted to the ED. This was particularly evident in patients whose risk stratification scores did not indicate severe illness. We suggest that the addition of prehospital lactate analysis could improve recognition of subjects with suspected sepsis and increased mortality risk.
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Multicenter Study
Interpretable machine learning model for outcome prediction in patients with aneurysmatic subarachnoid hemorrhage.
Aneurysmatic subarachnoid hemorrhage (aSAH) is a critical condition associated with significant mortality rates and complex rehabilitation challenges. Early prediction of functional outcomes is essential for optimizing treatment strategies. ⋯ The novel deep learning model demonstrated strong predictive performance in determining functional outcomes in patients with aSAH, making it a valuable tool for guiding early rehabilitation strategies.
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Intermediate care units (IMCUs) provide care for patients who need more intensive treatment than general wards but less than intensive care units (ICUs). Although the concept of an IMCU requires co-location with an ICU, some hospitals have IMCUs but no ICUs, which potentially worsens patient outcomes. This study aimed to examine the annual trends and care processes, and compare the outcomes of patients admitted to IMCUs in hospitals with and without ICUs using a nationwide inpatient database in Japan. ⋯ Admission in IMCUs in hospitals without ICUs increased, but was associated with higher in-hospital mortality. These findings suggest that IMCUs should be placed in hospitals with ICUs.