Hospital practice (1995)
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Hospital practice (1995) · Jan 2015
ReviewThe use of volume-assured pressure support noninvasive ventilation in acute and chronic respiratory failure: a practical guide and literature review.
Noninvasive positive pressure ventilation (NPPV) is an important tool in the management of acute and chronic respiratory failure. Traditionally, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP) have been the most commonly utilized modes for these purposes. Newer hybrid modes of NPPV, such as average volume-assured pressure support (VAPS), combine the properties of both volume- and pressure-controlled NPPV and represent another tool in the treatment of acute and chronic respiratory failure. ⋯ The limited evidence available suggests that VAPS is equally effective in treating acute and chronic respiratory failure compared to BPAP. Overall, the evidence to suggest superiority of one mode over the other is lacking. There is a need for larger studies before firm conclusions can be made.
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Nutrition support is important in critical illness, and accurate recording is particularly important to determine whether nutritional goals are met both from a caloric and volume perspective. ⋯ This study highlights the importance of accurate nutritional monitoring in the ICU and demonstrates that educational interventions can improve enteral feeding protocols. Pump calibrations, frequent interrogation and vigilant nutritional documentation can improve enteral nutrition delivery. Future studies are needed to determine if the effects are sustainable and if further education will further improve documentation and delivery.
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Hospital practice (1995) · Jan 2015
Factors associated with inpatient readmission among managed care enrollees with COPD.
To assess factors associated with inpatient readmission among a US managed care population with chronic obstructive pulmonary disease (COPD). ⋯ Many of the factors associated with inpatient readmission documented here can be ascertained at discharge and may be used to inform discharge plans, with the end goal of improving patient outcomes, including reducing the risk of readmission.
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Hospital practice (1995) · Jan 2015
Risk assessment scores for patients with upper gastrointestinal bleeding and their use in clinical practice.
Upper gastrointestinal bleeding (UGIB) is a common cause for emergency admission to hospital representing a significant clinical as well as economic burden. UGIB encompasses a wide range of severities from life-threatening exsanguination to minor bleeding that may not require hospital admission. Patients with UGIB are often initially assessed and managed by junior doctors and non-gastroenterologists. ⋯ A minority of patients will require emergency endoscopy following resuscitation, but at present there is no evidence that risk scores can accurately identify this very high-risk group. Studies have shown the latest risk assessment score, the AIMS65, looks promising in the prediction of mortality. However, to date there is no data on the use of the AIMS65 in identifying low risk patients for possible outpatient management.
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Hospital practice (1995) · Dec 2014
Multicenter StudyAbility of nurse clinicians to predict unplanned returns to hospital within thirty days of discharge.
To evaluate the ability of nurse clinician discharge flow coordinators (DFCs) to identify medical patients at risk of unplanned return to the hospital emergency department within 30 days of discharge and whether a higher predicted risk of return was correlated with preventability. ⋯ In a large urban center, experienced nurse clinician DFCs were able to predict 30-day emergency department returns with reasonable accuracy. They were also able to identify the returns to the hospital that were most likely to be preventable. Our data suggests that DFCs can be used to target patients identified as having an increased probability of return with interventions that may be able to reduce the burden of return to hospital.