Respiratory rate monitoring and early detection of deterioration practices.

Background: Growing evidence points to respiratory rate (RR) being the most important vital sign for early detection of patient deterioration. However, RR is the vital sign most likely to be inaccurate or missed.

Aims: To measure prevalence of early detection of deterioration protocols, examine whether RR was perceived as the leading indicator of deterioration, and understand RR monitoring practices used by nurses around the world.

Nursing process, derived from the clinical care classification system components, as an earlier indicator of nursing care during a pandemic.

Background: During COVID pandemic response, an early signal was desired beyond typical financial classifications or order sets. The foundational work of Virginia K Saba informed the essential, symbiotic relationship of nursing practice and resource utilization by means of the Clinical Care Classification System [CCC]. Scholars have confirmed the use of the CCC as the structure for data modeling, focusing on the concept of nursing cost [1].

Evaluation of Clinical Questions and Patient-Important Outcomes Associated With the Treatment of Age-Related Macular Degeneration.

Importance: Identifying and prioritizing unanswered clinical questions may help to best allocate limited resources for research associated with the treatment of age-related macular degeneration (AMD).

Objective: To identify and prioritize clinical questions and outcomes for research associated with the treatment of AMD through engagement with professional and patient stakeholders.

Design, Setting, And Participants: Multiple cross-sectional survey questions were used in a modified Delphi process for panel members of US and international organizations, the American Academy of Ophthalmology (AAO) Retina/Vitreous Panel (n=7), health care professionals from the American Society of Retinal Specialists (ASRS) (n=90), Atlantic Coast Retina Conference (ACRC) and Macula 2017 meeting (n=34); and patients from MD (Macular Degeneration) Support (n=46).

Point of Care Solutions for Electronic Documentation of Nursing Practice.

Unlabelled: The panel focuses on Point-of-Care (POC) solutions for the documentation of nursing practice in electronic health record (EHR) and/or healthcare information technology (HIT) systems using the Clinical Care Classification (CCC) System. The CCC System was developed by Dr. Saba and Colleagues for the electronic documentation of patient care by nurses and allied health professionals and has been approved by American Nurses Association and U.

Population trends in substances used in deliberate self-poisoning leading to intensive care unit admissions from 2000 to 2010.

Objective: To examine population trends in serious intentional overdoses leading to admission to intensive care units (ICUs) in Winnipeg, Manitoba, Canada.

Method: Participants consisted of 1,011 individuals presenting to any of the 11 ICUs in Winnipeg, Canada, with deliberate self-poisonings from January 2000 to December 2010. Eight categories of substances were created: poisons, over-the-counter medications, prescription medications, tricyclic antidepressants (TCAs), sedatives and antidepressants, anticonvulsants, lithium, and cocaine.

Twenty-four-hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses.

Rationale: Around-the-clock intensivist presence in intensive care units (ICUs) has been promoted as necessary to optimize outcomes. Little data have addressed how it affects the multiple stakeholders in such care.

Objectives: To assess effects of around-the-clock intensivist presence on intensivists, patients, families, housestaff, and nurses.

The role of functional status in discharge to assisted care facilities and in-hospital death among dialysis patients.

Background: Functional status is an important component in the assessment of hospitalized patients. We set out to determine the scope, severity, and prognostic significance of impaired functional status in acutely hospitalized dialysis patients.

Study Design: Retrospective cohort study.

High rates of mortality and technique failure in peritoneal dialysis patients after critical illness.

Introduction: Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU.

Methods: Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU.

Long-term outcomes of end-stage renal disease patients admitted to the ICU.

Background: End-stage renal disease (ESRD) patients admitted to the intensive care unit (ICU) have poor survival and high rates of readmission; however, little evidence exists on long-term outcomes. We set out to investigate the long-term (6 and 12 months) survival of ESRD patients admitted to the ICU and whether differential survival could be explained by dialysis modality and vascular access.

Methods: We compared the admission characteristics, outcomes and readmission rates of 619 ESRD [95 peritoneal dialysis (PD), 334 hemodialysis with a catheter (HD CVC), 190 hemodialysis with an AV fistula (HD AVF)] patients admitted to 11 ICU's in Winnipeg, Manitoba, Canada.

End-stage renal disease status and critical illness in the elderly.

Background And Objectives: Elderly patients (> 65 years old) are a rapidly growing demographic in the ESRD and intensive care unit (ICU) populations, yet the effect of ESRD status on critical illness in elderly patients remains unknown. Reliable estimates of prognosis would help to inform care and management of this frail and vulnerable population.

Design, Setting, Participants, & Measurements: The effect of ESRD status on survival and readmission rates was examined in a retrospective cohort of 14,650 elderly patients (>65 years old) admitted to 11 ICUs in Winnipeg, Manitoba, Canada between 2000 and 2006.

Acute kidney injury in critically ill patients infected with 2009 pandemic influenza A(H1N1): report from a Canadian Province.

Background: 2009 pandemic influenza A(H1N1) has led to a global increase in severe respiratory illness. Little is known about kidney outcomes and dialytic requirements in critically ill patients infected with pandemic H1N1.

Study Design: Prospective observational study.

Outcomes of chronic dialysis patients admitted to the intensive care unit.

Admission rates and outcomes of patients who have ESRD and are admitted to an intensive care unit (ICU) are not well defined. We conducted a historical cohort study using a prospective regional ICU database that captured all 11 adult ICUs in Winnipeg, Canada. Between 2000 and 2006, there were 34,965 total admissions to the ICU, 1173 (3.

Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock.

Objective: Our goal was to determine the impact of the initiation of inappropriate antimicrobial therapy on survival to hospital discharge of patients with septic shock.

Methods: The appropriateness of initial antimicrobial therapy, the clinical infection site, and relevant pathogens were retrospectively determined for 5,715 patients with septic shock in three countries.

Results: Therapy with appropriate antimicrobial agents was initiated in 80.

PDA-based informatics strategies for tobacco use screening and smoking cessation management: a case study.

The purpose of this case study is to describe three incremental personal digital PDA-based informatics strategies aimed at improving screening for tobacco use and guideline-based tobacco cessation management: 1) PDA clinical log with tobacco cessation diagnoses and plan of care options, 2) PDA decision support system, and 3) PDA decision support system with infobuttons--context-specific links to the National Cancer Institute's Cancer Information Services tobacco cessation information. These strategies were implemented within the context of an evidence-based advanced practice nurse curriculum at the Columbia University School of Nursing.

Integrating evidence into clinical information systems for nursing decision support.

Purpose: To illustrate approaches for providing decision support for evidence-based nursing practice through integration of evidence into clinical information systems (CISs) with examples from our experience at Columbia University Medical Center.

Organizing Construct: Examples are organized according to three types of decision support functions: information management, focusing attention, and patient-specific consultation.

Methods: Three decision support tools that are integrated into three types of CISs are discussed: (1) infobuttons that provide context-specific access to digital sources of evidence; (2) automated Fall-Injury Risk Assessment; and (3) personal digital assistant-based screening reminders, screening assessments, and tailored documentation templates for the identification and management of obesity, depression, and tobacco cessation.

Promoting patient safety through informatics-based nursing education.

The Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing safe and effective health care. In addition to technical aspects such as regional or national health information infrastructures, to achieve this goal, healthcare professionals must receive the requisite training during basic and advanced educational programs. In this article, we describe a two-pronged strategy to promote patient safety through an informatics-based approach to nursing education at the Columbia University School of Nursing: (1) use of a personal digital assistant (PDA) to document clinical encounters and to retrieve patient safety-related information at the point of care, and (2) enhancement of informatics competencies of students and faculty.

Columbia University's competency and evidence-based Acute Care Nurse Practitioner Program.

New clinical information is being generated faster than practicing clinicians can effectively assimilate it. Since the gold standard of clinical information is evidence-based information, tools and techniques that facilitate both the building of evidence for practice and the application of evidence to practice are essential for practicing clinicians. As such, the Acute Care Nurse Practitioner (ACNP) program at Columbia University's School of Nursing was reconfigured to incorporate both theoretically based competency evaluation standards and strategies to foster an evidence-based practice approach to clinical care.

Response of ventilator-dependent patients to delayed opening of exhalation valve.

In conventional mechanical ventilation, the inflation cycle often extends into neural expiration (TEN), potentially exacerbating dynamic hyperinflation (DH). We wished to determine the extent to which patients defend against DH when this happens. Such defense may include prolongation of TEN (timing response) and/or expiratory muscle recruitment (neuromuscular response).