Adherence to guidelines for the management of donors after brain death.

Purpose: Guideline adherence for the management of a donor after brain death (DBD) is largely unknown. This study aimed to perform an importance-performance analysis of prioritized key interventions (KIs) by linking guideline adherence rates to expert consensus ratings for the management of a DBD.

Materials And Methods: This observational, cross-sectional multicenter study was performed in 21 Belgian ICUs.

Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach.

Background: A substantial degree of variability in practices exists amongst donor hospitals regarding the donor detection, determination of brain death, application of donor management techniques or achievement of donor management goals. A possible strategy to standardize the donation process and to optimize outcomes could lie in the implementation of a care pathway. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact.

Biomarkers in patients admitted to the emergency department after exposure to acrylonitrile in a major railway incident involving bulk chemical material.

Background: A railway incident with victims of exposure to the cyanogenic substance acrylonitrile (ACN).

Aims: We retrospectively (i)built an inventory of the clinical characteristics of individuals admitted to surrounding emergency departments (ED's) and (ii)studied the correlation between N-2-cyanoethylvaline (CEV), a biomarker used in a population study for evaluating exposure to ACN, with lactate and thiocyanate (SCN), biomarkers determined during emergency care.

Results: 438 patients from 11 ED's were included and presented with known symptoms of ACN poisoning but also with concern about the risks.

Recommendations for further improvement of the deceased organ donation process in Belgium.

Belgium has achieved high deceased organ donation rates but according to the medical record data in the Donor Action database, deceased potential donors are still missed along the pathway. Between 2010 and 2014, 12.9 ± 3.

Care pathways for organ donation after brain death: guidance from available literature?

Aims: A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death.

Background: Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process.

The Value of E-Learning for the Prevention of Healthcare-Associated Infections.

BACKGROUND Healthcare workers (HCWs) lack familiarity with evidence-based guidelines for the prevention of healthcare-associated infections (HAIs). There is good evidence that effective educational interventions help to facilitate guideline implementation, so we investigated whether e-learning could enhance HCW knowledge of HAI prevention guidelines. METHODS We developed an electronic course (e-course) and tested its usability and content validity.

Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress.

Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation.

Background: In order to avoid microaspiration and tracheal injury, the target for endotracheal tube cuff pressure is 20 to 30 cm H2O.

Objective: To assess the effect of changes in body position on cuff pressure in adult patients.

Methods: Twelve orally intubated and sedated patients received neuromuscular blockers and were positioned in a neutral starting position (backrest, head-of-bed elevation 30º, head in neutral position) with cuff pressure at 25 cm H2O.

Should we use automated external defibrillators in hospital wards?

Automated external defibrillators (AEDs) have shown to improve survival after cardiopulmonary arrest (CPA) in many, but not all clinical settings. A recent study reported that the use of AEDs in-hospital did not improve survival. The current retrospective study reports the results of an in-hospital AED programme in a university hospital, and focuses on the quality of AED use.

A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients.

Rationale: The clinical relevance of Aspergillus-positive endotracheal aspirates in critically ill patients is difficult to assess.

Objectives: We externally validate a clinical algorithm to discriminate Aspergillus colonization from putative invasive pulmonary aspergillosis in this patient group.

Methods: We performed a multicenter (n = 30) observational study including critically ill patients with one or more Aspergillus-positive endotracheal aspirate cultures (n = 524).

European expert opinion on the management of invasive candidiasis in adults.

This report discusses the present status of antifungal therapy and treatment options for candidaemia, considered by experts in the field in Europe. A conference of 26 experts from 13 European countries was held to discuss strategies for the treatment and prevention of invasive candidiasis, with the aim of providing a review on optimal management strategies. Published and unpublished comparative trials on antifungal therapy were analysed and discussed.

[Southern European intensive care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia].

Objectives: To assess Southern European intensive care unit nurses' knowledge about evidence-based guidelines for the prevention of ventilator-associated pneumonia and to compare these findings with a pan-European perspective.

Design: A sub-analysis from an observational study performed using a 9-questions, multiple-choice questionnaire performed during the period October 2006 - March 2007.

Setting: Six Southern European countries, selected from 22 participant European countries.

Thrombocytopenia and outcome in critically ill patients with bloodstream infection.

Objective: Thrombocytopenia is common in intensive care units (ICUs), and is associated with a poor prognosis. An acute decrease in total platelet count is frequently observed in severe sepsis, followed by a relative increase indicating organ-failure recovery. However, few data are available describing this effect and its relationship with outcomes in specific subgroups of ICU patients.

Nurses' knowledge of evidence-based guidelines for the prevention of surgical site infection.

Background: Prevention of surgical site infection (SSI) is an important responsibility for nurses. Knowledge of the related evidence-based recommendations is necessary to provide high-quality nursing care.

Aim: Development of an evaluation tool and subsequent evaluation of intensive care unit (ICU) nurses' knowledge of the SSI prevention guideline to identify their specific educational needs, as part of a needs analysis preceding the development of an e-learning module on infection prevention.

Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients.

Background: We investigated the epidemiology of nosocomial bloodstream infection in elderly intensive care unit (ICU) patients.

Methods: In a single-center, historical cohort study (1992-2006), we compared middle-aged (45-64 years; n = 524), old(65-74 years; n = 326), and very old ICU patients (> 75 years; n = 134) who developed a nosocomial bloodstream infection during their ICU stay.

Results: Although the total number of ICU admissions (patients aged > or = 45 years) decreased by approximately 10%, the number of very old patients increased by 33% between the periods 1992-1996 and 2002-2006.

Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses.

Objective: To determine European intensive care unit (ICU) nurses' knowledge of guidelines for preventing central venous catheter-related infection from the Centers for Disease Control and Prevention.

Design: Multicountry survey (October 2006-March 2007).

Setting: Twenty-two European countries.

Evidence-based guidelines for the prevention of ventilator-associated pneumonia: results of a knowledge test among European intensive care nurses.

As part of a needs analysis preceding the development of an e-learning platform on infection prevention, European intensive care unit (ICU) nurses were subjected to a knowledge test on evidence-based guidelines for preventing ventilator-associated pneumonia (VAP). A validated multiple-choice questionnaire was distributed to 22 European countries between October 2006 and March 2007. Demographics included nationality, gender, ICU experience, number of ICU beds and acquisition of a specialised degree in intensive care.