Articles: cations.
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Critical care nurse · Apr 2022
An In Situ Mock Code Program in the Pediatric Intensive Care Unit: A Multimodal Nurse-Led Quality Improvement Initiative.
Lifesaving resuscitation is required for approximately 1 in 100 patients in the pediatric intensive care unit. Certification renewal alone is insufficient to guarantee adequate knowledge, skills, and confidence among staff members involved in infrequent resuscitation events. ⋯ An in situ mock code program using a multimodal approach to education can be a successful educational adjunct to biennial pediatric advanced life support certification.
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Anesthesia and analgesia · Apr 2022
Randomized Controlled TrialWhy a Propofol Infusion Should Be the Anesthetic of Choice for Auditory Brainstem Response Testing in Children.
Auditory brainstem response (ABR) testing is considered to be relatively resistant to effects of volatile anesthetics. The impact of newer anesthetics on interpretability of ABR testing is unknown. This study compared sevoflurane versus propofol anesthesia on qualitative interpretability of ABR click-testing in children. ⋯ Sevoflurane produced more false positives for hearing loss and suggested more severe hearing loss than propofol. False-positive ABR tests, produced by certain anesthetic agents, can have significant life-long impact and negative psychosocial and developmental implications. Use of the intravenous anesthetic propofol is superior to sevoflurane for ABR testing in children.
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Nosocomial pneumonia is associated with worsened prognosis when diagnosed in intensive care unit (ICU), ranging from 12 to 48% mortality. The incidence rate of ventilation-acquired pneumonia tends to decrease below 15/1,000 intubation-day. Still, international guidelines are heterogeneous about diagnostic criteria because of inaccuracy of available methods. ⋯ The development of molecular diagnostic tools may improve the adequacy of antimicrobial therapies of ventilated patients with pneumonia, but we need to further assess its impact in non-ventilated pneumonia. In this review we introduce distinction between hospital-acquired pneumonia according to the localization in the hospital and the oxygenation/ventilation mode. A clarification of definition is the first step to develop more accurate diagnostic strategies and to improve the patients' prognosis.
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Curr Opin Anaesthesiol · Apr 2022
ReviewExamining intersectionality in anesthesiology training, academics, and practice.
Intersectionality, or the overlapping nature of social categorizations, such as race, class, and gender, creates interdependent systems of discrimination, disadvantage, and health disparities. The present review examines common shortcomings to diversity management, and proposes targeted improvement frameworks for anesthesiology departments that would offer competitive advantage in training, hiring, and retention, and improved care delivery aimed toward reducing health disparities. ⋯ The synergy of intersectionality mounts considerable challenges that impact patients, colleagues, and communities of practice. Examining intersectionality in education and workplace policy affords tremendous opportunity for improving quality of care for marginalized populations, reducing healthcare costs, and normalizing culture that is inclusive, equitable, and empowering.
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Review
Assessing Operative Skill in the Competency-Based Education Era: Lessons from the UK and Ireland.
Decisions regarding the operative competence of surgical residents in the United Kingdom and Ireland are informed by operative workplace-based assessments (WBAs) and operative number targets for index procedures. This review seeks to outline the validity evidence of these assessment methods. ⋯ Operative WBAs are reliable. Scores achieved correlate with both time spent in training and recorded operative experience. Trainers and residents have concerns regarding the subjectivity of these assessments and the opportunistic nature in which they are used. Operative number targets are not criterion-referenced, lack validity evidence, and may be set too low to ensure operative competence.