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Cochrane Db Syst Rev · Jan 2013
ReviewMechanical ventilation for amyotrophic lateral sclerosis/motor neuron disease.
Amyotrophic lateral sclerosis, also known as motor neuron disease, is a fatal neurodegenerative disease. Neuromuscular respiratory failure is the commonest cause of death, usually within two to five years of the disease onset. Supporting respiratory function with mechanical ventilation may improve survival and quality of life. This is the first update of a review first published in 2009. ⋯ Evidence from a single randomised trial of non-invasive ventilation in 41 participants suggests that it significantly prolongs survival and improves or maintains quality of life in people with ALS. Survival and some measures of quality of life were significantly improved in the subgroup of people with better bulbar function, but not in those with severe bulbar impairment. Future studies should examine the health economics of NIV and factors influencing access to NIV. We need to understand the factors, personal and socioeconomic, that determine access to NIV.
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Given the increasing incidence of adverse events and medication errors in healthcare settings, a greater emphasis is being placed on the integration of patient safety competencies into health professional education. Nurses play an important role in preventing and minimizing harm in the healthcare setting. Although patient safety concepts are generally incorporated within many undergraduate nursing programs, the level of students' confidence in learning about patient safety remains unclear. ⋯ These findings suggest nursing students are confident in what they are learning about clinical aspects of patient safety, however, their confidence in learning about sociocultural aspects declines as they are increasingly exposed to the clinical environment. This suggests a need to address the impact of the practice environment on nursing students' confidence in what they are learning about patient safety.
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To examine the effect of fast track on emergency department (ED) length of stay (LOS). ⋯ ED fast track decreased ED LOS for non-admitted patients without compromising waiting times and ED LOS for other ED patients.
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Unilateral medical futility policies, which allow health-care providers to limit or withdraw life-sustaining treatment over patient or surrogate objections, are increasingly designed around a procedural approach. Medical or ethics committees follow a prespecified process, the culmination of which is a justified decision about whether ongoing treatment should be withheld or withdrawn. These procedures have three stages. ⋯ We review the available data on procedure-based futility policies, arguing that there is limited information on their potential harms and how these harms are distributed. We consider the ethical implications of policy-making under informational uncertainty, invoking the precautionary principle--in the absence of clear data, if a policy has significant risk of significant harm, the burden of proof that it is not harmful falls on those recommending the policy--as the guiding moral standard for hospitals and professional organizations considering whether to adopt a procedural approach to medical futility. On the basis of this principle, we argue that any new futility guideline must include a significant commitment to collecting prospective data on its application.
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Comparative Study
A comparative study on reliability of point of care sodium and potassium estimation in a pediatric intensive care unit.
To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer. ⋯ Blood gas analyzers underestimates Na + and K + values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman's analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.