SOCIETY OF CRITICAL CARE MEDICINE 34TH CRITICAL CARE CONGRESS PHOENIX, ARIZONA, USA JANUARY 15-19, 2005: Poster Presentation: Clinical Science: Sepsis/Inflammation/Infection/Antimicrobial Agents (Adult) VI
Background: Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation. Objective: To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception. Methods: Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non–mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures. Results: Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; P = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; P = 0.0003) compared with before implementation. Conclusion and Relevance: A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.
The study is all about relationship, contribution and prediction among personal values, career aspirations, socio-economic status, academic achievement and educational choice at senior secondary level. The present investigation is based on a population of class XI students, more specially, the new entrants into different educational streams. The sample consisted of 500 students selected from different senior secondary schools. Out of these 500 students, 250 were female and 250 were male. The “incidental sampling” technique being the most feasible, was used to select the sample. The sample covered a wide geographical area of Uttar Pradesh and Delhi. For the purpose of data collection the investigator used Personal Values Questionnaire (PVQ), Personal data Sheet (PDS) and Occupational Aspiration Scale. Finally, it was found that academic achievement of science students at senior secondary stage was better than the commerce students and arts students and there is a strong positive correlation between academic achievement and socio-economic status which is generally expected.
A two-phase program to increase pharmacist involvement in management of pain, agitation and delirium (PAD) at a large community teaching hospital is described.Florida Orlando Hospital implemented a two-phase initiative to decrease intensive care unit (ICU) length of stay (LOS), ventilator use, sedative use, and hospital expenditures while advancing pharmacists' scope of practice. Phase 1 of the initiative involved a pilot project to evaluate pharmacist management of sedative therapy for mechanically ventilated patients. Using a newly developed PAD order set, a pharmacist performed daily sedation management in a cohort of patients; relative to physician-managed standard care, pharmacist-directed sedation management resulted in fewer hours of patient exposure to continuous sedation, with an overall 46% reduction in continuous infusions of sedatives and reductions in both ICU and total hospital LOS, resulting in estimated savings of $1.2 million in direct hospital costs and $183,216 in drug costs. In phase 2 of the project, an expanded group of pharmacists collaborated with interprofessional teams to manage PAD using an integrated "ABCDE bundle" to promote early mobility and weaning from sedatives and analgesics. A retrospective comparison of data on a cohort of medical ICU patients managed using the ABCDE bundle approach (n = 436) and a standard-care cohort (n = 499) demonstrated improvements in several outcomes, including mean ventilator days per patient, ICU LOS, and mortality.The provision of proactive critical care pharmacist services directed at PAD management is an innovative approach to fostering interprofessional collaboration and optimizing clinical outcomes.
Giant colonic diverticulum is an uncommon presentation of colonic diverticular disease. It is characterised by the presence of a diverticulum exceeding 4 cm in size, with approximately 90% of the cases involving the sigmoid colon. Typically, diagnosis relies on CT of the abdomen and pelvis (CTAP). The preferred treatment approach is sigmoid resection with a primary colonic anastomosis. However, in complicated or emergency cases, proctosigmoidectomy with end colostomy (Hartmann’s procedure) is often considered the safest surgical option. We present an atypical case of a symptomatic patient with a giant sigmoid diverticulum that had increased in size and symptoms over several years. Initial diagnosis by CTAP revealed an incidental 6 cm sigmoid diverticulum. Over approximately 6 years, the diverticulum enlarged substantially, reaching 20 cm in size. This caused compression of the stomach and splinting of the left hemidiaphragm, resulting in nutritional failure. He was admitted with a plan to optimise for curative surgery; however complications such as nutritional failure and frailty developed, leading to a decision for palliative care.
Ergonomic researchers are investigating the cause and effect relationship due to hand transmitted vibration exposure.These relationships make occupational safety and health practitioners determine the possible root or intermittent cause which can be harmful to workers using an artificial intelligence system.In maintenance of the agriculture sector, there is a need to study hand-arm vibration exposure due to significant vascular and sensori-neural disorder.This paper presents the development of a hand numerical scoring prediction model among grass cutter workers in Malaysia using an artificial neural network.In this study, the independent variables consist of age, working experience and estimated hand-arm vibration exposure A(8) while the dependent variables is hand numerical scoring for each hand.Artificial neural network architecture has been developed and applied to the randomized onsite data collection.The artificial neural network will be based on the feed forward back propagation network using "tan" sigmoid activation function.The results of predicting the hand-arm vibration effect were evaluated by using mean square error and regression for both hands.Both hand prediction models were produced less than 0.1 relative error of prediction as compared to actual data.Our conclusion has been that the developments of prediction model have archived the best validation and more efficient means using nonlinear techniques, hence providing health welfare among grass cutter worker against hand-arm vibration syndrome.
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