The Southern African journal of critical care : the official journal of the Critical Care Society最新文献

{"title":"Shock epidemiology and outcomes among internal medicine patients.","authors":"C Maluangnon, B Joyjumroon, C Phawanawichian, S Tongyoo","doi":"10.7196/SAJCC.2025.v41i1.2453","DOIUrl":"10.7196/SAJCC.2025.v41i1.2453","url":null,"abstract":"<p><strong>Background: </strong>Shock, characterised by circulatory hypoperfusion and cellular hypoxia, represents a critical medical condition requiring immediate attention. Despite its significance, there are limited data on shock incidence and outcomes, particularly within the context of Thailand.</p><p><strong>Objectives: </strong>This retrospective observational study aimed to investigate the incidence, management and outcomes of shock patients admitted to the internal medicine department of Siriraj Hospital, a referral university hospital in Bangkok, Thailand. Additionally, the study sought to identify factors associated with mortality among these patients.</p><p><strong>Methods: </strong>Medical records of patients admitted were reviewed. Shock cases were identified based on specific diagnostic criteria, and demographic and clinical data were extracted for analysis.</p><p><strong>Results: </strong>A total of 125 patients were included in the study, with septic shock being the most prevalent condition (40.0%), followed by cardiogenic shock (39.2%), hypovolaemic shock (18.4%) and obstructive shock (2.4%). The overall intensive care unit (ICU) admission rate was 46.7%, varying among shock types, with cardiogenic shock patients exhibiting the highest rate. The overall 28-day mortality rate was 23.7%, with septic shock patients admitted to the ICU demonstrating the highest mortality rate (50.0%). The multivariate analysis identified factors associated with mortality, including colloid resuscitation (adjusted odds ratio (aOR) 3.10 (1.08 - 8.9), p=0.036); vasopressor dose of more than 0.2 µg/kg/min (aOR 4.38 (1.39 - 13.74), p=0.011); and renal replacement therapy (aOR 3.43 (1.04 - 11.28), p=0.043).</p><p><strong>Conclusion: </strong>This study provides significant insights into shock incidence, management and outcomes in a tertiary referral hospital in Thailand. It also highlights challenges related to ICU bed availability and identifies predictors of mortality. Early recognition and tailored interventions are crucial for improving outcomes in shock patients.</p><p><strong>Contribution of the study: </strong>This study provides the comprehensive evaluation of shock incidence, management and outcomes among internal medicine patients. By identifying critical care resource limitations and key predictors of mortality, the findings offer valuable insights for improving early recognition and tailored interventions in resource-constrained settings.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2453"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification and predictive models using supervised machine learning: A conceptual review.","authors":"M A Pienaar, K D Naidoo","doi":"10.7196/SAJCC.2025.v411.2937","DOIUrl":"10.7196/SAJCC.2025.v411.2937","url":null,"abstract":"<p><strong>Background: </strong>Supervised machine learning models (SMLMs) are likely to be a prevalent approach in the literature on medical machine learning. These models have considerable potential to improve clinical decision-making through enhanced prediction and classification. In this review, we present an overview of SMLMs. We provide a discussion of the conceptual domains relevant to machine learning, model development, validation, and model explanation. This discussion is accompanied by clinical examples to illustrate key concepts.</p><p><strong>Contribution of the study: </strong>This conceptual review provides an overview and guide to the interpretation of SMLMs in the medical literature.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2937"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144982024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between serum procalcitonin levels and outcomes of patients admitted to two tertiary paediatric intensive care units in Bloemfontein: A retrospective analytical study.","authors":"A M Luyo Sanchez, M A Pienaar","doi":"10.7196/SAJCC.2025.v41i1.2247","DOIUrl":"10.7196/SAJCC.2025.v41i1.2247","url":null,"abstract":"<p><strong>Background: </strong>Procalcitonin (PCT) is used in the diagnosis of sepsis. Its capability as a prognostic marker is unclear. The association between PCT and paediatric intensive care unit (PICU) outcomes has not been investigated in the South African setting.</p><p><strong>Objectives: </strong>To determine the association between admission PCT, and trends within 72 hours of admission, and outcomes of patients admitted to the PICU at two tertiary academic hospitals.</p><p><strong>Methods: </strong>The study was a two-year, double centre, retrospective, analytical cross-sectional medical record review.</p><p><strong>Results: </strong>A total of 381 participants were included in the study; 55 died and 220 required mechanical ventilation. Non-survivors had a higher median admission PCT than survivors (p<0.0001, 95% confidence interval (CI) 1.28 - 15.12). Non-survivors had a higher median PCT at 48 - 72 hours than survivors (p<0.0001, 95% CI 2.50 - 21.72). Non-survivors had less of a median decrease in PCT than survivors (p=0.22, 95% CI -0.59 - 4.72). The area under the receiver operating characteristics curve (AUROCC) for admission PCT to discriminate for mortality was 0.6702 and for the 48 - 72 hour PCT it was 0.7369. There was a positive correlation between PCT and number of ventilator days (Spearman correlation co-efficient =0.1477, p=0.0138). There was no correlation between the length of PICU stay and admission PCT (p=0.7579) or PCT change (p=0.2034).</p><p><strong>Conclusion: </strong>Single PCT measurements display some ability to discriminate for PICU mortality. Serial PCT measurements provide greater prognostic information. Non-survivors had a significantly greater median admission PCT, median PCT at 48 - 72 hours and a lower median PCT decrease than survivors.</p><p><strong>Contribution of the study: </strong>This study clarifies the role and limitations of procalcitonin measurements and trends in PICU outcomes.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2247"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making sense of the outcome of a rehabilitation implementation trial in the intensive care unit: Mixed methods.","authors":"F Karachi, J J Maritz, T M Esterhuizen, R Gosselink, S D Hanekom","doi":"10.7196/SAJCC.2695.v41i1.2695","DOIUrl":"10.7196/SAJCC.2695.v41i1.2695","url":null,"abstract":"<p><strong>Background: </strong>Evidence for implementation of evidence-based protocols (EBPs) in resource-constrained intensive care units (ICUs) is sparse.</p><p><strong>Objectives: </strong>To evaluate a tailored best-practice multifaceted strategy for implementation of a validated physiotherapy EBP for the management of surgical ICU (SICU) patients. Also, to explore the physiotherapists' perceptions regarding the implementation process and factors affecting protocol adherence, guided by the Consolidated Framework for Implementation Research.</p><p><strong>Methods: </strong>A type 2 hybrid implementation study design was applied, including all adult patients admitted over 16 months to two (control and experimental) SICUs in Western Cape Province, South Africa. The physiotherapists eligible to participate in the qualitative study (N=17) were those who participated in the implementation process and worked in the experimental SICU. The Therapeutic Index Scoring System-28 (TISS-28) and four process of care indicators (POCIs) were the primary and secondary outcomes, respectively, both analysed in Stata version 15. Thematic content analysis of textual data generated physiotherapists' perceptions of the implementation process.</p><p><strong>Results: </strong>The intervention strategy did not result in protocol adherence, with no significant difference (p>0.05) in TISS-28 and POCI outcomes during and after implementation in the experimental unit and all phases of the control. Physiotherapists (71%; n=12/17) perceived that the process affected their thinking and clinical decision-making, but not the organisation of physiotherapy services, except for a more multidisciplinary approach to care in the experimental unit. Organisational factors (time constraints, workload/flow barriers) affected adherence, explaining the lack of practice change.</p><p><strong>Conclusion: </strong>The importance of organisational change and support of the physiotherapy departments providing services to ICUs while also addressing the healthcare needs of a diverse group of hospitalised patients is highlighted.</p><p><strong>Contribution of the study: </strong>The study provides insights for rehabilitation implementation in resource-constrained intensive care settings. It highlights the importance of taking the next step towards implementation in complex environments and a new approach to facilitating the uptake of evidence and ensuring sustainable change through addressing the structural and organisational aspects of physiotherapy service delivery and care, and the inclusion of a multidisciplinary team approach to the implementation of any discipline-specific evidence-based protocols in the intensive care setting.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2695"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical pertussis infection in the paediatric intensive care unit: A case series in an outbreak.","authors":"H Crichton, N Nkado, B Morrow, S Salie, C Procter","doi":"10.7196/SAJCC.2025.v41i1.2049","DOIUrl":"10.7196/SAJCC.2025.v41i1.2049","url":null,"abstract":"<p><strong>Background: </strong><i>Bordetella pertussis</i> is a highly infectious disease associated with increased mortality in young infants. Critical pertussis is defined as pertussis disease resulting in paediatric intensive care unit admission or death.</p><p><strong>Objectives: </strong>This study describes the clinical profile, morbidity, mortality and management of children with critical pertussis admitted to a South African paediatric intensive care unit (PICU).</p><p><strong>Study design: </strong>A retrospective analysis of children with critical pertussis admitted to the PICU over 1 year (January 2022 - December 2022).</p><p><strong>Results: </strong>There were 1 273 PICU admissions during the study period, of which 101 (7.9%) were tested and 19 (1.5%) tested positive for <i>B. pertussis</i>. Of those, 13 (68.4%) were completely unimmunised, mainly owing to young age (n=9). The median (interquartile range) total duration of ventilation was 7.0 (3.0 - 21.0) days, with a maximum of 35 days. Mortality was 36.8% (n=7) in those with <i>B. pertussis</i>; with more deaths in HIV-exposed patients (n=3/7,42.9% v. n=3/12, 25%; p<0.001) and preterm infants (n=4/7,57.1% v. n=4/12, 33.3%; p<0.001), as well as those with septic shock (n=7/7, 100% v. n=4/7, 33.3%; p = 0.02) and acute kidney injury (n=6/7, 85.7% v. n=2/12, 16.7%; p<0.001). The maximum white cell count was significantly lower in survivors (27.75 v. 76.32; p<0.001). None of the variables was independently associated with mortality on multivariable regression.</p><p><strong>Conclusion: </strong>Critical <i>B. pertussis</i> infection is associated with significant morbidity and mortality in this setting. The low rate of vaccination is a concern, and advocacy is needed to promote access to vaccination during the third trimester of pregnancy as well as strengthening current immunisation programmes. Further research is required to identify the prevalence of critical pertussis and risk factors for poor outcomes in resource-limited settings.</p><p><strong>Contribution of the study: </strong>This study demonstrated high mortality rates in infants with critical pertussis under the age of 3 months, especially in infants who are unimmunized or partially immunized. We therefore recommend vaccination against <i>Bordetella pertussis</i> in the third trimester of pregnancy and stress the importance of strengthening current immunization programmes. Our study highlights the importance of describing the markers of disease severity, such as hyperleukocytosis, especially in resource constrained settings, in order to ensure timeous transfer to PICU. We recommend further research regarding these markers of disease severity as well as therapies offered such as leukoreduction or exchange transfusion.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2049"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilation distribution in mechanically ventilated children in response to positioning: An exploratory study.","authors":"A Lupton-Smith, A Argent, B Morrow","doi":"10.7196/SAJCC.2025.v41i1.2885","DOIUrl":"10.7196/SAJCC.2025.v41i1.2885","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, it was understood that children universally show greater ventilation of the non-dependent lung. Recent studies have questioned the understanding of ventilation distribution patterns in the paediatric population. There are no studies examining the effect of body position in mechanically ventilated infants/children.</p><p><strong>Objectives: </strong>To determine the effect of body position on regional ventilation distribution in mechanically ventilated children.</p><p><strong>Methods: </strong>Thoracic electrical impedance tomography (EIT) measurements were taken in left- and right-side lying, supine and prone positions in mechanically ventilated infants/children. Functional EIT images were produced, and regional relative tidal impedance (ΔZ) in the left, right, ventral and dorsal lung regions was calculated. The proportion of ventilation occurring in large lung regions and regional filling were also calculated.</p><p><strong>Results: </strong>Seventeen children (n=8; 47% male) aged 6 months - 6 years are presented. Many of the children (n=8; 47%) consistently showed greater ventilation in the right lung in both side-lying positions, and in the dorsal lung region (n=6; 35%) in both the supine and prone positions. Regional filling was similar between lung regions in the different body positions.</p><p><strong>Conclusion: </strong>Ventilation distribution in mechanically ventilated infants/children with mild lung disease is variable and similar to that of healthy spontaneously breathing infants/children.</p><p><strong>Contribution of the study: </strong>Ventilation distribution in mechanically ventilated children with mild disease is not dissimilar to that in healthy infants and children. Positioning to optimise ventilation should be tailored to each child's responses. This study provides exploratory data describing ventilation distribution in mechanically ventilated infants and children. These data can be used to inform further research study design.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2885"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating the Measure of Processes of Care for Service Providers (MPOC-SP(A)) tool in adult intensive care units.","authors":"C O N Oghenetega, S Chetty","doi":"10.7196/SAJCC.2025.v411.2662","DOIUrl":"10.7196/SAJCC.2025.v411.2662","url":null,"abstract":"<p><strong>Background: </strong>The Measures of Process of Care for Service Providers (MPOC-SP(A)) tool, developed by the CanChild Centre for Childhood Disability Research in Canada, assesses service providers' perceptions of family-centred care (FCC) in adult rehabilitation. It consists of 27 items categorised into four domains: 'showing interpersonal sensitivity', 'providing general information', 'communicating specific information', and 'treating people respectfully'. Each domain encompasses a distinct aspect of family-centred care applicable in the intensive care unit (ICU). An earlier version of the tool was previously validated for use in neonatal ICUs. However, this tool has not been validated for use in adult ICUs.</p><p><strong>Objectives: </strong>To validate the content validity index of the MPOC-SP(A) tool for healthcare professionals working in adult ICUs in South Africa.</p><p><strong>Methods: </strong>Following approval from the Human Research Ethics Committee, a multidisciplinary group of experienced ICU healthcare professionals was invited to review the MPOC-SP(A) tool, rating each item's relevance on a four-point scale to avoid neutrality. The content validity index (CVI) was calculated for each item (I-CVI) and domain (S-CVI/Ave) using Microsoft Excel. An I-CVI of 0.83 and S-CVI/Ave of 0.9 were deemed acceptable. Items with a CVI below 0.83 were discarded.</p><p><strong>Results: </strong>The scale-level CVI (S-CVI/Ave) for every domain was 0.9 and above, which is acceptable. Two items in domain A and one item in domain B were deleted owing to low I-CVI values. Two items were revised to improve the item's clarity. Thus, a 24-item MPOC-SP(A) tool applicable to adult ICUs was generated following the content validity analysis.</p><p><strong>Conclusion: </strong>The content experts' assessment of the instrument's items is essential to ensure its validity. This study has finalised the content validation process of the MPOC-SP(A) tool for use in the adult ICU. The refined tool is now ready for the next phase of validation focusing on construct and internal consistency.</p><p><strong>Contribution of the study: </strong>This study contributes to the field of research by providing robust evidence for the content validity of the MPOC-SP(A) tool in adult ICU settings, supporting its relevance, clarity, and comprehensiveness for measuring family-centred care practices. It also offers a framework for future validation studies in similar resource-limited healthcare contexts.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"41 1","pages":"e2662"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A validation of machine learning models for the identification of critically ill children presenting to the paediatric emergency room of a tertiary hospital in South Africa: A proof of concept.","authors":"M A Pienaar, N Luwes, J B Sempa, E George, S C Brown","doi":"10.7196/SAJCC.2024.v40i3.1398","DOIUrl":"10.7196/SAJCC.2024.v40i3.1398","url":null,"abstract":"<p><strong>Background: </strong>Machine learning (ML) refers to computational algorithms designed to learn from patterns in data to provide insights or predictions related to that data.</p><p><strong>Objectives: </strong>Multiple studies report the development of predictive models for triage or identification of critically ill children. In this study, we validate machine learning models developed in South Africa for the identification of critically ill children presenting to a tertiary hospital.</p><p><strong>Results: </strong>The validation sample comprised 267 patients. The event rate for the study outcome was 0.12. All models demonstrated good discrimination but weak calibration. Artificial neural network 1 (ANN1) had the highest area under the receiver operating characteristic curve (AUROC) with a value of 0.84. ANN2 had the highest area under the precision-recall curve (AUPRC) with a value of 0.65. Decision curve analysis demonstrated that all models were superior to standard strategies of treating all patients or treating no patients at a proposed threshold probability of 10%. Confidence intervals for model performance overlapped considerably. Post hoc model explanations demonstrated that models were logically coherent with clinical knowledge.</p><p><strong>Conclusions: </strong>Internal validation of the predictive models correlated with model performance in the development study. The models were able to discriminate between critically ill children and non-critically ill children; however, the superiority of one model over the others could not be demonstrated in this study. Therefore, models such as these still require further refinement and external validation before implementation in clinical practice. Indeed, successful implementation of machine learning in practice within the South African setting will require the development of regulatory and infrastructural frameworks in conjunction with the adoption of alternative approaches to electronic data capture, such as the use of mobile devices.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"40 3","pages":"e1398"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation strategies to overcome barriers to early mobilisation practices in Zimbabwean and South African public sector ICUs: A Delphi study.","authors":"C Tadyanemhandu, V Ntsiea, H van Aswegen","doi":"10.7196/SAJCC.2024.v40i3.1692","DOIUrl":"10.7196/SAJCC.2024.v40i3.1692","url":null,"abstract":"<p><strong>Background: </strong>Barriers to early mobilisation in healthcare settings encompass various factors, including practical challenges, accountability and the crucial role of leadership.</p><p><strong>Objectives: </strong>To gain consensus from multidisciplinary team members in South African (SA) and Zimbabwean public sector hospitals to formulate implementation strategies addressing identified barriers for early mobilisation.</p><p><strong>Methods: </strong>An online two-round modified Delphi study including 23 experts from SA and Zimbabwe was undertaken. The implementation strategies were aligned with the Consolidated Framework for Implementation Research that outlines five areas impacting implementation.</p><p><strong>Results: </strong>The expert panel included intensive care unit (ICU) clinicians, academics and managers, who participated in both Delphi rounds. The median years of ICU experience was 8.5 (range 5 - 17) years, with 16 (80.0%) having a general ICU background. The panel reached consensus on several strategies to standardise early mobilisation practices in ICUs, including defining specific early mobilisation activities, appointing champion leaders, ensuring timely management of fractures, promoting patient admission to specialised units, creating dedicated physiotherapy positions, and providing skills training for staff responsible for implementing early mobilisation activities in ICUs.</p><p><strong>Conclusion: </strong>The strategies developed represent an important step toward implementation of early mobilisation in routine ICU patient care.</p><p><strong>Contribution of the study: </strong>This study provides implementation strategies, aligned with the Consolidated Framework for Implementation Research, to overcome barriers to early patient mobilisation in public sector ICUs. These strategies emanate from consensus reached by a panel of experts and serve as the first step in guiding clinicians towards developing and implementing early mobilisation protocols for their units to promote better-quality patient care in daily clinical practice.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"40 3","pages":"e1692"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes and practices of administration of intravenous antimicrobial medicines among intensive care nurses: A descriptive cross-sectional study.","authors":"J Rout, S Essack, P Brysiewicz","doi":"10.7196/SAJCC.2024.v40i3.1539","DOIUrl":"10.7196/SAJCC.2024.v40i3.1539","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial stewardship (AMS) has become integral to healthcare. In the case of antimicrobial medicines, nurses are responsible for preparing medication, and ensuring its correct and safe administration.</p><p><strong>Objectives: </strong>To describe intensive care nurses' knowledge, attitudes and practices of intravenous antimicrobial infusion administration in the context of access to AMS teaching.</p><p><strong>Methods: </strong>Convenience sampling was conducted of all 161 bedside nurses working in three general intensive care units. The nursing unit manager from each unit was requested to provide information detailing unit demographics and AMS activity within the unit (e.g. existence of AMS; nurse inclusion on the AMS team; frequency of AMS rounds; availability of AMS policies, protocols or guidelines; and training on the administration of intravenous antimicrobial medicines).</p><p><strong>Results: </strong>Intensive care nursing management reported cessation of AMS programmes in all three units during COVID-19, with minimal activity in one intensive care unit even before the onset of the pandemic. Responses from bedside nurses emphasised the unavailability of in-service AMS teaching in the units (46.4%). Questions on antibiotic groups scored poorly (55.7%). Respondents (63.8%) indicated that the hospital intravenous antibiotic policy was useful but 21.7% reported that they had never seen this policy in their unit. Opportunities for training on intravenous administration of antimicrobial medications were provided on induction to the hospital (14.5%), or in-service (30.4%) by the clinical facilitators (34.8%), or by doctors (24.6%). Fifty-one percent of respondents reported administering antibiotics through a dedicated antibiotic infusion line. Forty-five percent of respondents used a non-dedicated line, and 56.5% of respondents flushed the line between doses.</p><p><strong>Conclusion: </strong>Results suggest inadequate training. This, coupled with the evident poor access to policies and protocols, may adversely affect nurse knowledge of principles to prevent antimicrobial resistance.</p><p><strong>Contribution of the study: </strong>This study highlights that a lack of antimicrobial stewardship guidance to bedside nurses persists; that nurses do not always have access to in-service training and policies, protocols, and guidelines; and that flushing the IV administration line following the administration of an intermittent antimicrobial infusion, should be viewed as best practice to ensure the complete delivery of the dose.</p>","PeriodicalId":75194,"journal":{"name":"The Southern African journal of critical care : the official journal of the Critical Care Society","volume":"40 3","pages":"e1539"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}