American Journal of Critical Care最新文献_第10页

Severity-of-Illness Scores and Discharge Disposition in Patients Admitted to Long-Term Acute Care Hospitals. 入住长期急性护理医院的患者的疾病严重程度评分和出院处置。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-09-01 DOI: 10.4037/ajcc2023289

Dena H Tran, Zain Nagaria, Harsh Y Patel, Dalwinder Basra, Kam Ho, Waqas Bhatti, Avelino C Verceles

{"title":"Severity-of-Illness Scores and Discharge Disposition in Patients Admitted to Long-Term Acute Care Hospitals.","authors":"Dena H Tran, Zain Nagaria, Harsh Y Patel, Dalwinder Basra, Kam Ho, Waqas Bhatti, Avelino C Verceles","doi":"10.4037/ajcc2023289","DOIUrl":"10.4037/ajcc2023289","url":null,"abstract":"Background: After an intensive care unit (ICU) admission, nearly 20% of survivors of chronic critical illness require admission to a long-term acute care hospital (LTACH) for continued subspecialty care. The effect of the burden of medical comorbidities on discharge disposition after LTACH admission remains unclear.Methods: A retrospective cohort study was performed involving patients with chronic critical illness who were discharged from the medical ICU and admitted to an LTACH between 2016 and 2018. The patients' Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), Nutrition Risk in the Critically Ill (NUTRIC), and Charlson Comorbidity Index (CCI) scores at the time of LTACH admission were calculated from electronic medical records. The mean scores on each instrument were compared by discharge disposition.Results: A total of 156 patients were admitted to the LTACH from the medical ICU between 2016 and 2018. They had a mean (SD) age of 61.5 (13.3) years, a mean (SD) body mass index of 28.1 (8.3), a median (IQR) ICU stay of 16.3 (1-108) days, and a median (IQR) LTACH stay of 38.2 (1-227) days. Patients who were discharged home had lower mean (SD) APACHE II (14.6 [5.0] vs 18.2 [5.4], P = .01), SOFA (3.3 [2.1] vs 4.6 [2.1], P = .03), NUTRIC (3.3 [1.4] vs 4.6 [1.4], P = .001), and CCI (4.3 [2.5] vs 6.1 [2.8], P = .02) scores on admission to the LTACH than those who were not discharged home.Conclusion: Severity-of-illness scores on admission to an LTACH can be used to predict patients' likelihood of being discharged home.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10135677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia. 住院老年痴呆患者功能护理的相关因素

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023440

Barbara Resnick, Marie Boltz, Elizabeth Galik, Ashley Kuzmik, Brittany F Drazich, Rachel McPherson, Chris L Wells

{"title":"Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia.","authors":"Barbara Resnick, Marie Boltz, Elizabeth Galik, Ashley Kuzmik, Brittany F Drazich, Rachel McPherson, Chris L Wells","doi":"10.4037/ajcc2023440","DOIUrl":"10.4037/ajcc2023440","url":null,"abstract":"Background: Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia.Objective: To explore factors associated with participation in function-focused care in this patient population.Methods: This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing.Results: The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14.Conclusion: For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Heart-Brain Connection: Role of the Central Nervous System. 心脑连接:中枢神经系统的作用。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023191

Teri M Kozik, Dillon J Dzikowicz, Salah S Al-Zaiti

引用次数: 0

Outcomes of Sepsis in Patients With and Without HIV Infection: A Retrospective Study. 有和没有HIV感染的脓毒症的结局:一项回顾性研究。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023446

Kevin Gray, Milo Engoren

{"title":"Outcomes of Sepsis in Patients With and Without HIV Infection: A Retrospective Study.","authors":"Kevin Gray, Milo Engoren","doi":"10.4037/ajcc2023446","DOIUrl":"10.4037/ajcc2023446","url":null,"abstract":"Background: HIV infection is associated with increased infections.Objectives: To (1) compare patients with sepsis with and without HIV, (2) assess whether HIV is associated with mortality in sepsis, and (3) identify factors associated with mortality in patients with HIV and sepsis.Methods: Patients who met Sepsis-3 criteria were studied. HIV infection was defined as administration of highly active antiretroviral therapy, a diagnosis of AIDS encoded by the International Classification of Diseases, or a positive HIV blood test result. Propensity scores were used to match patients with HIV to similar patients without HIV, and mortality was compared with χ2 tests. Logistic regression was used to determine factors independently associated with mortality.Results: Sepsis developed in 34 673 patients without HIV and 326 patients with HIV. Of these, 323 (99%) patients with HIV were matched to similar patients without HIV. The 30-60- and 90-day mortality was 11%, 15%, and 17%, respectively, in patients with sepsis and HIV, which was similar to the 11% (P > .99), 15% (P > .99), and 16% (P = .83) in patients without HIV. Logistic regression to adjust for confounders showed that obesity (odds ratio, 0.12; 95% CI, 0.03-0.46; P = .002) and high total protein on admission (odds ratio, 0.71; 95% CI, 0.56-0.91; P = .007) were associated with lower mortality. Mechanical ventilation at sepsis onset, renal replacement therapy, positive blood culture, and platelet transfusion were associated with increased mortality.Conclusions: HIV infection was not associated with increased mortality in patients with sepsis.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9739953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Critical Access Hospital Nurses' Perceptions of Obstacles to End-of-Life Care: A Qualitative Study. 关键医院护士对临终关怀障碍的认知:一项质性研究。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023186

Renea L Beckstrand, Janelle L B Macintosh, Jeanette Drake, Con Newman, Ryan Rasmussen, Karlen E Luthy

{"title":"Critical Access Hospital Nurses' Perceptions of Obstacles to End-of-Life Care: A Qualitative Study.","authors":"Renea L Beckstrand, Janelle L B Macintosh, Jeanette Drake, Con Newman, Ryan Rasmussen, Karlen E Luthy","doi":"10.4037/ajcc2023186","DOIUrl":"10.4037/ajcc2023186","url":null,"abstract":"Background: Critical care nurses working in urban settings have reported obstacles in caring for dying patients. However, the perceptions of such obstacles by nurses working in critical access hospitals (CAHs), which are located in rural areas, are unknown.Objective: To study stories and experiences related to obstacles in providing end-of-life care reported by CAH nurses.Methods: This exploratory, cross-sectional study presents the qualitative stories and experiences of nurses working in CAHs as reported on a questionnaire. Quantitative data have been previously reported.Results: Sixty-four CAH nurses provided 95 categorizable responses. Two major categories emerged: (1) family, physician, and ancillary staff issues and (2) nursing, environment, protocol, and miscellaneous issues. Issues with family behaviors were families' insistence on futile care, intrafamily disagreement about do-not-resuscitate and do-not-intubate orders, issues with out-of-town family members, and family members' desire to hasten the patient's death. Issues with physician behaviors were providing false hope, dishonest communication, continuation of futile treatments, and not ordering pain medications. Nursing-related issues were not having enough time to provide end-of-life care, already knowing the patient or family, and compassion for the dying patient and the family.Conclusion: Family issues and physician behaviors are common obstacles in rural nurses' provision of end-of-life care. Education of family members on end-of-life care is challenging because it is most families' first experience with intensive care unit terminology and technology. Further research on end-of-life care in CAHs is needed.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correction. 修正。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023315

引用次数: 0

Longitudinal Associations Among Symptoms of Family Intensive Care Unit Syndrome. 家庭重症监护病房综合征症状的纵向关联

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023443

Grant A Pignatiello, Stephanie Griggs, Elliane Irani, Seth Alan Hoffer, Ronald L Hickman

{"title":"Longitudinal Associations Among Symptoms of Family Intensive Care Unit Syndrome.","authors":"Grant A Pignatiello, Stephanie Griggs, Elliane Irani, Seth Alan Hoffer, Ronald L Hickman","doi":"10.4037/ajcc2023443","DOIUrl":"10.4037/ajcc2023443","url":null,"abstract":"Background: Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue.Objectives: This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU.Methods: The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline.Results: The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7.Conclusions: Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9751568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Pearls. 临床珍珠。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023613

Rhonda Board

引用次数: 0

Talk of Personalization in Health Care. 谈谈医疗保健中的个性化。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023238

Aluko A Hope, Cindy L Munro

引用次数: 0

Mortality and Discharge Location of Intensive Care Patients With Alzheimer Disease and Related Dementia. 阿尔茨海默病及相关痴呆重症监护患者的死亡率和出院地点

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2023-07-01 DOI: 10.4037/ajcc2023328

Mary Lynn Davis-Ajami, Chiang-Hua Chang, Sumedha Gupta, Babar Ali Khan, Craig A Solid, Husam El Sharu, Malaz Boustani, Brandon A Yates, Kosali Simon

{"title":"Mortality and Discharge Location of Intensive Care Patients With Alzheimer Disease and Related Dementia.","authors":"Mary Lynn Davis-Ajami, Chiang-Hua Chang, Sumedha Gupta, Babar Ali Khan, Craig A Solid, Husam El Sharu, Malaz Boustani, Brandon A Yates, Kosali Simon","doi":"10.4037/ajcc2023328","DOIUrl":"10.4037/ajcc2023328","url":null,"abstract":"Background: Intensive care unit (ICU) utilization has increased among patients with Alzheimer disease and related dementia (ADRD), although outcomes are poor.Objectives: To compare ICU discharge location and subsequent mortality between patients with and patients without ADRD enrolled in Medicare Advantage.Methods: This observational study used Optum's Clinformatics Data Mart Database from years 2016 to 2019 and included adults aged >67 years with continuous Medicare Advantage coverage and a first ICU admission in 2018. Alzheimer disease and related dementia and comorbid conditions were identified from claims. Outcomes included discharge location (home vs other facilities) and mortality (within the same calendar month of discharge and within 12 months after discharge).Results: A total of 145 342 adults met inclusion criteria; 10.5% had ADRD and were likely to be older, female, and have more comorbid conditions. Only 37.6% of patients with ADRD were discharged home versus 68.6% of patients who did not have ADRD (odds ratio [OR], 0.40; 95% CI, 0.38-0.41). Both death in the same month as discharge (19.9% vs 10.3%; OR, 1.54; 95% CI, 1.47-1.62) and death in the 12 months after discharge (50.8% vs 26.2%; OR, 1.95; 95% CI, 1.88-2.02) were twice as common among patients with ADRD.Conclusions: Patients with ADRD have lower home discharge rates and greater mortality after an ICU stay than patients without ADRD.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9739957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0