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Infection control
Published in Philip Woodrow, Nursing Acutely Ill Adults, 2015
Close proximity of beds significantly increases risks of airborne infection (Eggimann and Pittet, 2001), often undermining short-term financial savings from closing beds by increasing longer-term costs from cross-infection. Invasive procedures, especially dressing changes, should whenever possible be planned to avoid bed-making, when airborne skin scales are likely to increase. Dirty linen should be carefully folded, and linen skips brought to the bedside. Low staffing levels and high workloads correlate with increased cross-infection (Allen, 2005; Coia et al., 2006; Rogowski et al., 2013), largely because busy staff attempt to cut corners, such as basic hygiene.
Prehospital COVID-19-Related Encounters Predict Future Hospital Utilization
Published in Prehospital Emergency Care, 2023
Zachary Finn, Patrick Carter, David Rogers, Aaron Burnett
This Minnesota-specific dataset shows that ILI (assumed to represent COVID-19 PUIs) and COVID-19-specific responses predict future medical-surgical and ICU bed utilization. These linear regression models accurately predict bed utilization for COVID-19 patients far enough into the future to potentially allow for reallocation of resources. Even in the models above which best predicted bed use 6 days following EMS surge, these models could allow for earlier modification of elective procedure scheduling, shifting resources locally and/or nationally, and changing patient care staffing as needed. With the majority of EMS runs being reported through MNSTAR within 24 hours, and nearly all runs being reported within 72 hours, a preparation period of at least three days would still be available. Of note, in the second wave of cases, EMS responses were best predictive of ICU bed use 12 to 14 days in the future, and three to five days for medical-surgical hospital bed, making it more challenging to use the latter for decision making and changing resource allocations.
Endovascular Closure of Pulmonary Arteriovenous Malformations after Cryptogenic Stroke: A Case Series
Published in Structural Heart, 2019
Geoffrey Rubin, Barbara Spencer, Robert J. Sommer
The PAVM has important physiologic differences compared with the PFO, even though both produce RTLS. PAVMs most commonly have a single afferent blood supply from the right or left pulmonary artery (systemic venous blood) and an efferent limb that drains directly into a pulmonary vein or the left atrium without an intervening filtering capillary bed. The larger vessels of the PAVM offer a low resistance alternative to the higher resistance pulmonary capillary bed, making the PAVM the preferred pathway back to the left atrium. Over time, the abnormal vessels may grow substantially with increasing flow, lowering resistance even further. Still, because PAVMs are generally localized as isolated lesions most often in the lower lobes, in contrast with the PFO which “sees” all of the systemic venous return, only a fraction of the systemic blood volume is exposed to the PAVM.18,19 A thromboembolism from the pelvis, for example, will always pass the atrial septum on its way to the lungs, but thereafter the clot may pass to the unaffected lung, or to a normal lobe or segment in the lung with the PAVM. Serious neurologic events including TIA, stroke, and brain abscess occur in 30%–40% of patients with PAVMs that have feeding arteries 3 mm or greater in diameter, making 3 mm a generally accepted size threshold for primary prevention endovascular closure.19
Comparison of efficacy and complications between radiofrequency ablation and repeat surgery in the treatment of locally recurrent thyroid cancers: a single-center propensity score matching study
Published in International Journal of Hyperthermia, 2019
Yangsean Choi, So Lyung Jung, Ja-Sung Bae, So-Hee Lee, Chan-Kwon Jung, Jinhee Jang, Na-Young Shin, Hyun Seok Choi, Kook-Jin Ahn, Bum-Soo Kim
Our results for complications were also in agreement with those of Kim et al., who had reported that the total number of complications was lower in the RFA group [24]; however, in this current study, significantly lower overall complication rates were observed in the RFA group. A meta-analysis on evaluating safety of RFA in the treatment of recurrent thyroid cancers reported that overall and major complication rates were 10.98 and 6.71%, respectively [32], which are similar to our findings of 10.4 and 3.1% of overall and major complication rates, respectively. In addition, hypocalcemia was observed exclusively in the repeat surgery group and not observed in the RFA group, which was also in agreement with prior studies [4,24,25,33]. Furthermore, unlike the study by Kim et al., the incidence of voice changes was significantly higher in the repeat surgery group (18.4%), which is slightly higher than, but comparable to, prior results of permanent recurrent laryngeal nerve paralysis rates after repeat surgeries (1–12%) [34]. However, this difference was no longer observed—after propensity score matching. Several cases of voice changes after RFA on surgical beds were previously reported [4,25,35], which suggests that RFA is less safe when applied on the surgical bed. Baek et al. explained that the recurrent laryngeal nerve is not well visualized on US on the surgical bed, making it more vulnerable to thermal injury [4]. However, while a higher proportion of RFA procedures was performed in the central cervical regions in our study, only a few patients experienced voice changes (8.6%). This suggests that it is probably still safe to perform RFA on surgical beds, especially when careful attention is paid to the recurrent laryngeal nerve along with the provision of additional protective procedures to minimize recurrent laryngeal nerve injury (e.g. hydrodissection, pulled-away method, and cold distilled water injection after RFA).