Thesis (Mnutr)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: INTRODUCTION Many patients seen by dietitians in Tygerberg Academic Hospital require feeding via the enteral route. Prior to this study all enteral feeds were mixed individually by hand, and production was time consuming and very labour intensive. The purpose of this study was, therefore, to compare the current method of production, with mechanised bulk production (MP) and "Ready to hang" (RTH) products, taking time, safety and cost effectiveness into consideration. MATERIALS AND METHODS A machine was designed and built to produce and decant bulk volumes of enteral feed. Production methods were evaluated and data was obtained regarding the time taken to produce a feed, and the true cost of the feeds produced. Microbiological samples were collected and the safety of all the three systems was determined and compared. RESULTS MP production time was significantly longer than hand production (HP), but MP decanting was significantly more accurate. RTH feeds cost 152% more than HP feeds, and MP feeds cost 95% of HP feeds. Seventy-one per cent of HP feeds, 74% of MP feeds and 34% of RTH feeds were contaminated just after administration had began. CONCLUSIONS Mechanisation is less labour intensive than HP and helps to decrease total costs. RTH feeds quickly become contaminated after administration decreasing their other advantages. / AFRIKAANSE OPSOMMING: IN L E ID IN G Baie van die pasiente wat deur dieetkundiges in Tygerberg hospitaal gesien word, benodig buisvoedings. Vo or hierdie studie geloots was, was alle buisvoedings by Tygerberg hospitaal met die hand gemaak. Hierdie metode is baie tydsaam en arbeidsintensief. Die doel van hierdie studie was, om die voorlopige sisteem van produksie te vergelyk met gemeganiseerde grootmaat produksie en "ready to hang" (RTH). Die studie het die volgende in ag geneenv produksietyd, mikrobiologiese veiligheid en koste effektieweteit. METODE 'n Masjien was ontwerp en gebou om grootmaat buisvoedings aan te maak en aftegiet. Produksie metodes was geevalueer en inligting bymekaar gemaak met betrekking tot produksietyd, en die ware koste van die voedings. Mikrobiologiese monsters was versamel en die mikrobiologiese veiligheid van al drie sisteme is bepaal en vergelyk. RESULTATE Produksie met die masjien was betekenisvol longer as die voedings wat met die hand gemaak was, maar die masjien het betekenisvol meer akkuraat afgemeet met afgiet. RTH voedings se koste beloop 152% meer as voedings wat met die hand gemaak word, en voedings wat deur die masjien gemaak word kos 95% van die wat met die hand gemaak is. Een en sewentig persent van die voedings wat met die hand gemaak was, 74% van die masjiengemaakte voedings en 34% van die RTH voedings was besmet net na toediening begin was. GEVOLGTREKKINGS Meganisasie is minder arbeidsintensief as voedings wat met die hand gemaak is en help om die kostes af te bring. RTH voedings word vinnig besmet met organismes na die begin van toediening en dit verminder hulle ander voordele.

Background: Up to 40% of trauma patients die during the first 24 hours after injury due to massive hemorrhage. In patients who survive this critical time period, no information is available on rates of delayed major bleeding or factors associated with delayed major bleeding. Methods: A retrospective chart review of 150 critically ill adult trauma patients was used to determine the incidence of delayed major bleeding events. Cox proportional hazards multivariate analysis was performed to assess for risk factors associated with delayed major bleeding events. The anticipated rate of delayed major bleeding events was 10%. Results: The incidence of delayed major bleeding in this cohort of critically ill trauma patients was 44%. Predictors that were statistically significantly associated with delayed major bleeding included: male gender, pre-injury use of the antiplatelet agents aspirin and/or clopidogrel, presence of intracranial bleeding, higher injury severity scores, requirement of massive transfusion, and low pH values. Use of anticoagulant prophylaxis was not associated with delayed major bleeding. Conclusion: The rate of delayed major bleeding was higher than estimated. Larger retrospective and prospective cohorts are needed to confirm these findings.

No description available.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008. / Title from first page of PDF file (viewed Aug. 1, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 120-127).

Thesis (M.S.)--University of Michigan, 1975.

Thesis (M.S.)--University of Michigan, 1975.

BACKGROUND:Some comprehensive cancer centers in industrialized countries have reported improved outcomes in their cardiopulmonary arrest (CPA) patients. Little is known about the outcomes and predictors of CPA in cancer centers in other parts of the world. The objective of this study was to examine the predictors of CPA outcome in a comprehensive cancer center closed medical-surgical intensive care unit (ICU) located in Amman, Jordan.METHODS:In this retrospective single-center cohort study, we identified 104 patients who had a CPA during their stay in the ICU between 1/1/2008 and 6/30/2009. Demographic data and CPA-related variables and outcome were extracted from medical records. Comparisons between different variables and CPA outcome were conducted using logistic regression.RESULTS:The mean age of the group was 49.7+/-15.3years. The mean APACHE II score was 23.7+/-8.0. Thirty six patients (34.6%) were resuscitated successfully but 8 of them (7.7% of the cohort) left the ICU alive and only 6 out of the 8 (5.8% of the cohort) left the hospital alive. The following variables predict resuscitation failure: acute kidney injury (OR 1.7, CI: 1.1 - 2.6), being on mechanical ventilation (OR 3.8, CI: 1.3 - 11), refractory shock (OR 4.7, CI: 1.8 - 12) and CPR duration (OR 1.1, CI: 1.1 - 1.2).CONCLUSION:Survival among cancer patients who develop CPA in the ICU continues to be poor. Once cancer patients suffered a CPA in the ICU multiple factors predicted resuscitation failure but CPR duration was the only factor that predicted resuscitation failure and ICU as well as hospital mortality.

The aim of this study was to evaluate the fluid balance of polytrauma patients hospitalized in the intensive care unit at the University Hospital in Hradec Kralove. Very little knowledge about this issue can be found; therefore we tried to clarify how the body responds to trauma and whether it is possible to influence the further course of the disease by controlling the amount of administered fluid. The study included 13 patients, 12 men and 1 woman with different length of hospitalization. The examination of the patients was carried out by the bioelectrical impedance analysis of the body composition which is able to determine the proportion of individual body components (water, muscle mass, fat). All the patients were examined twice, each after a different time period. Other data were collected from medical documentation related to fluid balance and laboratory results. After assessing the results we discovered differences in the measured values in the first and second test. While during the first examination no statistical correlation between the distribution of the fluids in the body and the intake and output was found, the second examination showed a statistically significant relationship between the fluid intake and subsequent body composition (fluid overload, total body water, extra and...

Parents’ presence and participation in their child’s care in the paediatric intensive care unit (PICU) is now commonplace. Despite parents expressing a deep need to be with their child particularly during periods of crisis, it is precisely at these times that they are often prevented from staying. The growing debate regarding family presence during a cardiopulmonary (CPR) resuscitation attempt continues to be controversial and conflicting. Current knowledge is mostly derived from quantitative studies conducted in the adult intensive care or emergency environments. The experiences of parents of children in the PICU, and the nurses caring for them are unknown. Using van Manen’s hermeneutic phenomenological approach, this study describes the phenomenon of parental presence during resuscitation of a child in PICU for eight Australian parent couples and six nurses. Experiential descriptions, obtained in tape-recorded unstructured interviews were subjected to two layers of analysis. Thematic analysis provided the phenomenological description in seven themes. Four themes refer to the parents’ experience in Being only for a child; Making sense of a living nightmare; Maintaining hope: facing reality and Living in a relationship with staff. Three themes describe the nurses’ experience: Under the parents’ gaze; Walking in their shoes and Holding parents in mind. A second layer of hermeneutic analysis revealed parents’ and nurses’ collective experience to have their being in four elements of the phenomenon. These elements are Being in chaos; Struggling to connect; Being for another and Being complete. The final description of the parents’ and nurses’ experience of parental presence during resuscitation in PICU as Sharing and surviving the resuscitation is drawn from the findings from each of these layers of meaning. The findings from this study conclude that the parents’ inherent need to be with their child overrode their anxieties of the resuscitation scene, curbing their feelings of chaos. Parental presence however, was a complex and dynamic concept that required a new relationship between parents and nurses. Implications of this study include recommendations for improving staff knowledge and education, as well as practical interventions for enhanced support for both parents and nurses / Doctor of Philosophy (PhD)

Caring is a universal need of all humans and is central to the practice of nursing (Watson, 1979). Considerable research has been conducted in the study of caring behavior and caring. However, there has been little nursing research which focuses on the meaning of care as perceived by the patient. The purpose of this study was to further determine the patient's perceptions of caring behaviors of nurses by using Watson's (1979) theory of carative nursing.Watson's theory identified ten carative factors which served as the basis for the caring behavior's assessment instrument's (CBA) seven subscales. The instrument was administered to a convenience sample of 100 adults, 59% female, 40% male over 21 years of age hospitalized during 1997-1998 on the progressive care unit of a large Midwest hospital.Data were analyzed using descriptive and correlational statistics as well as MANOVA. The Cronbach's alpha reliability coefficient for each subscale ranged from 0.88 to 0.98. Principle components factor analysis revealed seven factors which accounted for 71% of the variance in the data and provided support for construct validity of the instrument.Finding showed that critical care patients perceived caring behaviors of nurses in a critical care setting as having much importance on all seven subscales of the CBA. Overall, they perceived technical professional, helping/ trusting subscale and teaching/learning subscale as having much importance. There were no significant differences found on behaviors based on age, sex, education, length of hospital stay and number of hospital admissions.There were no significant differences between those who were married and not married. Married patients perceived as less caring behavior on humanism helping/trusting and teaching subscales.A major conclusion was that patients in the critical care setting overall perceived all behaviors of nurses in a critical care setting as identified in the CBA's seven subscales of the instrument as having the most importance. The behaviors identified as having the most important were technical-professional including giving shots and taking care of equipment (monitor). / School of Nursing