Class of 2014 Abstract / Specific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.

Queijo, AF. Tradução para o português e validação de um instrumento de medida de carga de trabalho de enfermagem em unidade de terapia intensiva: NURSING ACTIVITIES SCORE (N. A. S.). [Dissertação]. São Paulo (SP): Escola de Enfermagem da USP; 2002. O presente estudo teve como objetivos traduzir para o português e avaliar as propriedades de medida do Nursing Activities Score (NAS). A finalidade deste instrumento é medir carga de trabalho de enfermagem em UTI. O estudo foi subdividido em duas partes. A primeira composta da tradução do NAS para a língua portuguesa e a segunda, da análise da confiabilidade e validade do instrumento. Após o processo de tradução para a língua portuguesa, foi realizada sua aplicação em uma amostra de 200 pacientes adultos internados em UTIs. A avaliação da confiabilidade do instrumento, feita por meio da repetibilidade entre dois observadores, demonstrou alta concordância (99,8%) e índice Kappa médio de 0,99. Já a análise da consistência interna, verificada pelo coeficiente Alpha de Cronbach revelou que o NAS possui 23 medidas independentes que não comportam consolidação ou redução. O NAS também foi aplicado para as validades de critério (concorrente) e de constructo (convergente). A validade concorrente mostrou correlação estatisticamente significativa entre o TISS-28 e o NAS (r=0,67; p<0,0001), o mesmo ocorrendo quando se utilizou a análise de regressão (R2=94,4%; p<0,0001) Quanto a validade convergente, pela técnica da análise de regressão verificou-se associação estatisticamente significativa entre o NAS e o índice de gravidade SAPS II, quando ao modelo foi inserida a variável idade. (R2=99,8%; p<0,0001). Pelos resultados obtidos, o NAS mostrou-se um instrumento confiável e válido para mensurar carga de trabalho de enfermagem em UTI, na realidade brasileira. / Queijo, AF. Translation to portuguese and validation of a instrument to measure work load of nursing in the intensive care unit (ICU): NURSING ACTIVITIES SCORE (N.A.S.). [Dissertação]. São Paulo (SP): Escola de Enfermagem da USP; 2002. The present study aimed to translate into Portuguese and to evaluate the properties of measure of the Nursing Activities Score (NAS). The purpose of this instrument is to measure work load of nursing in the intensive care unit (ICU). The study was subdivided in two parts. The first composed of translation and cross-cultural adaptation; and second, in the analysis of the reliability and the validity of the instrument. After the process of translation into Portuguese language and cross-cultural adaptation, was carried through its application in 200 adult inpatients in ICUs, in order to get the measure of reliability. At once, this was obtained by the repeatable between two observers by the statistical test of Kappa that demonstrated one high concord (99,8%) and average Kappa of 0,99. At once, the analysis of the internal consistency verified for the Cronbach´s alpha coefficient disclosed that it possess 23 independent measures that do not hold consolidation or reduction. The NAS was also applied for the validities of criterion (competing) and constructo (convergent). The competing validity showed statisticaly significant correlatio between the TISS-28 and NAS (r=0,67; p<0,001), the same occurring when the analysis of regression was used (r2=94,4%; p<0,001). About the convergent validity, by the technique of the regression analysis, it was verified signicant association statisticaly between NAS and the index of gravity SAPS II, when was inserted to the model the changeable age (r2=99,8%, p<0,001). For the gotten results, in the Brazilian reality, the NAS revealed a trustworthy and valid instrument to measure work load of nursing in ICU.

Masters of Science - Msc (Physiotherapy) / The Physiotherapist is an important member of the multidisciplinary team managing critically ill patients in the ICU. Physiotherapy practice in the ICU has shown itself to be effective, whereas the lack of physiotherapy management in the care of critically ill patients may prolong recovery. Therefore, the knowledge and attitudes about physiotherapy management by the other Health Care Professionals of the team is essential in order to facilitate efficient and effective medical services. This study aimed to determine other Health Care Professional' knowledge, attitudes regarding physiotherapy management in the ICU. As well as, it determined the current physiotherapy practices applied by physiotherapists in ICUs in Khartoum State - Republic of Sudan. The study was conducted due to limited studies in this field.

<p>Syftet med denna studie var att beskriva i vilka situationer IVA-sjuksköterskor upplever stress och hur de hanterar stressen i det vardagliga arbetet. Studien hade en beskrivande design med kvalitativ ansats. I studien deltog 10 intensivvårdssjuksköterskor. Inklusionskriterierna var att sjuksköterskorna skulle ha en specialistutbildning, och de skulle ha arbetat mer än ett år som intensivvårdsjuksköterska. Data samlades in med en semistrukturerad intervju som varade mellan 7 till 25 minuter. De teman som växte fram under bearbetning av data var ´Låg påverkansmöjlighet, höga arbetskrav och avsaknad av bekräftelse leder till rädsla för att tappa kontrollen´, Obalans mellan krav och bemanning´ samt ´Stödjande faktorer och eget ansvar kan minska stressupplevelsen´. Slutresultatet visade på att IVA-sjuksköterskor upplevde stress i situationer när arbetskraven var för många och ledde till oro för att tappa kontrollen. De höga kraven och otillräcklig bemanning ledde till en obalans där IVA-sjuksköterskorna upplevde otillräcklighet i sitt arbete. Stöd från arbetskollegorna samt individuella sätt att hantera den egna stressen, ansågs vara ett sätt att hantera stress på arbetsplatsen bland intensivvårdssjuksköterskorna. Sammanfattningsvis kan sägas att IVA-sjuksköterskorna upplevde stress på sin arbetsplats av olika orsaker samt att hanteringen av stressen skedde främst via ventilering med arbetskollegor.</p> / <p>The aim of the study was to describe in what situations Intensive Care Unit (ICU) nurses experiences stress and how they cope with the stress in the ordinary work. The study had a descriptive design with a qualitative approach. Ten intensive care nurses took part in the study. The inclusions criteria were that the nurses had an education in intensive care and had worked more than a year as an intensive care nurse. The data were collected with a semi- structured interview that lasted between 7 to 25 minutes. The themes developed from the data were ‘Low influence possibility, high work demands and lack of confirmation leads to fear of loosing the control’, ‘Imbalance between demands and number of staff’, and ‘Supportive factors and own responsibility can reduce the stress experience’ The final result showed that nurses experience stress in situations when the work demands were to high which led to anxiety of loosing control. High demands and insufficient number of staff led to an imbalance and the nurses felt inadequacy in their work. Support from the colleagues and own individual ways to handle the stress, were considered to be ways to cope with it among the nurses. To sum up, the intensive care nurses experienced stress their workplace from various causes and they coped with their stress principally through ventilation with their colleagues.</p>

Syftet med denna studie var att beskriva i vilka situationer IVA-sjuksköterskor upplever stress och hur de hanterar stressen i det vardagliga arbetet. Studien hade en beskrivande design med kvalitativ ansats. I studien deltog 10 intensivvårdssjuksköterskor. Inklusionskriterierna var att sjuksköterskorna skulle ha en specialistutbildning, och de skulle ha arbetat mer än ett år som intensivvårdsjuksköterska. Data samlades in med en semistrukturerad intervju som varade mellan 7 till 25 minuter. De teman som växte fram under bearbetning av data var ´Låg påverkansmöjlighet, höga arbetskrav och avsaknad av bekräftelse leder till rädsla för att tappa kontrollen´, Obalans mellan krav och bemanning´ samt ´Stödjande faktorer och eget ansvar kan minska stressupplevelsen´. Slutresultatet visade på att IVA-sjuksköterskor upplevde stress i situationer när arbetskraven var för många och ledde till oro för att tappa kontrollen. De höga kraven och otillräcklig bemanning ledde till en obalans där IVA-sjuksköterskorna upplevde otillräcklighet i sitt arbete. Stöd från arbetskollegorna samt individuella sätt att hantera den egna stressen, ansågs vara ett sätt att hantera stress på arbetsplatsen bland intensivvårdssjuksköterskorna. Sammanfattningsvis kan sägas att IVA-sjuksköterskorna upplevde stress på sin arbetsplats av olika orsaker samt att hanteringen av stressen skedde främst via ventilering med arbetskollegor. / The aim of the study was to describe in what situations Intensive Care Unit (ICU) nurses experiences stress and how they cope with the stress in the ordinary work. The study had a descriptive design with a qualitative approach. Ten intensive care nurses took part in the study. The inclusions criteria were that the nurses had an education in intensive care and had worked more than a year as an intensive care nurse. The data were collected with a semi- structured interview that lasted between 7 to 25 minutes. The themes developed from the data were ‘Low influence possibility, high work demands and lack of confirmation leads to fear of loosing the control’, ‘Imbalance between demands and number of staff’, and ‘Supportive factors and own responsibility can reduce the stress experience’ The final result showed that nurses experience stress in situations when the work demands were to high which led to anxiety of loosing control. High demands and insufficient number of staff led to an imbalance and the nurses felt inadequacy in their work. Support from the colleagues and own individual ways to handle the stress, were considered to be ways to cope with it among the nurses. To sum up, the intensive care nurses experienced stress their workplace from various causes and they coped with their stress principally through ventilation with their colleagues.

Η Μονάδα Εντατικής Θεραπείας – Μ.Ε.Θ. (Intensive Care Unit – ICU) προϋποθέτει ευρύ φάσμα γνώσεων από έναν επαγγελματία υγείας (νοσηλευτή ή ιατρό), που εργάζεται στον χώρο. Σε καθημερινή βάση έρχεται αντιμέτωπος µε απειλητικές καταστάσεις για τη ζωή του ασθενούς και η αντιμετώπιση των διαταραχών της οξεοβασικής ισορροπίας είναι το στοίχημα, που πρέπει να κερδηθεί. Η ορθή ερμηνεία της ανάλυσης των αερίων του αρτηριακού αίματος από έναν επαγγελματία υγείας αποτελεί το βασικό συστατικό για την προαγωγή της υγείας ενός ασθενή στη Μ.Ε.Θ. Όμως παρά την αλματώδη τεχνολογική εξέλιξη του εργαστηριακού τομέα διαπιστώνουμε μια πολύχρονη στασιμότητα στον διαγνωστικό τομέα. Αυτό έχει ως αποτέλεσμα την επιπλέον επιβάρυνση της υγείας του ασθενή, αλλά και επιπρόσθετο φορτίο στο οικονομικό σκέλος. Στη παρούσα διπλωματική εργασία περιγράφεται η δημιουργία ενός ευφυούς συστήματος υποστήριξης αποφάσεων, με σκοπό να αποτελέσει σύμβουλο λήψης αποφάσεων από μη εξειδικευμένους επαγγελματίες υγείας, όταν αυτοί αντιμετωπίζουν προβλήματα οξεοβασικών διαταραχών στις ΜΕΘ, αλλά και να συμβάλλει στην αποτελεσματικότερη και ταχύτερη υποστήριξη του νοσηλευτικού και ιατρικού προσωπικού γενικά. Επίσης στόχος της διπλωματικής αυτής εργασίας είναι να αξιολογηθούν και να συγκριθούν οι μέθοδοι, διά των οποίων δημιουργήθηκε το ευφυές σύστημα. Για να γίνει αυτό δημιουργήσαμε 4 διαφορετικά συστήματα. Στη δημιουργία του πρώτου συστήματος χρησιμοποιήθηκαν κανόνες ασαφούς λογικής(FuzzyClips) και στα επόμενα τρία, μέθοδοι εξόρυξης γνώσης με μηχανική μάθηση. Στο τέλος έγινε η σύγκριση αποτελεσματικότητάς τους, με βάση διεθνώς χρησιμοποιούμενες μετρικές.Τα συστήματα με τη βοήθεια μεθόδων εξόρυξης γνώσης του WEKA παρουσίασαν και τη μεγαλύτερη αποτελεσματικότητα. Τα συστήματα αυτά δεν έχουν σκοπό την αντικατάσταση ενός επαγγελματία υγείας. Έχουν ως κύριο στόχο να λειτουργήσουν επικουρικά, στην καλύτερη, ταχύτερη και πιο αξιόπιστη διάγνωση οξεοβασικών διαταραχών των ασθενών, που νοσηλεύονται σε Μονάδα Εντατικής Θεραπείας ενός νοσοκομείου, αλλά και να χρησιμοποιηθεί ως εργαλείο με εκπαιδευτικό χαρακτήρα σε αρχάριους επαγγελματίες υγείας . / -

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Queijo, AF. Tradução para o português e validação de um instrumento de medida de carga de trabalho de enfermagem em unidade de terapia intensiva: NURSING ACTIVITIES SCORE (N. A. S.). [Dissertação]. São Paulo (SP): Escola de Enfermagem da USP; 2002. O presente estudo teve como objetivos traduzir para o português e avaliar as propriedades de medida do Nursing Activities Score (NAS). A finalidade deste instrumento é medir carga de trabalho de enfermagem em UTI. O estudo foi subdividido em duas partes. A primeira composta da tradução do NAS para a língua portuguesa e a segunda, da análise da confiabilidade e validade do instrumento. Após o processo de tradução para a língua portuguesa, foi realizada sua aplicação em uma amostra de 200 pacientes adultos internados em UTIs. A avaliação da confiabilidade do instrumento, feita por meio da repetibilidade entre dois observadores, demonstrou alta concordância (99,8%) e índice Kappa médio de 0,99. Já a análise da consistência interna, verificada pelo coeficiente Alpha de Cronbach revelou que o NAS possui 23 medidas independentes que não comportam consolidação ou redução. O NAS também foi aplicado para as validades de critério (concorrente) e de constructo (convergente). A validade concorrente mostrou correlação estatisticamente significativa entre o TISS-28 e o NAS (r=0,67; p<0,0001), o mesmo ocorrendo quando se utilizou a análise de regressão (R2=94,4%; p<0,0001) Quanto a validade convergente, pela técnica da análise de regressão verificou-se associação estatisticamente significativa entre o NAS e o índice de gravidade SAPS II, quando ao modelo foi inserida a variável idade. (R2=99,8%; p<0,0001). Pelos resultados obtidos, o NAS mostrou-se um instrumento confiável e válido para mensurar carga de trabalho de enfermagem em UTI, na realidade brasileira. / Queijo, AF. Translation to portuguese and validation of a instrument to measure work load of nursing in the intensive care unit (ICU): NURSING ACTIVITIES SCORE (N.A.S.). [Dissertação]. São Paulo (SP): Escola de Enfermagem da USP; 2002. The present study aimed to translate into Portuguese and to evaluate the properties of measure of the Nursing Activities Score (NAS). The purpose of this instrument is to measure work load of nursing in the intensive care unit (ICU). The study was subdivided in two parts. The first composed of translation and cross-cultural adaptation; and second, in the analysis of the reliability and the validity of the instrument. After the process of translation into Portuguese language and cross-cultural adaptation, was carried through its application in 200 adult inpatients in ICUs, in order to get the measure of reliability. At once, this was obtained by the repeatable between two observers by the statistical test of Kappa that demonstrated one high concord (99,8%) and average Kappa of 0,99. At once, the analysis of the internal consistency verified for the Cronbach´s alpha coefficient disclosed that it possess 23 independent measures that do not hold consolidation or reduction. The NAS was also applied for the validities of criterion (competing) and constructo (convergent). The competing validity showed statisticaly significant correlatio between the TISS-28 and NAS (r=0,67; p<0,001), the same occurring when the analysis of regression was used (r2=94,4%; p<0,001). About the convergent validity, by the technique of the regression analysis, it was verified signicant association statisticaly between NAS and the index of gravity SAPS II, when was inserted to the model the changeable age (r2=99,8%, p<0,001). For the gotten results, in the Brazilian reality, the NAS revealed a trustworthy and valid instrument to measure work load of nursing in ICU.

Please read the abstract in the front section of this document / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2005. / Medical Microbiology / unrestricted

Patients who require mechanical ventilation (MV) are at risk for developing ventilator associated pneumonia (VAP). Nurses’ adherence to sedation vacations (SVs) has a direct impact on the development of VAP, because SVs have been shown to reduce patients’ average duration of MV and length of stay (LOS) in the intensive care unit (ICU). The purposes of this study guided by Donabedian’s (1966) model were to quantify nurses’ level of adherence to SVs, in relation to the health outcomes of critically ill patients, and identify the barriers and facilitators to performing SVs. A correlational design was used. The design included three components: abstraction of patient data from the electronic medical record (EMR) (n=79 with VAP and n=79 without VAP), administration of surveys to ICU nurses (N =34), and vignettes related to SVs. Analyses included descriptive statistics, t-tests, correlations, and analyses of covariance. Most nurses held a Bachelors degree (70.6%), had < 9 years of ICU experience (52.9%), worked in a medical ICU (47.1%), and reported high confidence in managing SVs (M =8.88, SD =1.25). The majority of patients (N =158) were Black (58.2%), males (56.3%), and on average middle-aged (M =61.5, SD =14.91), with a long ICU LOS (M =15.5, SD =11.84), extended duration of MV (M =9.5, SD =8.47), and high acuity (APACHE III) (M =70.2, SD =25.42). The nurses’ education, advanced certification, and ICU experience were not associated with the appropriate implementation of SVs in the vignettes. On average nurses’ had low scores on the vignettes (M =6.97, SD =2.21; possible range =0-14). The adherence rate of nurses’ implementation of SVs, determined using EMR data, was also low (M =24%; SD =23%). There were higher rates of SV adherence in patients without VAP (p (p < .01), and a duration of MV < 6 days (p =.04). These findings indicate that even with established protocols, nurses may not consistently implement the evidenced-based interventions that have been shown to prevent nosocomial infections. Future research is needed to improve nursing practice and the quality of care in this patient population.