A number of interventions have been shown to improve the outcomes of patients who are invasively ventilated in intensive care units (ICUs). However, significant problems still exist in implementing research findings into clinical practice. The aim of this study was to assess whether the systematic and methodical implementation of evidence-based interventions encapsulated in a care bundle influenced length of ventilation and ICU length of stay (LOS). A ventilator care bundle was introduced within a general ICU and evaluated 1 year later. The care bundle was composed of four protocols that consisted of prophylaxis against peptic ulceration, prophylaxis against deep vein thrombosis, daily cessation of sedation and elevation of the patient's head and chest to at least 30 degrees to the horizontal. Compliance with the bundle was assessed, as was ICU LOS, ICU mortality and ICU/high-dependency unit patient throughput. Mean ICU LOS was reduced from 13-75 [standard deviation (SD) 19.11] days to 8.36 (SD 10.21) days (p<0.05). Mean ventilator days were reduced from 10.8 (SD 15.58) days to 6.1 (SD 8.88) days. Unit patient throughput increased by 30.1% and the number of invasively ventilated patients increased by 39.5%. Care bundles encourage the consistent and systematic application of evidence-based protocols used in particular treatment regimes. Since the introduction of the ventilator care bundle, length of ventilation and ICU LOS have reduced significantly.

No abstract

Studies investigated the long term achievement of Get-Set children, Philadelphia Head Start, who participated in SCILS, the Self-Controlled Interactive Learning Systems program at the Drexel Early Childhood Center, and who were later enrolled in eighteen Philadelphia public and parochial schools. The original purpose for the program was to find ways of creating an environment to enhance learning, creativity, and exploration. It was assumed that if the above occurred it would be reflected in standardized testing regardless of subject matter. Its premise is that learning involves both the acquisition of skills, training, and the formation of new concepts, going beyond the “given,” education. The proper use of instructional technology is to enable the learner—the child—to acquire skills which can be utilized in new concept formation. The teacher's role then shifts from concentration on training to involvement in education. However, if instructional technology is to be effective in helping students acquire mastery it should incorporate: 1) choice, 2) control by the student, 3) instantaneous dynamic feedback to the student which allows for self-control, self-organization, self-regulation, and self-correction, and 4) enhancement of adapting behavior. Fifty-seven Head Start children who were enrolled in the Drexel Early Childhood Center for an average of 2.54 years were the subject of these studies. Fifty-three of the subjects were followed through the sixth grade, fourteen through the ninth and a small group (all those who could be found) were followed into the tenth and eleventh grades. SCILS children are at or above grade level in reading and reading comprehension with thirty hours of instructional time. Outcomes compared with other Early Intervention Programs, in the United States, since the 1960s, show that with SCILS the Head Start children's achievement reaches the level of average middle-class children.

No abstract