Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C‐collar) device in situ and are subsequently exposed to device‐related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C‐collar‐related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C‐collar were retrieved over a 9‐year period. Chi square and t‐tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine‐year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C‐collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024‐1.723, P = .033). Time in the C‐collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P < .001) were associated with pressure injury development. Patients with C‐collar devices are a vulnerable group at risk for pressure injury development because of their immobility and length of ICU stay.
Background The American Medical Association Code of Medical Ethics states that any clinical image taken for public education forms part of the patient’s records. Hence, a patient’s informed consent is required to collect, share, and distribute their image. Patients must be informed of the intended use of the clinical image and the intended audience as part of the informed consent. Objective This paper aimed to determine whether a random selection of instructional videos containing footage of central venous catheter insertion on real patients on YouTube (Google LLC) would mention the presence of informed consent to post the video on social media. Methods We performed a prospective evaluation by 2 separate researchers of the first 125 videos on YouTube with the search term “central line insertion.” After duplicates were deleted and exclusion criteria applied, 41 videos of patients undergoing central line insertion were searched for reference to patient consent. In the case of videos of indeterminate consent status, the posters were contacted privately through YouTube to clarify the status of consent to both film and disseminate the video on social media. A period of 2 months was provided to respond to initial contact. Furthermore, YouTube was contacted to clarify company policy. The primary outcome was to determine if videos on YouTube were amended to include details of consent at 2 months postcontact. The secondary outcome was a response to the initial email at 2 months. Results The researchers compiled 143 videos. Of 41 videos that contained footage of patient procedures, 41 were of indeterminate consent status and 23 contained identifiable patient footage. From the 41 posters that were contacted, 3 responded to initial contact and none amended the video to document consent status. Response from YouTube is pending. Conclusions There are instructional videos for clinicians on social media that contain footage of patients undergoing medical procedures and do not have any verification of informed consent. While this study investigated a small sample of available videos, the problem appears ubiquitous and should be studied more extensively.
A recurring case of 'no trace, right place' during emergency tracheal intubations in the critical care settingWe wish to highlight a safety issue concerning the use of the Mapleson C circuit along with high fresh gas flows and the potential impact this could have on capnography. The
Background The current National Institute for Health and Care Excellence guidelines, in accordance with the Association of Anaesthetists of Great Britain and Ireland guidelines, recommend the following haematological investigations for all patients undergoing major elective surgery: full blood count, renal profile and coagulation screen if clinically indicated. However, the guidelines fail to specify a time-interval for which normal blood results remain valid. Currently all patients in Ireland undergoing substantial elective surgery requiring general or regional anaesthetic have a preoperative assessment prior to the surgery. Patients have phlebotomy performed as part of this assessment. Patients admitted for elective surgery often have these bloods repeated on the morning of surgery. Objectives To determine if blood investigations taken over a one-year period prior to surgery can be used as a baseline for clinically stable patients undergoing elective surgery. Study design and methods All consecutive day of surgery admission patients >18 years of age undergoing elective orthopaedic surgery in Tallaght Hospital between 1 December 2014 and 1 December 2015 were identified using hospital records. Their blood results in the one-year period prior to surgery were compared to the blood results on the morning of surgery, using a McNemar’s test. A further clinical analysis was performed. Results There was no statistically significant change between blood results from three months prior to the surgery and the morning of surgery (P < 0.05). Furthermore, the blood results remained largely unchanged in the one year prior to surgery. No patient had the operation deferred due to aberrant blood results, following previously normal results prior to surgery. The potential cost-saving of omitting bloods is enormous. Conclusions There appears to be neither a statistical nor clinical benefit to repeating blood tests on the morning of surgery, following normal bloods <3 months in a clinically stable individual.
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