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Critical care medicine 09/2011; 39(9):2202-3. · 6.37 Impact Factor
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ABSTRACT: We report a case of temporary impaired hemoglobin scavenging in a patient with an acute HIV-1 retroviral syndrome. The patient was presented at the emergency department in a severe inflammatory state, mimicking bacterial sepsis and/or hemophagocytic syndrome. The serum showed a hemolytic aspect. In contrast, serum haptoglobin concentration was not decreased.
The hemolysis index was determined and the visual absorbance spectroscopy spectrum of the serum was studied. alpha1 microglobulin and hemopexin concentrations were determined in serum. The presence of circulating hemoglobin:haptoglobin complexes in serum and the saturation of the haptoglobin were investigated using starch gel electrophoresis followed by peroxidase staining. CD163 expression on peripheral blood monocytes was analyzed using flow cytometry.
A temporarily impaired hemoglobin scavenging was documented by an increased hemolysis index, absence of decreased haptoglobin levels, presence of circulating hemoglobin:haptoglobin complexes in serum and decreased hemopexin and alpha1 microglobulin concentrations.
A temporarily impaired hemoglobin scavenging was observed due to a transient CD163 pathway impairment following an acute HIV-1 retroviral syndrome. The patient improved clinically and biochemically after initiation of HIV-1 anti-retroviral therapy. The data suggest a transient HIV-1 mediated CD163 impairment, although a latent drug mediated block could not be ruled out completely.
Clinica chimica acta; international journal of clinical chemistry 04/2010; 411(7-8):521-3. · 2.54 Impact Factor
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Infection Control and Hospital Epidemiology 11/2009; 30(11):1127; author reply 1128. · 3.67 Impact Factor
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ABSTRACT: Prevention of surgical site infection (SSI) is an important responsibility for nurses. Knowledge of the related evidence-based recommendations is necessary to provide high-quality nursing care.
Development of an evaluation tool and subsequent evaluation of intensive care unit (ICU) nurses' knowledge of the SSI prevention guideline to identify their specific educational needs, as part of a needs analysis preceding the development of an e-learning module on infection prevention.
We developed a multiple-choice knowledge test concerning evidence-based SSI prevention. After expert assessment of its face and content validity, the test was used in a survey among 809 ICU nurses. Demographics included were gender, ICU experience, number of ICU beds, and whether respondents had obtained a specialized ICU qualification. Based on the test results, an item analysis was performed.
Face and content validity were achieved for 9 out of 10 items of the questionnaire. From the survey, we collected 650 questionnaires (response rate 80.3%). The item analysis revealed overall good results with values for item difficulty ranging from 0.1 to 0.5 for eight questions, while one question had a value of 0.02; discriminative values ranging from 0.27 to 0.53 and values for the quality of the response alternatives between 0.1 and 0.7. Overall, these results demonstrate the questionnaire's reliability. The nurses' mean score on the knowledge test was 29%. Males were shown to have better scores.
Opportunities exist to improve ICU nurses' knowledge about SSI prevention recommendations. Current guidelines should support their ongoing training and education.
Worldviews on Evidence-Based Nursing 11/2009; 7(1):16-24. · 1.24 Impact Factor
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Critical care medicine 11/2009; 37(11):2998-9; author reply 2999. · 6.37 Impact Factor
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Anesthesia and analgesia 01/2009; 107(6):2091; author reply 2091-2. · 3.08 Impact Factor
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ABSTRACT: To study the occurrence of multiple-drug-resistant pathogens in nosocomial bloodstream infection associated with pneumonia. To evaluate prediction of multiple drug resistance by systematic surveillance cultures.
A retrospective study of a prospectively gathered cohort.
Fifty-four-bed adult medical-surgical intensive care unit of a tertiary hospital.
One hundred twelve intensive care unit patients with nosocomial bloodstream infection associated with pneumonia from 1992 through 2001.
None.
Concordance of blood cultures with prior surveillance culture was assessed. Surveillance cultures were taken routinely as thrice weekly urinary cultures and oral swabs, once weekly anal swabs, and thrice weekly tracheal aspirates in intubated patients. Tracheal surveillance cultures from 48 to 96 hrs before bloodstream infection and surveillance cultures from any site during the same intensive care unit episode but >or=48 hrs before bloodstream infection were evaluated separately. Forty-four bloodstream infections (39%) were caused by a multiple-drug-resistant pathogen. Multiple-drug-resistant pathogens were predicted by tracheal surveillance culture in 70% (concordant); in 15%, tracheal surveillance culture grew a multiple-drug-resistant pathogen not found in blood cultures (discordant). Multiple-drug-resistant pathogens were predicted by any surveillance culture in 88%, but these surveillance cultures grew additional multiple-drug-resistant pathogens not causing bloodstream infection in up to 46% of patients. In 86% of bloodstream infections, early (i.e., within 48 hrs) antibiotic therapy was appropriate. Patients were divided into four risk categories for multiple-drug-resistant bloodstream infection based on length of prior intensive care unit stay and prior antibiotic exposure. In patients with two risk factors, knowledge of surveillance cultures increased appropriateness of early antibiotic therapy from 75-79% to 90% (p<.05) while limiting use of broad-spectrum antibiotics such as antipseudomonal betalactams, fluoroquinolones, and carbapenems.
In our intensive care unit, tracheal surveillance culture predicted multiple-drug-resistant etiology of bloodstream infection associated with pneumonia in 70% of patients but yielded discordant resistant pathogens in 15%. In the subgroup of patients with two risk factors for multiple-drug-resistant infection, incorporating results of surveillance cultures moderately contributed to adequacy of early antibiotic therapy while limiting antibiotic consumption.
Critical Care Medicine 04/2006; 34(3):653-9. · 6.33 Impact Factor
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ABSTRACT: To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies.
Prospective observational study in a 14-bed medical ICU at a tertiary university hospital.
A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient's outcome and C-reactive protein levels.
In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p<0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06-0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06-0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications.
Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time.
Intensive Care Medicine 07/2005; 31(7):934-42. · 5.40 Impact Factor
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ABSTRACT: Changes in patient profile, and in the health care environment, altering socioeconomic conditions and advances in science and information technology challenge the nursing profession, in particular intensive care nursing. All these changes will undoubtedly affect the way we will practice in the (near) future. A comprehensive understanding of these factors is therefore essential if nursing is to meet the challenges presented by tomorrow's critical care environment. Precisely because of the often expensive high-tech evolutions that have occurred at a rapid pace and are to be further expected, a continued focus on the basics of nursing, the core role of care, as well as maintaining confidence in the capacity to deliver safe, high-quality, and evidence-based patient care will increasingly be a challenge to critical care nurses. In particular, basic nursing skills and knowledge remain a key prerequisite in the prevention of nosocomial infections, which is a continuing major complication and threat to intensive care unit patients. However, critical care nurses' knowledge about the evidence-based consensus recommendations for infection prevention and control has been found to be rather poor. It has nevertheless been demonstrated that a meticulous implementation of such preventive bundles may result in significantly better patient and process outcomes. Moreover, many preventive strategies are considered to be easy to implement and inexpensive. As such, a first and critical step should be to increase critical care nurses' adherence to the recommendations of the Centers for Disease Control and Prevention.
In this article, an up-to-date assessment of evidence-based recommendations for the prevention of nosocomial infections, with special focus on catheter-related bloodstream infections and strategies relevant for nurses working in critical care environments, will be provided. Additionally, we will detail on a number of approaches advocated to translate the internationally accepted consensus recommendations to the needs and expectations of critical care nurses, and to consequently enhance the likelihood of successful implementation and adherence. These steps will help critical care nurses in their striving towards excellence in their profession.
Intensive care nurses can make a significant contribution in preventing nosocomial infections by assuming full responsibility for quality improvement measures such as evidence-based infection prevention and control protocols. However, as general knowledge of the preventive measures has been shown to be rather poor, nurses' education should include supplementary support from evidence-based recommendations.
Nursing in Critical Care 15(5):251-6. · 1.08 Impact Factor
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ABSTRACT: A case of fatal oral poisoning with formic acid resulting in shock, metabolic acidosls, and hemolysis is reported. The formic acid concentration on admission was 348 μg/mL, which, together with an increase in lactin acid, contributed to the metabolic acidosis. Because it has been suggested in the literature that formic acid might induce hemolysis via a direct cytotoxic action on the RBCs, an in vitro study was performed using human RBCs in saline, phosphate buffered saline, and plasma in order to define the mechanism of the hemolysis. These experiments indicate that the hemolysis is not a cytotoxic effect of formic acid but is related to the degree of acidity in itself.
The American Journal of Emergency Medicine.
