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Nurses’ knowledge about and attitudes toward organ donation in state and private hospitals in Johannesburg, South Africa 南非约翰内斯堡公立和私立医院护士对器官捐献的认知和态度
Kim Crymble, H. Etheredge, J. Fabian, P. Gaylard
Background . Nurses are intricately involved in organ donation; however, the referral of donors appears to be declining in Johannesburg, South Africa (SA). This may be due to barriers in the referral process. Objectives . The objectives of this study were to explore nurses’ knowledge of the organ donation process and to explore personal beliefs and attitudes around organ donation. Methods . A quantitative, self-administered questionnaire was completed by nurses in Johannesburg, SA. Results. A total of 273 nurses participated, of whom most were female and <50 years old. The majority of participants (64.2%) reported positive attitudes, and 63.2% stated that their personal beliefs about organ donation did not influence the advice they gave to patients. However, only 36.8% felt confident referring potential donors and 35.8% felt that referral was within their scope of practice. Most participants (84.5%) felt that it was the doctor’s responsibility to refer donors, but 80.3% noted that they would refer donors themselves if there was a mandatory referral protocol. Only 61% of nurses were aware that there was access to a transplant procurement coordinator through their hospitals; however, there was uncertainty regarding the role of the coordinator. Conclusion . There is an urgent need to clarify the role of nurses in the process of organ donor referral in SA. Although nurses felt positive about organ donation, they expressed uncertainties about referring potential donors. However, if a clear protocol for referral was introduced, the majority of nurses noted that they would willingly follow it. We advocate for the development and implementation of a nationally endorsed protocol for donor referral and for the training of nurses in organ donation in SA.
背景。护士参与器官捐赠的过程错综复杂;然而,在南非约翰内斯堡,捐助者的转诊情况似乎正在下降。这可能是由于转诊过程中的障碍。目标。本研究的目的是探讨护士对器官捐献过程的了解,并探讨个人对器官捐献的信念和态度。方法。南非约翰内斯堡的护士完成了一份定量的、自我管理的问卷。结果。共有273名护士参与,其中女性居多,年龄<50岁。大多数参与者(64.2%)报告了积极的态度,63.2%的人表示他们对器官捐赠的个人信仰并不影响他们给病人的建议。然而,只有36.8%的人有信心推荐潜在的捐赠者,35.8%的人认为推荐在他们的实践范围内。大多数参与者(84.5%)认为推荐献血者是医生的责任,但80.3%的人指出,如果有强制性推荐协议,他们会自己推荐献血者。只有61%的护士知道可以通过所在医院联系到器官移植采购协调员;但是,协调员的作用是不确定的。结论。有一个迫切需要澄清护士在器官供体转诊过程中的作用。尽管护士们对器官捐赠持积极态度,但他们对推荐潜在捐赠者表示不确定。然而,如果引入一个明确的转诊协议,大多数护士指出,他们愿意遵循它。我们提倡制定和实施一项国家认可的供体转诊协议,并对南非的器官捐赠护士进行培训。
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引用次数: 9
Spectrum of microbial growth and antimicrobial usage in an intensive-care unit of a tertiary-care hospital in Trinidad, West Indies 西印度群岛特立尼达一家三级护理医院重症监护病房微生物生长和抗微生物药物使用谱
S. Bidaisee, S. Hariharan, D. Chen
Background. Intensive-care units (ICUs) are a source of multidrug-resistant organisms, owing to the indiscriminate usage of broad-spectrum antimicrobial drugs. In such settings, one must be aware of the spectrum of microbes and pattern of antibiotic usage. Objectives . To evaluate the spectrum, susceptibility and resistance patterns of microbes found in ICU patients in a tertiary-care teaching hospital in Trinidad, and to quantify antimicrobial usage. Methods . All adult patients (≥15 years of age) admitted to the ICU for ≥48 h who developed nosocomial infections conforming to the Centers for Disease Control and Prevention criteria were included. Demographic data and clinical data, including specimens sent, isolates grown, antimicrobial sensitivity and resistance patterns, the usage of antimicrobials and patient outcomes, were recorded. Variables such as age, admission white blood cell count, duration of first antibiotic used, length of ICU stay, length of hospital stay, organ support and total comorbidities were analysed. Antimicrobial usage was quantified as the defined daily dosage per 1 000 patient-days. Results . A total of 153 patients with 287 microbiological specimens were studied. The mean patient age was 48.4 years, and the mean ICU length of stay was 7.9 days. The most common admitting diagnoses were sepsis and multiple trauma. Staphylococcus aureus was the most common isolate from blood and central venous lines, and Pseudomonas aeruginosa from tracheal aspirates and wound swabs. Non-survivors had significantly higher age, leucocyte count and organ support requirements, and shorter lengths of stay. Cefuroxime was the most-used antimicrobial in the unit. Conclusion. The usage pattern of antimicrobials did not correlate with susceptibility in most instances. There is a need to improve antimicrobial usage by implementing antimicrobial-stewardship programmes to establish an  antimicrobial protocol and guidelines for usage in the ICU.
背景。由于滥用广谱抗菌药物,重症监护病房(icu)是耐多药微生物的一个来源。在这种情况下,人们必须了解微生物的种类和抗生素使用的模式。目标。评估特立尼达一家三级护理教学医院ICU患者中发现的微生物的谱、敏感性和耐药模式,并量化抗菌药物的使用。方法。所有发生符合美国疾病控制与预防中心标准的院内感染并在ICU住院≥48小时的成年患者(≥15岁)被纳入研究。记录了人口统计数据和临床数据,包括发送的标本、培养的分离株、抗菌素敏感性和耐药性模式、抗菌素使用情况和患者结局。分析年龄、入院白细胞计数、首次使用抗生素时间、ICU住院时间、住院时间、器官支持和总合并症等变量。抗菌药物使用量量化为每1 000患者日定义的每日剂量。结果。共153例患者,287份微生物标本。患者平均年龄48.4岁,平均ICU住院时间7.9天。最常见的入院诊断是败血症和多发性创伤。金黄色葡萄球菌是血液和中心静脉最常见的分离物,铜绿假单胞菌是气管吸入物和伤口拭子中最常见的分离物。非幸存者的年龄、白细胞计数和器官支持需求明显更高,住院时间也更短。头孢呋辛是该单位使用最多的抗菌药物。结论。在大多数情况下,抗菌剂的使用模式与易感性无关。有必要通过实施抗菌药物管理规划来改善抗菌药物的使用,以建立ICU的抗菌药物使用方案和指南。
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引用次数: 3
Abstracts of scientific presentations at the 2017 Annual National Congress of the Critical Care Society of Southern Africa 2017年南非重症监护学会年度全国大会科学报告摘要
B. Morrow
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引用次数: 0
Exploring the role of the ICU nurse in the antimicrobial stewardship team at a private hospital in KwaZulu-Natal, South Africa 探索ICU护士在南非夸祖鲁-纳塔尔省一家私立医院抗菌药物管理团队中的作用
J. Rout, P. Brysiewicz
Background . Care of the critically ill patient has become increasingly challenging, with a rising incidence of resistant pathogens resulting in the ineffectiveness of many antibiotics. Severe infection is associated with prolonged intensive care unit (ICU) length of stay, and increased morbidity, mortality, and healthcare costs. Antimicrobial stewardship (AMS) aims to prevent resistance and protect patients and the wider community by promoting correct antimicrobial use. The current AMS literature has failed to describe the role of the ICU nurse in this important initiative. Objective . To explore the perceptions of AMS team members regarding the role of the ICU nurse in the AMS team. Methods . Using a qualitative research approach, purposive sampling was used to identify participants in an ICU. Semi-structured interviews were conducted with 15 participants, including ICU shift-leader nurses, nursing management, surgeons, anaesthetists, physicians, microbiologists and pharmacists. Data were analysed and categorised using content analysis. The study was conducted in a general ICU in the private healthcare sector in KwaZulu-Natal, South Africa. Results. Participants representing various disciplines of the AMS team felt that the role of the ICU nurse within the team was an important part of the AMS programme. Four categories that emerged from the data are discussed: organisational, advocacy, clinical and collaborative roles. Conclusion . The role of the ICU nurse was found to be essential to the success of AMS in the ICU. These findings provide implications for practice, which, if recognised and supported by all healthcare stakeholders from ICU and hospital management, could improve AMS in this acute care area.
背景。由于耐药病原体的发病率不断上升,导致许多抗生素无效,重症患者的护理变得越来越具有挑战性。严重感染与重症监护病房(ICU)住院时间延长、发病率、死亡率增加和医疗费用增加有关。抗菌素管理(AMS)旨在通过促进正确使用抗菌素来预防耐药性并保护患者和更广泛的社区。目前的AMS文献未能描述ICU护士在这一重要举措中的作用。目标。探讨医疗辅助队成员对ICU护士在医疗辅助队中的角色的看法。方法。采用定性研究方法,目的抽样用于识别ICU的参与者。对15名参与者进行了半结构化访谈,包括ICU值班护士、护理管理人员、外科医生、麻醉师、内科医生、微生物学家和药剂师。使用内容分析对数据进行分析和分类。该研究是在南非夸祖鲁-纳塔尔省私营医疗保健部门的普通ICU进行的。结果。代表医疗辅助队不同学科的参加者认为,ICU护士在团队中的角色是医疗辅助队计划的重要组成部分。讨论了从数据中出现的四个类别:组织,倡导,临床和协作角色。结论。ICU护士的作用被发现是至关重要的AMS在ICU的成功。这些发现为实践提供了启示,如果得到ICU和医院管理层所有医疗保健利益相关者的认可和支持,可以改善AMS在这一急性护理领域的应用。
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引用次数: 16
Organ donation in South Africa – a call to action 南非的器官捐赠——行动呼吁
D. Thomson
In this issue of the SAJCC, Crymble et al.[1] correctly point out that there is a desperate need for organ donors in South Africa (SA). Their article highlights the integral role of nurses in the organ donation process,[2] and elegantly shows that nurses would welcome a greater role, while at the same time noting that expanded education efforts are desperately needed. Despite our place in history for performing the first heart transplant,[3] SA organ donation rates do not compare well with other countries. Our deceased donor rate is <3 per million population. Spain is the world leader in deceased organ donation, with a rate approaching 40 per million population and Brazil achieves a rate of 14 per million population.[4] Many people see living-related donation as the way forward, yet living-related donation is only an option for certain organ transplants. The majority of patients in need of an organ do not have a suitable living donor. Living donation also exposes donors to a degree of risk which deceased donors by definition do not have, since they are always certified legally dead through a rigorous testing process. Under SA law, certification of brain death is required to be performed by two doctors, of whom one is required to have >5 years of experience and both should be completely independent of the transplant team.[5] The reasons for SA’s low deceased donation rate are multiple. The lack of awareness and knowledge among both the public and medical professionals about brain death and organ donation needs to be addressed.[6] Free, open-access online educational resources, such as the University of Cape Town’s course ‘Organ Donation: From Death to Life’, have been developed to improve training and awareness about brain death and organ donation.[7] The SA government’s healthcare policy, which is rightly focused on primary healthcare interventions as a cost-effective strategy to improve the health of the population,[8] should not neglect transplantation. Although it is not prioritised as a major health need, transplantation activity is a reflection of the whole healthcare system. One can only be assessed as a potential organ donor when all treatment options have been exhausted and the clinical team has left no stone unturned. The family can only be approached for consent for donation when they have been adequately counselled about the clinical situation. If this is not done well, consent will not be given and without consent there can be no organ donation. As such, organ donation rates can and should be used as a measurable healthcare outcome. In SA, the consent rate for deceased organ donation at Groote Schuur Hospital for 2017 was 18% at the time of publication of this editorial, in other words 82% of families opt not to support organ donation. Even in countries where consent is presumed, the family is always counselled. Spain has a 16% refusal rate based on family objections. It is important to note that signing onto the organ donor registry
[1]已经说明了一种可能的干预措施,通过授权护士来改善我们的器官捐赠系统,护士在死亡过程中和之后与家庭密切接触,在病人的器官捐赠转诊中发挥作用。这种努力需要在国家一级跨公共和私营保健机构进行。SA在hiv -to - hiv移植、[16]循环性死亡后的捐赠以及分裂供体肝脏[17]等方面的开创性努力仍然受到缺乏已故器官供体的限制。最终,器官捐赠总是归结为治疗临床团队与移植团队和决定支持器官捐赠的家庭讨论潜在的捐赠者。
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引用次数: 6
Antibiotic stewardship – it starts with you! 抗生素管理——从你开始!
Malcolm G A Miller
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引用次数: 1
Analysis of damping characteristics of arterial catheter blood pressure monitoring in a large intensive care unit 某大型重症监护病房动脉导管血压监测阻尼特性分析
W. Rook, J. Turner, T. Clutton-Brock
Background. For many reasons, the invasive measurement of systolic and diastolic blood pressure should be accurate. Accuracy is determined, in part, by the damping characteristics of the arterial catheter blood pressure monitoring system. Objectives . To ascertain the damping characteristics of arterial catheter blood pressure monitoring in a large tertiary intensive care unit (ICU) and to elicit any causes of under- or over-damping of the measurement systems. Methods. A cross-sectional, observational study of arterial line measurements in a large general ICU. The coefficient of damping (CoD) was calculated from the waveform generated from a ‘fast flush’. Results . Thirty systems (19%) were adequately damped (CoD 0.4 - 0.8), 56 (37%) were overdamped, and 68 (44%) were underdamped. We did not find that poor damping characteristics were associated with the age of the arterial catheter or the type of catheter used. Conclusion. Most systems observed in this study were inappropriately damped, which would result in the inaccurate display of the waveform and systolic and diastolic pressures.
背景。由于许多原因,有创测量收缩压和舒张压应该是准确的。准确性部分取决于动脉导管血压监测系统的阻尼特性。目标。确定大型三级重症监护病房(ICU)动脉导管血压监测的阻尼特性,并找出测量系统阻尼不足或阻尼过高的任何原因。方法。一项大型普通ICU动脉线测量的横断面观察研究。阻尼系数(CoD)是从“快速冲洗”产生的波形中计算出来的。结果。30个系统(19%)被充分阻尼(CoD 0.4 - 0.8), 56个系统(37%)被过阻尼,68个系统(44%)被欠阻尼。我们没有发现不良的阻尼特性与动脉导管的年龄或所使用导管的类型有关。结论。在本研究中观察到的大多数系统都有不适当的阻尼,这将导致波形和收缩压和舒张压的不准确显示。
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引用次数: 8
Sugar, Pressure and Pregnancy 糖、压力和怀孕
W. L. Michell
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引用次数: 0
The need for setting standards in critical care transfers 制定重症监护转院标准的必要性
M. Venter, D. Stanton, N. Conradie, L. Jordaan, C. Venter, W. Stassen
1 Netcare 911, Netcare (Pty) Ltd., Midrand, South Africa 2 Critical Care Transport Unit, Department of Health, Gauteng Provincial Government, South Africa 3 Department of Emergency Medical Care, Faculty of Health Sciences, University of Johannesburg, South Africa 4 Department of Emergency Medical Care, Faculty of Health Sciences, Cape Peninsula University of Technology, Cape Town, South Africa 5 Critical Care Retrieval Services, ER24, Johannesburg, South Africa
1 .南非米德兰德Netcare 911, Netcare (Pty) Ltd.,南非2 .南非豪登省政府卫生部重症监护运输部,南非3 .南非约翰内斯堡大学健康科学学院紧急医疗护理部,南非开普敦开普半岛理工大学健康科学学院紧急医疗护理部,南非约翰内斯堡5 .南非约翰内斯堡ER24重症监护检索服务
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引用次数: 7
Correlation between different methods of intra-abdominal pressure monitoring in varying intra-abdominal hypertension models 不同腹内高压模型中不同腹内压监测方法的相关性
R. Wise, R. Rodseth, L. Correa-Martín, F. M. S. Margallo, P. Becker, G. Castellanos, M. Malbrain
Grant from Extremadura Regional Government through the Plan Regional de Investigacion de Extremadura (PRI09A161 to Minimally Invasive Surgery Center Jesus Uson).
由埃斯特雷马杜拉地区政府通过埃斯特雷马杜拉地区调查计划(PRI09A161至微创手术中心Jesus Uson)资助。
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引用次数: 3
期刊
The Southern African journal of critical care : the official journal of the Critical Care Society
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