Abstract Purpose Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) ...initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients. Materials and Methods We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention. Results Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities. Conclusions Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements.
BACKGROUND:Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health ...status which may last for months and years after hospital discharge.
OBJECTIVES:To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families.
PARTICIPANTS:Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge.
DESIGN:Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems.
MEASUREMENTS AND MAIN RESULTS:Three major themes emerged from the conference regarding(1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member.
CONCLUSIONS:Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.
BACKGROUND:Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The ...post–intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families.
OBJECTIVES:To report on engagement with non–critical care providers and survivors during the 2012 Society of Critical Care Medicine post–intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes.
PARTICIPANTS:Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members.
DESIGN:Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences.
MEETING OUTCOMES:Future steps were planned regarding 1) recognizing, preventing, and treating post–intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post–intensive care syndrome across the continuum of care, including explicit “functional reconciliation” (assessing gaps between a patient’s pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post–intensive care syndrome research topic areas were identified across the continuum of recoverycharacterization of at-risk patients (including recognizing risk factors, mechanisms of injury, and optimal screening instruments), prevention and treatment interventions, and outcomes research for patients and families.
CONCLUSIONS:Raising awareness of post–intensive care syndrome for the public and both critical care and non–critical care clinicians will inform a more coordinated approach to treatment and support during recovery after critical illness. Continued conceptual development and engagement with additional stakeholders is required.
Forty two infants below the age of 2 years presenting with chronic non-infective diarrhoea and shown to have histologically proved colitis were investigated over a five year period. Allergic colitis ...was the most common cause of colitis, accounting for 62% of the cases. Other colitides diagnosed included: non-specific colitis, autoimmune enterocolitis, and ulcerative colitis accounting for 10% each; severe combined immunodeficiency 7%, and Crohn’s disease 3%. A positive family history and a personal history of atopy were obtained in 48% and 29% of the cases respectively. Serum immunoglobulin A, IgG2, and IgG4 were very low in over 50% of the entire cohort of infants with colitis; 66% of those with severe combined immunodeficiency, autoimmune enterocolitis, and ulcerative colitis (n = 11) had low CD3 and CD4 T lymphocytes with an accompanying increase in CD8 in two thirds of those with severe combined immunodeficiency. T lymphocytes were normal in those with allergic colitis. Thus infants with proved non-infective colitis as a group show a high prevalence of IgA, IgG2, and IgG4 deficiency. It is likely that this minor deficiency of mucosa associated immunoglobulin production has a role in the pathogenesis of the colitic process.
According to best estimates, some 800,000 faculty members, close to two-thirds of the total nationwide, are adjunct, "contingent," or "lecturer." The severity of their plight, rapidly worsening in ...today's economic crisis, intersects the interrelated domains of human rights, fair employment, and the future of higher education. In those areas where neither unionization nor social history presents strategies for significant improvement, adjuncts must rely on the conscience of informed and fair-minded administrators and legislators to act on their behalf. As an adjunct at one of those community colleges seeking to articulate their concerns to salaried faculty members and administrators, the author recently designed and disseminated a comprehensive survey to several hundred adjuncts on her own campus, where they make up what she calculates to be more than 80 percent of the faculty. The survey gathered information on the respondents' sociocultural profiles, how they viewed themselves as educators, and their experiences on the campus. It also included a section that allowed for open-ended elaboration or comments. Despite the limited sample, the results were startlingly consistent with what observers have been saying anecdotally for at least a decade about the status and general character of adjuncts across the country. The survey responses also indicated that the most compelling issues include the need for increased base compensation, benefits, and expense reimbursements; more-flexible absence policies; tuition remission; and equal access to professional-development resources. Administrators, faculty associations, and policy makers should also be aware of concerns that involve state and federal labor standards, like working without contracts and inequitable delays in pay at the start of the academic year. The fact that issues of compensation were front and center of the survey results is certainly no surprise. The standard baseline formula for college instruction is three hours of preparation and follow-up for every hour in the classroom. In this article, the author presents a list of how colleges and state governments could substantially improve the working conditions and performance of adjunct faculty members.
According to best estimates, some 800,000 faculty members, close to two-thirds of the total nationwide, are adjunct, "contingent," or "lecturer." The severity of their plight, rapidly worsening in ...today's economic crisis, intersects the interrelated domains of human rights, fair employment, and the future of higher education. Louis presents suggestions on what state governments should do to help.
This is a study of female subjectivity, of “woman-ness,” in South Africa. The history of racial oppression and exploitation under colonialism and apartheid has created radical social divisions and ...inequalities in South African society. In their engagements with one another women of different social and racial categories have had to negotiate these divisions, and in the process have developed shared cultural sensibilities about their places in the world. Domesticity, in the broadest sense of nurturing, maintaining order and harmony in the home and family, was central in configuring female subjectivity across different social and racial categories. It not only shaped women's lives in the home and family but also provided the logic for women's engagements beyond the boundaries of the home and household. Philanthropy, which entails doing good for others, for one's fellow human being, provided a legitimate means for women to engage in public and political life. Through their activities in voluntary associations and clubs and community or neighborhood associations women became active participants in family, community, and national politics. These sites provided insights into the ways in which inequality and hierarchy were reproduced and articulated in the context of shared cultural sensibilities. Philanthropy is often a feminized mode of power; the logic of virtue and goodness was implicated in regimes of power that were all the more powerful for being configured in the apparently benign and “worthy” terms of “upliftment,” “improvement,” education, and development. These are productive form of power that have been shaped by European middle class sensibilities. They have been central in the configuration of relations of power and domination between white and black, educated and uneducated, urban and rural men and women. In the New South Africa non governmental organizations were a new arena in which philanthropic modes of power were being exercised and transformed. The rhetoric of reconstruction and development, empowerment and education, obscured the ways in which power configured relationships between national and international agencies, government structures, NGOs, and the people whom they claimed to represent. Although projects aimed at helping the “needy” were frequently attempting to address “real” needs—housing, water, food, electricity, and so forth—they functioned through the ideals of goodness, virtue, and worthiness. Informed by Christian rhetoric such notions as shared humanity, and the common good were central mechanisms for disciplining the modern citizen, for producing citizens oriented toward constructive, cooperative engagements in their communities, in civic life, and national politics.
The purpose of this master's thesis is to examine Frances Harper's narrative strategy and moral didacticism in Iola Leroy: or Shadows Uplifted (1892) as she strives to achieve consubstantiality and a ..."heightened consciousness" within her characters and her audience while adhering to the literary and feminist paradigms of the late nineteenth century. Harper identifies with her African-American male audience's dilemma of "double-consciousness" and their veil of androcentrism. She also identifies with her Euro-American female audience's delicate and matriarchal roles, while also attempting to uplift their position of the "Other" to the "One." Finally, with her African-American female audience, Harper identifies with their complex situatedness of "double-consciousness" and the "Other," while also attempting to uplift them from a historically imposed position of selflessness to one of empowerment.
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