UI - 22463863
PMID- 12577166
OWN - nlm
STAT- completed
DA - 20030210
DCOM- 20030401
IS - 0003-2417
VI - 52
IP - 1
DP - 2003 Jan
TI - [Suicide attempt with high-dose ecstasy]
PG - 51-4
AB - The case of a 16-year-old female patient is reported, who has taken in
30
tablets of Ecstasy in a suicide attempt.Initially were seen a
tachycardia,hyperdynamic circulation, dehydration, leg-myocloni in the
awake excited female patient.For prophylaxis of aspiration general
anaesthesia and intubation with following gastric lavage were performed.
During the intensive care treatment the high blood pressure persisted,
although general anaesthesia and anti-hypertensive therapy was
continued.After extubation the neurologic status of the patient was
normal. Emergency physicians see more and more often
Ecstasy-intoxications.Signs of an acute intoxication with Ecstasy are a
sympathomimetic reaction with tachycardia,hypertonic blood pressure and
cardiac arrhythmia as well as fever, respiratory and renal insufficiency,
rhabdomyolysis, cerebral edema and convulsion. A specific antidote does
not exist; the symptomatic therapy consists of airway management,
hemodynamic stabilisation, primary drug-elimination and, in case of need,
application of betablockers and relaxants.
AD - Institut fur Anasthesiologie und Operative Intensivmedizin,
Universitatsklinikum Mannheim. hinkelbein@akutmedizin.de
FAU - Hinkelbein, J
AU - Hinkelbein J
FAU - Gabel, A
AU - Gabel A
FAU - Volz, M
AU - Volz M
FAU - Ellinger, K
AU - Ellinger K
LA - ger
PT - Journal Article
TT - Suizidale hochdosierte Ecstasy-Einnahme.
PL - Germany
TA - Anaesthesist
JID - 0370525
RN - 0 (Antihypertensive Agents)
RN - 0 (Hallucinogens)
RN - 42542-10-9 (N-Methyl-3,4-methylenedioxyamphetamine)
SB - IM
MH - Adolescent
MH - Anesthesia, General
MH - Antihypertensive Agents/therapeutic use
MH - Case Report
MH - English Abstract
MH - Female
MH - Gastric Lavage
MH - Hallucinogens/*poisoning
MH - Hemodynamics/drug effects
MH - Human
MH - Intensive Care
MH - Myoclonus/chemically induced/psychology
MH - N-Methyl-3,4-methylenedioxyamphetamine/*poisoning
MH - *Suicide, Attempted
EDAT- 2003/02/11 04:00
MHDA- 2003/04/02 05:00
AID - 10.1007/s00101-002-0433-3 [doi]
PST - ppublish
SO - Anaesthesist 2003 Jan;52(1):51-4.
UI - 22515573
PMID- 12628895
OWN - nlm
STAT- completed
DA - 20030311
DCOM- 20030402
IS - 0012-3692
VI - 123
IP - 3
DP - 2003 Mar
TI - An appraisal of multivariable logistic models in the pulmonary and
critical care literature.
PG - 923-8
AB - OBJECTIVE: Multivariable modeling techniques are appearing in today's
medical literature with increasing frequency. Improper reporting of these
statistical models can potentially make the results of a study inaccurate,
misleading, or difficult to interpret. We performed a manual literature
search of five international pulmonary and critical care journals to
determine the accuracy in the reporting of logistic regression modeling
strategies. DESIGN: We examined all of the published manuscripts for 12
potential limitations in the reporting of important statistical
methodologies over a 6-month period from July 1, 2000, until December 31,
2000. RESULTS: Of the 81 articles that included multivariable logistic
regression analyses, only 65% (53 analyses) properly reported the coding
classification of pertinent independent variables that were included in
the final model. An odds ratio and confidence interval were reported for
the independent variables included in the final model for 79% (64
analyses) and 74% (60 analyses), respectively. Only 12% (10 articles)
referenced whether interaction terms or effect modifications were
examined, 1% (1 article) reported testing for collinearity, and only 16%
(13 articles) included a goodness-of-fit analysis of the logistic model.
The type of statistical package was reported in 69% (56 articles).
Finally, approximately 39% of the articles (22 of 57) may have overfit the
logistic regression model, leading to potentially unreliable regression
coefficients and odds ratios. CONCLUSIONS: Our results indicate that the
reporting of multivariable logistic regression analyses in the pulmonary
and critical care literature is often incomplete, therefore making it
difficult for the reader to accurately interpret the manuscript. We
recommend the implementation of adequate guidelines that will lead to
overall improvements in the reporting and possibly to the conducting of
multivariable analyses in the pulmonary medicine and critical care
medicine literature.
AD - Department of Medicine, Division of Pulmonary and Critical Care Medicine,
Emory Unversity, Atlanta, GA, USA. marc_moss@emory.org
FAU - Moss, Marc
AU - Moss M
FAU - Wellman, D Andrew
AU - Wellman DA
FAU - Cotsonis, George A
AU - Cotsonis GA
LA - eng
PT - Evaluation Studies
PT - Journal Article
PL - United States
TA - Chest
JID - 0231335
SB - AIM
SB - IM
CIN - Chest. 2003 Mar;123(3):677-8. PMID: 12628861
MH - *Critical Care
MH - Human
MH - *Logistic Models
MH - Multivariate Analysis
MH - Publishing/*standards
MH - *Pulmonary Disease (Specialty)
MH - Research/*statistics & numerical data
EDAT- 2003/03/12 04:00
MHDA- 2003/04/04 05:00
PST - ppublish
SO - Chest 2003 Mar;123(3):923-8.
UI - 22515566
PMID- 12628888
OWN - nlm
STAT- completed
DA - 20030311
DCOM- 20030402
IS - 0012-3692
VI - 123
IP - 3
DP - 2003 Mar
TI - Clinical utility of blood cultures drawn from central vein catheters and
peripheral venipuncture in critically ill medical patients.
PG - 854-61
AB - STUDY OBJECTIVE: To determine the sensitivity, specificity, and positive
and negative predictive values of blood cultures obtained through a
central vein catheter compared with peripheral venipuncture. DESIGN:
Prospective cohort study. SETTING: A medical ICU (19 beds) from a
university-affiliated urban teaching hospital. PATIENTS: Between February
2001 and October 2001, 300 paired blood culture specimens were obtained
from 119 patients (2.52 paired cultures per patient). INTERVENTION:
Prospective patient surveillance and data collection. Measurements and
main results: Thirty-four paired culture results (11.3%; 95% confidence
interval, 7.8 to 14.8%) were accepted as true-positives representing a
true bacteremia. The sensitivity of catheter-drawn and peripheral
venipuncture samples was 82.4% and 64.7%, respectively, and specificity
was 92.5% and 95.9%. The positive predictive value was 58.3% for
catheter-drawn samples and 66.7% for peripheral venipuncture samples, and
the respective negative predictive values were 97.6% and 95.5%.
CONCLUSIONS: In critically ill medical patients, the negative predictive
value of blood samples obtained by catheter draw or peripheral
venipuncture for suspected bloodstream infection is good. However, the
sensitivity of blood samples obtained by either catheter draw or
peripheral venipuncture alone is not adequate to recommend the elimination
of blood samples obtained from the other site. Clinicians should also be
aware that additional blood samples may be necessary when interpreting
positive blood culture results for common skin or central vein catheter
contaminants.
AD - Pulmonary and Critical Care Division, Washington University School of
Medicine, St. Louis 63110, USA.
FAU - Beutz, Michelle
AU - Beutz M
FAU - Sherman, Glenda
AU - Sherman G
FAU - Mayfield, Jennie
AU - Mayfield J
FAU - Fraser, Victoria J
AU - Fraser VJ
FAU - Kollef, Marin H
AU - Kollef MH
LA - eng
PT - Journal Article
PL - United States
TA - Chest
JID - 0231335
SB - AIM
SB - IM
MH - Bacteremia/*diagnosis/epidemiology/etiology/mortality
MH - *Catheterization, Central Venous/adverse effects
MH - *Cell Culture
MH - Comparative Study
MH - Critical Care
MH - Cross Infection/*diagnosis/epidemiology/etiology/mortality
MH - Female
MH - Hospital Mortality
MH - Human
MH - Logistic Models
MH - Male
MH - Middle Age
MH - Missouri/epidemiology
MH - Phlebotomy/*methods
MH - Predictive Value of Tests
MH - Prevalence
MH - Prospective Studies
MH - Sensitivity and Specificity
EDAT- 2003/03/12 04:00
MHDA- 2003/04/04 05:00
PST - ppublish
SO - Chest 2003 Mar;123(3):854-61.
UI - 22515539
PMID- 12628861
OWN - nlm
STAT- completed
DA - 20030311
DCOM- 20030402
IS - 0012-3692
VI - 123
IP - 3
DP - 2003 Mar
TI - Clinician or statistician?
PG - 677-8
FAU - Brown, Carlos V R
AU - Brown CV
FAU - Velmahos, George C
AU - Velmahos GC
LA - eng
PT - Comment
PT - Editorial
PL - United States
TA - Chest
JID - 0231335
SB - AIM
SB - IM
CON - Chest. 2003 Mar;123(3):923-8. PMID: 12628895
MH - *Critical Care
MH - Human
MH - *Logistic Models
MH - Publishing/*standards
MH - *Pulmonary Disease (Specialty)
MH - Research/*statistics & numerical data
EDAT- 2003/03/12 04:00
MHDA- 2003/04/04 05:00
PST - ppublish
SO - Chest 2003 Mar;123(3):677-8.
UI - 22558454
PMID- 12671174
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Evidence-based approach to change in clinical practice: introduction of
expanded nasal continuous positive airway pressure use in an intensive
care nursery.
PG - e542-7
AB - OBJECTIVE: Recent studies provide evidence that nasal intermittent
positive pressure ventilation (NIPPV) may stabilize the airway of
extremely low birth weight infants after endotracheal extubation. The
objective of this project was to introduce the use of NIPPV into a busy
level 3 intensive care nursery. METHODS: This report describes the process
of NIPPV introduction using a series of rapid-cycle improvement projects,
as proposed by the Vermont Oxford Network. RESULTS: In the first cycle, 7
(88%) of 8 infants were successfully extubated with NIPPV after meeting
criteria for reintubation on nasal continuous positive airway pressure
alone. Proper positioning of the prongs in the nasopharynx was found to be
an important determinant of success. In a second cycle, shorter 2.5-cm
nasopharyngeal prongs were more effective than standard 4-cm prongs in 12
recently extubated infants as assessed by objective measurements and
subjective nursing reports. A third cycle confirmed the acceptance of this
technique in our unit and demonstrated an associated decrease in markers
of chronic lung disease in extremely low birth weight infants during the
22 months after its introduction. CONCLUSION: This experience supports the
role for the rapid-cycle change model in achieving effective
evidence-based medical practices in a neonatal intensive care setting.
AD - Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City
School of Medicine, Kansas City, Missouri 64108, USA. jjackson@cmh.edu
FAU - Jackson, Jodi K
AU - Jackson JK
FAU - Vellucci, Judy
AU - Vellucci J
FAU - Johnson, Patrice
AU - Johnson P
FAU - Kilbride, Howard W
AU - Kilbride HW
LA - eng
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - Data Collection
MH - *Evidence-Based Medicine
MH - Human
MH - Infant, Newborn
MH - *Infant, Very Low Birth Weight
MH - Intensive Care Units, Neonatal/*organization & administration/standards
MH - Intensive Care, Neonatal/organization & administration/*standards
MH - Medical Audit
MH - Organizational Innovation
MH - Patient Care Team/organization & administration
MH - Positive-Pressure Respiration/instrumentation/*methods
MH - Respiratory Insufficiency/*therapy
MH - Technology Transfer
MH - Total Quality Management/methods
MH - Treatment Outcome
MH - Ventilator Weaning
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e542-7.
UI - 22558448
PMID- 12671168
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Implementing potentially better practices for multidisciplinary team
building: creating a neonatal intensive care unit culture of
collaboration.
PG - e482-8
AB - OBJECTIVE: Part of the process of deriving and refining the CARE
(communication, accountability, respect, empowerment) focus group's
potentially better practices (PBPs) for multidisciplinary teamwork was to
evaluate and experience the PBPs through implementation. METHODS: The 4
neonatal intensive care units (NICUs) in the CARE focus group each worked
with implementation of the PBPs. The choice of initial PBP and method of
implementation was left up to each NICU's core team. RESULTS: The
experience of each of the PBPs that is reported was selected from only 1
of the NICUs. These are summarized and described in a plan-do-study-act
type of format. CONCLUSIONS: There was no ideal PBP with which to start.
The intertwined nature of all of the PBPs provided additional
opportunities to implement other PBPs. A change seemed to be a matter
first of vocabulary, then of tentative acceptance, followed by gradual
integration into the culture. Change was facilitated when there was
acknowledgment of a need to do things differently by the NICU leadership.
Although the validity of the PBPs and their importance in cultural change
have yet to be confirmed, once there was a persisting intent to change,
the makeup of the NICU culture moved to embrace change as part of its
culture.
AD - Presbyterian St Luke's Medical Center, Denver, Colorado, USA.
marksbrown@compuserve.com
FAU - Brown, Mark S
AU - Brown MS
FAU - Ohlinger, Judy
AU - Ohlinger J
FAU - Rusk, Connie
AU - Rusk C
FAU - Delmore, Paula
AU - Delmore P
FAU - Ittmann, Patricia
AU - Ittmann P
CN - CARE Group.
LA - eng
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - *Benchmarking
MH - Communication
MH - Cooperative Behavior
MH - Health Plan Implementation/*methods
MH - Human
MH - Infant, Newborn
MH - Intensive Care Units, Neonatal/*organization & administration/standards
MH - Leadership
MH - Organizational Innovation
MH - Organizational Objectives
MH - Patient Care Team/*organization & administration
MH - Questionnaires
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e482-8.
UI - 22558447
PMID- 12671167
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Development of potentially better practices for the neonatal intensive
care unit as a culture of collaboration: communication, accountability,
respect, and empowerment.
PG - e471-81
AB - OBJECTIVE: The Vermont Oxford Network (VON) CARE Group was formed in
response to the need to create organizational cultures supportive of
change and quality improvement. METHODS: The CARE Group consisted of team
members from 4 participating neonatal intensive care units (NICUs). All
CARE Group members chose to work on multidisciplinary teamwork for the
duration of the Neonatal Intensive Care Quality Improvement Collaborative
Year 2000. A questionnaire was developed by the CARE Group and
administered to the 4 focus group NICUs. The survey focused on 6 domains
of the organization: unit coordination, working in the NICU, leadership,
management of disagreements, authority, and unit culture. Benchmarking
visits were completed to supplement the information found in the survey
and the literature. RESULTS: Seven potentially better practices (PBPs)
were developed on the basis of the surveys, benchmark visits, and
literature reviews. The PBPs include 1) a clear, shared NICU purpose,
goals, and values; 2) effective communication among and between teams and
team members; 3) leaders lead by example; 4) nurture a collaborative NICU
environment with trust and respect; 5) live principled standards of
conduct and standards of excellence; 6) nurture competent and committed
teams and team members; and 7) commit to effective and positive conflict
management. CONCLUSIONS: The CARE Group successfully used quality
improvement methods and collaboration to delineate principles and
practices of multidisciplinary teamwork.
AD - Children's Hospital Medical Center of Akron, Akron, Ohio 44308, USA.
johlinger@chmca.org
FAU - Ohlinger, Judy
AU - Ohlinger J
FAU - Brown, Mark S
AU - Brown MS
FAU - Laudert, Sue
AU - Laudert S
FAU - Swanson, Sue
AU - Swanson S
FAU - Fofah, Ona
AU - Fofah O
CN - CARE Group.
LA - eng
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - *Benchmarking
MH - Communication
MH - Cooperative Behavior
MH - Evidence-Based Medicine
MH - Focus Groups
MH - Human
MH - Infant, Newborn
MH - Intensive Care Units, Neonatal/*organization & administration/standards
MH - Leadership
MH - Organizational Innovation
MH - Organizational Objectives
MH - Patient Care Team/*organization & administration
MH - Program Development
MH - Questionnaires
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e471-81.
UI - 22558446
PMID- 12671166
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Evaluation, development, and implementation of potentially better
practices in neonatal intensive care nutrition.
PG - e461-70
AB - OBJECTIVE: The desire for evidence-based clinical guidelines for
nutritional support of the preterm infant has been identified. Published
evidence has not yielded clear guidelines about the best method of
delivery, substrate use, or appropriate outcome measure to evaluate
nutrition support. In addition, reports on research of nutrition support
often fail to give the most rudimentary process necessary to improve
quality in various unit settings. METHODS: The Vermont Oxford Network "Got
Milk" focus group developed eight potentially better practices for
nutrition support, implementation strategies for these practices, and a
comprehensive appraisal process to measure nutrition outcome in preterm
infants. RESULTS: After implementation of the potentially better
practices, all participating institutions showed earlier initiation of
nutrition support, earlier attainment of adequate energy intakes, reduced
delay in reaching full enteral feeds, more consistent nutrition support
practice, decreased length of stay, cost savings, and improved growth at
time of discharge. CONCLUSIONS: Development and implementation of
evidence-based better nutrition support practices in neonates led to
improved nutrient intake and growth with reduced length of stay and
related costs. Consistent, comprehensive, multidisciplinary appraisal of
practice is an integral component of improving nutrition outcomes in the
neonatal population.
AD - Mercy Children's Hospital, Toledo, Ohio 43608, USA.
barbara_kuzma_oreilly@mhsnr.org
FAU - Kuzma-O'Reilly, Barbara
AU - Kuzma-O'Reilly B
FAU - Duenas, Maria L
AU - Duenas ML
FAU - Greecher, Coleen
AU - Greecher C
FAU - Kimberlin, Lois
AU - Kimberlin L
FAU - Mujsce, Dennis
AU - Mujsce D
FAU - Miller, Debra
AU - Miller D
FAU - Walker, Donna Jean
AU - Walker DJ
LA - eng
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - *Benchmarking
MH - Breast Feeding
MH - Cooperative Behavior
MH - Enteral Nutrition/*standards
MH - Evidence-Based Medicine
MH - Health Plan Implementation
MH - Human
MH - *Infant Nutrition
MH - Infant, Low Birth Weight
MH - Infant, Newborn
MH - *Infant, Premature
MH - Intensive Care Units, Neonatal/organization & administration
MH - Intensive Care, Neonatal/organization & administration/*standards
MH - Organizational Innovation
MH - Organizational Objectives
MH - Parenteral Nutrition, Total/standards
MH - Practice Guidelines
MH - Program Development
MH - Program Evaluation
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e461-70.
UI - 22558445
PMID- 12671165
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Implementing potentially better practices for improving family-centered
care in neonatal intensive care units: successes and challenges.
PG - e450-60
AB - OBJECTIVE: Multidisciplinary teams from 11 medical center neonatal
intensive care units collaborated in a quality improvement project with a
focus on family-centered care. METHODS: Through a process of
self-analysis, literature review, benchmarking site visits, and expert
consultation, 10 potentially better practice (PBP) areas were defined.
Improvement activities in 4 of the 10 areas are given as examples of
successes and challenges that individual centers encountered. The 4 areas
are vision and philosophy, unit culture, family participation in care, and
families as advisors. RESULTS: Centers were at different places for all of
the PBPs at the beginning and throughout the collaboration. Seven centers
developed or revised their vision or philosophy of care statements about
family-centered care. Incorporating the vision and philosophy of care into
performance appraisals, hiring of new personnel, and changing unit culture
to a more family-centered practice were more challenging than developing
the statements. Full parent participation in care requires unrestricted
access to the neonatal intensive care unit. The shift from considering
parents to be "visitors" to being partners in caring for their child
was
more difficult for centers with restricted visitation policies. All
centers developed, expanded, or started plans for establishing family
advisory councils. The experience of 2 centers is described. CONCLUSIONS:
Family-centered care is more of a journey than a destination.
Collaborating centers in this project found themselves at different places
in that journey. Through perseverance in implementing the PBPs, all have
moved further along the path.
AD - Children's Hospital at Providence Alaska Medical Center, Anchorage,
Alaska, USA.
FAU - Moore, Kimberly A Cisneros
AU - Moore KA
FAU - Coker, Kara
AU - Coker K
FAU - DuBuisson, Allison B
AU - DuBuisson AB
FAU - Swett, Betsy
AU - Swett B
FAU - Edwards, William H
AU - Edwards WH
LA - eng
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - *Benchmarking
MH - Consumer Satisfaction
MH - Cooperative Behavior
MH - Data Collection
MH - Evidence-Based Medicine
MH - Family
MH - Family Nursing/methods/*standards
MH - Health Plan Implementation
MH - Human
MH - Infant, Low Birth Weight
MH - Infant, Newborn
MH - Intensive Care Units, Neonatal/organization & administration/*standards
MH - Intensive Care, Neonatal/*methods/standards
MH - Organizational Innovation
MH - Organizational Objectives
MH - Parents
MH - Professional-Family Relations
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e450-60.
UI - 22558444
PMID- 12671164
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Evaluation and development of potentially better practices for improving
family-centered care in neonatal intensive care units.
PG - e437-49
AB - OBJECTIVE: Technological and scientific advances have progressively
decreased neonatal morbidity and mortality. Less attention has been given
to meeting the psychosocial needs of the infant and family than on meeting
the infant's physical needs. Parents' participation in making decisions
and caring for their child has often been limited. Environments designed
for efficient technological care may not be optimal for nurturing the
growth and development of sick neonates or their families. Eleven centers
collaborating on quality improvement tried to make the care of families
better by focusing on understanding and improving family-centered care.
METHODS: Through internal process analysis, review of the evidence,
collaborative learning, and benchmarking site visits to centers of
excellence in family-centered care, a list of potentially better practices
was developed. Choice of which practices to implement and methods of
implementation were center specific. Improvement goals were in 3 areas:
parent-reported outcomes, staff beliefs and practices, and clinical
outcomes in length of stay and feeding practices. Measurement tools for
the first 2 areas were developed and pilots were conducted. RESULTS:
Length of stay and feeding outcomes were not different before the
collaboration (1998) and at the formal end of the collaboration (2000).
CONCLUSIONS: Prospective parent-reported outcomes are being collected, and
the staff beliefs and practices questionnaire will be repeated in all
centers to determine the impact of the project in those areas.
AD - Women's Hospital of Greensboro, Greensboro, North Carolina, USA.
FAU - Saunders, Roger P
AU - Saunders RP
FAU - Abraham, Marie R
AU - Abraham MR
FAU - Crosby, Mary Jo
AU - Crosby MJ
FAU - Thomas, Karen
AU - Thomas K
FAU - Edwards, William H
AU - Edwards WH
LA - eng
PT - Evaluation Studies
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - *Benchmarking
MH - Cooperative Behavior
MH - Data Collection
MH - Evidence-Based Medicine
MH - Family Nursing/*standards
MH - Focus Groups
MH - Human
MH - Infant, Low Birth Weight
MH - Infant, Newborn
MH - Intensive Care Units, Neonatal/organization & administration/*standards
MH - Intensive Care, Neonatal/*methods/standards
MH - Organizational Innovation
MH - Organizational Objectives
MH - Outcome and Process Assessment (Health Care)
MH - Parents
MH - Questionnaires
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e437-49.
UI - 22558441
PMID- 12671161
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - Using organizational assessment surveys for improvement in neonatal
intensive care.
PG - e419-25
AB - BACKGROUND: Problems with organizational culture, lack of or poor team
communications, and conflict are often seen as barriers to improvement
efforts. METHODS: A survey measuring aspects of organizational culture was
administered twice to staff in neonatal intensive care units participating
in the Neonatal Intensive Care Unit Quality Improvement Collaborative Year
2000 collaborative. The surveys provided comparative data on coordination,
teamwork and leadership, conflict management, unit leadership and unit
culture. These data were summarized and fed back to NICU teams with
guidance on their use. Interviews on the use of the survey were held with
12 medical directors and patient care leaders in 9 different NICUs.
RESULTS: The findings indicated that all the units contacted saw
themselves as committed to undertaking the organizational survey and using
the results. Some units shared the data widely and initiated changes.
Other units limited the distribution of data to the unit leadership. There
was no apparent relationship between scores on the survey and activities
undertaken. Several respondents credited the survey with helping to
promote discussions about organizational and team issues. CONCLUSIONS:
Future use of the survey should include additional materials to assist in
disseminating the results to staff.
AD - Department of Health Policy, Management and Evaluation, University of
Toronto, Toronto, Ontario, Canada. ross.baker@utoronto.ca
FAU - Baker, G Ross
AU - Baker GR
FAU - King, Hannah
AU - King H
FAU - MacDonald, Jeanne L
AU - MacDonald JL
FAU - Horbar, Jeffrey D
AU - Horbar JD
LA - eng
PT - Journal Article
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - Data Collection
MH - Health Services Research/methods
MH - Human
MH - Infant, Newborn
MH - Intensive Care Units, Neonatal/manpower/*organization &
administration/standards
MH - Interprofessional Relations
MH - Leadership
MH - Organizational Culture
MH - Patient Care Team/organization & administration
MH - Support, Non-U.S. Gov't
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e419-25.
UI - 22558439
PMID- 12671159
OWN - nlm
STAT- completed
DA - 20030402
DCOM- 20030425
IS - 1098-4275
VI - 111
IP - 4 Pt 2
DP - 2003 Apr
TI - NIC/Q 2000: establishing habits for improvement in neonatal intensive care
units.
PG - e397-410
AB - OBJECTIVES: The Vermont Oxford Network is a group of health professionals
who are committed to improving the quality and safety of medical care for
newborn infants and their families. Neonatal Intensive Care Quality
Improvement Collaborative Year 2000 (NIC/Q 2000) was the second in a
series of multiorganization improvement collaboratives organized and
administered by the Vermont Oxford Network. The objective of this
collaborative was to make measurable improvements in the quality and
safety of neonatal intensive care, develop new tools and resources for
improvement specific to the neonatal intensive care unit setting, evaluate
improvement progress, and disseminate the learning. METHODS: The 34
centers that participated in NIC/Q 2000 learned and applied 4 key habits
for improvement: the habit for change, the habit for evidence-based
practice, the habit for systems thinking, and the habit for collaborative
learning. A plan-do-study-act method of rapid-cycle improvement was an
integral part of the habit for change. Multidisciplinary teams from the
participating centers worked closely together in face-to-face meetings,
conference calls, and dedicated e-mail listservs under the guidance of
trained facilitators and expert faculty. Focus groups formed around
specific improvement topics used critical appraisal of the published
literature, detailed process analysis, benchmarking, and round-robin site
visits to identify potentially better practices (PBPs). RESULTS: The focus
groups developed a total of 51 PBPs. Each focus group has developed a
"resource kit" summarizing its work. Many of these PBPs have been
tested
and implemented at the participating centers using rapid-cycle
improvement. The PBPs and descriptions of individual center PDSA cycles
are available to participants on NICQ.org, the dedicated Internet site for
the collaborative. CONCLUSIONS: Collaborative quality improvement based on
the 4 key habits can assist multidisciplinary neonatal intensive care unit
teams in identifying, testing, and successfully implementing change.
AD - Vermont Oxford Network, Burlington, Vermont 05401, USA.
FAU - Horbar, Jeffrey D
AU - Horbar JD
FAU - Plsek, Paul E
AU - Plsek PE
FAU - Leahy, Kathy
AU - Leahy K
CN - NIC/Q 2000.
LA - eng
PT - Journal Article
PT - Multicenter Study
PL - United States
TA - Pediatrics
JID - 0376422
SB - AIM
SB - IM
MH - Cooperative Behavior
MH - Evidence-Based Medicine
MH - Focus Groups
MH - Human
MH - Infant, Newborn
MH - Intensive Care Units, Neonatal/organization & administration/*standards
MH - Organizational Innovation
MH - Organizational Objectives
MH - Total Quality Management/*methods
MH - United States
EDAT- 2003/04/03 05:00
MHDA- 2003/04/26 05:00
PST - ppublish
SO - Pediatrics 2003 Apr;111(4 Pt 2):e397-410.