Abstract:
OBJECTIVES:Reviews of patient safety efforts suggest that technical/administrative change must be augmented by global factors such as organizational culture and climate. The objective was to outline a comprehensive model for healthcare climate and test one of its elements, the nursing subclimate, in terms of several patient safety outcomes. DESIGN:Measure organizational climate in nursing units, followed by random sampling of patient safety practices in each unit 6 months later. SETTING:Sixty-nine inpatient units in three hospitals that make up the entire tertiary care system in one metropolitan area. SUBJECTS:A total of 955 nurses. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:A two-part Nursing Climate Scale referring to hospital- and unit-level climates, followed by five randomly timed observations of patient safety practices covering routine and emergency care in each unit. Climate scales met the criteria of internal reliability, within-unit agreement, and between-unit variability, using standard statistics of climate research. Both the hospital and unit nursing climates exhibited significant variation, which predicted the routine medication safety scores (Z = 2.65 and 2.93 accordingly, p < .01), with similar results for emergency safety scores. A significant interaction (Z = 2.78, p < .01) indicated that best/worst safety is obtained when the unit and hospital climates are aligned (for better or worse) and that positive unit climate can compensate for the detrimental effect of poor hospital climate. Furthermore, climate's strength increased its predictive power with regard to patient safety practices (Z = 3.64 for medication and 2.28 for emergency safety; p < .01). The small number of participating hospitals limits organization-level analyses. CONCLUSIONS:The nursing climate identifies units where the likelihood of adverse events is greater or lower than the hospital's average. Such information can guide prevention efforts in selected units. These data encourage the development of additional climate subscales subsumed under the healthcare climate model (e.g., physicians subclimate).
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Zohar D,Livne Y,Tenne-Gazit O,Admi H,Donchin Ydoi
10.1097/01.CCM.0000262404.10203.C9subject
Has Abstractpub_date
2007-05-01 00:00:00pages
1312-7issue
5eissn
0090-3493issn
1530-0293journal_volume
35pub_type
杂志文章,多中心研究abstract:OBJECTIVES:To determine plasma aluminum concentrations and 24-hr urine aluminum excretion rate in long-term mechanically ventilated patients treated with 6 g of sucralfate daily for stress ulcer prophylaxis. DESIGN:Prospective study in long-term mechanically ventilated critically ill patients. SETTING:A surgical inte...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:
更新日期:1994-11-01 00:00:00
abstract::The records of 101 drowning or near-drowning victims admitted to Children's Hospital of Los Angeles (CHLA) between January 1975 and June 1978 were reviewed. The admission Glasgow coma score could be assigned retrospectively to 94 patients. A low score (less than 5) predicted a high risk group of patients with 80% mort...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:
更新日期:1981-07-01 00:00:00
abstract:OBJECTIVE:The clinical value of stroke volume variations to assess intravascular fluid status in critically ill patients is well known. Electrical impedance tomography is a noninvasive monitoring technology that has been primarily used to assess ventilation. We investigated the potential of electrical impedance tomogra...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182227e65
更新日期:2011-09-01 00:00:00
abstract::Subcutaneous, transcutaneous, and conjunctival oxygen tensions (PscO2, PtcO2, and PcjO2, respectively) were measured in anesthetized dogs subjected sequentially to normoxia, hyperoxia, and hypoxia. Intravascular pressure, hemodynamic and oxygen transport variables were measured simultaneously. PtcO2 and PcjO2 closely ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198812000-00011
更新日期:1988-12-01 00:00:00
abstract:OBJECTIVE:To determine whether extreme obesity (morbid obesity; body mass index > or =40 kg/m(2)) is an independent risk factor for death among critically ill patients; this objective is most salient in the subset of patients who sustain a prolonged intensive care unit stay during which the burdens of care imposed by o...
journal_title:Critical care medicine
pub_type: 评论,杂志文章
doi:10.1097/01.CCM.0000205758.18891.70
更新日期:2006-04-01 00:00:00
abstract::Because determining cardiac output is difficult in premature infants, little is known about the hemodynamic effects of PEEP in this age group. We used pulsed-wave Doppler echocardiography to assess the hemodynamic effects of PEEP increments in ten premature infants with respiratory distress syndrome. At a PEEP of 4 cm...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198707000-00007
更新日期:1987-07-01 00:00:00
abstract:OBJECTIVE:Acute lung injury results in acute respiratory distress syndrome. There is no standard therapy for acute respiratory distress syndrome but supportive care. Stem cells offer a new therapeutic potential for tissue regeneration as a result of their self-renewal, multipotency, and paracrine capabilities. The obje...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31823bc89a
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:To validate scoring algorithm criteria established by the Japanese Association for Acute Medicine (JAAM) for disseminated intravascular coagulation (DIC) and to evaluate its diagnostic property by comparing the two leading scoring systems for DIC, from the Japanese Ministry of Health and Welfare (JMHW) and I...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000202209.42491.38
更新日期:2006-03-01 00:00:00
abstract::Balloon flotation catheterization of the central circulation provides data which may be most meaningful and important to the management of critically ill patients. It allows the measurements of the filling pressures of the right and left ventricle as well as the cardiac output. These data combined with information con...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197505000-00001
更新日期:1975-05-01 00:00:00
abstract:OBJECTIVE:To determine the association between symptomatic central venous line-related deep venous thrombosis and a mortality-adjusted measure of duration of mechanical ventilation in critically ill children with central venous lines. DESIGN:Retrospective matched cohort study. SETTING:Eleven pediatric intensive care ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820eb8a1
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND AND METHODS:We aimed to characterize the effects of an endotoxin insult (Escherichia coli 0127:B8) on the relationships between pulmonary vascular pressure and flow in intact dogs. To achieve this goal, multipoint plots of total pressure gradient, arterial pressure gradient, and venous pressure gradient vs. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199207000-00018
更新日期:1992-07-01 00:00:00
abstract:OBJECTIVES:To measure energy expenditure in critically ill children and compare it with the energy expenditure predicted by recommended formulas, and relate the measured energy expenditure to nutritional and clinical indices. DESIGN:A prospective, clinical study. SETTING:Tertiary care pediatric intensive care unit in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200004000-00042
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To assess the effects of step-changes in tidal volume on work of breathing during lung-protective ventilation in patients with acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS). DESIGN:Prospective, nonconsecutive patients with ALI/ARDS. SETTING:Adult surgical, trauma, and medical int...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000194538.32158.af
更新日期:2006-01-01 00:00:00
abstract::Patient comfort is not assured by common practices for terminal extubation. Treatment guidelines suggest minimizing dosage of opioids and sedatives. Multiple lines of evidence indicate that clinicians are limited in their ability to recognize distress in such patients and tend to undermedicate patients in distress. Ye...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318228235d
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVES:Venovenous extracorporeal gas exchange is increasingly used in awake, spontaneously breathing patients as a bridge to lung transplantation. Limited data are available on a similar use of extracorporeal gas exchange in patients with acute respiratory distress syndrome. The aim of this study was to investigate...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000121
更新日期:2014-03-01 00:00:00
abstract::The determination of minute oxygen consumption (VO2) for metabolic studies on patients using either the Beckman Metabolic Cart (MMC) or the Respiratory Monitoring System (RMS) requires a stable fractional inspired oxygen concentration (FIO2). Measurement of VO2 on mechanically ventilated patients using the Bourns BEAR...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198202000-00003
更新日期:1982-02-01 00:00:00
abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001822
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:To test the reliability and validity of a modified moral distress tool, originally developed for the nursing profession, on respiratory care practitioners. To describe the relationship between moral distress, career dissatisfaction, and job turnover in respiratory care. DESIGN:A 28-question survey was develo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000248879.19054.73
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:After a stay in the intensive care unit, patients risk experiencing delusional memories, memory loss, and symptoms of posttraumatic stress. Since the 1990s, diaries have been kept for intensive care unit patients to help fill in memory gaps, aid psychosocial recovery, and improve health-related quality of lif...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e31821e89c8
更新日期:2011-08-01 00:00:00
abstract::We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alpha-tocopherol d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198608000-00010
更新日期:1986-08-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to test the hypothesis that recruitment maneuvers (RMs) might act differently in models of pulmonary (p) and extrapulmonary (exp) acute lung injury (ALI) with similar transpulmonary pressure changes. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181760e5d
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective. DATA SOURCES:Systematic literature searc...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000000148
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:The aim of the present study was to characterize pulmonary surfactant properties in children undergoing cardiovascular surgery with cardiopulmonary bypass. DESIGN:Prospective clinical trial. SETTING:University hospital pediatric intensive care unit. PATIENTS:Fifty pediatric patients with congenital cardiac...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200301000-00045
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVES:Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin tria...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002627
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:To determine whether chest wall vibration with tracheal gas insufflation during bronchoconstriction maintains gas exchange at lower airway and intrathoracic pressures than those that occur during positive pressure ventilation. DESIGN:Prospective study. SETTING:Experimental laboratory. SUBJECTS:Six anesthet...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00057
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnos...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002053
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES:Patient medical records. STUDY SELECTION:Not applicable. DATA EXTRACTION:Not applicable. DATA SYNTHESIS:No...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000935
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVE:The requirement for a blood transfusion after trauma is associated with an increased risk of acute lung injury. Residual leukocytes contaminating red cells are potential mediators of this syndrome. The goal of this trial was to test our hypothesis that prestorage leukoreduction of blood would reduce rates of ...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e318170a9ce
更新日期:2008-05-01 00:00:00
abstract::The authors have examined cardiopulmonary resuscitation (CPR) skills retention in a police force initially trained to instructor level performance skills as defined by the 1977 American Heart Association Instructor Manual. In 1977, the entire Winnipeg Police Force received a basic 8-h course of CPR training with recor...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198011000-00011
更新日期:1980-11-01 00:00:00
abstract:OBJECTIVE:To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis. DESIGN:Prospective observational study. SETTING:EDs of ten academic medical centers. PATIENTS:There were 971 patients enrolled. INCLUSION CRITERIA:1) ED p...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318192fd9d
更新日期:2009-01-01 00:00:00