Nowadays, Health Care Training-based System (HCTS) is a vital component in the education and training of health care in 3D Virtual Environment (VE). The practice of HCTS continues to grow at rapid pace throughout all ...Nowadays, Health Care Training-based System (HCTS) is a vital component in the education and training of health care in 3D Virtual Environment (VE). The practice of HCTS continues to grow at rapid pace throughout all of the healthcare disciplines, however research in this field is still in its early stage. Increasingly, decision makers and developers look forward to offer more sophisticated, much larger, and more complex HCTS to serve the desired outcome and improve the quality and safety of patient care. Due to the rapidly increasing usage of personal mobile devices and the need of executing HCTS applications in environments that have no previous network infrastructure available, Mobile Health Care Training-based System (MHCTS) is an expected future trend. In such systems, medical staff will share and collaborate in a 3D virtual environment through their mobile devices in an ad-hoc network (MANET) in order to accomplish specific missions’ typically surgical emergency room. Users are organized into various groups (Radiologists, Maternity departments, and General surgery etc...), and need to be managed by a multicast scheme to save network bandwidth and offer immersive sense. MHCTS is sensitive to networking issues, since interactive 3D graphics requires additional load due to the use of mobile devices. Therefore, we need to emphasize on the importance and the improvement of multicast techniques for the effectiveness of MHCTS and the management of collaborative group interaction. Research so far has devoted little attention to the network communication protocols design of such systems which is crucial to preserve the sense of immersion for participating users. In this paper, we investigate the effect of multicast routing protocol in advancing the field of Health care Training-based System to the benefit of patient’s safety, and health care professional. Also, we address the issue of selecting a multicast protocol to provide the best performance for a particular e-health system at any time. Previous work has demonstrated that multicast operates at least as efficiently as traditional MAODV. A comprehensive analysis about various ad-hoc multicast routing protocols is proposed. The selection key factors for the right protocol for MHCTS applications were safety and robustness. To the best of our knowledge, this work will be the first initiative involving systematic literature reviews to identify a research gate for the use of multicast protocol in health care simulation learning community.展开更多
AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed ...AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.展开更多
AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on ent...AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on enteral nutrition(EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol(pre-intervention) and six months after implementation(post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were preintervention and 51 post-intervention.RESULTS: Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate(pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase(3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showeda non-significant decline in the post-intervention phase(P = 0.24) and the overall volume administered daily was higher in the post-intervention phase(61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions(interruptions for unknown reasons) were lower in the post-intervention phase(pre = 23/124, post = 9/96; P = 0.06).CONCLUSION: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.展开更多
Globally,there is a great gulf between medical knowledge and clinical practice.Translating knowledge into clinical decision support(CDS) application has become the biggest challenge faced by evidence based medicine.Th...Globally,there is a great gulf between medical knowledge and clinical practice.Translating knowledge into clinical decision support(CDS) application has become the biggest challenge faced by evidence based medicine.This paper proposed a comprehensive motivation framework to facilitate knowledge translation in healthcare.Based on a unified medical knowledge ontology and knowledge base,the framework provides an infrastructure of fundamental services,such as inference service and data acquisition,to support development of knowledge-driven CDS applications and integration into clinical workflow.The framework has been implemented in a 2600-bed Chinese hospital,and is able to reduce the time and cost of developing typical CDS applications.展开更多
BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implem...BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implemented in post-anaesthesia care units.Introducing a nurse-led extubation protocol may lead to reduced extubation time.AIM To investigate results of the implementation of a nurse-led protocol for early extubation after elective cardiac surgery,aiming at higher extubation rates by the third postoperative hour.METHODS A single centre prospective study in an 18-bed,consultant-led Cardiothoracic ICU,with a 1:1 nurse-to-patient ratio.During a 3-wk period,the protocol was implemented with:(1)Structured teaching sessions at nurse handover and at bed-space(all staff received teaching,over 90%were exposed at least twice;(2)Email;and(3)Laminated sheets at bed-space.We compared“standard practice”and“intervention”periods before and after the protocol implementation,measuring extubation rates at several time-points from the third until the 24th postoperative hour.RESULTS Of 122 cardiac surgery patients admitted to ICU,13 were excluded as early weaning was considered unsafe.Therefore,109 patients were included,54 in the standard and 55 in the intervention period.Types of surgical interventions and baseline left ventricular function were similar between groups.From the third to the 12th post-operative hour,the intervention group displayed a higher proportion of patients extubated compared to the standard group.However,results were significant only at the sixth hour(58%vs 37%,P=0.04),and not different at the third hour(13%vs 6%,P=0.33).From the 12th post-operative hour time-point onward,extubation rates became almost identical between groups(83%in standard vs 83%in intervention period).CONCLUSION The implementation of a nurse-led protocol for early extubation after cardiac surgery in ICU may gradually lead to higher rates of early extubation.展开更多
文摘Nowadays, Health Care Training-based System (HCTS) is a vital component in the education and training of health care in 3D Virtual Environment (VE). The practice of HCTS continues to grow at rapid pace throughout all of the healthcare disciplines, however research in this field is still in its early stage. Increasingly, decision makers and developers look forward to offer more sophisticated, much larger, and more complex HCTS to serve the desired outcome and improve the quality and safety of patient care. Due to the rapidly increasing usage of personal mobile devices and the need of executing HCTS applications in environments that have no previous network infrastructure available, Mobile Health Care Training-based System (MHCTS) is an expected future trend. In such systems, medical staff will share and collaborate in a 3D virtual environment through their mobile devices in an ad-hoc network (MANET) in order to accomplish specific missions’ typically surgical emergency room. Users are organized into various groups (Radiologists, Maternity departments, and General surgery etc...), and need to be managed by a multicast scheme to save network bandwidth and offer immersive sense. MHCTS is sensitive to networking issues, since interactive 3D graphics requires additional load due to the use of mobile devices. Therefore, we need to emphasize on the importance and the improvement of multicast techniques for the effectiveness of MHCTS and the management of collaborative group interaction. Research so far has devoted little attention to the network communication protocols design of such systems which is crucial to preserve the sense of immersion for participating users. In this paper, we investigate the effect of multicast routing protocol in advancing the field of Health care Training-based System to the benefit of patient’s safety, and health care professional. Also, we address the issue of selecting a multicast protocol to provide the best performance for a particular e-health system at any time. Previous work has demonstrated that multicast operates at least as efficiently as traditional MAODV. A comprehensive analysis about various ad-hoc multicast routing protocols is proposed. The selection key factors for the right protocol for MHCTS applications were safety and robustness. To the best of our knowledge, this work will be the first initiative involving systematic literature reviews to identify a research gate for the use of multicast protocol in health care simulation learning community.
基金Supported by the Ministry of Education and Research of Estonia(IUT34-24)
文摘AIM To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS An uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit(ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012(the Before group) and 2014-2015(the After group) were obtained from a local electronic database, the national Population Registry and the hospital's Infection ControlService. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed. RESULTS In total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group(86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospitalacquired infections, length of ICU stay and ICU, 30-and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d(P = 0.026) and 120-d(P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently(P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally(P = 0.049) and a lower cumulative amount of parenterally(P < 0.001) provided calories by day 7, with an overall reduction in caloric provision(P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding(total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After(P < 0.001). Inclusion in the Before group, previous abdominal surgery, intraabdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSION The use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.
文摘AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit(SICU) patients.METHODS: A retrospective chart review was conducted on patients initiated on enteral nutrition(EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol(pre-intervention) and six months after implementation(post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were preintervention and 51 post-intervention.RESULTS: Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate(pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase(3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showeda non-significant decline in the post-intervention phase(P = 0.24) and the overall volume administered daily was higher in the post-intervention phase(61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions(interruptions for unknown reasons) were lower in the post-intervention phase(pre = 23/124, post = 9/96; P = 0.06).CONCLUSION: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.
基金National High-Tech R&D Program of China(No.2012AA02A601)National Natural Science Foundation of China(No.30900329)
文摘Globally,there is a great gulf between medical knowledge and clinical practice.Translating knowledge into clinical decision support(CDS) application has become the biggest challenge faced by evidence based medicine.This paper proposed a comprehensive motivation framework to facilitate knowledge translation in healthcare.Based on a unified medical knowledge ontology and knowledge base,the framework provides an infrastructure of fundamental services,such as inference service and data acquisition,to support development of knowledge-driven CDS applications and integration into clinical workflow.The framework has been implemented in a 2600-bed Chinese hospital,and is able to reduce the time and cost of developing typical CDS applications.
文摘BACKGROUND Protocols for nurse-led extubation are as safe as a physician-guided weaning in general intensive care unit(ICU).Early extubation is a cornerstone of fast-track cardiac surgery,and it has been mainly implemented in post-anaesthesia care units.Introducing a nurse-led extubation protocol may lead to reduced extubation time.AIM To investigate results of the implementation of a nurse-led protocol for early extubation after elective cardiac surgery,aiming at higher extubation rates by the third postoperative hour.METHODS A single centre prospective study in an 18-bed,consultant-led Cardiothoracic ICU,with a 1:1 nurse-to-patient ratio.During a 3-wk period,the protocol was implemented with:(1)Structured teaching sessions at nurse handover and at bed-space(all staff received teaching,over 90%were exposed at least twice;(2)Email;and(3)Laminated sheets at bed-space.We compared“standard practice”and“intervention”periods before and after the protocol implementation,measuring extubation rates at several time-points from the third until the 24th postoperative hour.RESULTS Of 122 cardiac surgery patients admitted to ICU,13 were excluded as early weaning was considered unsafe.Therefore,109 patients were included,54 in the standard and 55 in the intervention period.Types of surgical interventions and baseline left ventricular function were similar between groups.From the third to the 12th post-operative hour,the intervention group displayed a higher proportion of patients extubated compared to the standard group.However,results were significant only at the sixth hour(58%vs 37%,P=0.04),and not different at the third hour(13%vs 6%,P=0.33).From the 12th post-operative hour time-point onward,extubation rates became almost identical between groups(83%in standard vs 83%in intervention period).CONCLUSION The implementation of a nurse-led protocol for early extubation after cardiac surgery in ICU may gradually lead to higher rates of early extubation.
