This document discusses strategies to improve patient outcomes related to vascular access at a hospital. It describes a Failure Mode Effects Analysis project led by various clinicians to review processes for central line care, education materials, supplies, and statistics on catheter-related infections. Areas of variation and practices not meeting best standards were identified. The team developed approaches to standardize line flushing, dressing changes, and evaluate practices to reduce risks of emboli, occlusion, extravasation, and infection.
This document summarizes minimally invasive glaucoma surgery (MIGS) procedures. MIGS offers more modest intraocular pressure (IOP) lowering than traditional glaucoma surgery, but with a safer risk profile. The document describes various MIGS procedures including the iStent, Hydrus, CyPass, and XEN gel stent. It provides details on the mechanism of action, surgical technique, efficacy and safety data from clinical studies for each procedure. MIGS provides an alternative treatment option for glaucoma patients to lower IOP and reliance on eye drops without the risks of more invasive surgeries.
J ENDOVASC THER 2010;17:517–524-Clinical Investigation- Aneurysm Sac ‘‘Thrombization’’ and Stabilization
in EVAR: A Technique to Reduce the Risk of Type II Endoleak
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
The document provides guidance on evidence-based practices for preventing central line-associated bloodstream infections (CLABSI), including following maximal barrier precautions during insertion, using chlorhexidine for skin preparation, avoiding the femoral site when possible, maintaining daily review of line necessity, and adhering to proper insertion and care techniques. It emphasizes that bundling these prevention strategies can significantly reduce the incidence of CLABSI and related morbidity, mortality and costs. Proper technique and team communication are important to ensure safe central line insertion and management.
This document discusses strategies for preventing catheter-related infections in hemodialysis patients. Central venous catheters are increasingly used for hemodialysis but carry a risk of infectious complications. Several preventive approaches are outlined, including universal precautions, sutureless securement devices, topical antiseptic ointments at exit sites, antimicrobial locking solutions, needleless connectors, and coated catheters. Proper hand hygiene and skin cleansing are also emphasized. Sutureless devices and antimicrobial locks may help reduce infections, but evidence on other strategies like chlorhexidine dressings is less clear. Overall prevention requires a multifaceted approach.
This document discusses a prototype technology called CoVa that uses capnography to detect increased carbon dioxide levels after injecting sodium bicarbonate intravenously. This allows clinicians to confirm correct placement of intravenous catheters. The technology has been tested on 200 patients in a phase 3 clinical trial with statistically significant results. It could help prevent complications from malpositioned catheters like extravasation and infiltration, which are common problems that result in high costs to hospitals. Regulatory approval pathways are straightforward and initial development costs are estimated at $500,000 over 2 years to start sales.
This document discusses strategies to improve patient outcomes related to vascular access at a hospital. It describes a Failure Mode Effects Analysis project led by various clinicians to review processes for central line care, education materials, supplies, and statistics on catheter-related infections. Areas of variation and practices not meeting best standards were identified. The team developed approaches to standardize line flushing, dressing changes, and evaluate practices to reduce risks of emboli, occlusion, extravasation, and infection.
This document summarizes minimally invasive glaucoma surgery (MIGS) procedures. MIGS offers more modest intraocular pressure (IOP) lowering than traditional glaucoma surgery, but with a safer risk profile. The document describes various MIGS procedures including the iStent, Hydrus, CyPass, and XEN gel stent. It provides details on the mechanism of action, surgical technique, efficacy and safety data from clinical studies for each procedure. MIGS provides an alternative treatment option for glaucoma patients to lower IOP and reliance on eye drops without the risks of more invasive surgeries.
J ENDOVASC THER 2010;17:517–524-Clinical Investigation- Aneurysm Sac ‘‘Thrombization’’ and Stabilization
in EVAR: A Technique to Reduce the Risk of Type II Endoleak
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
The document provides guidance on evidence-based practices for preventing central line-associated bloodstream infections (CLABSI), including following maximal barrier precautions during insertion, using chlorhexidine for skin preparation, avoiding the femoral site when possible, maintaining daily review of line necessity, and adhering to proper insertion and care techniques. It emphasizes that bundling these prevention strategies can significantly reduce the incidence of CLABSI and related morbidity, mortality and costs. Proper technique and team communication are important to ensure safe central line insertion and management.
This document discusses strategies for preventing catheter-related infections in hemodialysis patients. Central venous catheters are increasingly used for hemodialysis but carry a risk of infectious complications. Several preventive approaches are outlined, including universal precautions, sutureless securement devices, topical antiseptic ointments at exit sites, antimicrobial locking solutions, needleless connectors, and coated catheters. Proper hand hygiene and skin cleansing are also emphasized. Sutureless devices and antimicrobial locks may help reduce infections, but evidence on other strategies like chlorhexidine dressings is less clear. Overall prevention requires a multifaceted approach.
This document discusses a prototype technology called CoVa that uses capnography to detect increased carbon dioxide levels after injecting sodium bicarbonate intravenously. This allows clinicians to confirm correct placement of intravenous catheters. The technology has been tested on 200 patients in a phase 3 clinical trial with statistically significant results. It could help prevent complications from malpositioned catheters like extravasation and infiltration, which are common problems that result in high costs to hospitals. Regulatory approval pathways are straightforward and initial development costs are estimated at $500,000 over 2 years to start sales.
Peripheral venous catheters (PVCs) are commonly used to deliver intravenous therapy, but are associated with complications like infection and phlebitis. It is estimated that one in three hospital patients have a PVC inserted at any given time. Careful observation and monitoring of PVC sites, along with strict hygiene practices during insertion and maintenance, are essential to minimize risks and quickly identify any complications. PVCs should be removed as soon as they are no longer clinically necessary to reduce health risks.
Salon 2 14 kasim 15.30 17.00 duygu sönmez düzkaya-ing1tyfngnc
This study compared the efficacy of chlorhexidine-impregnated dressings to standard dressings in preventing central venous catheter-associated bloodstream infections in a pediatric intensive care unit. The randomized controlled study involved 100 patients, with 50 receiving chlorhexidine dressings and 50 receiving standard dressings. The rates of catheter colonization, local catheter infection, and catheter-related bloodstream infection were all lower in the chlorhexidine group compared to the standard group, though the differences were not statistically significant. The study concluded that chlorhexidine dressings may reduce infection risks and recommends their use in pediatric intensive care units.
This document discusses the issues with current intravenous cannulation procedures and introduces a new cannulation device called the U-Cannula. It notes that current cannulation techniques often require multiple puncture attempts, which increases trauma, risk of infection, and healthcare costs. The U-Cannula aims to address this by using an introducer strap to smoothly guide the cannula into place in one attempt. Clinical studies found the U-Cannula successful in 94% of first attempts compared to average attempts of 2.48 for standard cannulas. While the concept has support from doctors, major manufacturers have been reluctant due to concerns it could reduce skills or increase costs. The document argues the U-Cannula could help reduce infection
Healthcare-associated infections affect millions of hospital patients each year, causing prolonged hospital stays, increased costs, and preventable deaths. Urinary tract infections are the most common type of healthcare-associated infection, with catheter-associated UTIs accounting for the majority. Inserting and leaving urinary catheters in place when not medically necessary can increase infection risks. Proper training of staff, following guidelines for catheter insertion and maintenance, and removing catheters as soon as possible can help reduce unnecessary catheter use and prevent catheter-associated UTIs.
Ianchulev Office-Based Cataract Surgery Ophthalmology 2016Mark Packer
This study analyzed over 21,000 office-based cataract surgeries performed between 2011-2014 to evaluate safety and effectiveness outcomes. Key findings include:
1) Post-operative visual acuity was excellent, with a mean of 20/28.
2) Intraoperative complications like capsule tears and vitreous loss occurred in 0.55% and 0.34% of cases respectively.
3) Postoperative adverse events like iritis and corneal edema each affected around 1-2% of cases. No cases of endophthalmitis were reported.
Second surgeries were required in 0.70% of cases within 6 months. The study found office-based cataract
This study compared the efficacy of a topical tranexamic acid pack versus a hot saline pack for hemorrhage control following adenoidectomy. 180 patients were randomly assigned to receive one of the two packs or no pack following surgery. Results found that the tranexamic acid pack was more effective, achieving hemostasis faster with fewer additional procedures compared to the hot saline pack. There was also less postoperative bleeding in the tranexamic acid group. The study concluded that a topical tranexamic acid pack is more effective for post-adenoidectomy hemostasis than a hot saline pack.
Optical sensing techniques for quality control of cathetersmbaltazar
This document discusses using optical spectroscopy techniques like reflectance spectroscopy for quality control testing of antimicrobial coatings on catheters. It describes how one catheter manufacturer is using an Ocean Insight spectrometer setup to measure coating concentration and uniformity onsite, providing a faster and less destructive alternative to traditional HPLC testing. The spectrometer measurements showed high correlation to HPLC results, demonstrating its effectiveness for ensuring catheter coating quality meets standards. Preventing device infections is important for patient safety and reducing healthcare costs.
Anastomotic dehiscence after colorectal surgeryKETAN VAGHOLKAR
Anastomotic dehiscence after colorectal surgery can have disastrous consequences. Various factors determine the
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in this article.
This document discusses proper vascular access device care and prevention of catheter-related infections. It emphasizes that standardization of care practices like hand hygiene, maximal barrier precautions during insertion, and disinfecting catheter hubs can significantly reduce infections. It also explains the risks of biofilm formation on devices and how microbes within biofilms are highly resistant to antibiotics. Education of healthcare workers and patients on infection prevention is vital to improving outcomes.
This document provides information about sialadenoscopy, a procedure using a flexible endoscope to examine and treat conditions within the salivary glands and ducts. It describes the sialoscope device, which has a small diameter and channels for a camera, irrigation, and working instruments. The technique involves identifying the duct opening, dilating it, inserting the scope, and using irrigation to extend to the gland hilum while diagnosing and potentially treating issues like stones or strictures. Complications can include duct strictures, bleeding, or ranulas, but the procedure allows diagnosis and treatment of various intraductal and intra-glandular pathologies as an alternative to gland excision in many cases.
Vascular graft infection do we need antimicrobial graftsuvcd
Vascular graft infections pose serious risks and costs. Preventing surgical site infections is a high priority. While various preventive measures have been attempted, graft infections still occur. New antimicrobial grafts containing combinations of agents like silver acetate and triclosan show promise in inhibiting early microbial colonization based on in vitro studies, but more research is needed to determine their efficacy in preventing infections in vivo. Antimicrobial grafts may help reduce the morbidity, mortality, and economic burden of vascular graft infections if shown to be effective through further investigation.
Pterygium Excision with Free Conjunctival Limbal Autograftiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Jourding-Etiology and prognosis of canalicular.pptxShaliNovizar1
This study aimed to assess whether there is a correlation between objective improvement in visual acuity measured using high contrast visual acuity charts and subjective improvement in quality of life measured using a low vision quality of life questionnaire in patients with low vision. The study found that while both objective visual acuity and subjective quality of life scores improved with the use of low vision aids, there was no statistical correlation found between the improvements in these two measures. The results provide insight into the relationship between objective and subjective measures of vision improvement in low vision patients.
This document provides instructions for central venous catheterization of the subclavian vein. It describes the indications, contraindications, necessary equipment, patient preparation, ultrasound guidance, procedure steps, potential complications, and references for central venous catheterization of the subclavian vein. The subclavian vein is the preferred site according to recent evidence. Ultrasound can help with placement despite bony landmarks. Key steps include identifying anatomic landmarks, local anesthesia, inserting the needle at a 30 degree angle, obtaining venous access, introducing the guidewire, dilating the vein, advancing the catheter over the wire, and securing the line. Potential complications include pneumothorax, hemothorax, and infection.
The document discusses surgical site infections (SSIs), including:
1. SSIs are defined as infections occurring within 30 days of surgery or 1 year if an implant is placed. Common types are superficial and deep incisional infections.
2. SSIs are among the most common and costly healthcare-associated infections, with incidence higher following some orthopedic procedures.
3. Risk factors for SSIs include patient characteristics like diabetes as well as surgical factors like prolonged operating time and implant use. Proper prevention techniques can help reduce SSI risk.
4. Diagnosis involves clinical presentation as well as microbiological and histological testing. Treatment depends on infection severity but often involves wound opening, debride
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
All scientific theories must be able to make testable predictions. S.docxoreo10
The document discusses the concepts of phyletic gradualism and punctuated equilibrium, two theories of how evolution occurs. Punctuated equilibrium predicts a fossil record with long periods of little change punctuated by short periods of rapid evolution. It suggests rapid evolution is driven by environmental pressures while periods of stasis are due to stabilizing evolutionary factors. The debate between these two theories continues as evidence both supports gradual evolution as well as punctuated periods of rapid change throughout the fossil record.
All I wnat is to write a reflection paper on my project which is hac.docxoreo10
All I wnat is to write a reflection paper on my project which is hacking tools
My project is about using those 5 tools :
1-
Ice Hole for
Phishing
2-
SocialKlepto for
Social
3-
SmartphonePF and
Mactans
for Mobile
4-
Hping and
Yersinia for networks
5-
LCP and
Cain and Abel for
PasswordCracking
.
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Peripheral venous catheters (PVCs) are commonly used to deliver intravenous therapy, but are associated with complications like infection and phlebitis. It is estimated that one in three hospital patients have a PVC inserted at any given time. Careful observation and monitoring of PVC sites, along with strict hygiene practices during insertion and maintenance, are essential to minimize risks and quickly identify any complications. PVCs should be removed as soon as they are no longer clinically necessary to reduce health risks.
Salon 2 14 kasim 15.30 17.00 duygu sönmez düzkaya-ing1tyfngnc
This study compared the efficacy of chlorhexidine-impregnated dressings to standard dressings in preventing central venous catheter-associated bloodstream infections in a pediatric intensive care unit. The randomized controlled study involved 100 patients, with 50 receiving chlorhexidine dressings and 50 receiving standard dressings. The rates of catheter colonization, local catheter infection, and catheter-related bloodstream infection were all lower in the chlorhexidine group compared to the standard group, though the differences were not statistically significant. The study concluded that chlorhexidine dressings may reduce infection risks and recommends their use in pediatric intensive care units.
This document discusses the issues with current intravenous cannulation procedures and introduces a new cannulation device called the U-Cannula. It notes that current cannulation techniques often require multiple puncture attempts, which increases trauma, risk of infection, and healthcare costs. The U-Cannula aims to address this by using an introducer strap to smoothly guide the cannula into place in one attempt. Clinical studies found the U-Cannula successful in 94% of first attempts compared to average attempts of 2.48 for standard cannulas. While the concept has support from doctors, major manufacturers have been reluctant due to concerns it could reduce skills or increase costs. The document argues the U-Cannula could help reduce infection
Healthcare-associated infections affect millions of hospital patients each year, causing prolonged hospital stays, increased costs, and preventable deaths. Urinary tract infections are the most common type of healthcare-associated infection, with catheter-associated UTIs accounting for the majority. Inserting and leaving urinary catheters in place when not medically necessary can increase infection risks. Proper training of staff, following guidelines for catheter insertion and maintenance, and removing catheters as soon as possible can help reduce unnecessary catheter use and prevent catheter-associated UTIs.
Ianchulev Office-Based Cataract Surgery Ophthalmology 2016Mark Packer
This study analyzed over 21,000 office-based cataract surgeries performed between 2011-2014 to evaluate safety and effectiveness outcomes. Key findings include:
1) Post-operative visual acuity was excellent, with a mean of 20/28.
2) Intraoperative complications like capsule tears and vitreous loss occurred in 0.55% and 0.34% of cases respectively.
3) Postoperative adverse events like iritis and corneal edema each affected around 1-2% of cases. No cases of endophthalmitis were reported.
Second surgeries were required in 0.70% of cases within 6 months. The study found office-based cataract
This study compared the efficacy of a topical tranexamic acid pack versus a hot saline pack for hemorrhage control following adenoidectomy. 180 patients were randomly assigned to receive one of the two packs or no pack following surgery. Results found that the tranexamic acid pack was more effective, achieving hemostasis faster with fewer additional procedures compared to the hot saline pack. There was also less postoperative bleeding in the tranexamic acid group. The study concluded that a topical tranexamic acid pack is more effective for post-adenoidectomy hemostasis than a hot saline pack.
Optical sensing techniques for quality control of cathetersmbaltazar
This document discusses using optical spectroscopy techniques like reflectance spectroscopy for quality control testing of antimicrobial coatings on catheters. It describes how one catheter manufacturer is using an Ocean Insight spectrometer setup to measure coating concentration and uniformity onsite, providing a faster and less destructive alternative to traditional HPLC testing. The spectrometer measurements showed high correlation to HPLC results, demonstrating its effectiveness for ensuring catheter coating quality meets standards. Preventing device infections is important for patient safety and reducing healthcare costs.
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This document discusses proper vascular access device care and prevention of catheter-related infections. It emphasizes that standardization of care practices like hand hygiene, maximal barrier precautions during insertion, and disinfecting catheter hubs can significantly reduce infections. It also explains the risks of biofilm formation on devices and how microbes within biofilms are highly resistant to antibiotics. Education of healthcare workers and patients on infection prevention is vital to improving outcomes.
This document provides information about sialadenoscopy, a procedure using a flexible endoscope to examine and treat conditions within the salivary glands and ducts. It describes the sialoscope device, which has a small diameter and channels for a camera, irrigation, and working instruments. The technique involves identifying the duct opening, dilating it, inserting the scope, and using irrigation to extend to the gland hilum while diagnosing and potentially treating issues like stones or strictures. Complications can include duct strictures, bleeding, or ranulas, but the procedure allows diagnosis and treatment of various intraductal and intra-glandular pathologies as an alternative to gland excision in many cases.
Vascular graft infection do we need antimicrobial graftsuvcd
Vascular graft infections pose serious risks and costs. Preventing surgical site infections is a high priority. While various preventive measures have been attempted, graft infections still occur. New antimicrobial grafts containing combinations of agents like silver acetate and triclosan show promise in inhibiting early microbial colonization based on in vitro studies, but more research is needed to determine their efficacy in preventing infections in vivo. Antimicrobial grafts may help reduce the morbidity, mortality, and economic burden of vascular graft infections if shown to be effective through further investigation.
Pterygium Excision with Free Conjunctival Limbal Autograftiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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This study aimed to assess whether there is a correlation between objective improvement in visual acuity measured using high contrast visual acuity charts and subjective improvement in quality of life measured using a low vision quality of life questionnaire in patients with low vision. The study found that while both objective visual acuity and subjective quality of life scores improved with the use of low vision aids, there was no statistical correlation found between the improvements in these two measures. The results provide insight into the relationship between objective and subjective measures of vision improvement in low vision patients.
This document provides instructions for central venous catheterization of the subclavian vein. It describes the indications, contraindications, necessary equipment, patient preparation, ultrasound guidance, procedure steps, potential complications, and references for central venous catheterization of the subclavian vein. The subclavian vein is the preferred site according to recent evidence. Ultrasound can help with placement despite bony landmarks. Key steps include identifying anatomic landmarks, local anesthesia, inserting the needle at a 30 degree angle, obtaining venous access, introducing the guidewire, dilating the vein, advancing the catheter over the wire, and securing the line. Potential complications include pneumothorax, hemothorax, and infection.
The document discusses surgical site infections (SSIs), including:
1. SSIs are defined as infections occurring within 30 days of surgery or 1 year if an implant is placed. Common types are superficial and deep incisional infections.
2. SSIs are among the most common and costly healthcare-associated infections, with incidence higher following some orthopedic procedures.
3. Risk factors for SSIs include patient characteristics like diabetes as well as surgical factors like prolonged operating time and implant use. Proper prevention techniques can help reduce SSI risk.
4. Diagnosis involves clinical presentation as well as microbiological and histological testing. Treatment depends on infection severity but often involves wound opening, debride
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
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2-
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Eliminate
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planning and implementing
a program that will address reduction in exposure of the community, particularly children, to air pollution and thereby reducing the impact of air pollution in the community.
Write a 2-3 page paper in which you do the following:
1. Describe the common health problems associated with
indoor and outdoor air pollution
in urban settings.
2. Describe why children are more vulnerable to the effects of air pollutants.
3. Describe how you (as a Health Educator and consultant in this multi-disciplinary team), would assist the nurse to
plan and implement
a program that will reduce the exposure of this community to air pollution as well as reduce the impact of air pollution on the health of children. In your response, make sure to include preventive steps that can be taken by the community (home and school, for example) to reduce the exposure of children to air pollutants.
.
After your topic has been approved, the next step is to research.docxoreo10
After your topic has been approved, the next step is to research current articles and publications (within one year) and write an outline. You will need to use at least six credible sources that provide objective, authoritative, and accurate descriptions of your selected microeconomics topic. Two of your sources must be from academic journals. Your sources can include the following:
Academic journals
Financial and economic publications like the Wall Street Journal, the Economist, and industry-specific publications
Newspapers such as the New York Times and the Washington Post
Research databases like ProQuest
Use the
Hunt Library (Links to an external site.)
to conduct your research. Do not use Investopedia or Wikipedia.
You may write a formal outline or present your information in paragraph form using current APA formatting. Regardless of the outline format, you must provide the following:
Details that align with your microeconomics topic
List of your sources
Two of the sources must be from academic journals.
.
After watching three of the five movie clips listed in the Multime.docxoreo10
After watching three of the five movie clips listed in the
Multimedia
section, above, describe how they fit into a specific genre (or subgenre) as explained in the text. What elements of the film are characteristic of that genre? How does it fulfill the expectations of that genre? How does it play against these expectations?
.
Aging and Disability WorksheetPart IIdentify 2 or .docxoreo10
Aging and Disability Worksheet
Part I
Identify 2 or 3 issues faced by the aging population.
1.
2.
3.
Answer the following questions in 100 to 200 words each
.
Provide citations for all
the
sources
you use
.
·
What is ageism? How does ageism influence the presence of diversity in society?
·
What is the
Age
Dis
criminitation in Employment
Act (AD
E
A)? How does the AD
E
A address issues for the aging population?
·
What is being done to address the issues you identified?
·
Is the number of aging population expected to rise in numbers or decrease?
·
What types of legislation may or may not be affected by the aging population?
·
How does poverty affect the aging population?
Part II
Answer the following questions in 100 to 200 words each
.
Provide citations for all
the
sources
you use
.
·
What does the ADA provide for people with disabilities?
·
How have people with disabilities been treated in the past?
·
How has the attitude toward people with disabilities changed over time?
·
What are some unique circumstances or issues encountered by people with disabilities?
·
What is being done to address those issues?
·
What types of legislation have been introduced to address issues faced by people with disabilities?
.
After watching the video and reading the Web Resource, CDC Autism .docxoreo10
After watching the video and reading the Web Resource, "CDC: Autism Spectrum Disorders: Signs and Symptoms," discuss how you as an early childhood professional can use this information to increase awareness and early identification of autism, specifically discussing assessment tools that can be used with children with autism.
.
AI Artificial Intelligence1Reading responsePeter .docxoreo10
AI: Artificial Intelligence
1
Reading response
Peter Dormer, “Craft and the Turing Test for Practical Thinking,” in The Challenge of Technology.
What is personal know-how? What is distributed knowledge?
How do they relate to the Turing test?
Give one example of your own how these concepts matter today to artists and makers, or better yet, in your own experience?
Journal homework
Keep a record (text and drawings) of events in daily life where human and machine intersect and interact. Fill at least two pages with your observations.
Mary Shelley, Frankenstein, or The Modern Prometheus, 1818
Boris Karloff in Frankenstein in 1931 directed by James Whale
Mary Shelley first published Frankenstein, or the Modern Prometheus 1818. the novel allegorizes the Romantic obsession with discovering the power or principle of life. Ideas about a life power were consistent with the scientific understanding of the day. Darwin himself spoke of an organizing “spirit of animation” in his Zoonomia; or, The Laws of Organic Life, in which he stated “the world itself might have been generated, rather than created.”
Dr. Frankenstein picked all the parts for his monster based on their beauty, but when it comes to life, the monster is unbearably ugly. “I had worked hard for nearly two years, for the sole purpose of infusing life into an inanimate body…the beauty of the dream vanished, and breathless horror and disgust filled my heart. Unable to endure the aspect of the being I had created, I rushed out of the room”.
4
Two definitions of AI:
“The use of computer programs and programming techniques to cast light on the principles of intelligence in general and human thought in particular.
--Margaret Boden
“The science of making machines do things that would require intelligence if done by humans.”
-Marvin Minsky
BOTH OF THESE STATEMENTS ORIGINATE IN ALAN TURING’S FIRST COMPUTER SCIENCE ARTICLE
Working assumption: all cognition is computable
Question:
Is what’s not yet known to be computable actually computable?
if so, then what?
if not, why not, and what does that tell us about cognition?
7
Who was Alan Turing?
B. 1912 London, attended King’s College, Cambridge and Princeton University. He studied mathematics and logic (he hadn’t invented computer science yet)
At 23, he invented the “Turing machine” and published “On Computable Numbers in 1936, the first and most important paper in comp. sci.
During WWII, solved the German Enigma code by use of electromechanical devices—a precursor to the computer
Laid the foundation for major subfields of comp sci: theory of computation, design of hardware and software, and the study of artificial intelligence
“The Imitation Game,”
aka
“The Turing Test”
In 1950, Turing posited a way to test machine intelligence: a person in a room before a screen. S/he would correspond with two agents and based on their responses, decide which was a machine and which was human. If the machine can pass fo.
Agree or disagree with, and discuss the following statement Corp.docxoreo10
Agree or disagree with, and discuss the following statement: "Corporate intelligence is not corporate espionage because 95 percent of the information a company needs to make strategic decisions is available and accessible to the public." Explain your rationale.
Your response should be at least 200 words in length. All sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations.
David, F. (2011). 1.
Strategic management: concepts & cases
(Custom Edition ed., pp. 72-74). New York: McGraw-Hill Irwin.
No Wiki, Dictionary.com or Plagiarism
.
After watching Reactions to an Impending Death Sentence and Ti.docxoreo10
After watching
Reactions to an Impending Death Sentence
and
Ties That Bind
, discuss the impact of our various relationships with those who are dying on how death impacts us. For example, how would you relate to a dying child, adult or older adult when they are dying? How would you relate to those left behind: parents, siblings, children, grandchildren, spouse? How do you feel about your own death? Discuss these questions in 250 – 300 words
.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
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Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
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THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx
1. THE PRACTICE OF EMERGENCY MEDICINE/ORIGINAL
RESEARCH
196 Ann
Skin Glue Reduces the Failure Rate of Emergency
Department–Inserted Peripheral Intravenous Catheters:
A Randomized Controlled Trial
Simon Bugden, MBChB, FACEM*; Karla Shean, RN; Mark
Scott, MBBS, FACEM; Gabor Mihala, MEng(Mech),
GradCert(Biostatistics);
Sean Clark, MBBS, FACEM; Christopher Johnstone, MBChB,
FACEM; John F. Fraser, MD, PhD; Claire M. Rickard, PhD, RN
*Corresponding Author. E-mail: [email protected]
Study objective: Peripheral intravenous catheters are the most
common invasive device in health care yet have very
high failure rates. We investigate whether the failure rate could
be reduced by the addition of skin glue to standard
peripheral intravenous catheter care.
Methods: We conducted a single-site, 2-arm, nonblinded,
randomized, controlled trial of 380 peripheral intravenous
catheters inserted into 360 adult patients. The standard care
group received standard securement. The skin glue group
received standard securement plus cyanoacrylate skin glue
applied to the skin insertion site. The primary outcome was
peripheral intravenous catheter failure at 48 hours, regardless of
cause. Secondary outcomes were the individual
modes of peripheral intravenous catheter failure: infection,
3. but also micromotion, leading to vein irritation (phlebitis
or occlusion) and entry of skin bacteria into the entry
site (infection).3 Peripheral intravenous catheter failure
frequently occurs after 48 hours postinsertion, suggesting
that improvements in securement can be targeted at this
timeframe. Borderless polyurethane transparent dressings
als of Emergency Medicine
have typically been used to secure peripheral intravenous
catheters, although alternative products such as cloth-
bordered polyurethane dressings and commercial
securement devices are becoming more prevalent. Despite
this, a recent Cochrane review concluded that there is a
lack of high-quality evidence and continued uncertainty
about the best methods to dress and secure peripheral
intravenous catheters.3
A novel approach for improved peripheral intravenous
catheter fixation is the use of medical-grade skin glue
(cyanoacrylate) at the insertion site. Skin glue has been
reported to be effective for securing central venous,
epidural, and peripheral arterial catheters, with improved
fixation compared with standard polyurethane dressings.4-8
The arterial catheter failure rate was reported in 2
randomized pilot studies to decrease from 21% to 11%7
and from 20% to 6%8 when skin glue was used. A pilot
Volume 68, no. 2 : August 2016
mailto:[email protected]
https://www.surveymonkey.com/r/HXC988P
http://www.annemergmed.com
http://annemergmed.com/content/podcast
http://www.annemergmed.com
http://dx.doi.org/10.1016/j.annemergmed.2015.11.026
http://crossmark.crossref.org/dialog/?doi=10.1016/j.annemergm
4. ed.2015.11.026&domain=pdf
Bugden et al Skin Glue to Reduce Insertion Failure Rates of
Peripheral Intravenous Catheters
Editor’s Capsule Summary
What is already known on this topic
Peripheral intravenous catheters are commonly
inserted in the emergency department (ED) but often
fail later from dislodgement, phlebitis, or other
causes.
What question this study addressed
Does the use of a skin adhesive glue to secure a
peripheral intravenous line improve failure rates
compared with standard securing measures?
What this study adds to our knowledge
In this randomized trial of 380 intravenous line ED
insertions, addition of skin adhesive glue decreased
catheter dislodgement (7% less) and overall failure
(10% less) at 48 hours compared with standard
approaches, and without harm.
How this is relevant to clinical practice
Adding a drop of adhesive helps peripheral
intravenous catheter stabilization, though the cost-
effectiveness depends on the adhesive chosen.
study of peripheral intravenous catheters inserted in a
ward setting showed a reduction in failure rates from 38%
to 14%.9 In addition, cyanoacrylate has antimicrobial
properties; in vitro testing shows direct inhibition of
Gram-positive organisms, suggesting potential benefit in
preventing infection.6,10 A large trial in an ED setting,
5. comparing skin glue with the current best evidence
comparator, was needed to clarify the potential role of skin
glue with peripheral intravenous catheters.
Importance
Peripheral intravenous catheter failure is associated with
disruption to therapy such as hydration, antibiotics, and
analgesia, as well as the increased cost, anxiety, and
discomfort of reinsertion. Costs to the health system include
increased staff time, consumables, hospital length of stay,
and adverse event management. Given that more than
100 million peripheral intravenous catheters are inserted
every year in the United States alone, a small reduction in
device failure will translate to a large improvement in care,
outcomes, flow, and costs.1 Systemic sepsis caused by
peripheral intravenous catheter infection occurs in less
than 0.1% of peripheral intravenous catheters, but the
subsequent effect on morbidity, mortality, and hospital
costs is large, such that small reductions in these infections
are important.11,12
Volume 68, no. 2 : August 2016
Goals of This Investigation
We hypothesized that the addition of skin glue to the
insertion site of peripheral intravenous catheters in the ED
would reduce the device failure rate at 48 hours.
MATERIALS AND METHODS
Study Design and Setting
We conducted a single-site, 2-arm, nonblinded,
randomized, controlled trial of superiority from November
2012 to March 2013. Enrollment was rapid initially and
at the end of this period but was halted in between by a
funding interruption. Caboolture Hospital is a 160-bed
community hospital 50 km north of Brisbane, with 52,000
6. ED presentations annually. Approval was obtained from
the hospital human research ethics committee before
commencement, and the trial was prospectively registered
withthe Australian and New Zealand Clinical Trials Registry.
Selection of Participants
Screening of eligible patients by one of 3 trained ED
research nurses occurred 16 hours per day, 7 days a week.
Screening took place only after a patient was identified
as requiring hospital admission to exclude those being
discharged home from the ED. Patients were eligible for
enrollment if they were aged 18 years or older, had a patent
upper limb peripheral intravenous catheter inserted through
healthy intact skin by an emergency physician or ED nurse,
and gave written informed consent. Peripheral intravenous
catheter patency was confirmed by a 10-mL 0.9% saline
solution flush. Exclusion criteria were known allergy or
irritation to skin glue or standard peripheral intravenous
catheter securement material; presence of infection near the
peripheral intravenous catheter, upper limb phlebitis, or
venous thrombosis; high likelihood of intentional peripheral
intravenous catheter removal (eg, agitated patients); and
non–English-speaking patients without an interpreter.
Interventions
All patients had their preexisting peripheral intravenous
catheter dressing and anchoring tapes carefully removed by
the research nurse. Patients were then randomized with
Randomizer for Clinical Trials software (Medsharing,
Fontenay-sous-Bois,France)ina1:1ratio,withnoblockingor
stratification, to either standard peripheral intravenous
catheter securement (standard care group) or standard
peripheral intravenous catheter securement plus the addition
ofskin gluetotheperipheral intravenouscatheterinsertion site
7. (skin glue group).
Patients in the standard care group received peripheral
intravenous catheter securement with cloth-bordered
Annals of Emergency Medicine 197
Figure 2. Application of skin glue: 1 drop to the skin insertion
site and 1 drop under the peripheral intravenous catheter hub.
Table 1. Patient and PIVC characteristics.
Number of Patients (n[360) Standard Care 184 Skin Glue 176
Age, mean, y 57 60
Women 83 82
Immunosuppressed 1 1
Anticoagulated 14 19
Skin Glue to Reduce Insertion Failure Rates of Peripheral
Intravenous Catheters Bugden et al
transparent polyurethane dressing and tape (Tegaderm IV
Transparent Film Dressing 1633; 3M, St Paul, MN). The
dressing was labeled with the time, date, and study name
(Figure 1).
Patients in the skin glue group received 1 drop of
cyanoacrylate glue (single-use Histoacryl; B Braun,
Melsungen, Germany) at the peripheral intravenous
catheter skin insertion site and 1 drop under the
peripheral intravenous catheter hub (Figure 2; Video 1,
available online at https://youtu.be/DEW8mNLzw8A).
The glue was allowed to dry (<30 seconds), and then
peripheral intravenous catheter tape and dressing were
applied in a manner identical to that for the standard care
8. group. Blinding was not possible because of the subtle
glue color and appearance present at intervention and
follow-up.
Methods of Measurement
All peripheral intravenous catheters were BD Insyte
Autoguard (Becton Dickinson & Company, Franklin
Lakes, NJ), inserted after skin cleansing with Solu-I.V.
swabs (2% chlorhexidine, 70% alcohol; Solumed, Quebec,
Canada). Ongoing care of the peripheral intravenous
catheter was in accordance with the Queensland
Department of Health state guideline.13 Skin glue was
easily removed before peripheral intravenous catheter
removal by use of commercial adhesive removal wipes
(Uni-Solve; Smith & Nephew, Hull) (Video 2, available
online at https://youtu.be/_LJ5YzL3sXc).
Baseline demographic and possible confounder details
were collected at enrollment (Table 1). Anticoagulation
was defined as the use of warfarin or novel oral
anticoagulants. Antibiotic use included any oral or
intravenous antibiotics administered from the day
Figure 1. Securement with transparent cloth-bordered
polyurethane dressing and tape applied to all study
participants.
198 Annals of Emergency Medicine
preceding enrollment through follow-up at 48 hours.
Immunosuppression was defined as the presence of words
related to “neutropenia” or “immunosuppression” in the
clinical record.
Outcome Measures
The primary outcome was peripheral intravenous
9. catheter failure at 48 hours, defined as a composite of one
or more of infection, phlebitis, occlusion, or dislodgement.
This composite outcome was considered the most
meaningful from the patient’s perspective because he or she
is concerned more with the fact that the device failed than
Antibiotics 58 61
INR �1.5 0 2
Number of PIVCs (n¼380) 195 185
Right side of body 118 91
Inserted by physician 128 137
Insertion site
Antecubital 119 96
Dorsum of hand 54 52
Forearm 22 37
PIVC gauge
14 0 2
16 1 0
18 54 47
20 128 120
22 5 9
24 7 7
Hours from insertion to
intervention, median
3.8 3.6
Hours from intervention
to follow-up, median
47 48
INR, International normalized ratio; PIVC, peripheral
intravenous catheter.
Volume 68, no. 2 : August 2016
10. https://youtu.be/DEW8mNLzw8A
https://youtu.be/_LJ5YzL3sXc
Enrollment
Figure 3. Tracking of study devices.
Table 2. Results of primary and secondary outcomes.
Standard Care, Skin Glue, Difference
Bugden et al Skin Glue to Reduce Insertion Failure Rates of
Peripheral Intravenous Catheters
how it failed. Consistent with related studies, the following
definitions were applied: infection, clinical impression of
cellulitis or pus at the peripheral intravenous catheter site;
phlebitis, 2 or more symptoms of pain, redness, swelling, or
palpable venous cord; occlusion, inability to flush 10 mL of
0.9% saline solution or history of peripheral intravenous
catheter removed because “it was not working”; and
dislodgement, subcutaneous extravasation or history of “it
fell out.”14,15 Outcomes were assessed by the research nurses
either in person (if the patient was still in the hospital) or by
telephone if the patient was already discharged (no direct
visualization possible) at 48 hours or more after enrollment
(Table 1).16 Replacement of the peripheral intravenous
catheter during the initial 48 hours for any reason was
considered a device failure. Secondary outcomes were the
individual modes of peripheral intravenous catheter failure:
infection, phlebitis, occlusion, and dislodgement. These
were identified by a combination of direct visualization,
chart review, and standard patient questionnaire.
No. (%) No. (%) (95% CI), %
Primary outcome
11. PIVC failure 52 (27) 31 (17) –10 (–18 to –2)
Secondary outcomes
Infection 0 0 0
Phlebitis 9 (5) 6 (3) –1 (–5 to 3)
Occlusion 20 (11) 15 (8) –2 (–8 to 4)
Dislodgement 26 (14) 13 (7) –7 (–13 to 0)
CI, Confidence interval.
Primary Data Analysis
The sample size of 174 patients per group was
determined by assuming a single peripheral intravenous
catheter per patient and hypothesizing rates of 11%
and 4% peripheral intravenous catheter failure in the
control and intervention groups, respectively, with 80%
power (a¼.05). All data were entered directly into a
Volume 68, no. 2 : August 2016
portable tablet at collection (iPad; Apple, Cupertino, CA)
with Form Connect software (v1.5.4; Form Connections,
Laguna Niguel, CA) and then exported into Stata
(version 12.1; StataCorp, College Station, TX). Peripheral
intravenous catheter devices were the unit of measurement
and analysis was by intention to treat. Time until
intervention was calculated as the time from original
peripheral intravenous catheter insertion until application
of study peripheral intravenous catheter dressing.
Given the low rate of loss to follow-up (2.8% per device;
0.83% per patient) and similar occurrence in both groups,
only those devices or patients with complete outcome data
were included in the analyses. Absolute differences of
outcome rates were calculated with 95% confidence
intervals. Statistical significance was declared at P<.05.
Given that there were multiple devices observed for
12. some patients, per-patient analyses were also undertaken
according to the patient’s first peripheral intravenous
catheter.
RESULTS
Characteristics of Study Subjects
A totalof380peripheral intravenous catheter devices (360
patients) were both enrolled and allocated. There was no
discontinuation or crossover, 11 patients were lost to follow-
up, and data for 369 patients were analyzed (Figure 3).
Main Results
Peripheral intravenous catheter failure was 17% in
the skin glue group versus 27% with standard care
(D¼–10%; 95% confidence interval –18% to –2%;
P¼.02). The secondary outcome of peripheral intravenous
catheter failure by dislodgement was 7% less frequent (95%
confidence interval –13% to 0) in the skin glue group
(7.0%) versus standard care (14%). Peripheral intravenous
catheter failure by phlebitis and occlusion were similar in
both groups. There were no peripheral intravenous catheter
failures caused by infection (Table 2).
Annals of Emergency Medicine 199
Skin Glue to Reduce Insertion Failure Rates of Peripheral
Intravenous Catheters Bugden et al
The per-patient analysis yielded similar results for both
the primary and secondary outcomes in the skin glue
(n¼170) and standard care (n¼179) groups (infection,
phlebitis, occlusion, or dislodgement failures 28 versus 51,
infection 0 versus 0, phlebitis 5 versus 9, occlusion 14
versus 20, and dislodgement 12 versus 25).
LIMITATIONS
The randomized controlled trial design was unavoidably
13. nonblinded. Anecdotally, no patients declined the approach
for enrollment, but formal screening logs were not kept. The
data were collected at a single site with local case-mix and
procedural practices potentially influencing translatability,
although the study site ED triage practices and hospital
admission rate are consistent with national Australian
benchmarks. The use of sclerotic medications (eg, 50%
dextrose, potassium chloride), use of anticoagulants, number
of peripheral intravenous catheter accesses, and dwell time
were not measured and are potential confounders.
Average hospital length of stay is 2.7 days at our facility, so
some patients were discharged before personal review by the
research nurse. Outcome assessment for discharged patients
occurred by telephone (n¼209), including standardized
questionnaire, chart review, and discussion with ward staff,
but not direct visualization, which may have provided
different information to the inpatient assessments by
research nurses (n¼171). However, it has been previously
shown that discharged patients are successfully able to report
peripheral intravenous catheter complications.16 Failure
rates were assessed at 48 hours, not at peripheral intravenous
catheter removal. Many were removed before this time, so
observed failure rates may reflect a shorter period. Peripheral
intravenous catheter failure rates increase with dwell time17,
so outcomes beyond 48 hours are likely higher but cannot be
extrapolated from this study.
DISCUSSION
To our knowledge, this study is the first randomized
controlledtrialusing skin glue tosecureperipheral intravenous
catheters in the ED setting. The standard peripheral
intravenous catheter and ED processes, and failure rates in our
control group (28%) consistent with those in recent literature
14. (33% to 37%), suggest generalizability of the results.3
Patients in the skin glue group experienced a 10%
absolute reduction (37% relative reduction) in device
failure. This indicates a number needed to treat of 10 to
prevent 1 peripheral intravenous catheter failure. Most of
this reduction was due to a lower rate of dislodgement,
which was statistically significant (even though the study
was not powered to detect differences in secondary
200 Annals of Emergency Medicine
outcomes). The skin glue group also experienced trends
to reduction in rates of phlebitis and occlusion.
The exclusion of patients who had a high likelihood
of intentional peripheral intravenous catheter removal
(eg, agitated patients) potentially excluded patients who
may have benefited the most. This exclusion may have
underestimated the dislodgement benefit of skin glue.
The relatively short follow-up time, with many peripheral
intravenous catheters removed before 48 hours, is also
likely to have underestimated the benefit of skin glue. In
patients with longer peripheral intravenous catheter dwell
times, failure is expected to increase, with the skin glue
benefit likely to be more pronounced over time.
The technique of skin glue application is rapid and
simple to perform in a busy ED setting. Adverse skin
reactions to the glue or its removal were assessed by daily
communication with ward staff, a 24-hour telephone
reporting number, and questioning during patient follow-
up. There were no reported incidents of skin adverse
events, although there were occasional comments of a
“pulling” feeling during removal. When these occurred,
patients stated the glue dissolution wipe was applied too
briefly, or the patients had very hairy arms.
15. Significant reduction in peripheral intravenous catheter
failure rates is expected to have beneficial effects on patient
comfort and outcomes, along with hospital flow and costs.
The financial effect awaits a future cost-benefit analysis.
Considerations include skin glue cost (approximately 30%
the cost of a peripheral intravenous catheter replacement),
peripheral intravenous catheter replacement consumables
and staff time, prolonged hospital length of stay, more
intensive care for patients experiencing serious peripheral
intravenous catheter complications, peripheral intravenous
catheter complication funding penalties, and patient
complaint- or satisfaction-related costs.
In summary, this study supports the use of skin glue in
addition to standard care to reduce peripheral intravenous
catheter failure rates for adult ED patients admitted to the
hospital.
The authors acknowledge Adrian Barnett, PhD, for
statistical advice, Jenny Murfield, BSc (Hons), for article
preparation assistance, and research nurses Lynda Lange, RN,
and Annabelle Johnstone, RN.
Supervising editor: Donald M. Yealy, MD
Author affiliations: From the Department of Emergency
Medicine,
Caboolture Hospital, Queensland, Australia (Bugden, Shean,
Scott,
Clark, Johnstone); the University of Queensland, Brisbane,
Queensland, Australia (Bugden, Scott, Clark, Johnstone); the
Centre for Applied Health Economics, School of Medicine,
Menzies
Volume 68, no. 2 : August 2016
16. Bugden et al Skin Glue to Reduce Insertion Failure Rates of
Peripheral Intravenous Catheters
Health Institute Queensland, Griffith University, Logan
Campus,
Queensland, Australia (Mihala); the NHMRC Centre of
Research
Excellence in Nursing, Centre for Health Practice Innovation,
Menzies Health Institute Queensland, Griffith University,
Nathan
Campus, Brisbane, Queensland, Australia (Bugden, Fraser,
Rickard); and the Critical Care Research Group, the Prince
Charles
Hospital and University of Queensland, Brisbane, Queensland,
Australia (Bugden, Fraser, Rickard).
Author contributions: SB, JFF, and CMR conceived the study.
SB,
KS, MS, and SC designed the trial. SB and KS obtained
research
funding. SB, KS, and MS supervised the conduct of the trial and
data collection and managed the data, including quality control.
KS undertook recruitment of patients. MS and GM provided
statistical oversight and analyzed the data. CMR provided
clinical
trial advice. JFF and CMR provided research mentoring. SB
drafted
the article, and all authors contributed substantially to its
revision.
SB takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required
to
disclose any and all commercial, financial, and other
relationships
in any way related to the subject of this article as per ICMJE
17. conflict
of interest guidelines (see www.icmje.org). Research grant
funding
for the study was received from the Queensland Emergency
Medicine Research Foundation and the School of Medicine at
the
University of Queensland. Dr. Rickard’s employer has received
funding on her behalf for unrelated vascular access research
projects and professional speaker engagements from 3M, Bard,
B
Braun, Becton, Dickinson, Carefusion, and Centurion.
Publication dates: Received for publication May 25, 2015.
Revisions received October 10, 2015, and November 8, 2015.
Accepted for publication November 18, 2015. Available online
December 31, 2015.
Trial registration number: ACTRN12612001212842
REFERENCES
1. Zingg W, Pittet D. Peripheral venous catheters: an under-
evaluated
problem. Int J Antimicrob Agents. 2009;34:S38-42.
2. Limm EI, Fang X, Dendle C, et al. Half of all peripheral
intravenous lines
in an Australian tertiary emergency department are unused: pain
with
no gain? Ann Emerg Med. 2013;62:521-525.
3. Marsh N, Webster J, Mihala G, et al. Devices and dressings
to secure
peripheral venous catheters to prevent complications [review].
Cochrane Database Syst Rev. 2015;6:CD011070.
Did you k
18. Annals accepts audio and video files
Visit http://www.annemergmed.com/
Volume 68, no. 2 : August 2016
4. Wilkinson JN, Fitz-Henry J. Securing epidural catheters with
Histoacryl
glue. Anaesthesia. 2008;63:324.
5. Wilkinson JN, Sheikh N, Jayamaha J. Tissue adhesive as an
alternative
to sutures for securing central venous catheters. Anaesthesia.
2007;62:969-970.
6. Simonova G, Rickard CM, Dunster KR, et al. Cyanoacrylate
tissue
adhesives—effective securement technique for intravascular
catheters:
in vitro testing of safety and feasibility. Anaesth Intensive Care.
2012;40:460-466.
7. Edwards M, Rickard CM, Rapchuk I, et al. A pilot trial of
bordered
polyurethane dressings, tissue adhesive and sutureless devices
compared with standard polyurethane dressings for securing
short-
term arterial catheters. Crit Care Resusc. 2014;16:175-183.
8. Reynolds H, Taraporewalla K, Tower M, et al. Novel
technologies can
provide effective dressing and securement for peripheral arterial
catheters: a pilot randomised controlled trial in the operating
theatre
and the intensive care unit. Aust Crit Care. 2015;28:140-148.
9. Marsh N, Webster J, Flynn J, et al. Securement methods for
19. peripheral
venous catheters to prevent failure: a randomised controlled
pilot trial.
J Vasc Access. 2015;16:237-244.
10. Wilkinson JN, Chikhani M, Mortimer K, et al. The
antimicrobial effect of
Histoacryl skin adhesive. Anaesthesia. 2008;63:1382-1384.
11. Stuart RL, Cameron DR, Scott C, et al. Peripheral
intravenous
catheter–associated Staphylococcus aureus bacteraemia: more
than
5 years of prospective data from two tertiary health services.
Med J
Aust. 2013;198:551-553.
12. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream
infection
in adults with different intravascular devices: a systematic
reviewof 200
published prospective studies. Mayo Clin Proc. 2006;81:1159-
1171.
13. Centre for Healthcare Related Infection Surveillance and
Prevention,
Queensland Government Department of Health, Australia.
Peripheral
intravenous catheter (PIVC) guideline. 2015. Available at:
https://www.
health.qld.gov.au/publications/clinical-practice/guidelines-
procedures/
diseases-infection/governance/icare-pivc-guideline.pdf.
Accessed
December 28, 2015.
20. 14. Webster J, Clarke S, Paterson D, et al. Routine care of
peripheral
intravenous catheters versus clinically indicated replacement:
randomised controlled trial. BMJ. 2008;337:157-162.
15. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for
the prevention
of intravascular catheter–related infections. Clin Infect Dis.
2011;52:
e162-e193.
16. Rickard CM, Webster J, Wallis MC, et al. Routine versus
clinically
indicated replacement of peripheral intravenous catheters: a
randomised controlled equivalence trial. Lancet. 2012;380:
1066-1074.
17. Wallis MC, McGrail M, Webster J, et al. Risk factors for
peripheral
intravenous catheter failure: a multivariate analysis of data from
a
randomized controlled trial. Infect Control Hosp Epidemiol.
2014;35:
63-68.
now?
as ancillaries to the main article.
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23. SONM Use Only
Assessment 3: Critical Evaluation
2300 words
Weighting 50 %
Critical Evaluation Tool template (Quantitative Study)
PICO(T)
Complete this table
What is the problem/population?
What is the intervention?
What is the Comparator?
What is the primary outcome?
What are the secondaryoutcome/s?
What was the Length of Time of the intervention?
Introduction (200 words)
Model for critique
Identify other models that can be used for research critique and
appraisal.
24. Journal
Present an overview of this journal e.g. Briefly determine if it is
a highly regarded journal by impact factor, ranking or ERA
ranking. In what country is the journal published? How will this
information about the journal affect your decision when
considering using this research in practice?
Authors
Are there any authors who are experts in the field? How can you
tell? Identify the institution where the research was conducted.
How will this information about the authors affect your decision
when considering using this research in practice?
Title and Abstract(100 words)
a. Is the title of the research paper congruent with the text?
b. Were the aims and/or objectives stated? What are they?
c. Did the abstract contain information about the stages of the
research process (e.g., aims, hypothesis, research design,
sample, instruments and findings)? Explain these.
Structuring the study (300 words)
a. Is the motivation for the study demonstrated through the
literature review? Provide a summary of the
Background/literature review.
b. Is the literature cited current, relevant and comprehensive?
Are the references recent?
c. What is the recognised gap in the reviewed literature?
d. How was the investigation carried out?
e. Is the hypothesis stated?
25. f. If so, which hypothesis is stated: the scientific hypothesis or
the null hypothesis?
g. Does the hypothesis indicate that the researcher is interested
in testing for differences between groups or in testing for
relationships?
The sample (150 words)
a. Is the sample described?
b. How was the sample size determined?
Data collection (300 words)
a. How were the data collected (questionnaires or other data
collection tools)?
b. Who collected the data?
c. Are the data adequately described?
d. What is the origin of the measurement instruments?
e. Are the instruments adequately described?
f. Were the data collection instruments valid or validated?
g. Was the reliability of the measurement instruments assessed
or reported?
h. Were ethical issues discussed?
Data analysis (300 words)
(See chapter on Making Sense of Statistical Results in the
eText)
a. Was the follow-up complete enough to make the results
credible?
b. Was the assessment “blind” or masked to avoid performance
bias?
c. Are the results statistically or clinically significant?
d. Were the statistics primarily descriptive, correlational or
inferential?
e. Identify the outcome of each statistical analysis.
f. Explain the meaning of each outcome analysed.
Findings (300 words)
26. a. Were the findings expected?
b. Is there enough information present to judge the results?
c. Are the results clearly and completely stated?
d. Summarise the researcher’s report of the findings.
e. Identify any limitations in the study.
f. Were suggestions for further research made?
g. Did the researcher mention the implications of the study for
healthcare?
h. Was there sufficient information in the report to permit
replication of the study?
Conclusion (150 words)
a. What did the authors conclude was their most important
finding and what is the relevance of that finding?
Relevance to nursing practice (500 words)
Critically evaluate, with reference to a range of recent,
scholarly literature, how this research is relevant to the clinical
nursing setting using the principles of evidence based practice.
These include:
· Patient values
· Clinical expertise
· Available evidence
References
27. 1
SONM Use Only
Assessment 3: Critical Evaluation
2300words
Weighting: 50 %
The aim of this assignment is to critically evaluate a journal
article. This will provide you with the skills and knowledge to
28. be able to evaluate the quality and relevance of research so that
you can make informed decisions about applying it to practice.
This assignment addresses the following course learning
outcome/s:
1. Examine the contribution of research to evidence-based
practice;
2. Evaluate the credibility of the information provided by
research studies;
3. Demonstrate understanding of the major elements of the
research process that underpin translation to practice.
Task Description (Instructions):
For this task you need to write a 2300 word critical evaluation
report. In your report you will critically evaluate a journal
article and discuss its relevance to clinical nursing practice.
You must choose to evaluate a Randomised Controlled Trial
(see below).
For this report you must use the ‘critical evaluation tool
template’(available in the BELOW) to guide what information
to include in each section.
· MUST INCLUDE MORE THEN 11 REFERENCES(Ensure that
you use scholarly literature1 (digitised readings, research
articles, relevant Government reports and text books) that have
been published within the last 6 years.
· MUST INCLUDE INTEXT REFERENCES THROUGH OUT
YOUR WORK.
· WORD LIMIT – 2300 INCLUDING INTEXT REFERENCES
In your report you must use the following headings:
· Introduction (200 words)
· Title and Abstract (100 words)
· Structuring the Study (300 words)
· The sample (150 words)
29. · Data Collection (300 words)
· Data Analysis (300 words)
· Findings (300 words)
· Conclusion (150 words)
· Relevance to clinical nursing practice (500 words)
· You need to include a reference list(not included in word
count).
· APA 6TH EDITION REFERENCING STYLE
Case Studies – You need to choose ONE of these case studies to
evaluate in your report.
CHOICE 1: Randomised Controlled Trial, Case Study
Journal Article:
Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S.,
Johnstone, C., … Rickard, C. (2016). Skin glue reduces the
failure rate of emergency department-inserted peripheral
intravenous catheters: A randomized controlled trial. Annals of
Emergency Medicine, 68, 196–201.
http://dx.doi.org/10.1016/j.annemergmed.2015.11.026
What the study is about:
Peripheral intravenous catheters are the most commonly used
medical invasive device in hospitals today and are frequently
initiated in the emergency department. Peripheral intravenous
catheter failure frequently occurs after 48 hours post insertion,
suggesting that improvements in securement can be targeted at
this timeframe. A novel approach for improved peripheral
intravenous catheter fixation is the use of medical-grade skin
glue (cyanoacrylate) at the insertion site. Skin glue has been
reported to be effective for securing central venous, epidural,
and peripheral arterial catheters, with improved fixation
compared with standard polyurethane dressings.
Other elements:
· Ensure that you use scholarly literature1 (digitised readings,
research articles, relevant Government reports and text books)
that have been published within the last 6 years.
30. · Use academic language2 throughout.
1 Scholarly or peer-reviewed journal articles are written by
scholars or professionals who are experts in their fields, as
opposed to literature such as magazine articles, which reflect
the tastes of the general public and are often meant as
entertainment.
2 Everyday language is predominantly subjective. It is mainly
used to express opinions based on personal preference or belief
rather than evidence. Written academic English is formal. It
avoids colloquialisms and slang, which may be subject to local
and social variations. Formal language is more precise and
stable, and therefore more suitable for the expression of
complex ideas and the development of reasoned argumentation.
Formatting and Submission
Please submit your Report as ONE document that includes (in
this order):
1. Assignment Cover sheet. A merged template is available on
the Assignment Presentation Formatting Guidelines page of the
Health Writing and Referencing Guide.
2. Assignment Title Page with correct details.
3. Your report, appropriately formatted (font, line spacing,
margins, page numbers, student number etc.).
4. Reference list on a separate sheet and appropriately
formatted. This is additional to the word limit.
1