Showing posts with label mortality. Show all posts
Showing posts with label mortality. Show all posts

Wednesday, February 2, 2011

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis -- Lipitz-Snyderman et al. 342 -- bmj.com

The US Institute of Medicine highlighted the serious problem of patient safety and importance of evidence based quality improvement initiatives to reduce adverse events.1 Evidence that quality improvement initiatives intended to reduce adverse events result in a measurable impact on other important outcomes, such as mortality and length of hospital stay, is limited. Without this evidence, hospitals and healthcare payers face uncertainty about whether investment in any specific quality improvement intervention will significantly benefit patients and represent a good use of limited financial resources.

The Michigan Health and Hospital Association Keystone ICU (intensive care unit) project, developed by researchers at Johns Hopkins and undertaken by the Michigan Health and Hospital Association, about 80 of its member hospitals, and researchers at Johns Hopkins Medical Institutions, is a recent example of a successful, large scale quality improvement initiative.2 3 4 The project adopted a comprehensive approach to improving patient safety that included promoting a culture of safety, improving communication between providers, and implementing evidence based practices to reduce rates of catheter related bloodstream infections and ventilator associated pneumonia. Evidence based interventions for preventing catheter related bloodstream infections were promoting handwashing, full barrier precautions, skin antisepsis with chlorhexidine, avoiding the femoral site during catheter insertion, and removing unnecessary catheters. Interventions to prevent ventilator associated pneumonia included a mechanical ventilator “bundle” consisting of use of semirecumbent positioning, daily interruption of sedation infusions, and prophylaxis for peptic ulcer disease and deep venous thrombosis.5 The project showed that measures of culture and infection rates in the intensive care unit were substantially improved for up to 36 months after implementing the quality improvement measures.2 4 5 6

via bmj.com

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CDC Features - February is American Heart Month

About every 25 seconds, an American will have a coronary event.

Heart disease is the leading cause of death in the United States and is a major cause of disability. The most common heart disease in the United States is coronary heart disease, which often appears as a heart attack. In 2010, an estimated 785,000 Americans had a new coronary attack, and about 470,000 had a recurrent attack. About every 25 seconds, an American will have a coronary event, and about one every minute will die from one.1

The chance of developing coronary heart disease can be reduced by taking steps to prevent and control factors that put people at greater risk. Additionally, knowing the signs and symptoms of heart attack are crucial to the most positive outcomes after having a heart attack. People who have survived a heart attack can also work to reduce their risk of another heart attack or a stroke in the future. For more information on heart disease and stroke, visit CDC's Division for Heart Disease and Stroke Prevention.

Diseases and Conditions That Put Your Heart at Risk

Other conditions that affect your heart or increase your risk of death or disability include arrhythmia, heart failure, and peripheral artery disease (PAD). High cholesterol, high blood pressure, obesity, diabetes, tobacco use, unhealthy diet, physical inactivity, and secondhand smoke are also risk factors associated with heart disease. For a full list of diseases and conditions along with risk factors and other health information associated with heart disease, visit the American Heart AssociationExternal Web Site Icon.

Know Your Signs and Symptoms

Some heart attacks are sudden and intense; however, most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs

via cdc.gov

Read the full article at cdc.gov

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Andrew Lopez, RN
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Sunday, December 12, 2010

PT Perspective: Heart Disease in Women - Overshadowed and Understated|putmebacktogether.com

It’s good to be informed. As PTs, I’d add that it’s our responsibility to inform ourselves then to pass on the information to patients. I’ve come across many women, patients, and co-workers who recognize the dangers of breast cancer and the necessity of research to cure it.

Clearly, breast cancer is serious business and the stats are grim. The lifetime prevalence: 1 in 8; number of deaths per year: 40,000.
But consider this. Lung cancer claims 70,000 women a year which is more than breast, ovarian and uterine cancers combined. Of those diagnosed with lung cancer, only 1 in 8 survives.  The public consciousness seems misinformed on this.

Heart disease is another poorly understood killer. Every year, heart disease claims the lives of 500,000 women. That’s 1000% more deaths than breast cancer. People seem to think breast cancer is the biggest monster out there gobbling up women’s lives while the real boogey man disease lives in virtual anonymity.

Why does this happen? Why would such a big problem get such short shrift? Part of the problem is the stereotype that only type A men get heart attacks.  The fact is heart disease doesn’t dabble in gender politics. Whether you’re from Venus or Mars, the odds are pretty even.
If you’re a woman, your sirens should be ringing (blaring stridently; in fact), particularly if you have a family history, like to wash down your corn-fed Angus cuts with a keg of beer, and exercise by walking from the couch to the kitchen during commercial breaks. If this describes you or your patients, beware, but don’t despair.

Giving up leads to paralysis and paralysis doesn’t help. What does help is information (keeping in mind that the step after information is informed action).  Unlike breast cancer which is largely genetic and difficult to prevent (if such as word even applies), heart disease responds to the following life-saving changes:

  • Smoking cessation
  • A well-balanced diet, low in saturated and trans fat
  • Regular exercise
  • Weight loss
  • Stress reduction
  • Social support
  • Decreased alcohol consumption 
Those who campaign against breast cancer do a wonderful job of raising awareness about a terrible disease. We should applaud these efforts and replicate them with heart disease, spreading the word the way rumors spread in the girl’s middle school bathrooms across America.  First whispered conspiratorially, the message gets passed on via three very simple words: “Pass it on!”
via putmebacktogether.com

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
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Monday, October 11, 2010

A Push to Ban Soda Purchases With Food Stamps - NYTimes.com

A Push to Ban Soda Purchases With Food Stamps - NYTimes.com:"Mayor Michael R. Bloomberg sought federal permission on Wednesday to bar New York City’s 1.7 million recipients of food stamps from using them to buy soda or other sugared drinks. "The request, made to the United States Department of Agriculture, which finances and sets the rules for the food-stamp program, is part of an aggressive anti-obesity push by the mayor that has also included advertisements, stricter rules on food sold in schools and an unsuccessful attempt to have the state impose a tax on the sugared drinks."
http://www.nytimes.com/2010/10/07/nyregion/07stamps.html

About Morbid Obesity, Definition and Medical Impact:"A clear definition of morbid obesity is very important, because this definition is used to guide physicians in selection of therapy for people who are overweight. Basically, one is morbidly obese when he or she is so heavy that the fat tissue load creates (or predictably will create) other medical problems. Roughly, individuals are usually morbidly obese if their weight is more that 100 pounds in excess of the Ideal Body Weight (IBW). However a more exact (and more widely accepted) way to define morbid obesity is to use the Body Mass Index (BMI)."
CHRISTUS Santa Rosa Medical Center Tower 2
2833 Babcock Rd., Suite 415 San Antonio, TX 78229
(210) 614-3370 voice, (210) 614-6859 fax
http://www.sabariatric.com/about_morbid_obesity.php

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California, What is Morbid Obesity? Alvarado Bariatric Surgeons:"Medically, the word "morbid" means causing disease or injury. Morbid Obesity is a serious disease process, in which the accumulation of fatty tissue on the body becomes excessive, and interferes with, or injures the other bodily organs, causing serious and life-threatening health problems, which are called co-morbidities. Morbid Obesity is also called Clinically Severe Obesity, and is recognized by the consensus of medical opinion as a serious problem, a disease process. In most cases, the underlying cause is genetic -- you inherit the tendency to gain weight, and once the problem is established, there is very little that will power can do about it -- any more than a diabetic can control his blood sugar by will power."
1-800-ALVARADO (1-800-258-2723)
http://www.gastricbypass.com/WhatIsMorbidObesity.htm

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Association For Morbid Obesity Support:"Did you know that about 5 million people suffer or have suffered from morbid obesity? So far, 133551 are members of this site. Who are we? We're 20,000 tons of support. Though rapidly growing, we have a long way to go to reduce the frustration and isolation of morbid obesity. Please join us. Pre-op or post-op, this site is for you. Take a look around. Find a surgeon, insurance company, or list of local peers. Please return the favor by posting your own information here for the benefit of others. By working together, we're ganging up on ignorance and insurance discrimination and having a lot of fun in the process! Click here to sign up."
http://www.obesityhelp.com/

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Obesity Education Initiative, National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH):"The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) launched the Obesity Education Initiative (OEI) in January 1991. The overall purpose of the initiative is to help reduce the prevalence of overweight along with the prevalence of physical inactivity in order to reduce the risk of coronary heart disease (CHD) and overall morbidity and mortality from CHD."
http://www.nhlbi.nih.gov/about/oei/index.htm

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    Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, National Heart, Lung, and Blood Institute:"The National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and digestive and Kidney Diseases, released the first Federal guidelines on the identification, evaluation, and treatment of overweight and obesity. About 97 million adults in the United States are overweight or obese.
    http://www.nhlbi.nih.gov/nhlbi/cardio/obes/prof/guidelns/ob_home.htm

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    National Cholesterol Education Program:"The National Heart, Lung, and Blood Institute (NHLBI) launched the National Cholesterol Education Program (NCEP) in November 1985. The goal of the NCEP is to contribute to reducing illness and death from coronary heart disease (CHD) in the United States by reducing the percent of Americans with high blood cholesterol."
    http://www.nhlbi.nih.gov/nhlbi/othcomp/opec/ncep/ncedirectpatientcare.htm

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Understanding Adult Obesity, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health:"What is obesity? How is obesity measured? Body Mass Index Body Fat Distribution: "Pears" vs. "Apples" Causes of Obesity Genetic factors Environmental factors Psychological factors Other causes of obesity Consequences of Obesity Health Risks Psychological and social effects Who should lose weight? How is obesity treated? Additional Reading."
Office of Communications and Public Liaison, NIDDK, NIH
Building 31, room 9A04 Center Drive, MSC 2560
Bethesda, MD 20892-2560, USA.
http://www.niddk.nih.gov/health/nutrit/pubs/unders.htm#

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Gastrointestinal Surgery For Severe Obesity, Weight-control Information Network, National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health:"Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Gastrointestinal surgery is the best option for people who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems. The surgery promotes weight loss by restricting food intake and, in some operations, interrupting the digestive process. As in other treatments for obesity, the best results are achieved with healthy eating behaviors and regular physical activity."
1 WIN WAY
BETHESDA, MD 20892-3665
Phone: (202) 828-1025 FAX: (202) 828-1028 Email: WIN@info.niddk.nih.gov
Toll-free number: 1-877-946-4627 http://win.niddk.nih.gov/publications/gastric.htm

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About WeightWatchers.com:"Weight Watchers® has over 40 years experience developing safe, easy-to-follow weight-loss plans that emphasize the importance of enjoying food and living life to the fullest. The NEW FlexPoints weight-loss plan, is the easiest, most FLEXIBLE plan ever! It's designed to handle your real life—full of unpredictable situations you can't control. With FlexPoints you can enjoy a spontaneous dinner out or share pizza at an impromptu business lunch and still lose weight! Discover what FlexPoints can do for you!
http://www.nursefriendly.com/ww/

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Nursing Entrepreneurs:

Healthy Performance, Dr. Bridget Chufo (RN):"Healthy Performance was founded by Dr. Bridget Chufo to meet the nutritional and weight loss needs of her clients. Since 1980, Dr. Chufo has been involved in this area of nutrition and weight loss. It has become more and more apparent that individuals need to take better care of themselves through proper nutrition. Her education includes a B.S.N. in Nursing from Villanova University, an M.S.N. in Nursing Administration from Duquesne University, and a Ph.D. in Nursing Research in the study of weight loss and obesity from New York University. In addition, she holds four (4) R.N. Certifications in the states of Pennsylvania, New York, New Jersey and California."
1525 Park Manor Boulevard Robinson Town Centre, Suite 304
Pittsburgh, PA 15205
info@healthyperformance.net
http://www.dbchealthyperformance.com/

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