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Biomedical subjects

Donna Wilson

Publications and source records attributed to Donna Wilson.

9 recordsLinked to original sources
PubMed2006

Use of computerized ICU documentation to capture ICU core measures.

BACKGROUND: Intensive care unit (ICU) core measures that target the prevention of catheter-related bloodstream infections (CRBSIs) and ventilator-associated pneumonia (VAP) in ventilated ICU patients are underway across the United States. Implementation often requires additional personnel to educate providers and collect the data. We hypothesized that use of our current computerized ICU flowsheet could provide timely, accurate data on ICU core measures without additional personnel dedicated to data capture. METHODS: In a 10-bed, closed surgical ICU with existing protocols for deep vein thrombosis (DVT) prophylaxis, stress ulcer bleeding prophylaxis (SUP), ventilator weaning parameters, and glucose control, we created a reporting tool that would document daily weaning parameters, head of bed (HOB) at 30 degrees , glucose levels, DVT prophylaxis, and SUP. Our glucose protocol targeted <150 mg/dL, with all daily glucose values reported rather than just the morning value. The results from the previous 12 am to 11:59 pm were available to the rounding team at 7 am. We examined compliance at the start and after education of medical staff (March/April for HOB up, DVT, and SUP; May/June for glucose control). RESULTS: During 2005, compliance with all protocols improved. Percent compliance for DVT prophylaxis, SUP, and HOB up rose from as low as 32% at the start of the documentation process to consistently higher than the target level of 95%. Compliance for glucose control increased after intensive education of nursing and physicians with the mean glucose falling from 144 to 122 mg/dL. There was increased nursing workload for checking glucose levels in which the mean number of glucose checks rose from a low of 1.5 per patient to as high as 8.2 per patient per day. CRBSI and VAP rates did not decrease during this period compared with the prior year. Length of stay and mortality were unchanged. CONCLUSIONS: Reporting of ICU core measures to treating staff can be done accurately and promptly with a computerized system. Education was effective in improving compliance levels. No additional personnel were required to create reports, capture data, or improve compliance after initial development and testing. Although compliance with core measures met target levels at the end of the year, we did not observe improved outcomes in terms of CRBSI, VAP, mortality, or length of stay.

APACHE↗
PubMed2006

A literature review of randomized controlled trials of the organization of care at the end of life.

We searched nine electronic databases for randomized controlled trials (RCTs) about care at the end of life and found 23 RCTs. We assessed their quality using the criteria of the Cochrane Collaboration. The RCTs researched three themes: (a) the effect of providing palliative care through dedicated community teams on quality of life, on the management of symptoms, on satisfaction with care, on the duration of the palliative period, and on place of death; (b) the effects of specific palliative care interventions-advanced planning of care for the end of life, patient-held records, providing quality-of-life data to patients and physicians, grief education for relatives, palliative care education for nurses, and palliative care for patients with dementia; and (c) the costs of palliative compared to conventional care. We identify difficulties in conducting research on palliative care and solutions and discuss future possible research themes.

Community Health Services↗
PubMed2005

Randomized controlled trials of non-medical and non-surgical therapies for palliative care: a literature review.

A systematic review of randomized controlled trials (RCTs) of non-medical and non-surgical therapies for palliative care was undertaken to provide guidance for best practice palliative care. Nine databases were searched (ERIC, EMBASE, MEDLINE, CINAHL, AHMED, Psychinfo, HealthStar, Sociological Abstracts, and the Cochrane Library, including Central and Systematic Reviews) for RCTs and systematic reviews. Fifteen RCTs, varied in intervention and outcome measures, were identified. Several studies found positive results but the sample sizes were small, the methodological quality of the RCTs did not meet Cochrane Collaboration criteria, and the conclusions were at high risk of bias. Improved planning of the protocols and execution, with the addition of experienced trialists and statisticians, is required to improve the quality of the evidence collected in future studies.

Palliative Care↗
PubMed2005

Comparing the health services utilization of long-term-care residents, home-care recipients, and the well elderly.

Research has typically supported the concern that health services utilization increases with aging. Yet most health services utilization studies have focused on the use of 1 as opposed to all health services, the use of health services over 1 year as opposed to a longer period, and the use of health services during the 1970s or 1980s. Current, comprehensive utilization studies are needed in order to better inform health policy and health services decision-making. This study was designed to compare the health services utilization of 3 groups of seniors: those residing in long-term-care (LTC) facilities, those receiving home care, and those neither institutionalized nor receiving home care. Individual-anonymous and population-based inpatient hospital data, ambulatory care (day surgery, outpatient clinic, and emergency room) data, and physician services data collected by the health ministry of the Canadian province of Alberta over a 2-year period were analyzed using descriptive and comparative statistical tests available in the SPSS computer program. With the exception of physician and LTC services, LTC residents were the least likely to use health services. Furthermore, and despite concerns that LTC residents may be stigmatized or rationed with regard to access to tertiary care, the data indicate that LTC residents are not disadvantaged in terms of type or scope of hospital services. These and other findings suggest an appreciation for LTC in managing both the health and the care needs of the oldest seniors. The findings also raise concerns about the adequacy of formal home care and of the health care received by the well elderly.

Activities of Daily Living↗
PubMed2002

Silk: molecular organization and control of assembly.

The interface between the science and engineering of biology and materials is an area of growing interest. One of the goals of this field is to utilize biological synthesis and processing of polymers as a route to gain insight into topics such as molecular recognition, self-assembly and the formation of materials with well-defined architectures. The biological processes involved in polymer synthesis and assembly can offer important information on fundamental interactions involved in the formation of complex material architectures, as well as practical knowledge into new and important materials related to biomaterial uses and tissue engineering needs. Classic approaches in biology, including genetic engineering, controlled microbial physiology and enzymatic synthesis, are prototypical methods used to control polymer structure and chemistry, including stereoselectivity and regioselectivity, to degrees unattainable using traditional synthetic chemistry. This type of control can lead to detailed and systematic studies of the formation of the structural hierarchy in materials and the subsequent biological responses to these materials.

Animals↗
PubMedDate not supplied

The possibilities and the realities of home care.

BACKGROUND: An analysis of a provincial home care dataset, comparing home care client, service, and providers in 1991/92 through 2000/01, was undertaken to describe changes over the decade, and permit a more informed discussion of home care in relation to Canadian health policy developments and health system reforms. METHODS: After data were obtained upon request from Alberta's Ministry of Health and Wellness, descriptive and comparative statistical analyses were undertaken using the SPSS computer program. Logistic regression was used to compare multiple client characteristics in the first and last years. RESULTS: Home care clients doubled and the mean hours of care per client increased substantially, although the duration of care provision declined. The mean age of clients also declined. Home care continued to be primarily provided by Home Support Aides, with self-managed care increasing dramatically. Sustained geographical differences in home care were noted. CONCLUSION: Although home care has much potential for enabling early discharge from hospital, and for maintaining or improving health, few population-level studies of home care trends exist. In Alberta, although formal home care hours increased, home care expansion was not uniform across the province. Home Support Aides continued to be the primary care provider. In the face of substantial hospital downsizing, these observations could imply that the provision of home care has been off loaded to families. Moreover, home care increases do not appear to be related to an aging population.

Aged↗