ABSTRACT
Claire Osborne, Paediatric Advanced Practitioner, Oxford University Hospitals (Claire.Osborne@ouh.nhs.uk), reflects on the reasons behind the nursing strikes and the level of support for action.
Subject(s)
Strikes, Employee , Humans , Child , Hospitals, UniversityABSTRACT
BACKGROUND: Non-intubated intensive care patients commonly receive supplemental oxygen by high-flow face mask (HFFM), simple face mask (FM) and nasal prongs (NP) during their ICU admission. However, high-flow nasal prongs (HFNP) offer considerable performance capabilities that may sufficiently meet all their oxygen therapy requirements. STUDY AIMS: To assess the feasibility, safety and cost-effectiveness of introducing a protocol in which HFNP was the primary oxygen delivery device for non-intubated intensive care patients. METHOD: Prospective 4-week before-and-after study (6 months apart) for all adult patients admitted to a 22-bed tertiary ICU in Melbourne, Australia. RESULTS: 117 patients (57 before, 60 after) were included: 86 (73.5%) received mechanical ventilation. Feasibility revealed a significant reduction in HFFM (52.6-0%, p<.001), FM (35.1-8.3%, p=.002) and NP (75.4-36.7%, p<.001) use and an increase in HFNP use (31.6-81.7%, p<.05) during the after period. Following extubation, there was a significant reduction in HFFM use (65.7% vs. 0%, p<.05) and an increase HFNP use (8.6% vs. 87.5%, p<.05). Costing was in favour of the after period with a consumable cost saving per patient (AUD $32.56 vs. $17.62, p<.05). During the after period, more patients were discharged from ICU with HFNP than during the before period (5 vs. 33 patients, p<.05) and fewer patients (5 vs. 14 patients) used three or more oxygen delivery devices. Safety outcomes demonstrated no significant difference in the number of intubations, re-intubations, readmissions or non-invasive ventilation use between the two time periods. CONCLUSIONS: Using HFNP as the primary oxygen delivery method for non-intubated intensive care patients was feasible, appeared safe, and the oxygen device costs were reduced. The findings of our single-centre study support further multi-centre evaluations of HFNP therapy protocols in non-ventilated intensive care patients.
Subject(s)
Intensive Care Units , Oxygen Inhalation Therapy/methods , Aged , Australia , Cost-Benefit Analysis , Feasibility Studies , Female , Humans , Male , Masks , Middle Aged , Oxygen Inhalation Therapy/instrumentation , Patient Safety , Pilot Projects , Prospective Studies , Respiration, Artificial , Treatment OutcomeABSTRACT
Despite the substantial interest in memory for complex pictorial stimuli, there has been virtually no research comparing memory for static scenes with that for their moving counterparts. We report that both monochrome and color moving images are better remembered than static versions of the same stimuli at retention intervals up to one month. When participants studied a sequence of still images, recognition performance was the same as that for single static images. These results are discussed within a theoretical framework which draws upon previous studies of scene memory, face recognition, and representational momentum.
