More isn't always better: Technology in the intensive care unit.

BACKGROUND: Clinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload. PURPOSE: The aim of this study was to investigate clinicians' experiences with and perceptions of technology in ICUs. METHODOLOGY/APPROACH: We analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs. RESULTS: Our interviews identified three main challenges associated with technology in the ICU: (a) too many technologies and too much data; (b) inconsistent and inaccurate technologies; and (c) not enough integration among technologies, alignment with clinical workflows, and support for clinician identities. To address these challenges, interviewees highlighted mitigation strategies to address both social and technical systems and to achieve joint optimization. CONCLUSION: When new technologies are added to the ICU, they have potential both to improve and to disrupt patient care. To successfully implement technologies in the ICU, clinicians' perspectives are crucial. Understanding clinicians' perspectives can help limit the disruptive effects of new technologies, so clinicians can focus their time and attention on providing care to patients. PRACTICE IMPLICATIONS: As technology and data continue to play an increasingly important role in ICU care, everyone involved in the design, development, approval, implementation, and use of technology should work together to apply a sociotechnical systems approach to reduce possible negative effects on clinical care for critically ill patients.

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.

BACKGROUND: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. OBJECTIVE: The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. METHODS: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. RESULTS: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. CONCLUSIONS: RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

Development of Ctenocephalides felis felis (Siphonaptera: Pulicidae) in different substrates for maintenance under laboratory conditions.

The aim of this study was to evaluate the efficiency of different substrates for larval development of Ctenocephalides felis felis during its biological cycle. Eight hundred eggs of C. felis felis from a flea maintenance colony were used. Different diets were formulated, in which the main substrates were meat flour, powdered milk, sugar, lyophilized bovine blood, tick metabolites and lyophilized egg. The flea eggs were placed in test tubes (10 per tube) and approximately 2 g of the diet to be tested was added to each tube. There were 10 replicates for each substrate. After 28 days, each tube was evaluated individually for the presence of pupae and emerged adults. The following percentages of the larvae completed the cycle to the adult stage: 67% in diets containing tick metabolites; 55%, meat flour; 39%, dehydrated bovine blood; 14%, powdered milk; and less than 1% in diets containing sugar, lyophilized bovine blood, lyophilized egg or wheat bran. It was concluded that among the diets tested, the one constituted by tick metabolites as the substrate was shown to be the most satisfactory for maintaining a laboratory colony of C. felis felis, followed by the one containing meat flour.

Activity of Syzygium aromaticum essential oil and its main constituent eugenol in the inhibition of the development of Ctenocephalides felis felis and the control of adults.

The aim of this study was to evaluate the in vitro activity of Syzygium aromaticum essential oil (SAEO) and its main constituent eugenol (EG) against adult fleas and their action in the maturation of eggs into adults of Ctenocephalides felis felis. In order to evaluate the pulicidal activity, 10 adult fleas were exposed to a filter paper impregnated with SAEO and EG at increasing concentrations of 0.047; 0.094; 0.188; 0.375; 0.750; 1.50; 3.00; 6.00; 12.00 and 24.00 µg cm-2. Flea mortality was evaluated 24 and 48 h after exposure. In order to evaluate the inhibition of the maturation of eggs into adults, 10 eggs were exposed to filter paper impregnated with SAEO and EG at the same concentrations used in the pulicidal test, and the evaluation was performed 30 days after incubation. Untreated repetitions were maintained in both studies (control group). The lethal concentration 50 (LC50) of pulicidal activity to SAEO was 5.70 µg cm-2 in 24 h and 3.91 µg cm-2 in 48 h. The LC90 was 16.10 µg cm-2 and 15.80 µg cm-2 in 24 and 48 h, respectively. The LC50 of inhibition of the maturation of eggs into adults was 0.30 µg cm-2 and the LC90 3.44 µg cm-2. The LC50 of pulicidal activity to EG was 2.40 µg cm-2 in 24 h and 1.40 µg cm-2 in 48 h; the LC90 was 8.10 µg cm-2 and 3.70 µg cm-2 in 24 h and 48 h, respectively. The LC50 of inhibition of the maturation of eggs into adults was 0.10 µg cm-2 and the LC90 0.68 µg cm-2. Based on the results obtained, it is possible to conclude that the both SAEO and EG have in vitro pulicidal activity as well as acting as inhibitors of the maturation of eggs into adults of the flea C. felis felis.

In vitro activity of essential oils against adult and immature stages of Ctenocephalides felis felis.

Essential oils (EOs) are considered a new class of ecological products aimed at the control of insects for industrial and domestic use; however, there still is a lack of studies involving the control of fleas. Ctenocephalides felis felis, the most observed parasite in dogs and cats, is associated with several diseases. The aim of this study was to evaluate the in vitro activity, the establishment of LC50 and toxicity of EOs from Alpinia zerumbet (Pers.) B. L. Burtt & R. M. Sm, Cinnamomum spp., Laurus nobilis L., Mentha spicata L., Ocimum gratissimum L. and Cymbopogon nardus (L.) Rendle against immature stages and adults of C. felis felis. Bioassay results suggest that the method of evaluation was able to perform a pre-screening of the activity of several EOs, including the discriminatory evaluation of flea stages by their LC50. Ocimum gratissimum EO was the most effective in the in vitro assays against all flea stages, presenting adulticide (LC50 = 5.85 µg cm-2), ovicidal (LC50 = 1.79 µg cm-2) and larvicidal (LC50 = 1.21 µg cm-2) mortality at low doses. It also presented an excellent profile in a toxicological eukaryotic model. These findings may support studies involving the development of non-toxic products for the control of fleas in dogs and cats.

Development of Ctenocephalides felis felis (Siphonaptera: Pulicidae) in different substrates for maintenance under laboratory conditions / Desenvolvimento de Ctenocephalides felis felis (Siphonaptera: Pulicidae) em diferentes substratos para manutenção em condições laboratoriais

Abstract The aim of this study was to evaluate the efficiency of different substrates for larval development of Ctenocephalides felis felis during its biological cycle. Eight hundred eggs of C. felis felis from a flea maintenance colony were used. Different diets were formulated, in which the main substrates were meat flour, powdered milk, sugar, lyophilized bovine blood, tick metabolites and lyophilized egg. The flea eggs were placed in test tubes (10 per tube) and approximately 2 g of the diet to be tested was added to each tube. There were 10 replicates for each substrate. After 28 days, each tube was evaluated individually for the presence of pupae and emerged adults. The following percentages of the larvae completed the cycle to the adult stage: 67% in diets containing tick metabolites; 55%, meat flour; 39%, dehydrated bovine blood; 14%, powdered milk; and less than 1% in diets containing sugar, lyophilized bovine blood, lyophilized egg or wheat bran. It was concluded that among the diets tested, the one constituted by tick metabolites as the substrate was shown to be the most satisfactory for maintaining a laboratory colony of C. felis felis, followed by the one containing meat flour.

Resumo Este trabalho teve como objetivo avaliar a eficiência de diferentes substratos no desenvolvimento larval de Ctenocephalides felis felis durante seu ciclo biológico. Foram utilizados 800 ovos de C. felis felis, oriundos de colônia de manutenção de pulgas. Diferentes dietas foram formuladas, contendo como substratos principais a farinha de carne, leite em pó, açúcar, sangue bovino liofilizado, metabólitos de carrapato e ovo liofilizado. Foram distribuídos 10 ovos por tubo de ensaio, aos quais foram acrescidos as dietas a serem testadas, realizando-se10 repetições para cada substrato. Após 28 dias, cada tubo foi avaliado individualmente pela presença de pupas e adultos emergidos. Nas dietas que continham metabólitos de carrapato, 67% das larvas completaram o ciclo até a fase adulta; 55% nas que continham farinha de carne; 39% contendo sangue bovino desidratado; 14% com leite em pó, e menos de 1% em dietas contendo açúcar, sangue bovino liofilizado, ovo liofilizado e farelo de trigo. Conclui-se que, entre as dietas testadas, a constituída por metabólitos de carrapato como substrato, mostrou-se a mais satisfatória para a manutenção de colônia laboratorial de C.felis felis, seguida da que continha farinha de carne.

Efficacy of a dinotefuran, pyriproxyfen and permethrin combination product against Ctenocephalides felis felis (Bouché, 1835) (Siphonaptera: Pulicidae) on artificially infested rabbits.

The aim of this study was to evaluate the efficacy of an insecticidal product in rabbits that combines the neonicotinoid dinotefuran with the pyrethroid permethrin plus the insect growth regulator pyriproxyfen. Adult New Zealand rabbits (n = 12) were infested with Ctenocephalides felis felis (50 males and 50 females per rabbit) at days -7, -2, +5, +12 and +19. The control group (n = 6) received no treatment and the treated group (n = 6) received the commercial formulation, indicated for use in dogs, which was applied topically on day 0. The animals were mechanically evaluated with combs (comb test), to assess pulicidal efficacy, on days -5, +2, +7, +14 and +21. All flea removals and counts were performed by region, following the order: head, ears, neck, forelegs, dorsum, abdomen, hind limbs and tail, in order to determine the preferred sites of parasitism by the C. felis felis flea in rabbits. The distribution of fleas prevailed in the head region (about 62%), followed by the neck and back (14 and 11%, respectively). The insecticidal efficacy was calculated using arithmetic means, showing effectiveness of 100% on days +2 and +7 and 82.2% and 81.6%, on days +14 and +21, respectively. Thus the present study has shown the combination to be a viable option in the treatment and control of rabbits infested by C. felis felis.

Eficácia do fipronil em cães infestados com diferentes cargas parasitárias de Ctenocephalides felis felis (Siphonaptera: Pulicidae) / Efficacy of fipronil for dogs with different parasite burdens of Ctenocephalides felis felis (Siphonaptera: Pulicidae)

O objetivo do trabalho foi avaliar através de teste in vivo, a eficácia e o período residual de proteção do fipronil 10% "top spot" em cães infestados com diferentes cargas parasitárias de Ctenocephalides felis felis. Foram utilizados 24 cães da raça Beagle, compondo seis animais por grupo. Os cães foram divididos em quatro grupos. Os cães dos grupos controles I e II não receberam tratamento, enquanto que os cães dos grupos tratados I e II receberam tratamento com formulação de fipronil 10% "top spot". Os cães dos grupos controle I e tratado I foram infestados com 100 pulgas adultas não alimentadas, e os cães dos grupos controle II e tratado II foram infestados com 300 pulgas adultas não alimentadas. As infestações foram realizadas nos dias, -2, +5, +12, +19, +26, +33 e +40 e nos dias +2, +7, +14, +21, +28, +35 e +42 foi realizada retirada mecânica e contagem de pulgas para avaliação. As eficácias pulguicidas, para o grupo tratado I, nos dias +2, +7, +14, +21, +28, +35 e +42, foram respectivamente 99,36%; 99,73%; 99,48%; 99,74%; 99,75%; 95,06% e 67,62%...

The objective of the study was to evaluate through in vivo test, the efficacy and residual period of protection of 10% fipronil "top spot" for dogs with different Ctenocephalides felis felis burdens of infestations. For this, 24 Beagles were used, divided into four groups of six dogs each. The dogs of the control groups I and II were not treated, while the dogs of the treated groups I e II were treated with the formulation of 10% fipronil "top spot". The dogs of the control group I and treated group I were infested with 100 unfed C. felis felis and dogs of group control II and treated II one were infested with 300 unfed C. felis felis each. Infestations were performed on days -2, +5, +12, +19, +26, +33 and +40, and on days +2, +7, +14, +21, +28, +35 and +42 fleas were mechanical removed and counted for evaluation. Efficacy for treated group I on days +2, +7, +14, +21, +28, +35 and +42 was respectively 99.36%, 99.73%, 99.48%, 99.00%, 74.00%, 99.75%, 95.06% and 67.62%...

Fourth Annual Nursing Leadership Congress: "Driving Patient Safety Through Transformation" Conference proceedings.

In September 2008, nurse executives from around the country met in Scottsdale, Ariz, to develop practical tools and recommendations for "Driving Patient Safety Through Transformation," the theme of the fourth annual Nursing Leadership Congress. The Congress was made possible through an educational grant from McKesson and Intel in collaboration with sponsorship from the American Organization of Nurse Executives, Institute for Safe Medication Practices and National Patient Safety Foundation. This paper summarizes the Congress plenary sessions and roundtable discussions. Plenaries included the following: *Transformational Leadership: The Role of Leaders in Managing Complex Problems *Using the Baldrige Business Model as the Infrastructure for Creating a Culture of Patient Safety *Prospects for Structural Reform in Health Care Roundtables included the following: *Joy and Meaning in Work *Managing Chronic Care Across the Continuum *The Future of Acute Care Delivery in Light of Changing Reimbursement* Leveraging Transparency to Drive Patient Safety *Collaborative Partnerships for Driving a Patient Safety Agenda *Innovative Solutions for Patient Safety *Implementing the Fundamentals of the Toyota Production Model forHealthcare

Advanced practice organ procurement techniques: placement of pulmonary artery catheters.

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.

Visceral leishmaniasis in eastern Sudan: parasite identification in humans and dogs; host-parasite relationships.

In 1996, an epidemic outbreak of visceral leishmaniasis (VL) started in Barbar el Fugara, a village in Gedarif State (eastern Sudan). From 1997 to 2000, regular epidemiological studies were carried out in the human population, as well as in mammals and sand flies. In symptomatic patients, 46/69 lymph node, 6/20 post kala-azar dermal leishmaniasis (PKDL) and 1/4 cutaneous cultures in NNN medium were positive. In 69 dogs, 23/79 lymph node cultures were positive. In other mammals (47 rodents, five donkeys, one mongoose and one monkey) spleen and/or blood cultures were negative. Characterization of isolated strains (by starch gel electrophoresis and isoelectrofocusing) identified three zymodemes of Leishmania donovani, two of L. infantum and two of L. archibaldi complexes from patient samples and three zymodemes of L. donovani, three of L. infantum and two of L. archibaldi complexes from dog samples. Five of them were present in both man and dog. For the first time, a strain from a PKDL case was identified as L. infantum, and a child had the same L. infantum zymodeme in VL and in subsequent PKDL. Blood samples from dogs were studied by immunofluorescent antibody test (IFAT). The seroprevalence in dogs was 72.5%, 74.3% and 42.9% in 1998, 1999 and 2000, respectively. By using CDC miniature light traps 12 745 sand flies were collected and then identified. Phlebotomus papatasi (7%) and P. orientalis (5%) were sympatric, mainly inside homes (85% and 75%, respectively). These results, the relative stability of seroprevalence in dogs and the intradomiciliar presence of P. orientalis, known as a vector of VL in Sudan, suggest several hypotheses: (i) man is responsible for the disease in dogs, (ii) the dog is the reservoir of VL, (iii) the dog is an intermediate host between a possible sylvatic cycle and the anthroponotic cycle. More extensive studies are needed to assess the transmission cycle of VL in this area of Sudan.