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Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap.

ABSTRACT: An accurate creatinine (Cr) estimate is pivotal for the assessment of renal function. Both patient- and practice-spawned factors palliate the test accuracy of serum creatinine (sCr) and can erratically represent actual kidney function. This study evaluated the caregivers' awareness of enzymatic serum creatinine (E-sCr) assay interfering in dopamine/dobutamine (DD)-infused patient samples and the frequency of such interference in a critical care setting. We conducted an sCr awareness survey among UT Southwestern physicians, nurses, and pharmacists. We then performed a cross-sectional E-sCr comparison against the kinetic Jaffe method using the DD-infused patient samples collected from central venous catheters (CVC), peripherally inserted central catheter (PICC) lines, and the peripheral vein (PV). We retrospectively compared the longitudinal E-sCr results of the CVC/PICC draws with the corresponding blood urea nitrogen (BUN) levels. The survey results show a significant lack of awareness among caregivers about the negative interference of DD infusions on E-sCr. Cross-sectional E-sCr assessment relative to the Jaffe method displayed a negative interference in 12% of CVC/PICC line samples (7/57 DD-infused patients) compared to none in the PV draws. A longitudinal assessment of E-sCr, BUN, and potassium (K) levels from CVC/PICC line samples further confirmed a spurious decrease for E-sCr in about 12/50 (24%) patients who did not show a concurrent BUN or K decrease. The results suggest that a direct PV sampling accompanied by clinical laboratory-directed proactive discussion/activities can foster awareness among caregivers and eschew the false E-sCr estimates in DD-infused patients.

SUBMITTER: Shah T

PROVIDER: S-EPMC8071156 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundA 2017 nationwide disability survey conducted by the General Authority of Statistics in Saudi Arabia, a sample representing the whole population living in Saudi Arabia, reported that approximately 5% and 2% of the Saudi population suffers from visual or hearing impairments, respectively. Patients with these disabilities find it difficult to convey their medical history and chief complaints to paramedics, causing communication breakdowns that can lead to misinterpretation of patient history, leave medical problems unaddressed, and reduce patient engagement and autonomy. We aimed to assess paramedics' knowledge, attitude, and level of confidence when managing patients with visual or hearing problems.MethodsDescriptive cross-sectional design was used to report the knowledge and experience of paramedics towards patients with hearing/vision disabilities in Saudi Arabia. A validated questionnaire was distributed to our study sample of paramedics in Riyadh, Saudi Arabia between 01, July 2020 and 31, December 2020. Ethical approval was obtained from King Abdullah International Medical Research Center.ResultsNinety-seven participants completed the survey. Male paramedics accounted for 77% of the study participants; 24% were Saudi Red Crescent employees, and 57% were 20-25 years old. Most participants encountered 1-5 cases of patients with hearing disability (55%) as well as patients with visual disability (48%) during their career. Taking medical history was a challenge indicated by 42% of the participants, and 30% reported difficulties in explaining procedures. Of the participants, 44% were confident in handling patients with hearing or visual impairment. There was a strong association between participants who indicated higher confidence levels and those who had obtained specific training for patients with hearing or visual impairments.ConclusionAssisting patients with hearing or visual impairments is challenging, especially during an emergency. We recommend programs that provide specific training in handling hearing or visually impaired patients to close the communication gap in emergent medical situations handled by paramedics or other emergency medicine doctors and nurses.

Project description:IntroductionFor pregnant women, vaccination with inactivated influenza vaccine (IIV) and tetanus, diphtheria, acellular pertussis vaccine (Tdap) is recommended. In Peru, uptake is nonetheless low. A study was conducted to identify factors affecting maternal vaccination coverage. The study's primary objectives were to describe the knowledge, attitudes, and practices regarding maternal immunization among pregnant/postpartum women and health care professionals (HCPs). The secondary objective was to determine the vaccination coverage and the impact of Ministry of Health (MOH) recommendations.MethodsAn observational multicenter, cross-sectional survey study was conducted from February 1, 2021 to June 30, 2021 in five cities in Peru. Two surveys were conducted to assess knowledge, attitudes, and practices concerning maternal immunization: one among pregnant/postpartum women and one among HCPs.ResultsParticipants were 668 pregnant/postpartum women with a mean age of 29.6 years and 219 HCPs-mostly midwives (46.6%) and obstetricians/gynecologists (44.7%). Of the pregnant/postpartum women, 66.9% knew that, in general, vaccinations are given for prevention, and 98.5% believed vaccines are important. Nonetheless, 69.6% of pregnant/postpartum women had poor or moderate knowledge of maternal vaccination. Disease knowledge of influenza (89.1%) and tetanus (87.0%) was high, while knowledge of pertussis (37.7%) was low. Women agreed/strongly agreed that they would get vaccinated with Tdap if a doctor (96.3%), midwife (88.9%), or nurse (72.0%) recommended it. Of the HCPs, 81.3% routinely recommended Tdap vaccination for pregnant women.ConclusionsTo enhance vaccine acceptance in pregnant women in Peru, we must improve knowledge of the diseases, MOH recommendations, and benefits of the offered vaccinations. HCPs could provide this vaccination knowledge and information along with their vaccination recommendation as the pregnant/postpartum women indicated they would take the vaccines if recommended by their HCPs. Our findings are important for the successful implementation of maternal immunization programs in Peru.

Project description:BackgroundPhysical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU.MethodsSingle-center, prospective observational study in a university teaching hospital. Patient observations, conducted Monday through Sunday from 08:30 am to 08:00 pm and for 1 minute every 10 minutes, included data points of patient location, people in attendance, and highest level of activity. Descriptive statistics were utilized to analyze and report data.ResultsForty-two ICU and 11 VWU patients were recruited, with 2646 and 693 observations, respectively, recorded. In the ICU, patients spent a median (interquartile range) of 100% (96%-100%) of the day (10.5 [10.0-10.5] hours) located in bed, with minimal/no activity for 99% (96%-100%) of the day (10.4 [9.7-10.5] hours). Nursing staff were most frequently observed in attendance with patients irrespective of ventilation or sedation status, although patients still spent approximately two-thirds of the day alone. Bed-to-chair transfer was the highest activity level observed. In the VWU, patients spent 94% (73%-100%) of the day (9.9 [7.7-10.5] hours) in bed and 56% (43%-60%) of time alone. Physical activity levels were higher and included ambulation. All physical activities occurred during physical rehabilitation sessions.ConclusionsThese profiles of low physical activity behavior across both patients in the ICU and VWU highlight the need for targeted strategies to improve levels beyond therapeutic rehabilitation and support for a culture shift toward providing patients with, and engaging them in, a multidisciplinary, multiprofessional environment that optimizes overall physical activity.

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Variable Creatinine Levels in Critical Care Patients: A Concerning Knowledge Gap.

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