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To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE).
Methods:
Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care.
Results:
In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital.
Conclusion:
Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.
Tracheal intubation and mechanical ventilation provide essential support for patients with respiratory failure, but the course of mechanical ventilation may be complicated by adverse ventilator-associated events (VAEs), which may or may not be associated with infection. We sought to understand how the frequency of subglottic suction, an indicator of the quantity of sputum produced by ventilated patients, relates to the onset of all VAEs and infection-associated VAEs.
Design:
We performed a case-crossover study including 87 patients with VAEs, and we evaluated 848 days in the pre-VAE period at risk for a VAE.
Setting and participants:
Critically ill patients were recruited from the medical intensive care unit of an academic medical center.
Methods:
We used the number of as-needed subglottic suctioning events performed per calendar day to quantify sputum production, and we compared the immediate pre-VAE period to the preceding period. We used CDC surveillance definitions for VAE and to categorize whether events were infection associated or not.
Results:
Sputum quantity measured by subglottic suction frequency is greater in the period immediately prior to VAE than in the preceding period. However, it does not discriminate well between infection-associated VAEs and VAEs without associated infection.
Conclusions:
Subglottic suction frequency may serve as a valuable marker of sputum quantity, and it is associated with risk of a VAE. However, our results require validation in a broader population of mechanically ventilated patients and intensive care settings.
Appropriate policies for housing, land, and property (HLP) are important elements of a successful peace operation. This chapter considers property-related policies in East Timor, the Solomon Islands, and Bougainville. These cases fall in the region to the northeast of Australia that has become known as an “arc of instability.” While each case involved very different forms of peace operations – from the UN transitional administration in East Timor to Australian-led peacekeeping in the Solomon Islands and Bougainville – all had very similar HLP problems. These included a range of post-conflict phenomena: mass population displacement, widespread damage to housing and land administration, and systematic failure in the institutions of government. They also involved a land issue common to many postcolonial conflicts, namely, the status and recognition of customary land tenure.
We base our analysis of each case around the application (or nonapplication) of international standards. The relevant international standards relating to property may be summarized as follows:
Housing: There is a basic right to adequate housing. There are also more specific rights to equality and nondiscrimination in the provision of housing.
Restitution: All displaced persons have a basic right of return. This right may now include a right of return to one's home, or compensation in lieu of such return.
Tenure Security: Landholders have a right to secure forms of land tenure. This right may be found in guarantees of private property, or in support for common property systems. It encompasses protection against forced evictions.
Access: Indigenous groups have a right to access and manage resources in their traditional territory.
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