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Diestro JDB, Vyas M, Jung Y, Kishibe T, Leochico C, Espiritu A, Dorotan MK, Dimal N, Omar AT, Sienes A, Saposnik G, Marotta TR, Zafar A, Mendes Pereira V, Spears J. Long-term neuropsychiatric complications of aneurysmal subarachnoid hemorrhage: a narrative review. J Neurointerv Surg 2024:jnis-2023-020979. [PMID: 38609175 DOI: 10.1136/jnis-2023-020979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
This review focuses on the often-neglected long-term neuropsychiatric consequences of aneurysmal subarachnoid hemorrhage (aSAH), beyond traditional randomized trial outcomes of mortality and retreatment. While current guidelines recommend screening for these sequalae, it may not be routinely practiced. This review will underscore the prevalence and management of common neuropsychiatric sequalae, including anxiety, depression, cognitive dysfunction, headaches, seizures, and sexual dysfunction, all of which can significantly impact the quality of life of survivors of aSAH. We emphasize the critical role neurointerventionalists can play by going beyond the customary practice of radiological monitoring for treated aneurysms by screening for and helping guide management of these common neuropsychiatric complications.
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Affiliation(s)
- Jose Danilo Bengzon Diestro
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Manav Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Youngkyung Jung
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
- Health Sciences Library, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Carl Leochico
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Rehabilitation Medicine, University of the Philippines Manila, Manila, Philippines
- Department of Physical Medicine and Rehabilitation, St. Luke's Medical Center, Quezon City, Philippines
| | - Adrian Espiritu
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, North Yorkshire, Canada
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Maria Kristina Dorotan
- Division of Epilepsy, Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nico Dimal
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abdelsimar Tan Omar
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - April Sienes
- Trauma and Neurosurgery Program, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital- Unity Health Toronto, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Atif Zafar
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Umezurike I, Dittborn M, Whitelaw J, Bedford H, Brierley J. Barriers to initiating and implementing palliative and end-of-life care for children with life-limiting conditions: a mixed-methods study in a UK children's hospital. Arch Dis Child 2024:archdischild-2023-326776. [PMID: 38906681 DOI: 10.1136/archdischild-2023-326776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND To ensure that children with life-limiting conditions (LLC) and their families have access to a palliative care pathway from diagnosis to death and bereavement, a better understanding of the challenges experienced by paediatric healthcare professionals caring for children with LLC is needed. AIM To explore the barriers paediatricians face in initiating and implementing palliative and end-of-life care for children with LLC. METHODS Due to the challenges of COVID-19, the study was performed as a service evaluation using semi-structured interviews and an online questionnaire with consultant paediatricians in general paediatrics, community paediatrics and multiple subspecialties at a UK children's hospital between December 2020 and August 2021. Twelve interviews and 18 online questionnaires were completed. Interviews were analysed using reflexive thematic analysis, and descriptive statistics were used for questionnaire responses. RESULTS Recurring themes from both data sets were further analysed and five themes were developed: (1) Problems with the leadership of palliative and end-of-life care; (2) Problems with preparing advanced care plans; (3) Lack of training in paediatric palliative care and advanced communication; (4) Problems communicating with families; and (5) Lack of recognition of children with LLC and high-profile cases. CONCLUSIONS We found that the barriers to effective palliative and end-of-life planning are multifaceted and pervasive, so healthcare professionals must establish clearer pathways to overcome them. Approaches suggested included (1) discussing palliative care for children with LLC at professional encounters, for example, departmental meetings, peer-review meetings and morbidity and mortality meetings and (2) advanced communication training in palliative and end-of-life care.
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Affiliation(s)
- Indira Umezurike
- Paediatric Bioethics Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Mariana Dittborn
- Paediatric Bioethics Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | | | - Helen Bedford
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Joe Brierley
- Paediatric Bioethics Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
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203
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Jin M, Qian R, Wang J, Yuan Z, Long J, Zeng L, Yang H, Liao D, Xie Y, Liu X. The mediating effect of coping styles between emergency capacity and mental workload among clinical nurses: A cross-sectional study. Int Nurs Rev 2024. [PMID: 38899768 DOI: 10.1111/inr.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/21/2024] [Indexed: 06/21/2024]
Abstract
AIMS This study aimed to examine the relationship between emergency capacity, coping styles, and mental workload among nurses. BACKGROUND Emergency capacity, coping styles, and mental workload are all variables associated with work. Identifying the relationship between these variables can facilitate administrators to implement tailored and effective intervention strategies to improve individual performance, quality of care, and medical safety. METHODS A quantitative cross-sectional study was carried out to investigate 605 Chinese clinical nurses in seven tertiary hospitals by using personal information form, emergency capacity scale for nurses, simplified coping skill questionnaire, and the NASA-Task Load Index. RESULTS Emergency capacity and mental workload were found at moderate levels. The multiple linear regression model suggested that spinsterhood, no children, high workload, always anxiety or nervousness, and lower monthly income were the influencing factors of mental workload. Positive coping style was positively correlated with emergency capacity and negatively correlated with mental workload. Negative coping style was negatively related to emergency capacity and positively related to mental workload. Additionally, coping styles played a partial mediating role in the relationship between emergency capacity and mental workload through constructing a structural equation model, but the effects of positive coping style and negative coping style are opposite. CONCLUSION Our results showed that coping styles played a mediating role in the relationship between emergency capacity and mental workload. Managers can alleviate the mental workload of nurses by cultivating positive coping styles and improving emergency capacity. IMPLICATIONS FOR NURSING AND NURSING POLICY Mental workload of nurses deserves more attention in medical institutions. The results of our study provide evidence for improving employee health, promoting positive behaviors, and optimizing organizational management. Nursing managers should take feasible measures to fulfill nurses' needs for emergency capacity and coping strategies to alleviate nurses' mental workload, so as to stimulate their intrinsic motivation and positive organizational behavior.
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Affiliation(s)
- Man Jin
- Operating room, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Rong Qian
- Operating room, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Jialin Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhongqing Yuan
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Juan Long
- Operating room, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Li Zeng
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
| | - Huawu Yang
- Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Center of Gastrointestinal and Minimally Invasive Surgery, Chengdu, Sichuan, China
| | - Dan Liao
- Operating room, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yunhui Xie
- Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Center of Gastrointestinal and Minimally Invasive Surgery, Chengdu, Sichuan, China
| | - Xu Liu
- Operating room, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
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Sutton E, Ibrahim M, Plath W, Booth L, Sujan M, McCulloch P, Mackintosh N. Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study. BMJ Qual Saf 2024:bmjqs-2024-017132. [PMID: 38902021 DOI: 10.1136/bmjqs-2024-017132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND). METHODS The research used ethnographic methods, including over 100 hours of observations on surgical units in three English hospitals in order to understand the everyday context of care. Observations focused on the coordination of activities such as handovers and how rescue featured as part of this. We also conducted 27 interviews with a range of clinical and managerial staff and patients. We employed a thematic analysis approach, combined with a theoretically focused implementation coding framework, based on Normalisation Process Theory. RESULTS We found that organisational infrastructural support in the form of a leadership support and clinical care outreach teams with capacity were enablers in implementing the patient-led escalation system. Barriers to implementation included making changes to professional practice without discussing the value and legitimacy of operationalising patient concerns, and ensuring equity of use. We found that organisational work is needed to overcome patient fears about disrupting social and cultural norms. CONCLUSIONS This paper reveals the need for infrastructural support to facilitate the implementation of a patient-led escalation system, and leadership support to normalise the everyday process of involving patients and families in escalation. This type of system may not achieve its goals without properly understanding and addressing the concerns of both nurses and patients.
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Affiliation(s)
| | - Mudathir Ibrahim
- Department of General Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - William Plath
- Nuffield Department of Surgery, Oxford University, Oxford, UK
| | | | - Mark Sujan
- Human Factors Everywhere, Woking, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter McCulloch
- Nuffield Department of Surgery, Oxford University, Oxford, UK
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Joo Y, Jang Y, Kwon OY. Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review. Nurs Crit Care 2024. [PMID: 38899600 DOI: 10.1111/nicc.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging. AIM To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs. STUDY DESIGN We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. RESULTS Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay. CONCLUSIONS This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions. RELEVANCE TO CLINICAL PRACTICE Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.
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Affiliation(s)
- Youngshin Joo
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Oh Young Kwon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Freeman-Sanderson A, Brodsky MB, Dale C, Gupta A, Haines K, Happ MB, Hart N, Hemsley B, Istanboulian L, Spronk P, Sullivan R, Sutt AL, Rose L. A Core Outcome Set for Research Evaluating Interventions to Enable Communication in Patients With an Artificial Airway: An International Delphi Consensus Study (Comm-COS). Crit Care Med 2024:00003246-990000000-00346. [PMID: 38899947 DOI: 10.1097/ccm.0000000000006347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population. DESIGN 1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages. SETTING Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting. SUBJECTS Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention. CONCLUSIONS This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity.
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Affiliation(s)
- Amy Freeman-Sanderson
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Speech Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Anushua Gupta
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Speech Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Department of Physiotherapy, Western Health, Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- The Ohio State University College of Nursing, Columbus, OH
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, ON, Canada
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, The Netherlands
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Kimberley Haines
- Department of Physiotherapy, Western Health, Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH
| | - Nicholas Hart
- Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Bronwyn Hemsley
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Laura Istanboulian
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, ON, Canada
| | - Peter Spronk
- Department of Intensive Care, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Rebecca Sullivan
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Elsayed SM, Eltaybani S, Elbiaa MA. Factors associated with the readiness for oral intake in post-extubated critically ill adult patients: A prospective observational study. Nurs Crit Care 2024. [PMID: 38895878 DOI: 10.1111/nicc.13109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Post-extubation dysphagia (PED) is a common post-extubation complication that may lead to serious problems, such as malnutrition and longer hospital and intensive care unit (ICU) stays. AIM To explore factors associated with the readiness for oral intake in post-extubated critically ill adult patients. STUDY DESIGN This prospective observational study involved 125 extubated patients. Readiness for oral intake was assessed using the Gugging Swallowing Screen (GUSS), and regression analysis was used to determine its predictors. RESULTS The median age of the participants was 40.0 years, and 51.2% were female. The median GUSS score was 12.0 (possible range, 0-20), and 35.2% of the studied patients had severe dysphagia (scored 0-9). Bivariate regression analysis showed that older age, male, higher APACHE II score, body mass index (BMI) ≥30, smoking history, longer ICU stay, muscle relaxants use, large-bore endotracheal and orogastric tubes and frequent intubation attempts were associated with lower GUSS score (p-value <.05). Multivariate regression analysis showed that age, BMI and smoking history predicted 37.2% of the variability in the GUSS score (F = 23.865, p-value <.001). Adding the ICU length of stay, muscle relaxants use, size of the endotracheal tube, size of the orogastric tube and frequency of intubation attempts to the regression model raised the predictability to 86.0% (F = 88.809, p-value <.001). CONCLUSIONS More than one-third of extubated patients have severe PED with a high risk of aspiration. Several modifiable factors, such as muscle relaxant use and endotracheal and orogastric tube size, predict post-extubation readiness for oral intake. RELEVANCE TO CLINICAL PRACTICE Using endotracheal and orogastric tubes of appropriate sizes, careful assessment of patients with a high risk for difficult intubation, and minimal use of muscle relaxants may help increase patients' readiness for post-extubation oral intake.
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Affiliation(s)
- Shimmaa Mohamed Elsayed
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Damanhour University, Damanhour, Egypt
| | - Sameh Eltaybani
- Global Nursing Research Center, The University of Tokyo, Tokyo, Japan
| | - Maysa Abdalla Elbiaa
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Matrouh University, Matrouh, Egypt
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Zhang Q, Wang L, Liu X, Liu Z, Pu Z, Fang Z, Li L, Guo D, Lu R, Jia P. Analysis of the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals. Sci Rep 2024; 14:14162. [PMID: 38898038 PMCID: PMC11187208 DOI: 10.1038/s41598-024-64996-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
To analyze the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals and to provide a reference for improving the quality of medical care. Through the National Nursing Quality Data Platform, unplanned endotracheal extubation data reported by ICUs in China's tertiary hospitals from 2019 to 2022 were analyzed. The situation of reported hospitals, causes, and the current status of "pseudo" unplanned endotracheal extubation in ICU patients was analyzed. The indicator of unplanned endotracheal extubation in ICUs of China's tertiary hospitals is mainly from first-class tertiary hospitals (74.9%), most of which are self-extractions by patients (74.6%). The proportion of "pseudo" unplanned endotracheal extubation is 45.1%. "Pseudo" unplanned endotracheal extubation is common in the ICUs of China's tertiary hospitals. As such, management blind spots deserve attention from managers and clinical staff.
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Affiliation(s)
- Qin Zhang
- Department of Day Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Wang
- Department of NICU, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoli Liu
- Department of Proctology, Deyang People's Hospital, Deyang, China
| | - Zhenwei Liu
- Department of NICU, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zaichun Pu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ziji Fang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lele Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Danyang Guo
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Lu
- Department of NICU, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Ping Jia
- Department of NICU, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Yan F, Yuan LH, He X, Yu KF. Correlation between pre-anesthesia anxiety and emergence agitation in non-small cell lung cancer surgery patients. World J Psychiatry 2024; 14:930-937. [PMID: 38984337 PMCID: PMC11230093 DOI: 10.5498/wjp.v14.i6.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Preoperative anxiety is a common emotional problem during the perioperative period and may adversely affect postoperative recovery. Emergence agitation (EA) is a common complication of general anesthesia that may increase patient discomfort and hospital stay and may be associated with the development of postoperative complications. Pre-anesthetic anxiety may be associated with the development of EA, but studies in this area are lacking. AIM To determine the relationship between pre-anesthetic anxiety and EA after radical surgery in patients with non-small cell lung cancer (NSCLC). METHODS Eighty patients with NSCLC undergoing surgical treatment between June 2020 and June 2023 were conveniently sampled. We used the Hospital Anxiety and Depression Scale's (HADS) anxiety subscale (HADS-A) to determine patients' anxiety at four time points (T1-T4): Patients' preoperative visit, waiting period in the surgical waiting room, after entering the operating room, and before anesthesia induction, respectively. The Riker Sedation-Agitation Scale (RSAS) examined EA after surgery. Scatter plots of HADS-A and RSAS scores assessed the correlation between patients' pre-anesthesia anxiety status and EA. We performed a partial correlation analysis of HADS-A scores with RSAS scores. RESULTS NSCLC patients' HADS-A scores gradually increased at the four time points: 7.33 ± 2.03 at T1, 7.99 ± 2.22 at T2, 8.05 ± 2.81 at T3, and 8.36 ± 4.17 at T4. The patients' postoperative RSAS score was 4.49 ± 1.18, and 27 patients scored ≥ 5, indicating that 33.75% patients had EA. HADS-A scores at T3 and T4 were significantly higher in patients with EA (9.67 ± 3.02 vs 7.23 ± 2.31, 12.56 ± 4.10 vs 6.23 ± 2.05, P < 0.001). Scatter plots showed the highest correlation between HADS-A and RSAS scores at T3 and T4. Partial correlation analysis showed a strong positive correlation between HADS-A and RSAS scores at T3 and T4 (r = 0.296, 0.314, P < 0.01). CONCLUSION Agitation during anesthesia recovery in patients undergoing radical resection for NSCLC correlated with anxiety at the time of entering the operating room and before anesthesia induction.
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Affiliation(s)
- Fen Yan
- Department of Anesthesiology, Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan 430000, Hubei Province, China
| | - Li-Hua Yuan
- Department of Anesthesiology, Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan 430000, Hubei Province, China
| | - Xiao He
- Department of Anesthesiology, Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan 430000, Hubei Province, China
| | - Kai-Feng Yu
- Department of Anesthesiology, Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan 430000, Hubei Province, China
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Enriquez de Salamanca Gambara R, Sanz-García A, del Pozo Vegas C, López-Izquierdo R, Sánchez Soberón I, Delgado Benito JF, Martínez Diaz R, Pérez-Oleaga CM, López NMM, Domínguez Azpíroz I, Martín-Rodríguez F. A Comparison of the Clinical Characteristics of Short-, Mid-, and Long-Term Mortality in Patients Attended by the Emergency Medical Services: An Observational Study. Diagnostics (Basel) 2024; 14:1292. [PMID: 38928707 PMCID: PMC11203341 DOI: 10.3390/diagnostics14121292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
AIM The development of predictive models for patients treated by emergency medical services (EMS) is on the rise in the emergency field. However, how these models evolve over time has not been studied. The objective of the present work is to compare the characteristics of patients who present mortality in the short, medium and long term, and to derive and validate a predictive model for each mortality time. METHODS A prospective multicenter study was conducted, which included adult patients with unselected acute illness who were treated by EMS. The primary outcome was noncumulative mortality from all causes by time windows including 30-day mortality, 31- to 180-day mortality, and 181- to 365-day mortality. Prehospital predictors included demographic variables, standard vital signs, prehospital laboratory tests, and comorbidities. RESULTS A total of 4830 patients were enrolled. The noncumulative mortalities at 30, 180, and 365 days were 10.8%, 6.6%, and 3.5%, respectively. The best predictive value was shown for 30-day mortality (AUC = 0.930; 95% CI: 0.919-0.940), followed by 180-day (AUC = 0.852; 95% CI: 0.832-0.871) and 365-day (AUC = 0.806; 95% CI: 0.778-0.833) mortality. DISCUSSION Rapid characterization of patients at risk of short-, medium-, or long-term mortality could help EMS to improve the treatment of patients suffering from acute illnesses.
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Affiliation(s)
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina, Spain
| | - Carlos del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, 47011 Valladolid, Spain; (C.d.P.V.); (F.M.-R.)
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain; (R.E.d.S.G.); (R.L.-I.)
- Faculty of Medicine, Universidad de Valladolid, 47011 Valladolid, Spain; (C.d.P.V.); (F.M.-R.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Irene Sánchez Soberón
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain; (I.S.S.); (J.F.D.B.)
| | - Juan F. Delgado Benito
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain; (I.S.S.); (J.F.D.B.)
| | - Raquel Martínez Diaz
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Department of Project Management, Universidad de La Romana, La Romana 22000, Dominican Republic
| | - Cristina Mazas Pérez-Oleaga
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Arecibo 00613, Puerto Rico
- Department of Project Management, Universidade Internacional do Cuanza, Cuito EN250, Angola
| | - Nohora Milena Martínez López
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Fundación Universitaria Internacional de Colombia, Bogotá 111321, Colombia
| | - Irma Domínguez Azpíroz
- Department of Project Management, Universidad Europea del Atlántico, 39011 Santander, Spain; (R.M.D.); (C.M.P.-O.); (N.M.M.L.); (I.D.A.)
- Department of Project Management, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Department of Project Management, Universidad de La Romana, La Romana 22000, Dominican Republic
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, 47011 Valladolid, Spain; (C.d.P.V.); (F.M.-R.)
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain; (I.S.S.); (J.F.D.B.)
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211
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Nataraj M. ICU health literacy to registry-building: a roadmap for better intensive care delivery in low-middle income countries. Intensive Care Med 2024:10.1007/s00134-024-07510-8. [PMID: 38896268 DOI: 10.1007/s00134-024-07510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Megha Nataraj
- Department of Cardiovascular & Respiratory Physiotherapy, MGM College of Physiotherapy, Navi Mumbai, Maharashtra, India.
- MGM Hospital & Research Centre, CBD Belapur, Navi Mumbai, Maharashtra, 400614, India.
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212
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Parlak AG, Akkuş Y, Araz Ö. The Effect of Foot Reflexology on Stress, Fatigue, and Low Back Pain in Intensive Care Unit Nurses: A Randomized Controlled Trial. Pain Manag Nurs 2024:S1524-9042(24)00186-3. [PMID: 38897824 DOI: 10.1016/j.pmn.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES This study, which uses a randomized controlled design, aimed to determine the effect of foot reflexology on stress, fatigue, and low back pain (LBP) in intensive care unit (ICU) nurses. METHODS The study was conducted with intensive care unit nurses at two hospitals in a city between September 2022 and April 2023. The study sample consisted of 42 nurses, 21 of whom had low back pain for at least 3 months and 21 of whom were controls. In the study, foot reflexology was applied to the intervention group for 20 minutes (10 minutes on each foot) once a week for 4 weeks. There was no intervention applied to the control group. Data were collected using the Personal Information Form, the Perceived Stress Scale (PSS), the Fatigue Severity Scale (FSS), and the Visual Analog Scale (VAS). FINDINGS Based on the change in the mean scores of the scale in the intervention and control groups over time, a statistically significant decrease was found between the pre-test (before foot reflexology) and post-test mean scores of the LBP-VAS (from 6.33 to 2.24, respectively) and the Fatigue Severity Scale (from 4.81 to 3.60, respectively) in the intervention group. Although there was no statistically significant difference between the perceived stress scale pre-test and post-test scores, it was found that there was a decrease in favor of the intervention group. CONCLUSION Foot reflexology appears to offer promise as an effective method for ICU nurses to reduce lower back pain and fatigue.
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Affiliation(s)
- Ayşe Gül Parlak
- Kafkas University Faculty of Health Science, Nursing Department Kars 36100, Turkey.
| | - Yeliz Akkuş
- Kafkas University Faculty of Health Science, Nursing Department Kars 36100, Turkey
| | - Özkan Araz
- Kars Harakani State Hospital, Department of Physical Medicine and Rehabilitation, Kars 36000, Turkey
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213
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Latimer S, Walker RM, Chaboyer W, Thalib L, Coyer F, Deakin JL, Gillespie BM. Prophylactic dressings to prevent sacral pressure injuries in adult patients admitted to intensive care units: A three-arm feasibility randomized controlled trial. Intensive Crit Care Nurs 2024; 84:103746. [PMID: 38896962 DOI: 10.1016/j.iccn.2024.103746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Pressure injuries in intensive care patients are a safety issue. Specialized foam sacral prophylactic dressings prevent pressure injuries with several products available for clinicians to choose from. OBJECTIVES Assess the feasibility of conducting a multisite trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients. METHODS Using a three-arm pilot randomized trial design, adult intensive care unit patients at risk for pressure injuries were randomly allocated to the Mepilex® Sacrum dressing, the Allevyn™ Life Sacrum dressing or the control group. Daily pressure injury data were collected including a de-identified sacral photograph, which the blinded outcome assessor used to determine the study end point: a new sacral pressure injury. Pre-determined feasibility criteria were measured in terms of eligibility, recruitment, retention, intervention fidelity and missing data. RESULTS From May-September 2021, we screened 602 intensive care unit adult patients for eligibility with 93 % (n = 558) excluded. Forty-four (7 %) were eligible, and all were recruited and randomized (100 %). After receipt of the intervention two participants withdrew from the study. Our final sample of 42 participants were randomly allocated to the Mepilex® (n = 12), Allevyn™ (n = 14) or control (n = 16) group. The interventions were delivered as intended and there were 11 (6 %) cases of missing outcome data. Five participants (12 %) developed a sacral pressure injury, four of whom received a sacral dressing. CONCLUSIONS A larger trial is feasible with minor refinement to the length of stay eligibility criterion. IMPLICATIONS FOR PRACTICE Prophylactic sacral dressings are recommended for pressure injury prevention. Determining the feasibility of a larger trial to test the effectiveness of two dressings versus usual care in preventing sacral pressure injuries in intensive care patients can provide evidence to aid clinicians, policy makers and managers make value-based care decisions.
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Affiliation(s)
- Sharon Latimer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Rachel M Walker
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Division of Surgery, Metro South Health, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, St. Lucia, QLD, Australia.
| | - Jodie L Deakin
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia.
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214
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Kirton L, Kung S, Bird G, Black M, Semprini R, Eathorne A, Weatherall M, Semprini A, Beasley R. Automated oxygen titration with non-invasive ventilation in hypoxaemic adults with cardiorespiratory disease: a randomised cross-over trial. BMJ Open Respir Res 2024; 11:e002196. [PMID: 38897612 PMCID: PMC11191803 DOI: 10.1136/bmjresp-2023-002196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Closed-loop oxygen control systems automatically adjust the fraction of inspired oxygen (FiO2) to maintain oxygen saturation (SpO2) within a predetermined target range. Their performance with low and high-flow oxygen therapies, but not with non-invasive ventilation, has been established. We compared the effect of automated oxygen on achieving and maintaining a target SpO2 range with nasal high flow (NHF), bilevel positive airway pressure (bilevel) and continuous positive airway pressure (CPAP), in stable hypoxaemic patients with chronic cardiorespiratory disease. METHODS In this open-label, three-way cross-over trial, participants with resting hypoxaemia (n=12) received each of NHF, bilevel and CPAP treatments, in random order, with automated oxygen titrated for 10 min, followed by 36 min of standardised manual oxygen adjustments. The primary outcome was the time taken to reach target SpO2 range (92%-96%). Secondary outcomes included time spent within target range and physiological responses to automated and manual oxygen adjustments. RESULTS Two participants were randomised to each of six possible treatment orders. During automated oxygen control (n=12), the mean (±SD) time to reach target range was 114.8 (±87.9), 56.6 (±47.7) and 67.3 (±61) seconds for NHF, bilevel and CPAP, respectively, mean difference 58.3 (95% CI 25.0 to 91.5; p=0.002) and 47.5 (95% CI 14.3 to 80.7; p=0.007) seconds for bilevel and CPAP versus NHF, respectively. Proportions of time spent within target range were 68.5% (±16.3), 65.6% (±28.7) and 74.7% (±22.6) for NHF, bilevel and CPAP, respectively.Manually increasing, then decreasing, the FiO2 resulted in similar increases and then decreases in SpO2 and transcutaneous carbon dioxide (PtCO2) with NHF, bilevel and CPAP. CONCLUSION The target SpO2 range was achieved more quickly when automated oxygen control was initiated with bilevel and CPAP compared with NHF while time spent within the range across the three therapies was similar. Manually changing the FiO2 had similar effects on SpO2 and PtCO2 across each of the three therapies. TRIAL REGISTRATION NUMBER ACTRN12622000433707.
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Affiliation(s)
- Louis Kirton
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Stacey Kung
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Georgina Bird
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Melissa Black
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Ruth Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Alex Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University Wellington, Wellington, New Zealand
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215
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Lockhorst EW, van Noordenne M, Klouwens L, Govaert KM, de Bruijn E, Verhoef C, Gobardhan PD, Schreinemakers JMJ. Improving diagnosis of early complications (<1 week) through continuous vital sign monitoring following oncological gastrointestinal surgical procedures. World J Surg 2024. [PMID: 38890767 DOI: 10.1002/wjs.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Patients undergoing major oncological abdominal surgery are prone to postoperative complications, making early recognition crucial. Clinical deterioration is often preceded by changes in vital signs, which are typically measured thrice a day by a nurse. However, intermittent measurements may delay recognizing clinical deterioration. Continuous vital parameter monitoring may lead to earlier recognition and management of complications and reduce nursing workload. OBJECTIVE To compare vital parameter measurements between ward nurses and a wireless continuous monitoring system (Sensium® wireless patch) and assess whether this patch can detect clinical deterioration earlier in patients with complications in the first postoperative week. METHODS Vital parameters (heart rate, respiratory rate, and temperature) were collected in patients undergoing an oncological resection of the liver, colorectal, or pancreas. Sensium® patch measurements were compared to nurses' measurements to assess the percentages of discordant measurements. In patients with complications in the first postoperative week, time discrepancies between nurses and Sensium® patch measurements were identified in cases of clinical deterioration (respiratory rate ≥15/min, heart rate ≥100/min, and temperature ≥38°C). RESULTS Among 227 patients, 22% of the patients experienced complications. Nurse and Sensium® measurements were discrepant in 586/2272 measurements (26%). In 506/586 discrepancies (86%), this was due to the respiratory rate (difference ≥4/min). Compared to nurses, the Sensium® patch detected an elevated respiratory rate 14 h earlier and heart rate 2 h earlier within complications in the first postoperative week. For temperature, no difference was observed. CONCLUSION Continuous monitoring with the Sensium® wireless patch holds promise for earlier recognition of complications in patients who underwent major oncological abdominal surgery.
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Affiliation(s)
- Elize W Lockhorst
- Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC University Cancer Institute, Rotterdam, The Netherlands
| | | | - Linda Klouwens
- Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands
| | - Klaas M Govaert
- Department of Surgery, Maasziekenhuis Pantein, Boxmeer, The Netherlands
| | - Eva de Bruijn
- Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC University Cancer Institute, Rotterdam, The Netherlands
| | - Paul D Gobardhan
- Department of Surgery, Amphia Hospital Breda, Breda, The Netherlands
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Cimoli M, Gibney J, Lim M, Castles J, Dammert P. Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1410023. [PMID: 38957683 PMCID: PMC11217566 DOI: 10.3389/fresc.2024.1410023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.
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Affiliation(s)
- Michelle Cimoli
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Jennifer Gibney
- Speech Pathology Department, Nepean Hospital, Penrith, NSW, Australia
| | - Mathew Lim
- Dental Services, Alfred Health, Prahran, VIC, Australia
- Melbourne Dental School, University of Melbourne, Carlton, VIC, Australia
| | - Jo Castles
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Pedro Dammert
- Pulmonary and Critical Care Department, Scripps Mercy Hospital Chula Vista, Chula Vista, CA, United States
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Rousseau AF, Fontana M, Georis S, Lambermont B, Cavalleri J, Pirotte M, Tronconi G, Paquay M, Misset B. Implementation of a routine post-shift debriefing program in ICU aiming at quality-of-care improvement: A primary analysis of feasibility and impacts. Intensive Crit Care Nurs 2024; 84:103752. [PMID: 38896963 DOI: 10.1016/j.iccn.2024.103752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/02/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES This report describes the implementation of a clinical debriefing (CD) program in intensive care units (ICU) and analyses its feasibility and its impact on staff well-being. DESIGN Observational study. SETTING From April to September 2023, post-shift CDs were run once a week in 2 out of 7 units in our department, using an adapted version of the DISCOVER-PHASE tool. CD sessions were performed face-to-face with volunteer members of the multidisciplinary ICU team. MAIN OUTCOME MEASURES After 6 months, a survey assessing the satisfaction of the debriefed teams was conducted. The impact of CD on staff well-being was assessed using three validated questionnaires (Maslach Burnout Inventory, Ways of Coping Checklist, Professional Quality of Life Scale) administered in the 7 units before and after the CD period. RESULTS A total of 44 CDs were performed, lasting 15 (4-35) min. There were 6 (1-9) attendees per CD, mainly nurses (64.6%). Discussions focused mainly on basic problems related to dysfunctional material, communication and organization inside the team. The two debriefed teams were satisfied of the program and gave 9, 8 and 8 out of 10 on a visual analogical scale for the climate of confidence of the DC, their organisation, and their ability to improve working conditions and quality of care, respectively. Subscores at the three questionnaires assessing staff well-being before and after the CD period were similar, whether teams experienced CD or not. CONCLUSIONS Implementing of post-shift debriefings in our ICU was feasible and well accepted. More prolonged programs are probably needed to demonstrate benefits on staff well-being. IMPLICATIONS FOR CLINICAL PRACTICE This report offers elements that other teams can use to successfully conduct post-shift debriefings and to plan future research on longer-term programs.
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Affiliation(s)
- Anne-Françoise Rousseau
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium; Research Unit for a Life-Course Perspective on Health & Education-RUCHE, University of Liège, Liège, Belgium.
| | - Michael Fontana
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Stéphanie Georis
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Bernard Lambermont
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Jonathan Cavalleri
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Marc Pirotte
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Gaëlle Tronconi
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
| | - Méryl Paquay
- Centre for Medical Simulation, University of Liège, Belgium; Emergency Department, University Hospital of Liège, University of Liège, Belgium
| | - Benoit Misset
- Intensive Care Department, University Hospital of Liège, University of Liège, Belgium
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218
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Navarra-Ventura G, Godoy-González M, Gomà G, Jodar M, Sarlabous L, Santos-Pulpón V, Xifra-Porxas A, de Haro C, Roca O, Blanch L, López-Aguilar J, Fernández-Gonzalo S. Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness. Eur J Psychotraumatol 2024; 15:2363654. [PMID: 38881386 PMCID: PMC11185090 DOI: 10.1080/20008066.2024.2363654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Background: Intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) are associated with psychological distress and trauma. The COVID-19 pandemic brought with it a series of additional long-lasting stressful and traumatic experiences. However, little is known about comorbid depression and post-traumatic stress disorder (PTSD).Objective: To examine the occurrence, co-occurrence, and persistence of clinically significant symptoms of depression and PTSD, and their predictive factors, in COVID-19 critical illness survivors.Method: Single-centre prospective observational study in adult survivors of COVID-19 with ≥24 h of ICU admission. Patients were assessed one and 12 months after ICU discharge using the depression subscale of the Hospital Anxiety and Depression Scale and the Davidson Trauma Scale. Differences in isolated and comorbid symptoms of depression and PTSD between patients with and without IMV and predictors of the occurrence and persistence of symptoms of these mental disorders were analysed.Results: Eighty-nine patients (42 with IMV) completed the 1-month follow-up and 71 (34 with IMV) completed the 12-month follow-up. One month after discharge, 29.2% of patients had symptoms of depression and 36% had symptoms of PTSD; after one year, the respective figures were 32.4% and 31%. Coexistence of depressive and PTSD symptoms accounted for approximately half of all symptomatic cases. Isolated PTSD symptoms were more frequent in patients with IMV (p≤.014). The need for IMV was associated with the occurrence at one month (OR = 6.098, p = .005) and persistence at 12 months (OR = 3.271, p = .030) of symptoms of either of these two mental disorders.Conclusions: Comorbid depressive and PTSD symptoms were highly frequent in our cohort of COVID-19 critical illness survivors. The need for IMV predicted short-term occurrence and long-term persistence of symptoms of these mental disorders, especially PTSD symptoms. The specific role of dyspnea in the association between IMV and post-ICU mental disorders deserves further investigation.Trial registration: ClinicalTrials.gov identifier: NCT04422444.
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Affiliation(s)
- Guillem Navarra-Ventura
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Godoy-González
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Spain
| | - Gemma Gomà
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Jodar
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Spain
- Neurology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Leonardo Sarlabous
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Verónica Santos-Pulpón
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Xifra-Porxas
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Candelaria de Haro
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Oriol Roca
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Lluís Blanch
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina López-Aguilar
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Sol Fernández-Gonzalo
- Critical Care Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Li C, Lei Q, Ju P, Liu J, Deng W, Chen L. Effect of trans-theoretical model-based nursing intervention on emotion and fear in post-liver cancer surgery patients. Am J Transl Res 2024; 16:2346-2357. [PMID: 39006267 PMCID: PMC11236662 DOI: 10.62347/myea6043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To investigate the efficacy of nursing interventions grounded in the trans-theoretical model on emotion and fear among patients undergoing surgery for hepatocellular carcinoma (HCC). METHODS The study included 188 surgical patients from the Second People's Hospital of Lanzhou City who underwent HCC intervention between March 2020 and May 2022. The control group comprised 81 patients receiving standard postoperative care, while the observation group included 107 patients who received nursing interventions based on the trans-theoretical model. We assessed outcomes using the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), Quality of Life Questionnaire Core 30 (QLQ-C30), Gastrointestinal Comfort Questionnaire (GCQ), Self-Rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) before and after the intervention. Logistic regression was used to identify factors influencing post-intervention fear. RESULTS Both groups showed improvement in FOP-Q-SF, QLQ-C30, GCQ, SAS, and SDS scores after the intervention. However, the observation group demonstrated significantly greater improvements (P < 0.05). There was a positive correlation between FOP-Q-SF scores and both SAS and SDS scores (all P < 0.05), and a negative correlation with QLQ-C30 and GCQ scores (both P < 0.05). Multifactorial logistic regression revealed that age (P < 0.001, OR: 8.328), gender (P < 0.001, OR: 0.181), literacy level (P < 0.001, OR: 0.354), and nursing care regimen (P < 0.001, OR: 0.078) were significant independent risk factors for persistence of fearpost-intervention. CONCLUSION The implementation of nursing interventions based on the trans-theoretical model significantly reduces postoperative fear and anxiety, improves pain perception, and enhances overall comfort in patients after liver cancer surgery.
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Affiliation(s)
- Caihong Li
- Department of Hepatology II, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Qingfen Lei
- Department of Hepatology II, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Ping Ju
- Department of Gastroenterology, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Junlan Liu
- Department of Hepatology II, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Wenmin Deng
- Department of Gastroenterology, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Li Chen
- Department of Endoscopy Center, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
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220
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Jia D, Chen Y, Liu C, Ding S, Fang Y. Investigating optimal compression approach following radial artery puncture: a retrospective study. Am J Transl Res 2024; 16:2389-2397. [PMID: 39006301 PMCID: PMC11236670 DOI: 10.62347/bwup6404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/25/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND The method for compressing hemorrhagic sites after transradial access has been a topic of interest, yet definitive guidelines remain elusive. This study aims to address this gap by optimizing the mechanical compression hemostasis protocol after transradial access. METHODS This retrospective analysis included 300 patients from the Department of Cerebrovascular Diseases, Shanghai Fourth People's Hospital affiliated to Tongji University, who underwent transradial access for cerebrovascular angiography. Following the procedure, patients received radial artery compression hemostasis using a balloon compressor. They were divided into group A (n=100, continuous deflation) and group B (n=200, intermittent deflation) according to different hemostasis methods. The incidence of bleeding at the puncture site and complications were compared between the two groups. RESULTS The rate of bleeding at the puncture site was significantly lower in group B (20 out of 200 patients) compared to group A (20 out of 100 patients) (P=0.032). Similarly, the incidence of puncture site complications, such as edema, congestion, and wound infection was lower in group B (5 out of 200 patients) compared to group A (10 out of 100 patients) (P=0.006). CONCLUSION Four hours of compression with intermittent deflation (group B) emerged as the optimal compression method after transradial access, demonstrating fewer complications at the patient's puncture site.
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Affiliation(s)
- Dandan Jia
- Department of Cerebrovascular Diseases, Shanghai Fourth People’s Hospital, Tongji UniversityShanghai 200434, China
| | - Yuting Chen
- Department of Emergency, Shanghai Fourth People’s Hospital, Tongji UniversityShanghai 200434, China
| | - Changyu Liu
- Medical Laboratory Center, Hainan Provincial People’s Hospital, Clinical College Affiliated to Hainan Medical CollegeHaikou 570100, Hainan, China
| | - Silian Ding
- Department of Cerebrovascular Diseases, Shanghai Fourth People’s Hospital, Tongji UniversityShanghai 200434, China
| | - Yibin Fang
- Department of Cerebrovascular Diseases, Shanghai Fourth People’s Hospital, Tongji UniversityShanghai 200434, China
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221
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Sakalauskas L, Dulskis V, Jankunas RJ. Compartmental modeling for pandemic data analysis: The gap between statistics and models. Heliyon 2024; 10:e31410. [PMID: 38832260 PMCID: PMC11145209 DOI: 10.1016/j.heliyon.2024.e31410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
A scrutiny analysis of the COVID-19 data is required to get insights into effective strategies for pandemic control. However, there is a gap between official data and methods used to assess the effectiveness of the potential measures, which was partly addressed in an editorial-letter-type discussion on the impact of the COVID-19 passport in Lithuania. The therein-applied descriptive statistics method provides only limited evidence, while detailed analysis requires more sensitive and reliable methods. In this regard, this paper advocates a maximum likelihood compartmental modeling approach, which provides the flexibility to raise various hypotheses about infection, recovery, and mortality dynamics and to find the most likely answers given the data. Our paper is based on COVID-19 deaths, which are more reliable and essential than infection cases. It should also be noted that officially collected data are unsuitable for in-depth analyses, including compartmental modeling, as they do not capture important information. Overall, this paper does not aim to solve the underlying problems completely but rather stimulate a discussion.
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Affiliation(s)
- Leonidas Sakalauskas
- Klaipeda University, H. Manto st. 84, Klaipeda, LT-92294, Lithuania
- Health Law Institute, Ulonu st. 5-303, Vilnius, LT-08240, Lithuania
| | - Vytautas Dulskis
- Vilnius University Institute of Data Science and Digital Technologies, Akademijos st. 4, Vilnius, LT-08412, Lithuania
| | - Rimas Jonas Jankunas
- Medical Academy, Lithuanian University of Health Sciences, Mickeviciaus st. 9, Kaunas, LT-44307, Lithuania
- Health Law Institute, Ulonu st. 5-303, Vilnius, LT-08240, Lithuania
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You H, Docherty SL, Ashana DC, Oyesanya TO. Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care. AACN Adv Crit Care 2024; 35:97-108. [PMID: 38848572 DOI: 10.4037/aacnacc2024982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another location or level of care. Transitions theory is a middle-range nursing theory that aims to provide guidance for safe and effective nursing care and research while an individual experiences a transition. Intensive care unit nurses are well positioned to provide ICU transitional care planning early. This article applies the transitions theory as a theoretical model to guide the study of the transition to home after acute hospital care for ICU patients and their families. This theory application can help ICU nurses provide holistic patient- and family-centered transitional care to achieve optimal outcomes by addressing the predischarge and postdischarge needs of patients and families.
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Affiliation(s)
- HyunBin You
- HyunBin You is a PhD candidate, School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham, NC 27710
| | - Sharron L Docherty
- Sharron L. Docherty is Associate Professor, School of Nursing, and Associate Professor, Department of Medicine, Duke University, Durham, North Carolina
| | - Deepshikha C Ashana
- Deepshikha C. Ashana is Assistant Professor, Department of Medicine; Core Faculty Member, Duke-Margolis Center for Health Policy; and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Tolu O Oyesanya
- Tolu O. Oyesanya is Associate Professor, School of Nursing, Duke University, Durham, North Carolina
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223
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Ayalasomayajula Y, Hesaraghatta A, Dantuluri N, Yassine J, Saleem F, Mansour H, Chayawatto C, Rangarajan N, Rangarajan S, Krishnan S, Panguluri SK. Influence of age and sex on physical, cardiac electrical and functional alterations in progressive hyperoxia treatment: A time course study in a murine model. Exp Gerontol 2024; 191:112435. [PMID: 38636569 DOI: 10.1016/j.exger.2024.112435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Oxygen supplementation is a widely used treatment for ICU patients. However, it can lead to hyperoxia, which in turn can result in oxidative stress, cardiac remodeling, and even mortality. This paper expands upon previous research conducted by our lab to establish time-dependent cardiac changes under hyperoxia. In this study, both young and aged mice (male and female) underwent 72 h of hyperoxia exposure and were monitored at 24-hour intervals for cardiac electrophysiological and functional parameters using ECG and electrocardiogram data. Our analysis showed that young male mice experienced significant weight loss as well as significant lung edema by 48 h. Although young male mice were highly susceptible to physical changes, they were resistant to early cardiac functional and electrophysiological changes compared to the other groups. Both young and aged female and aged males developed functional impairments by 24 h of hyperoxia exposure. Furthermore, sex and age differences were noted in the onset of electrophysiological changes. While some groups could resist early cardiac remodeling, our data suggests that 72 h of hyperoxia exposure is sufficient to induce significant cardiac remodeling across all age and sex groups. Our data establishes that time-dependent cardiac changes due to oxygen supplementation can have devastating consequences even with short exposure periods. These findings can aid in developing clinical practices for individuals admitted to the ICU by elucidating the impact of aging, sex, and length of stay under mechanical ventilation to limit hyperoxia-induced cardiac remodeling.
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Affiliation(s)
- Yashwant Ayalasomayajula
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Anagha Hesaraghatta
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Neha Dantuluri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Jenna Yassine
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Faizan Saleem
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Hussein Mansour
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Chayapatou Chayawatto
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Nishank Rangarajan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Sashank Rangarajan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Smrithi Krishnan
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA
| | - Siva Kumar Panguluri
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA; Cell Biology, Microbiology and Molecular Biology, College of Arts and Sciences, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, USA.
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Bloomer MJ, O'Neill K, Hewitt J, Wheaton A, O'Connor M, Bonner A. "How to navigate this new area": Intensive care clinicians' perceptions of voluntary assisted dying in the intensive care unit: A multisite exploratory study. Aust Crit Care 2024:S1036-7314(24)00094-8. [PMID: 38880708 DOI: 10.1016/j.aucc.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND There is growing momentum worldwide for assisted dying. In Australia, voluntary assisted dying may occur in any setting, including an intensive care unit (ICU). As the subject of much debate worldwide, exploring ICU clinicians' perceptions of assisted dying is essential. AIM The aim of this study was to explore clinicians' perceptions of and preparedness for voluntary assisted dying in the ICU. METHOD An exploratory qualitative descriptive design using individual interviews was used. Medical, nursing, and allied health clinicians from three ICUs were recruited. Interviews were conducted between Nov 2022 and Jan 2023, with a hypothetical scenario about voluntary assisted dying used to prompt discussion. Interviews were recorded, professionally transcribed, and analysed using inductive content analysis. FINDINGS ICU registered nurses (n = 20), physicians (n = 2), and allied health clinicians (n = 4) participated with interviews lasting 18-45 min (mean: 28 min). Analysis revealed four themes: (i) purpose of ICU reflected that ICU care was not all about saving lives, yet recognising dying and changing priorities was challenging; (ii) dying in the ICU is complex due to difficulties in talking about dying, accepting death as the outcome and evaluating care efficacy; (iii) voluntary assisted dying is a lot of grey because of perceived clinical and ethicolegal challenges; and finally, (iv) respecting choice was about respecting patients' values, beliefs, and autonomy, as well as clinicians' beliefs and right to exercise autonomy through conscientious objection. CONCLUSION Dying and death are inevitable, and views and perspectives about assisted dying will continue to evolve. Respecting patient choice is at the core of assisted dying, but respecting clinicians' perspectives and choice is equally important. With voluntary assisted dying now legal in all Australian states, ensuring ICU team and individual clinician preparedness through access to education, resources, and specialist support services is key to raising awareness and easing uncertainty about deaths through voluntary assisted dying.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia.
| | - Kylie O'Neill
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Queen Elizabeth II Hospital, Metro South Health and Hospital Service, Coopers Plains, QLD, Australia; Law Futures Centre, Griffith University, Nathan, QLD, Australia
| | - Andrew Wheaton
- Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Margaret O'Connor
- School of Nursing and Midwifery, Monash University, Peninsula Campus, Frankston, VIC, Australia; Voluntary Assisted Dying Review Board, Melbourne, VIC, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Kidney Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
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Krüger L, Zittermann A, Mannebach T, Wefer F, Becker T, Lohmeier S, Lüttermann A, von Dossow V, Rojas SV, Gummert J, Langer G. Randomized feasibility trial for evaluating the impact of primary nursing on delirium duration during intensive care unit stay. Intensive Crit Care Nurs 2024; 84:103748. [PMID: 38875775 DOI: 10.1016/j.iccn.2024.103748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE We tested the feasibility of a randomized controlled trial for comparing primary nursing with standard care. RESEARCH METHODOLOGY Elective cardiac surgical patients were eligible for inclusion. Patients with an intensive care unit stay of ≥ 3 days were followed up until intensive care unit discharge. Recruitment period was one year. SETTING Two intensive care units at a university hospital specialized in cardiovascular and diabetic diseases. MAIN OUTCOME MEASURES Primary outcomes were recruitment and delivery rate. Primary clinical outcome was duration of delirium, as assessed by the Confusion Assessment Method for Intensive Care Units. Secondary outcomes included the incidence of delirium, anxiety (10-point Numeric Rating Scale), and the satisfaction of patient relatives (validated questionnaire). RESULTS Of 369 patients screened, 269 could be allocated to primary nursing (n = 134) or standard care (n = 135), of whom 46 patients and 48 patients, respectively, underwent an intensive care unit stay ≥ 3 days. Thus, recruitment and delivery rates were 73 and 26 %, respectively. During primary nursing and standard care, 18 and 24 patients developed a delirium, with a median duration of 32 (IQR: 14-96) and 24 (IQR: 8-44) hours (P = 0.10). The risk difference of delirium for primary nursing versus standard care was 11 % and the relative risk was 0.65 (95 % CI: 0.28-1.46; P = 0.29). The extent of anxiety was similar between groups (P = 0.13). Satisfaction could be assessed in 73.5 % of relatives, without substantial differences between groups. CONCLUSION Data demonstrate that a trial for comparing primary nursing with standard care is generally feasible. However, the incidence of delirium may be a better primary outcome parameter than delirium duration, both in terms of long-term patient outcome and robustness of data quality. IMPLICATIONS FOR CLINICAL PRACTICE A randomized clinical trial regarding nursing organization during intensive care unit stay requires detailed planning of patient recruitment, data evaluation, and power calculation.
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Affiliation(s)
- Lars Krüger
- Project and Knowledge Management/Care Development Intensive Care, Care Directorate, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany.
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Thomas Mannebach
- Surgical Intensive Care Unit, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Franziska Wefer
- Care Development, Care Directorate, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany; Institute of Nursing Science, Medical Faculty and University Hospital Cologne, University of Cologne, Gleueler Strasse 176-178, 50935 Cologne, Germany
| | - Tobias Becker
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Sarah Lohmeier
- Surgical Intensive Care Unit, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Anna Lüttermann
- Surgical Intensive Care Unit, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32345 Bad Oeynhausen, Germany
| | - Gero Langer
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle (Saale), Germany
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Dantan E, Foucher Y, Simon-Pimmel J, Léger M, Campfort M, Lasocki S, Lakhal K, Bouras M, Roquilly A, Cinotti R. Long-term survival of traumatic brain injury and intra-cerebral haemorrhage patients: A multicentric observational cohort. J Crit Care 2024; 83:154843. [PMID: 38875914 DOI: 10.1016/j.jcrc.2024.154843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/13/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE Mortality is often assessed during ICU stay and early after, but rarely at later stage. We aimed to compare the long-term mortality between TBI and ICH patients. MATERIALS AND METHODS From an observational cohort, we studied 580 TBI patients and 435 ICH patients, admitted from January 2013 to February 2021 in 3 ICUs and alive at 7-days post-ICU discharge. We performed a Lasso-penalized Cox survival analysis. RESULTS We estimated 7-year survival rates at 72.8% (95%CI from 67.3% to 78.7%) for ICH patients and at 84.9% (95%CI from 80.9% to 89.1%) for TBI patients: ICH patients presenting a higher mortality risk than TBI patients. Additionally, we identified variables associated with higher mortality risk (age, ICU length of stay, tracheostomy, low GCS, absence of intracranial pressure monitoring). We also observed anisocoria related with the mortality risk in the early stage after ICU stay. CONCLUSIONS In this ICU survivor population with a prolonged follow-up, we highlight an acute risk of death after ICU stay, which seems to last longer in ICH patients. Several variables characteristic of disease severity appeared associated with long-term mortality, raising the hypothesis that the most severe patients deserve closer follow-up after ICU stay.
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Affiliation(s)
- E Dantan
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France.
| | - Y Foucher
- Poitiers Université, CHU de Poitiers, CIC INSERM 1402, Poitiers, France
| | - J Simon-Pimmel
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France
| | - M Léger
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - M Campfort
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - S Lasocki
- Department of Anaesthesiology and Critical Care, Angers University, CHU Angers, Angers, France
| | - K Lakhal
- Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation Chirurgicale, Hôpital Laennec, Nantes F-44093, France
| | - M Bouras
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR, 1064 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC0004, 1413 Nantes, France
| | - A Roquilly
- Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR, 1064 Nantes, France; CHU Nantes, INSERM, Nantes Université, Anesthesie Reanimation, CIC0004, 1413 Nantes, France
| | - R Cinotti
- Nantes Université, Univ Tours, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; Nantes Université, CHU Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes F-44093, France
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Flynch M, Frederickson K. Disrupted Sensemaking-Understanding Family Experiences of Physical Restraints in ICU: A Phenomenological Approach in the Context of COVID-19. Healthcare (Basel) 2024; 12:1182. [PMID: 38921296 PMCID: PMC11202988 DOI: 10.3390/healthcare12121182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The emergence of COVID-19 profoundly influenced the dynamics within intensive care units, significantly altering the patient-family experience. As the pandemic unfolded, the longstanding practice of using physical restraints for patient safety persisted, introducing new challenges in healthcare settings. This study explored the ramifications of these enduring safety measures on family members of ICU patients during the pandemic, illuminating their lived experiences and the psychological impact of seeing their loved ones restrained. OBJECTIVES To explore family members' lived experiences with physical restraints in the ICU during COVID-19 and inform improvements in patient-centered care. METHODS Utilizing hermeneutic phenomenology, the study engaged ten family members in detailed interviews to gain an understanding of their experiences with ICU physical restraints during COVID-19. Conducted at a northeastern U.S. hospital, the collected narratives underwent thematic analysis within a sensemaking framework, yielding a profound understanding of family perspectives. RESULTS Family members faced challenges in understanding and coping with physical restraints, revealing a need for improved healthcare system support for family sensemaking and well-being. CONCLUSIONS The study advocates integrating empathetic communication and family engagement into ICU care practices, underlining the importance of sensemaking during healthcare crises.
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Affiliation(s)
- Michele Flynch
- College of Health Professions, Lienhard School of Nursing, Pace University, Pleasantville, NY 10570, USA;
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Latham S, Leach MJ, White VM, Webber K, Jefford M, Lisy K, Davis N, Millar JL, Evans S, Emery JD, IJzerman M, Ristevski E. Health-related quality of life in rural cancer survivors compared with their urban counterparts: a systematic review. Support Care Cancer 2024; 32:424. [PMID: 38864894 PMCID: PMC11168981 DOI: 10.1007/s00520-024-08618-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE We conducted a systematic review to describe health-related quality of life (HRQOL) in rural cancer survivors (RCS), and compare HRQOL between RCS and urban cancer survivors (UCS). METHOD We searched Medline, Embase, CINAHL Plus, and PsycINFO for studies with HRQOL in adult cancer survivors living in rural, regional, remote, and urban areas, who had completed definitive primary cancer treatment, without evidence of residual disease. Where available, we used normative and clinically important values to ascribe meaning to HRQOL data. FINDINGS Fifteen studies (16 papers) were included. Most were from the US (n = 8) and reported on breast cancer survivors (n = 9). Six HRQOL instruments, collecting data across 16 domains, were used. Three instruments were specific to the survivorship phase. Normative and clinical data were available for 12 studies. Compared with normative populations, RCS had clinically worse physical HRQOL (6/12 studies), better social/family (5/7), and functional (3/6) HRQOL, and there were no differences in emotional or/mental HRQOL (9/12). In six studies with rural-urban comparator groups and normative and clinically important data, RCS and UCS had clinically worse physical (3/6 and 2/6, respectively) and better social/family (3/4 and 2/4 studies, respectively) HRQOL than normative populations. Functional HRQOL was better in RCS (2/4 studies) than UCS and normative populations. In 3/6 studies, there were no clinical differences in emotional or/mental HRQOL between RCS, UCS, and normative populations. CONCLUSION Overall, HRQOL is not clearly better or worse in RCS than UCS. Future research should include different tumor types, rural residents, and survivorship-specific HRQOL instruments.
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Affiliation(s)
- S Latham
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
- Department of Oncology, Eastern Health, Box Hill, Victoria, Australia
- Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - M J Leach
- School of Rural Health, Monash University, Bendigo, VIC, Australia
| | - V M White
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - K Webber
- Department of Oncology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - M Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, , Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - K Lisy
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, , Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - N Davis
- Cancer Survivor, Melbourne, Australia
| | - J L Millar
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - S Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J D Emery
- Department of General Practice and Primary Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Cancer Research, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - M IJzerman
- Centre for Health Policy, Cancer Health Services Research, Melbourne School of Population and Global/Total Health, The University of Melbourne, Carlton, Victoria, Australia
| | - E Ristevski
- School of Rural Health, Monash University, 15 Sargeant Street, Warragul, VIC, 3820, Australia.
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Soong JL, Ho PL, Neo VSH, Lie SA. Evaluating the carbon footprint of sedation practices in intensive care. Nurs Crit Care 2024. [PMID: 38866584 DOI: 10.1111/nicc.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/24/2023] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs. AIM To evaluate carbon footprint arising from sedation practices in the ICUs. STUDY DESIGN A pilot, prospective observational study was conducted in two ICUs from 1 August to 22 September 2022 in Singapore General Hospital. Adult patients who were consecutively sedated, intubated and expected to be mechanically ventilated for at least 24 h were included. Total amount of analgesia and sedatives used and wasted in eligible patients were collected. Carbon emission from ICU sedation practices were then quantified using available life cycle assessment data. RESULTS A total of 31 patients were recruited. Top analgesia and sedative used in both ICUs were fentanyl and propofol, respectively. Carbon footprint from sedative usage and wastage across 7 weeks in both ICUs were 2.206 kg CO2-e and 0.286 g CO2-e, respectively. In total, this equates to driving 15.8 km by car. Proportion of drug wasted ranged from 5.1% to 25.0%, with the top reason for wastage being the drug was no longer clinically indicated. Recommendations to reduce carbon footprint include choosing sedatives with lower carbon emissions where possible and having effective communication among doctors and nurses regarding management plans to minimize unnecessary wastage. CONCLUSION Our study quantified carbon footprint arising from sedation practices, mainly drug usage and wastage in two ICUs in Singpore General Hospital. RELEVANCE TO CLINICAL PRACTICE Adopting a holistic approach to environmental sustainability in the ICU, sedation practices also contribute to generating greenhouse gases, albeit small, and can be targeted to reduce unnecessary carbon footprint.
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Affiliation(s)
- Jie Lin Soong
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Department of Pharmacy and Pharmaceutical Sciences, National University of Singapore, Singapore, Singapore
| | - Pei Lin Ho
- Division of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | | | - Sui An Lie
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore, Singapore
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230
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Hotta S, Ashida K, Tanaka M. Night Physician-Nurse Collaboration: Developing the Scale of Physicians' Difficulties and Exploring Related Factors in Acute Care Hospitals. J Multidiscip Healthc 2024; 17:2831-2845. [PMID: 38881754 PMCID: PMC11180433 DOI: 10.2147/jmdh.s454578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 06/18/2024] Open
Abstract
Background Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores. Methods We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics. Results By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach's alpha and McDonald's omega coefficients were 0.81-0.84 and 0.81-0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician's charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores. Conclusion We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians' characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.
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Affiliation(s)
- Soichiro Hotta
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kaoru Ashida
- Department of Nursing, College of Nursing, Kanto Gakuin University, Kanazawa-ku, Yokohama, Japan
| | - Makoto Tanaka
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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231
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Bourke-Matas E, Doan T, Bowles KA, Bosley E. A prediction model for prehospital clinical deterioration: The use of early warning scores. Acad Emerg Med 2024. [PMID: 38863230 DOI: 10.1111/acem.14963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Various prognosticative approaches to assist in recognizing clinical deterioration have been proposed. To date, early warning scores (EWSs) have been evaluated in hospital with limited research investigating their suitability in the prehospital setting. This study evaluated the predictive ability of established EWSs and other clinical factors for prehospital clinical deterioration. METHODS A retrospective cohort study investigating adult patients of all etiologies attended by Queensland Ambulance Service paramedics between January 1, 2018, and December 31, 2020, was conducted. With logistic regression, several models were developed to predict adverse event outcomes. The National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Queensland Adult Deterioration Detection System (Q-ADDS), and shock index were calculated from vital signs taken by paramedics. RESULTS A total of 1,422,046 incidents met the inclusion criteria. NEWS, MEWS, and Q-ADDS were found to have comparably high predictive ability with area under the receiver operating characteristic curve (AUC-ROC) between 70% and 90%, whereas shock index had relatively low AUC-ROC. Sensitivity was lower than specificity for all models. Although established EWSs performed well when predicting adverse events, these scores require complex calculations requiring multiple vital signs that may not be suitable for the prehospital setting. CONCLUSIONS This study found NEWS, MEWS, and Q-ADDS all performed well in the prehospital setting. Although a simple shock index is easier for paramedics to use in the prehospital environment, it did not perform comparably to established EWSs. Further research is required to develop suitably performing parsimonious solutions until established EWSs are integrated into technological solutions to be used by prehospital clinicians in real time.
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Affiliation(s)
- Emma Bourke-Matas
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
- Queensland Ambulance Service, Queensland Government Department of Health, Kedron, Queensland, Australia
| | - Tan Doan
- Queensland Ambulance Service, Queensland Government Department of Health, Kedron, Queensland, Australia
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Emma Bosley
- Department of Paramedicine, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
- Queensland Ambulance Service, Queensland Government Department of Health, Kedron, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Ferguson B, Baldwin A, Henderson A. Early warning tools and clinician 'agency' for strengthening safety culture: An integrative review. J Adv Nurs 2024. [PMID: 38863203 DOI: 10.1111/jan.16260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/30/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
AIM Identify and analyse literature investigating nurses' and midwives' use of early warning tools during the care of adult inpatients. DESIGN An integrative literature review. METHODS Whittemore and Knafl's (2005) framework guided this integrative review. PubMed, CINAHL, EMCARE and Google Scholar were systematically searched. The authors assessed the methodological quality of 21 papers meeting inclusion criteria and thematically analysed key data. RESULTS Three main themes were identified, each with further sub-themes. CONCLUSION Early warning tools operate within various systems and cultural contexts. However, their potential for improved patient safety may be hindered. Protocols influencing tool usage may make nurses and midwives distanced from patients and their expertise. For early warning tools to enhance patient safety, assessing their integration into practice is crucial to maximizing effectiveness. IMPACT This review emphasizes the importance of integrating human relationships with early warning tools for patient safety. PATIENT OR PUBLIC CONTRIBUTION This integrative literature review does not include patient or public input. IMPLICATIONS FOR PRACTICE/POLICY Adapting early warning tools to balance standardization for safety and efficiency and promoting nurses' and midwives' expertise and autonomy is required to optimize delivery of quality care and uphold patient safety. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used.
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Affiliation(s)
- Bridget Ferguson
- Central Queensland University Australia, Rockhampton, North Queensland, Australia
| | - Adele Baldwin
- Central Queensland University Australia, Townsville City, Queensland, Australia
| | - Amanda Henderson
- Central Queensland University Australia, Brisbane, Queensland, Australia
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Tronstad O, Zangerl B, Patterson S, Flaws D, Yerkovich S, Szollosi I, White N, Garcia-Hansen V, Leonard FR, Weger BD, Gachon F, Brain D, Lavana J, Hodgson C, Fraser JF. The effect of an improved ICU physical environment on outcomes and post-ICU recovery-a protocol. Trials 2024; 25:376. [PMID: 38863018 PMCID: PMC11167845 DOI: 10.1186/s13063-024-08222-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Intensive care medicine continues to improve, with advances in technology and care provision leading to improved patient survival. However, this has not been matched by similar advances in ICU bedspace design. Environmental factors including excessive noise, suboptimal lighting, and lack of natural lights and views can adversely impact staff wellbeing and short- and long-term patient outcomes. The personal, social, and economic costs associated with this are potentially large. The ICU of the Future project was conceived to address these issues. This is a mixed-method project, aiming to improve the ICU bedspace environment and assess impact on patient outcomes. Two innovative and adaptive ICU bedspaces capable of being individualised to patients' personal and changing needs were co-designed and implemented. The aim of this study is to evaluate the effect of an improved ICU bedspace environment on patient outcomes and operational impact. METHODS This is a prospective multi-component, mixed methods study including a randomised controlled trial. Over a 2-year study period, the two upgraded bedspaces will serve as intervention beds, while the remaining 25 bedspaces in the study ICU function as control beds. Study components encompass (1) an objective environmental assessment; (2) a qualitative investigation of the ICU environment and its impact from the perspective of patients, families, and staff; (3) sleep investigations; (4) circadian rhythm investigations; (5) delirium measurements; (6) assessment of medium-term patient outcomes; and (7) a health economic evaluation. DISCUSSION Despite growing evidence of the negative impact the ICU environment can have on patient recovery, this is an area of critical care medicine that is understudied and commonly not considered when ICUs are being designed. This study will provide new information on how an improved ICU environment impact holistic patient recovery and outcomes, potentially influencing ICU design worldwide. TRIAL REGISTRATION ACTRN12623000541606. Registered on May 22, 2023. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385845&isReview=true .
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Irene Szollosi
- Sleep Disorders Centre, The Prince Charles Hospital, Brisbane, Australia
| | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Benjamin D Weger
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Frédéric Gachon
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - David Brain
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jayshree Lavana
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Physiotherapy Department, Alfred Hospital, Melbourne, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Rode Road, Chermside, Brisbane, Qld, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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234
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Ueno R, Reddy MP, Jones D, Pilcher D, Subramaniam A. The impact of frailty on survival times up to one year among patients admitted to ICU with in-hospital cardiac arrest. J Crit Care 2024; 83:154842. [PMID: 38865757 DOI: 10.1016/j.jcrc.2024.154842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/18/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is a serious medical emergency. When IHCA occurs in patients with frailty, short-term survival is poor. However, the impact of frailty on long-term survival is unknown. METHODS We performed a retrospective multicentre study of all critically ill adult (age ≥ 16 years) patients admitted to Australian intensive care units (ICU) between 1st January 2018 to 31st March 2022. We included all patients who had an IHCA within the 24 h before ICU admission with a documented Clinical Frail Scale (CFS). The primary outcome was median survival up to one year following ICU admission. The effect of frailty on one-year survival was assessed using a Cox proportional hazards model, adjusting for age, sex, comorbidities, sequential organ failure assessment (SOFA) score, and hospital type. RESULTS We examined 3769 patients, of whom 30.8% (n = 1160) were frail (CFS ≥ 5). The median survival was significantly shorter for patients with frailty (median [IQR] days 19 [1-365] vs 302 [9-365]; p < 0.001). The overall one-year mortality was worse for the patients with frailty when compared to the non-frail group (64.8% [95%CI 61.9-67.5] vs 36.4% [95%CI 34.5-38.3], p < 0.001). Each unit increment in the CFS was associated with 22% worse survival outcome (adjusted Hazard ratio = 1.22, 95%-CI 1.19-1.26), after adjustment for confounders. The survival trend was similar among patients who survived the hospitalization. CONCLUSION In this retrospective multicentre study, frailty was associated with poorer one-year survival in patients admitted to Australian ICUs following an IHCA.
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Affiliation(s)
- Ryo Ueno
- Intensive Care Medicine, Eastern Health, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia.
| | - Mallikarjuna Ponnapa Reddy
- Intensive Care Medicine, Peninsula Health, Victoria, Australia; Intensive Care Medicine, Calvary Hospital Health, Canberra, Australia
| | - Daryl Jones
- Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia; Intensive Care Medicine, Austin Health, Victoria, Australia; University of Melbourne, Victoria, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia; Intensive Care Medicine, Alfred Health, Victoria, Australia; Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resources Evaluation, Victoria, Australia
| | - Ashwin Subramaniam
- Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia; Intensive Care Medicine, Peninsula Health, Victoria, Australia; Intensive Care Medicine, Monash Health, Victoria, Australia; Monash University, Peninsula Clinical School, Victoria, Australia
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235
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Alodan HA, Sutt AL, Hill R, Alsadhan J, Cross JL. Effectiveness, experience, and usability of low-technology augmentative and alternative communication in intensive care: A mixed-methods systematic review. Aust Crit Care 2024:S1036-7314(24)00085-7. [PMID: 38866691 DOI: 10.1016/j.aucc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Patients in the intensive care unit (ICU) are commonly on mechanical ventilation, either through endotracheal intubation or tracheostomy, which usually leaves them nonverbal. Low-technology augmentative and alternative communication (AAC) strategies are simple and effective ways to enhance communication between patients and their communication partners but are underutilised. AIM The aim of this study was to systematically review current evidence regarding the effectiveness, experience of use, and usability of low-technology AAC with nonverbal patients and their communication partners in the ICU. METHODS This review included quantitative, qualitative, and mixed-methods studies of adult ICU patients aged 18 or older who were nonverbal due to mechanical ventilation and their communication partners. Studies using low-technology AAC, such as communication boards and pen and paper, were included. Six databases were searched, and the review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A convergent segregated approach was used for data synthesis. RESULTS Thirty-two studies were included. Low-technology AAC improved patient satisfaction, facilitated communication, and met patients' physical and psychological needs. Communication boards with mixed content (e.g., pictures, words, and letters) were preferred but were used less frequently than unaided strategies due to patients' medical status, tool availability, and staff attitudes. Boards should be user-friendly, tailored, include pen/paper, and introduced preoperation to increase patient's comfort when using them postoperatively. CONCLUSION Existing evidence support low-technology AAC's efficacy in meeting patients' needs. Better usability hinges on proper implementation and addressing challenges. Further research is crucial for refining communication-board design, ensuring both user-friendliness and sophistication to cater to ICU patients' diverse needs. REGISTRATION The review protocol was registered in the International Prospective Register of Systematic Reviews, with registration number CRD42022331566.
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Affiliation(s)
- Hissah A Alodan
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK; College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Anna-Liisa Sutt
- Institute of Molecular Bioscience, University of Queensland, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Rebekah Hill
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Joud Alsadhan
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Jane L Cross
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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236
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Bohingamu Mudiyanselage S, Considine J, Hutchinson AM, Mitchell I, Mohebbi M, Watts JJ, Bucknall TK. An economic evaluation of the Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) clinical trial. Resuscitation 2024; 201:110272. [PMID: 38866230 DOI: 10.1016/j.resuscitation.2024.110272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/26/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Early recognition and response to clinical deterioration reduce the frequency of in-hospital cardiac arrests, mortality, and unplanned intensive care unit (ICU) admissions. This study aimed to investigate the impact of the Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) intervention on hospital costs and patient length of stay (LOS). METHOD The PRONTO cluster randomised control trial was conducted to improve nurses' responses to patients with abnormal vital signs. Hospital data were collected pre-intervention (T0) at 6 months (T1) and 12 months (T2) post-intervention. The economic evaluation involved a cost-consequence analysis from the hospital's perspective. Generalised estimating equations were used to estimate the parameters for regression models of the difference in costs and LOS between study groups and time points. RESULTS Hospital admission data for 6065 patients (intervention group, 3102; control group, 2963) were collected from four hospitals for T0, T1 and T2. The intervention cost was 69.61 A$ per admitted patient, including the additional intervention training for nurses and associated labour costs. The results showed cost savings and a shorter LOS in the intervention group between T0 - T1 and T0 - T2 (cost differences T0 - T1: -364 (95% CI -3,782; 3049) A$ and T0 - T2: -1,710 (95% CI -5,162; 1,742) A$; and LOS differences T0 - T1: -1.10 (95% CI -2.44; 0.24) days and T0 & T2: -2.18 (95% CI -3.53; -0.82) days). CONCLUSION The results of the economic analysis demonstrated that the PRONTO intervention improved nurses' responses to patients with abnormal vital signs and significantly reduced hospital LOS by two days at 12 months in the intervention group compared to baseline. From the hospital's perspective, savings from reduced hospitalisations offset the costs of implementing PRONTO.
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Affiliation(s)
- Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia
| | - Imogen Mitchell
- Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia; Research and Academic Partnerships, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Jennifer J Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
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Patsaki I, Dimopoulos S. Increasing role of post-intensive care syndrome in quality of life of intensive care unit survivors. World J Crit Care Med 2024; 13:90428. [PMID: 38855270 PMCID: PMC11155501 DOI: 10.5492/wjccm.v13.i2.90428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/11/2024] [Accepted: 03/26/2024] [Indexed: 06/03/2024] Open
Abstract
In this editorial we comment on the detrimental consequences that post-intensive care syndrome (PICS) has in the quality of life of intensive care unit (ICU) survivors, highlighting the importance of early onset of multidisciplinary rehabilitation from within the ICU. Although, the syndrome was identified and well described early in 2012, more awareness has been raised on the long-term PICS related health problems by the increased number of coronavirus disease 2019 ICU survivors. It is well outlined that the syndrome affects both the patient and the family and is described as the appearance or worsening of impairment in physical, cognitive, or mental health as consequence of critical illness. PICS was described in order: (1) To raise awareness among clinicians, researchers, even the society; (2) to highlight the need for a multilevel screening of these patients that starts from within the ICU and continues after discharge; (3) to present preventive strategies; and (4) to offer guidelines in terms of rehabilitation. An early multidisciplinary approach is the key element form minimizing the incidence of PICS and its consequences in health related quality of life of both survivors and their families.
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Affiliation(s)
- Irini Patsaki
- Department of Physiotherapy, University of West Attika, Athens 12243, Greece
| | - Stavros Dimopoulos
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Centre, Athens 17674, Greece
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Mansour M, Knebusch N, Daughtry J, Fogarty TP, Lam FW, Orellana RA, Lai YC, Erklauer J, Coss-Bu JA. Feasibility of Achieving Nutritional Adequacy in Critically Ill Children with Critical Neurological Illnesses (CNIs)?-A Quaternary Hospital Experience. CHILDREN (BASEL, SWITZERLAND) 2024; 11:711. [PMID: 38929290 PMCID: PMC11202205 DOI: 10.3390/children11060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
The literature on the nutritional needs and outcomes of critically ill children is scarce, especially on those with critical neurological illnesses (CNIs). Current evidence shows a lower mortality in patients who achieve two-thirds of their nutritional needs during the first week of pediatric intensive care unit (PICU) admission. We hypothesized that achieving 60% of the recommended dietary intake during the first week of a PICU stay is not feasible in patients with CNI. We designed an observational retrospective cohort study where we included all index admissions to the PICU in our institution of children (1 month to 18 years) with CNI from January 2018 to June 2021. We collected patient demographics, anthropometric measures, and caloric and protein intake (enteral and parenteral) information during the first week of PICU admission. Goal adequacy for calories and protein was defined as [(intake/recommended) × 100] ≥ 60%. A total of 1112 patients were included in the nutrition assessment, 12% of whom were underweight (weight for age z score < -2). Of this group, 180 met the criteria for nutrition support evaluation. On the third day of admission, 50% of the patients < 2 years achieved caloric and protein goal adequacy, compared to 25% of patients > 2 years, with p-values of 0.0003 and 0.0004, respectively. Among the underweight patients, 60% achieved both caloric and protein goal adequacy by day 3 vs. 30% of non-underweight patients with p-values of 0.0006 and 0.002, respectively. The results show that achieving 60% of the recommended dietary intake by days 5 and 7 of admission was feasible in more than half of the patients in this cohort. Additionally, children who were evaluated by a clinical dietician during the first 48 h of PICU admission reached higher nutrition adequacy.
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Affiliation(s)
- Marwa Mansour
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Nicole Knebusch
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Jennifer Daughtry
- Department of Clinical Nutrition Services, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Thomas P. Fogarty
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Fong Wilson Lam
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Renan A. Orellana
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Yi-Chen Lai
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Jennifer Erklauer
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jorge A. Coss-Bu
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
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la Cour KN, Andersen-Ranberg NC, Mortensen C, Poulsen LM, Mathiesen O, Egerod I, Collet M. Patient recall of intensive care delirium: A qualitative investigation. Acta Anaesthesiol Scand 2024. [PMID: 38850120 DOI: 10.1111/aas.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/28/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering. The aim of our study was to investigate the subjective patient experience of delirium, delirium-related distress, and delirium management in ICU. METHODS Our study had a qualitative multicenter design applying individual interviews and thematic analysis. Participants were critically ill adult patients that were determined delirium positive according to validated delirium screening tools during ICU admission. The interviews were conducted after ICU discharge when patients were delirium-free as assessed by the "Rapid clinical test for delirium" (4AT) and able to participate in an interview. RESULTS We interviewed 30 patients choosing the main themes deductively: Delirium experience; Delirium related distress; and Delirium management. Despite variations in recollection detail, ICU survivors consistently reported delirium-related distress during and after their ICU stay, manifesting as temporal confusion, misinterpretations, and a sense of distrust towards ICU staff. Delusions were characterized by a blend of factual and fictional elements. Impaired short-term memory hindered communication and intensified feelings of isolation, neglect, and loss of control. CONCLUSION The ICU survivors in our study recalled delirium as an unpleasant and frightening experience, often leading to delirium-related distress during and after their ICU stay, indicating the necessity for enhanced assessment and treatment.
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Affiliation(s)
- Kirstine N la Cour
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
| | | | - Camilla Mortensen
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
| | - Lone M Poulsen
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
| | - Ole Mathiesen
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Marie Collet
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Chen C, Zhai R, Lan X, Yang S, Tang S, Xiong X, He Y, Lin J, Feng J, Chen D, Shi J. The influence of sleep disorders on perioperative neurocognitive disorders among the elderly: A narrative review. IBRAIN 2024; 10:197-216. [PMID: 38915944 PMCID: PMC11193868 DOI: 10.1002/ibra.12167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024]
Abstract
This review comprehensively assesses the epidemiology, interaction, and impact on patient outcomes of perioperative sleep disorders (SD) and perioperative neurocognitive disorders (PND) in the elderly. The incidence of SD and PND during the perioperative period in older adults is alarmingly high, with SD significantly contributing to the occurrence of postoperative delirium. However, the clinical evidence linking SD to PND remains insufficient, despite substantial preclinical data. Therefore, this study focuses on the underlying mechanisms between SD and PND, underscoring that potential mechanisms driving SD-induced PND include uncontrolled central nervous inflammation, blood-brain barrier disruption, circadian rhythm disturbances, glial cell dysfunction, neuronal and synaptic abnormalities, impaired central metabolic waste clearance, gut microbiome dysbiosis, hippocampal oxidative stress, and altered brain network connectivity. Additionally, the review also evaluates the effectiveness of various sleep interventions, both pharmacological and nonpharmacological, in mitigating PND. Strategies such as earplugs, eye masks, restoring circadian rhythms, physical exercise, noninvasive brain stimulation, dexmedetomidine, and melatonin receptor agonists have shown efficacy in reducing PND incidence. The impact of other sleep-improvement drugs (e.g., orexin receptor antagonists) and methods (e.g., cognitive-behavioral therapy for insomnia) on PND is still unclear. However, certain drugs used for treating SD (e.g., antidepressants and first-generation antihistamines) may potentially aggravate PND. By providing valuable insights and references, this review aimed to enhance the understanding and management of PND in older adults based on SD.
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Affiliation(s)
- Chao Chen
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Rui‐Xue Zhai
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Xin Lan
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Sheng‐Feng Yang
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Si‐Jie Tang
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Xing‐Long Xiong
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
| | - Yu‐Xin He
- Department of Gastroenterology and HepatologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jing‐Fang Lin
- Department of Anesthesiology, Fujian Provincial HospitalSheng Li Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Jia‐Rong Feng
- Khoury College of Computer SciencesNortheastern UniversityBostonAmerica
| | - Dong‐Xu Chen
- Department of Anesthesiology, West China Second HospitalSichuan UniversityChengduChina
| | - Jing Shi
- Department of Anesthesiology/Department of NeurosurgeryThe Affiliated Hospital of Guizhou Medical UniversityGuiyangChina
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Kelly E, Nazeer S, Fazzini B, Sutt AL, Olusanya S, Campion T, Puthucheary Z. Assessing the oral and suprahyoid muscles in healthy adults using muscle ultrasound to inform the swallowing process: a proof-of-concept study. Sci Rep 2024; 14:13198. [PMID: 38851791 PMCID: PMC11162466 DOI: 10.1038/s41598-024-62032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/13/2024] [Indexed: 06/10/2024] Open
Abstract
The oral and suprahyoid muscles are responsible for movements of swallowing. Our study aimed to determine the reproducibility of static and dynamic measurements of these muscles using bedside ultrasound equipment. Forty healthy participants were recruited prospectively. Primary outcomes were evaluation of mass measurements of the anterior bellies of the digastric, mylohyoid, geniohyoid and tongue in B-mode ultrasound. Secondary outcomes were evaluation of geniohyoid muscle layer thickness and function using M-mode. Muscle mass measurements demonstrated little within-participant variability. Coefficient of Variance (CoV) across muscles were: anterior belly digastric (5.0%), mylohyoid (8.7%), geniohyoid (5.0%) and tongue (3.2%). A relationship between sex (r2 = 0.131 p = 0.022) was demonstrated for the geniohyoid muscle, with males having higher transverse Cross Sectional Area (CSA) (14.3 ± 3.6 mm vs. 11.9 ± 2.5 mm, p = 0.002). Tongue size was correlated with weight (r2 = 0.356, p = 0.001), height (r2 = 0.156, p = 0.012) and sex (r2 = 0.196, p = 0.004). Resting thickness of the geniohyoid muscle layer changed with increasing bolus sizes (f = 3.898, p = 0.026). Velocity increased with bolus size (p = < 0.001, F = 8.974). However swallow time and slope distance did not, potentially influenced by higher coefficients of variation. Oral and suprahyoid muscle mass are easily assessed using bedside ultrasound. Ultrasound may provide new information about muscle mass and function during swallowing.
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Affiliation(s)
- Eileen Kelly
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK.
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
- Department of Speech and Language Therapy, The Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - Saira Nazeer
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Brigitta Fazzini
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Anna-Liisa Sutt
- Department of Speech and Language Therapy, The Royal London Hospital, Barts Health NHS Trust, London, UK
- Critical Care Research Group, Institute of Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Segun Olusanya
- Consultant in Intensive Care Medicine and ECMO, Department of Perioperative Medicine, Barts Heart Centre, London, UK
| | - Thomas Campion
- Consultant Head and Neck Neck/Neuroradiologist, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Zudin Puthucheary
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
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Pradhan PM, Marmor S, Tignanelli C, Misono S, Hoffmeister J. Independent Risk Factors for Prolonged Tube Feeding After Endotracheal Intubation and Ventilation. J Intensive Care Med 2024:8850666241258960. [PMID: 38850040 DOI: 10.1177/08850666241258960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
PURPOSE Postextubation dysphagia (PED) can lead to prolonged tube feeding, but risk factors associated with prolonged tube feeding in this population are largely unknown. The purpose of this study was to identify factors independently associated with prolonged tube feeding in adult inpatients who required intubation and mechanical ventilation. MATERIALS AND METHODS Retrospective observational cohort study in a dataset of 1.3 million inpatients. Extubated adults without preventilation dysphagia or tube feeding who underwent instrumental swallowing assessment were included. To characterize factors independently associated with prolonged tube feeding, we compiled a set of potential factors, completed factor selection using a random forest algorithm, and performed logistic regression. RESULTS In total, 206 of 987 (20.9%) patients had prolonged tube feeding. The regression model produced an area under the curve of 0.79. Factors with the greatest influence on prolonged tube feeding included dysphagia with thickened liquids, dysphagia with soft/solid foods, preadmission weight loss, number of intubations, admission for neurologic disorder, and hospital of admission. CONCLUSIONS Several factors predicted prolonged tube feeding after extubation. The strongest were some, but not all, aspects of swallowing function and clinical practice pattern variability. Clinical decision-making should consider bolus-specific data from instrumental swallowing evaluation rather than binary presence or absence of dysphagia.
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Affiliation(s)
- Prajwal M Pradhan
- Institute of Health Informatics, University of Minnesota, Minneapolis, USA
- Center for Quality Outcomes, Discovery and Evaluation, University of Minnesota, Minneapolis, USA
| | - Schelomo Marmor
- Center for Quality Outcomes, Discovery and Evaluation, University of Minnesota, Minneapolis, USA
- Division of Surgical Oncology, University of Minnesota, Minneapolis, USA
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Christopher Tignanelli
- Center for Quality Outcomes, Discovery and Evaluation, University of Minnesota, Minneapolis, USA
- Department of Surgery, University of Minnesota, Minneapolis, USA
| | - Stephanie Misono
- Center for Quality Outcomes, Discovery and Evaluation, University of Minnesota, Minneapolis, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, USA
| | - Jesse Hoffmeister
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, USA
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Kocakabak C, van den Hoogen A, Rothfus M, Campbell-Yeo M, Kostenzer J, Axelin A, Schofield P, Latour JM. Identifying outcomes and outcome measures in neonatal family-centered care trials: a systematic review. Pediatr Res 2024:10.1038/s41390-024-03293-2. [PMID: 38849484 DOI: 10.1038/s41390-024-03293-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND A wide range of outcomes for infants and parents has been reported in clinical trials testing FCC interventions. This systematic review aimed to identify outcomes, outcome measures, and time-points reported in experimental studies testing FCC interventions in neonatal care units. METHODS This review included experimental studies investigating FCC interventions in neonatal settings. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Cochrane, PsycINFO, Scopus, JBI, Lilacs, and SciELO, completed in December 2022 and updated in November 2023. Critical appraisal was performed using the JBI checklist for randomized controlled trials, and a narrative synthesis process was used. Outcomes were categorized into the Comet Taxonomy core areas. RESULTS The search identified 8787 papers; 42 studies were included in the analysis. Totally, 60 outcomes were identified: 42 infant and 18 parents' outcomes. Outcomes were clustered into 12 domains for infants and five domains for parents and measured by 97 outcome measures. The included studies reported 25 and 27 different time-points for infants and parents, respectively. CONCLUSION This review of studies testing FCC interventions identified heterogeneity and inconsistency of outcomes, outcome measures, and time-points measuring the outcomes. Developing a core outcome set for FCC studies is warranted to benchmark the evidence and identify best-practices. IMPACT This systematic review identified inconsistency of outcomes, outcome measures, and time-points reported in quantitative studies testing family-centered care interventions in neonatal care settings. The lack of standardized outcomes and outcome measures reported in clinical trials makes it difficult to synthesize data to provide conclusive recommendations. This systematic review will contribute to the development of a core outcome set for research testing family-centered care interventions in neonatal care settings.
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Affiliation(s)
- Cansel Kocakabak
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Agnes van den Hoogen
- Department Women and Baby, Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands, Utrecht University, Utrecht, The Netherlands
| | - Melissa Rothfus
- Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Johanna Kostenzer
- European Foundation for the Care of Newborn Infants, Munich, Germany
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Patricia Schofield
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
- Curtin School of Nursing, Curtin University, Perth, WA, Australia
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Rosu D, Enache IS, Muntean RI, Stefanica V. Effects of Kin Ball Initiation: Pre- and Post-Pandemic Impact on Palmar Muscle Strength, Endurance, and Coordination in Non-Athlete Participants. Sports (Basel) 2024; 12:158. [PMID: 38921852 PMCID: PMC11207812 DOI: 10.3390/sports12060158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of our research is to introduce Kin Ball for the first time in Romania and assess its impact on the motor capacities of practitioners, particularly focusing on its potential contribution to developing motor skills in young students within the academic sphere, despite the challenges posed by the COVID-19 pandemic. DESIGN A retrospective, case-control study with a focus on four distinct research groups. SETTING The research was conducted in a camp setting, situated in the mountainous region of Bughea de Sus, Romania. PARTICIPANTS The study included 94 students, comprising 54 boys and 40 girls, with an overall average age of 20.85 ± 2 years. All participants were classified as non-athletes based on their level of sports practice. INTERVENTIONS The Kin Ball initiation program, a key component of the study, comprised 20 training sessions conducted in 10-day stages, systematically evaluating participants' motor skills. MAIN OUTCOME MEASURES The study assessed palmar muscle strength, endurance, and co-ordination function. RESULTS Statistical analyses, including the Kolmogorov-Smirnov test, revealed notable differences in the initiation process and significant variations (p < 0.05) in all measurements performed in 2022. In 2019, the tests recorded both significant and statistically insignificant differences, as indicated by the calculation of Cohen's d indicator. CONCLUSIONS The study underscored the influence of reduced movement during the pandemic on motor skills and highlighted Kin Ball's potential as an alternative sport within physical education curricula. Despite lower baseline motor capacities observed in 2022, participants exhibited significant progress, emphasizing Kin Ball's capacity to improve physical skills. These findings underscore the importance of alternative sports such as Kin Ball in fostering holistic personal development and mitigating the impact of pandemic-induced disruptions on motor skills.
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Affiliation(s)
- Daniel Rosu
- Department of Physical Education and Sport, Faculty of Sciences, Physical Education and Informatics, National University of Science and Technology Politehnica Bucharest, Pitesti University Center, 110040 Pitesti, Romania; (D.R.); (I.-S.E.); (V.S.)
| | - Ion-Sebastian Enache
- Department of Physical Education and Sport, Faculty of Sciences, Physical Education and Informatics, National University of Science and Technology Politehnica Bucharest, Pitesti University Center, 110040 Pitesti, Romania; (D.R.); (I.-S.E.); (V.S.)
| | - Raul-Ioan Muntean
- Department of Physical Education and Sport, Faculty of Law and Social Sciences, University “1 Decembrie 1918” of Alba Iulia, 510009 Alba Iulia, Romania
| | - Valentina Stefanica
- Department of Physical Education and Sport, Faculty of Sciences, Physical Education and Informatics, National University of Science and Technology Politehnica Bucharest, Pitesti University Center, 110040 Pitesti, Romania; (D.R.); (I.-S.E.); (V.S.)
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Alrø AB, Svenningsen H, Nedergaard HK, Jensen HI, Dreyer P. Patients' and relatives' experiences of cognitive impairment following an intensive care unit admission. A qualitative study. Aust Crit Care 2024:S1036-7314(24)00091-2. [PMID: 38839438 DOI: 10.1016/j.aucc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Cognitive impairment poses a significant challenge following critical illness in the intensive care unit. A knowledge gap exists concerning how patients experience cognitive impairments. OBJECTIVES The aim was to explore patients' and relatives' experiences of patients' cognitive impairment due to critical illness following an intensive care unit admission. METHODS A qualitative multicentre study was conducted in Denmark with 3- and 6-month follow-ups using single and dyadic interviews. A phenomenological hermeneutic approach was adopted using a Ricoeur-inspired textual in-depth analysis method. The Consolidated Criteria for Reporting Qualitative Research checklist was used. RESULTS Three themes emerged from interviews with 18 patients and 14 relatives: 'It feels like living in a parallel world', 'Getting back to a normal everyday life with a vulnerable self', and 'Managing everyday life using self-invented strategies'. Patients used self-invented strategies to manage their vulnerability and newly acquired cognitive impairments when no help or support was provided specifically targeting their cognitive impairments. Not being as cognitively capable as they previously had been turned their lives upside down. Losing control and not being themselves made them vulnerable. Patients did not want to burden others. However, support from relatives was invaluable in their recovery and rehabilitation. CONCLUSIONS Patients experienced multiple cognitive impairments affecting their adaption to everyday life. They strove to overcome their vulnerability using a variety of self-invented strategies and activities.
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Affiliation(s)
- Anette Bjerregaard Alrø
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Aarhus University, Institute of Public Health, Section of Nursing, Bartholins Alle' 2, 3. sal, Building 1260, 8000 Aarhus C, Denmark.
| | - Helle Svenningsen
- Research Centre for Health and Welfare Technology, VIA University College, Campus Aarhus N, Hedeager 2, Aarhus N, Denmark.
| | - Helene Korvenius Nedergaard
- Department of Anaesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, Sygehusvej 24, 6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Winsløvsparken 19,3., 5000 Odense C, Denmark.
| | - Hanne Irene Jensen
- Departments of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark; Departments of Anaesthesiology and Intensive Care, Vejle Hospital, University Hospital of Southern Denmark, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Aarhus University, Institute of Public Health, Section of Nursing, Bartholins Alle' 2, 3. sal, Building 1260, 8000 Aarhus C, Denmark.
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Rahman E, Webb WR, Rao P, Yu N, Garcia PE, Ioannidis S, Philipp-Dormston WG, Sayed K, Rahman Z, Mosahebi A, Carruthers JDA. Generational Exploration on Aesthetic Medicine Products: Influence of Social Media, Reviews, and Brand Identity-GEMS Bond Survey. Aesthetic Plast Surg 2024:10.1007/s00266-024-04109-8. [PMID: 38839613 DOI: 10.1007/s00266-024-04109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION The study investigates the impact of social media reviews and brand identity on consumer preferences in the non-surgical aesthetics products across different generations. It highlights the evolving landscape of aesthetic medicine and surgery, driven by technological advancements and a cultural shift towards individual well-being. The research aims to explore the interplay between generational preferences, the influence of social media, and the role of brand identity in shaping consumer decisions. METHODS A cross-sectional study design was employed, with a sample size of > 5000 participants stratified across various generational cohorts. The study utilized an online questionnaire to capture both quantitative and qualitative insights into consumer behaviour, with statistical analysis performed to identify patterns and relationships. RESULTS Analysis of 5850 responses revealed distinct generational preferences and behaviours. Social media engagement varied significantly across generations, with younger cohorts placing a higher emphasis on online reviews. The study also found that brand identity's influence is diminishing in decision-making processes, with consumers increasingly relying on peer reviews and social media content. CONCLUSION The findings highlight a pivotal shift in the non-surgical aesthetics consumer market, emphasizing the growing importance of social media and peer reviews over traditional brand identities. Importantly, the study underscores the critical need for integrating patient safety and evidence-based practice within marketing strategies. As consumer preferences evolve towards valuing transparency and authenticity, non-surgical aesthetics providers must prioritize these elements, ensuring that their services are not only appealing but also grounded in safety and scientific validity. LEVEL OF EVIDENCE IV "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."
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Affiliation(s)
- Eqram Rahman
- Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK.
| | | | - Parinitha Rao
- The Skin Address, Aesthetic Dermatology Practice, Bengaluru, India
| | - Nanze Yu
- Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | | | | | | | - Karim Sayed
- Nomi Oslo, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | - Zakia Rahman
- Stanford Dermatology, Stanford university School of Medicine, Redwood City, California, USA
| | - Ash Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, Hempstead, London, UK
| | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
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247
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Jeffs E, Newall F, Delany C, Kinney S. Goals of Morbidity and Mortality meetings in paediatric acute care. A qualitative case study. J Child Health Care 2024:13674935241249597. [PMID: 38831718 DOI: 10.1177/13674935241249597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Morbidity and Mortality meetings are conducted in varied clinical contexts including paediatrics. Widely cited as an educational or quality improvement tool, the reality is more complex. In this qualitative study, the aim was to explore the perceived goals of the paediatric acute care Morbidity and Morbidity meeting. This study used semi-structured interviews and observation within a qualitative case study methodology. Data were collected in a large paediatric quaternary hospital. Analysis generated themes related to meeting observations and the participant's interpretation of meeting goals. A total of 44 interviews were conducted with 14 nurses, 29 doctors, and 1 allied health professional. Thirty-two meetings in six clinical departments were observed. Two themes were developed: complex and nuanced goals; and tensions and contest between and within goals. Meeting goals to evaluate care, learn, support, adhere, and change and respond were sometimes in competition and had varied interpretations. Morbidity and Mortality meetings in this setting are valued and occupy a complex role which reaches beyond identification of measurable patient safety interventions. Understanding goals more fully can lead to optimised conduct and meaningful measurement of efficacy. The strength in these meetings may be the way they promote an embedded safety culture, and an informed and skilled workforce.
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Affiliation(s)
- Emma Jeffs
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
- The Women's and Children's Hospital Adelaide, Adelaide, SA, Australia
| | - Fiona Newall
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Clare Delany
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Sharon Kinney
- The Royal Children's Hospital, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
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Deffert F, Vilela APO, Cobre ADF, Furlan LHP, Tonin FS, Fernandez-Lllimos F, Pontarolo R. Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools. Fam Pract 2024:cmae029. [PMID: 38831566 DOI: 10.1093/fampra/cmae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.
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Affiliation(s)
- Flávia Deffert
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Ana Paula Oliveira Vilela
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Alexandre de Fátima Cobre
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | | | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Avenida D. João II, Lote 4.69.01, Parque das Nações, Lisboa 1990-096, Portugal
| | - Fernando Fernandez-Lllimos
- Applied Molecular Biosciences Unit (UCIBIO), Institute for Health and Bioeconomy (i4HB), Laboratory of Pharmacology Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto 4050-313, Portugal
| | - Roberto Pontarolo
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
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Rollinson TC, Connolly B, Denehy L, Hepworth G, Berlowitz DJ, Berney S. Ultrasound-derived rates of muscle wasting in the intensive care unit and in the post-intensive care ward for patients with critical illness: Post hoc analysis of an international, multicentre randomised controlled trial of early rehabilitation. Aust Crit Care 2024:S1036-7314(24)00076-6. [PMID: 38834392 DOI: 10.1016/j.aucc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND AIMS Muscle wasting results in weakness for patients with critical illness. We aim to explore ultrasound-derived rates of change in skeletal muscle in the intensive care unit (ICU) and following discharge to the post-ICU ward. DESIGN Post hoc analysis of a multicentre randomised controlled trial of functional-electrical stimulated cycling, recumbent cycling, and usual care delivered in intensive care. METHOD Participants underwent ultrasound assessment of rectus femoris at ICU admission, weekly in the ICU, upon awakening, ICU discharge, and hospital discharge. The primary outcome was rate of change in rectus femoris cross-sectional area (ΔRFCSA) in mm2/day in the ICU (enrolment to ICU discharge) and in the post-ICU ward (ICU discharge to hospital discharge). Secondary outcomes included rate of change in echo intensity (ΔEI), standard deviation of echo intensity (ΔEISD), and the intervention effect on ultrasound measures. Echo intensity is a quantitative assessment of muscle quality. Elevated echo intensity may indicate fluid infiltration, adipose tissue, and reduced muscle quality. RESULTS 154 participants were included (mean age: 58 ± 15 years, 34% female). Rectus femoris cross-sectional area declined in the ICU (-4 mm2/day [95% confidence interval {CI}: -9 to 1]) and declined further in the ward (-9 mm2/day [95% CI: -14 to -3]) with a mean difference between ICU and ward of -5 mm2/day ([95% CI: -2, to 11]; p = 0.1396). There was a nonsignificant difference in ΔEI between in-ICU and the post-ICU ward of 1.2 ([95% CI: -0.1 to 2.6]; p = 0.0755), a statistically significant difference in ΔEISD between in-ICU and in the post-ICU ward of 1.0 ([95% CI, 0.5 to 1.5]; p = 0.0003), and no difference in rate of change in rectus femoris cross-sectional area between groups in intensive care (p = 0.411) or at hospital discharge (p = 0.1309). CONCLUSIONS Muscle wasting occurs in critical illness throughout the hospital admission. The average rate of loss in muscle cross-sectional area does not slow after ICU discharge, even with active rehabilitation.
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Affiliation(s)
- Thomas C Rollinson
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, United Kingdom; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; Centre for Human and Applied Physiological Sciences, King's College London, United Kingdom
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - David J Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Farrell MS, Agapian JV, Appelbaum RD, Filiberto DM, Gelbard R, Hoth J, Jawa R, Kirsch J, Kutcher ME, Nohra E, Pathak A, Paul J, Robinson B, Cuschieri J, Stein DM. Surgical and procedural antibiotic prophylaxis in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001305. [PMID: 38835633 PMCID: PMC11149119 DOI: 10.1136/tsaco-2023-001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
The use of prophylactic measures, including perioperative antibiotics, for the prevention of surgical site infections is a standard of care across surgical specialties. Unfortunately, the routine guidelines used for routine procedures do not always account for many of the factors encountered with urgent/emergent operations and critically ill or high-risk patients. This clinical consensus document created by the American Association for the Surgery of Trauma Critical Care Committee is one of a three-part series and reviews surgical and procedural antibiotic prophylaxis in the surgical intensive care unit. The purpose of this clinical consensus document is to provide practical recommendations, based on expert opinion, to assist intensive care providers with decision-making for surgical prophylaxis. We specifically evaluate the current state of periprocedural antibiotic management of external ventricular drains, orthopedic operations (closed and open fractures, silver dressings, local, antimicrobial adjuncts, spine surgery, subfascial drains), abdominal operations (bowel injury and open abdomen), and bedside procedures (thoracostomy tube, gastrostomy tube, tracheostomy).
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Affiliation(s)
| | | | - Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dina M Filiberto
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rondi Gelbard
- Department of Surgery, University of Alabama at Birmingham Center for Health Promotion, Birmingham, Alabama, USA
| | - Jason Hoth
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Randeep Jawa
- Stony Brook University, Stony Brook, New York, USA
| | | | - Matthew E Kutcher
- Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Eden Nohra
- University of Colorado Boulder, Boulder, Colorado, USA
| | - Abhijit Pathak
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmeet Paul
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Bryce Robinson
- Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Joseph Cuschieri
- Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA
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