1
|
Complications following hospital admission for traumatic brain injury: A multicenter cohort study. J Crit Care 2017; 41:1-8. [PMID: 28477507 DOI: 10.1016/j.jcrc.2017.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/11/2017] [Accepted: 04/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the incidence, determinants and impact on outcome of in-hospital complications in adults with traumatic brain injury (TBI). MATERIALS AND METHODS We conducted a multicenter cohort study of TBI patients admitted between 2007 and 2012 in an inclusive Canadian trauma system. Risk ratios of complications, odds ratios of mortality and geometric mean ratios of length of stay (LOS) were calculated using generalized linear models with adjustment for prognostic indicators and hospital cluster effects. RESULTS Of 12,887 patients, 3.2% had at least one neurological complication and 22.6% a non-neurological complication. Mechanical ventilation, head injury severity, blood transfusion and neurosurgical intervention had the strongest correlation with neurological complications. Mechanical ventilation, the Glasgow Coma Scale, blood transfusion and concomitant injuries had the strongest correlation with non-neurological complications. Neurological and non-neurological complications were associated with a 85% and 53% increase in the odds of mortality, and a 60% and two-fold increases in LOS, respectively. CONCLUSIONS More than 20% of patients with TBI developed a complication. Many of these complications were associated with increased mortality and LOS. Results highlight the importance of prevention strategies adapted to treatment decisions and underline the need to improve knowledge on the underuse and overuse of clinical interventions.
Collapse
|
2
|
Keurhorst M, Anderson P, Heinen M, Bendtsen P, Baena B, Brzózka K, Colom J, Deluca P, Drummond C, Kaner E, Kłoda K, Mierzecki A, Newbury-Birch D, Okulicz-Kozaryn K, Palacio-Vieira J, Parkinson K, Reynolds J, Ronda G, Segura L, Słodownik L, Spak F, van Steenkiste B, Wallace P, Wolstenholme A, Wojnar M, Gual A, Laurant M, Wensing M. Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial. Implement Sci 2016; 11:96. [PMID: 27422283 PMCID: PMC4947288 DOI: 10.1186/s13012-016-0468-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 07/07/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. METHODS In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. RESULTS Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. CONCLUSIONS The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. TRIAL REGISTRATION ClinicalTrials.gov: NCT01501552.
Collapse
Affiliation(s)
- M. Keurhorst
- Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
- Centre for Nursing Research, Saxion University of Applied Sciences, Deventer, Enschede The Netherlands
| | - P. Anderson
- Institute of Health and Society, Newcastle University, Newcastle, England, UK
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - M. Heinen
- Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden
| | - Begoña Baena
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Krzysztof Brzózka
- State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, England, UK
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Artur Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | | | - Jorge Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Kathryn Parkinson
- Institute of Health and Society, Newcastle University, Newcastle, England, UK
| | - Jillian Reynolds
- Hospital Clínic de Barcelona, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain
| | - Gaby Ronda
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Luiza Słodownik
- State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland
| | - Fredrik Spak
- Department of Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ben van Steenkiste
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Paul Wallace
- Department of Primary Care and Population Health, University College London, London, UK
| | - Amy Wolstenholme
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Antoni Gual
- Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - M. Laurant
- Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - M. Wensing
- Radboud Institute for Health Sciences, Radboud Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
- Department of General Practice and Health Services Research, University Heidelberg Hospital, Heidelberg, Germany
| |
Collapse
|
3
|
Keurhorst M, van Beurden I, Anderson P, Heinen M, Akkermans R, Wensing M, Laurant M. GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme. BMC FAMILY PRACTICE 2014; 15:70. [PMID: 24742032 PMCID: PMC4021502 DOI: 10.1186/1471-2296-15-70] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/09/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs' role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme. METHODS In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme. RESULTS Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 - 0.73) but not role security (p = 0.58; 95%-CI -0.31 - 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment. CONCLUSIONS A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs' therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs' role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00298220.
Collapse
Affiliation(s)
- Myrna Keurhorst
- Radboud university medical center, Scientific Institute for Quality of Healthcare (IQ healthcare), P,O, Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|