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Wang Q, Feng W, Li W, Li S, Wu Q, Liu Z, Li X, Yu C, Cheng Y, Huang H, Fan R. Prediction Model for Postoperative Pressure Injury in Patients with Acute Type A Aortic Dissection. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38117173 DOI: 10.1097/asw.0000000000000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To establish a risk assessment model to predict postoperative National Pressure Injury Advisory Panel stage 2 or higher pressure injury (PI) risk in patients undergoing acute type A aortic dissection surgery. METHODS This retrospective assessment included consecutive patients undergoing acute type A aortic dissection surgery in the authors' hospital from September 2017 to June 2021. The authors used LASSO (logistic least absolute shrinkage and selection operator) regression analysis to identify the most relevant variables associated with PI by running cyclic coordinate descent with 10-times cross-validation. The variables selected by LASSO regression analysis were subjected to multivariate logistic analysis. A calibration plot, receiver operating characteristic curve, and decision curve analysis were used to validate the model. RESULTS There were 469 patients in the study, including 94 (27.5%) with postoperative PI. Ten variables were selected from LASSO regression: body mass index, diabetes, Marfan syndrome, stroke, preoperative skin moisture, hemoglobin, albumin, serum creatinine, platelet, and d-dimer. Four risk factors emerged after multivariate logistic regression: Marfan syndrome, preoperative skin moisture, albumin, and serum creatinine. The area under the receiver operating characteristic curve of the model was 0.765. The calibration plot and the decision curve analysis both suggested that the model was suitable for predicting postoperative PI. CONCLUSIONS This study built an efficient predictive model that could help identify high-risk patients.
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Affiliation(s)
- Qiuji Wang
- Qiuji Wang, MS, is PhD Candidate, Department of Cardiac Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China. Weiqi Feng, BS, is Master Candidate, School of Medicine, South China University of Technology, Guangzhou, China. Also at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Wenhui Li, BS, and Shan Li, BS, are Nurse Practitioners, Department of Cardiac Surgery; Qiuyi Wu, BS, is Nurse, Department of Cardiac Surgery; Zhichang Liu, BS, is Nurse, Department of Cardiac Surgery Intensive Care Unit 1; Xin Li, MS, and Changjiang Yu, MS, are Deputy Chief Physicians, Department of Cardiac Surgery; Yunqing Cheng, BS, is Head Nurse, Department of Cardiac Surgery; and Ruixin Fan, PhD, is Chief, Department of Cardiac Surgery. Acknowledgments: Editorial support and funding for the publication charge for this research were supplied by the Science and Technology Planning Project of Guangdong Province (no. 2015A020214017). The authors have disclosed no other financial relationships related to this article. Submitted October 18, 2022; accepted in revised form March 16, 2023
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Dijkstra S, Hartog J, Fleer J, van der Harst P, van der Woude LHV, Mariani MA. Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients - a longitudinal cohort study. BMC Sports Sci Med Rehabil 2023; 15:173. [PMID: 38115103 PMCID: PMC10731823 DOI: 10.1186/s13102-023-00786-1] [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: 05/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND This study aimed to determine the feasibility of a preoperative and postoperative (in- and outpatient) physical rehabilitation program, the Heart-ROCQ-pilot program. METHODS This cohort study included patients undergoing cardiac surgery (including coronary artery bypass graft surgery, valve surgery, aortic surgery, or combinations of these surgeries) and participated in the Heart-ROCQ-pilot program. Feasibility involved compliance and characteristics of bicycle and strength training sessions in the three rehabilitation phases. RESULTS Of the eligible patients, 56% (n = 74) participated in the program (41% of exclusions were due to various health reasons). On average across the rehabilitation phases, the compliance rates of bicycle and strength training were 88% and 83%, respectively. Workload to heart rate (W/HR) ratio and total absolute volume load for bicycle and strength training, respectively, improved in each rehabilitation phase (P < 0.05). The W/HR-ratio was higher during the last postoperative session compared to the first preoperative session (0.48 to 0.63 W/beat, P < 0.001) and similar to the last preoperative session (0.65 to 0.64 W/beat, P < 0.497). During less than 1% of the bicycle sessions, patients reported discomfort scores of 5 to 6 (scale 0-10, with higher scores indicating a higher level). CONCLUSIONS The Heart-ROCQ-pilot program was feasible for patients awaiting cardiac surgery. Patients were very compliant and were able to safely increase the training load before surgery and regained this improvement within eight weeks after surgery.
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Affiliation(s)
- Sandra Dijkstra
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Olsen DB, Pedersen PU, Noergaard MW. Prehabilitation before elective coronary artery bypass grafting surgery: a scoping review. JBI Evid Synth 2023:02174543-990000000-00142. [PMID: 36929938 DOI: 10.11124/jbies-22-00265] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The objective of this scoping review was to identify and map existing preoperative interventions, referred to as prehabilitation, in adult patients at home awaiting elective coronary artery bypass grafting surgery. This review also sought to report feasibility and patient experiences to shape clinical practice and underpin a future systematic review. INTRODUCTION As patients age, comorbidities become more common. Strategies to improve postoperative outcomes and to accelerate recovery are required in patients undergoing coronary artery bypass grafting. Prehabilitation refers to a proactive process of increasing functional capacity before surgery to improve the patient's ability to withstand upcoming physiologic stress and, thus, avoid postoperative complications. INCLUSION CRITERIA Studies that included adult patients awaiting coronary artery bypass grafting surgery at home and that described interventions optimizing preoperative physical and psychological health in any setting were included. METHODS The JBI methodology for conducting scoping reviews was used to identify relevant studies in MEDLINE, CINAHL, Cochrane Library, Embase, Scopus, SweMed+, PsycINFO, and PEDro. Gray literature was identified searching Google Scholar, ProQuest Dissertations and Theses, MedNar, OpenGrey, NICE Evidence search, and SIGN. Studies in Danish, English, German, Norwegian, and Swedish were considered for inclusion, with no geographical or cultural limitations, or date restrictions. Two independent reviewers screened titles and abstracts, and studies meeting the inclusion criteria were imported into Covidence. Sixty-seven studies from November 1987 to September 2022 were included. The data extraction tool used for the included papers was developed in accordance with the review questions and tested for adequacy and comprehensiveness with the first 5 studies by the same 2 independent reviewers. The tool was then edited to best reflect the review questions. Extracted findings are described and supported by figures and tables. RESULTS Sixty-seven studies were eligible for inclusion, representing 28,553 participants. Analyses of extracted data identified various preoperative interventions for optimizing postoperative and psychological outcomes for adult patients awaiting elective coronary artery bypass grafting surgery. Based on similarities, interventions were grouped into 5 categories. Eighteen studies reported on multimodal interventions, 17 reported on psychological interventions, 14 on physical training interventions, 13 on education interventions, and 5 on oral health interventions. CONCLUSION This scoping review provides a comprehensive summary of strategies that can be applied when developing a prehabilitation program for patients awaiting elective coronary artery bypass surgery. Although prehabilitation has been tested extensively and appears to be feasible, available evidence is mostly based on small studies. For patients undergoing elective coronary artery bypass grafting to derive benefit from prehabilitation, methodologically robust clinical trials and knowledge synthesis are required to identify optimal strategies for patient selection, intervention design, adherence, and intervention duration. Future research should also consider the cost-effectiveness of prehabilitation interventions before surgery. Finally, there is a need for more qualitative studies examining whether individual interventions are meaningful and appropriate to patients, which is an important factor if interventions are to be effective.
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Affiliation(s)
- Dorte Baek Olsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Preben U Pedersen
- Danish Centre of Systematic Reviews: A JBI Centre of Exellence, Centre of Clinical Guidelines - Danish National Clearinghouse, Faculty of Medicine, Aalborg University, Denmark
| | - Marianne Wetendorff Noergaard
- Danish Centre of Systematic Reviews: A JBI Centre of Exellence, Centre of Clinical Guidelines - Danish National Clearinghouse, Faculty of Medicine, Aalborg University, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Rodrigues SFNM, Henriques HMDSR, Henriques MAP. Needs of older persons undergoing cardiac surgery: Exploring the perceptions of nurses, patients waiting for and patients having had surgery. Nurs Open 2022; 9:1774-1784. [PMID: 35318826 PMCID: PMC8994954 DOI: 10.1002/nop2.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/12/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Aims The purpose of this research was to identify the needs of older persons waiting for elective open‐heart surgery. Design A qualitative exploratory design methodology, using Focus Groups. Methods A purposive sampling technique was used. Three interviews were conducted with experienced nurses, individuals waiting for open‐heart surgery (≥65years) and individuals having had open‐heart surgery (≥65years); enrolling up to 17 participants from October 2019 to January 2020. Qualitative data analysis was conducted using the iteractive model and MaxQDA® software, and EQUATOR COREQ guidelines were followed. Results Three themes were identified from the analysis of all three Focus Groups: (i) Needing health information; (ii) Needing emotional support; and (iii) Needing access to care.
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Affiliation(s)
- Soraia Filipa Nicola Martins Rodrigues
- Lisbon Nursing School, Lisbon University, Lisbon, Portugal.,Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal.,Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | | | - Maria Adriana Pereira Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal.,Lisbon Nursing School, Lisbon, Portugal.,ISAMB_Lisbon Medical School, Lisbon, Portugal
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Rodrigues SN, Henriques HR, Henriques MA. Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review. Rev Port Cardiol 2021; 40:229-244. [PMID: 33707091 DOI: 10.1016/j.repc.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/16/2022] Open
Abstract
Postoperative pulmonary complications are a common cause of morbidity and mortality in patients undergoing cardiac surgery, leading to an increase in length of hospital stay and healthcare costs. This systematic literature review aims to determine whether patients undergoing cardiac surgery who undergo preoperative breathing exercise training have better postoperative outcomes such as respiratory parameters, postoperative pulmonary complications, and length of hospital stay. Systematic searches were performed in the CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Clinical Answers, Cochrane Database of Systematic Reviews, MEDLINE and MedicLatina databases. Studies were included if they examined adult patients scheduled for elective cardiac surgery, who underwent a preoperative breathing exercise training aimed at improving breathing parameters, preventing postoperative pulmonary complications, and reducing hospital length of stay. This systematic review was based on Cochrane and Prisma statement recommendations in the design, literature search, analysis, and reporting of the review. The search yielded 608 records. Eleven studies met the inclusion criteria. Ten studies were randomized controlled trials and one was an observational cohort study. Data from 1240 participants was retrieved from these studies and meta-analysis was performed whenever possible. A preoperative breathing intervention on patients undergoing cardiac surgery may help improve respiratory performance after surgery, reduce postoperative pulmonary complications and hospital length of stay. However, more trials are needed to support and strengthen the evidence.
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Affiliation(s)
- Soraia Nicola Rodrigues
- Lisbon University, Lisbon, Portugal; Lisbon Nursing School, Lisbon, Portugal; Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal.
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Rodrigues SN, Henriques HR, Henriques MA. Effectiveness of preoperative breathing exercise interventions in patients undergoing cardiac surgery: A systematic review. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fulbrook P, Mbuzi V, Miles S. Incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care: A systematic review and meta-analysis. Int J Nurs Stud 2021; 114:103826. [PMID: 33352437 DOI: 10.1016/j.ijnurstu.2020.103826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure injury is recognised as an adverse event occurring in healthcare settings. Patients in intensive care are at high risk of developing a pressure injury. Cardiac patients are also among those at higher risk. OBJECTIVES To systematically assess the incidence and prevalence of pressure injury in adult cardiac patients admitted to intensive care. DESIGN Systematic review and meta-analysis of incidence and prevalence REVIEW METHODS: Articles published in English between 2009 and 2018, reporting pressure injury as a primary outcome were selected based on inclusion criteria. Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted. Sub-group meta-analyses were conducted to investigate potential causes of heterogeneity. RESULTS Fifteen studies met the criteria for inclusion in the systematic review, of which 14 were incidence studies. Heterogeneity was significant and there was large observed variance between studies. The 95% confidence interval of cumulative incidence across all 14 studies, with an overall sample size of 6371, was 9.8-25.6%. In 11 studies that included all-stage pressure injury the 95% confidence interval was 8.3-28.3%. In seven studies in which Stage 1 pressure injury was excluded, the 95% confidence interval was 5.8-22.7%. In the single prevalence study included, which excluded Stage 1 pressure injury, prevalence was 8.8%. CONCLUSIONS The incidence of pressure injury in cardiac intensive care patients was similar to that found in general intensive care patients. However, our results suggest that the incidence may be significantly higher in cardiac surgical patients admitted to intensive care. There were significant differences across the various studies in the ways in which data were collected and reported. Further well-designed studies are required to better understand incidence in this population, using standardised methods of data collection and reporting.
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Affiliation(s)
- Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Vainess Mbuzi
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.
| | - Sandra Miles
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane, Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia.
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Zhang Y, Zhu S, Yuan Z, Li Q, Ding R, Bao X, Zhen T, Fu Z, Fu H, Xing K, Yuan H, Chen T. Risk factors and socio-economic burden in pancreatic ductal adenocarcinoma operation: a machine learning based analysis. BMC Cancer 2020; 20:1161. [PMID: 33246424 PMCID: PMC7694304 DOI: 10.1186/s12885-020-07626-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Surgical resection is the major way to cure pancreatic ductal adenocarcinoma (PDAC). However, this operation is complex, and the peri-operative risk is high, making patients more likely to be admitted to the intensive care unit (ICU). Therefore, establishing a risk model that predicts admission to ICU is meaningful in preventing patients from post-operation deterioration and potentially reducing socio-economic burden. METHODS We retrospectively collected 120 clinical features from 1242 PDAC patients, including demographic data, pre-operative and intra-operative blood tests, in-hospital duration, and ICU status. Machine learning pipelines, including Supporting Vector Machine (SVM), Logistic Regression, and Lasso Regression, were employed to choose an optimal model in predicting ICU admission. Ordinary least-squares regression (OLS) and Lasso Regression were adopted in the correlation analysis of post-operative bleeding, total in-hospital duration, and discharge costs. RESULTS SVM model achieved higher performance than the other two models, resulted in an AU-ROC of 0.80. The features, such as age, duration of operation, monocyte count, and intra-operative partial arterial pressure of oxygen (PaO2), are risk factors in the ICU admission. The protective factors include RBC count, analgesic pump dexmedetomidine (DEX), and intra-operative maintenance of DEX. Basophil percentage, duration of the operation, and total infusion volume were risk variables for staying in ICU. The bilirubin, CA125, and pre-operative albumin were associated with the post-operative bleeding volume. The operation duration was the most important factor for discharge costs, while pre-lymphocyte percentage and the absolute count are responsible for less cost. CONCLUSIONS We observed that several new indicators such as DEX, monocyte count, basophil percentage, and intra-operative PaO2 showed a good predictive effect on the possibility of admission to ICU and duration of stay in ICU. This work provided an essential reference for indication in advance to PDAC operation.
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Affiliation(s)
- Yijue Zhang
- Department of Anesthesiology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Sibo Zhu
- School of Life Sciences, Fudan University, Shanghai, China
| | - Zhiqing Yuan
- Department of General Surgery, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qiwei Li
- Department of General Surgery, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ruifeng Ding
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | | | | | | | - Hailong Fu
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003 China
| | | | - Hongbin Yuan
- Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003 China
| | - Tao Chen
- Department of Anesthesiology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 2000 Jiangyue Road, Pujin Street, Minhang District, Shanghai, 201100 China
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Incidence and Variables Predictive of Pressure Injuries in Patients Undergoing Ventricular Assist Device and Total Artificial Heart Surgeries: An 8-Year Retrospective Cohort Study. Adv Skin Wound Care 2020; 33:651-660. [PMID: 33021600 DOI: 10.1097/01.asw.0000717236.91761.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the incidence and risk factors of pressure injury (PI) development after ventricular assist device (VAD) or total artificial heart (TAH) surgery. METHODS The investigator reviewed all VAD-TAH surgeries performed between 2010 and 2018 in a large academic health system. The PIs were reported by case incidence, patient incidence, and incidence density for each of the respective 1,000 patient days during the study period. Statistics on four different VAD-TAH devices were assessed; variables significant in bivariate analysis were entered into a stepwise logistic regression model to identify significant predictors of PI. RESULTS The sample included 292 independent VAD-TAH surgeries among 265 patients. Thirty-two patients developed 45 PIs. The PI incidence was 11% (32/292), with a PI incidence per patient of 12% (32/265). Incidence density was 10 per 1,000 patient days (1%) for 2010-2012, 12 per 1,000 patient days (1.2%) for 2013-2015, and 10 per 920 patient days (1.1%) for 2016-2018. Logistic regression revealed that significant predictor variables for PI were age, mechanical ventilation time, and preoperative Braden Scale score. The mean time to PI was 23 days after admission and over 14 days after surgery, indicating a low rate of intraoperative and ICU-associated PI. CONCLUSIONS The incidence of PI was lower than anticipated given historic rates. Potential mechanisms by which these patients were protected from PI are discussed. Prospective studies to further investigate significant risk factors and effective prevention measures are warranted.
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Xing H, Xiang D, Li Y, Ji X, Xie G. Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery. Psychogeriatrics 2020; 20:487-494. [PMID: 31951677 DOI: 10.1111/psyg.12511] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postoperative delirium (POD) is a very common complication in elderly patients after hip fracture surgery, which has poorly understood pathophysiology. This study aimed to investigate potential risk factors for POD. METHODS Elderly patients (aged ≥65 years) scheduled to undergo selective surgery in our hospital were consecutively recruited. Patient characteristics, preoperative laboratory tests and prognostic nutritional index (PNI) levels were compared between patients with or without POD. The risk factors for POD were evaluated by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of PNI and age for POD. RESULTS Fifty-seven of the 163 enrolled patient had suffered POD within postoperative day 7 with an incidence of 35.0%. Multivariate logistic analyses revealed that an advanced age (cut-off value: 71.5 years, sensitivity: 48.1%, specificity: 75.4%, odds ratio (OR): 3.24, 95% CI: 1.16-8.69, P = 0.026) and lower PNI level (cut-off value: 47.45, sensitivity: 86.0%, specificity: 51.9%, OR: 2.88, 95% CI: 1.25-6.64, P = 0.012) were two independent predictive factors associated with POD. According to the ROC curve analysis, preoperative PNI level was a predictor for POD with an area under the curve of 0.686 (95% CI: 0.604-0.767, P < 0.001). CONCLUSIONS Advanced age and lower preoperative PNI level were significantly associated with POD in elderly patients after hip fracture surgery.
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Affiliation(s)
- Hailin Xing
- Department of Anesthesiology, Taizhou People's Hospital, Medical School of Nantong University, Taizhou, China
| | - Dong Xiang
- Department of Anesthesiology, Taizhou People's Hospital, Medical School of Nantong University, Taizhou, China
| | - Yunxiang Li
- Department of Anesthesiology, Taizhou People's Hospital, Medical School of Nantong University, Taizhou, China
| | - Xiaoli Ji
- Department of Anesthesiology, Taizhou People's Hospital, Medical School of Nantong University, Taizhou, China
| | - Guozhu Xie
- Department of Anesthesiology, Taizhou People's Hospital, Medical School of Nantong University, Taizhou, China
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Banjongrewadee M, Wongpakaran N, Wongpakaran T, Pipanmekaporn T, Punjasawadwong Y, Mueankwan S. The role of perceived stress and cognitive function on the relationship between neuroticism and depression among the elderly: a structural equation model approach. BMC Psychiatry 2020; 20:25. [PMID: 31959135 PMCID: PMC6971914 DOI: 10.1186/s12888-020-2440-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 01/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression comprises common psychological problems, and has been strongly related to neuroticism and perceived stress. While neuroticism has been shown to have a direct effect on depression, it also has an indirect effect via perceived stress. Among the elderly, cognitive function produces influences that should not be overlooked when investigating depression. This study aimed to determine the role of mediating effects of perceived stress as well as cognitive function on neuroticism and depression among elderly patients. METHODS This research constituted a secondary analysis, with data collected during the pre-operative period of 429 elderly individuals undergoing elective, noncardiac surgery. The evaluation included the Perceived Stress Scale, the Neuroticism Inventory, the Montreal Cognitive Assessment, and the Geriatric Depression Scale. Structural equation modeling was used to investigate the hypothesized model. RESULTS Neuroticism exhibited a significant indirect effect on perceived stress via depression and cognition (β = 0.162, 95% CI 0.026, 0.322, p = .002). Neuroticism initially had a direct effect on depression (β = 0.766, 95% CI 0.675, 0.843 p = 0.003); thereafter, it was reduced after covariates were added (β = 0.557, 95% CI 0.432, 0.668 p = 0.002). Based on this model, the total variance explained by this model was 67%, and the model showed an acceptable fit with the data. CONCLUSIONS Both perceived stress and cognitive function partially mediated the effect of neuroticism on depression, with perceived stress exhibiting a greater effect. TRIAL REGISTRATION The study protocol has been registered at Clinicaltrials.gov under registered number: NCT02131181.
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Affiliation(s)
- Mukda Banjongrewadee
- 0000 0000 9039 7662grid.7132.7Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200 Thailand
| | - Nahathai Wongpakaran
- Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200, Thailand.
| | - Tinakon Wongpakaran
- 0000 0000 9039 7662grid.7132.7Geriatric Psychiatry Unit, Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai, 50200 Thailand
| | - Tanyong Pipanmekaporn
- 0000 0000 9039 7662grid.7132.7Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yodying Punjasawadwong
- 0000 0000 9039 7662grid.7132.7Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirirat Mueankwan
- 0000 0004 0640 1251grid.470093.9Division of Surgical Critical Care and Trauma, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
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Lopez-Delgado JC, Muñoz-del Rio G, Flordelís-Lasierra JL, Putzu A. Nutrition in Adult Cardiac Surgery: Preoperative Evaluation, Management in the Postoperative Period, and Clinical Implications for Outcomes. J Cardiothorac Vasc Anesth 2019; 33:3143-3162. [DOI: 10.1053/j.jvca.2019.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 02/07/2023]
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Mufti HN, Hirsch GM, Abidi SR, Abidi SSR. Exploiting Machine Learning Algorithms and Methods for the Prediction of Agitated Delirium After Cardiac Surgery: Models Development and Validation Study. JMIR Med Inform 2019; 7:e14993. [PMID: 31558433 PMCID: PMC6913743 DOI: 10.2196/14993] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/02/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022] Open
Abstract
Background Delirium is a temporary mental disorder that occasionally affects patients undergoing surgery, especially cardiac surgery. It is strongly associated with major adverse events, which in turn leads to increased cost and poor outcomes (eg, need for nursing home due to cognitive impairment, stroke, and death). The ability to foresee patients at risk of delirium will guide the timely initiation of multimodal preventive interventions, which will aid in reducing the burden and negative consequences associated with delirium. Several studies have focused on the prediction of delirium. However, the number of studies in cardiac surgical patients that have used machine learning methods is very limited. Objective This study aimed to explore the application of several machine learning predictive models that can pre-emptively predict delirium in patients undergoing cardiac surgery and compare their performance. Methods We investigated a number of machine learning methods to develop models that can predict delirium after cardiac surgery. A clinical dataset comprising over 5000 actual patients who underwent cardiac surgery in a single center was used to develop the models using logistic regression, artificial neural networks (ANN), support vector machines (SVM), Bayesian belief networks (BBN), naïve Bayesian, random forest, and decision trees. Results Only 507 out of 5584 patients (11.4%) developed delirium. We addressed the underlying class imbalance, using random undersampling, in the training dataset. The final prediction performance was validated on a separate test dataset. Owing to the target class imbalance, several measures were used to evaluate algorithm’s performance for the delirium class on the test dataset. Out of the selected algorithms, the SVM algorithm had the best F1 score for positive cases, kappa, and positive predictive value (40.2%, 29.3%, and 29.7%, respectively) with a P=.01, .03, .02, respectively. The ANN had the best receiver-operator area-under the curve (78.2%; P=.03). The BBN had the best precision-recall area-under the curve for detecting positive cases (30.4%; P=.03). Conclusions Although delirium is inherently complex, preventive measures to mitigate its negative effect can be applied proactively if patients at risk are prospectively identified. Our results highlight 2 important points: (1) addressing class imbalance on the training dataset will augment machine learning model’s performance in identifying patients likely to develop postoperative delirium, and (2) as the prediction of postoperative delirium is difficult because it is multifactorial and has complex pathophysiology, applying machine learning methods (complex or simple) may improve the prediction by revealing hidden patterns, which will lead to cost reduction by prevention of complications and will optimize patients’ outcomes.
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Affiliation(s)
- Hani Nabeel Mufti
- Division of Cardiac Surgery, Department of Cardiac Sciences, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - Western Region, Jeddah, Saudi Arabia.,College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Samina Raza Abidi
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Syed Sibte Raza Abidi
- kNowledge Intensive Computing for Healthcare Enterprise Research Group, Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
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Pedersen PU, Tracey A, Sindby JE, Bjerrum M. Preoperative oral hygiene recommendation before open-heart surgery: patients' adherence and reduction of infections: a quality improvement study. BMJ Open Qual 2019; 8:e000512. [PMID: 31206058 PMCID: PMC6542424 DOI: 10.1136/bmjoq-2018-000512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 01/08/2023] Open
Abstract
Aim To implement recommendations for oral hygiene before elective open-heart surgery in a thoracic surgery ward and to evaluate whether the number of patients who needed to be treated with antibiotics postoperatively was reduced. Background Healthcare systems are challenged to implement initiatives that reduce the development of nosocomial infections, to offer patients a safe and cost-efficient treatment and to reduce the use of antibiotics. Previous interventions have focused on staff behaviour in reducing postoperative infections. In this study, patients were recommended to carry out oral hygiene as recommended in a clinical guideline. Methods A quasiexperimental design with a control and an intervention group was used. Information on adherence to the recommendation was collected at admission. All medical information and prescriptions of antibiotics were obtained from patients’ medical records. Data were reported as intention to treat. Results Altogether 972 patients (506 controls and 466 interventions) were included in the study. Of the intervention patients, 405 (86.9%, 95% CI 83.3 to 89.8) reported that they had adhered to the oral hygiene recommendation. 64 (12.6%) control patients and 36 (7.7%) in the intervention group (p=0.015) were treated with antibiotics postoperatively. Conclusions It was feasible to involve patients in a programme for oral hygiene and thereby reduce the number of patients needing antibiotics after open-heart surgery and this might contribute to reducing costs.
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Affiliation(s)
- Preben Ulrich Pedersen
- Aalborg University, Department of Clinical Medicine, Centre of Clinical Guidelines and Clinical Research Unit, Aalbirg University Hospital, Aalborg University, Aalborg, Denmark
| | - Anita Tracey
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Eske Sindby
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Merete Bjerrum
- Section of Nursing Research, Aarhus Universitet, Aarhus, Denmark
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Szylińska A, Listewnik M, Rotter I, Rył A, Kotfis K, Mokrzycki K, Kuligowska E, Walerowicz P, Brykczyński M. The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2572. [PMID: 30453599 PMCID: PMC6266912 DOI: 10.3390/ijerph15112572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/16/2022]
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Krzysztof Mokrzycki
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Ewelina Kuligowska
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Paweł Walerowicz
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
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Zhu Z, Zhou H, Ni Y, Wu C, Zhang C, Ling X. Can dexmedetomidine reduce atrial fibrillation after cardiac surgery? A systematic review and meta-analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:521-531. [PMID: 29559768 PMCID: PMC5856293 DOI: 10.2147/dddt.s153834] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose Cardiac surgery patients always present with atrial fibrillation (AF) after admission to the intensive care unit, leading to high mortality and lengthy hospitalization. Dexmedetomidine (DEX) is a popular medication used for sedation in the intensive care unit; however, whether it can reduce AF needs to be analyzed. Materials and methods Three primary databases, Medline, Embase (Ovid SP) and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched. All English language and randomized control designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two independent colleagues conducted the data extraction and quality assessments. The subgroup analysis was performed according to the medicine used, age, AF history, and whether previous beta-blocker premedication and cardiopulmonary bypass (CPB) were applied. The overall incidence of AF was analyzed. Results A total of 1,295 patients in nine studies met the selection criteria among 2,587 studies screened from the database. After quantitative synthesis, our results revealed that the DEX group was not associated with a decreased incidence of AF compared with the placebo (risk ratio [RR] 0.76, 95% CI 0.37, 1.55, P=0.44) and morphine groups (RR 0.86, 95% CI 0.56, 1.31, P=0.48). Subgroup analysis also indicated that the DEX vs propofol comparison exhibited no difference: 1) for patients of age >60 years (P=0.69) or ≤60 years (P=0.69); 2) under CPB surgery (P=0.45) or without CPB surgery (P=0.88); 3) with beta-blocker premedication (P=0.32) or without beta-blocker premedication (P=0.90); and 4) with AF history (RR 1.07, 95% CI 0.85, 1.36, P=0.57) or without AF history (P=0.30). Conclusion This meta-analysis revealed that DEX could not reduce the incidence of AF compared to control medicines following cardiac surgery. DEX may have an increased influence on AF occurrence if patients had a history of AF. However, cautious interpretation should be made due to high clinical heterogeneity.
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Affiliation(s)
- Zhipeng Zhu
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Hongmei Zhou
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Yunjian Ni
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Cheng Wu
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Caijun Zhang
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Xiaoyan Ling
- Outpatient-Nursing Department, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
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Ling X, Zhou H, Ni Y, Wu C, Zhang C, Zhu Z. Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A meta-analysis of randomized controlled trials. PLoS One 2018; 13:e0193303. [PMID: 29494685 PMCID: PMC5832237 DOI: 10.1371/journal.pone.0193303] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/08/2018] [Indexed: 12/19/2022] Open
Abstract
Background Cardiac surgery patients often experience several types of tachyarrhythmias after admission to the intensive care unit (ICU), which increases mortality and morbidity. Dexmedetomidine (DEX) is a popular medicine used for sedation in the ICU, and its other pharmacological characteristics are gradually being uncovered. Purpose To determine whether DEX has an antiarrhythmic effect after cardiac surgery. Methods The three primary databases MEDLINE, Embase (OVID SP) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched, and all English-language and randomized control-designed clinical publications comparing DEX to control medicines for sedation after elective cardiac surgery were included. Two colleagues independently extracted the data and performed other quality assessments. A subgroup analysis was performed according to the different medicines used and whether cardiopulmonary bypass (CPB) was applied. All tachyarrhythmias that occurred in the atria and ventricles were analyzed. Results A total of 1295 patients in 9 studies met the selection criteria among 2587 studies that were screened. After quantitative synthesis, our results revealed that the DEX group was associated with a lower incidence of ventricular arrhythmia (VA, OR 0.24, 95% CI 0.09–0.64, I2 = 0%, P = 0.005) than the control group. Subgroup analysis did not reveal a significant difference between the DEX and propofol subgroups (OR 0.13, 95% CI 0.03–0.56, I2 = 0%, P = 0.007). Additionally, no difference in the incidence of atrial fibrillation (AF) was observed regardless of the different control medicines (OR 0.82, 95% CI 0.60–1.10, I2 = 25%, P = 0.19) or whether CPB was applied. Conclusions This meta-analysis revealed that DEX has an antiarrhythmic effect that decreases the incidence of VA compared to other drugs used for sedation following cardiac surgery. DEX may not have an effect on AF, but cautious interpretation should be exercised due to high heterogeneity.
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Affiliation(s)
- Xiaoyan Ling
- Outpatient Nursing Department, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Hongmei Zhou
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Yunjian Ni
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Cheng Wu
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Caijun Zhang
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
| | - Zhipeng Zhu
- Department of Anesthesiology, the Second Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, China
- * E-mail:
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Increasing value and reducing waste by optimizing the development of complex interventions: Enriching the development phase of the Medical Research Council (MRC) Framework. Int J Nurs Stud 2017; 79:86-93. [PMID: 29220738 DOI: 10.1016/j.ijnurstu.2017.12.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/17/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years there has been much emphasis on 'research waste' caused by poor question selection, insufficient attention to previous research results, and avoidable weakness in research design, conduct and analysis. Little attention has been paid to the effect of inadequate development of interventions before proceeding to a full clinical trial. OBJECTIVE We therefore propose to enrich the development phase of the MRC Framework by adding crucial elements to improve the likelihood of success and enhance the fit with clinical practice METHODS: Based on existing intervention development guidance and synthesis, a comprehensive iterative intervention development approach is proposed. Examples from published reports are presented to illustrate the methodology that can be applied within each element to enhance the intervention design. RESULTS A comprehensive iterative approach is presented by combining the elements of the MRC Framework development phase with essential elements from existing guidance including: problem identification, the systematic identification of evidence, identification or development of theory, determination of needs, the examination of current practice and context, modelling the process and expected outcomes leading to final element: the intervention design. All elements are drawn from existing models to provide intervention developers with a greater chance of producing an intervention that is well adopted, effective and fitted to the context. CONCLUSION This comprehensive approach of developing interventions will strengthen the internal and external validity, minimize research waste and add value to health care research. In complex interventions in health care research, flaws in the development process immediately impact the chances of success. Knowledge regarding the causal mechanisms and interactions within the intended clinical context is needed to develop interventions that fit daily practice and are beneficial for the end-user.
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Mufti HN, Hirsch GM. Perioperative prediction of agitated (hyperactive) delirium after cardiac surgery in adults - The development of a practical scorecard. J Crit Care 2017; 42:192-199. [PMID: 28772221 DOI: 10.1016/j.jcrc.2017.07.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 07/08/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Delirium is a temporary mental disorder that occurs frequently among hospitalized patients. In this study we sought to develop a user-friendly scorecard based on perioperative features to identify patients at risk of developing agitated delirium after cardiac surgery. METHODS Retrospective analysis was performed on adult patients undergoing cardiac surgery in a single center. A parsimonious predictive model was created, with subsequent internal validation. Then a simple scorecard was developed that can be used to predict the probability of agitated delirium. RESULTS Among the 5584 patients who met the study criteria, 614 (11.4%) developed postoperative agitated delirium. Independent predictors of postoperative agitated delirium were age, male gender, history of cerebrovascular disease, procedure other than isolated Coronary Arteries Bypass Surgery, transfusion of blood products within the first 48h, mechanical ventilation for >24h, length of stay in the Intensive Care Unit. The scorecard stratified patients into 4 categories at risk of postoperative agitated delirium ranging from <5% to >30%. CONCLUSION Using a large cohort of adult patient's undergoing cardiac surgery, a user-friendly scorecard was developed and validated, which will facilitate the implementation of timely interventions to mitigate adverse effects of agitated delirium in this high risk population.
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Affiliation(s)
- Hani N Mufti
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Cardiac Surgery, Department of Cardiac Sciences, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Gregory M Hirsch
- Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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van Laar C, TImman ST, Noyez L. Decreased physical activity is a predictor for a complicated recovery post cardiac surgery. Health Qual Life Outcomes 2017; 15:5. [PMID: 28069013 PMCID: PMC5220604 DOI: 10.1186/s12955-016-0576-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/09/2016] [Indexed: 01/15/2023] Open
Abstract
Background Physical activity (PA) reduces the risk of cardiovascular disease and physically active survivors of a cardiac event are at lower risk of recurrent events. We hypothesized that patients with a decreased PA, undergoing cardiac surgery, are at higher risk for a postoperative complicated recovery (PCR). Methods Three thousand three hundred eighty two patients undergoing elective cardiac surgery between January 2007 and December 2013 were included. The group was divided into three subgroups: group A, aged ≤ 65 years (N = 1329); group B, aged > 65 years and ≤ 75 years (N = 1250); and group C aged >75 years (N = 803). To assess PA, the criteria of the Corpus Christy Heart Project were used. A PCR consists of the occurrence of a major postoperative event, defined as any of the following complications: reoperation, deep sternal wound infection, renal failure, stroke, postoperative ventilation > 2 days, intensive care stay ≥ 5 days, hospital stay ≥ 10 days, or hospital mortality. Results One thousand three hundred sixty seven patients (40%) were considered as patients with a decreased PA. Both in group B (p = 0.001) and in group C (p = 0.003), patients with a decreased PA were significantly associated with an increased risk of a PCR, which was not the case in group A (p = 0.28). Logistic regression analysis identified a decreased PA as an independent predictor for PCR in groups B (p = 0.003, odds 1.71) and C (p = 0.033, odds 1.48), but not in group A (p = 0.11, odds 0.71). Conclusion Decreased physical activity is an independent predictor for a PCR in patients aged 65 years or older undergoing elective cardiac surgery.
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Affiliation(s)
- Charlotte van Laar
- Department of Cardio-Thoracic Surgery - 615, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Simone T TImman
- Department of Cardio-Thoracic Surgery - 615, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Luc Noyez
- Department of Cardio-Thoracic Surgery - 615, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Kim LK, Looser P, Swaminathan RV, Minutello RM, Wong SC, Girardi L, Feldman DN. Outcomes in patients undergoing coronary artery bypass graft surgery in the United States based on hospital volume, 2007 to 2011. J Thorac Cardiovasc Surg 2016; 151:1686-92. [DOI: 10.1016/j.jtcvs.2016.01.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
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Kim LK, Minutello RM, Feldman DN, Swaminathan RV, Bergman G, Singh H, Kaple RK, Wong SC. Association Between Transcatheter Aortic Valve Implantation Volume and Outcomes in the United States. Am J Cardiol 2015; 116:1910-5. [PMID: 26508710 DOI: 10.1016/j.amjcard.2015.09.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
Abstract
With the rapid advance of transcatheter aortic valve implantation (TAVI), it is important to evaluate the relationship between TAVI volumes and outcomes. The aim of this study was to analyze in-hospital outcomes after TAVI stratified according to hospital volumes. Using the National Inpatient Sample files from 2012, hospitals performing transfemoral (TF)-TAVI and transapical (TA)-TAVI were divided into high-volume and low-volume centers. A total of 7,660 patients underwent TAVI in 256 hospitals in 2012. In the TF-TAVI cohort, multivariate logistic regression analyses demonstrated that low TF-TAVI volume status was an independent predictor of death and bleeding. In the TA-TAVI cohort, low volume status was a predictor of death, myocardial infarction, and need for permanent pacemaker. In addition, hospitals that performed low TA-TAVI volume were associated with significantly higher rate of death after surgical aortic valve replacement in comparison with the hospitals that perform high TA-TAVI volume (3.6% vs 2.3%, p <0.001). In conclusion, centers with lower volume of TAVI had more frequent adverse events compared with higher volume centers.
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Abstract
PURPOSE OF REVIEW Evidence is emerging that delirium is associated with both short-term and long-term morbidity and mortality. This review highlights the epidemiology, outcomes, prevention and treatment strategies associated with delirium after cardiac surgery. RECENT FINDINGS The incidence of delirium after cardiac surgery is estimated to be 26-52%, with a significant percentage being hypoactive delirium. It is clear that without an appropriate structured test for delirium, the incidence of delirium will be underrecognized clinically. Delirium after cardiac surgery is associated with poor outcomes, including increased long-term mortality, increased risk of stroke, poor functional status, increased hospital readmissions and substantial cognitive dysfunction for 1 year following surgery. The effectiveness of prophylactic antipsychotics to reduce the risk of delirium is controversial, with data from recent small studies in noncardiac surgery potentially showing a benefit. Although antipsychotic medications are often used to treat delirium, the evidence that antipsychotics in cardiac surgery patients reduce duration of delirium or improve long-term outcomes following delirium is poor. SUMMARY Clinicians in the ICU must recognize the impact of delirium in predicting long-term outcomes for patients. Further research is needed in determining interventions that will be effective in preventing and treating delirium in cardiac surgical setting.
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Affiliation(s)
- Charles H Brown
- Department of Anesthesiology and Critical Care Medicine, The John Hopkins School of Medicine, Baltimore, Maryland, USA
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Ettema RGA, Hoogendoorn ME, Kalkman CJ, Schuurmans MJ. Development of a nursing intervention to prepare frail older patients for cardiac surgery (the PREDOCS programme), following phase one of the guidelines of the Medical Research Council. Eur J Cardiovasc Nurs 2013; 13:494-505. [DOI: 10.1177/1474515113511715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In older patients undergoing elective cardiac surgery, the timely identification and preparation of patients at risk for frequent postoperative hospital complications provide opportunities to reduce the risk of these complications. Aims: We developed an evidence-based, multi-component nursing intervention (Prevention of Decline in Older Cardiac Surgery Patients; the PREDOCS programme) for application in the preadmission period to improve patients’ physical and psychosocial condition to reduce their risk of postoperative complications. This paper describes in detail the process used to design and develop this multi-component intervention. Methods: In a team of researchers, experts, cardiac surgeons, registered cardiac surgery nurses, and patients, the revised guidelines for developing and evaluating complex interventions of the Medical Research Council (MRC) were followed, including identifying existing evidence, identifying and developing theory and modelling the process and outcomes. Additionally, the criteria for reporting the development of complex interventions in healthcare (CReDECI) were followed. Results: The intervention is administered during a consultation by the nurse two to four weeks before the surgery procedure. The consultation includes three parts: a general part for all patients, a second part in which patients with an increased risk are identified, and a third part in which selected patients are informed about how to prepare themselves for the hospital admission to reduce their risk. Conclusions: Following the MRC guidelines, an extended, stepwise, multi-method procedure was used to develop the multi-component nursing intervention to prepare older patients for cardiac surgery, creating transparency in the assumed working mechanisms. Additionally, a detailed description of the intervention is provided.
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Affiliation(s)
- Roelof GA Ettema
- University of Applied Science Utrecht, Faculty of Health Care, The Netherlands
- University Medical Centre Utrecht, The Netherlands
| | | | | | - Marieke J Schuurmans
- University of Applied Science Utrecht, Faculty of Health Care, The Netherlands
- University Medical Centre Utrecht, The Netherlands
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