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Mastwyk S, Taylor NF, Lowe A, Dalton C, Peiris CL. "You don't know what you don't know": Knowledge, attitudes, and current practice of physiotherapists in recognising and managing metabolic syndrome, a mixed methods study. Physiotherapy 2024; 124:75-84. [PMID: 38875840 DOI: 10.1016/j.physio.2024.01.008] [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: 04/12/2023] [Revised: 12/11/2023] [Accepted: 01/24/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To determine the knowledge, attitudes, and current practice of primary care physiotherapists in recognising and managing clients with metabolic syndrome. DESIGN Mixed-methods research design comprising an online survey and focus groups. PARTICIPANTS Australian and English physiotherapists (n = 183) working in a primary care setting responded to the survey. Twelve physiotherapists participated in focus groups. RESULTS Metabolic syndrome was not on physiotherapists radar. They did not screen for metabolic syndrome nor provide management for it in primary care. Although most physiotherapists had some awareness of metabolic syndrome, they were not knowledgeable. Physiotherapists reported a need to focus on their clients' presenting condition, and there was uncertainty on whether metabolic syndrome management was within their scope of practice. Despite this, physiotherapists felt they had an important role to play in exercise and physical activity prescription for chronic disease management and were keen to further their knowledge and skills related to metabolic syndrome. Survey responses and focus group data were convergent. CONCLUSION Physiotherapists working in primary care settings are well-placed to identify metabolic risk factors in their clients and provide physical activity interventions to enhance management but currently lack knowledge to embed this in clinical practice. Training and resources are required to enable physiotherapists to identify and manage metabolic syndrome within their practice. CONTRIBUTION OF PAPER.
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Affiliation(s)
- Sally Mastwyk
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.
| | - Anna Lowe
- National Centre for Sports & Exercise Medicine, Sheffield Hallam University, Sheffield, UK.
| | - Caroline Dalton
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Casey L Peiris
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Australia; Allied Health, The Royal Melbourne Hospital, Parkville, Australia.
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Karimijashni M, Westby M, Ramsay T, Beaulé PE, Poitras S. Development and content validation of a questionnaire identifying patients' functional priorities and abilities after hip or knee arthroplasty. Disabil Rehabil 2024:1-15. [PMID: 39154246 DOI: 10.1080/09638288.2024.2390648] [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: 03/13/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To develop a self-report questionnaire evaluating functional priorities after hip or knee arthroplasty and evaluate patients' understanding of its items and conceptual relevance. METHODS A self-report questionnaire was first developed based on the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis (OA). In the second stage, two research physiotherapists thoroughly reviewed and refined the questionnaire, and another physiotherapist conducted cognitive think-aloud interviews with 18 patients to assess the face and content validity of the questionnaire. RESULTS All categories and corresponding activities of ICF core set for OA were used to develop the questionnaire. Several questionnaire issues were identified and addressed. Most challenges were related to comprehension, followed by item ordering and visual elements. Patients identified ambiguous wording which we subsequently simplified. Ten activities of the core set were excluded due to lack of face validity, two activities were added, and four activities were modified. CONCLUSION The findings suggest that the ICF core set for OA needs to be adjusted for patients undergoing hip or knee arthroplasty and highlight the feasibility of applying a modified core set to assess functional priorities after hip or knee arthroplasty.
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Affiliation(s)
- Motahareh Karimijashni
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Westby
- Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Steele CM, Burdick RJ, Dallal-York J, Shapira-Galitz Y, Abrams SW. EQUATOR Network Mapping Review for Dysphagia Research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-13. [PMID: 39151057 DOI: 10.1044/2023_ajslp-23-00306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE The EQUATOR Network is an international initiative aimed at improving published health research through use of reporting guidelines. We conducted a review to determine the extent to which EQUATOR Network guidelines contain recommendations relevant for dysphagia research in human subjects. METHOD We downloaded all 542 EQUATOR Network guidelines on November 8, 2022. Each guideline was reviewed by two independent raters and judged for relevance to dysphagia and related fields (e.g., otolaryngology, gastroenterology). Dysphagia-relevant guidelines pertaining to quantitative human subjects research were further inspected to identify reporting guidance regarding (a) general research elements (e.g., data collection, statistical methods), (b) participant characteristics (e.g., demographics, accrual, randomization), (c) screening and clinical/noninstrumental assessments, (d) videofluoroscopic examinations, (e) flexible endoscopic examinations, (f) other instrumentation in swallowing research, (g) dysphagia treatment, (h) patient-/care provider-reported outcome measures, and (i) any other narrowly specified focus relevant for research on swallowing. Discrepancies were resolved by consensus. RESULTS Of 542 guidelines, 156 addressed quantitative research in human subjects relevant to dysphagia. Of these, 104 addressed general research elements and 108 addressed participant characteristics. Only 14 guidelines partially addressed the other topics of interest, and none addressed elements relevant to reporting videofluoroscopic or endoscopic assessments of swallowing. CONCLUSIONS We were unable to find guidelines with specific relevance to reporting key methods in dysphagia research. This lack of guidance illustrates a gap that hinders the critical appraisal of research quality in the field of dysphagia. Our review highlights the need to develop dysphagia-specific tools for critical appraisal and guidance regarding adequate research reporting. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25014017.
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Affiliation(s)
- Catriona M Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Ontario, Canada
| | - Ryan J Burdick
- Swallowing and Salivary Bioscience Lab, Department of Medicine, Division of Geriatrics and Gerontology, Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Yael Shapira-Galitz
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
- Hadassah School of Medicine, Hebrew University of Jerusalem, Israel
| | - Sophia Werden Abrams
- Aging Swallow Research Laboratory, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Cantor-Cutiva LC, Malebrán C, de Oliveira IB, Cerda F, Dalmasso MDC, Díaz A, Manzano C, Morales A, Piccolotto Ferreira L, Ramonda J, Vaz Masson ML. Prospective Teacher's Voice Questionnaire (PTVQ): Development of a Questionnaire to Assess Training-Related Voice Symptoms Among Prospective Teachers. J Voice 2024:S0892-1997(24)00238-8. [PMID: 39142924 DOI: 10.1016/j.jvoice.2024.07.027] [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: 05/23/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024]
Abstract
AIM To develop and validate a self-administered population-specific survey, available in Spanish, Portuguese, and English, which investigates the prevalence of voice symptoms and perceptions of risk factors associated with training among prospective teachers. METHODS The present study had three stages: the first stage included a literature review and content validation by experts that supported the survey development. From this phase, we defined five aspects of the Prospective Teacher's Voice Questionnaire (PTVQ): (1) target population, (2) research objectives, (3) questions to be included, (4) scales for the answers, and (5) relevance, comprehensiveness, clarityclarity, and understandability of the questions. This process was performed in parallel for the three languages (Spanish, Portuguese, and English). The second stage included pilot testing. This involved administering the first draft of the survey to a group of 120 students to evaluate the feasibility and effectiveness of the survey instrument, identify any potential problems with the survey, and refine the instrument based on feedback from the pilot participants. The third stage includes the restructuring of the questionnaire's voice quality section to eliminate redundant questions. Through Principal Component Analysis, multicollinear variables were condensed, facilitating the removal of redundant items, and ensuring that the final questionnaire comprised only the most relevant and discriminative questions. RESULTS AND DISCUSSION The final version of the survey, available in Spanish, Portuguese, and English, consists of four sections with a total of 57 questions. The development of the PTVQ represents a significant step toward better understanding and addressing voice disorders among prospective teachers. Future research could further refine the questionnaire and explore its predictive validity in identifying individuals at risk of voice disorders early in their teaching careers. Additionally, interventions based on the findings from the PTVQ could be developed to support the voice health and well-being of prospective teachers, ultimately improving teaching quality and job satisfaction in educational settings.
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Affiliation(s)
| | - Celina Malebrán
- School of Speech-Language Pathology, College of Dentistry and Rehabilitation Sciences, Universidad San Sebastián, Santiago, Chile
| | | | - Felipe Cerda
- Department of Speech-Language and Pathology, College of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Adriana Díaz
- National Division of Health for the Police Department (Hospital Policial), Montevideo, Uruguay
| | - Carlos Manzano
- Hospital Médica Sur/Centro Médico ABC, Mexico City, Mexico
| | - Alejandro Morales
- Program of Speech and Language Pathology and Audiology, Manuela Beltran University, Bogota, Colombia
| | - Léslie Piccolotto Ferreira
- Department of Theories and Methods in Speech Therapy and Physiotherapy, Pontifical Catholic University of São Paulo, São Paulo, SP, Brazil
| | - Jessica Ramonda
- Instituto Superior de ORL y Fonoaudiología, Cordoba, Argentina
| | - Maria Lúcia Vaz Masson
- Speech-Language-Pathology-Hearing Sciences Department, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Bahia, Brazil
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Thomas J, Abdallah C, Cai Z, Jaber K, Gotman J, Beniczky S, Frauscher B. Investigating current clinical opinions in stereoelectroencephalography-informed epilepsy surgery. Epilepsia 2024. [PMID: 39096434 DOI: 10.1111/epi.18076] [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: 02/16/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) is increasingly utilized worldwide in epilepsy surgery planning. International guidelines for SEEG terminology and interpretation are yet to be proposed. There are worldwide differences in SEEG definitions, application of features in epilepsy surgery planning, and interpretation of surgical outcomes. This hinders the clinical interpretation of SEEG findings and collaborative research. We aimed to assess the global perspectives on SEEG terminology, differences in the application of presurgical features, and variability in the interpretation of surgery outcome scores, and analyze how clinical expert demographics influenced these opinions. METHODS We assessed the practices and opinions of epileptologists with specialized training in SEEG using a survey. Data were qualitatively analyzed, and subgroups were examined based on geographical regions and years of experience. Primary outcomes included opinions on SEEG terminology, features used for epilepsy surgery, and interpretation of outcome scores. Additionally, we conducted a multilevel regression and poststratification analysis to characterize the nonresponders. RESULTS A total of 321 expert responses from 39 countries were analyzed. We observed substantial differences in terminology, practices, and use of presurgical features across geographical regions and SEEG expertise levels. The majority of experts (220, 68.5%) favored the Lüders epileptogenic zone definition. Experts were divided regarding the seizure onset zone definition, with 179 (55.8%) favoring onset alone and 135 (42.1%) supporting onset and early propagation. In terms of presurgical SEEG features, a clear preference was found for ictal features over interictal features. Seizure onset patterns were identified as the most important features by 265 experts (82.5%). We found similar trends after correcting for nonresponders using regression analysis. SIGNIFICANCE This study underscores the need for standardized terminology, interpretation, and outcome assessment in SEEG-informed epilepsy surgery. By highlighting the diverse perspectives and practices in SEEG, this research lays a solid foundation for developing globally accepted terminology and guidelines, advancing the field toward improved communication and standardization in epilepsy surgery.
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Affiliation(s)
- John Thomas
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
| | - Chifaou Abdallah
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Zhengchen Cai
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Kassem Jaber
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Jean Gotman
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Sandor Beniczky
- Danish Epilepsy Center and Aarhus University Hospital, Aarhus, Denmark
| | - Birgit Frauscher
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
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Magon H, Smith J, Besson J, Hau E, Taylor S, Ruben J, Jones D, Mabb K, Feldman J, Gholam Rezaei L, Lee YY. Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes - an Australian multi-institutional radiation oncology survey. AUST HEALTH REV 2024; 48:388-395. [PMID: 38467124 DOI: 10.1071/ah23183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
Objective To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians.
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Affiliation(s)
- Honor Magon
- Digital Health and Informatics, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld 4102, Australia
| | - Justin Smith
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia; and Faculty of Medicine, University of QLD, Brisbane, Qld, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
| | - Jacqueline Besson
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia
| | - Eric Hau
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia; and Blacktown Haematology and Oncology Cancer Cente, Blacktown Hospital, Sydney, NSW, Australia; and Westmead Institute of Medical Research, Sydney, NSW, Australia; and Westmead Medical School, University of Sydney, Sydney, NSW, Australia
| | - Suzanne Taylor
- Faculty of Medicine, University of QLD, Brisbane, Qld, Australia; and Department of Radiation Oncology, Princess Alexandra Hospital Raymond Terrace Campus, Brisbane, Qld, Australia
| | | | - Diana Jones
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia
| | - Kira Mabb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital Ipswich Road Campus, Brisbane, Qld, Australia
| | - Jamie Feldman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital Ipswich Road Campus, Brisbane, Qld, Australia
| | - Leily Gholam Rezaei
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Yoo Young Lee
- Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road Campus, Brisbane, Qld, Australia; and Faculty of Medicine, University of QLD, Brisbane, Qld, Australia
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Massicotte-Azarniouch D, Canney M, Karnabi P, Merkel PA, Jones RB, Pepper RJ, Salama AD, Derebail VK, Milman N, Junek M, Pagnoux C, Jayne DR, Walsh M. Glucocorticoid Minimization in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: An International Survey of Clinicians. Kidney Med 2024; 6:100858. [PMID: 39131917 PMCID: PMC11315210 DOI: 10.1016/j.xkme.2024.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Rationale & Objective Research in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has focused on reducing treatment toxicities, notably through reduction of exposure to glucocorticoids. Glucocorticoid-sparing therapies such as avacopan are not widely available in many countries, and patients are exposed to high glucocorticoid doses. There is little data concerning what clinicians should accept as the lowest glucocorticoid dosing that can be used in induction therapy for AAV. Study Design International, online survey. Setting & Participants Clinicians in various countries with experience in managing vasculitis. Exposure and Outcomes Survey questions to gauge interest and preferences in studying an induction of remission regimen for severe AAV using only 2 or 4 weeks of glucocorticoids without avacopan. Data collected included general opinions about standard of care for induction agents, glucocorticoids, and avacopan. Respondents were presented with 3 candidate trial designs, 2 of which proposed a combination of cyclophosphamide and rituximab induction. Analytical Approach Using a 10-point Likert scale, respondents ranked each candidate trial on its usefulness in demonstrating whether a minimal glucocorticoid regimen would be safe and effective and their willingness to randomize into the trial. Results There were 210 respondents to the survey. The candidate trials were rated moderate-to-high for usefulness to demonstrate safety and efficacy (scores 6-7/10), and moderate (scores 5-6/10) for willingness to randomize. Four-week glucocorticoid duration was preferred to 2 weeks, and combination cyclophosphamide-rituximab with 4-week glucocorticoids was the most preferred design. Forty-two percent of respondents felt avacopan had to be incorporated into a minimal GC trial design to want to recruit patients. Limitations Representativeness of survey sample and generalizability of findings. Conclusions Combination cyclophosphamide-rituximab may be the ideal way of studying minimal glucocorticoid use in severe AAV. Given its increasing uptake, incorporating avacopan into a potential trial design is important.
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Affiliation(s)
- David Massicotte-Azarniouch
- Division of Nephrology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark Canney
- Division of Nephrology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Priscilla Karnabi
- Clinical Epidemiology Program, the Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter A. Merkel
- Division of Rheumatology, Department of Medicine and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Rachel B. Jones
- Renal Medicine, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ruth J. Pepper
- University College London Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
| | - Alan D. Salama
- University College London Department of Renal Medicine, Royal Free Hospital, London, United Kingdom
| | - Vimal K. Derebail
- Division of Nephrology and Hypertension, Department of Medicine, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nataliya Milman
- Division of Rheumatology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mats Junek
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christian Pagnoux
- Division of Rheumatology, Vasculitis Clinic, Mount Sinai Hospital, University Health Network, Toronto, ON, Canada
| | - David R.W. Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Michael Walsh
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Nielsen AH, Kaldan G, Gade LM, Egerod I. Postextubation dysphagia management in Danish intensive care units: A national survey. Acta Anaesthesiol Scand 2024; 68:949-955. [PMID: 38719567 DOI: 10.1111/aas.14438] [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: 02/05/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. METHODS Self-reported, cross-sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. RESULTS Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio-oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under-recognition of dysphagia as a health issue, and lack of standardized protocols. CONCLUSION Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Gudrun Kaldan
- Research Unit 98A52, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen O, Denmark
| | - Lotte Madsen Gade
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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Wtorek P, Weiss MJ, Singh JM, Hrymak C, Chochinov A, Grunau B, Paunovic B, Shemie SD, Lalani J, Piggott B, Stempien J, Archambault P, Seleseh P, Fowler R, Leeies M. Beliefs of physician directors on the management of devastating brain injuries at the Canadian emergency department and intensive care unit interface: a national site-level survey. Can J Anaesth 2024; 71:1145-1153. [PMID: 38570415 PMCID: PMC11269388 DOI: 10.1007/s12630-024-02749-7] [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: 06/04/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI. METHODS We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians. RESULTS Of 303 eligible respondents, we received 98 (32%) completed surveys (EM physician directors, 46; CCM physician directors, 52). Most physician directors reported participating in the decision to withdraw life-sustaining measures (WLSM) for patients with DBI in the ED (80%, n = 78), but 63% of these (n = 62) said this was infrequent. Physician directors reported that existing neuroprognostication methods are rarely sufficient to support WLSM in the ED (49%, n = 48) and believed that an ICU stay is required to improve confidence (99%, n = 97). Most (96%, n = 94) felt that providing caregiver visitation time prior to WLSM was a valid reason for ICU admission. CONCLUSION In our survey of Canadian EM and CCM physician directors, 80% participated in WLSM in the ED for patients with DBI. Despite this, most supported ICU admission to optimize neuroprognostication and patient-centred end-of-life care, including organ donation.
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Affiliation(s)
- Piotr Wtorek
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, JJ399-820 Sherbrook St., Ann Thomas Building, Winnipeg, MB, R3A 1R9, Canada.
| | - Matthew J Weiss
- Transplant Québec, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Quebec City, QC, Canada
| | - Jeffrey M Singh
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carmen Hrymak
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Alecs Chochinov
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Grunau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bojan Paunovic
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | | | | | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Patrick Archambault
- Department of Anesthesiology and Critical Care, Université Laval, Laval, QC, Canada
| | - Parisa Seleseh
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - Murdoch Leeies
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, MB, Canada
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Krewulak KD, Sheikh F, Heirali A, Marshall JC, Burns KEA, Kupsch S, Maratta C, Murthy S, O'Hearn K, Russell K, Mehta S, Fiest K. Core socioDemographic data variables in ICU Trials (CoDe-IT): a protocol for generating core data variables using a Delphi consensus process. BMJ Open 2024; 14:e082912. [PMID: 39043595 PMCID: PMC11268068 DOI: 10.1136/bmjopen-2023-082912] [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: 12/06/2023] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Sociodemographic variables influence health outcomes, either directly (ie, gender identity) or indirectly (eg, structural/systemic racism based on ethnoracial group). Identification of how sociodemographic variables can impact the health of critically ill adults is important to guide care and research design for this population. However, despite the growing recognition of the importance of collecting sociodemographic measures that influence health outcomes, insufficient and inconsistent data collection of sociodemographic variables persists in critical care studies. We aim to develop a set of core data variables (CoDaV) for social determinants of health specific to studies involving critically ill adults. METHODS AND ANALYSIS We will conduct a scoping review to generate a list of possible sociodemographic measures to be used for round 1 of the modified Delphi processes. We will engage relevant knowledge users (previous intensive care unit patients and family members, critical care researchers, critical care clinicians and research co-ordinators) to participate in the modified Delphi consensus survey to identify the CoDaV. A final consensus meeting will be held with knowledge user representatives to discuss the final CoDaV, how each sociodemographic variable will be collected (eg, level of granularity) and how to disseminate the CoDaV for use in critical care studies. ETHICS AND DISSEMINATION The University of Calgary conjoint health research ethics board has approved this study protocol (REB22-1648).
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Fatima Sheikh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alya Heirali
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Scotty Kupsch
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Christina Maratta
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Srinivas Murthy
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kristine Russell
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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11
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Tworek KB, Ma CH, Opgenorth D, Baig N, Zampieri FG, Basmaji J, Rochwerg B, Lewis K, Kilcommons S, Mehta S, Honarmand K, Stelfox HT, Wilcox ME, Kutsogiannis DJ, Fiest KM, Karvellas CJ, Sligl W, Rewa O, Senaratne J, Sharif S, Bagshaw SM, Lau VI. Nonsteroidal anti-inflammatory drugs for analgesia in intensive care units: a survey of Canadian critical care physicians. Can J Anaesth 2024:10.1007/s12630-024-02800-7. [PMID: 39042215 DOI: 10.1007/s12630-024-02800-7] [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: 07/05/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Opioids remain the mainstay of analgesia for critically ill patients, but its exposure is associated with negative effects including persistent use after discharge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be an effective alternative to opioids with fewer adverse effects. We aimed to describe beliefs and attitudes towards the use of NSAIDs in adult intensive care units (ICUs). METHODS Our survey of Canadian ICU physicians was conducted using a web-based platform and distributed through the Canadian Critical Care Society (CCCS) email distribution list. We used previously described survey development methodology including question generation and reduction, pretesting, and clinical sensibility and pilot testing. RESULTS We received 115 completed surveys from 321 CCCS members (36%). Nonsteroidal anti-inflammatory drugs use was most described as "rarely" (59 respondents, 51%) with the primary concern being adverse events (acute kidney injury [108 respondents, 94%] and gastrointestinal bleeding [92 respondents, 80%]). The primary preferred analgesic was acetaminophen (75 respondents, 65%) followed by opioids (40 respondents, 35%). Most respondents (91 respondents, 80%) would be willing to participate in a randomized controlled trial examining NSAID use in critical care. CONCLUSIONS In our survey, Canadian critical care physicians did not mention commonly using NSAIDs primarily because of concerns about adverse events. Nevertheless, respondents were interested in further studying ketorolac, a commonly used NSAID outside of the ICU, in critically ill patients.
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Affiliation(s)
- Kimberly B Tworek
- Alberta Health Services, Edmonton, AB, Canada.
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
| | - Chen-Hsiang Ma
- Alberta Health Services, Edmonton, AB, Canada
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dawn Opgenorth
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
| | - Nadia Baig
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Fernando G Zampieri
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence & Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence & Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Sangeeta Mehta
- Sinai Health System, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Mackenzie Health, Vaughan, ON, Canada
| | - H Tom Stelfox
- Sinai Health System, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, University Health Network, Toronto, ON, Canada
| | - Demetrios J Kutsogiannis
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kirsten M Fiest
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Constantine J Karvellas
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Wendy Sligl
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Oleksa Rewa
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Janek Senaratne
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sameer Sharif
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sean M Bagshaw
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Vincent I Lau
- Alberta Health Services, Edmonton, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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12
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Lilly K, Walsh AL, Foreman R, Moran C, Taylor J. Communicating about sexual activity and intimacy after a heart attack: a cross-sectional survey of Australian health professionals. Eur J Cardiovasc Nurs 2024; 23:478-485. [PMID: 38170837 DOI: 10.1093/eurjcn/zvad110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
AIMS Sexual activity and intimacy improve quality of life for heart attack survivors. After a heart attack, patients frequently experience sexual dysfunction and anxiety about resuming sexual activity. However, most health professionals do not discuss sex or intimacy with their patients. The aim of this research was to explore the perceptions and practices of Australian health professionals in discussing sexual activity and intimacy with heart attack survivors and the barriers to achieving this. METHODS AND RESULTS This study employed a cross-sectional study design and online self-administered survey questionnaire. Study participants were a convenience sample of Australian health professionals working with cardiac patients, including general practitioners, cardiologists, cardiac rehabilitation specialists, registered nurses, and allied health professionals. Data were analysed using descriptive statistics and cross-tabulations to understand the different perspectives of health professional groups and the overall sample. Of 252 respondents, almost all believed discussing sex and intimacy with heart attack survivors was important, yet less than a quarter reported regularly doing so. About three-quarters reported feeling comfortable discussing sex and intimacy with either men or women, with half comfortable to do so with patients from diverse cultures. Barriers included lack of time, privacy, consumer resources, and protocols to guide discussions. CONCLUSION This research supports the need for structural changes such as a clinical protocol, longer and more private consultations, staff training, and culturally appropriate patient-oriented resources to support health professionals to guide discussions about sexual activity and intimacy with patients who have had a heart attack.
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Affiliation(s)
- Kara Lilly
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Anthony Leo Walsh
- School of Exercise and Nutrition Sciences, Faculty of Health, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Rachelle Foreman
- Brisbane North Primary Health Network, Lutwyche, Queensland, Australia
| | - Claire Moran
- True Relationships and Reproductive Health (Family Planning Queensland), Windsor, Queensland, Australia
| | - Jane Taylor
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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13
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Staibano P, McKechnie T, Thabane A, Xie M, Zhang H, Gupta MK, Au M, Pasternak JD, Parpia S, Young JEM, Bhandari M. Trends in using intraoperative parathyroid hormone monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons. PLoS One 2024; 19:e0301153. [PMID: 38980868 PMCID: PMC11233005 DOI: 10.1371/journal.pone.0301153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024] Open
Abstract
Hyperparathyroidism is a common endocrine disorder that occurs secondary to abnormal parathyroid gland functioning. Depending on the type of hyperparathyroidism, surgical extirpation of hyperfunctioning parathyroid glands can be considered for disease cure. Intraoperative parathyroid hormone (IOPTH) monitoring improves outcomes in patients undergoing surgery for primary hyperparathyroidism, but studies are needed to characterize its institutional adoption and its role in surgery for secondary and tertiary hyperparathyroidism, as these entities can be difficult to cure. Hence, we will perform a cross-sectional survey study of surgeon rationale, operational details, and barriers associated with IOPTH monitoring adoption across North America. We will utilize a convenience sampling technique to distribute an online survey to head and neck surgeons and endocrine surgeons across North America. This survey will be distributed via email to three North American professional societies (i.e., Canadian Society for Otolaryngologists-Head and Neck Surgeons, American Head and Neck Society, and American Association of Endocrine Surgeons). The survey will consist of 30 multiple choice questions that are divided into three concepts: (1) participant demographics and training details, (2) details of surgical adjuncts during parathyroidectomy, and (3) barriers to adoption of IOPTH. Descriptive analyses and multiple logistic regression will be used to evaluate the impact of demographic, institutional, and training variables on the use of IOPTH monitoring in surgery for all types of hyperparathyroidism and barriers to IOPTH monitoring adoption. Ethics approval was obtained by the Hamilton Integrated Research Ethics Board (2024-17173-GRA). These findings will characterize surgeon and institutional practices with regards to IOPTH monitoring during parathyroid surgery and will inform future trials aimed to optimize the use of IOPTH monitoring in secondary and tertiary hyperparathyroidism.
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Affiliation(s)
- Phillip Staibano
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Xie
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Han Zhang
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael K. Gupta
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Au
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jesse D. Pasternak
- Endocrine Surgery Section Head, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - James Edward Massey Young
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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14
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Got Y, Borotikar B, Sandillon-Garétier C, Le Coat A, Dulou R, Garétier M. Use of Instant Messaging Applications by General Practitioners During Overseas Deployment: A Survey of the French Military Health Service. Mil Med 2024; 189:e1745-e1752. [PMID: 38079462 DOI: 10.1093/milmed/usad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Instant messaging applications (MAs) represent a major component of modern telecommunications for data transmission. During overseas deployments, military doctors increasingly rely on MAs due to their availability and the urgent need to obtain advice from specialists for optimal patient management. In this study, we aimed to describe and analyze the context and usage characteristics of these MAs for transmitting medical data by military general practitioners (GPs) during overseas missions. MATERIALS AND METHODS This observational study was conducted between June 2020 and December 2020, based on a survey sent to GPs from the French Military Health Service who had been deployed overseas in military operations between 2010 and 2020. RESULTS We received 233 surveys of which 215 were analyzed. Among these, 141 military GPs used instant MAs to transmit medical data during deployment. Notably, WhatsApp was used by 97% of the participants. The military GPs mainly used these applications for the speed of exchanges (45%) and their ease of use (28%). The physician specialties predominantly involved in data sharing were trauma and orthopedic surgery (38%) and dermatology (31%). The correspondents were mainly military specialist physicians from French military teaching hospitals (85%). A response time of less than 1 h was reported in 78% of the cases. Additionally, 72 doctors (51%) undertook their last deployment in an isolated post. CONCLUSION MAs were extensively utilized communication tools among GPs during their overseas deployments. Although the use of these applications seems essential in telemedicine, it raises several legal and ethical questions. Thus, we recommend employing these tools while ensuring medical and military confidentiality.
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Affiliation(s)
- Yannis Got
- Val-de-Grâce Military Medical Academy, Paris 75005, France
- 53e AM-4e CMA, Epinal 55400, France
| | - Bhushan Borotikar
- Symbiosis Centre for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra 412115, India
| | | | - Anne Le Coat
- Emergency Department, Military Teaching Hospital Clermont-Tonnerre, Brest 29240, France
| | - Renaud Dulou
- Val-de-Grâce Military Medical Academy, Paris 75005, France
- Military Teaching Hospital Percy, Clamart 92140, France
| | - Marc Garétier
- Radiology Department, Military Teaching Hospital Clermont-Tonnerre, Brest 29240, France
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15
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Cook D, Taneja S, Krewulak K, Zytaruk N, Menon K, Fowler R, Lamontagne F, Kho ME, Rochwerg B, Masse MH, Lauzier F, O'Hearn K, Adhikari NKJ, Burns KEA, Bosma KJ, English S, McNally D, Turgeon AF, Brochard L, Parker M, Clayton L, Rishu A, Tuttle A, Daneman N, Fergusson D, McIntyre L, Kelly L, Orr S, Austin P, Mulligan S, Fiest K. Barriers, Solutions, and Opportunities for Adapting Critical Care Clinical Trials in the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2420458. [PMID: 38995645 PMCID: PMC11245722 DOI: 10.1001/jamanetworkopen.2024.20458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Importance The COVID-19 pandemic created unprecedented challenges for clinical trials worldwide, threatening premature closure and trial integrity. Every phase of research operations was affected, often requiring modifications to protocol design and implementation. Objectives To identify the barriers, solutions, and opportunities associated with continuing critical care trials that were interrupted during the pandemic, and to generate suggestions for future trials. Design, Setting, and Participants This mixed-methods study performed an explanatory sequential analysis involving a self-administered electronic survey and focus groups of principal investigators (PIs) and project coordinators (PCs) conducting adult and pediatric individual-patient randomized trials of the Canadian Critical Care Trials Group during the COVID-19 pandemic. Eligible trials were actively enrolling patients on March 11, 2020. Data were analyzed between September 2023 and January 2024. Main Outcomes and Measures Importance ratings of barriers to trial conduct and completion, solutions employed, opportunities arising, and suggested strategies for future trials. Quantitative data examining barriers were analyzed using descriptive statistics. Data addressing solutions, opportunities, and suggestions were analyzed by qualitative content analysis. Integration involved triangulation of data sources and perspectives about 13 trials, synthesized by an interprofessional team incorporating reflexivity and member-checking. Results A total of 13 trials run by 29 PIs and PCs (100% participation rate) were included. The highest-rated barriers (on a 5-point scale) to ongoing conduct during the pandemic were decisions to pause all clinical research (mean [SD] score, 4.7 [0.8]), focus on COVID-19 studies (mean [SD] score, 4.6 [0.8]), and restricted family presence in hospitals (mean [SD] score, 4.1 [0.8]). Suggestions to enable trial progress and completion included providing scientific leadership, implementing technology for communication and data management, facilitating the informed consent process, adapting the protocol as necessary, fostering site engagement, initiating new sites, streamlining ethics and contract review, and designing nested studies. The pandemic necessitated new funding opportunities to sustain trial enrollment. It increased public awareness of critical illness and the importance of randomized trial evidence. Conclusions and Relevance While underscoring the vital role of research in society and drawing the scientific community together with a common purpose, the pandemic signaled the need for innovation to ensure the rigor and completion of ongoing trials. Lessons learned to optimize research procedures will help to ensure a vibrant clinical trials enterprise in the future.
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Affiliation(s)
- Deborah Cook
- Departments of Medicine, Health Research Evidence & Impact, McMaster University, Hamilton, Canada
| | - Shipra Taneja
- Department of Health Research Evidence & Impact, McMaster University, Hamilton, Canada
| | - Karla Krewulak
- Department of Critical Care, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Zytaruk
- Department of Health Research Evidence & Impact, McMaster University, Hamilton, Canada
| | - Kusum Menon
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Rob Fowler
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | | | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Bram Rochwerg
- Departments of Medicine, Health Research Evidence & Impact, McMaster University, Hamilton, Canada
| | - Marie-Hélène Masse
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - François Lauzier
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Katie O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Keenan Research Center, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario
| | - Karen J Bosma
- Department of Medicine, Division of Critical Care Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Shane English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Canada and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dayre McNally
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
- Keenan Research Center, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario
| | - Melissa Parker
- Departments of Pediatrics and Emergency Medicine, McMaster University, Hamilton, Canada
| | - Lucy Clayton
- CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Asgar Rishu
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Angie Tuttle
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | | | - Sherrie Orr
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Peggy Austin
- Departments of Medicine, Health Research Evidence & Impact, McMaster University, Hamilton, Canada
| | - Sorcha Mulligan
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Kirsten Fiest
- Department of Critical Care, University of Calgary, Calgary, Alberta, Canada
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16
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Carver A, Scaggion A, Jurado-Bruggeman D, Blanck O, Dalqvist E, Romana Giglioli F, Jenko A, Karlsson K, Staykova V, Swinnnen A, Warren S, Mancosu P, Jornet N. Treatment planning and delivery practice of lung SBRT: Results of the 2022 ESTRO physics survey. Radiother Oncol 2024; 196:110318. [PMID: 38702015 DOI: 10.1016/j.radonc.2024.110318] [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: 11/20/2023] [Revised: 03/18/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE The use of Stereotactic Body Radiation Therapy (SBRT) in lung cancer is increasing. However, there is no consensus on the most appropriate treatment planning and delivery practice for lung SBRT. To gauge the range of practice, quantify its variability and identify where consensus might be achieved, ESTRO surveyed the medical physics community. MATERIALS AND METHODS An online survey was distributed to ESTRO's physicist membership in 2022, covering experience, dose and fractionation, target delineation, dose calculation and planning practice, imaging protocols, and quality assurance. RESULTS Two-hundred and forty-four unique answers were collected after data cleaning. Most respondents were from Europe the majority of which had more than 5 years' experience in SBRT. The large majority of respondents deliver lung SBRT with the VMAT technique on C-arm Linear Accelerators (Linacs) employing daily pre-treatment CBCT imaging. A broad spectrum of fractionation schemes were reported, alongside an equally wide range of dose prescription protocols. A clear preference was noted for prescribing to 95% or greater of the PTV. Several issues emerged regarding the dose calculation algorithm: 22% did not state it while 24% neglected to specify the conditions under which the dose was calculated. Contouring was usually performed on Maximum or Average Intensity Projection images while dose was mainly computed on the latter. No clear indications emerged for plan homogeneity, complexity, and conformity assessment. Approximately 40% of the responders participated in inter-centre credentialing of SBRT in the last five years. Substantial differences emerged between high and low experience centres, with the latter employing less accurate algorithms and older equipment. CONCLUSION The survey revealed an evident heterogeneity in numerous aspects of the clinical implementation of lung SBRT treatments. International guidelines and codes of practice might promote harmonisation.
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Affiliation(s)
- Antony Carver
- University Hospitals Birmingham NHS Foundation Trust, Department of Medical Physics, Birmingham, United Kingdom
| | - Alessandro Scaggion
- Medical Physics Department, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Diego Jurado-Bruggeman
- Institut Català d'Oncologia, Medical Physics and Radiation Protection Department, Girona, Spain
| | - Oliver Blanck
- University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel, Germany
| | - Emmy Dalqvist
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | | | - Aljasa Jenko
- Institute of Oncology Ljubljana, Department of Radiotherapy, Ljubljana, Slovenia
| | - Kristin Karlsson
- Karolinska University Hospital, Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden; KarolinskaInstitutet, Department of Oncology-Pathology, Stockholm, Sweden
| | - Vanya Staykova
- Guy's and St Thomas' NHS Foundation Trust, Radiotherapy Physics, London, United Kingdom
| | - Ans Swinnnen
- GROW School for Oncology, Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Samantha Warren
- Northern Centre for Cancer Care, Freeman Hospital, Department of Medical Physics, Newcastle Upon Tyne, United Kingdom
| | - Pietro Mancosu
- IRCCS Humanitas Research Hospital, Medical Physics Unit, Department of Radiotherapy and Radiosurgery, Rozzano-Milan, Italy.
| | - Nuria Jornet
- Hospital de la Santa Creu i Sant Pau, Servei de Radiofísica i Radioprotecció, Barcelona, Spain
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Mahmoud HA, Mulpuru S, Thavorn K, McIsaac D, Forster AJ. Development of a survey to support assessment of safety learning systems. BMJ Open Qual 2024; 13:e002738. [PMID: 38926135 PMCID: PMC11216063 DOI: 10.1136/bmjoq-2023-002738] [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: 12/29/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Patient safety learning systems play a critical role in supporting safety culture in healthcare organisations. A lack of explicit standards leads to inconsistent implementation across organisations, causing uncertainty about their roles and impact. Organisations can address inconsistent implementation by using a self-assessment tool based on agreed-on best practices. Therefore, we aimed to create a survey instrument to assess an organisation's approach to learning from safety events. METHODS The foundation for this work was a recent systematic review that defined features associated with the performance of a safety learning system. We organised features into themes and rephrased them into questions (items). Face validity was checked, which included independent pre-testing to ensure comprehensibility and parsimony. It also included clinical sensibility testing in which a representative sample of leaders in quality at a large teaching hospital (The Ottawa Hospital) answered two questions to judge each item for clarity and necessity. If more than 20% of respondents judged a question unclear or unnecessary, we modified or removed that question accordingly. Finally, we checked the internal consistency of the questionnaire using Cronbach's alpha. RESULTS We initially developed a 47-item questionnaire based on a prior systematic review. Pre-testing resulted in the modification of 15 of the questions, 2 were removed and 2 questions were added to ensure comprehensiveness and relevance. Face validity was assessed through yes/no responses, with over 80% of respondents confirming the clarity and 85% the necessity of each question, leading to the retention of all 47 questions. Data collected from the five-point responses (strongly disagree to strongly agree) for each question were used to assess the questionnaire's internal consistency. The Cronbach's alpha was 0.94, indicating a high internal consistency. CONCLUSION This self-assessment questionnaire is evidence-based and on preliminary testing is deemed valid, comprehensible and reliable. Future work should assess the range of survey responses in a large sample of respondents from different hospitals.
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Affiliation(s)
- Hassan Assem Mahmoud
- Public Health, Canadian Red Cross, Ottawa, Ontario, Canada
- Epidemiology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel McIsaac
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan J Forster
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Ma K, Rahimi A, Rajagopal M, Yaskina M, Goldman RD, Jones A, Erickson T, Poonai N, McGahern C, Weingarten L, Lerman B, Auclair MC, Wong H, Hartling L, Schreiner K, Scott S, Ali S. A national survey of children's experiences and needs when attending Canadian pediatric emergency departments. PLoS One 2024; 19:e0305562. [PMID: 38917134 PMCID: PMC11198794 DOI: 10.1371/journal.pone.0305562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Optimizing a child's emergency department (ED) experience positively impacts their memories and future healthcare interactions. Our objectives were to describe children's perspectives of their needs and experiences during their ED visit and relate this to their understanding of their condition. METHODS 514 children, aged 7-17 years, and their caregivers presenting to 10 Canadian pediatric EDs completed a descriptive cross-sectional survey from 2018-2020. RESULTS Median child age was 12.0 years (IQR 9.0-14.0); 56.5% (290/513) were female. 78.8% (398/505) reported adequate privacy during healthcare conversations and 78.3% (395/504) during examination. 69.5% (348/501) understood their diagnosis, 89.4% (355/397) the rationale for performed tests, and 67.2% (338/503) their treatment plan. Children felt well taken care of by nurses (90.9%, 457/503) and doctors (90.8%, 444/489). Overall, 94.8% (475/501) of children were happy with their ED visit. Predictors of a child better understanding their diagnosis included doctors talking directly to them (OR 2.21 [1.15, 4.28]), having someone answer questions and worries (OR 2.51 [1.26, 5.01]), and older age (OR 1.08 [1.01, 1.16]). Direct communication with a doctor (OR 2.08 [1.09, 3.99]) was associated with children better understanding their treatment, while greater fear/ 'being scared' at baseline (OR 0.59 [0.39, 0.89]) or at discharge (OR 0.46 [0.22, 0.96]) had the opposite effect. INTERPRETATION While almost all children felt well taken care of and were happy with their visit, close to 1/3 did not understand their diagnosis or its management. Children's reported satisfaction in the ED should not be equated with understanding of their medical condition. Further, caution should be employed in using caregiver satisfaction as a proxy for children's satisfaction with their ED visit, as caregiver satisfaction is highly linked to having their own needs being met.
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Affiliation(s)
- Keon Ma
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Asa Rahimi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Maryna Yaskina
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
| | - Ran D. Goldman
- Department of Pediatrics, University of British Columbia and BC Children’s Hospital Research Institute, Division of Emergency Medicine, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Vancouver, BC, Canada
| | - Ashley Jones
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Tannis Erickson
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Naveen Poonai
- Departments of Paediatrics, Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Candice McGahern
- Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Laura Weingarten
- Division of Pediatric Emergency Medicine, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Bethany Lerman
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kurt Schreiner
- Pediatric Emergency: Advancing Knowledge (PEAK) Research Team, University of Alberta, Edmonton, AB, Canada
| | - Shannon Scott
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
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Terrett LA, McIntyre L, O'Kelly C, Ramsay T, Turgeon AF, English SW. Blood Pressure Management in Early Aneurysmal Subarachnoid Hemorrhage: A National Cross-Sectional Survey of Canadian Intensivists and Cerebrovascular Neurosurgeons. Neurocrit Care 2024:10.1007/s12028-024-02011-4. [PMID: 38862709 DOI: 10.1007/s12028-024-02011-4] [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: 01/29/2024] [Accepted: 05/09/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND In aneurysmal subarachnoid hemorrhage (aSAH), rebleeding of the culprit aneurysm is associated with significant morbidity and mortality. Blood pressure reduction to specific target levels, with the goal of preventing rebleeding, has been a mainstay of care prior to definitively securing the aneurysm. Clinical practice guidelines have recently changed and no longer recommend specific blood pressure targets. This survey aims to identify the reported practice patterns and beliefs regarding blood pressure management during the early phase of aSAH. METHODS We conducted a self-administered, Web-based survey of critical care physicians and cerebrovascular neurosurgeons practicing in Canada. The questionnaire contained 21 items, including 3 case-based scenarios to elicit blood pressure target selection, both before and after aneurysm securing. RESULTS In the presecured period, systolic blood pressures of 160 mm Hg (50% [144 of 287]) and 140 mm Hg (42% [120 of 287]) were the most frequently selected upper-limit targets. In the postsecured period, a systolic blood pressure of 180 mm Hg (32% [93 of 287]) was the most frequently selected upper-limit target, but there was a wide distribution of targets selected across all three cases ranging from 100 to > 200 mm Hg. A mean arterial pressure of 65 mm Hg was the most common lower-limit target in both the presecured and postsecured periods. There was little change in blood pressure targets with increasing clinical severity. Predictors of higher or lower blood pressure target selection and barriers to implementation of the desired target were identified. CONCLUSIONS During the presecured period, nearly half of the reported upper-limit blood pressure targets are lower than previous guideline recommendations. These targets remain consistent despite increasing clinical severity and could potentially exacerbate cerebral ischemia and negatively impact clinical outcomes. In the postsecured period, there is wide variation in the reported blood pressure targets. A clinical trial is urgently needed to guide decision-making.
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Affiliation(s)
- Luke A Terrett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
- Department of Adult Critical Care, Saskatchewan Health Authority, 103 Hospital Drive, Saskatoon, SK, S7N0W8, Canada.
| | - Lauralyn McIntyre
- Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Cian O'Kelly
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Tim Ramsay
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Unit, Centre Hospitalier Universitaire de Québec - Université Laval Research Center, Quebec City, QC, Canada
| | - Shane W English
- Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
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Usberg G, Clari M, Conti A, Põld M, Kalda R, Kangasniemi M. COVID-19 and nurses' ethical issues: Comparisons between two European countries. Nurs Ethics 2024:9697330241255936. [PMID: 38835232 DOI: 10.1177/09697330241255936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND The global pandemic raised ethical issues for nurses about caring for all patients, not just those with COVID-19. Italy was the first European country to be seriously affected by the first wave, while Estonia's infection and death rates were among the lowest in Europe. Did this raise different ethical issues for nurses in these two countries as well? AIM The aim was to describe and compare ethical issues between nurses working during the first wave of the COVID-19 pandemic in Estonia and Italy. RESEARCH DESIGN A cross-sectional survey study with a self-administered questionnaire. The impact of COVID-19 emergency on nursing care questionnaire was used. PARTICIPANTS AND RESEARCH CONTEXT Convenience sampling was used to recruit 1098 nurses working during the first wave of the pandemic in 2020: 162 from Estonia and 936 from Italy. ETHICAL CONSIDERATIONS Research ethics approvals were obtained, and the nurses provided informed consent. RESULTS The most frequent ethical issues for Estonian nurses were professional communication and ensuring access to care for patients without COVID-19, and for Italian nurses, the end-of-life care and the risk of them getting the virus and transmitting it to their loved ones. There were no statistically significant differences in the frequency of ethical issues between Estonian nurses working with patients with and without COVID-19. Italian nurses caring for COVID-19 patients faced statistically significantly more (both p < .001) issues around prioritising patients and end-of-life. Nurses working with patients without COVID-19 in Italy faced more issues about access to care (p < .001). CONCLUSIONS Estonian and Italian nurses, working in different clinical contexts during the first wave of the pandemic, faced different ethical issues. Local contextual aspects need to be considered to support nurses' ethical decision-making in providing care during future crises and to ensure ethical care for patients.
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21
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Lewis KO, Kilbride HW, Bose C, Burchfield DJ. Fundamentals of designing high-quality surveys: revisiting neonatal perinatal medicine survey applications. J Perinatol 2024; 44:777-784. [PMID: 37863984 DOI: 10.1038/s41372-023-01801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
Surveys in neonatal perinatal medicine are practical instruments for gathering information about medical practices, and outcomes related to the care of newborns and infants. This includes research for identifying needs, assessing requirements, analyzing the effects of change, creating policies, and developing curriculum initiatives. Surveys also provide useful data for enhancing the provision of healthcare services, assessing medical specialties, and evaluating training programs. However, creating a high-quality survey can be difficult for many practitioners, particularly when deciding how to formulate the right questions, whether to utilize various types of questions and how best to arrange or format the survey tool for effective responses. Problems with design principles have been evident in many surveys submitted for dissemination to the members of the Section of Neonatal Perinatal Medicine (SoNPM). To prevent potential measurement errors and increase the quality of surveys, it is crucial to follow a systematic approach in developing surveys by adhering to the principles of effective survey design. This review article provides a brief summary of survey use within the SoNPM, and offers guidance for creating high-quality surveys, including identifying important factors to consider in survey development and characteristics of well-written and effective questions. We briefly note techniques that optimize survey design for distribution through digital media.
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Affiliation(s)
- Kadriye O Lewis
- Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Howard W Kilbride
- Children's Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Carl Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Meade MJ, Weir T, Seehra J, Fleming PS. Clear aligner therapy practice among orthodontists in the United Kingdom and the Republic of Ireland: A cross-sectional survey of the British Orthodontic Society membership. J Orthod 2024; 51:120-129. [PMID: 37830274 PMCID: PMC11141077 DOI: 10.1177/14653125231204889] [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: 02/03/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS). DESIGN A cross-sectional online survey. METHODS An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems. RESULTS Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy. CONCLUSION CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.
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Affiliation(s)
- Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, SA, Australia
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental School, Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, SA, Australia
| | - Jadbinder Seehra
- Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - Padhraig S Fleming
- Division of Public and Child Dental Health, Dublin Dental University Hospital, Dublin, Ireland
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23
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Dilawri A, Muir J, Brodie D, Abrams D, Agerstrand C, Madahar P, Dzierba AL. Practices surrounding antimicrobial use in patients managed with extracorporeal membrane oxygenation: An international survey. J Crit Care 2024; 81:154534. [PMID: 38367526 DOI: 10.1016/j.jcrc.2024.154534] [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: 11/14/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE This study aimed to survey critical care clinicians and characterize their perception of antimicrobial dosing strategies in patients receiving extracorporeal membrane oxygenation (ECMO). METHODS International, cross-sectional survey distributed to members of the Society of Critical Care Medicine in October 2022. RESULTS Respondents were primarily physicians (45%), with 92% practicing in North America. Ninety-seven percent of respondents reported antimicrobial dosing in critically ill patients to be challenging, due to physiological derangements seen in the patient population. Eighty-seven percent reported consideration of physicochemical drug properties when dosing antimicrobials in ECMO-supported patients, with lipophilicity (83%) and degree of protein binding (74%) being the two most common. Respondents' approach to antimicrobial dosing strategies did not significantly differ in critically ill ECMO-supported patients, compared to patients with equal severity of illness not receiving ECMO support. CONCLUSION Approaches to antimicrobial dosing strategies do not significantly differ among respondents between critically ill patients on ECMO support, compared to patients with equal severity of illness not receiving ECMO support. These findings were unexpected considering the added physiologic complexity of the ECMO circuit to critically ill adult patients and the need for well designed and adequately powered studies to inform empiric dosing guidance for ECMO-supported patients.
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Affiliation(s)
- Atul Dilawri
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Justin Muir
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Daniel Brodie
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Cara Agerstrand
- Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Purnema Madahar
- Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Amy L Dzierba
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, United States of America; Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, NY, United States of America.
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24
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Lockhart-Bouron M, Vanel N, Levy M, Briant AR, Javouhey E, Breinig S, Dina J, Caseris M, Angoulvant F, Leteurtre S, Recher M, Brossier DW. Severe acute respiratory syndrome coronavirus-2-related and imputable deaths in children: results from the French pediatric national registry. World J Pediatr 2024; 20:611-620. [PMID: 38506979 DOI: 10.1007/s12519-023-00791-x] [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: 08/14/2023] [Accepted: 12/14/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death. METHODS This national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories. RESULTS There were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome. CONCLUSIONS SARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.
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Affiliation(s)
- Marguerite Lockhart-Bouron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Noémie Vanel
- Pediatric Intensive Care Unit, CHU de Marseille, Marseille, France
| | - Michael Levy
- Pediatric Intensive Care Unit, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Anaïs R Briant
- Biostatistics and Clinical Research Unit, CHU de Caen Normandie, 14000, Caen, France
| | | | - Sophie Breinig
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Toulouse, France
| | - Julia Dina
- Virology Department, INSERM U1311 Dynamicure, Univ CAEN Normandie, CHU de Caen, 14000, Caen, France
- Medical School, Université Caen Normandie, 14000, Caen, France
| | - Marion Caseris
- Department of Pediatrics, CHU Robert-Debré, Assistance Publique Hôpitaux de Paris, Paris, France
| | - François Angoulvant
- Department Women-Mother-Child, Service of Pediatrics, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stéphane Leteurtre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Morgan Recher
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - David W Brossier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
- Medical School, Université Caen Normandie, 14000, Caen, France.
- Pediatric Intensive Care Unit, Réanimation Et Soins Intensifs Pédiatriques, CHU de CAEN, Avenue de La Côte de Nacre, 14000, Caen, France.
- CHU Sainte Justine Research Center, Montréal, Canada.
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25
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Lewis BR, Spicer OJ, McLaughlin WS, Moons K. Survey of National Health Service (NHS) orthodontic practitioners in Wales, UK. Part 1: working patterns 2021-2022. J Orthod 2024; 51:137-146. [PMID: 38282526 DOI: 10.1177/14653125231224459] [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: 01/30/2024]
Abstract
OBJECTIVE To ascertain the working patterns of the NHS orthodontic workforce in Wales and any possible future changes. DESIGN Descriptive cross-sectional survey. PARTICIPANTS NHS orthodontic practitioners in Wales. METHODS An anonymised email distributed an electronic two-part survey of the Welsh NHS orthodontic workforce. The survey consisted of three sections: (1) demographic information; (2) respondents' working pattern (part 1); and (3) perceptions of professional satisfaction (part 2). RESULTS Part 1 of the survey yielded a 70.5% response rate (n = 79); 65.8% of the respondents were women. Of the respondents, 45.6% (n = 36) worked full time (F/T), 39.2% (n = 31) worked less than F/T and 15.2% (n = 12) worked more than F/T. Of the male respondents, 81.5% (n = 22) worked 10 sessions or more compared to 50% (n = 26) of women. The respondents undertook 508.5 orthodontic clinical sessions per week within Wales; of these sessions, 87.6% (n = 445.5) delivered NHS orthodontic care. Of the respondents, 8.4% (n = 7) were planning to increase their orthodontic clinical time within the next 2 years, 24.1% (n = 19) were planning to decrease it and 20.3% (n = 16) were unsure. One-quarter of respondents indicated that they were planning to stop clinical orthodontic activity within the next 5 years, including 53.3% (n = 8) of DwSIs, 37% (n = 10) of primary care specialists and 13.3% (n = 2) of consultants. The pandemic was an influencing factor for 80% of these clinicians. CONCLUSIONS Part 1 of the survey suggested that the majority of the orthodontic workforce was female, were working full time or more, and spent most sessions delivering NHS care. One-quarter of respondents were planning to cease undertaking orthodontic activity within the next 5 years.
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Affiliation(s)
- Benjamin Rk Lewis
- Orthodontic Department, Glan Clwyd Hospital, Bodelwyddan, UK
- Orthodontic Depertment, Department 8, Wrexham Maelor Hospital, Wrexham, UK
| | - Olivia J Spicer
- Health Education and Improvement Wales, Nantgarw, Rhondda Cynon Taff, UK
| | | | - Kirstie Moons
- Health Education and Improvement Wales, Nantgarw, Rhondda Cynon Taff, UK
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Azarias E, Thillainadesan J, Hanger C, Scott J, Boudville A, Moran C, O'Sullivan R, Maddison J, Eagar K, Harvey G, King A, Kearney L, Naganathan V. Hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand. Australas J Ageing 2024. [PMID: 38798032 DOI: 10.1111/ajag.13331] [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: 10/17/2023] [Revised: 02/28/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To describe the types of hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand, and to explore head of department (HOD) views on issues in current and future service provision. METHODS An electronic survey was sent to HODs of public geriatric medicine departments. RESULTS Seventy-six (89%) of 85 identified HODs completed the survey. Seventy-one (93%) departments admit inpatients and 51 (67%) admit acute inpatients, with variable admission criteria. Sixty-four (84%) have hospitals with an inpatient general medicine service, and 58 (91%) of these admit older patients with acute geriatric issues. Sixty (79%) departments provide inpatient rehabilitation. Forty (53%) have beds for behavioural symptoms of dementia and/or delirium. Seventy (92%) provide a proactive orthogeriatric service. In terms of out-of-hospital services, 74 (97%) departments have outpatient clinics, 59 (78%) have telehealth and 68 (89%) perform home visits. Forty-five (59%) provide an inreach/outreach service to nursing homes. The most frequent gaps in service provision identified by HODs were acute geriatrics, surgical liaison, a designated dementia/delirium behavioural management unit, geriatricians in Emergency, outreach/inreach to residential care and shared care with some medical specialities. Increasing staff numbers and government policy change were the most frequently identified ways to address these gaps. CONCLUSIONS Geriatric medicine service provision is variable across Australia and New Zealand, with key gaps identified. These findings will inform future directions in implementation of geriatric medicine models of care and discussions with various levels of government about the ongoing development of geriatric medicine services.
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Affiliation(s)
- Eleni Azarias
- The University of Sydney Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - Janani Thillainadesan
- The University of Sydney Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | | | - John Scott
- University of Auckland, Auckland, New Zealand
| | - Amanda Boudville
- St John of God Bunbury Hospital, Bunbury, Western Australia, Australia
| | - Chris Moran
- Monash University, Melbourne, Victoria, Australia
| | | | | | - Kathy Eagar
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Gillian Harvey
- Flinders University, Adelaide, South Australia, Australia
| | - Alison King
- Australian and New Zealand Society for Geriatric Medicine, Sydney, New South Wales, Australia
| | - Leanne Kearney
- The University of Sydney Centre for Education and Research on Ageing, Concord, New South Wales, Australia
| | - Vasi Naganathan
- The University of Sydney Centre for Education and Research on Ageing, Concord, New South Wales, Australia
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Cani E, Tsang JLY, Binnie A, dos Santos CC, Fowler R, Lamontagne F, Mehta S, Liaw PC. Barriers to participation in biosampling-based translational research: A cross-sectional survey of Canadian critical care researchers. PLoS One 2024; 19:e0303304. [PMID: 38758919 PMCID: PMC11101101 DOI: 10.1371/journal.pone.0303304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Collection of biosamples for translational research studies is vital for understanding biological pathways, discovering disease-related biomarkers, and identifying novel therapeutic targets. However, a lack of infrastructure for sample procurement, processing, storage, and shipping may hinder the ability of clinical research units to effectively engage in translational research. The purpose of this study was to identify the barriers to biosampling-based translational research in the critical care setting in Canada. METHODS We administered an online survey to members of the Canadian Critical Care Trials Group (CCCTG), the Canadian Critical Care Translational Biology Group (CCCTBG), and the Canadian Critical Care Research Coordinators Group (CCCRCG). The survey focused on participants' personal experience of biosampling research, research infrastructure, motivating factors, and perceived barriers. RESULTS We received 59 responses from 31 sites, including 6 community intensive care unit (ICU) sites. The overall response rate was 11.3%. The majority of respondents were research coordinators (44%), followed by clinician-investigators (33.8%), graduate students (10.2%), and PhD-investigators (8.5%). Although most (63.8%) respondents reported an interest in participating in translational research, they also reported that their ICUs were currently contributing to a third of the number of translational studies compared to clinical studies. For respondents with experience in participating in translational research studies, the most common barriers were lack of funding, lack of time, and insufficient research staff. For respondents without previous experience, the perceived facilitators were more interest from their research group, improved training/mentorship, increased funding, and better access to laboratory equipment. CONCLUSIONS Our survey found that the majority of participants were interested in and recognize the value of participating in biosampling-based translational research but lacked funding, time, and research personnel trained in biosampling protocols. Our survey also identified factors that might encourage participation at new sites. Addressing these barriers will be a key step towards increasing translational research capacity across Canada.
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Affiliation(s)
- Erblin Cani
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Jennifer L. Y. Tsang
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Alexandra Binnie
- Intensive Care Department, William Osler Health System, Etobicoke, ON, Canada
| | - Claudia C. dos Santos
- Keenan Research Center for Biomedical Research, Unity Health Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care, Temerty School of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Francois Lamontagne
- Intensive Care Department, William Osler Health System, Etobicoke, ON, Canada
- Department of Medicine, Division of Critical Care Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Patricia C. Liaw
- Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Bosch-Donate E, Vico-Moreno E, Fernández-Domínguez JC, González-Trujillo A, Sastre-Munar A, Romero-Franco N. Symptomatology and knowledge regarding pelvic floor dysfunctions and influence of gender stereotypes in female athletes. Sci Rep 2024; 14:11052. [PMID: 38744879 PMCID: PMC11094071 DOI: 10.1038/s41598-024-61464-x] [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: 11/08/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
Pelvic floor dysfunctions (PFD) are highly prevalent among females who do athletics, a sport requiring jumping, strength, and running. Although educational approaches are useful options, the educational need for this particular population remains unknown. The objective of the present study was to describe the level of knowledge regarding PFD and its relationship with symptomatology and gender stereotypes in female athletes in Spain. A total of 255 female athletes completed an anonymous online survey to explore their knowledge regarding urinary incontinence (UI), pelvic organ prolapse (POP), anal incontinence (AI), and sexual dysfunction (SexD), as well as their PFD symptoms and gender stereotyped beliefs related to sport. Educational level and sports characteristics (training volume, experience, and athletic modality) were also explored. Participants demonstrated a low level of knowledge in terms of POP (52.5%), AI (64.0%), and SexD (40%), but not for UI (70.8%). The proportion of PFD complaints was 63.5% for dyspareunia, 51.8% for urine leakage, 42.4% for pelvic pain, 17.3% for AI, and 9.0% for POP, with no associations with knowledge (p > 0.05). Lower knowledge about UI and SexD was related to greater gender stereotypes (p < 0.05) and rejection of professional healthcare (p = 0.010). As a conclusion, the level of knowledge about PFD was low in female athletes who train and compete in athletics in Spain, mainly with regard to sexual dysfunction. Although 63.5% of athletes had dyspareunia and 51.8% urinary leakages, symptomatology was not associated with level of knowledge. However, a lower level of knowledge was associated with more stereotyped beliefs and rejection of professional healthcare for PFD. These findings confirm the need to design appropriate educational interventions to disseminate information on all the types of PFD, particularly sexual contents. The potential influence of gender stereotypes makes it appropriate to include the gender perspective in these interventions.
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Affiliation(s)
- Elisa Bosch-Donate
- Nursing and Physiotherapy Department, University of the Balearic Islands, Crta de Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
| | - Elena Vico-Moreno
- Nursing and Physiotherapy Department, University of the Balearic Islands, Crta de Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
| | - Juan Carlos Fernández-Domínguez
- Nursing and Physiotherapy Department, University of the Balearic Islands, Crta de Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain.
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain.
| | - Antonio González-Trujillo
- Nursing and Physiotherapy Department, University of the Balearic Islands, Crta de Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
| | - Andreu Sastre-Munar
- Nursing and Physiotherapy Department, University of the Balearic Islands, Crta de Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
| | - Natalia Romero-Franco
- Nursing and Physiotherapy Department, University of the Balearic Islands, Crta de Valldemossa, Km 7.5, 07122, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
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Pocock H, Dove A, Pointeer L, Couper K, Perkins GD. Systematic analysis of approaches used in cardiac arrest trials to inform relatives about trial enrolment of non-surviving patients. Emerg Med J 2024:emermed-2023-213648. [PMID: 38729750 DOI: 10.1136/emermed-2023-213648] [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: 09/21/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The recruitment of patients to emergency research studies without the requirement for prior informed consent has furthered the conduct of randomised studies in cardiac arrest. Frameworks enabling this vary around the world depending on local legal or ethical requirements. When an enrolled patient does not survive, researchers may take one of three approaches to inform relatives of their enrolment: a direct (active) approach, providing information indirectly (passively) and inviting relatives to seek further information if they choose, or providing no information about the trial (no attempt). Previous studies have described experiences of US researchers' active approach but there is little known about approaches elsewhere.We aimed to conduct a structured investigation of methods used in cardiac arrest trials to provide information about trial enrolment to relatives of non-surviving patients. METHODS We systematically searched trial registries to identify randomised clinical trials that recruited cardiac arrest patients. Trials were eligible for inclusion if they recruited adults during cardiac arrest (or within 1 hour of return of spontaneous circulation) between 2010 and 2022 (in the decade prior to study conception). We extracted data from trial registries and, where relevant, published papers and protocols. Investigators were contacted and asked to describe the style, rationale and timing of approach to relatives of non-surviving patients. We present descriptive statistics. RESULTS Our trial registry search identified 710 unique trials, of which 108 were eligible for inclusion. We obtained information from investigators for 64 (62%) trials. Approximately equal numbers of trials attempted to actively inform relatives of non-survivors (n=28 (44% (95% CI; 31% to 57%))), or made no attempt (n=25 (39% (95% CI; 27% to 52%))). The remaining studies provided general information about the trial to relatives but did not actively inform them (n=11 (17% (95% CI; 8% to 29%))). CONCLUSIONS There is wide variability in the approach taken to informing relatives of non-surviving patients enrolled in cardiac arrest randomised clinical trials.
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Affiliation(s)
- Helen Pocock
- University of Warwick Medical School, Coventry, UK
- South Central Ambulance Service NHS Foundation Trust, Bicester, Oxfordshire, UK
| | - Abigail Dove
- University of Warwick Medical School, Coventry, UK
| | | | - Keith Couper
- University of Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gavin D Perkins
- University of Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Chapur J, Meckler G, Doan Q, Bone JN, Burstein B, Sabhaney V. National Survey on the Emergency Department Management of Febrile Infants 29 to 60 Days Old With an Abnormal Urinalysis. Pediatr Emerg Care 2024; 40:341-346. [PMID: 37972994 DOI: 10.1097/pec.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Recent clinical practice guidelines recommend that decisions regarding lumbar puncture (LP) for febrile infants older than 28 days should no longer be based on urinalysis results, but rather independently determined by inflammatory markers and sometimes guided by shared decision-making (SDM). This study sought to assess management decisions for febrile infants aged 29 to 60 days with an abnormal urinalysis. METHODS A scenario-based survey was sent to emergency department physicians at all 15 Canadian tertiary pediatric centers. Participants were asked questions regarding management decisions when presented with a well-appearing febrile infant in the second month of life with either an abnormal or normal urinalysis. RESULTS Response rate was 50.2% (n = 116/231). Overall, few respondents would perform an LP based on either an abnormal or normal urinalysis alone (10.3% and 6.0%, respectively). However, regression analysis demonstrated that decisions regarding LP were influenced by urinalysis results ( P < 0.001), with respondents more likely to defer to inflammatory marker results for infants with a normal urinalysis result (57.8%) compared with those with an abnormal urinalysis (28.4%). Hospitalization (62.1%) and empiric antibiotic treatment by intravenous route (87.9%) were both frequent for low-risk infants with an abnormal urinalysis. Nearly half of respondents reported rarely (<25% of encounters) engaging families in SDM regarding LP decisions. CONCLUSIONS Knowledge translation initiatives reflecting current evidence should target use of inflammatory markers rather than urinalysis results to guide decisions regarding LP. Efforts emphasizing outpatient management with oral antibiotics and SDM for low-risk infants with an abnormal urinalysis could also further align management with current evidence and guidelines.
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Affiliation(s)
- Jeronimo Chapur
- From the Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Lee LA, Martin DA, Mahoney M, James L, Avitzur Y, Carroll A, Piggott B, Tomlinson C, Urschel S, Hamiwka L. Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022. Pediatr Crit Care Med 2024; 25:416-424. [PMID: 37966310 PMCID: PMC11060061 DOI: 10.1097/pcc.0000000000003404] [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] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers. DESIGN A cross-sectional survey carried out 2021-2022. SETTING Canadian PICUs affiliated with a donor physician network. SUBJECTS Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution. MEASUREMENTS AND MAIN RESULTS A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units. CONCLUSIONS Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.
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Affiliation(s)
- Laurie A Lee
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Dori-Ann Martin
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meagan Mahoney
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Lee James
- Canadian Blood Services, Ottawa, ON, Canada
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology and Nutrition, SickKids Hospital, Toronto, ON, Canada
| | - Allison Carroll
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Christopher Tomlinson
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Simon Urschel
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Lorraine Hamiwka
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Bencsik CM, Kramer AH, Couillard P, MacKay M, Kromm JA. Postarrest Neuroprognostication: Practices and Opinions of Canadian Physicians. Can J Neurol Sci 2024; 51:404-415. [PMID: 37489539 DOI: 10.1017/cjn.2023.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Objective, evidence-based neuroprognostication of postarrest patients is crucial to avoid inappropriate withdrawal of life-sustaining therapies or prolonged, invasive, and costly therapies that could perpetuate suffering when there is no chance of an acceptable recovery. Postarrest prognostication guidelines exist; however, guideline adherence and practice variability are unknown. OBJECTIVE To investigate Canadian practices and opinions regarding assessment of neurological prognosis in postarrest patients. METHODS An anonymous electronic survey was distributed to physicians who care for adult postarrest patients. RESULTS Of the 134 physicians who responded to the survey, 63% had no institutional protocols for neuroprognostication. While the use of targeted temperature management did not affect the timing of neuroprognostication, an increasing number of clinical findings suggestive of a poor prognosis affected the timing of when physicians were comfortable concluding patients had a poor prognosis. Variability existed in what factors clinicians' thought were confounders. Physicians identified bilaterally absent pupillary light reflexes (85%), bilaterally absent corneal reflexes (80%), and status myoclonus (75%) as useful in determining poor prognosis. Computed tomography, magnetic resonance imaging, and spot electroencephalography were the most useful and accessible tests. Somatosensory evoked potentials were useful, but logistically challenging. Serum biomarkers were unavailable at most centers. Most (79%) physicians agreed ≥2 definitive findings on neurologic exam, electrophysiologic tests, neuroimaging, and/or biomarkers are required to determine a poor prognosis with a high degree of certainty. Distress during the process of neuroprognostication was reported by 70% of physicians and 51% request a second opinion from an external expert. CONCLUSION Significant variability exists in post-cardiac arrest neuroprognostication practices among Canadian physicians.
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Affiliation(s)
- Caralyn M Bencsik
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Andreas H Kramer
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Julie A Kromm
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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McKechnie T, Saddik M, Doumouras A, Eskicioglu C, Parpia S, Bhandari M. PREscribing preoperative weight loss prior to major non-bariatric abdominal surgery for patients with Elevated weight: Patient and Provider Survey Protocols (PREPARE surveys). PLoS One 2024; 19:e0302482. [PMID: 38687754 PMCID: PMC11060585 DOI: 10.1371/journal.pone.0302482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Preoperative very low energy diet (VLED) interventions are used routinely in patients undergoing bariatric surgery, a surgical subspecialty that deals almost exclusively with patients with obesity. Yet, their use and study has been limited in non-bariatric abdominal surgery. To investigate the use of VLEDs in non-bariatric surgery, we plan on conducting a randomized controlled trial (RCT). Prior to proceeding, however, we have designed two surveys as important pre-emptive studies aimed at elucidating patient and provider perspectives regarding these interventions. METHODS The patient survey is a cross-sectional, single-center survey aimed at assessing the safety, adherence, barriers to adherence, and willingness to participate in preoperative optimization protocols with VLEDs prior to undergoing elective non-bariatric intra-abdominal surgery (S1 File). The population of interest is all adult patients with obesity undergoing elective non-bariatric intra-abdominal surgery at St. Joseph's Healthcare Hamilton who were prescribed a course of preoperative VLED. The primary outcomes will be safety and adherence. The target sample size is 35 survey responses. The provider survey is a cross-sectional national survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery aimed assessing the willingness and ability to prescribe preoperative weight loss interventions amongst practicing Canadian surgeons who perform major non-bariatric abdominal surgery (S2 File). The population of interest is independent practicing surgeons in Canada who perform major non-bariatric abdominal surgery. The primary outcome will be willingness to prescribe preoperative VLED to patients with obesity undergoing major non-bariatric abdominal surgery for both benign and malignant indications. The target sample size is 61 survey responses. Descriptive statistics will be used to characterize the sample populations. To determine variables associated with primary outcomes in the surveys, regression analyses will be performed. DISCUSSION These survey data will ultimately inform the design of an RCT evaluating the efficacy of preoperative VLEDs for patients with obesity undergoing major abdominal surgery.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maisa Saddik
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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van Doornik SP, Pijnenburg MBM, Janssen KI, Ren Y, Kuijpers-Jagtman AM. Evaluation of the use of a clinical practice guideline for external apical root resorption among orthodontists. Prog Orthod 2024; 25:15. [PMID: 38644413 PMCID: PMC11033249 DOI: 10.1186/s40510-024-00515-5] [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: 09/25/2023] [Accepted: 03/08/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND External apical root resorption (EARR) is a frequently observed adverse event in patients undergoing fixed appliance therapy. Assessing the patients' risk during treatment is important, as certain factors are assumed to be associated with an increased likelihood of occurrence. However, their predictive value remains limited, making evidence-based clinical decision-making challenging for orthodontists. To address this issue, the Dutch Association of Orthodontists (NvVO) developed a clinical practice guideline (CPG) for EARR in accordance with the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) in 2018. The aim of this study is to get insight into the actual utilization and the practical implementation of the guideline among orthodontists. The hypothesis to be tested was that after its introduction, clinical practice for EARR has changed towards the recommendations in the CPG. OBJECTIVE To investigate the use of the 2018 clinical practice guidelines for EARR among orthodontists 3 years after its introduction. METHODS A questionnaire using a 7-point Likert scale was developed concerning four domains of EARR described in the guideline. The questionnaire was piloted, finalised, and then distributed digitally among Dutch orthodontists. REDCap was used for data collection, starting with an invitation email in June 2021, followed by two reminders. Effect was tested by the Mann-Whitney U test, and the influence of demographic variables was analysed. RESULTS Questionnaires were sent out to all 275 and completed by 133 (response rate 48%); N = 59 females and N = 73 males were included; 81% had their training in the Netherlands, 89% had ≥ 6 years of work experience, and 89% worked in private orthodontic practice. One hundred thirty orthodontists (98.5%) reported changes in clinical practice. The biggest positive change in clinical behaviour regarding EARR occurred if EARR was diagnosed during treatment. Sex, clinical experience, country of specialist training, and working environment of the respondents did not affect clinical practices regarding EARR. CONCLUSIONS This questionnaire demonstrated that, 3 years after introduction of the guideline, orthodontists improved their self-reported clinical practices to a more standardised management of root resorption. None of the demographic predictors had a significant effect on the results.
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Affiliation(s)
- Sebastiaan P van Doornik
- Department of Orthodontics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Marlotte B M Pijnenburg
- Center for Dentistry and Oral Hygiene, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FB 21, 9713 AV, Groningen, The Netherlands
| | - Krista I Janssen
- Department of Orthodontics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Yijin Ren
- Department of Orthodontics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical Faculty, University of Bern, Hochschulstrasse 4, 3012, Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jalan Salemba Raya No. 4, Jakarta, 10430, Indonesia
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Adolph M, Schweikert D, Wehner A, Fritsche A, Bamberg M, Tischler K, Wessels B. [Comprehensive nutrition therapy in hospitals - Wishful thinking or reality? A survey-based cross-sectional study of the nutritional therapy in hospitals of Baden-Württemberg]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 185:17-26. [PMID: 38448358 DOI: 10.1016/j.zefq.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Malnutrition is widespread in German hospitals, has a negative impact on therapeutic success and quality of life, and it leads to increasing costs. An individualized nutritional support by nutritional professionals in accordance with current guidelines was shown to reduce mortality of malnourished inpatients. Ideally, nutritional support is conducted by an interdisciplinary nutrition support team. Current data on the nutritional therapy in German hospitals is missing. METHODS In order to ascertain the current status of nutritional support in hospitals in the federal state of Baden-Württemberg, clinic managements of all hospitals in Baden-Württemberg received an online questionnaire. Affiliated hospitals, specialist hospitals, as well as hospitals with less than 50 beds were excluded from the analysis. RESULTS The response rate was 84% (n = 94). The presence of a nutrition support team was reported by 34% of the hospitals. Twelve percent of the hospitals meet the structural characteristic of the OPS Code 8-98j Ernährungsmedizinische Komplexbehandlung, which means that their nutrition support team includes a physician. A validated nutritional risk screening is performed in 72% of the hospitals. Only 40% of the hospitals report that this is performed throughout every department. Nutrition support teams are more often concerned with malnutrition, enteral and parenteral nutrition as compared to nutritionists who are not organized in a team. Moreover, nutrition support teams have a wider range of tasks and more often a physician as a team member. Also, nutritional risk screenings are more often applied in hospitals with nutrition support teams. DISCUSSION Compared with a nationwide survey from 2004, there are markedly more nutrition support teams available in hospitals in Baden-Württemberg. When compared internationally, however, the rate of nutrition support teams is still low. In addition, there is no comprehensive nutritional care available. High-quality nutritional support is more often found in hospitals with nutrition support teams. CONCLUSION There is still a great potential of improving clinical nutritional care in hospitals in Baden-Württemberg. Moreover, an increase in nutrition support teams, also comprising medical members, should be achieved. Therefore, legal regulations and a sufficient refinancing are indispensable.
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Affiliation(s)
- Michael Adolph
- Universitätsklinikum Tübingen, Stabsstelle Ernährungsmanagement, Tübingen, Deutschland; Universitätsklinikum Tübingen, Anästhesiologie und Intensivmedizin, Tübingen, Deutschland.
| | - Daniela Schweikert
- Universitätsklinikum Tübingen, Stabsstelle Ernährungsmanagement, Tübingen, Deutschland
| | - Annalena Wehner
- Universitätsklinikum Tübingen, Stabsstelle Ernährungsmanagement, Tübingen, Deutschland
| | - Andreas Fritsche
- Universitätsklinikum Tübingen, Stabsstelle Ernährungsmanagement, Tübingen, Deutschland; Universitätsklinikum Tübingen, Innere Medizin IV - Diabetologie, Endokrinologie, Nephrologie, Tübingen, Deutschland
| | - Michael Bamberg
- Universitätsklinikum Tübingen, Klinikumsvorstand, Tübingen, Deutschland
| | - Klaus Tischler
- Universitätsklinikum Tübingen, Klinikumsvorstand, Tübingen, Deutschland
| | - Britta Wessels
- Universitätsklinikum Tübingen, Stabsstelle Ernährungsmanagement, Tübingen, Deutschland
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Krewulak K, Ogunyannwo T, Martin DA, Ruddell S, Yasmeen I, Fiest K. ICU Care Team's Perception of Clinical Research in the ICU: A Cross-Sectional Study. Crit Care Explor 2024; 6:e1072. [PMID: 38567383 PMCID: PMC10986907 DOI: 10.1097/cce.0000000000001072] [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] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES Adequate recruitment is essential for successful clinical research. ICU nurses play a crucial role in identifying eligible patients, introducing research teams, facilitating informed consent, and caring for enrolled patients. However, a larger group of multidisciplinary healthcare professionals (the ICU care team) is equally important in promoting clinical research participation.To describe the ICU care team's experiences in ongoing clinical research, identifying perceived barriers and enablers to their participation, and apply a behavior framework to enhance research engagement. DESIGN Cross-sectional survey study. SETTING Four adult ICUs and one PICU between June 2021 and March 2023. SUBJECTS We recruited nurses, physicians, nurse practitioners, allied health professionals, and unit clerks. MEASUREMENT AND MAIN RESULTS We developed and validated a cross-sectional survey based on the Capability, Opportunity, Motivation, Behavior model. This survey included: 1) demographic questions (n = 7); 2) research experience questions (n = 6), 3) capability questions (n = 8); 4) opportunity questions (n = 11); 5) and motivation questions (n = 13).A total of 172 ICU care team members completed the survey. Results showed differences in capabilities, opportunities, and motivations among ICU care team members. For example, fellow/attending physicians and nurse practitioners reported higher confidence in discussing research with patients/families, while registered nurses and allied health professionals expressed less confidence. CONCLUSIONS ICU care team members face multiple barriers that impact their involvement with the conduct of ICU research. To effectively engage healthcare professionals in this process, it is essential to address their capabilities (research knowledge and skills to communicate research with patients/families), create opportunities (collaboration/communication with research team, discuss research during multidisciplinary rounds), and motivate them (recognize their help and share the results of the research being conducted at their site) to improve ICU care team engagement in the conduct of ICU research.
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Affiliation(s)
- Karla Krewulak
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Toyin Ogunyannwo
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Dori-Ann Martin
- Section of Critical Care Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
| | - Stacy Ruddell
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Israt Yasmeen
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Department of Community Health Sciences, O'Brien Institute of Public Health, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Pershad AR, Kidwai MS, Lugo CA, Lee E, Tummala N, Thakkar P. Factors Influencing Underrepresented Medical Students' Career Choice in Surgical Subspecialties. Laryngoscope 2024; 134:1498-1506. [PMID: 37787431 DOI: 10.1002/lary.31094] [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: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Surgical subspecialties rank among the least racially and gender diverse of the medical specialties. The purpose of this systematic review is to evaluate the current factors that influence female, gender and sexual minority (GSM), and underrepresented in medicine (URiM)-identifying medical students' decision to pursue a career in a surgical subspecialty. DATA SOURCES A structured literature search of PubMed, Scopus, Web of Science, and Medline was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Criteria for eligibility included surveys and interviews assessing factors and barriers influencing underrepresented medical students' career choices. REVIEW METHODS Two independent researchers screened the articles' titles and abstracts for relevance; three performed full-text reviews. RESULTS Of 343 studies identified, 17 met the inclusion criteria. Fourteen (82%) were survey-based studies; three (18%) were qualitative interviews. Represented minorities included females (14), URiM (13), and GSM (4). Female medical students were most influenced by (1) exposure to surgery, (2) mentorship, and (3) surgical lifestyle. URiM medical students were most influenced by (1) mentorship, (2) culture and diversity, (3) research opportunities, and (4) personality fit. GSM medical students were most influenced by identity acceptance and instances of discrimination and bias. CONCLUSIONS Our review provides granular data on positive and negative factors influencing career choice among underrepresented medical students to facilitate the development of a more diverse surgical workforce. Female medical students were more positively influenced by increased exposure to surgical subspecialties, whereas URiM medical students were more positively influenced by race-concordant mentorship. Laryngoscope, 134:1498-1506, 2024.
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Affiliation(s)
- Alisha R Pershad
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mohammad S Kidwai
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ciara A Lugo
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Esther Lee
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Neelima Tummala
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Punam Thakkar
- Department of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Giannopoulos S, AbuHasan Q, Connors JDN, Athanasiadis DI, Hilgendorf W, Gardiner R, Martine V, Baumgartner TC, Stefanidis D. Patients' perspectives on weight recurrence after bariatric surgery: a single-center survey. Surg Endosc 2024; 38:2252-2259. [PMID: 38409612 DOI: 10.1007/s00464-023-10664-z] [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: 07/30/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients' quality of life negatively. Patient perspectives on WR are not well known. OBJECTIVES Assess patient needs, goals, and preferences regarding WR treatment. SETTING Single MBSAQIP-accredited academic center, and online recruitment. METHODS An 18-item, web-based survey was distributed to adults seeking treatment for WR after a primary bariatric surgery (PBS), in addition to online recruitment, between 2021 and 2023. Survey items included somatometric data, questions about the importance of factors for successful weight loss, procedure decision-making, and treatment expectations. RESULTS Fifty-six patients with > 10% increase from their nadir weight were included in the study. Patients had initially undergone Roux-en-Y gastric bypass (62.5%), sleeve gastrectomy (28.6%), adjustable gastric banding (3.6%), or other procedures (5.3%). When assessing their satisfaction with PBS, 57.1% were somewhat/extremely satisfied, 33.9% somewhat/extremely dissatisfied, while 8.9% were ambivalent. Patients considered the expected benefits (for example, weight loss) as the most important factor when choosing a treatment option for WR. Patient goals included "feeling good about myself" (96.4% very/extremely important), "being able to resume activities I could not do before" (91% very/extremely important), and "improved quality of life" and "-life expectancy" (> 90% very/extremely important). Finally, RBS, lifestyle modification with peer support, and anti-obesity medication were ranked as first treatment options for WR by 40%, 38.8%, and 29.8% of the respondents, respectively. CONCLUSIONS Patients considered weight loss as the most important factor when choosing treatment modality for WR, with RBS and lifestyle changes being preferred over weight-loss medications. Large prospective randomized trials are needed to counsel this patient population better.
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Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Qais AbuHasan
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - William Hilgendorf
- General Surgery, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Robin Gardiner
- Indiana University Health North Hospital, Carmel, IN, USA
| | - Victoria Martine
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Timothy C Baumgartner
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
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Ezad SM, Ryan M, Barrett N, Camporota L, Swol J, Antonini MV, Donker DW, Pappalardo F, Kapur NK, Rose L, Perera D. Left ventricular unloading in patients supported with veno-arterial extra corporeal membrane oxygenation; an international EuroELSO survey. Perfusion 2024; 39:13S-22S. [PMID: 38651575 DOI: 10.1177/02676591241229647] [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: 04/25/2024]
Abstract
INTRODUCTION Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) improves end-organ perfusion in cardiogenic shock but may increase afterload, which can limit cardiac recovery. Left ventricular (LV) unloading strategies may aid cardiac recovery and prevent complications of increased afterload. However, there is no consensus on when and which unloading strategy should be used. METHODS An online survey was distributed worldwide via the EuroELSO newsletter mailing list to describe contemporary international practice and evaluate heterogeneity in strategies for LV unloading. RESULTS Of 192 respondents from 43 countries, 53% routinely use mechanical LV unloading, to promote ventricular recovery and/or to prevent complications. Of those that do not routinely unload, 65% cited risk of complications as the reason. The most common indications for unplanned unloading were reduced arterial line pulsatility (68%), pulmonary edema (64%) and LV dilatation (50%). An intra-aortic balloon pump was the most frequently used device for unloading followed by percutaneous left ventricular assist devices. Echocardiography was the most frequently used method to monitor the response to unloading. CONCLUSIONS Significant variation exists with respect to international practice of ventricular unloading. Further research is required that compares the efficacy of different unloading strategies and a randomized comparison of routine mechanical unloading versus unplanned unloading.
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Affiliation(s)
- Saad M Ezad
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Nicholas Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Marta V Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, Netherlands
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USA
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Division of Applied Technologies for Clinical Care, King's College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
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Esmeijer AA, van der Ven F, Koornstra E, Kuipers L, van Oosten P, Swart P, Valk CM, Schultz MJ, Paulus F, Stilma W. Nursing Practice of Airway Care Interventions and Prone Positioning in ICU Patients with COVID-19-A Dutch National Survey. J Clin Med 2024; 13:1983. [PMID: 38610748 PMCID: PMC11012421 DOI: 10.3390/jcm13071983] [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: 02/19/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Airway care interventions and prone positioning are used in critically ill patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) to improve oxygenation and facilitate mucus removal. At the onset of the COVID-19 pandemic, the decision-making process regarding the practice of airway care interventions and prone positioning was challenging. Objective: To provide an overview of the practice of airway care interventions and prone positioning during the second wave of the pandemic in the Netherlands. Method: Web-based survey design. Seventy ICU nurses, each representing one intensive care in the Netherlands, were contacted for participation. Potential items were generated based on a literature search and formulated by a multidisciplinary team. Questions were pilot tested for face and construct validity by four intensive care nurses from four different hospitals. Results: The response rate was 53/77 (69%). This survey revealed widespread use of airway care interventions in the Netherlands in COVID-19 patients, despite questionable benefits. Additionally, prone positioning was used in invasively and non-invasively ventilated patients. Conclusions: The use of airway care interventions and prone positioning is time consuming and comes with the production of waste. Further research is needed to assess the effectiveness, workload, and environmental impact of airway care interventions and prone positioning.
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Affiliation(s)
- Andrea A. Esmeijer
- Department of Intensive Care, Amsterdam University Medical Center, Location VUmc, 1081 HV Amsterdam, The Netherlands (L.K.)
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Fleur van der Ven
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care, Rode Kruis Ziekenhuis, 1942 LE Beverwijk, The Netherlands
| | - Eveline Koornstra
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Location ‘Oost’, 1091 AC Amsterdam, The Netherlands;
| | - Laurien Kuipers
- Department of Intensive Care, Amsterdam University Medical Center, Location VUmc, 1081 HV Amsterdam, The Netherlands (L.K.)
| | - Paula van Oosten
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Pien Swart
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Christel M. Valk
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Mahidol-Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine, Medical University Vienna, 1090 Vienna, Austria
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Willemke Stilma
- Department of Intensive Care, Amsterdam University Medical Center, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
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Irfan A, Feng W, McElroy K, Dudeja V, Reddy S, Rose JB. What would you do? A survey of HPB surgeons practice patterns. HPB (Oxford) 2024; 26:436-443. [PMID: 38143165 DOI: 10.1016/j.hpb.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The surgical decision making for pancreatic adenocarcinoma is complex. Although practice guidelines exist for many scenarios, these do not cover many common eventualities that may be encountered during these cases. We sought to identify the practice pattern variations amongst pancreatic surgeons in response to commonly experienced clinical scenarios. METHODS A multiple-choice questionnaire was distributed to all full members of the IHPBA. Participant demographics, training history, and clinical practice information were obtained. The survey provided various operative scenarios and participants were asked how they would likely proceed. Responses were collected and stored anonymously in a secure database. Statistical analysis was performed using Stata 16.0. RESULTS 164 responses were submitted. Most of the respondents were male and had been in practice for over 10 years. The median age range was 40-50 years old. When asked about staging laparoscopy, the majority performed it selectively. For most respondents a pathological aorto-caval nodes was a reason to abort the procedure but most would have continued in the setting of a positive hepatic artery node. When encountering a single Segment 2 liver metastasis, participants who practiced in Europe were significantly more likely to resect and proceed compared to those in Asia and North America. Participants who had undergone only a Surgical Oncology fellowship were most likely to abort. With respect to direct colonic invasion, most participants would resect the specimen en bloc. Respondents who participated in fewer that 20 PDAC operations/year were most likely to abort. CONCLUSIONS Surgical decision making in PDAC surgery is complex and there is significant disagreement on the correct management. While formal guidelines cannot exist for all situations, this survey highlights the need for consensus on commonly encountered operative scenarios.
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Affiliation(s)
- Ahmer Irfan
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Wendy Feng
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katherine McElroy
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vikas Dudeja
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sushanth Reddy
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Bart Rose
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Jacek CC, Fritz KM, Lizon ME, Packham TL. Knowledge Gaps Regarding Indigenous Health in Occupational Therapy: A National Survey. Can J Occup Ther 2024; 91:65-77. [PMID: 37654201 PMCID: PMC10903141 DOI: 10.1177/00084174231197622] [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: 09/02/2023]
Abstract
Background. There is a need for the occupational therapy profession to respond to the Truth and Reconciliation Commission of Canada Calls to Action and work towards supporting the health and well-being of Indigenous Peoples. Purpose. (1) To determine the knowledge gaps of occupational therapists about Indigenous health and (2) to create recommendations to address identified gaps and inform responses from the profession. Method. A national needs survey was created and distributed to occupational therapists across Canada to determine the knowledge of occupational therapists about Indigenous health. Survey results were analyzed using thematic analysis and descriptive statistics. Findings. Data collected from 364 survey responses informed six distinct themes representing knowledge gaps of occupational therapists related to Indigenous health as follows: lack of foundational knowledge, power relations, lifelong learner, need for appropriate tools/approaches, respectful collaboration, and environmental influences. Implications. The project offers insight into the role of the occupational therapy profession in the process of reconciliation. Insights are focused on decolonizing occupational therapy practice, building trusting relationships with Indigenous Peoples, and the provision of appropriate training for occupational therapists to engage in culturally safer practices.
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Strong SM, McDougall AA, Abdelmohsen AM, Maku A, Dehnel A, Mallick R, Odejinmi F. Current opinion on large-scale prospective myomectomy databases toward evidence-based preconception and antenatal counselling utilising a standardised myomectomy operation note. Facts Views Vis Obgyn 2024; 16:59-65. [PMID: 38551475 PMCID: PMC11198879 DOI: 10.52054/fvvo.16.4.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Background No large-scale databases exist of pregnancy outcomes and rate of uterine rupture for women after myomectomy, resulting in inconsistent antenatal counselling and decision-making regarding mode and timing of delivery. Standardising information collected at myomectomy may facilitate data collection, informing prenatal/ antenatal counselling. Objectives To determine clinician opinions regarding standardisation of myomectomy operation notes to allow comprehensive data input into a prospective database of pregnancy outcomes, toward an evidence-based approach to decision making regarding timing and mode of delivery in subsequent pregnancies. Materials and Methods A google forms survey was emailed to all consultant (attending-level) obstetricians and gynaecologists across 25 hospitals in London, Kent, Surrey, and Sussex (UK) between March and May 2022. To enhance response rates, two further email reminders were sent alongside in-person reminders from selected local unit representatives. Main outcome measures Senior clinician opinion for characteristics necessary to collect at time of surgery to develop a widescale database of post myomectomy pregnancy outcomes. Results 209/475 (44%) responses received; 95% (198/209) agreed with standardising operation notes. Criteria selected for inclusion included cavity breach (98%, 194/198), location (98%, 194/198), number of fibroids removed (93%, 185/198) and number of uterine incisions (96%, 190/198). Conclusions Gynaecologists support standardising myomectomy operation notes to inform the development of prospective large-scale databases of pregnancy outcomes after myomectomy. What is new? Acquisition of clinician opinions on the development and content of a standardised myomectomy operation note to aid the development of a pregnancy-outcome database for women after myomectomy.
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Manning MX, Cleary C, McCaughey C. How do speech and language therapists enact aphasia psychosocial support in Ireland? A cross-sectional online survey informed by normalization process theory. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:698-714. [PMID: 37815803 DOI: 10.1111/1460-6984.12959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 09/01/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Supporting psychosocial well-being in aphasia is necessarily person-centred, interdisciplinary and coordinated. Shortcomings in such support are described in Ireland and elsewhere. Speech and language therapists (SLTs) are integral; and describing current practice and barriers they experience is important for enhancing service delivery. AIMS To understand how SLTs enact, and are supported to enact, aphasia psychosocial care in Ireland. METHODS & PROCEDURES This is a cross-sectional, online, self-administered clinician survey targeting SLTs working minimally 1 year post-qualification with persons with aphasia of any aetiology in Ireland. The survey questions were charted against key constructs of the implementation science framework, normalization process theory (NPT), and descriptive statistics were applied. OUTCOMES & RESULTS A total of 54 eligible datasets were included. SLTs believed psychosocial support to be part of their role, but perceived multiple barriers in enacting it. These included a lack of training, clinical supervision, management support, role recognition, and access to and joint working with mental health professionals and services. CONCLUSIONS & IMPLICATIONS SLTs in Ireland face a range of individual and structural barriers, including care coordination and resourcing. There is a clear need not only for training, upskilling and mentorship, but also for wider changes around access to mental health professionals and clarity around the processes of referral, coordination and integration of aphasia care across settings. These findings comprise preliminary insights into current practices. Further research is needed as well as clarity on best-practice pathways for different aetiologies of aphasia. Articulating current practices using NPT may have utility for developing empirically informed and principled interventions to improve service delivery. WHAT THIS PAPER ADDS What is already known on this subject People with aphasia of all aetiologies are at risk of psychosocial problems. Shortcomings in access and the availability of appropriate support have been documented both internationally and in Ireland. To address this issue, an important first step is to understand how SLTs in Ireland currently enact and are supported to enact aphasia psychosocial care. What this study adds to the existing knowledge The findings describe the potential levers and barriers to progressing aphasia psychosocial care in Ireland. A range of individual, team and structural factors were identified. These were locally contextualized but similar issues are reported in other countries. Linking attitudes with NPT constructs provides a first step for further principled implementation projects. What are the practical and clinical implications of this study? Addressing psychosocial problems is perceived as a legitimate part of the speech and language therapy role. SLTs in Ireland enact a range of therapeutic approaches but may need opportunities for formal training and supervision, and for better coordination and integration with other mental health services and disciplines. Understanding differences in care pathways across the range of aphasia aetiologies is additionally important given the emphasis on post-stroke aphasia in the literature.
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Affiliation(s)
- Molly X Manning
- School of Allied Health, University of Limerick, Limerick, Ireland
- Public and Patient Involvement Research Unit, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Caoimhe Cleary
- School of Allied Health, University of Limerick, Limerick, Ireland
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Patel B, Said AS, Justus A, Abrams D, Pham T, Antonini MV, Moore E, Shekar K, Zakhary B. An International Survey of Extracorporeal Membrane Oxygenation Education and Credentialing Practices. ATS Sch 2024; 5:71-83. [PMID: 38633517 PMCID: PMC11022670 DOI: 10.34197/ats-scholar.2022-0132oc] [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: 11/30/2022] [Accepted: 09/05/2023] [Indexed: 04/19/2024] Open
Abstract
Background The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge. Objective The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics. Methods We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains. Results A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high-ECMO volume centers compared with 136 (87.5%) low-ECMO volume centers (P = 0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high-ECMO volume centers compared with 51 (37.5%) low-ECMO volume centers (P = 0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non-Extracorporeal Life Support Organization center (P < 0.001). Conclusion We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed.
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Affiliation(s)
- Bhoumesh Patel
- Division of Cardiac Anesthesiology,
Department of Anesthesiology, Yale School of Medicine, New Haven,
Connecticut
| | - Ahmed S. Said
- Division of Pediatric Critical Care,
Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Angelo Justus
- Adult Intensive Care, Sunshine Coast
University Hospital, Sunshine Coast, Queensland, Australia
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and
Critical Care, Columbia University Medical Center, New York, New York
| | - Tái Pham
- Service de Médecine
Intensive-Réanimation, Hôpitaux Universitaires Paris-Saclay, Le
Kremlin-Bicêtre, France
- Université Paris-Saclay, Villejuif,
France
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital,
Cesena, Italy
- Department of Biomedical, Metabolic, and
Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elizabeth Moore
- University of Iowa Heart and Vascular
Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kiran Shekar
- Adult Intensive Care Services, the
Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane,
Queensland, Australia
- University of Queensland, Brisbane,
Queensland, Australia
- Institute of Health and Biomedical
Innovation, Queensland University of Technology, Brisbane and Faculty of
Medicine, Bond University, Gold Coast, Queensland, Australia; and
| | - Bishoy Zakhary
- Pulmonary and Critical Care Medicine,
Oregon Health and Science University, Portland, Oregon
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Whitcroft KL, Alobid I, Altundag A, Andrews P, Carrie S, Fahmy M, Fjaeldstad AW, Gane S, Hopkins C, Hsieh JW, Huart C, Hummel T, Konstantinidis I, Landis BN, Mori E, Mullol J, Philpott C, Poulios A, Vodička J, Ward VM. International clinical assessment of smell: An international, cross-sectional survey of current practice in the assessment of olfaction. Clin Otolaryngol 2024; 49:220-234. [PMID: 38153760 DOI: 10.1111/coa.14123] [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: 01/27/2023] [Revised: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. DESIGN Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. PARTICIPANTS ENT surgeons who assess olfaction. RESULTS Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. CONCLUSIONS To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.
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Affiliation(s)
- Katherine L Whitcroft
- UCL Ear Institute, University College London, London, UK
- Smell and Taste Clinic, Department of Otolaryngology, TU Dresden, Dresden, Germany
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Isam Alobid
- Skull Base Unit, ENT Department, Hospital Clinic Barcelona University, Barcelona, Spain
- CIBER of Respiratory diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Aytug Altundag
- Department of Otolaryngology, Head and Neck Surgery, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Sean Carrie
- Department of Otolaryngology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Miriam Fahmy
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Alexander W Fjaeldstad
- Department of Otorhinolaryngology, Flavour Clinic, University Clinic for Flavour, Balance and Sleep, Regional Hospital Gødstrup, Herning, Denmark
- Department of Clinical Medicine, Flavour Institute, Aarhus University, Aarhus, Denmark
| | - Simon Gane
- Centre for Olfactory Research Applications (CORA), IP, School of Advanced Study, London, UK
- Royal National and ENT Hospital (RNENT), London, UK
| | - Claire Hopkins
- ENT Department, Guy's and St Thomas' NHS Trust, London, UK
| | - Julien Wen Hsieh
- Rhinology-Olfactory Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - Caroline Huart
- ENT Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otolaryngology, TU Dresden, Dresden, Germany
| | - Iordanis Konstantinidis
- 2nd Academic Department, Smell and Taste Clinic, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Baslie N Landis
- Rhinology-Olfactory Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Geneva Medical School, Geneva, Switzerland
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University School of Medicine, Tokyo, Japan
| | - Joaquim Mullol
- CIBER of Respiratory diseases (CIBERES), Health Institute Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Rhinology Unit and Smell Clinic, ENT Department Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carl Philpott
- Norwich Medical School, Norwich, UK
- The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, James Paget and Norfolk and Norwich University Hospitals, Norfolk, UK
- Fifth Sense, London, UK
| | - Aristotelis Poulios
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Jan Vodička
- Department of Otorhinolaryngology and Head and Neck Surgery, Regional Hospital Pardubice, Pardubice, Czech Republic
- Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Victoria M Ward
- ENT Department, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Moss SJ, Stelfox M, McArthur E, Sriskandarajah C, Ahmed SB, Birnie K, Halperin DM, Halperin SA, Harley M, Hu J, Kamstra JN, Leppan L, Nickel A, Racine N, Russell K, Smith S, Solis M, Tutelman PR, Stelfox HT, Fiest KM, Parsons Leigh J. Social factors associated with self-reported changes in mental health symptoms among youth in the COVID-19 pandemic: a cross-sectional survey. BMC Public Health 2024; 24:631. [PMID: 38413913 PMCID: PMC10900679 DOI: 10.1186/s12889-024-18087-8] [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: 10/17/2023] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Children and youth experienced marked impacts on day-to-day life in the COVID-19 pandemic that were associated with poorer familial and friend relationships, and greater mental health challenges. Few studies provide self-report data on mental health symptoms from children and youth themselves. We sought to examine the associations between social factors and child and youth self-reported symptoms of worsened mood, anxiety, and irritability during the COVID-19 pandemic. METHODS A nationally representative cross-sectional survey was administered online to collect self-report data across 10 Canadian provinces among children (11-14 years) and youth (15-18 years), April-May 2022. Age-appropriate questions were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. Associations between a priori defined social factors (e.g., relationship quality) and respondent self-reported mental health were evaluated using ordinal logistic regression models adjusted for age, sex, and geographic location. RESULTS We analyzed data from 483 (51.7%) children (11-14 years; 227, 47.0% girls) and 450 (48.3%) youth (15-18 years; 204, 45.3% girls). The parents of most children and youth had resided in Canada for over 20 years (678, 72.7%). Over one-quarter of children and youth self-identified as Black, Indigenous, or a Person of Color (134, 27.7%; 134, 29.8%, respectively). Over one-third of children and youth self-reported symptoms of worsened mood (149, 30.9%; 125, 27.8%, respectively), anxiety (181, 37.5%; 167, 37.1%, respectively), or irritability (160, 33.1%; 160, 35.6%, respectively) during, compared to pre-pandemic. In descending order of odds ratios (OR), for children and youth, worsened familial relationships (during compared to pre-pandemic) was associated with the self-reported symptoms of worsened mood (child: OR 4.22, 95%CI 2.51-6.88; youth: OR 6.65 95%CI 3.98-11.23), anxiety (child: OR 4.24, 95%CI2.69-6.75; youth: OR 5.28, 95%CI 3.17-8.86), and irritability (child: OR 2.83, 95%CI 1.76-4.56; youth: OR 6.46, 95%CI 3.88-10.90). CONCLUSIONS Self-reported data from a nationally representative sample of children and youth suggest strong associations between social factors and mental health during the COVID-19 pandemic. Interventions targeting child and youth familial relationships may positively impact child and youth mental health.
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Affiliation(s)
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | | | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Birnie
- Departments of Anesthesiology, Perioperative, and Pain Medicine, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Donna M Halperin
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, Halifax, NS, Canada
| | | | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Stacie Smith
- Young Canadian Roundtable On Health, Toronto, ON, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Kharrat A, Diambomba Y, Jain A. Corticosteroid use in neonatal hypotension: A survey of Canadian neonatologists. Pediatr Neonatol 2024:S1875-9572(24)00005-6. [PMID: 38388227 DOI: 10.1016/j.pedneo.2023.09.013] [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: 04/25/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE To assess prescribing practices and perspectives regarding the use of corticosteroids in the management of neonatal hypotension. METHODS Cross-sectional questionnaire-based electronic survey of neonatologists (n = 206) practicing at tertiary neonatal intensive care units across 30 academic centres in Canada. RESULTS The overall response rate was 33% (72/206), with a completion rate was 94%. Most (48/72, 64%) worked in a unit that covered both inborn and outborn infants, and 53% (37/70) worked in units with >100 very low birth weight infants admitted annually. Among the 72 respondents, 39% use a loading dose, of whom most (57%) use 2 mg/kg. Dosing ranges were variable, most using either 0.5 mg/kg or 1 mg/kg, q6h. Among the 56% (40/72) of neonatologists who reported measuring cortisol before initiation of hydrocortisone, cut-offs for initiation of hydrocortisone varied from <100 to <500 nmol/L, most of whom (48%) used <100 nmol/L. Of 71 respondents, 92% (65) indicated that a randomized control trial examining the use of corticosteroids in neonatal hypotension is needed, of whom 52% (37) indicated that the intervention group should receiving hydrocortisone after one vasopressor/inotrope. CONCLUSIONS This survey provides insight into the prescribing practices of tertiary neonatologists with regards to the use of corticosteroids in neonatal hypotension. While corticosteroids are frequently prescribed, there is variability in the indication, dosing, and duration of corticosteroid use. The findings from this survey can be used to inform further research, including a clinical trial, regarding the practice in the management of neonatal hypotension.
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Affiliation(s)
- Ashraf Kharrat
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
| | - Yenge Diambomba
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Amish Jain
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
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49
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Leigh JP, FitzGerald EA, Moss SJ, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin D, Ahmed SB, MacDonald SE, Straus SE, Manca T, Kamstra JN, Soo A, Longmore S, Kupsch S, Sept B, Halperin S. Factors affecting hesitancy toward COVID-19 vaccine booster doses in Canada: a cross-national survey. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:26-39. [PMID: 37991692 PMCID: PMC10853155 DOI: 10.17269/s41997-023-00823-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE COVID-19 transmission, emergence of variants of concern, and weakened immunity have led to recommended vaccine booster doses for COVID-19. Vaccine hesitancy challenges broad immunization coverage. We deployed a cross-national survey to investigate knowledge, beliefs, and behaviours toward continued COVID-19 vaccination. METHODS We administered a national, cross-sectional online survey among adults in Canada between March 16 and March 26, 2022. We utilized descriptive statistics to summarize our sample, and tested for demographic differences, perceptions of vaccine effectiveness, recommended doses, and trust in decisions, using the Rao-Scott correction for weighted chi-squared tests. Multivariable logistic regression was adjusted for relevant covariates to identify sociodemographic factors and beliefs associated with vaccine hesitancy. RESULTS We collected 2202 completed questionnaires. Lower education status (high school: odds ratio (OR) 1.90, 95% confidence interval (CI) 1.29, 2.81) and having children (OR 1.89, CI 1.39, 2.57) were associated with increased odds of experiencing hesitancy toward a booster dose, while higher income ($100,000-$149,999: OR 0.60, CI 0.39, 0.91; $150,000 or more: OR 0.49, CI 0.29, 0.82) was associated with decreased odds. Disbelief in vaccine effectiveness (against infection: OR 3.69, CI 1.98, 6.90; serious illness: OR 3.15, CI 1.69, 5.86), disagreeing with government decision-making (somewhat disagree: OR 2.70, CI 1.38, 5.29; strongly disagree: OR 4.62, CI 2.20, 9.7), and beliefs in over-vaccinating (OR 2.07, CI 1.53, 2.80) were found associated with booster dose hesitancy. CONCLUSION COVID-19 vaccine hesitancy may develop or increase regarding subsequent vaccines. Our findings indicate factors to consider when targeting vaccine-hesitant populations.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
- Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada.
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Stephana J Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donna Halperin
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Sofia B Ahmed
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
| | - Josh Ng Kamstra
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott Halperin
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Rodriguez-Armendariz AG, Saint-Germain MA, Khalafallah AM, Huq S, Almeida ND, Dornbos DL, Graffeo CS, Sivakumar W, Mukherjee D, Johnson JN. The neurosurgery research & education foundation-young neurosurgeons committee webinar series: Providing education and inspiration during the COVID-19 pandemic. J Clin Neurosci 2024; 120:221-228. [PMID: 38295463 DOI: 10.1016/j.jocn.2024.01.021] [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: 10/25/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE During the COVID-19 pandemic, the American Association of Neurological Surgeons (AANS) Young Neurosurgeons Committee (YNC) and Neurosurgery Research & Education Foundation (NREF) launched the YNC-NREF Webinar Series to provide young and aspiring neurosurgeons with timely information, education, and inspiration in the absence of in-person programming. DESIGN Five 90-minute Zoom webinars were evaluated, each including 1-2 keynote speakers, a panel discussion, and an audience question-and-answer section. Topics included overviews of neurosurgery, the match, subspecialties, and inspirational career stories. Optional pre- and post-webinar surveys with 11-point Likert-type scores were distributed to attendees. We compared groups using chi-squared and Kruskal-Willis tests, and perceptions pre- and post-webinar using Mann-Whitney tests. SETTING The webinars were live using Zoom, and the recordings were published on NREF's YouTube channel. PARTICIPANTS The webinar series targeted young neurosurgeons. The first five episodes had a particular focus on medical students and undergraduates. RESULTS A total of 673 unique participants attended the webinar series; 257 (38%) and 78 (11%) attendees completed the pre- and post-webinar survey, respectively. Respondents had high baseline interest in neurosurgery and were motivated to learn about the match and training in the US, understand neurosurgeons' day-to-day lives, and ask questions. There were significant differences in perceptions between USMSs, IMSs, and undergraduate students. The webinar improved attendees' knowledge about neurosurgical specialties, the match, and US neurosurgery training. CONCLUSIONS The YNC and NREF effectively engaged a large, diverse audience through an online webinar series, building a foundation for future virtual programming by organized neurosurgery. ACGME competencies.
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Affiliation(s)
- Ana G Rodriguez-Armendariz
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey. 2501 Eugenio Garza Sada, Nuevo León, Monterrey 64849, Mexico.
| | - Max A Saint-Germain
- Department of Neurosurgery, Johns Hopkins University School of Medicine. 1800 Orleans St. Baltimore, MD 21287, USA.
| | - Adham M Khalafallah
- Department of Neurosurgery, University of Miami Miller School of Medicine, 1475 Northwest 12th Avenue, Floor 1, Miami, FL 33136, USA
| | - Sakibul Huq
- Department of Neurosurgery, University of Pittsburgh School of Medicine, UPMC Presbyterian, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Neil D Almeida
- The George Washington University, School of Medicine and Health Sciences, The George Washington University, 23000 St NW, Washington, DC 20052, USA; Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, 131 Biomedical Education Building, Buffalo, NY 14214, USA.
| | - David L Dornbos
- Department of Neurosurgery, Semmes-Murphey Clinic, 6325 Humphreys Blvd, Memphis, TN 38120, USA
| | - Christopher S Graffeo
- Department of Neurological Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Walavan Sivakumar
- Department of Neurosurgery, Pacific Neuroscience Institute, 2125 Arizona Ave, Santa Monica, CA 90404, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine. 1800 Orleans St. Baltimore, MD, USA 21287.
| | - Jeremiah N Johnson
- Department of Neurological Surgery, Baylor College of Medicine, 7200 Cambridge, Suite 9A, Houston, TX 77030, USA; Department of Neurosurgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, 300 Stein Plaza, Suite 562, Box 956901, Los Angeles, CA 90095-6901, USA
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