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Patrician PA, Campbell CM, Javed M, Williams KM, Foots L, Hamilton WM, House S, Swiger PA. Quality and Safety in Nursing: Recommendations From a Systematic Review. J Healthc Qual 2024; 46:203-219. [PMID: 38717788 PMCID: PMC11198958 DOI: 10.1097/jhq.0000000000000430] [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] [Indexed: 06/27/2024]
Abstract
ABSTRACT As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.
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Smith LM, Campbell D, Prush N, Trojanowski S, Sherman E, Yost E. Implementation and Mixed-Methods Assessment of an Early Mobility Interprofessional Education Simulation. Dimens Crit Care Nurs 2024; 43:158-167. [PMID: 38564459 DOI: 10.1097/dcc.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Extended periods of bed rest and mechanical ventilation (MV) have devastating effects on the body. BACKGROUND Early mobility (EM) for patients in respiratory failure is safe and feasible, and an interprofessional team is recommended. Using simulation to train EM skills improves student confidence. The purpose of this study was to enable health care student collaboration as an interprofessional team in providing safe management and monitoring during an EM simulation for a patient requiring MV. METHODS Nursing (n = 33), respiratory (n = 7), occupational (n = 24), and physical therapist students (n = 55) participated in an EM interprofessional education (IPE) simulation experience. A mixed-methods analytic approach was used with pre/post quantitative analysis of the Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument and qualitative analysis of students' guided reflection papers. RESULTS Pre/post surveys completion rate was 39.5% (n = 47). The Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument indicated a significant improvement (P = .037) in students' perceptions of interprofessional collaborative practice. Qualitative data showed a positive response to the EM simulation IPE. Themes reflected all 4 Interprofessional Education Collaborative competencies. DISCUSSION This study demonstrated improved perception of interprofessional collaborative practice and better understanding of the Interprofessional Education Collaborative competencies. CONCLUSION Students collaborated in the simulation-based IPE to provide EM for a patient requiring MV and reported perceived benefits of the experience.
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Whitlock K, Rzewnicki D, Krieger B, Miller C, Creel-Bulos C. "Beyond waking and walking. Intensive rehabilitation in patients requiring extended durations of advanced mechanical circulatory support: A case series". Perfusion 2024; 39:840-848. [PMID: 36847239 DOI: 10.1177/02676591231159570] [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: 03/01/2023]
Abstract
Physical therapy (PT) utilization in patients requiring mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) has been reported; however, little is known about intensive rehabilitation and associated outcomes in patients requiring extended complex MCS and/or ECMO support. Authors sought to explore safety, feasibility and outcomes associated with active rehabilitation in patients requiring prolonged advanced MCS/ECMO support. Single-center retrospective series evaluated functional, clinical, and longitudinal outcomes of sample of eight critically ill, adult (≥18 years of age) patients who underwent a intensive rehabilitation while receiving prolonged MCS/ECMO through advanced configurations including: venovenous (VV-ECMO), venoarterial (VA-ECMO), oxygenator with right ventricular assist device (Oxy-RVAD) and right ventricular assist device (RVAD). 406 sessions were conducted; 246 during provision of advanced MCS/ECMO support. Incidence of major adverse events-accidental decannulation, migration of cannulas, circuit failure, hemorrhage, major flow limitations, and major hemodynamic instability-was 1.2 events per 100 sessions. None of reported major adverse events impeded longitudinal ability to participate in PT. Increased time to PT initiation was associated with a statistically significant increase in intensive care unit (ICU) length-of-stay (β1 1.93, CI 0.55-3.30) and reduced ambulatory distance during last session on MCS/ECMO (β1 -47.64, CI - 93.93, -1.66). All patients survived to hospital discharge and 12 months from sentinel hospitalization. Amongst those patients discharged to an inpatient rehabilitation center (n = 4), all were discharged home within 3 months. Findings support the safety and feasibility of active rehabilitational PT in patients requiring extended durations of advanced MCS/ECMO support. Moreover, it highlights potentially associated benefits of this degree of intensive rehabilitation for these unique patients. Further investigation is needed to identify associations with longitudinal clinical outcomes, as well as predictors of success in this population.
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Affiliation(s)
- Katelyn Whitlock
- Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, GA, USA
- Department of Rehabilitation Therapy, Emory University Hospital, Atlanta, GA, USA
| | | | - Briana Krieger
- Department of Rehabilitation Therapy, Emory University Hospital, Atlanta, GA, USA
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Casey Miller
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Christina Creel-Bulos
- Emory Critical Care Center, Division of Critical Care Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Luijks ECN, van der Slikke EC, van Zanten ARH, Ter Maaten JC, Postma MJ, Hilderink HBM, Henning RH, Bouma HR. Societal costs of sepsis in the Netherlands. Crit Care 2024; 28:29. [PMID: 38254226 PMCID: PMC10802003 DOI: 10.1186/s13054-024-04816-3] [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: 07/21/2023] [Accepted: 01/18/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Sepsis is a life-threatening syndrome characterized by acute loss of organ function due to infection. Sepsis survivors are at risk for long-term comorbidities, have a reduced Quality of Life (QoL), and are prone to increased long-term mortality. The societal impact of sepsis includes its disease burden and indirect economic costs. However, these societal costs of sepsis are not fully understood. This study assessed sepsis's disease-related and indirect economic costs in the Netherlands. METHODS Sepsis prevalence, incidence, sepsis-related mortality, hospitalizations, life expectancy, QoL population norms, QoL reduction after sepsis, and healthcare use post-sepsis were obtained from previous literature and Statistics Netherlands. We used these data to estimate annual Quality-adjusted Life Years (QALYs), productivity loss, and increase in healthcare use post-sepsis. A sensitivity analysis was performed to analyze the burden and indirect economic costs of sepsis under alternative assumptions, resulting in a baseline, low, and high estimated burden. The results are presented as a baseline (low-high burden) estimate. RESULTS The annual disease burden of sepsis is approximately 57,304 (24,398-96,244; low-high burden) QALYs. Of this, mortality accounts for 26,898 (23,166-31,577) QALYs, QoL decrease post-sepsis accounts for 30,406 (1232-64,667) QALYs. The indirect economic burden, attributed to lost productivity and increased healthcare expenditure, is estimated at €416.1 (147.1-610.7) million utilizing the friction cost approach and €3.1 (0.4-5.7) billion using the human capital method. Cumulatively, the combined disease and indirect economic burdens range from €3.8 billion (friction method) to €6.5 billion (human capital method) annually within the Netherlands. CONCLUSIONS Sepsis and its complications pose a substantial disease and indirect economic burden to the Netherlands, with an indirect economic burden due to production loss that is potentially larger than the burden due to coronary heart disease or stroke. Our results emphasize the need for future studies to prevent sepsis, saving downstream costs and decreasing the economic burden.
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Affiliation(s)
- Erik C N Luijks
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Elisabeth C van der Slikke
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Division of Human Nutrition and Health, Wageningen University Research, Wageningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk B M Hilderink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Robert H Henning
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hjalmar R Bouma
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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Johnson JK, Hamilton AC, Hu B, Pack QR, Lindenauer PK, Fox RJ, Hashmi A, Siegmund LA, Burchill CN, Taksler GB, Goto T, Stilphen M, Rothberg MB. Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial. Trials 2023; 24:471. [PMID: 37488588 PMCID: PMC10367239 DOI: 10.1186/s13063-023-07501-y] [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: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hospitalized older adults spend as much as 95% of their time in bed, which can result in adverse events and delay recovery while increasing costs. Observational studies have shown that general mobility interventions (e.g., ambulation) can mitigate adverse events and improve patients' functional status. Mobility technicians (MTs) may address the need for patients to engage in mobility interventions without overburdening nurses. There is no data, however, on the effect of MT-assisted ambulation on adverse events or functional status, or on the cost tradeoffs if a MT were employed. The AMBULATE study aims to determine whether MT-assisted ambulation improves mobility status and decreases adverse events for older medical inpatients. It will also include analyses to identify the patients that benefit most from MT-assisted mobility and assess the cost-effectiveness of employing a MT. METHODS The AMBULATE study is a multicenter, single-blind, parallel control design, individual-level randomized trial. It will include patients admitted to a medical service in five hospitals in two regions of the USA. Patients over age 65 with mild functional deficits will be randomized using a block randomization scheme. Those in the intervention group will ambulate with the MT up to three times daily, guided by the Johns Hopkins Mobility Goal Calculator. The intervention will conclude at hospital discharge, or after 10 days if the hospitalization is prolonged. The primary outcome is the Short Physical Performance Battery score at discharge. Secondary outcomes are discharge disposition, length of stay, hospital-acquired complications (falls, venous thromboembolism, pressure ulcers, and hospital-acquired pneumonia), and post-hospital functional status. DISCUSSION While functional decline in the hospital is multifactorial, ambulation is a modifiable factor for many patients. The AMBULATE study will be the largest randomized controlled trial to test the clinical effects of dedicating a single care team member to facilitating mobility for older hospitalized patients. It will also provide a useful estimation of cost implications to help hospital administrators assess the feasibility and utility of employing MTs. TRIAL REGISTRATION Registered in the United States National Library of Medicine clinicaltrials.gov (# NCT05725928). February 13, 2023.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Aaron C Hamilton
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, USA
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, USA
| | - Robert J Fox
- Mellen Center for Treatment and Research in Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ardeshir Hashmi
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Lee Anne Siegmund
- Office of Nursing Research and Innovation, and Consultant Staff, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Glen B Taksler
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Population Health Research Institute, Case Western Reserve University at MetroHealth System, Cleveland, OH, USA
| | - Toyomi Goto
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA
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Ravara B, Giuriati W, Maccarone MC, Kern H, Masiero S, Carraro U. Optimized progression of Full-Body In-Bed Gym workout: an educational case report. Eur J Transl Myol 2023. [PMID: 37358234 PMCID: PMC10388607 DOI: 10.4081/ejtm.2023.11525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023] Open
Abstract
People suffering from fatigue syndromes spend less time exercising each day, thus aggravating their motor difficulties. Indeed, muscles and mobility deteriorate with age, while exercising muscles is the only sure countermeasure. It is useful to offer a safe and toll-free rehabilitation training: Full-Body In-Bed Gym, easy to learn and performe at home. We suggest a 10-20 min daily routine of easy and safe physical exercises that may improve the main 200 skeletal muscles used for every-day activities. Many of the exercises can be performed in bed (Full-Body In-Bed Gym), so hospital patients can learn this light workout before leaving the hospital. The routine consists of series of repetitions of 15 bodyweight exercises to be performed one after the other without time breaks in between. Alternating sequences of arm and leg exercises are followed by moving body parts in lying and sitting positions in bed. These are followed by series of tiptoeing off the bed. Progressive improvements can be tested by a series of push-ups on the floor. Starting from 3-5, number of repetitions are increased by adding 3 more every week. To maintain or even shorten total daily time of workout each movement is weekly speeded up. The devoted time every morning (or at least five days a week) to train all the major muscles of the body can remain under 10 minutes. Because there are no breaks during and between sets, the final push-ups become very challenging: at the end of the daily workout heart rate, depth and number of ventilations and frontal perspiration increase for a few minutes. We here provide an example of how to implement the progression of the Full-Body In-Bed Gym presenting an educational Case Report of a trained 80-year old person in stable pharmacological managements. In addition to strengthening the main muscles, including the ventilatory muscles, Although performed in bed, Full-Body In-Bed Gym is a resistance training equivalent to a short jog.. Started in early winter and continued regularly throughout spring and summer, Full-Body In-Bed Gym can help maintain independence of frail people, including those younger persons suffering with the fatigue syndrome related to the viral infection of the recent COVID-19 pandemic.
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Affiliation(s)
- Barbara Ravara
- Department of Biomedical Sciences, University of Padova, Padua, Italy; CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; A&C M-C Foundation for Translational Myology, Padua.
| | - Walter Giuriati
- Department of Biomedical Sciences, University of Padova, Padua.
| | - Maria Chiara Maccarone
- Physical Medicine and Rehabilitation School, University of Padova, Padua, Italy; Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | - Helmut Kern
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten, Austria; Institute of Physical Medicine and Rehabilitation, Prim. Dr. H Kern GmbH, Amstetten.
| | - Stefano Masiero
- CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua.
| | - Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Padua, Italy; CIR-Myo-Interdepartmental Research Center of Myology, University of Padova, Padua, Italy; A&C M-C Foundation for Translational Myology, Padua.
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Elsalam S, Morsy W, Youseif M, Mohammed F. Effect of implementing mobility protocol on selected outcomes among critically ill elderly patients. EGYPTIAN NURSING JOURNAL 2023; 20:104. [DOI: 10.4103/enj.enj_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Incidence of and risk factors for post-intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional, prospective study. Aust Crit Care 2022:S1036-7314(22)00096-0. [PMID: 36104256 DOI: 10.1016/j.aucc.2022.07.005] [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: 03/23/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients transferred from the respiratory intensive care unit (ICU) can experience post-intensive care syndrome (PICS), which comprises cognitive, psychological, and physical disorders that seriously affect the quality of life. Therefore, it was necessary to explore the incidence of and the risk factors for PICS among respiratory ICU patients. OBJECTIVES This study evaluated PICS among respiratory ICU patients and explored the risk factors for PICS. METHODS This cross-sectional, prospective study was performed at one hospital in China. Using convenience sampling, 125 respiratory ICU patients from August 2018 to June 2019 were recruited for the study. The Mini-Mental State Examination, Confusion Assessment Method for the Intensive Care Unit, Hospital Anxiety and Depression Scale, Medical Research Council Scale, activities of daily living scale, Pittsburgh Sleep Quality Index, and the 14-item fatigue scale were used to comprehensively assess the patients' cognitive status, psychological status, and physiological status when entering the ICU and 2 weeks after leaving the ICU. Factors affecting PICS were measured using researcher-created questionnaires of patients' general information and disease-related information. RESULTS Fifteen patients were lost to follow-up. Fifty-nine patients had PICS (incidence rate, 53.6%). Logistic regression showed that risk factors for PICS were age, invasive mechanical ventilation, noninvasive ventilator-assisted ventilation, and coronary heart disease (P < 0.05). CONCLUSION The PICS incidence was high. Older age, longer invasive mechanical ventilation times, longer noninvasive ventilator times, and coronary heart disease were risk factors for PICS. ICU medical workers in China should pay more attention on PICS, know the risk factors, and implement preventive measures.
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Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4452308. [PMID: 35432836 PMCID: PMC9007641 DOI: 10.1155/2022/4452308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
The aim of the study was to explore the effect of intensive psychological nursing intervention on HAMD and SF-36 scores in patients with severe liver cancer in intensive care unit (ICU). 134 critically ill patients with liver cancer in ICU who underwent resection of primary liver cancer from July 2019 to November 2021 were selected. The patients were randomly divided into control group and study group. The patients in the control group received routine nursing. The patients in the study group received intensive psychological nursing intervention on the basis of routine nursing. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and the MOS 36-item short-form health survey (SF-36) scores before and after nursing were compared between the two groups. The satisfaction of the two groups of patients with nursing was counted. The HAMA, HAMD, and SF-36 scores of patients receiving intensive psychological nursing intervention were significantly better than those receiving routine nursing. The nursing satisfaction of patients receiving intensive psychological nursing intervention was significantly higher than that of patients receiving routine nursing. Intensive psychological nursing intervention for patients with severe liver cancer in ICU can significantly reduce HAMD, improve SF-36 score, and patient nursing satisfaction. It is worthy of wide clinical promotion.
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Zbar RI. Socio-Ecologic Perspective: Barriers Complicating Post-Intensive Care Syndrome Mitigation. J Patient Exp 2022; 9:23743735211074434. [PMID: 35155747 PMCID: PMC8832571 DOI: 10.1177/23743735211074434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective:Post-intensive care syndrome (PICS) is a phenomenon whereby survivors of an intensive care unit (ICU) admission subsequently experience issues with physical, cognitive, or mental health status persisting beyond the acute hospitalization. Risk factors for developing PICS include prolonged mechanical ventilation with sedation and immobility. PICS is a devastating illness that negatively alters the life path of many individuals with tremendous economic impact. Methods: This qualitative study employed a grounded theory approach to understand the systemic barriers blocking mitigation and treatment of PICS in all seven ICUs across Essex County, New Jersey (NJ) through semi-scripted interviews conducted with 11 members of the healthcare teams with at least one from each site. Thematic analysis was performed with open, axial, and selective coding. Results: Applying socio-ecologic viewpoint to data illustrate significant barriers on both an interpersonal and organizational level that decrease the operationalization of PICS mitigation measures as identified by healthcare providers. Of those interviewed, eight (73%) were physicians and the remaining were nurses. Significant thematic issues included understanding the risk factors of PICS but feeling powerless to institute mitigation efforts; experiencing lack of enthusiasm due to the absence of institutionalized mitigation protocols; noting frustration about closing the gap between academic recommendations and the ability to operationalize these appropriately; and feeling unable to effectuate meaningful change. Conclusion: Providing education to the target population and healthcare provider stakeholders regarding the barriers against PICS mitigation can alter the status quo.
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Affiliation(s)
- Ross I.S. Zbar
- Department of Plastic Surgery, Chilton Medical Center, Glen Ridge, NJ, USA
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Mukpradab S, Mitchell M, Marshall AP. An Interprofessional Team Approach to Early Mobilisation of Critically Ill Adults: An Integrative Review. Int J Nurs Stud 2022; 129:104210. [DOI: 10.1016/j.ijnurstu.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Whitlock KC, Mandala M, Bishop KL, Moll V, Sharp JJ, Krishnan S. Lower AM-PAC 6-Clicks Basic Mobility Score Predicts Discharge to a Postacute Care Facility Among Patients in Cardiac Intensive Care Units. Phys Ther 2022; 102:6413902. [PMID: 34723327 DOI: 10.1093/ptj/pzab252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 08/19/2021] [Accepted: 10/02/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study was to determine the ability of the Activity Measure for Post-Acute Care "6-Clicks" Basic Mobility Short Form to predict patient discharge destination (home vs postacute care [PAC] facility) from the cardiac intensive care unit (ICU), including patients from the cardiothoracic surgical ICU and coronary care unit. METHODS This retrospective cohort study utilized electronic medical records of patients in cardiac ICU (n = 359) in an academic teaching hospital in the southeastern region of United States from September 1, 2017, through August 31, 2018. RESULTS The median interquartile range age of the sample was 68 years (75-60), 55% were men, the median interquartile range 6-Clicks score was 16 (20-12) at the physical therapist evaluation, and 79% of the patients were discharged to home. Higher score on 6-Clicks indicates improved function. A prediction model was constructed based on a machine learning approach using a classification tree. The classification tree was constructed and evaluated by dividing the sample into a train-test split using the Leave-One-Out cross-validation approach. The classification tree split the data into 4 distinct groups along with their predicted outcomes. Patients with a 6-Clicks score >15.5 and a score between 11.5 and 15.5 with primary insurance other than Medicare were discharged to home. Patients with a 6-Clicks score between 11.5 and 15.5 with Medicare insurance and those with a score ≤11.5 were discharged to a PAC facility. CONCLUSION Patients with lower 6-Clicks scores were more likely to be discharged to a PAC facility. Patients without Medicare insurance had to be significantly lower functioning, as indicated by lower 6-Clicks scores for PAC facility placement than those with Medicare insurance. IMPACT The ability of 6-Clicks along with primary insurance to determine discharge destination allows for early discharge planning from cardiac ICUs.
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Affiliation(s)
- Katelyn C Whitlock
- Department of Rehabilitation Therapy, Emory University Hospital, Atlanta, Georgia, USA
| | - Mahender Mandala
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA.,Apollo Neuroscience, Inc, Pittsburgh, Pennsylvania, USA
| | - Kathy Lee Bishop
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vanessa Moll
- Department of Anesthesiology, Division of Critical Care Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Jennifer J Sharp
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shilpa Krishnan
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, USA.,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, U.S. Department of Veterans Affairs, Decatur, Georgia, USA
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dos Santos Moraes TL, de Farias JMF, Rezende BS, de Carvalho FO, Santiago MS, Porto ES, Doria FM, Santana KCS, Gomes MV, Leite VS, Madruga RETTA, dos Santos Maciel LY, Andrade JD, de Farias Neto JP, Aidar FJ, da Silva Junior WM. Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU. Clin Pract 2021; 12:8-16. [PMID: 35076492 PMCID: PMC8788280 DOI: 10.3390/clinpract12010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. MATERIALS AND METHODS This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). RESULTS A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23-636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002-0.30). CONCLUSION Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.
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Affiliation(s)
- Talita Leite dos Santos Moraes
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Joana Monteiro Fraga de Farias
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Brunielly Santana Rezende
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | | | - Michael Silveira Santiago
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Erick Sobral Porto
- Department of Medicine, Tiradentes University (UNIT), Aracaju 49032-490, SE, Brazil;
| | - Felipe Meireles Doria
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
| | | | - Marcel Vieira Gomes
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.V.G.); (V.S.L.)
| | - Victor Siqueira Leite
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.V.G.); (V.S.L.)
| | | | | | - Juliana Dantas Andrade
- University Hospital, Federal University of Sergipe (HU/UFS), Aracaju 49060-108, SE, Brazil; (F.O.d.C.); (J.D.A.)
| | | | - Felipe J. Aidar
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Walderi Monteiro da Silva Junior
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
- University Hospital, Federal University of Sergipe (HU/UFS), Aracaju 49060-108, SE, Brazil; (F.O.d.C.); (J.D.A.)
- Department of Physiotherapy, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
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Physical Therapy Practice for Critically Ill Patients With COVID-19 in the Intensive Care Unit. Cardiopulm Phys Ther J 2021. [DOI: 10.1097/cpt.0000000000000188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Skeletal muscle weakness in older adults home-restricted due to COVID-19 pandemic: a role for full-body in-bed gym and functional electrical stimulation. Aging Clin Exp Res 2021; 33:2053-2059. [PMID: 34047931 PMCID: PMC8160559 DOI: 10.1007/s40520-021-01885-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
Persons suffering with systemic neuromuscular disorders or chronic organ failures, spend less time for daily physical activity, aggravating their mobility impairments. From 2020, patients at risk are also older adults, who, though negative for the SARS-Cov-2 infection, suffer with a fatigue syndrome due to home restriction/quarantine. Besides eventual psycological managements, it could be useful to offer to these patients a rehabilitation workouts easy to learn and to independently repeat at home (Full-Body In-Bed Gym). Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation (FES), we suggest for this fatigue syndrome a 10–20 min long daily routine of easy and safe physical exercises that may recover from muscle weakness the main 400 skeletal muscles used for every-day activities. Leg muscles could be trained also by an adjunctive neuro-muscular electrical stimulation (NMES) in frail old persons. Many of the exercises could be performed in bed (Full-Body in-Bed Gym), thus hospitalized patients can learn this light training before leaving the hospital. Full-Body in-Bed Gym is, indeed, an extension of well-established cardiovascular-ventilation rehabilitation training performed by patients after heavy surgery. Blood pressure readings, monitored before and after daily routine of Full-Body in-Bed Gym, demonstrate a transient decrease in peripheral resistance due to increased blood flow to major body muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the fatigue syndrome related to the restrictions/quarantine imposed to the general population during the COVID-19 pandemic.
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Carraro U, Albertin G, Martini A, Giuriati W, Guidolin D, Masiero S, Kern H, Hofer C, Marcante A, Ravara B. To contrast and reverse skeletal muscle weakness by Full-Body In-Bed Gym in chronic COVID-19 pandemic syndrome. Eur J Transl Myol 2021; 31. [PMID: 33709653 PMCID: PMC8056156 DOI: 10.4081/ejtm.2021.9641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/01/2021] [Indexed: 01/30/2023] Open
Abstract
Mobility-impaired persons, either very old or younger but suffering with systemic neuromuscular disorders or chronic organ failures, spend small amounts of time for daily physical activity, contributing to aggravate their poor mobility by resting muscle atrophy. Sooner or later the limitations to their mobility enforce them to bed and to more frequent hospitalizations. We include among these patients at risk those who are negative for the SARS-COV-2 infection, but suffering with COVID-19 pandemic syndrome. Beside managements of psychological symptoms, it is mandatory to offer to the last group physical rehabilitation approaches easy to learn and self-managed at home. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation, we suggest also for chronic COVID-19 pandemic syndrome a 10-20 min long daily routine of easy and safe physical exercises that can activate, and recover from weakness, the main 400 skeletal muscles used for every-day mobility activities. Persons can do many of them in bed (Full-Body in-Bed Gym), and hospitalized patients can learn this light training before leaving the hospital. It is, indeed, an extension of well-established cardiovascular-respiratory rehabilitation training performed after heavy surgical interventions. Blood pressure readings, monitored before and after daily routine, demonstrate a transient decrease in peripheral resistance due to increased blood flow of many muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the COVID-19 pandemic syndrome.
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Affiliation(s)
- Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Italy; CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; A-C M-C Foundation for Translational Myology, Padova.
| | - Giovanna Albertin
- CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; A-C M-C Foundation for Translational Myology, Padova.
| | - Alessandro Martini
- Department of Neuroscience, University of Padova, Italy; Padova University Research Center "I Approve", University of Padov.
| | | | - Diego Guidolin
- Department of Neuroscience, Section of Human Anatomy, University of Padova.
| | - Stefano Masiero
- CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; Department of Neuroscience, Section of Rehabilitation, University of Padova.
| | - Helmut Kern
- Ludwig Boltzmann Institute for Rehabilitation Research, St. Pölten, Austria; Physiko- und Rheumatherapie, St. Pölten.
| | | | - Andrea Marcante
- UOC Recovery and Functional Rehabilitation, Lonigo Hospital, Azienda ULSS 8 Berica, Lonigo.
| | - Barbara Ravara
- Department of Biomedical Sciences, University of Padova, Italy; CIR-Myo - Interdepartmental Research Center of Myology, University of Padova, Italy; AC M-C Foundation for Translational Myology, Padova, Italy; Department of Neuroscience, Section of Human Anatomy, University of Padova.
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Carraro U, Albertin G, Martini A, Giuriati W, Guidolin D, Masiero S, Kern H, Hofer C, Marcante A, Ravara B. To contrast and reverse skeletal muscle weakness by Full-Body In-Bed Gym in chronic COVID-19 pandemic syndrome. Eur J Transl Myol 2021. [DOI: 10.4081/ejtm.2020.9641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mobility-impaired persons, either very old or younger but suffering with systemic neuromuscular disorders or chronic organ failures, spend small amounts of time for daily physical activity, contributing to aggravate their poor mobility by resting muscle atrophy. Sooner or later the limitations to their mobility enforce them to bed and to more frequent hospitalizations. We include among these patients at risk those who are negative for the SARS-COV-2 infection, but suffering with COVID-19 pandemic syndrome. Beside managements of psychological symptoms, it is mandatory to offer to the last group physical rehabilitation approaches easy to learn and self-managed at home. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based volitional exercises and functional electrical stimulation, we suggest also for chronic COVID-19 pandemic syndrome a 10–20 min long daily routine of easy and safe physical exercises that can activate, and recover from weakness, the main 400 skeletal muscles used for every-day mobility activities. Persons can do many of them in bed (Full-Body in-Bed Gym), and hospitalized patients can learn this light training before leaving the hospital. It is, indeed, an extension of well-established cardiovascular-respiratory rehabilitation training performed after heavy surgical interventions. Blood pressure readings, monitored before and after daily routine, demonstrate a transient decrease in peripheral resistance due to increased blood flow of many muscles. Continued regularly, Full-Body in-Bed Gym may help maintaining independence of frail people, including those suffering with the COVID-19 pandemic syndrome.
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18
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Plapler PG, de Souza DR, Kaziyama HHS, Battistella LR, de Barros-Filho TEP. Relationship between the coronavirus disease 2019 pandemic and immobilization syndrome. Clinics (Sao Paulo) 2021; 76:e2652. [PMID: 33567050 PMCID: PMC7847256 DOI: 10.6061/clinics/2021/e2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Pérola Grinberg Plapler
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Daniel Rubio de Souza
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Medicina de Reabilitacao (IMRea), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Helena Hideko Seguchi Kaziyama
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Linamara Rizzo Battistella
- Instituto de Medicina de Reabilitacao (IMRea), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail: /
| | - Tarcisio Eloy Pessoa de Barros-Filho
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Abstract
Background: Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult. Design: Qualitative interview study using grounded theory methodology. Setting: Single-site academic medical center. Patients: Hospitalized general medicine patients. Measurements: Interviews using a semistructured interview guide. Results: We recruited 20 general medicine inpatients from an academic medical center. Of the participants, 12 were women and the mean age was 55 years (range = 22-82 years). We found 4 major themes contributing to the hospital experience: (1) hospital environment (eg, food quality and entertainment), (2) patient factors (eg, indifference and expectations), (3) hospital personnel (eg, care team size and level of helpfulness), and (4) patient feelings (eg, level of control and feeling like an object). We discovered that these emotions arising from hospital experiences, together with the other 3 major themes, led to the patients’ perception of their hospital experience overall. We also explore the role that patient tolerance may play in the reporting of patient satisfaction. Conclusions: This article demonstrates the factors affecting how patients experience hospitalization. It provides insight into possible contributors to posthospital syndrome and offers a blueprint for specific quality improvement initiatives. Lastly, it briefly explores how patient tolerance may prove a challenge to the current system of quality reporting.
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Affiliation(s)
| | - Kathlyn E Fletcher
- Department of Internal Medicine, Medical College of Wisconsin and the Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
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Home-Based Functional Electrical Stimulation of Human Permanent Denervated Muscles: A Narrative Review on Diagnostics, Managements, Results and Byproducts Revisited 2020. Diagnostics (Basel) 2020; 10:diagnostics10080529. [PMID: 32751308 PMCID: PMC7460102 DOI: 10.3390/diagnostics10080529] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
Spinal cord injury (SCI) produces muscle wasting that is especially severe after complete and permanent damage of lower motor neurons, as can occur in complete conus and cauda equina syndrome. Even in this worst-case scenario, mass and function of permanently denervated quadriceps muscle can be rescued by surface functional electrical stimulation using a purpose designed home-based rehabilitation strategy. Early diagnostics is a key factor in the long-term success of this management. Function of quadriceps muscle was quantitated by force measurements. Muscle gross cross-sections were evaluated by quantitative color computed tomography (CT) and muscle and skin biopsies by quantitative histology, electron microscopy, and immunohistochemistry. Two years of treatment that started earlier than 5 years from SCI produced: (a) an increase in cross-sectional area of stimulated muscles; (b) an increase in muscle fiber mean diameter; (c) improvements in ultrastructural organization; and (d) increased force output during electrical stimulation. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that new trials start soon, providing patients the benefits they need.
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Rawat N, Rao V, Peven M, Shrock C, Reiter A, Saria S, Ali H. Comparison of Automated Activity Recognition to Provider Observations of Patient Mobility in the ICU. Crit Care Med 2020; 47:1232-1234. [PMID: 31162207 DOI: 10.1097/ccm.0000000000003852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare noninvasive mobility sensor patient motion signature to direct observations by physicians and nurses. DESIGN Prospective, observational study. SETTING Academic hospital surgical ICU. PATIENTS AND MEASUREMENTS A total of 2,426 1-minute clips from six ICU patients (development dataset) and 4,824 1-minute clips from five patients (test dataset). INTERVENTIONS None. MAIN RESULTS Noninvasive mobility sensor achieved a minute-level accuracy of 94.2% (2,138/2,272) and an hour-level accuracy of 81.4% (70/86). CONCLUSIONS The automated noninvasive mobility sensor system represents a significant departure from current manual measurement and reporting used in clinical care, lowering the burden of measurement and documentation on caregivers.
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Affiliation(s)
- Nishi Rawat
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vishal Rao
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | - Michael Peven
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | | | - Austin Reiter
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | - Suchi Saria
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Computer Science, Johns Hopkins University, Baltimore, MD.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Haider Ali
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
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Lima EAD, Rodrigues G, Peixoto Júnior AA, Sena RDS, Viana SMDNR, Mont’Alverne DGB. Mobility and clinical outcome of patients admitted to an intensive care unit. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.032.ao67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The hospital environment exacerbates the effects of immobility due to several exposure factors, and the functional assessment of individuals using reliable instruments is vital. Objective: To determine the relationship between functional mobility and the clinical outcome of patients admitted to an intensive care unit. Method: This is a prospective quantitative longitudinal study, approved by the institutional research ethics committee, carried out in the intensive care unit of a University Hospital. Clinical data and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were collected 24 hours after admission. The Perne Score was used to analyze patient mobility. Results: 33 patients participated, 63% female. With respect to mobility and transfers, 69.7% required total assistance from the supine to the sitting position and 70% to maintain balance, 9.1% needed minimum assistance from sitting to standing, and 100% total assistance for walking and endurance exercises. The main barriers to mobility were invasive ventilation (60%), assistive devices and intravenous infusion (100%). The following Perne Score domains were significantly associated with the outcome: mental status (p = 0.040), barriers to mobility (p = 0.016), strength (p = 0.010), mobility in bed (p = 0.024) and the total Perme Score ( p = 0.002). There were also significant associations between invasive ventilation and low Perme Scores (p = 0.000), and the Richmond Agitation-Sedation Scale (RASS) (-5 and -4) and death in 66.7% of patients (p = 0.011). The Perme Score and RASS (R = 0.745) were moderately correlated and APACHE II and Perme Score inversely moderately correlated (R = -0.526). Conclusion: Mobility assessed by the Perme Score was related to the clinical outcome and strongly associated with sedation level and patient severity.
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The Time Is Now for Early Mobility-Learning From Shared Staff Experiences and Common Staff Preconceptions to Maximize Successful Implementation. Pediatr Crit Care Med 2020; 21:108-109. [PMID: 31899758 DOI: 10.1097/pcc.0000000000002182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
OBJECTIVES Early mobility in the PICU is safe and feasible. However, PICUs continue to meet barriers to implementing early mobility. PICU providers were surveyed before and after initiating an early mobility protocol to determine perceived barriers and continued challenges in performing early mobility. DESIGN This single-center prospective study surveyed PICU providers regarding 26 potential barriers to early mobility using a five-point Likert scale. A survey was distributed 1 month prior to and 6 months after beginning an early mobility protocol. SETTING Free-standing academic tertiary care children's hospital. SUBJECTS PICU providers of various professions. INTERVENTIONS Implementation of PICU-wide early mobility protocol. MEASUREMENTS AND MAIN RESULTS Paired pre- and post-early mobility protocol implementation surveys from 97 providers were compared. System-based barriers decreased after implementation of the early mobility protocol, such as lack of guidelines (75-20%; p < 0.01), inadequate training (74-33%; p < 0.01), lack of early mobility orders (72-30%; p < 0.01), and delayed recognition of early mobility candidates (68-35%; p < 0.01). Difficulty coordinating early mobility sessions, although significantly decreased, still remained a concern for 66% of providers in the postsurvey. Lack of resources, specifically staff (85-82%; p = 0.68) and equipment (67-60%; p = 0.36), also remained significant barriers. Presence of an endotracheal tube was a barrier for only 29% of providers' post-early mobility protocol, compared with 69% prior (p < 0.01). Clinical instability remained a top concern (82-79%; p = 0.63) as well as agitation (74-67%; p = 0.23). Day shift providers, with more early mobility exposure, perceived fewer barriers compared with night shift providers. Ninety percentage of post-early mobility survey participants felt that early mobility positively impacted their patients. CONCLUSIONS Implementation of an early mobility protocol significantly changed provider perceptions regarding barriers to early mobility. Certain factors, such as staff availability, coordination difficulty, equipment shortage, and patient clinical factors, continue to be significant challenges to early mobility in the PICU population.
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Impact of Early Mobilization in the Intensive Care Unit on Psychological Issues. Crit Care Nurs Clin North Am 2019; 31:501-505. [PMID: 31685116 DOI: 10.1016/j.cnc.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Early mobilization is an intervention protocol that can be employed in the critically ill population to effectively reduce the risks and consequences normally associated with immobility in high-acuity patients. In turn, rate and quality of recovery are improved as well as overall patient outcomes. Although there are many challenges inherent to the implementation of an early mobilization program, success of such a program is achievable through structured education of staff and diligence in its application. As a result, staff and patient experience the benefits of medical treatment that addresses a patient's immediate needs without ignoring that treatment's long-term effect.
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Santos GO, Queiroz RSD, Jesus CSD, Carneiro JAO, Faria LMDA, Fernandes MH, Matos JMT. Pacientes internados em unidade de terapia intensiva que não adotam postura antigravitacional apresentam maiores chances de óbito. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17027526032019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Ainda há poucos marcadores de desempenho funcional com capacidade de predizer óbito em unidades de terapia intensiva (UTI). O objetivo do presente estudo foi identificar a associação entre a não adoção de postura antigravitacional e óbito em pacientes internados em uma UTI adulto. Trata-se de um estudo retrospectivo e analítico, realizado através da análise de prontuários. A associação entre a não adoção de postura antigravitacional e óbito foi testada por regressão logística múltipla ajustada por sexo, idade, gravidade da doença (mensurada pelo Acute Physiology and Chronic Health Classification System II [Apache II]), tempo de ventilação mecânica invasiva (VMI) e tempo de sedação. A odds ratio (OR) foi estimada com intervalo de confiança de 95%. Foram incluídos no estudo 92 pacientes sequenciais. Houve forte associação entre a não adoção de postura antigravitacional em UTI e óbito (ORajustada=37,7; IC=4,76-293; p=0,001). Conclui-se que pacientes que não adotaram postura antigravitacional durante o internamento em UTI apresentaram chances muito mais elevadas de mortalidade. Essa simples estratégia de classificação da capacidade funcional de pacientes críticos pode ser utilizada rotineiramente por equipes de saúde como uma variável simples e dicotômica de prognóstico de mortalidade em UTI.
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Rai S, Anthony L, Needham DM, Georgousopoulou EN, Sudheer B, Brown R, Mitchell I, van Haren F. Barriers to rehabilitation after critical illness: a survey of multidisciplinary healthcare professionals caring for ICU survivors in an acute care hospital. Aust Crit Care 2019; 33:264-271. [PMID: 31402265 DOI: 10.1016/j.aucc.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/04/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There is scant literature on the barriers to rehabilitation for patients discharged from the intensive care unit (ICU) to acute care wards. OBJECTIVES The objective of this study was to assess ward-based rehabilitation practices and barriers and assess knowledge and perceptions of ward clinicians regarding health concerns of ICU survivors. METHODS, DESIGN, SETTING, AND PARTICIPANTS This was a single-centre survey of multidisciplinary healthcare professionals caring for ICU survivors in an Australian tertiary teaching hospital. MAIN OUTCOME MEASURES The main outcome measures were knowledge of post-intensive care syndrome (PICS) amongst ward clinicians, perceptions of ongoing health concerns with current rehabilitation practices, and barriers to inpatient rehabilitation for ICU survivors. RESULTS The overall survey response rate was 35% (198/573 potential staff). Most respondents (66%, 126/190) were unfamiliar with the term PICS. A majority of the respondents perceived new-onset physical weakness, sleep disturbances, and delirium as common health concerns amongst ICU survivors on acute care wards. There were multifaceted barriers to patient mobilisation, with inadequate multidisciplinary staffing, lack of medical order for mobilisation, and inadequate physical space near the bed as common institutional barriers and patient frailty and cardiovascular instability as the commonly perceived patient-related barriers. A majority of the surveyed ward clinicians (66%, 115/173) would value education on health concerns of ICU survivors to provide better patient care. CONCLUSION There are multiple potentially modifiable barriers to the ongoing rehabilitation of ICU survivors in an acute care hospital. Addressing these barriers may have benefits for the ongoing care of ICU survivors.
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Affiliation(s)
- Sumeet Rai
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia.
| | - Lakmali Anthony
- Australian National University Medical School, Canberra, Australia
| | - Dale M Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA; John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | | | - Bindu Sudheer
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian Catholic University, Watson, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia
| | - Frank van Haren
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; University of Canberra, Bruce, Canberra, Australia
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Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial. Pediatr Crit Care Med 2019; 20:540-550. [PMID: 30707210 PMCID: PMC7112470 DOI: 10.1097/pcc.0000000000001881] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN Randomized controlled trial. SETTING Three tertiary care PICUs in the United States. PATIENTS Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. INTERVENTIONS Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). MEASUREMENTS AND MAIN RESULTS Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized (n = 26) and usual care groups (n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects (p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 (p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 (p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 (p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 (p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 (p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p < 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. CONCLUSIONS A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.
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Bruce R, Forry C. Integrating a Mobility Champion in the Intensive Care Unit. Dimens Crit Care Nurs 2018; 37:201-209. [PMID: 29847431 DOI: 10.1097/dcc.0000000000000306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In recent years, early progressive mobilization programs have become mainstays in intensive care units (ICUs). Significant evidence exists that early mobility programs decrease length of stay, reduce time on the ventilator, and decrease the development of delirium in ICU patients. Yet, current literature still describes many barriers to performing early mobility, such as the time required, staffing pressures, and increased workload. Our critical care leaders found that defining and implementing a dedicated mobility champion team member was successful in improving the effectiveness of our early mobility program. This article describes how to define the mobility champion role, consider options for the person in the role, and integrate this new role into the ICU team.
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Affiliation(s)
- Rose Bruce
- Rose Bruce, MSN, RN, ACNS-BC, CCRN, PCCN, is a critical care clinical nurse specialist at Legacy Health Systems. Cheryl Forry, MSN, RN, is a nurse manager at ICU/IMCU, Legacy Salmon Creek Medical Center
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31
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Improving Outcomes for Critically Ill Cardiovascular Patients Through Increased Physical Therapy Staffing. Arch Phys Med Rehabil 2018; 100:270-277.e1. [PMID: 30172645 DOI: 10.1016/j.apmr.2018.07.437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the effect of increasing physical therapy (PT) staff in a cardiovascular intensive care unit (CVICU) on temporal measures of PT interventions and on outcomes important to patients and hospitals. DESIGN Retrospective pre/post subgroup analysis from a quality improvement initiative. SETTING Academic medical center. PARTICIPANTS Cardiovascular patients in either a baseline (N=52) or quality improvement period (N=62) with a CVICU length of stay (LOS) ≥7 days and use of any one of the following: mechanical ventilation, continuous renal replacement therapy, or mechanical circulatory support. INTERVENTIONS The 6-month quality improvement initiative increased CVICU-dedicated PT staff from 2 to 4. MAIN OUTCOME MEASURES Changes in physical therapy delivery were examined using the frequency and daily duration of PT intervention. Post-CVICU LOS was the primary outcome. CVICU LOS, mobility change, and discharge level of care were secondary outcomes. A secondary analysis of hospital survivors was also conducted. RESULTS Compared to those in the baseline period, cardiovascular patients in the quality improvement period participated in PT for an additional 9.6 minutes (95% confidence interval [CI]: 1.9, 17.2) per day for all patients and 15.1 minutes (95% CI: 7.6, 22.6) for survivors. Post-CVICU LOS decreased 2.2 (95% CI: -6.0, 1.0) days for all patients and 2.6 days (95% CI: -5.3, 0.0) for survivors. CVICU LOS decreased 3.6 days (95% CI: -6.4, -0.8) for all patients and 3.1 days (95% CI: -6.4, -0.9) for survivors. Differences in mobility change and discharge level of care were not significant. CONCLUSIONS Additional CVICU-dedicated PT staff was associated with increased PT treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors.
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U C, G A, P G, B R, F P, S Z, H K, Pond A. Muscle and skin improve by home-based FES and full-body in-bed gym. ACTA ACUST UNITED AC 2018; 3. [PMID: 30820477 PMCID: PMC6390968 DOI: 10.15761/bem.1000s1003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
All progressive muscle contractile impairments, including advanced age-related muscle power decline, need permanent management. Most elderly persons, in particular octogenarians, spend small amounts of time in daily physical activity, resulting in a decline in body condition with more and more frequent hospitalizations and finally potentially forcing them to bed permanently. Further several neurological injuries, which are even more acutely debilitating than those problems related to aging, are responsible for early limitation of mobility. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based functional electrical stimulation (h-bFES) in both elderly and SCI patients, we suggest that the elderly and early aging patients participate in hbFES and add a 20 min daily routine of 12 easy and safe physical exercises, namely home-based Full-Body In-Bed Gym. Continued regularly, h-bFES and the Full-Body In-Bed Gym will help to maintain the independence of frail older people and may reduce the risks of serious consequences of accidental falls and pressure sore complications.
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Affiliation(s)
- Carraro U
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Italy.,A&C M-C Foundation for Translational Myology, Padova, Italy.,IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
| | - Albertin G
- Section of Anatomy, Department of Neuroscience, University of Padova, Italy
| | - Gargiulo P
- Institute for Biomedical and Neural Engineering/Biomedical Technology Centre Reykjavik University and Landspitali, Reykjavik, Iceland
| | - Ravara B
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Italy.,A&C M-C Foundation for Translational Myology, Padova, Italy
| | - Piccione F
- IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
| | - Zampieri S
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Italy.,Physiko- und Rheumatherapie, St. Poelten, Austria
| | - Kern H
- Physiko- und Rheumatherapie, St. Poelten, Austria
| | - Amber Pond
- Anatomy Department, Southern Illinois University School of Medicine, Carbondale, Il, USA
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van Mol M, Ista E, van Dijk M. Implementation and evaluation of a follow-up programme after intensive care treatment: A practice development project. Intensive Crit Care Nurs 2018; 49:6-13. [PMID: 29730086 DOI: 10.1016/j.iccn.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/04/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to measure the effects of a newly developed follow-up programme on intensive care unit patient quality of care, as perceived by their relatives, and the appropriateness of the programme according to nurses. METHODS AND SETTING This before and after implementation study was conducted in a level III intensive care unit for adult patients and related follow-up wards and included 135 intensive care nurses and 105 general ward nurses. The implemented programme included a personalised poster, a revised discharge protocol and follow-up visits on the ward. Eligible relatives of patients who had remained in the intensive care for a minimum of 48 hours were included. MAIN OUTCOME MEASURES AND RESULTS Total quality of care and communication were assessed by relatives as high according to the Quality Monitor. Most intensive care nurses evaluated the usefulness of the discharge protocol as positive (71.8% partly/totally agreed) and in accordance with the patients' needs (82.1% partly/totally agreed). CONCLUSION Communication and general support as perceived by patients' relatives improved; however, no influence on the total quality of care of the revised discharge protocol was shown. Nurses considered the programme as useful. The intervention might enable nurses to better respond to the instrumental and affective needs of patients and their relatives.
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Affiliation(s)
- Margo van Mol
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Erwin Ista
- Department of Intensive Care Children, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Carraro U. Exciting perspectives for Translational Myology in the Abstracts of the 2018Spring PaduaMuscleDays: Giovanni Salviati Memorial - Chapter IV - Abstracts of March 17, 2018. Eur J Transl Myol 2018; 28:7366. [PMID: 30057728 PMCID: PMC6047882 DOI: 10.4081/ejtm.2018.7366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 02/08/2023] Open
Abstract
Myologists working in Padua (Italy) were able to continue a half-century tradition of studies of skeletal muscles, that started with a research on fever, specifically if and how skeletal muscle contribute to it by burning bacterial toxin. Beside main publications in high-impact-factor journals by Padua myologists, I hope to convince readers (and myself) of the relevance of the editing Basic and Applied Myology (BAM), retitled from 2010 European Journal of Translational Myology (EJTM), of the institution of the Interdepartmental Research Center of Myology of the University of Padova (CIR-Myo), and of a long series of International Conferences organized in Euganei Hills and Padova, that is, the PaduaMuscleDays. The 2018Spring PaduaMuscleDays (2018SpPMD), were held in Euganei Hills and Padua (Italy), in March 14-17, and were dedicated to Giovanni Salviati. The main event of the “Giovanni Salviati Memorial”, was held in the Aula Guariento, Accademia Galileiana di Scienze, Lettere ed Arti of Padua to honor a beloved friend and excellent scientist 20 years after his premature passing. Using the words of Prof. Nicola Rizzuto, we all share his believe that Giovanni “will be remembered not only for his talent and originality as a biochemist, but also for his unassuming and humanistic personality, a rare quality in highly successful people like Giovanni. The best way to remember such a person is to gather pupils and colleagues, who shared with him the same scientific interests and ask them to discuss recent advances in their own fields, just as Giovanni have liked to do”. Since Giovanni’s friends sent many abstracts still influenced by their previous collaboration with him, all the Sessions of the 2018SpPMD reflect both to the research aims of Giovanni Salviati and the traditional topics of the PaduaMuscleDays, that is, basics and applications of physical, molecular and cellular strategies to maintain or recover functions of skeletal muscles. The translational researches summarized in the 2018SpPMD Abstracts are at the appropriate high level to attract endorsement of Ethical Committees, the interest of International Granting Agencies and approval for publication in top quality international journals. The abstracts of the presentations of the March 16, 2018 Padua Muscle Day and those of the remaining Posters are listed in this chapter IV. The Author Index of the 2018Spring PaduaMuscleDays follows at page 78.
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Affiliation(s)
- Ugo Carraro
- Laboratory of Translational Myology, Department of Biomedical Sciences, University of Padova.,A&C M-C Foundation for Translational Myology, Padova.,IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
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Carraro U, Gava K, Baba A, Marcante A, Piccione F. To Contrast and Reverse Skeletal Muscle Atrophy by Full-Body In-Bed Gym, a Mandatory Lifestyle for Older Olds and Borderline Mobility-Impaired Persons. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1088:549-560. [PMID: 30390269 DOI: 10.1007/978-981-13-1435-3_25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Older olds, that is octogenarians, spend small amounts of time for daily physical activity, contributing to aggravate their independence limitations up to force them to bed and to more and more frequent hospitalizations. All progressive muscle contractile impairments, including advanced age-related muscle power decline, need permanent management. Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based functional electrical stimulation and guided by common sense, we suggested to older olds a 15-30 min daily routine of 12 easy and safe physical exercises. Since persons can do many of them in bed (full-body in-bed gym), hospitalized elderly can continue this kind of light training that is an extension of the well-established cardiovascular-ventilation rehabilitation before and after admission. Monitoring arterial blood pressure before and after the daily routine demonstrates that peripheral resistance decreases in a few minutes by the functional hyperemia of the trained body muscles. Continued regularly, full-body in-bed gym helps to maintain the independence of frail older people and may reduce the risks of serious consequences of accidental falls.
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Affiliation(s)
- Ugo Carraro
- Interdepartmental Research Center of Myology (CIR-Myo), Department of Biomedical Science, University of Padova, Padova, Italy. .,A&C M-C Foundation for Translational Myology, Padova, Italy. .,IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy.
| | | | - Alfonc Baba
- IRCCS Fondazione Ospedale San Camillo, Venezia-Lido, Italy
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Engaging Survivors of Critical Illness in Health Care Assessment and Policy Development. Ethical and Practical Complexities. Ann Am Thorac Soc 2017; 13:1871-1876. [PMID: 27574861 DOI: 10.1513/annalsats.201606-497oi] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Health systems, granting agencies, and professional societies are increasingly involving patients and their family members in the delivery of health care and the improvement of health sciences. This is a laudable advance toward fully patient-centered medicine. However, patient engagement is not a simple matter, either practically or ethically. The complexities include (1) the physical limitations that patients and their family members may have, from traveling to meetings to special dietary needs; (2) the emotional sensitivities patients and their families might experience-from distress at discussions of disease prognosis, outcomes, and therapies to being inexperienced at public speaking; and (3) the fact that advocacy efforts by patients and family members, which may be encouraged at the national level, may threaten individual professionals providing care to individual patients and may result in risk to patients. In this article, a patient-physician and patient-bioethicist set out the obstacles, including ones that they have encountered in their own advocacy efforts. The aim is to survey the practical and ethical landscape so that solutions to various problems may be identified and solved as we move forward in our efforts to involve patients and their families in research, policy, and quality improvement in critical care medicine.
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Betters KA, Hebbar KB, Farthing D, Griego B, Easley T, Turman H, Perrino L, Sparacino S, deAlmeida ML. Development and implementation of an early mobility program for mechanically ventilated pediatric patients. J Crit Care 2017; 41:303-308. [PMID: 28821360 DOI: 10.1016/j.jcrc.2017.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Early mobility (EM) is being used in adult ICUs in an effort to treat and prevent intensive care unit acquired weakness (ICU-AW) and Post-Intensive Care Syndrome (PICS). Data supports children suffer from ICU-AW and PICS as well. Our objective was to create and implement an EM protocol for pediatric patients receiving invasive mechanical ventilation. METHODS A multidisciplinary EM committee was formed to create and implement an EM protocol in a quarternary care PICU. A quality database was used to prospectively monitor patient tolerance of EM sessions and for serious adverse events, defined as unplanned extubation, hemodynamic instability, loss of central venous line, loss of arterial line, displacement of ECMO cannula, or cardiopulmonary arrest. RESULTS Between December 2013 and October 2016, 74 patients received EM for a total of 130 unique sessions. No serious adverse events occurred. Two patients had an oxygen desaturation episode during mobility that resolved with ventilator modifications, and one patient had nasogastric tube displacement during mobility. CONCLUSIONS Early mobility is attainable in a quaternary care PICU population without serious adverse events, using a multidisciplinary approach and appropriate staff education. Further research is needed to understand the physical and neurocognitive benefits of EM in children.
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Affiliation(s)
- Kristina A Betters
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322, United States; Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States.
| | - Kiran B Hebbar
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322, United States; Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - David Farthing
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Brittany Griego
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Tricia Easley
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Hartley Turman
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Lauren Perrino
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Stephanie Sparacino
- Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
| | - Mary L deAlmeida
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA 30322, United States; Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, United States
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