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Istanboulian L, Dale C, Terblanche E, Rose L. Clinician-perceived barriers and facilitators for the provision of actionable processes of care important for persistent or chronic critical illness. J Adv Nurs 2024; 80:1619-1629. [PMID: 37902117 DOI: 10.1111/jan.15924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
AIM To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness. DESIGN Qualitative descriptive interview study. METHODS Secondary analysis of semi-structured telephone interviews (December 2018 - February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model. RESULTS We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Community-level barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator. CONCLUSION Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness. IMPACT Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness. REPORTING METHOD Consolidated criteria for reporting qualitative studies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Laura Istanboulian
- Michael Garron Hospital, Toronto, Canada
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing and Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ella Terblanche
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Jackson D, Aveyard H, Commodore-Mensah Y, Dale C, Noyes J, Smith GD, Sharps P, Timmins F, Yu D. The future is ours to shape: Nursing emerging from the pandemic with insight, optimism and courage. J Adv Nurs 2024; 80:1-3. [PMID: 37165794 DOI: 10.1111/jan.15706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Debra Jackson
- Susan Wakil School of Nursing, University of Sydney, Sydney, Australia
| | - Helen Aveyard
- School of Nursing, Oxford Brookes University, Oxford, UK
| | | | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | | | - Phyllis Sharps
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, UK
| | - Doris Yu
- LKS Faculty of Medicine, School of Nursing, The University of Hong Kong, Hong Kong, China
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Katsoulis M, Lai AG, Kipourou DK, Gomes M, Banerjee A, Denaxas S, Lumbers RT, Tsilidis K, Kostara M, Belot A, Dale C, Sofat R, Leyrat C, Hemingway H, Diaz-Ordaz K. On the estimation of the effect of weight change on a health outcome using observational data, by utilising the target trial emulation framework. Int J Obes (Lond) 2023; 47:1309-1317. [PMID: 37884665 PMCID: PMC10663146 DOI: 10.1038/s41366-023-01396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND/OBJECTIVES When studying the effect of weight change between two time points on a health outcome using observational data, two main problems arise initially (i) 'when is time zero?' and (ii) 'which confounders should we account for?' From the baseline date or the 1st follow-up (when the weight change can be measured)? Different methods have been previously used in the literature that carry different sources of bias and hence produce different results. METHODS We utilised the target trial emulation framework and considered weight change as a hypothetical intervention. First, we used a simplified example from a hypothetical randomised trial where no modelling is required. Then we simulated data from an observational study where modelling is needed. We demonstrate the problems of each of these methods and suggest a strategy. INTERVENTIONS weight loss/gain vs maintenance. RESULTS The recommended method defines time-zero at enrolment, but adjustment for confounders (or exclusion of individuals based on levels of confounders) should be performed both at enrolment and the 1st follow-up. CONCLUSIONS The implementation of our suggested method [adjusting for (or excluding based on) confounders measured both at baseline and the 1st follow-up] can help researchers attenuate bias by avoiding some common pitfalls. Other methods that have been widely used in the past to estimate the effect of weight change on a health outcome are more biased. However, two issues remain (i) the exposure is not well-defined as there are different ways of changing weight (however we tried to reduce this problem by excluding individuals who develop a chronic disease); and (ii) immortal time bias, which may be small if the time to first follow up is short.
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Affiliation(s)
- M Katsoulis
- MRC Unit for Lifelong Health and Ageing, Institute of Cardiovascular Science, University College London, London, UK.
| | - A G Lai
- Institute of Health Informatics, University College London, London, UK
| | - D K Kipourou
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- AstraZeneca, London, UK
| | - M Gomes
- Department of Applied Health Research, University College London, London, UK
| | - A Banerjee
- Institute of Health Informatics, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - S Denaxas
- Institute of Health Informatics, University College London, London, UK
- Alan Turing Institute, London, UK
| | - R T Lumbers
- Institute of Health Informatics, University College London, London, UK
| | - K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - A Belot
- Inequalities in Cancer Outcomes Network, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - C Dale
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - R Sofat
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - C Leyrat
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - H Hemingway
- Institute of Health Informatics, University College London, London, UK
| | - K Diaz-Ordaz
- Dept of Statistical Science, Faculty of Maths & Physical Sciences, University College London, London, UK
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Istanboulian L, Rose L, Yunusova Y, Dale C. Adapting co-design methodology to a virtual environment: co-designing a communication intervention for adult patients in critical care. Res Involv Engagem 2023; 9:103. [PMID: 37957776 PMCID: PMC10644625 DOI: 10.1186/s40900-023-00514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Research co-design is recommended to reduce misalignment between researcher and end-user needs and priorities for healthcare innovation. Engagement of intensive care unit patients, clinicians, and other stakeholders in co-design has historically relied upon face-to-face meetings. Here, we report on our co-design processes for the development of a bundled intensive care unit patient communication intervention that used exclusively virtual meeting methods in response to COVID-19 pandemic social distancing restrictions. METHODS We conducted a series of virtual co-design sessions with a committee of stakeholder participants recruited from a medical-surgical intensive care unit of a community teaching hospital in Toronto, Canada. Published recommendations for co-design methods were used with exclusively virtual adaptations to improve ease of stakeholder participation as well as the quality and consistency of co-design project set-up, facilitation, and evaluation. Virtual adaptations included the use of email for distributing information, videos, and electronic evaluations as well as the use of a videoconferencing platform for synchronous meetings. We used a flexible meeting plan including asynchronous virtual methods to reduce attendance barriers for time-constrained participants. RESULTS Co-design participants included a patient and a family member (n = 2) and professionally diverse healthcare providers (n = 9), plus a facilitator. Overall, participants were engaged and reported a positive experience with the virtually adapted co-design process. Reported benefits included incorporation of diverse viewpoints in the communication intervention design and implementation plan. Challenges related to lack of hands-on time during development of the co-designed intervention and participant availability to meet regularly albeit virtually. CONCLUSIONS This report describes the methods, benefits, and challenges of adapting in-person co-design methods to a virtual environment to produce a bundled communication intervention for use in the adult intensive care unit during the COVID-19 pandemic. Adapting recommended co-design methods to a virtual environment can provide further opportunities for stakeholder participation in intervention design.
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Affiliation(s)
- Laura Istanboulian
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 288 Church St., Toronto, M5B 1Z5, Canada.
- Michael Garron Hospital, 825 Coxwell Ave., Toronto, M4C 3E7, Canada.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
- Department of Critical Care and the Lane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, 500 University Ave. #160, Toronto, M5G 1V7, Canada
- KITE: Toronto Rehabilitation Institute, University Health Network, 550 University Ave., Toronto, M5G 2A2, Canada
- Harvitz Brain Sciences Program, Sunnybrook Research Institute Wellness Way, Toronto, M4N 3M5, Canada
| | - Craig Dale
- Tory Trauma Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, M4N 3M5, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, M5T 1P8, Canada
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Istanboulian L, Rose L, Yunusova Y, Dale C. Mixed-method acceptability evaluation of a co-designed bundled intervention to support communication for patients with an advanced airway in the intensive care unit during a pandemic. Nurs Crit Care 2023; 28:1069-1077. [PMID: 35878874 DOI: 10.1111/nicc.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although bundled communication interventions are recommended to address communication barriers for patients with an advanced airway in the intensive care unit (ICU) such interventions have not been evaluated in pandemic conditions. AIM To evaluate the acceptability, appropriateness, and feasibility of a co-designed bundled intervention to support communication with adult patients with an advanced airway in ICU in pandemic conditions. STUDY DESIGN Prospective, convergent mixed method design in a single centre medical-surgical ICU in Toronto, Canada between September 2021-March 2022. After the use of the co-designed bundled communication intervention quantitative data were collected from health care providers using validated acceptability, appropriateness, and feasibility measures and analysed using descriptive statistics. Qualitative data were collected from providers, patients and families using semi-structured interviews and analysed using content analysis applying the theoretical framework of acceptability. Joint table analysis enabled the integration of the two data sets. RESULTS A total of 64 (41.3%) HCPs responded to the survey: 54 (84.4%) rated the intervention acceptable; 55 (85.9%) appropriate; and 49 (76.6%) feasible for use in this context. Qualitative data (23 interviews: 13 healthcare providers, 6 families and 4 patients) and the joint table analysis extended the understanding that intervention acceptability was related to positive affective attitudes and reduced communication frustration. Appropriateness and feasibility were promoted through intervention alignment with values, ability to personalize tools, and ease of access. Recommendations to improve the acceptability included adaptation for immobilized and/or restrained patients, additional education, and integration into existing workflows. CONCLUSIONS This mixed method evaluation of a co-designed bundled intervention to support patient communication in the ICU during pandemic conditions demonstrated high rated and described acceptability, appropriateness, and feasibility by participants. RELEVANCE TO CLINICAL PRACTICE A co-designed communication intervention demonstrating stakeholder acceptability, appropriateness, and feasibility can be implemented into clinical practice in pandemic and other infection prevention and control contexts.
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Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Prolonged-Ventilation Weaning Centre for Excellence and Long-Term Ventilation, Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Harvitz Brain Sciences Program, Sunnybrook Research Institute Wellness Way, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Bérubé M, Côté C, Gagnon MA, Moore L, Tremblay L, Turgeon AF, Evans D, Berry G, Turcotte V, Belzile ÉL, Dale C, Orrantia E, Verret M, Dercksen J, Martel MO, Dupuis S, Chatillon CE, Lauzier F. Interdisciplinary strategies to prevent long-term and detrimental opioid use following trauma: a stakeholder consensus study. Pain Med 2023; 24:933-940. [PMID: 36944264 PMCID: PMC10391591 DOI: 10.1093/pm/pnad037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations. DESIGN A consensus study using the nominal group technique. SETTING Four trauma systems in Canada. SUBJECTS Participants included expert clinicians and decision makers, and people with lived experience. METHODS Participants had to discuss the relevance and implementation of 15 strategies and then rank them using a 7-point Likert scale. Implementation considerations were identified through a synthesis of discussions. RESULTS A total of 41 expert stakeholders formed the nominal groups. Overall, eight strategies were favored: 1) using multimodal approach for pain management, 2) professional follow-up in physical health, 3) assessment of risk factors for opioid misuse, 4) physical stimulation, 5) downward adjustment of opioids based on patient recovery, 6) educational intervention for patients, 7) training offered to professionals on how to prescribe opioids, and 8) optimizing communication between professionals working in different settings. Discussions with expert stakeholders revealed the rationale for the selected strategies and identified issues to consider when implementing them. CONCLUSION This stakeholder consensus study identified, for further scientific study, a set of interdisciplinary strategies to promote appropriate opioid use following traumatic injuries. These strategies could ultimately decrease the burden associated with long-term opioid use.
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Affiliation(s)
- Mélanie Bérubé
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
| | - Caroline Côté
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Faculty of Nursing, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
| | - Marc-Aurèle Gagnon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Social Preventive Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
| | - Lorraine Tremblay
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
| | - David Evans
- Department of Surgery, University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | - Greg Berry
- Departement of Orthopaedic Surgery, McGill University Health Centre, Montréal, Quebec H3G 1A4, Canada
| | - Valérie Turcotte
- Department of Nursing, CIUSSS du Nord-de-l’île-de-Montréal, Montréal, Quebec H4J 1C5, Canada
| | - Étienne L Belzile
- Department of Surgery, Division of Orthopeadic Surgery, CHU de Québec-Université Laval, Québec City, Quebec GIV 1Z4, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario M5T 1P8, Canada
- University of Toronto Centre for the Study of Pain (UTCSP), Toronto, Ontario M5T 1P8, Canada
| | - Eli Orrantia
- Marathon Family Health Team, Marathon, Ontario P0T 2E0, Canada
| | - Michael Verret
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Judy Dercksen
- Quesnel Primary Care Clinic, Quesnel, British Columbia V2J 2K8, Canada
| | - Marc-Olivier Martel
- Quebec Pain Research Network, Sherbrooke, Quebec J1H 5N4, Canada
- Faculty of Medicine & Dentistry, McGill University, Montréal, Quebec H3A 1G1, Canada
| | - Sébastien Dupuis
- Department of Pharmacy, CIUSSS du Nord-de-l’île-de-Montréal,Montréal, Quebec H4J 1C5, Canada
| | - Claude-Edouard Chatillon
- Division of Neurosurgery, CIUSSS de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Quebec G9A 5C5, Canada
| | - François Lauzier
- CHU de Québec-Université Laval Research Centre, Population Health and Optimal Practices Research Unit Research Unit (Trauma—Emergency—Critical Care Medicine), Québec City, Quebec G1V 0A6, Canada
- Department of Medicine, Université Laval, Québec City, Quebec G1V 0A6, Canada
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Alostaz Z, Rose L, Mehta S, Johnston L, Dale C. Physical restraint practices in an adult intensive care unit: A prospective observational study. J Clin Nurs 2023; 32:1163-1172. [PMID: 35194883 DOI: 10.1111/jocn.16264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To conduct a diagnostic evaluation of physical restraint practice using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. BACKGROUND Evidence indicates that physical restraints are associated with adverse physical, emotional and psychological sequelae and do not consistently prevent intensive care unit (ICU) patient-initiated device removal. Nevertheless, physical restraints continue to be used extensively in ICUs both in Canada and internationally. Implementation science frameworks have not been previously used to diagnose, develop and guide the implementation of restraint minimisation interventions. DESIGN A prospective observational study of restrained patients in a 20-bed, academic ICU in Toronto, Canada. METHODS Data collection methods included patient observation, electronic medical record review, and verbal check with the point-of-care nurses. Data were collected pertaining to framework domains of unit culture (restraint application/removal), evaluation capacity (documentation) and leadership (rounds discussion). The reporting of this study followed the STROBE guidelines. RESULTS A total of 102 restrained patients, 67 (66%) male and mean age 58 years (SD 1.92), were observed. All observed devices were wrist restraints. Restraint application and removal time was verified in 83 and 57 of 102 patients respectively. At application, 96.4% were mechanically ventilated and 71% sedated/unarousable. Nurses confirmed 71% were prophylactically restrained; 7.2% received restraint alternatives. Restraint removal occurred after interprofessional team rounds (87%), during daytime (79%) and following extubation (52.6%). Of the 923 discrete patient observation of physical restraint use, 691 (75%) were not documented. Of the 30 daytime interprofessional team rounds reviewed, physical restraint was discussed at 3 (10%). CONCLUSION In this single-centre study, a culture of prophylactic physical restraint was observed. Future facilitation of restraint minimisation warrants theoretically informed implementation strategies including leadership involvement to advance interprofessional collaboration. RELEVANCE TO CLINICAL PRACTICE The findings draw attention to the importance of a preliminary diagnostic study of the context prior to designing, and implementing, a physical restraint minimisation intervention.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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Webster F, Connoy L, Sud A, Rice K, Katz J, Pinto AD, Upshur R, Dale C. Chronic Struggle: An Institutional Ethnography of Chronic Pain and Marginalization. J Pain 2023; 24:437-448. [PMID: 36252618 DOI: 10.1016/j.jpain.2022.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
There have been several recent calls to re-think chronic pain in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often fail to offer a critical theoretical understanding of social and structural inequities. To truly rethink pain, we must also reconsider suffering, beginning in the everyday expert knowledge of people with chronic pain who can offer insights in relation to their bodies and also the organization of the social circumstances in which they live. Our team undertook a sociological approach known as institutional ethnography (IE) to explicate the work of people in managing lives beset by chronic pain and the inequities that stem from marginalization. In keeping with our critical paradigm, we describe participant accounts as situated, rather than lived, to de-emphasize the individual in favour of the social and relational. Through our analysis, we offer a new concept of chronic struggle to capture how pain, illness, economic deprivation, and suffering constitute a knot of experience that people living with chronic pain are obliged to simplify in order to fit existing logics of medicine. Our goal is to identify the social organization of chronic pain care which underpins experience in order to situate the social as political rather than medical or individual. PERSPECTIVE: This article explicates the health work of people living with chronic pain and marginalization, drawing on their situated experience. We offer the concept of chronic struggle as a conceptualization that allows us to bring into clear view the social organization of chronic pain in which the social is visible as political and structural rather than medical or individual.
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Affiliation(s)
- Fiona Webster
- Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Laura Connoy
- Arthur Labatt School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Abhimanyu Sud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Humber River Hospital, Toronto, Ontario, Canada
| | - Kathleen Rice
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health, Toronto, Ontario, Canada
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Smyth SJ, Dale C, Tully E, Breathnach FM. In Pursuit of Consensus - A National Review of Gestational Diabetes. Ir Med J 2023; 116:11. [PMID: 36916799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Cook S, Munteanu C, Papadopoulos E, Abrams H, Stinson JN, Pitters E, Stephens D, Lumchick M, Emmenegger U, Koneru R, Papadakos J, Shahrokni A, Durbano S, Menjak I, Mehta R, Haase K, Jang R, Krzyzanowska MK, Dale C, Jones J, Lemonde M, Alibhai S, Puts M. The development of an electronic geriatric assessment tool: Comprehensive health assessment for my plan (CHAMP). J Geriatr Oncol 2023; 14:101384. [PMID: 36216760 DOI: 10.1016/j.jgo.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Geriatric assessment (GA) provides information on key health domains of older adults and is recommended to help inform cancer treatment decisions and cancer care. However, GA is not feasible in many health institutions due to lack of geriatric staff and/or resources. To increase accessibility to GA and improve treatment decision making for older adults with cancer (≥65 years), we developed a self-reported, electronic geriatric assessment tool: Comprehensive Assessment for My Plan (CHAMP). MATERIALS AND METHODS Older adults with cancer were invited to join user-centered design sessions to develop the layout and content of the tool. Subsequently, they participated in usability testing to test the usability of the tool (ease of use, acceptability, etc.). Design sessions were also conducted with oncology clinicians (oncologists and nurses) to develop the tool's clinician interface. GA assessment questions and GA recommendations were guided by a systematic review and Delphi expert panel. RESULTS A total of seventeen older adults participated in the study. Participants were mainly males (82.4%) and 75% were aged 75 years and older. Nine oncology clinicians participated in design sessions. Older adults and clinicians agreed that the tool was user-friendly. Domains in the final CHAMP tool (with questions and recommendations) included functional status, falls risk, cognitive impairment, nutrition, medication review, social supports, depression, substance use disorder, and miscellaneous items. DISCUSSION CHAMP was designed for use by older adults and oncologists and may enhance access to GA for older adults with cancer. The next phase of the CHAMP study will involve field validation in oncology clinics.
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Affiliation(s)
- Simon Cook
- Technologies for Aging Gracefully Lab, University of Toronto, Toronto, Canada
| | - Cosmin Munteanu
- Technologies for Aging Gracefully Lab, University of Toronto, Toronto, Canada
| | | | - Howard Abrams
- Openlab, Toronto General Hospital, University Health Network, Toronto, Canada; Department of Medicine, University Health Network, University of Toronto, Canada
| | - Jennifer N Stinson
- Research Institute, The Hospital for Sick Children, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | | | | - Urban Emmenegger
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rama Koneru
- Department of Medical Oncology, R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, Ontario, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Armin Shahrokni
- Department of Geriatrics and Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, United States of America
| | - Sara Durbano
- Openlab, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Ines Menjak
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rajin Mehta
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kristen Haase
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Raymond Jang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Jennifer Jones
- ELLICSR: Health, Wellness and Cancer Survivorship Centre, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Shabbir Alibhai
- Department of Medicine, University Health Network, University of Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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11
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Nayfeh A, Conn LG, Dale C, Kratina S, Hales B, Das Gupta T, Chakraborty A, Taggar R, Fowler R. The effect of end-of-life decision-making tools on patient and family-related outcomes of care among ethnocultural minorities: A systematic review. PLoS One 2022; 17:e0272436. [PMID: 35925996 PMCID: PMC9352046 DOI: 10.1371/journal.pone.0272436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background End-of-life decision-making tools are used to establish a shared understanding among patients, families and healthcare providers about medical treatment and goals of care. This systematic review aimed to understand the availability and effect of end-of-life decision-making tools on: (i) goals of care and advance care planning; (ii) patient and/or family satisfaction and well-being; and (iii) healthcare utilization among racial/ethnic, cultural, and religious minorities. Methods A search was conducted in four electronic databases (inception to June 2021). Articles were screened for eligibility using pre-specified criteria. We focused on adult patients (aged ≥18 years) and included primary research articles that used quantitative, qualitative, and mixed-methods designs. Complementary quality assessment tools were used to generate quality scores for individual studies. Extracted data were synthesized by outcome measure for each type of tool, and an overall description of findings showed the range of effects. Results Among 14,316 retrieved articles, 37 articles were eligible. We found that advance care planning programs (eleven studies), healthcare provider-led interventions (four studies), and linguistically-tailored decision aids (three studies) increased the proportion of patients documenting advance care plans. Educational tools (three studies) strongly reduced patient preferences for life-prolonging care. Palliative care consultations (three studies) were strongly associated with do-not-resuscitate orders. Advance care planning programs (three studies) significantly influenced the quality of patient-clinician communication and healthcare provider-led interventions (two studies) significantly influenced perceived patient quality of life. Conclusion This review identified several end-of-life decision-making tools with impact on patient and family-related outcomes of care among ethnocultural minorities. Advance care planning programs, healthcare provider-led interventions and decision aids increased documentation of end-of-life care plans and do-not-resuscitate orders, and educational tools reduced preferences for life-prolonging care. Further research is needed to investigate the effect of tools on healthcare utilization, and with specific patient population subgroups across different illness trajectories and healthcare settings.
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Affiliation(s)
- Ayah Nayfeh
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Craig Dale
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sarah Kratina
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brigette Hales
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tracey Das Gupta
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Ru Taggar
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Fowler
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- H. Barrie Fairley Professor of Critical Care at the University Health Network, Toronto, Ontario, Canada
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Istanboulian L, Rose L, Yunusova Y, Dale C. Barriers to and facilitators for supporting patient communication in the adult ICU during the COVID-19 pandemic: A qualitative study. J Adv Nurs 2022; 78:2548-2560. [PMID: 35266178 PMCID: PMC9111498 DOI: 10.1111/jan.15212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Michael Garron Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Yana Yunusova
- Department of Speech Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Harvitz Brain Sciences Program, Sunnybrook Research Institute Wellness Way, Toronto, Ontario, Canada
| | - Craig Dale
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Wasilewski MB, Kokorelias KM, Nonoyama M, Dale C, McKim DA, Road J, Leasa D, Tandon A, Goldstein R, Rose L. The experience of family caregivers of ventilator-assisted individuals who participated in a pilot web-based peer support program: A qualitative study. Digit Health 2022; 8:20552076221134964. [DOI: 10.1177/20552076221134964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/05/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Family caregivers play an important role supporting the day-to-day needs of ventilator-assisted individuals (VAIs) living at home. Peer-to-peer communication can help support these caregivers and help them sustain caregiving in the community. Online peer-support has been suggested as a way to help meet caregivers’ support needs. Methods A qualitative descriptive approach was used to elicit the perspectives of support received from caregivers who participated in a pilot web-based peer support program from October to December 2018. Data were collected through the transcripts of weekly online peer-to-peer group chats. Data were analyzed using an integration of thematic and framework analysis. Results In total, eight caregivers and five peer mentors participated in the pilot. All five mentors and four of the caregivers participated in the weekly chats. We identified three themes, a) The experience of caregivers is characterized by unique challenges related to the complexity of VAI care including technology; b) Mentors and caregiver participants reciprocally share support; c) Despite hardships, there are things that make caregiving easier and joyful. Discussion Our results add to the growing body of evidence pointing to the importance of online communities for supporting vulnerable caregivers. The reciprocal element of peer support, where trained mentors and untrained participants both benefit from support, can help sustain peer-support interventions. Despite the challenges of providing care to a VAI, there are facilitators that may help ease the caregiving experience and caregivers can benefit from ongoing support that is tailored to their needs along the caregiving trajectory.
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Affiliation(s)
- Marina B. Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kristina M. Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mika Nonoyama
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Douglas A McKim
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeremy Road
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Leasa
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anu Tandon
- Division of Respiratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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14
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Alostaz Z, Rose L, Mehta S, Johnston L, Dale C. Implementation of nonpharmacologic physical restraint minimization interventions in the adult intensive care unit: A scoping review. Intensive Crit Care Nurs 2021; 69:103153. [PMID: 34920932 DOI: 10.1016/j.iccn.2021.103153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions. METHODOLOGY A scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains. RESULTS Seven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported. CONCLUSION Restraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Mount Sinai Hospital, 600 University Ave, Rm 18-216, Toronto, ON, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Suite 130, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
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15
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Rose L, Allum LJ, Istanboulian L, Dale C. Actionable processes of care important to patients and family who experienced a prolonged intensive care unit stay: Qualitative interview study. J Adv Nurs 2021; 78:1089-1099. [PMID: 34704627 DOI: 10.1111/jan.15083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
AIM To use positive deviance to identify actionable processes of care that may improve outcomes and experience from the perspectives of prolonged intensive care unit (ICU) stay survivors and family members. DESIGN Prospective qualitative interview study in two geographically distant settings: Canada (2018/19) and the United Kingdom (2019/20). METHODS Patient and family participant inclusion criteria comprised: aged over 18 years, ICU stay in last 2 years of over 7 days, able to recall ICU stay and provided informed consent. We conducted semi-structured in-person or telephone interviews. Data were analysed using a positive deviance approach. RESULTS We recruited 29 participants (15 Canadian; 14 UK). Of these, 11 were survivors of prolonged ICU stay and 18 family members. We identified 22 actionable processes (16 common to Canadian and UK participants, 4 Canadian only and 2 UK only). We grouped processes under three themes: physical and functional recovery (nine processes), patient psychological well-being (seven processes) and family relations (six processes). Most commonly identified physical/functional processes were regular physiotherapy, and fundamental hygiene and elimination care. For patient psychological well-being: normalizing the environment and routines, and alleviating boredom and loneliness. For family relations: proactive communication, flexible family visiting and presence with facilities for family. Our positive deviance analysis approach revealed that incorporation of these actionable processes into clinical practice was the exception as opposed to the norm perceived driven by individual acts of kindness and empathy as opposed to standardized processes. CONCLUSION Actionable processes of care important to prolonged ICU stay survivors and family members differ from those frequently used in ICU quality improvement (QI) tools. IMPACT Our study emphasizes the need to develop QI tools that standardize delivery of actionable processes important to patients and families experiencing a prolonged ICU stay. As the largest healthcare professional group, nurses can play an essential role in leading this.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Laura J Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Laura Istanboulian
- Michael Garron Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing and Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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16
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Nayfeh A, Yarnell CJ, Dale C, Conn LG, Hales B, Gupta TD, Chakraborty A, Pinto R, Taggar R, Fowler R. Evaluating satisfaction with the quality and provision of end-of-life care for patients from diverse ethnocultural backgrounds. BMC Palliat Care 2021; 20:145. [PMID: 34535122 PMCID: PMC8449427 DOI: 10.1186/s12904-021-00841-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022] Open
Abstract
Background Recently immigrated and ethnic minority patients in Ontario, Canada are more likely to receive aggressive life-prolonging treatment at the end of life in comparison to other patients. To explore this finding further, this survey-based observational study aimed to evaluate satisfaction with the quality of end-of-life care for patients from diverse ethnocultural backgrounds. Methods The End-of-Life Satisfaction Survey was used to measure satisfaction with the quality of inpatient end-of-life care from the perspective of next-of-kin of recently deceased patients at Sunnybrook Health Sciences Centre in Toronto, Ontario (between March 2012 to May 2019). The primary outcome was the global rating of satisfaction. Associations with patient ethnicity, patient religion, level of religiosity/spirituality, language/communication barriers, and location of death were assessed using univariable and multivariable modified Poisson regression. Secondary outcomes included differences in satisfaction and rates of dying in intensive care units (ICU) among patient population subgroups, and identification of high priority areas for quality-of-care improvement. Results There were 1,543 respondents. Patient ethnicities included Caucasian (68.2%), Mediterranean (10.5%), East Asian (7.6%), South Asian (3.5%), Southeast Asian (2.1%) and Middle Eastern (2.0%); religious affiliations included Christianity (66.6%), Judaism (12.3%) and Islam (2.1%), among others. Location of death was most commonly in ICU (38.4%), hospital wards (37.0%) or long-term care (20.0%). The mean(SD) rating of satisfaction score was 8.30(2.09) of 10. After adjusting for other covariates, satisfaction with quality of end-of-life care was higher among patients dying in ICU versus other locations (relative risk [RR] 1.51, 95%CI 1.05-2.19, p=0.028), lower among those who experienced language/communication barriers (RR 0.49 95%CI 0.23-1.06, p=0.069), and lower for Muslim patients versus other religious affiliations (RR 0.46, 95%CI 0.21-1.02, p=0.056). Survey items identified as highest priority areas for quality-of-care improvement included communication and information giving; illness management; and healthcare provider characteristics such as emotional support, doctor availability and time spent with patient/family. Conclusion Satisfaction with quality-of-care at the end of life was higher among patients dying in ICU and lower among Muslim patients or when there were communication barriers between families and healthcare providers. These findings highlight the importance of measuring and improving end-of-life care across the ethnocultural spectrum. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00841-z.
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Affiliation(s)
- Ayah Nayfeh
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, Ontario, M5T 3M7, Canada.
| | - Christopher J Yarnell
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, Ontario, M5T 3M7, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Sinai, Health Systems, Toronto, ON, Canada
| | - Craig Dale
- Sunnybrook Research Institute, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, Ontario, M5T 3M7, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | | | - Ru Taggar
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,H. Barrie Fairley Professorship of Critical Care at the University Health Network, Toronto, ON, Canada
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Lee J, Dale C, Acharya S, Shathur A. Brackets response. Br Dent J 2021; 230:495-496. [PMID: 33893403 PMCID: PMC8063162 DOI: 10.1038/s41415-021-2970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Pawluk DL, Dale C, Lai JY, Villacorta-Siegal N, Smith J, Joseph K, Lawrence HP. The impact of oral health education taken by personal support workers caring for a geriatric population in a long-term care facility: A mixed-methods study. Gerodontology 2021; 38:373-386. [PMID: 33529440 DOI: 10.1111/ger.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of an online oral health education module on personal support workers' (PSW) knowledge and beliefs in their care for long-term care (LTC) residents in one Canadian LTC residence. BACKGROUND LTC residents are dependent on PSWs for their oral health needs. However, PSWs receive minimal to no oral health education placing residents at risk for poor oral health. METHODS A mixed-methods convergent design comprising a before-and-after questionnaire (N = 88), focus groups (N = 23) and interviews (N = 4) exploring module learning. Analysis of each data set was followed by their amalgamation and comparison. RESULTS The online module had limited impact on the PSWs' knowledge and beliefs regarding resident oral health care. The quantitative results demonstrated knowledge improvements in two domains and changes in two belief domains. However, the qualitative results demonstrated new knowledge was not developed or sustained in practice. Themes that emerged include the following: lack of module recall, unmet learning needs and methods for oral care delivery, and timing of oral care in a busy clinical environment. CONCLUSION Online oral health education alone has limited impact on PSWs' knowledge and beliefs. Research evaluating multifaceted education interventions including hands-on training with a dental expert is warranted.
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Affiliation(s)
- Debra L Pawluk
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jim Yuan Lai
- Periodontology, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | | | | | - Karen Joseph
- Kunin-Lunenfeld Centre for Applied Research and Evaluation, Baycrest, Toronto, ON, Canada
| | - Herenia P Lawrence
- Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
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20
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Sadlers V, Dale C, Anderson E, Thursfield. R. WS03.6 Referral pathway to the genetics service for families of paediatric patients newly diagnosed with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Joshi R, Hingorani A, Engmann J, Dale C, Gaunt T, Jefferis B, Lawlor D, Price J, Papacosta O, Shah T, Tillin T, Chaturvedi N, Kivimaki M, Kuh D, Kumari M, Hughes A, Whincup P, Casas J, Humphries S, Schmidt A, Wannamethee S. Establishing reference intervals for triglyceride containing lipoprotein sub-fraction metabolites measured using nuclear magnetic resonance spectroscopy in a UK population. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Grundy Q, Cussen C, Dale C. Constructing a problem and marketing solutions: A critical content analysis of the nature and function of industry-authored oral health educational materials. J Clin Nurs 2020; 29:4697-4707. [PMID: 32979871 DOI: 10.1111/jocn.15510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To document the nature of industry-authored educational materials focused on oral health; and analyse how they construct the relationships between nurses and industry. BACKGROUND Nurses frequently rely on pharmaceutical and medical device companies for continuing education. However, industry-sponsored education is a key aspect of multi-faceted promotional campaigns and may introduce bias into clinical decision-making. DESIGN Critical qualitative content analysis reported according to the COREQ checklist. METHODS We purposively sampled educational documents from the websites of 4 major manufacturers of oral health products for acute care. Two researchers analysed each document using an open-ended coding form. We conducted an interpretive analysis using inductive coding methods. RESULTS We included 63 documents that emphasised the importance of education in the form of training, expert guidance, evidence syntheses and protocols to support oral care practices. Industry promoted its relationship with nursing as an oral health authority through three dominant messages: (1) Pneumonia is a source of morbidity, mortality and treatment costs, which informed nurses about a critical problem; (2) Comprehensive oral care reduces pneumonia risk, which instructed nurses about product-oriented solutions; and (3) Frequent oral care is important, which emphasised compliance to standardised protocols. These messages formed an accountability logic that prompted clinicians to address a problem for which the company's products served as a solution. In doing so, industry validated dominant administrative concerns including compliance, while promoting product uptake. CONCLUSIONS Industry-authored educational materials may promote industry interests, rather than nursing or patient agendas. Dependence on industry's information and product solutions may have unintended, negative consequences for nursing practice. RELEVANCE TO CLINICAL PRACTICE Though industry's educational materials present as convenient, helpful and evidence-based, they may serve to redirect care processes in ways that reinforce company goals rather than clinical priorities. Nurses should seek independent sources of continuing education where possible.
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Affiliation(s)
- Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Cliodna Cussen
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Dale C, Webster F. Need caring, compassion or comfort? Sorry, I’m a doctor. CMAJ 2020; 192:E687. [DOI: 10.1503/cmaj.75183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Istanboulian L, Rose L, Yunusova Y, Gorospe F, Dale C. Barriers to and facilitators for use of augmentative and alternative communication and voice restorative devices in the adult intensive care unit: a scoping review protocol. Syst Rev 2019; 8:311. [PMID: 31810494 PMCID: PMC6896663 DOI: 10.1186/s13643-019-1232-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mechanically ventilated patients in the intensive care unit (ICU) experience profound communication impairment, placing them at risk for poor physical and psychological outcomes. Patient communication strategies such as augmentative and alternative communication (AAC) and voice restorative devices are recommended to facilitate communication. These strategies, however, are inconsistently adopted in ICU practice signaling utilization barriers. Our objective is to map and synthesize the current evidence-base for stakeholder-reported barriers and facilitators to patient communication strategy utilization for adults with an advanced airway in the ICU. METHODS AND ANALYSIS We will use Arskey and O'Malley's recommended methods to conduct a scoping review using a rapid review framework to streamline the process. A single reviewer will conduct a search and an initial screen of titles and abstracts from five electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and PsychInfo) from 1990 to present to identify English language peer-reviewed studies. Subsequently, two reviewers will independently screen a shorter list of studies for inclusion. We will also search the reference lists of eligible studies. Two reviewers will independently extract study characteristics, communication strategy, and stakeholder reported barriers and facilitators. We will code and categorize the extracted barriers and facilitators according to the Theoretical Domains Framework (TDF), an integrative framework of behavior change. DISCUSSION To our knowledge, this will be the first scoping review to map and synthesize reported barriers and facilitators to communication strategy utilization in the adult ICU using a theoretical framework. The results of this scoping review will help to identify trends and gaps in the current evidence-base and support recommendations for improving patient-centered practice, policy, and research related to successfully establishing ICU patient communication.
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Affiliation(s)
- Laura Istanboulian
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, 57 Waterloo Rd, Lambeth, London, SE1 8WA, UK
| | - Yana Yunusova
- Department of Speech and Language Pathology, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1 V7, Canada
| | - Franklin Gorospe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
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Gorospe F, Istanboulian L, Puts M, Wong D, Lee E, Dale C. Identifying and mapping biopsychosocial factors associated with pain in adults with advanced liver disease: protocol for a scoping review. BMJ Open 2019; 9:e033064. [PMID: 31719094 PMCID: PMC6858197 DOI: 10.1136/bmjopen-2019-033064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Pain is highly prevalent in the adult population diagnosed with liver disease. Those progressing to advanced liver disease often experience persistent pain and poor pain relief. There is presently limited guidance for the management of pain and associated symptoms in this population. The current literature lacks attention on how physical, psychological and social domains of liver disease modulate the pain experience. In this paper, we outline our scoping review protocol to systematically review the literature from academic bibliographic databases and grey sources to identify and map the biopsychosocial factors associated with pain in adults with advanced liver disease. METHODS AND ANALYSIS Arksey and O'Malley's methodology, and Tricco et al's Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, will guide the process for this scoping review. The literature search will include electronic and hand-searching methods using scholarly and grey sources. Scholarly databases include Medline, Embase, Allied and Complementary Medicine and Cumulative Index to Nursing and Allied Health Literature. Grey databases will focus on research studies not captured in the scholarly databases including those by government agencies and professional organisations. Two members of the research team will independently screen the resulting publications following specific inclusion and exclusion criteria. Quality appraisal of the included research studies will employ the use of the Mixed Methods Appraisal Tool version 2018. Data collection and extraction of study characteristics will use a data extraction tool developed iteratively by the research team. Analysis of the factors associated with pain outcomes will be mapped and described according to the domains of the biopsychosocial model of pain. ETHICS AND DISSEMINATION The scoping review involves analysis of the published literature on pain and advanced liver disease and does not require ethics approval. The results will be shared with expert stakeholders to help establish clinical significance. We will disseminate the findings through publication in a scholarly journal: local, provincial, national and international scientific and professional conferences. PROSPERO REGISTRATION NUMBER CRD42019135677.
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Affiliation(s)
- Franklin Gorospe
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Perioperative Services, Toronto General Hospital - University Health Network, Toronto, Ontario, Canada
| | - Laura Istanboulian
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Acute Inpatient Respiratory Unit, Toronto East Health Network - Michael Garron Hospital, Toronto, Ontario, Canada
| | - Martine Puts
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - David Wong
- Hepatology Division, Toronto General Hospital - University Health Network, Toronto, Ontario, Canada
| | - Elizabeth Lee
- Hepatology Division, Toronto General Hospital - University Health Network, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Dale C, Burrows E, McCormack P, Woodland C, Southern K. P052 An audit of the management of newborn screened infants at the Liverpool paediatric cystic fibrosis centre. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Webster F, Rice K, Katz J, Bhattacharyya O, Dale C, Upshur R. An ethnography of chronic pain management in primary care: The social organization of physicians' work in the midst of the opioid crisis. PLoS One 2019; 14:e0215148. [PMID: 31042733 PMCID: PMC6493733 DOI: 10.1371/journal.pone.0215148] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 03/27/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study reports on physicians' experiences with chronic pain management. For over a decade prescription opioids have been a primary treatment for chronic pain in North America. However, the current opioid epidemic has complicated long-standing practices for chronic pain management which historically involved prescribing pain medication. Caring for patients with chronic pain occurs within a context in which a growing proportion of patients suffer from chronic rather than acute conditions alongside rising social inequities. METHODS Our team undertook an ethnographic approach known as institutional ethnography in the province of Ontario, Canada in order to explore the social organization of chronic pain management from the standpoint of primary care physicians. This paper reports on a subset of this study data, specifically interviews with 19 primary care clinicians and 8 nurses supplemented by 40 hours of observations. The clinicians in our sample were largely primary care physicians and nurses working in urban, rural and Northern settings. FINDINGS In their reflections on providing care for patients with chronic pain, many providers describe being most challenged by the work involved in helping patients who also struggled with poverty, mental health and addiction. These frustrations were often complicated by concerns that they could lose their license for inappropriate prescribing, thus shifting their work from providing treatment and care to policing their patients for malingering and opioid abuse. INTERPRETATION Our findings show that care providers find the treatment of patients with chronic pain-especially those patients also experiencing poverty-to be challenging at best, and at worst frustrating and overwhelming. In many instances, their narratives suggested experiences of depersonalization, loss of job satisfaction and emotional exhaustion in relation to providing care for these patients, key dimensions of burnout. In essence, the work that they performed in relation to their patients' social rather than medical needs seems to contribute to these experiences. Their experiences were further exacerbated by the fact that restricting and reducing opioid dosing in patients with chronic pain has become a major focus of care provision.
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Affiliation(s)
- Fiona Webster
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Kathleen Rice
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Toronto, ON, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Wasilewski MB, Nonoyama M, Dale C, McKim DA, Road J, Leasa D, Goldstein R, Rose L. Development of a Web-Based Peer Support Program for Family Caregivers of Ventilator-Assisted Individuals Living in the Community: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11827. [PMID: 30724737 PMCID: PMC6386648 DOI: 10.2196/11827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/24/2018] [Accepted: 11/01/2018] [Indexed: 01/27/2023] Open
Abstract
Background Across Europe, Canada, Australia, and the United States, the prevalence of home mechanical ventilation (HMV) prevalence is 6.6-12.9 per 100,000. At-home ventilator-assisted individuals (VAIs) are often vulnerable and highly comorbid, requiring complex care. In Canada, most VAI care is provided by family, leading to poor health-related quality of life and increased caregiver burden. No supportive interventions or peer support programs are tailored to VAI caregivers. Owing to the financial, geographic, and time limitations, Web-based support delivery may especially meet VAI family caregiver needs. We have developed a peer mentor training and Web-based peer support program for VAI caregivers including information-sharing, peer-to-peer communication, and peer mentorship. Objective Study Stage 1 aims to (1) evaluate the face and content validity of the peer mentor training program and (2) investigate participant satisfaction. Study Stage 2 aims to evaluate (1) the feasibility of participant recruitment and Web-based program delivery; (2) acceptability, usability, and satisfactoriness; (3) experiences of caregivers and peer mentors with the Web-based peer support program; and (4) effect of the Web-based peer support program on caregiver health outcomes. Methods Study Stage 1: We will train 7 caregivers to act as peer mentors for the Web-based peer support program trial; they will complete questionnaires rating the utility of individual training sessions and the training program overall. Study Stage 2: We will recruit 30 caregiver peers for a pilot randomized controlled trial of the 12-week Web-based peer support program using a waitlist control; the program includes private chat, a public discussion forum, and weekly moderated chats. Caregiver peers will be randomized to the intervention or waitlist control group using a 1:1 ratio using Randomize.net. Both groups will complete pre- and postintervention health outcome questionnaires (ie, caregiving impact, mastery, coping, personal gain, positive affect, and depression). Caregiver peers in the intervention arm will only complete a program evaluation and will be invited to participate in an interview to provide insight into their experience. Peer mentors will be invited to participate in a Web-based focus group to provide insight into their experience as mentors. We will judge the feasibility per the number of recruitment and program delivery goals met, use analysis of covariance to compare health outcomes between intervention and control groups, and analyze qualitative data thematically. Results Peer mentor training was completed with 5 caregivers in July 2018. To date, 2 caregivers have beta-tested the website, and the Web-based peer support program trial will commence in September 2018. Results are expected by early 2019. Conclusions This study will result in the production and initial evaluation of a rigorously developed, evidence- and stakeholder-informed Web-based peer training and peer support program for caregivers of VAIs residing at home. International Registered Report Identifier (IRRID) PRR1-10.2196/11827
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Affiliation(s)
- Marina B Wasilewski
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mika Nonoyama
- Faculty of Health Sciences, University of the Ontario Institute of Technology, Oshawa, ON, Canada
| | - Craig Dale
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Douglas A McKim
- Rehabilitation and Sleep Laboratory, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jeremy Road
- The Lung Centre, Vancouver General Hospital, Vancouver, BC, Canada
| | - David Leasa
- London Health Sciences Centre, London, ON, Canada
| | | | - Louise Rose
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, ON, Canada
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Joshi R, Wannamethee G, Rhodes D, Engmann J, Dale C, Gaunt T, Jefferis B, Papacosta O, Shah T, Tillin T, Wong A, Chaturvedi N, Kivimaki M, Kuh D, Kumari M, Hughes A, Ben-Shlomo Y, Casas JP, Hingorani AD, Schmidt AF. P15 TRIGLYCERIDE-CONTAINING LIPOPROTEIN SUB-FRACTIONS AND CORONARY HEART DISEASE AND STROKE RISK. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy216.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rose L, Istanboulian L, Smith OM, Silencieux S, Cuthbertson BH, Amaral ACKB, Fraser I, Grey J, Dale C. Feasibility of the electrolarynx for enabling communication in the chronically critically ill: The EECCHO study. J Crit Care 2018; 47:109-113. [PMID: 29945066 DOI: 10.1016/j.jcrc.2018.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/29/2018] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators. METHODS We included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction. Interviews explored barriers/facilitators. MEASUREMENTS AND MAIN RESULTS We recruited 24 participants (Jan2015-Dec2016). Mean (SD) intelligibility was 45%(18%) words correct: 57%(21%) when facing. Mean comprehension difficulty was 6.4(2.0) overall, indicating moderate difficulty (5.5(2.5) scored visualizing). Mean EES was 2.9(1.0) (3 = improved lip-reading through recognizable sounds). Anxiety decreased from median 3.8 to 2.0 (P = .007). Communication was rated easier (median 15 vs 12, P = .04) whereas satisfaction remained similar (P = .06). Facilitators included device friendliness, patient independence, and word intelligibility. Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility. CONCLUSION The electrolarynx may aid intelligible speech for some tracheostomized patients if the communication partner can visualize the users face, and reduce anxiety and make patient perceived communication easier.
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Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada; Michael Garron Hospital, 825 Coxwell Ave, Toronto M4C 3E7, Canada; Kings College London, 57 Waterloo Bridge Rd, London.
| | | | - Orla M Smith
- St. Michael's Hospital, 30 Bond St, Toronto M5B 1W8, Canada; Li Ka Shing Knowledge Institute, 209 Victoria St., Toronto M5B 1T8, Canada
| | | | - Brian H Cuthbertson
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada
| | - Andre Carlos Kajdacsy-Balla Amaral
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada
| | - Ian Fraser
- University of Toronto, 155 College St, Toronto M5T 1P8, Canada; Michael Garron Hospital, 825 Coxwell Ave, Toronto M4C 3E7, Canada
| | - Joanne Grey
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada
| | - Craig Dale
- Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, 2075 Bayview Ave, Toronto M4N 3M5, Canada; University of Toronto, 155 College St, Toronto M5T 1P8, Canada
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Mehmood S, Dale C, Parry M, Snead C, Valiante TA. Predictive coding: A contemporary view on the burden of normality and forced normalization in individuals undergoing epilepsy surgery. Epilepsy Behav 2017; 75:110-113. [PMID: 28843211 DOI: 10.1016/j.yebeh.2017.06.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 06/11/2017] [Indexed: 12/21/2022]
Abstract
Following epilepsy surgery, a good psychosocial outcome is not necessarily contingent on a good seizure outcome. Increasingly, it is believed that "successful" surgery is a combination of both an acceptable and expected seizure status as well as the individual's perception of improvements in quality of life (QOL). The factors that create this optimal outcome remain an ongoing area of research in the epilepsy community. That being said, there have been some major breakthroughs in observing and understanding poor outcomes seen in a subset of postoperative patients with epilepsy. Characteristics of burden of normality and forced normalization are two phenomena that have been evident in cases of poor postoperative outcomes. In this review, we provide a summary of research and concepts used to explain these poor QOL outcomes for a seemingly successful surgery and suggest a contemporary view in understanding the mechanism of forced normalization through understanding the brain as a predictive organ. Using such a predictive coding model together with recommendations of other studies, we suggest the crucial need for a preoperative intervention addressing patient predictions and expectations to optimize on the benefits achievable through epilepsy surgery.
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Affiliation(s)
- Sumayya Mehmood
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Carter Snead
- Division of Neurology, Departments of Medicine, Paediatrics and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Taufik A Valiante
- Krembil Research Institute, Toronto Western Hospital (TWH), Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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Burdess JS, Gallacher BJ, Grigg HT, Hu ZX, Dale C, Keegan N, Hedley J, Fu C, Spoors J. The theory of a trapped degenerate mode resonator. J Acoust Soc Am 2017; 141:4622. [PMID: 28679255 DOI: 10.1121/1.4986648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Resonance based biosensors are used in the detection of biological molecules for medical diagnostics. Sensing in a liquid environment is very desirable for this application, but presents a significant challenge for resonators based upon conventional technologies. In this paper, the major originality lies in the development and exposition of a fundamental theory enabling design of an original elastic resonant sensor whose modes are engineered to simultaneously possess three separate but complementary dynamical properties: namely, (1) in-plane displacement of the free interface whereby the SH waves are uncoupled from the SV and P waves; (2) intrinsic modal trapping; and finally, (3) cyclic symmetry and modal degeneracy. The modal trapping is due to the physical configuration of the resonator resulting in an imaginary wavenumber for one region of the resonator. The wave will be evanescent in this region and propagating elsewhere. The fundamental principles are elucidated, and analytical techniques are presented that facilitate the efficient design of this unique class of device.
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Affiliation(s)
- J S Burdess
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - B J Gallacher
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - H T Grigg
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - Z X Hu
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - C Dale
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - N Keegan
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - J Hedley
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - C Fu
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
| | - J Spoors
- Newcastle University, Newcastle, Tyne and Waer NE1 7RU, United Kingdom
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Rose L, Istanboulian L, Allum L, Burry L, Dale C, Hart N, Kydonaki C, Ramsay P, Pattison N, Connolly B. Patient- and family-centered performance measures focused on actionable processes of care for persistent and chronic critical illness: protocol for a systematic review. Syst Rev 2017; 6:84. [PMID: 28416020 PMCID: PMC5392946 DOI: 10.1186/s13643-017-0476-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/06/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Approximately 5 to 10% of critically ill patients transition from acute critical illness to a state of persistent and in some cases chronic critical illness. These patients have unique and complex needs that require a change in the clinical management plan and overall goals of care to a focus on rehabilitation, symptom relief, discharge planning, and in some cases, end-of-life care. However, existing indicators and measures of care quality, and tools such as checklists, that foster implementation of best practices, may not be sufficiently inclusive in terms of actionable processes of care relevant to these patients. Therefore, the aim of this systematic review is to identify the processes of care, performance measures, quality indicators, and outcomes including reports of patient/family experience described in the current evidence base relevant to patients with persistent or chronic critical illness and their family members. METHODS Two authors will independently search from inception to November 2016: MEDLINE, Embase, CINAHL, Web of Science, the Cochrane Library, PROSPERO, the Joanna Briggs Institute and the International Clinical Trials Registry Platform. We will include all study designs except case series/reports of <10 patients describing their study population (aged 18 years and older) using terms such as persistent critical illness, chronic critical illness, and prolonged mechanical ventilation. Two authors will independently perform data extraction and complete risk of bias assessment. Our primary outcome is to determine actionable processes of care and interventions deemed relevant to patients experiencing persistent or chronic critical illness and their family members. Secondary outcomes include (1) performance measures and quality indicators considered relevant to our population of interest and (2) themes related to patient and family experience. DISCUSSION We will use our systematic review findings, with data from patient, family member and clinician interviews, and a subsequent consensus building process to inform the development of quality metrics and tools to measure processes of care, outcomes and experience for patients experiencing persistent or chronic critical illness and their family members. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016052715.
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Affiliation(s)
- Louise Rose
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON Canada
- Lawrence S. Bloomberg Faculty of Nursing and Interdepartmental Division of Critical Care Medicine, University of Toronto, 155 College St. Suite 276, Toronto, ON Canada
- Provincial Centre of Weaning Excellence, Michael Garron Hospital, 825 Coxwell Ave, East York, ON M4C 3E7 Canada
- Lane Fox Respiratory Unit, St Thomas’s Hospital, Guy’s and St Thomas’s NHS Foundation Trust, Westminster Bridge Rd, London, UK
| | - Laura Istanboulian
- Provincial Centre of Weaning Excellence, Michael Garron Hospital, 825 Coxwell Ave, East York, ON M4C 3E7 Canada
| | - Laura Allum
- Lane Fox Respiratory Unit, St Thomas’s Hospital, Guy’s and St Thomas’s NHS Foundation Trust, Westminster Bridge Rd, London, UK
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, Mount Sinai Hospital, University of Toronto, 600 University Ave, Rm 18-377, Toronto, ON Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St. Rm 286, Toronto, ON Canada
| | - Nicholas Hart
- Lane Fox Respiratory Unit, St Thomas’s Hospital, Guy’s and St Thomas’s NHS Foundation Trust, Westminster Bridge Rd, London, UK
- Respiratory and Critical Care Medicine Department of Asthma, Allergy, and Respiratory Science Division of Asthma, Allergy and Lung Biology, King’s College London, London, UK
| | - Claire Kydonaki
- Adult Nursing, School of Health & Social Care, Teaching Fellow of the Academy of Higher Education, Edinburgh Napier University, Sighthill Campus, Sighthill Court, rm 3.b46, Edinburgh, Scotland EH11 4BN
| | - Pam Ramsay
- Nursing Studies, Edinburgh Napier University, Sighthill Campus, Sighthill Court, room rm 3B.45, Edinburgh, Scotland EH11 4BN
| | - Natalie Pattison
- The Royal Marsden NHS Foundation Trust, Dovehouse DB3, Fulham Rd, London, SW36J UK
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, Westminster Bridge Rd, London, UK
- Guy’s and St. Thomas’ NHS Foundation and King’s College London NIHR Biomedical Research Centre, London, UK
- Centre for Human and Aerospace Physiological Sciences, King’s College London, London, UK
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Sibbern T, Bull Sellevold V, Steindal SA, Dale C, Watt-Watson J, Dihle A. Patients’ experiences of enhanced recovery after surgery: a systematic review of qualitative studies. J Clin Nurs 2017; 26:1172-1188. [DOI: 10.1111/jocn.13456] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Tonje Sibbern
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
| | | | - Simen A Steindal
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
- Lovisenberg Diaconal University College; Oslo Norway
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto ON Canada
| | - Alfhild Dihle
- Diakonhjemmet University College; Institute of Nursing and Health; Oslo Norway
- Oslo and Akershus University College of Applied Sciences; Oslo Norway
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Rose L, Dale C, Smith OM, Burry L, Enright G, Fergusson D, Sinha S, Wiesenfeld L, Sinuff T, Mehta S. A mixed-methods systematic review protocol to examine the use of physical restraint with critically ill adults and strategies for minimizing their use. Syst Rev 2016; 5:194. [PMID: 27871314 PMCID: PMC5117692 DOI: 10.1186/s13643-016-0372-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/01/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Critically ill patients frequently experience severe agitation placing them at risk of harm. Physical restraint is common in intensive care units (ICUs) for clinician concerns about safety. However, physical restraint may not prevent medical device removal and has been associated with negative physical and psychological consequences. While professional society guidelines, legislation, and accreditation standards recommend physical restraint minimization, guidelines for critically ill patients are over a decade old, with recommendations that are non-specific. Our systematic review will synthesize evidence on physical restraint in critically ill adults with the primary objective of identifying effective minimization strategies. METHODS Two authors will independently search from inception to July 2016 the following: Ovid MEDLINE, CINAHL, Embase, Web of Science, Cochrane Library, PROSPERO, Joanna Briggs Institute, grey literature, professional society websites, and the International Clinical Trials Registry Platform. We will include quantitative and qualitative study designs, clinical practice guidelines, policy documents, and professional society recommendations relevant to physical restraint of critically ill adults. Authors will independently perform data extraction in duplicate and complete risk of bias and quality assessment using recommended tools. We will assess evidence quality for quantitative studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and for qualitative studies using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) guidelines. Outcomes of interest include (1) efficacy/effectiveness of physical restraint minimization strategies; (2) adverse events (unintentional device removal, psychological impact, physical injury) and associated benefits including harm prevention; (3) ICU outcomes (ventilation duration, length of stay, and mortality); (4) prevalence, incidence, patterns of use including patient and treatment characteristics and chemical restraint; (5) barriers and facilitators to minimization; (6) patient, family, and healthcare professional perspectives; (7) professional society-endorsed recommendations; and (8) evidence gaps and research priorities. DISCUSSION We will use our systematic review findings to produce updated guidelines on physical restraint use for critically ill adults and to develop a professional society-endorsed position statement. This will foster patient and clinician safety by providing clinicians, administrators, and policy makers with a tool to promote minimal and safe use of physical restraint for critically ill adults. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015027860.
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Affiliation(s)
- Louise Rose
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, M4N 3M5, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, M5T 1P8, Canada. .,Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, M4N 3M5, Canada. .,Provincial Centre of Weaning Excellence, Michael Garron Hospital, 825 Coxwell Ave, East York, M4C 3E7, Canada.
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, M5T 1P8, Canada
| | - Orla M Smith
- Department of Critical Care, Nursing/Clinical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, M5S 3M2, Canada.,Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada
| | - Glenn Enright
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, M5T 1P8, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 500 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, K1H 8M5, Canada
| | - Samir Sinha
- Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada.,Faculty of Medicine, University of Toronto Medical Sciences Building, 1 King's College Cir #3172, Toronto, M5S 1A8, Canada.,Department of Family and Community Medicine, 500 University Ave, Toronto, M5G 1V7, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | | | - Tasnim Sinuff
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, M4N 3M5, Canada.,Faculty of Medicine, University of Toronto Medical Sciences Building, 1 King's College Cir #3172, Toronto, M5S 1A8, Canada
| | - Sangeeta Mehta
- Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada.,Faculty of Medicine, University of Toronto Medical Sciences Building, 1 King's College Cir #3172, Toronto, M5S 1A8, Canada
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Horsley A, Maitra A, Gilchrist F, Shawcross A, Cunningham S, Jones A, Smith J, Dale C. WS15.3 Rapid and portable multiple breath washout (MBW) measurements for clinical application of lung clearance index (LCI). J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Doran Z, Shankar R, Keezer MR, Dale C, McLean B, Kerr MP, Devapriam J, Craig J, Sander JW. Managing anti-epileptic drug treatment in adult patients with intellectual disability: a serious conundrum. Eur J Neurol 2016; 23:1152-7. [DOI: 10.1111/ene.13016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Z. Doran
- Cornwall Partnership NHS Foundation Trust; Cornwall UK
| | - R. Shankar
- Cornwall Partnership NHS Foundation Trust; Cornwall UK
- Exeter Medical School; Truro UK
| | - M. R. Keezer
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
| | - C. Dale
- Cornwall Partnership NHS Foundation Trust; Cornwall UK
| | | | | | - J. Devapriam
- Leicestershire Partnership NHS Trust; Leicester UK
| | - J. Craig
- Belfast Health and Social Care Trust; Belfast UK
| | - J. W. Sander
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- Epilepsy Society; Chalfont St Peter Buckinghamshire UK
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Pedrelli P, Shapero B, Archibald A, Dale C. Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings. Curr Addict Rep 2016; 3:91-97. [PMID: 27162708 DOI: 10.1007/s40429-016-0084-0] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Alcohol Use Disorder (AUD) and alcohol misuse are common among adolescents and young adults and are associated with significant personal and societal problems. Similarly, Major Depressive Disorder (MDD) and depressive symptoms are prevalent in this population and when they co-occur with alcohol misuse lead to even more severe consequences. Numerous studies have investigated the association between depressive symptoms, AUD and various drinking behaviors presenting an unclear picture. In this review we summarize studies among adolescents and young adults that have examined these relationships. From this review it emerges that several factors affect results, including study design (cross-sectional vs longitudinal), participants' age (adolescents vs young adults), severity of problems considered (AUD vs heavy drinking; MDD vs depressive symptoms), and gender. Adolescents with AUD are at higher risk for MDD in particular at a younger age. During adolescence, several drinking behaviors, including weekly alcohol use and heavy drinking, increase the risk for depressive symptoms and MDD, while during young adulthood primarily AUD, but not other drinking behaviors, is associated with increased risk for MDD. Gender may have an effect on the association between depression and drinking behaviors but its role is still unclear. Some evidence suggests that the association between AUD and MDD is bidirectional such that mood problems contribute to the onset of alcohol problems and vice-versa. More longitudinal studies are needed to examine these associations in young adults and to clarify the effect of gender on these associations. To date, findings suggest the critical need to reduce any alcohol use at a young age and to treat both depressive symptoms and AUD to prevent the occurrence of comorbid disorders.
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Affiliation(s)
- P Pedrelli
- Massachusetts General Hospital; Harvard Medical School
| | - B Shapero
- Massachusetts General Hospital; Harvard Medical School
| | | | - C Dale
- Massachusetts General Hospital
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Abstract
BACKGROUND Critically ill adults often cannot self-report pain. OBJECTIVE To determine the effect of the Critical-Care Pain Observation Tool on frequency of documentation of pain assessment and administration of analgesics and sedatives in critically ill patients unable to self-report pain. METHODS Data on patients in 2 intensive care units of a university-affiliated hospital were collected before and after implementation of the tool. Patients were prospectively screened for eligibility; data were extracted retrospectively. RESULTS Data were recorded for a maximum of 72 hours before and after implementation of the tool in the cardiovascular intensive care unit (130 patients before and 132 after) and in the medical/surgical/trauma unit (59 patients before and 52 after). Proportion of pain assessment intervals with pain assessment documented increased from 15% to 64% (P < .001) in the cardiovascular unit and from 22% to 80% (P < .001) in the other unit. Median total dose of opioid analgesics decreased from 5 mg to 4 mg in the cardiovascular unit (P = .02) and increased from 27 mg to 75 mg (P = .002) in the other unit. Median total dose of benzodiazepines decreased from 12 mg to 2 mg (P < .001) in the cardiovascular unit and remained unchanged in the other unit. Increased documentation of pain assessment was associated with increased age in the cardiovascular unit and with decreased maximum scores on the Sequential Organ Failure Assessment in the other unit. CONCLUSION Implementation of the tool increased frequency of pain assessment and appeared to influence administration of analgesics in both units.
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Affiliation(s)
- Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Dale C, Angus JE, Sinuff T, Mykhalovskiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 2012; 29:266-74. [PMID: 23092851 DOI: 10.1016/j.iccn.2012.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients. METHODS The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time. RESULTS A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment. CONCLUSIONS Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
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Affiliation(s)
- Craig Dale
- Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, B508 - 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
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Rose L, Smith O, Gélinas C, Haslam L, Dale C, Luk E, Burry L, McGillion M, Mehta S, Watt-Watson J. Critical care nurses' pain assessment and management practices: a survey in Canada. Am J Crit Care 2012; 21:251-9. [PMID: 22751367 DOI: 10.4037/ajcc2012611] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Regular pain assessment can lead to decreased incidence of pain and shorter durations of mechanical ventilation and stays in the intensive care unit. OBJECTIVES To document knowledge and perceptions of pain assessment and management practices among Canadian intensive care unit nurses. METHODS A self-administered questionnaire was mailed to 3753 intensive care unit nurses identified through the 12 Canadian provincial/territorial nursing associations responsible for professional regulation. RESULTS A total of 842 nurses (24%) responded, and 802 surveys could be evaluated. Nurses were significantly less likely (P < .001) to use a pain assessment tool for patients unable to communicate (267 nurses, 33%) than for patients able to self-report (712 nurses, 89%). Significantly fewer respondents (P < .001) rated behavioral pain assessment tools as moderately to extremely important (595 nurses, 74%) compared with self-report tools (703 nurses, 88%). Routine (>50% of the time) discussion of pain scores during nursing handover was reported by 492 nurses (61%), and targeting of analgesia to a pain score or other assessment parameters by physicians by 333 nurses (42%). Few nurses (n = 235; 29%) were aware of professional society guidelines for pain assessment and management. Routine use of a behavioral pain tool was associated with awareness of published guidelines (odds ratio, 2.5; 95% CI, 1.7-3.7) and clinical availability of the tool (odds ratio, 2.6; 95% CI, 1.6-4.3). CONCLUSIONS A substantial proportion of intensive care unit nurses did not use pain assessment tools for patients unable to communicate and were unaware of pain management guidelines published by professional societies.
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Affiliation(s)
- Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, Ontario, Canada, M5T IP8.
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Croome K, Marotta P, Wall W, Dale C, Levstik M, Chandok N, Hernandez-Alejandro R. Should a Lower Quality Organ Go to the Least Sick Patient? Model for End-Stage Liver Disease Score and Donor Risk Index as Predictors of Early Allograft Dysfunction. Transplant Proc 2012; 44:1303-6. [DOI: 10.1016/j.transproceed.2012.01.115] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 01/25/2012] [Indexed: 12/28/2022]
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Seto Nielsen L, Angus JE, Lapum J, Dale C, Kramer-Kile M, Abramson B, Marzolini S, Oh P, Price J, Clark A. "I can't just follow any particular textbook": immigrants in cardiac rehabilitation. J Adv Nurs 2012; 68:2719-29. [PMID: 22429198 DOI: 10.1111/j.1365-2648.2012.05975.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM The study purpose was to examine how and under what circumstances immigrants combine diabetes self-care with cardiac rehabilitation recommendations. BACKGROUND Cardiac rehabilitation can improve and lengthen life in people with coronary heart disease as it promotes healthy physical and psychosocial behaviours and outcomes. This study is the first to examine the convergence of two common issues on participation: (1) the problems posed when cardiac rehabilitation patients must also contend with type II diabetes and (2) the experiences of immigrants in cardiac rehabilitation. DESIGN A critical ethnographic approach was employed. METHODS Two in depth interviews were conducted with 18 immigrants (eight men, ten women) enrolled in cardiac rehabilitation. Data were collected from 2008-2010. FINDINGS Threaded throughout immigrant participants' descriptions were biographical accounts of crossing geographical borders, establishing a sense of belonging in their adopted country and trying to feel 'at home' in cardiac rehabilitation. Participants described creative hybridization of transnationally informed knowledges and particularized practices to manage diabetes self-care and to reduce cardiac risk. Participants judiciously considered, assessed and blended knowledges from cardiac rehabilitation, experience with their own bodies and general 'wisdoms' passed on within their own and other immigrant communities. CONCLUSION These findings suggest that migration constitutes an important social positioning that contextualizes individual efforts to activate diabetes self-care and cardiac rehabilitation. Support to immigrants may improve when nurses recognize the significance of such experiences. Efforts are needed in practice and research to recognize and explore immigrants' creative efforts to engage in cardiac rehabilitation.
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Affiliation(s)
- Lisa Seto Nielsen
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.
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Dodek PM, Wong H, Jaswal D, Heyland DK, Cook DJ, Rocker GM, Kutsogiannis DJ, Dale C, Fowler R, Ayas NT. Organizational and safety culture in Canadian intensive care units: relationship to size of intensive care unit and physician management model. J Crit Care 2011; 27:11-7. [PMID: 21958984 DOI: 10.1016/j.jcrc.2011.07.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/28/2011] [Accepted: 07/17/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture. MATERIALS AND METHODS In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture. RESULTS Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P < .01), relative technical quality of care (r = 0.66; P < .01), and medical director budgeting authority (r = 0.46; P = .03), and moderately strong negative correlations with frequency of events reported (r = -0.46; P = .03), and teamwork across hospital units (r = -0.51; P = .01). There were similar patterns for relationships with intensivist management. For most pairs of domains, there were weak correlations between organizational and safety culture. CONCLUSION Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs.
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Affiliation(s)
- Peter M Dodek
- Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, Providence Health Care and University of British Columbia, Vancouver, British Columbia, Canada V6Z 1Y6.
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Brown L, Dale C, McCalman K, Martin J, Barber P, Booton R. 44 Bimodality surveillance of patients at high risk for lung cancer. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brown L, Joseph L, Dale C, Ashton G, Pepper S, Landberg G, Barber P, Booton R. 3 Maximising archival resources to unravel the transcriptome of squamous cell carcinoma. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Glasscoe C, Quittner A, Patel L, Dale C, Burrows E, Hope H, Lancaster G, Southern K, Nunn A. Components of risk associated with home intravenous antibiotic therapy (H-IVAT) in the UK. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Evans RJ, Dale C. Investigating the role of Wnt signalling in lobuloalveolar development of the mammary gland. Breast Cancer Res 2006. [PMCID: PMC3300255 DOI: 10.1186/bcr1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND Paracetamol and salicylate are commonly taken in acute overdose. Clinicians have a low threshold for excluding the presence of these two drugs, by ordering laboratory tests in any patient suspected of ingesting an overdose or with an altered mental state. AIM To test the effectiveness of a new point of care test that qualitatively detects paracetamol and salicylate in blood and to examine the potential time saved by its use. DESIGN Prospective multicentre trial. METHODS The new test was compared with laboratory analysis in a routine blood sample taken from patients presenting to emergency departments with suspected overdose. RESULTS The test had sensitivities of 98.5% and 88.5%, and specificities of 74.7% and 92%, for paracetamol and salicylate, respectively, at cut-off levels of 25 mg/l and 100 mg/l, respectively The point of care test results were available 2 h before the laboratory result. DISCUSSION This point-of-care test could be used to rule out an overdose with either of these two drugs, and could thus lead to earlier clinical decisions for suspected overdose patients. Recommendations have been made following this trial that the cut-off value for paracetamol should be reduced from 25 mg/l to 12.5 mg/l in order to increase its usefulness. To prevent the test being misread, we also suggest that each device should be embossed to remind users that the presence of a line indicates there is no drug present.
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Affiliation(s)
- C Dale
- Academic Department of Accident and Emergency Medicine, St Mary's Hospital, London W2 1NY, UK.
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