1
|
McCallie KR, Balasundaram M, Sarabu C. Family Perception of OpenNotes in the Neonatal Intensive Care Unit. Appl Clin Inform 2024; 15:170-177. [PMID: 38216145 PMCID: PMC10901642 DOI: 10.1055/a-2244-4478] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND OpenNotes, or sharing of medical notes via a patient portal, has been studied extensively in the adult population, but less in pediatric populations, and even more rarely in inpatient pediatric or intensive care settings. OBJECTIVES This study aimed to understand families' interaction with and perception of inpatient hospital notes shared via patient portal in a community Neonatal Intensive Care Unit (NICU). METHODS At the end of the NICU discharge education, completed in the patient portal before discharge, families were offered an anonymous survey on OpenNotes. RESULTS Out of 446 NICU patients from March 16, 2022 to March 16, 2023, there were 59 respondents (13%). Race was primarily Asian (48%), and English was the predominant language (93%). Most families indicated that the notes were "very or somewhat easy to understand" (93%). Seventy-three percent of respondents felt much better about the doctor(s) after reading the notes, and 53% contacted the physicians about something in the notes. Six (16%) felt that OpenNotes were more confusing than helpful. CONCLUSION To the authors' knowledge, this is the first study on NICU families' perceptions of OpenNotes, which indicated positive interactions with the doctors' daily progress notes and gave important suggestions for improvement.
Collapse
Affiliation(s)
- Katherine R. McCallie
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, United States
- Neonatal Intensive Care Unit, El Camino Health, Mountain View, California, United States
| | - Malathi Balasundaram
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, United States
- Neonatal Intensive Care Unit, El Camino Health, Mountain View, California, United States
| | - Chethan Sarabu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| |
Collapse
|
2
|
Jawa NA, Boyd JG, Maslove DM, Scott SH, Silver SA. Informed consent practices in clinical research: present and future. Postgrad Med J 2023; 99:1033-1042. [PMID: 37265442 DOI: 10.1093/postmj/qgad039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/06/2023] [Indexed: 06/03/2023]
Abstract
Clinical research must balance the need for ambitious recruitment with protecting participants' autonomy; a requirement of which is informed consent. Despite efforts to improve the informed consent process, participants are seldom provided sufficient information regarding research, hindering their ability to make informed decisions. These issues are particularly pervasive among patients experiencing acute illness or neurological impairment, both of which may impede their capacity to provide consent. There is a critical need to understand the components, requirements, and methods of obtaining true informed consent to achieve the vast numbers required for meaningful research. This paper provides a comprehensive review of the tenets underlying informed consent in research, including the assessment of capacity to consent, considerations for patients unable to consent, when to seek consent from substitute decision-makers, and consent under special circumstances. Various methods for obtaining informed consent are addressed, along with strategies for balancing recruitment and consent.
Collapse
Affiliation(s)
- Natasha A Jawa
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3L4, Canada
| | - J Gordon Boyd
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - David M Maslove
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ontario K7L 2V7, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Samuel A Silver
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario K7L 2V7, Canada
| |
Collapse
|
3
|
Aghababaie A, Downes A. 'Virtual neonatal crash course': quality improvement in neonatal teaching for paediatric trainees. Postgrad Med J 2023:7148068. [PMID: 37130831 DOI: 10.1093/postmj/qgad029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 05/04/2023]
Abstract
There are limited Foundation Programme posts with rotations in paediatrics. Many junior paediatric trainees therefore start their neonatal jobs, including a mandatory 6-month tertiary neonatal placement during Level 1 training, without prior experience. The aim of this project was to improve trainees' confidence in the practical aspects of neonatal medicine prior to their first neonatal jobs. A virtual course was delivered to paediatric trainees, on the core principles of neonatal intensive care medicine. Trainees' confidence levels in different domains of neonatology were assessed with pre- and postcourse questionnaires, showing a significant improvement in confidence following the course. Trainees' qualitative feedback was also overwhelmingly positive. Overall, there is evidently a desire for supplemental neonatal education for paediatric trainees. The long-term plan to address this is to build upon this course with a transition to face-to-face lectures paired with skills workshops for paediatric trainees in London. KEY MESSAGES What is already known on this topic: What this study adds: How this study might affect research, practice, or policy.
Collapse
Affiliation(s)
- Arameh Aghababaie
- Women and Children's Division, Homerton University Hospital, Homerton Healthcare NHS Trust, London E9 6SR, United Kingdom
| | - Alexandra Downes
- Women and Children's Division, Epsom and St Helier University Hospitals NHS Trust, London SM5 1AA, United Kingdom
| |
Collapse
|
4
|
Luxenburger H, Schmidt K, Biever P, Supady A, Sekandarzad A, Roehlen N, Reincke M, Neumann-Haefelin C, Schultheiss M, Wengenmayer T, Thimme R, Bettinger D. Survival prediction using the Freiburg index of post-TIPS survival (FIPS) in critically ill patients with acute- on chronic liver failure: A retrospective observational study. Front Med (Lausanne) 2022; 9:1042674. [PMID: 36619640 PMCID: PMC9812953 DOI: 10.3389/fmed.2022.1042674] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background and aim Liver cirrhosis in patients treated in the intensive care unit (ICU) is associated with high mortality. Well established scores are useful to allow for assessment of prognosis and support ICU treatment guidance. However, currently used scoring systems often do not reflect the complexity of critically ill patients. Therefore, we tested the newly developed Freiburg index-of post-TIPS survival (FIPS) score in order to assess its potential role for prognostication of cirrhotic patients in the ICU. Methods A total of 310 patients with liver cirrhosis treated in the ICU between 2010 and 2021 were enrolled in this retrospective observational study. Prognostic factors for mortality and 28-day mortality were assessed. Moreover, using c indices the prognostic discrimination of different prognostic scores was analyzed. Results The FIPS score allowed to discriminate patients with high ICU mortality and within 28-days after ICU treatment (ICU mortality: 42.2 vs. 59.9%, p = 0.008 and 28-day mortality: 43.3 vs. 74.1%, p < 0.001). However, the FIPS score in its current composition showed no superior prognostic discrimination compared to other established scores. Multivariable analyses identified the FIPS score (HR 1.25 [1.04-1.49], p = 0.015) and lactate at admission (HR 1.07 [1.04-1.09], p < 0.001) as significant predictors of ICU mortality. Lactate at admission substantially improved patient risk stratification within each FIPS risk groups. Conclusion Similar to other commonly used scores, the FIPS score in its current composition does not allow a sufficiently reliable prognostication of critically ill patients treated in the ICU. However, adding lactate as additional factor to the FIPS score may improve its prognostic ability.
Collapse
Affiliation(s)
- Hendrik Luxenburger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany,IMM-PACT, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Schmidt
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Paul Biever
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University Medical Center–University of Freiburg, Freiburg im Breisgau, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University Medical Center–University of Freiburg, Freiburg im Breisgau, Germany
| | - Asieb Sekandarzad
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University Medical Center–University of Freiburg, Freiburg im Breisgau, Germany
| | - Natascha Roehlen
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marlene Reincke
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael Schultheiss
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Faculty of Medicine, University Medical Center–University of Freiburg, Freiburg im Breisgau, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany,*Correspondence: Dominik Bettinger,
| |
Collapse
|
5
|
Mazzarelli A, Giancola ML, Fontana A, Piselli P, Binda E, Trivieri N, Mencarelli G, Marchioni L, Vulcano A, De Giuli C, Panebianco C, Villani A, Copetti M, Perri F, Fontana C, Nicastri E, Pazienza V. Gut microbiota composition in COVID-19 hospitalized patients with mild or severe symptoms. Front Microbiol 2022; 13:1049215. [PMID: 36560946 PMCID: PMC9763305 DOI: 10.3389/fmicb.2022.1049215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/20/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background and aimCOVID-19, the infectious disease caused by SARS-CoV-2 virus that has been causing a severe pandemic worldwide for more than 2 years, is characterized by a high heterogeneity of clinical presentations and evolution and, particularly, by a varying severity of respiratory involvement. This study aimed to analyze the diversity and taxonomic composition of the gut microbiota at hospital admission, in order to evaluate its association with COVID-19 outcome. In particular, the association between gut microbiota and a combination of several clinical covariates was analyzed in order to characterize the bacterial signature associate to mild or severe symptoms during the SARS-CoV-2 infection.Materials and methodsV3–V4 hypervariable region of 16S rRNA gene sequencing of 97 rectal swabs from a retrospective cohort of COVID-19 hospitalized patients was employed to study the gut microbiota composition. Patients were divided in two groups according to their outcome considering the respiratory supports they needed during hospital stay: (i) group “mild,” including 47 patients with a good prognosis and (ii) group “severe,” including 50 patients who experienced a more severe disease due to severe respiratory distress that required non-invasive or invasive ventilation. Identification of the clusters of bacterial population between patients with mild or severe outcome was assessed by PEnalized LOgistic Regression Analysis (PELORA).ResultsAlthough no changes for Chao1 and Shannon index were observed between the two groups a significant greater proportion of Campylobacterota and Actinobacteriota at phylum level was found in patients affected by SARS-CoV-2 infection who developed a more severe disease characterized by respiratory distress requiring invasive or non-invasive ventilation. Clusters have been identified with a useful early potential prognostic marker of the disease evolution.DiscussionMicroorganisms residing within the gut of the patients at hospital admission, were able to significantly discriminate the clinical evolution of COVID-19 patients, in particular who will develop mild or severe respiratory involvement. Our data show that patients affected by SARS-CoV-2 with mild or severe symptoms display different gut microbiota profiles which can be exploited as potential prognostic biomarkers paving also the way to new integrative therapeutic approaches.
Collapse
Affiliation(s)
- Antonio Mazzarelli
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Maria Letizia Giancola
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Andrea Fontana
- Biostatistic Unit, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, FG, Italy
| | - Pierluca Piselli
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Elena Binda
- Cancer Stem Cells Unit, Institute for Stem Cell Biologyl, Regenerative Medicine and Innovative Therapeutics (ISBReMIT), Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, Opera di San Pio da Pietrelcina, San Giovanni Rotondo, FG, Italy
| | - Nadia Trivieri
- Cancer Stem Cells Unit, Institute for Stem Cell Biologyl, Regenerative Medicine and Innovative Therapeutics (ISBReMIT), Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, Opera di San Pio da Pietrelcina, San Giovanni Rotondo, FG, Italy
| | - Gandino Mencarelli
- Cancer Stem Cells Unit, Institute for Stem Cell Biologyl, Regenerative Medicine and Innovative Therapeutics (ISBReMIT), Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, Opera di San Pio da Pietrelcina, San Giovanni Rotondo, FG, Italy
| | - Luisa Marchioni
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Antonella Vulcano
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Chiara De Giuli
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Concetta Panebianco
- Division of Gastroenterology, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, FG, Italy
| | - Annacandida Villani
- Division of Gastroenterology, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, FG, Italy
| | - Massimiliano Copetti
- Biostatistic Unit, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, FG, Italy
| | - Francesco Perri
- Division of Gastroenterology, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, FG, Italy
| | - Carla Fontana
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, INMI “Lazzaro Spallanzani”, IRCCS, Rome, Italy,*Correspondence: Emanuele Nicastri,
| | - Valerio Pazienza
- Division of Gastroenterology, Fondazione-IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, FG, Italy,Valerio Pazienza,
| |
Collapse
|
6
|
van Sleeuwen D, van de Laar FA, Simons K, van Bommel D, Burgers-Bonthuis D, Koeter J, Bisschops LLA, Vloet L, Brackel M, Teerenstra S, Adang E, van der Hoeven JG, Zegers M, van den Boogaard M. MiCare study, an evaluation of structured, multidisciplinary and personalised post-ICU care on physical and psychological functioning, and quality of life of former ICU patients: a study protocol of a stepped-wedge cluster randomised controlled trial. BMJ Open 2022; 12:e059634. [PMID: 36109035 PMCID: PMC9478839 DOI: 10.1136/bmjopen-2021-059634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over 70% of the intensive care unit (ICU) survivors suffer from long-lasting physical, mental and cognitive problems after hospital discharge. Post-ICU care is recommended by international guidelines, but evidence for cost-effectiveness lacks. The aim of this study is to evaluate the clinical effectiveness and cost-effectiveness of structured, multidisciplinary and personalised post-ICU care versus usual care on physical and psychological functioning and health-related quality of life (HRQoL) of ICU survivors, 1- and 2-year post-ICU discharge. METHODS AND ANALYSIS The MONITOR-IC post-ICU care study (MiCare study) is a multicentre stepped-wedge randomised controlled trial conducted in five hospitals. Adult patients at high risk for critical illness-associated morbidity post-ICU will be selected and receive post-ICU care, including an invitation to the post-ICU clinic 3 months after ICU discharge. A personalised long-term recovery plan tailored to patients' reported outcome measures will be made. 770 (intervention) and 1480 (control) patients will be included. Outcomes are 1- and 2-year HRQoL (EuroQol Instrument (EQ-5D-5L)), physical (fatigue and new physical problems), mental (anxiety, depression and post-traumatic stress disorder), and cognitive symptoms and cost-effectiveness. Medical data will be retrieved from patient records and cost data from health insurance companies. ETHICS AND DISSEMINATION Due to the lack of evidence, Dutch healthcare insurers do not reimburse post-ICU care. Therefore, evaluation of cost-effectiveness and integration in guidelines supports the evidence. Participation of several societies for physicians, nurses, paramedics, and patients and relatives in the project team increases the support for implementation of the intervention in clinical practice. Patients and relatives will be informed by the patient associations, hospitals and professional associations. Informing healthcare insurers about this project's results is important for the consideration for inclusion of post-ICU care in Dutch standard health insurance. The study is approved by the Radboud University Medical Centre research ethics committee (2021-13125). TRIAL REGISTRATION NUMBER NCT05066984.
Collapse
Affiliation(s)
- Dries van Sleeuwen
- Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Primary care and community care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Floris A van de Laar
- Primary care and community care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Koen Simons
- Intensive Care, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | | | - Julia Koeter
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | - Lilian Vloet
- Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- FCIC (Family and Patient Centered Intensive Care) Foundation, Alkmaar, The Netherlands
- Radboud institute for health sciences IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marianne Brackel
- FCIC (Family and Patient Centered Intensive Care) Foundation, Alkmaar, The Netherlands
- IC Connect, patient organisation for (former) ICU patients and relatives, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eddy Adang
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marieke Zegers
- Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
7
|
Ishiyama H, Ishii J, Yoshimura H, Ohara N, Kohara N, Kawamoto M. Authors Response: Adherence to Clear-cut Definitions Is Mandatory When Assessing Short- and Long-term Neurological Complications of COVID-19. Intern Med 2022; 61:2401. [PMID: 35022358 PMCID: PMC9424075 DOI: 10.2169/internalmedicine.8954-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hiroyuki Ishiyama
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| |
Collapse
|
8
|
Tang Q, Chen Z, Guo Y, Liang Y, Ward R, Menon C, Elgendi M. Robust Reconstruction of Electrocardiogram Using Photoplethysmography: A Subject-Based Model. Front Physiol 2022; 13:859763. [PMID: 35547575 PMCID: PMC9082149 DOI: 10.3389/fphys.2022.859763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/24/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Electrocardiography and photoplethysmography are non-invasive techniques that measure signals from the cardiovascular system. While the cycles of the two measurements are highly correlated, the correlation between the waveforms has rarely been studied. Measuring the photoplethysmogram (PPG) is much easier and more convenient than the electrocardiogram (ECG). Recent research has shown that PPG can be used to reconstruct the ECG, indicating that practitioners can gain a deep understanding of the patients’ cardiovascular health using two physiological signals (PPG and ECG) while measuring only PPG. This study proposes a subject-based deep learning model that reconstructs an ECG using a PPG and is based on the bidirectional long short-term memory model. Because the ECG waveform may vary from subject to subject, this model is subject-specific. The model was tested using 100 records from the MIMIC III database. Of these records, 50 had a circulatory disease. The results show that a long ECG signal could be effectively reconstructed from PPG, which is, to our knowledge, the first attempt in this field. A length of 228 s of ECG was constructed by the model, which was trained and validated using 60 s of PPG and ECG signals. To segment the data, a different approach that segments the data into short time segments of equal length (and that do not rely on beats and beat detection) was investigated. Segmenting the PPG and ECG time series data into equal segments of 1-min width gave the optimal results. This resulted in a high Pearson’s correlation coefficient between the reconstructed 228 s of ECG and referenced ECG of 0.818, while the root mean square error was only 0.083 mV, and the dynamic time warping distance was 2.12 mV per second on average.
Collapse
Affiliation(s)
- Qunfeng Tang
- School of Electronic Engineering and Automation, Guilin University of Electronic Technology, Guilin, China.,Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Zhencheng Chen
- School of Electronic Engineering and Automation, Guilin University of Electronic Technology, Guilin, China
| | - Yanke Guo
- School of Electronic Engineering and Automation, Guilin University of Electronic Technology, Guilin, China
| | - Yongbo Liang
- School of Electronic Engineering and Automation, Guilin University of Electronic Technology, Guilin, China
| | - Rabab Ward
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Carlo Menon
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Mohamed Elgendi
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| |
Collapse
|
9
|
Valk CMA, Zimatore C, Mazzinari G, Pierrakos C, Sivakorn C, Dechsanga J, Grasso S, Beenen L, Bos LDJ, Paulus F, Schultz MJ, Pisani L. The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome-An International Multicenter Observational Study. Front Med (Lausanne) 2022; 8:772056. [PMID: 35071263 PMCID: PMC8766516 DOI: 10.3389/fmed.2021.772056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/07/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The radiographic assessment for lung edema (RALE) score has an association with mortality in patients with acute respiratory distress syndrome (ARDS). It is uncertain whether the RALE scores at the start of invasive ventilation or changes thereof in the next days have prognostic capacities in patients with COVID-19 ARDS. Aims and Objectives: To determine the prognostic capacity of the RALE score for mortality and duration of invasive ventilation in patients with COVID-19 ARDS. Methods: An international multicenter observational study included consecutive patients from 6 ICUs. Trained observers scored the first available chest X-ray (CXR) obtained within 48 h after the start of invasive ventilation (“baseline CXR”) and each CXRs thereafter up to day 14 (“follow-up CXR”). The primary endpoint was mortality at day 90. The secondary endpoint was the number of days free from the ventilator and alive at day 28 (VFD-28). Results: A total of 350 CXRs were scored in 139 patients with COVID-19 ARDS. The RALE score of the baseline CXR was high and was not different between survivors and non-survivors (33 [24–38] vs. 30 [25–38], P = 0.602). The RALE score of the baseline CXR had no association with mortality (hazard ratio [HR], 1.24 [95% CI 0.88–1.76]; P = 0.222; area under the receiver operating characteristic curve (AUROC) 0.50 [0.40–0.60]). A change in the RALE score over the first 14 days of invasive ventilation, however, had an independent association with mortality (HR, 1.03 [95% CI 1.01–1.05]; P < 0.001). When the event of death was considered, there was no significant association between the RALE score of the baseline CXR and the probability of being liberated from the ventilator (HR 1.02 [95% CI 0.99–1.04]; P = 0.08). Conclusion: In this cohort of patients with COVID-19 ARDS, with high RALE scores of the baseline CXR, the RALE score of the baseline CXR had no prognostic capacity, but an increase in the RALE score in the next days had an association with higher mortality.
Collapse
Affiliation(s)
- Christel M A Valk
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands
| | - Claudio Zimatore
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.,Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Guido Mazzinari
- Department of Anaesthesiology and Critical Care, Hospital Universitario y Politecnico la Fe, Valencia, Spain.,Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Charalampos Pierrakos
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.,Department of Intensive Care, Centre Hospitalier Universitaire Brussels, Brussels, Belgium
| | - Chaisith Sivakorn
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jutamas Dechsanga
- Division of Pulmonary and Critical Care, Department of Medicine, Chonburi Hospital, Chonburi, Thailand
| | - Salvatore Grasso
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Ludo Beenen
- Department of Radiology, Amsterdam UMC, Amsterdam, Netherlands
| | - Lieuwe D J Bos
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.,Department of Pulmonology, Amsterdam UMC, Amsterdam, Netherlands
| | - Frederique Paulus
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marcus J Schultz
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Luigi Pisani
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Anaesthesia and Intensive Care Unit, Miulli Regional Hospital, Acquaviva delle Fonti, Italy
| |
Collapse
|
10
|
Keller K, Sagoschen I, Schmitt VH, Sivanathan V, Espinola-Klein C, Lavie CJ, Münzel T, Hobohm L. Obesity and Its Impact on Adverse In-Hospital Outcomes in Hospitalized Patients With COVID-19. Front Endocrinol (Lausanne) 2022; 13:876028. [PMID: 35586628 PMCID: PMC9108252 DOI: 10.3389/fendo.2022.876028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND An increasing level of evidence suggests that obesity not only is a major risk factor for cardiovascular diseases (CVDs) but also has adverse outcomes during COVID-19 infection. METHODS We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany from January to December 2020 and stratified them for diagnosed obesity. Obesity was defined as body mass index ≥30 kg/m2 according to the WHO. The impact of obesity on in-hospital case fatality and adverse in-hospital events comprising major adverse cardiovascular and cerebrovascular events (MACCE), acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE), and others was analyzed. RESULTS We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19 infection; among them, 9,383 (5.3%) had an additional obesity diagnosis. Although COVID-19 patients without obesity were older (72.0 [interquartile range (IQR) 56.0/82.0] vs. 66.0 [54.0/76.0] years, p < 0.001), the CVD profile was less favorable in obese COVID-19 patients (Charlson comorbidity index 4.44 ± 3.01 vs. 4.08 ± 2.92, p < 0.001). Obesity was independently associated with increased in-hospital case fatality (OR 1.203 [95% CI 1.131-1.279], p < 0.001) and MACCE (OR 1.168 [95% CI 1.101-1.239], p < 0.001), ARDS (OR 2.605 [95% CI 2.449-2.772], p < 0.001), and VTE (OR 1.780 [95% CI 1.605-1.973], p < 0.001) and also associated with increased necessity of treatment on intensive care unit (OR 2.201 [95% CI 2.097-2.310], p < 0.001), mechanical ventilation (OR 2.277 [95% CI 2.140-2.422], p < 0.001), and extracorporeal membrane oxygenation (OR 3.485 [95% CI 3.023-4.017], p < 0.001). CONCLUSIONS Obesity independently affected case fatality, MACCE, ARDS development, VTE, and other adverse in-hospital events in patients with COVID-19 infection. Obesity should be taken into account regarding COVID-19 prevention strategies, risk stratification, and adequate healthcare planning. Maintaining a healthy weight is important not only to prevent cardiometabolic diseases but also for better individual outcomes during COVID-19 infection.
Collapse
Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
- *Correspondence: Karsten Keller,
| | - Ingo Sagoschen
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK)Partner Site Rhine Main, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Gastroenterology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Carl J. Lavie
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, United States
| | - Thomas Münzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK)Partner Site Rhine Main, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| |
Collapse
|
11
|
Ishiyama H, Ishii J, Yoshimura H, Tsunogae M, Fujiwara S, Hiya S, Inui R, Shiomi Y, Nakazawa S, Kimura M, Kuroda T, Murakami Y, Maekawa K, Ohara N, Kohara N, Kawamoto M. Neurological Manifestations and Long-term Sequelae in Hospitalized Patients with COVID-19. Intern Med 2021; 60:3559-3567. [PMID: 34511566 PMCID: PMC8666216 DOI: 10.2169/internalmedicine.7802-21] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Various neurological manifestations have been increasingly reported in coronavirus disease 2019 (COVID-19). We determined the neurological features and long-term sequelae in hospitalized COVID-19 patients. Methods We retrospectively studied 95 consecutive hospitalized patients with COVID-19 between March 1 and May 13, 2020. Acute neurological presentations (within two weeks of the symptom onset of COVID-19) were compared between 60 non-severe and 35 severely infected patients who required high-flow oxygen. In the 12 ventilated patients (the most severe group), we evaluated neurological complications during admission, subacute neurological presentations, and neurological sequelae (51 and 137 days from the onset [median], respectively). Results Of the 95 patients (mean age 53 years old; 40% women), 63% had acute neurological presentations, with an increased prevalence in cases of severe infections (83% vs. 52%, p<0.001). Impaired consciousness and limb weakness were more frequent in severe patients than in non-severe ones (0% vs. 49%; p<0.001, and 0% vs. 54%; p<0.001, respectively). In the most severe group (mean age 72 years old; 42% women), 83% of patients had neurological complications [cerebrovascular disease (17%), encephalopathy (82%), and neuropathy (55%)], and 92% had subacute neurological presentations [impaired consciousness (17%), higher brain dysfunction (82%), limb weakness (75%), and tremor (58%)]. Neurological sequelae were found in 83% of cases, including higher brain dysfunction (73%), limb weakness (50%), and tremor (58%). Conclusions Neurological manifestations are common in COVID-19, with the possibility of long-lasting sequelae.
Collapse
Affiliation(s)
- Hiroyuki Ishiyama
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Junko Ishii
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Hajime Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Marie Tsunogae
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Satoru Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Satomi Hiya
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Ryoma Inui
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Yuma Shiomi
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Shinsaku Nakazawa
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Masamune Kimura
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Takehito Kuroda
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Yasutaka Murakami
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Kota Maekawa
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Nobuo Kohara
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| | - Michi Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, Japan
| |
Collapse
|
12
|
Johannesen TB, Smeland S, Aaserud S, Buanes EA, Skog A, Ursin G, Helland Å. COVID-19 in Cancer Patients, Risk Factors for Disease and Adverse Outcome, a Population-Based Study From Norway. Front Oncol 2021; 11:652535. [PMID: 33842366 PMCID: PMC8027113 DOI: 10.3389/fonc.2021.652535] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Cancer has been suggested as a risk factor for severe outcome of SARS-CoV-2 infection. In this population-based study we aimed to identify factors associated with higher risk of COVID-19 and adverse outcome. Methods Data on all confirmed SARS-CoV-2 positive patients in the period January 1 to May 31, 2020 were extracted from the Norwegian Surveillance System for Communicable Diseases. Data on cancer and treatment was available from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Prescription Database. Deaths due to COVID-19 were extracted from the Cause of Death Registry. From the Norwegian Intensive Care and Pandemic Registry we retrieved data on admittance to hospital and intensive care. We determined rates of COVID-19 disease in cancer patients and the rest of the population. We also ran multivariate analyses adjusting for age and gender. Results A total of 8 410 patients were diagnosed with SARS-CoV-2 infection in Norway during the study period, of which 547 (6.5%) were cancer patients. Overall, we found similar age adjusted rates of COVID-19 in the population with cancer as in the population without cancer. Unadjusted analysis showed that patients having undergone major surgery within the past 3 months had an increased risk of COVID-19 while we did not find increased Odds Ratio (OR) related to other oncological treatment modalities. No patients treated with stem cell or bone marrow transplant were diagnosed with COVID-19. The fatality rate of COVID-19 among cancer patients was 0.10. This was similar to non-cancer patients, when adjusting for age and sex with OR (95% CI) for death= 0.99 (0.68–1.42). Patients with distant metastases had significantly increased OR of death due to COVID-19 disease of 9.31 (95% CI 2.60–33.34). For the combined outcome death and/or admittance to hospital due to COVID-19, we found significant two-fold increased risk estimates for patients diagnosed with cancer less than one 1 year ago (OR 2.08, 95% CI 1.14–3.80), for those treated with anti-cancer drugs during the past 3 months (OR 1.80, 95% CI 1.07–3.01) and for patients undergoing major surgery during the past 3 months (OR 2.19, 95% CI 1.40–3.44).
Collapse
Affiliation(s)
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Stein Aaserud
- Registry Department, Cancer Registry of Norway, Oslo, Norway
| | - Eirik Alnes Buanes
- Norwegian Intensive Care and Pandemic Registry (NIPaR), Bergen Health Trust, Bergen, Norway.,Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Anna Skog
- Registry Department, Cancer Registry of Norway, Oslo, Norway
| | - Giske Ursin
- Registry Department, Cancer Registry of Norway, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Åslaug Helland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Department of Genetics, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
13
|
Abstract
BACKGROUND The intensive and critical care units are high-dependency areas, with patients requiring complex care. The intubated status of the intensive and critical care patients makes them dependent on healthcare providers not only for acute care, but also for intimate care, imposing a threat to their dignity. Nurses, being the central care providers, become the stakeholders for dignity promotion. The incorporation of dignity in patient care improves the quality of care, and promotes the health and well-being of intubated patients. OBJECTIVE The purpose of the study was to explore nurses' perceptions about the dignity of intubated patients in the intensive and critical care units. RESEARCH DESIGN A qualitative descriptive exploratory study design was used to explore the nurses' perceptions about the dignity of intubated patients. PARTICIPANTS AND RESEARCH CONTEXT The intensive and critical care nurses of a tertiary care hospital were recruited using the purposive sampling technique. The data were collected through in-depth individual interviews, using a semi-structured interview guide. The findings were manually analyzed into themes and categories through content analysis. ETHICAL CONSIDERATION The study was conducted after the approval from the Ethical Review Committee of the Aga Khan University. FINDINGS Four major themes emerged from the data analysis: (1) two sides of the contemporary nursing practice; (2) benefits of dignified nursing care; (3) challenges to the dignity of intubated patients; and (4) strategies for promoting the dignity of intubated patients. DISCUSSION Dignity incorporates both the science and the art of nursing. The provision of dignified care is the core component of the quality nursing care and patient well-being in the high-dependency units. CONCLUSION This is the first exploratory and descriptive study conducted in Pakistan that explored the nurses' perceptions about the dignity of intubated patients, and also generated contextual understanding about the phenomenon.
Collapse
|
14
|
Chaudhry F, Hunt RJ, Hariharan P, Anand SK, Sanjay S, Kjoller EE, Bartlett CM, Johnson KW, Levy PD, Noushmehr H, Lee IY. Machine Learning Applications in the Neuro ICU: A Solution to Big Data Mayhem? Front Neurol 2020; 11:554633. [PMID: 33162926 PMCID: PMC7581704 DOI: 10.3389/fneur.2020.554633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/23/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
The neurological ICU (neuro ICU) often suffers from significant limitations due to scarce resource availability for their neurocritical care patients. Neuro ICU patients require frequent neurological evaluations, continuous monitoring of various physiological parameters, frequent imaging, and routine lab testing. This amasses large amounts of data specific to each patient. Neuro ICU teams are often overburdened by the resulting complexity of data for each patient. Machine Learning algorithms (ML), are uniquely capable of interpreting high-dimensional datasets that are too difficult for humans to comprehend. Therefore, the application of ML in the neuro ICU could alleviate the burden of analyzing big datasets for each patient. This review serves to (1) briefly summarize ML and compare the different types of MLs, (2) review recent ML applications to improve neuro ICU management and (3) describe the future implications of ML to neuro ICU management.
Collapse
Affiliation(s)
- Farhan Chaudhry
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, United States
| | - Rachel J. Hunt
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, United States
| | - Prashant Hariharan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, United States
| | - Sharath Kumar Anand
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Surya Sanjay
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Ellen E. Kjoller
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Connor M. Bartlett
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Kipp W. Johnson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Phillip D. Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Houtan Noushmehr
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, United States
| | - Ian Y. Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, United States
| |
Collapse
|
15
|
Frégeau A, Cournoyer A, Maheu-Cadotte MA, Iseppon M, Soucy N, St-Cyr Bourque J, Cossette S, Castonguay V, Fleet R. Use of tabletop exercises for healthcare education: a scoping review protocol. BMJ Open 2020; 10:e032662. [PMID: 31915165 PMCID: PMC6955537 DOI: 10.1136/bmjopen-2019-032662] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/23/2022] Open
Abstract
INTRODUCTION There is a growing interest in developing interprofessional education (IPE) in the community of healthcare educators. Tabletop exercises (TTX) have been proposed as a mean to cultivate collaborative practice. A TTX simulates an emergent situation in an informal environment. Healthcare professionals need to take charge of this situation as a team through a discussion-based approach. As TTX are gaining in popularity, performing a review about their uses could guide educators and researchers. The aim of this scoping review is to map the uses of TTX in healthcare. METHODS AND ANALYSIS A search of the literature will be conducted using medical subject heading terms and keywords in PubMed, Medline, EBM Reviews (Evidence-Based Medicine Reviews), CINAHL (Cumulative Index of Nursing and Allied Health Literature), Embase and ERIC (Education Resources Information Center), along with a search of the grey literature. The search will be performed after the publication of this protocol (estimated to be January 1st 2020) and will be repeated 1 month prior to the submission for publication of the final review (estimated to be June 1st 2020). Studies reporting on TTX in healthcare and published in English or French will be included. Two reviewers will screen the articles and extract the data. The quality of the included articles will be assessed by two reviewers. To better map their uses, the varying TTX activities will be classified as performed in the context of disaster health or not, for IPE or not and using a board game or not. Moreover, following the same mapping objective, outcomes of TTX will be reported according to the Kirkpatrick model of outcomes of educational programs. ETHICS AND DISSEMINATION No institutional review board approval is required for this review. Results will be submitted for publication in a peer-reviewed journal. The findings of this review will inform future efforts to TTX into the training of healthcare professionals.
Collapse
Affiliation(s)
- Amélie Frégeau
- Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexis Cournoyer
- Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marc-André Maheu-Cadotte
- Research department, Institut de Cardiologie de Montréal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Massimiliano Iseppon
- Department of Emergency Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Nathalie Soucy
- Direction of Education and of CHUM Academy, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Julie St-Cyr Bourque
- Emergency Medicine Department, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Sylvie Cossette
- Research and International Development, Institut de Cardiologie de Montréal, Montreal, Quebec, Canada
| | - Véronique Castonguay
- Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Richard Fleet
- Department of Emergency Medicine, Université Laval, Lévis, Quebec, Canada
| |
Collapse
|
16
|
Crawshaw J, Presseau J, van Allen Z, Pinheiro Carvalho L, Jordison K, English S, Fergusson DA, Lauzier F, Turgeon AF, Sarti AJ, Martin C, D'Aragon F, Li AHT, Knoll G, Ball I, Brehaut J, Burns KEA, Fortin MC, Weiss M, Meade M, Marsolais P, Shemie S, Zaabat S, Dhanani S, Kitto SC, Chassé M. Exploring the experiences and perspectives of substitute decision-makers involved in decisions about deceased organ donation: a qualitative study protocol. BMJ Open 2019; 9:e034594. [PMID: 31874899 PMCID: PMC7008441 DOI: 10.1136/bmjopen-2019-034594] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In Canada, deceased organ donation provides over 80% of transplanted organs. At the time of death, families, friends or others assume responsibility as substitute decision-makers (SDMs) to consent to organ donation. Despite their central role in this process, little is known about what barriers, enablers and beliefs influence decision-making among SDMs. This study aims to explore the experiences and perspectives of SDMs involved in making decisions around the withdrawal of life-sustaining therapies, end-of-life care and deceased organ donation. METHODS AND ANALYSIS SDMs of 60 patients admitted to intensive care units will be enrolled for this study. Ten hospitals across five provinces in Canada in a prospective multicentre qualitative cohort study. We will conduct semistructured telephone interviews in English or French with SDMs between 6 and 8 weeks after the patient's death. Our sampling frame will stratify SDMs into three groups: SDMs who were not approached for organ donation; SDMs who were approached and consented to donate and SDMs who were approached but did not consent to donate. We will use two complementary theoretical frameworks-the Common-Sense Self-Regulation Model and the Theoretical Domains Framework- to inform our interview guide. Interview data will be analysed using deductive directed content analysis and inductive thematic analysis. ETHICS AND DISSEMINATION This study has been approved by the Centre Hospitalier de l'Université de Montréal Research Ethics Board. The findings from this study will help identify key factors affecting substitute decision-making in deceased organ donation, reasons for non-consent and barriers to achieve congruency between SDM and patient wishes. Ultimately, these data will contribute to the development and evaluation of tools and training for healthcare providers to support SDMs in making decisions about organ donation. TRIAL REGISTRATION NUMBER NCT03850847.
Collapse
Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kim Jordison
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Francois Lauzier
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), CHU de Quebec-Universite Laval, Quebec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Quebec City, Québec, Canada
| | - Aimee J Sarti
- Critical Care Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Claudio Martin
- Medicine (Critical Care), Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Frédérick D'Aragon
- Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Alvin Ho-Ting Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Ian Ball
- Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen E A Burns
- Critical Care, St Michael's Hospital, Toronto, Ontario, Canada
| | - Marie-Chantal Fortin
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
| | - Matthew Weiss
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
- Trauma-Emergency-Critical Care Medicine, Université Laval Faculté de médecine, Quebec City, Quebec, Canada
| | - Maureen Meade
- Medicine (Critical Care), McMaster University, Hamilton, Ontario, Canada
| | - Pierre Marsolais
- Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Sam Shemie
- Critical Care, McGill University, Montreal, Québec, Canada
| | | | | | - Simon C Kitto
- Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Innovation Hub, Centre de Recherche du CHUM, Montréal, Québec, Canada
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Québec, Canada
- Medicine (Critical Care), Université de Montréal, Montreal, Québec, Canada
| |
Collapse
|
17
|
Agerskov M, Thusholdt ANW, Højlund J, Meyhoff CS, Sørensen H, Wiberg S, Secher NH, Bang Foss N. Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients. BMJ Open 2019; 9:e031249. [PMID: 31753878 PMCID: PMC6886954 DOI: 10.1136/bmjopen-2019-031249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 04/24/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality. METHODS AND ANALYSIS We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed. ETHICS AND DISSEMINATION Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).
Collapse
Affiliation(s)
- Marianne Agerskov
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Højlund
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Sørensen
- Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Nicolai Bang Foss
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
18
|
Vogel R, McGraw C, Orlando A, Bourg P, Dreiman C, Peck L, Tanner A, Lynch N, Bar-Or D. Examining satisfaction of older adult patients and their caregivers following traumatic injury: a cross-sectional study of three level I trauma centres. BMJ Open 2019; 9:e032374. [PMID: 31719090 PMCID: PMC6858218 DOI: 10.1136/bmjopen-2019-032374] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore satisfaction of care received by older adult patients and their primary caregivers following traumatic injury. DESIGN Prospective, cross-sectional study using the FAMCARE (Family Satisfaction with Advanced Cancer Care Scale) satisfaction surveys prior to discharge. SETTING Three level I trauma centres in Colorado from November 2016 to December 2017. PARTICIPANTS Trauma patients ≥55 years old and their primary caregivers. OUTCOME MEASURES Overall mean (SD) satisfaction, satisfaction <80% vs ≥80%, and mean satisfaction by survey conceptual structures. RESULTS Of the 319 patients and 336 caregivers included, the overall mean (SD) patient satisfaction was 81.7% (15.0%) and for caregivers was 83.6% (13.4%). The area with the highest mean for patient and caregiver satisfaction was psychosocial care (85.4% and 86.9%, respectively). Information giving was the lowest for patients (80.4%) and caregivers (80.9%). When individual items were examined, patients were significantly more satisfied with 'availability of nurses to answer questions' (84.5 (15.3) vs 87.4 (14.8), p=0.02) and significantly less satisfied with 'speed with which symptoms were treated' (80.6 (17.9) vs 84.0 (17.0), p=0.03) compared with caregivers. Patients with a history of smoking (least squares mean difference: -0.096 (-0.18 to -0.07), p<0.001) and hospital discharge destination to an outside facility of care (adjusted OR: 1.6 (1.0 to 2.4), p=0.048) were identified as independent predictors of lower overall satisfaction in generalised linear and logistic models, respectively. CONCLUSIONS Our data suggest that patients' medical history was driving both patient and caregiver satisfaction. Patient characteristics and expectations need to be considered when tailoring healthcare interventions.
Collapse
Affiliation(s)
- Rebecca Vogel
- Trauma Services Department, St. Anthony's Hospital, Lakewood, Colorado, USA
| | - Constance McGraw
- Trauma Research Department, St Anthony Hospital, Lakewood, Colorado, USA
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
- Trauma Research Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Alessandro Orlando
- Trauma Research Department, St Anthony Hospital, Lakewood, Colorado, USA
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
- Trauma Research Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Pamela Bourg
- Trauma Services Department, St. Anthony's Hospital, Lakewood, Colorado, USA
| | - Chester Dreiman
- Trauma Services Department, St. Anthony's Hospital, Lakewood, Colorado, USA
| | - Laura Peck
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Allen Tanner
- Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Neal Lynch
- Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - David Bar-Or
- Trauma Research Department, St Anthony Hospital, Lakewood, Colorado, USA
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
- Trauma Research Department, Penrose Hospital, Colorado Springs, Colorado, USA
| |
Collapse
|
19
|
Khan M. Nurses should be empowered to be proactively involved in family decision meetings on intensive care unit patient care decisions. Evid Based Nurs 2019; 23:114. [PMID: 31511244 DOI: 10.1136/ebnurs-2019-103089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Mohammad Khan
- Community Medicine, School of Dental Science, Universiti Sains Malaysia, Kota Bharu, Malaysia
| |
Collapse
|
20
|
Kaldan G, Nordentoft S, Herling SF, Larsen A, Thomsen T, Egerod I. Evidence characterising skills, competencies and policies in advanced practice critical care nursing in Europe: a scoping review protocol. BMJ Open 2019; 9:e031504. [PMID: 31494624 PMCID: PMC6731915 DOI: 10.1136/bmjopen-2019-031504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The management of critically ill patients is challenged by increasing population age and prevalence of comorbid diseases. High-quality intensive care nursing practice is imperative to accommodate these issues. The roles of the nurse practitioner (NP) and the acute care NP have existed for decades in the USA, Canada and Australia but are still evolving in Europe. Some European countries have introduced the advanced practice nurse (APN), but the current standard of the advanced level of nursing is variable and consensus regarding the framework, role and definition is lacking. Literature and evidence are sparse as well. Identification of skills and competencies required for the APN is warranted. Mapping skills and competencies will enable future educational harmonisation and facilitate mobility of the advanced-level intensive care nursing workforce across Europe. The aim of our scoping review is to identify literature describing skills, competencies and policies characterising advanced nursing practice in intensive care across Europe. METHODS AND ANALYSIS We will apply a five-stage scoping review methodology with a comprehensive systematic literature search as outlined by Arksey and O'Malley. In collaboration with a research librarian, we will search nine interdisciplinary databases and grey literature for publications originating in European countries in 1992-2018. Using a two-stage screening process with Covidence to remove duplicates, we will first scan the title and abstract and then perform full-text review to determine the eligibility of the papers. Qualitative content analysis will be used to chart the data. ETHICS AND DISSEMINATION Our study is a part of the European Union-funded INACTIC project (International Nursing Advanced Competency-based Training for Intensive Care) with the overall aim of developing a common European curriculum for advanced practice critical care nursing. Results from this scoping review mapping the evidence of APNs in Europe will be presented at national and international conferences and published in a peer-reviewed journal.
Collapse
Affiliation(s)
- Gudrun Kaldan
- Research Unit 7831, Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Anders Larsen
- Department UCSF 9701, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Ingrid Egerod
- Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
21
|
Wright MC, Dunbar S, Macpherson BC, Moretti EW, Del Fiol G, Bolte J, Taekman JM, Segall N. Toward Designing Information Display to Support Critical Care. A Qualitative Contextual Evaluation and Visioning Effort. Appl Clin Inform 2016; 7:912-929. [PMID: 27704138 DOI: 10.4338/aci-2016-03-ra-0033] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 03/15/2016] [Accepted: 08/23/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to support the design of improved presentation of electronic health information. METHODS We conducted a contextual analysis and visioning project. We used an eye-tracker to record 20 clinicians' information use activities in critical care settings. We played video recordings back to clinicians in retrospective cued interviews and queried: 1) context and goals of information use, 2) impacts of current display design on use, and 3) processes related to information use. We analyzed interview transcripts using grounded theory-based content analysis techniques and identified emerging themes. From these, we conducted a visioning activity with a team of subject matter experts and identified key areas for focus of design and research for future display designs. RESULTS Analyses revealed four unique critical care information use activities including new patient assessment, known patient status review, specific directed information seeking, and review and prioritization of multiple patients. Emerging themes were primarily related to a need for better representation of dynamic data such as vital signs and laboratory results, usability issues associated with reducing cognitive load and supporting efficient interaction, and processes for managing information. Visions for the future included designs that: 1) provide rapid access to new information, 2) organize by systems or problems as well as by current versus historical patient data, and 3) apply intelligence toward detecting and representing change and urgency. CONCLUSIONS The results from this study can be used to guide the design of future acute care electronic health information display. Additional research and collaboration is needed to refine and implement intelligent graphical user interfaces to improve clinical information organization and prioritization to support care decisions.
Collapse
Affiliation(s)
- Melanie C Wright
- Melanie C. Wright, PhD, Program Director, Patient Safety Research, Trinity Health and Saint Alphonsus Health System, 1055 N. Curtis Rd, Boise ID 83702, , Phone: 208-367-7399
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Flodén A, Lennerling A, Fridh I, Rizell M, Forsberg A. Development and Psychometric Evaluation of the Instrument: Attitudes Towards Organ Donor Advocacy Scale (ATODAS). Open Nurs J 2011; 5:65-73. [PMID: 22046210 PMCID: PMC3204424 DOI: 10.2174/1874434601105010065] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/15/2011] [Accepted: 08/12/2011] [Indexed: 11/22/2022] Open
Abstract
The consequences of advocacy in nursing are critical when caring for a potential organ donor. No specific instrument has been available to measure attitudes toward organ donor advocacy. The aim of this study was to develop and psychometrically evaluate an instrument for measuring intensive and critical care (ICU) nurses' attitudes toward organ donor advocacy. The study was conducted in two stages: instrument development and instrument evaluation and refinement. A questionnaire was developed (Attitude Toward Organ Donor Advocacy Scale (ATODAS)), which was sent to half of all nurses working in ICUs (general-, neuro-, thoracic- or paediatric-) in Sweden (n=1180). The final response rate was 42.5% (n=502). In order to explore validity and reliability, the expected scale dimensionality of the questionnaire was examined both by explorative principal component analysis (with oblique, varimax rotation) and by confirmatory multi-trait analysis. The confirmatory factor analysis indicated that the ATODAS could best be explained by five factors; Attitudes toward championing organ donation at a structural hospital level; Attitudes toward championing organ donation at a political and research level; Attitudes toward actively and personally safeguarding the will and wishes of the potential organ donor, Attitudes toward safeguarding the potential donor's will and wishes by a professional approach and Attitudes toward safeguarding the will and wishes of the relatives. This initial testing indicated that the ATODAS has good psychometric properties and can be used in future research to explore if interventions may influence attitudes and behaviors related to organ donor advocacy.
Collapse
Affiliation(s)
- Anne Flodén
- The Unit for Organ and Tissue Donation, Sahlgrenska University Hospital, Blå stråket 5, SE-413 45 Gothenburg, Sweden
| | - Annette Lennerling
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, & The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabell Fridh
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Forsberg
- Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, & The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|