Work Description

Record #1 of 55
ID: CN-01168314
AU: Borenstein JE
AU: Aronow HU
AU: Bolton LB
AU: Dimalanta MI
AU: Chan E
AU: Palmer K
AU: Zhang X
AU: Rosen B
AU: Braunstein GD
TI: Identification and team-based interprofessional management of hospitalized vulnerable older adults
SO: Nursing outlook
YR: 2016
VL: 64
NO: 2
PG: 137-145
PM: PUBMED 26833250
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Academic Medical Centers;Electronic Health Records;Geriatric Assessment;Hospital Mortality;Hospital Units;Hospitalization;Intensive Care Units [utilization];Length of Stay [statistics & numerical data];Linear Models;Los Angeles;Patient Care Planning;Patient Care Team [organization & administration];Patient Discharge;Patient Transfer [statistics & numerical data];Quality Improvement;Vulnerable Populations;Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1016/j.outlook.2015.11.014
AB: PURPOSE: The purpose was to evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.METHOD: The evaluation included a cluster randomized controlled trial of 10 medical/surgical units and intention-to-treat analysis of all patients meeting risk screening criteria.RESULTS: N = 1,384, median age = 80.9 years, and 53.5% female. Mean difference in observed vs. expected length of stay was 1.03 days shorter (p = .006); incidence of complications (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.21-0.98) and transfer to intensive care (OR = 0.45; 95% CI = 0.25-0.79) lower among patients admitted to intervention units; incidence of discharge to institutional care was higher (OR = 1.43; 95% CI = 1.06-1.93). Mortality during hospitalization (OR = 0.64; 95% CI = 0.37-1.11) did not differ between groups.CONCLUSION: Reorganizing general medical/surgical units to provide team-based interprofessional care can improve outcomes among hospitalized older adults.BACKGROUND: Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes but, with the growing numbers of older adults, may be difficult to scale to meet needs.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/314/CN-01168314/frame.html

Record #2 of 55
ID: CN-00963197
AU: Weiss MJ
AU: Bhanji F
AU: Fontela PS
AU: Razack SI
TI: A preliminary study of the impact of a handover cognitive aid on clinical reasoning and information transfer
SO: Medical education
YR: 2013
VL: 47
NO: 8
PG: 832-841
PM: PUBMED 23837430
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Attitude of Health Personnel;Canada;Clinical Competence [standards];Communication;Intensive Care Units, Pediatric;Patient Handoff [standards];Patient Transfer [standards];Regression Analysis;Students, Medical [psychology];Child[checkword];Humans[checkword]
DOI: 10.1111/medu.12212
AB: METHODSThis study was a randomised controlled trial in an academic paediatric intensive care unit (PICU) of 20 handover events (10 events per group) from residents in their first PICU rotation using a written handover cognitive aid (intervention) or standard practice (control). Before rounds, an investigator generated a reference standard of the handover event by completing a handover aid. Resident handovers were then audio-recorded and transcribed by a blinded research assistant. The content of this transcript was inserted into a blank handover aid. A blinded content expert scored the quantity and accuracy of the information in this aid according to predetermined criteria and these information scores (ISs) were compared with the reference standard. The same expert also blindly scored the transcripts in five domains of clinical reasoning and effectiveness: (i) effective summary of events; (ii) expressed understanding of the care plan; (iii) presentation clarity; (iv) organisation; (v) overall handover effectiveness. Differences between intervention and control groups were assessed using the Mann-Whitney test and multivariate linear regression.RESULTSThe intervention group had total ISs that more closely approximated the reference standard (81% versus 61%; p < 0.01). The intervention group had significantly higher clinical reasoning scores when compared by total score (21.1 versus 15.9 points; p = 0.01) and in each of the five domains. No difference was observed in the duration of handover between groups (7.4 versus 7.7 minutes; p = 0.97).CONCLUSIONSUsing a novel scoring system, our simple handover cognitive aid was shown to improve information transfer and resident expression of clinical reasoning without prolonging the handover duration.OBJECTIVESTo assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/197/CN-00963197/frame.html

Record #3 of 55
ID: CN-01119721
AU: Mocova Bilkova D
AU: Motovska Z
AU: Prochazka B
AU: Groch L
AU: Zelizko M
AU: Aschermann M
AU: Widimsky P
TI: Transportation to primary percutaneous coronary intervention, compared with on-site fibrinolysis, is a strong independent predictor of functional status after myocardial infarction: 5-year follow-up of the PRAGUE-2 trial
SO: European heart journal. Acute cardiovascular care
YR: 2014
VL: 3
NO: 2
PG: 105-109
PM: PUBMED 24337919
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Coronary Care Units [statistics & numerical data];Follow-Up Studies;Hospitals, Community [statistics & numerical data];Myocardial Infarction [physiopathology] [therapy];Patient Transfer [statistics & numerical data];Percutaneous Coronary Intervention [statistics & numerical data];Thrombolytic Therapy [statistics & numerical data];Transportation of Patients [statistics & numerical data];Treatment Outcome;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.1177/2048872613516016
AB: METHODSThe PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention (PCI) centre (n=429) vs. fibrinolysis in community hospitals (n=421). The data were collected from either primary hospitals or PCI centres, as well as via questionnaires.RESULTSThe mean follow-up was 58 months. At 5 years, 45.4% of patients were in New York Heart Association class I following primary PCI vs. 31.8% of those treated with fibrinolysis (OR 2.02, 95% CI 1.37-2.97, p<0.002). At 5 years, 83.6% of patients had no symptoms of angina pectoris following invasive therapy vs. 58% of patients treated with fibrinolysis (OR 4.47, 95% CI 2.79-7.18, p<0.001).CONCLUSIONSThe symptoms of angina pectoris and heart failure were significantly lower in patients assigned to primary PCI in the acute stage of myocardial infarction compared with patients treated with fibrinolysis at the 5-year follow up.AIMSSubjective symptoms represent significant criteria of a patient's health condition; therefore, we focused on the long-term prevalence of heart failure symptoms and angina pectoris after myocardial infarction between two groups of patients in which two different therapeutic strategies were used during the acute phase of ST-elevation myocardial infarction (STEMI).
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/721/CN-01119721/frame.html

Record #4 of 55
ID: CN-00491745
AU: Arino M
AU: Barrington JP
AU: Morrison AL
AU: Gillies D
TI: Management of the changeover of inotrope infusions in children
SO: Intensive & critical care nursing
YR: 2004
VL: 20
NO: 5
PG: 275-280
PM: PUBMED 15450616
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Cardiac Surgical Procedures [adverse effects] [nursing];Cardiotonic Agents [administration & dosage];Clinical Nursing Research;Dopamine [administration & dosage];Drug Monitoring;Epinephrine [administration & dosage];Hospitals, Pediatric;Hospitals, University;Infusions, Intravenous [instrumentation] [methods] [nursing];Intensive Care Units, Pediatric;New South Wales;Norepinephrine [administration & dosage];Nursing Evaluation Research;Patient Transfer;Pediatric Nursing [methods] [standards];Postoperative Care [methods] [nursing] [standards];Risk Factors;Time Factors;Child[checkword];Child, Preschool[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-CHILD
DOI: 10.1016/j.iccn.2004.06.003
AB: METHODS: Thirty children receiving inotropes post-cardiac surgery admitted to PICU were included in the study. There were two methods of changing over inotropes in this study: Method 1, quick-change and Method 2, double infusion. A rescue bolus of 0.1 ml of the changeover inotrope was given for drops in mean arterial pressure (MAP) > or = 20% during the changeover period.RESULTS: Repeated measures analysis for MAP demonstrated no significant difference in the mean percentage change from baseline during the 30-min changeover period. Quick-change: -0.297 (95% CI: -6.43 to 0.5) and double-pump: 3.73 (95% CI: -2.81 to 10.27) (P = 0.078).CONCLUSIONS: There was no statistically or clinically significant difference detected in changes to MAP. A rescue bolus was required on only one occasion during quick-change over for a reduction in MAP of > or = 20% in the quick-change group. Therefore, a quick-change method can be considered more effective as it reduces the time required for changeover and the risk of tolerance to higher levels of inotrope, while maintaining haemodynamic stability in children after cardiac surgery.Inotropes are drugs that can assist the critically ill patient's heart to function more effectively by increasing contractility. Inotrope infusions are run continuously and fresh infusions are required on a regular basis. The two methods of changeover commonly used are the quick-change and the double-pump methods. Haemodynamic compromise can occur to some degree with both methods. Evidence regarding the most effective method is limited to individual experience and anecdote. Therefore, the aim of this project was to determine the best method of changing inotropic infusions in children.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/745/CN-00491745/frame.html

Record #5 of 55
ID: CN-00069161
AU: Weingarten S
AU: Ermann B
AU: Bolus R
AU: Riedinger MS
AU: Rubin H
AU: Green A
AU: Karns K
AU: Ellrodt AG
TI: Early "step-down" transfer of low-risk patients with chest pain. A controlled interventional trial
SO: Annals of internal medicine
YR: 1990
VL: 113
NO: 4
PG: 283-289
PM: PUBMED 2115754
XR: EMBASE 1990260221
PT: Clinical Trial; Controlled Clinical Trial; Journal Article
KY: Bed Occupancy [economics];Chest Pain;Coronary Care Units [economics] [utilization];Cost-Benefit Analysis;Decision Trees;Emergency Medical Services;Hospital Units [economics] [utilization];Hospitals, Community;Length of Stay [economics];Patient Transfer [economics];Pilot Projects;Private Practice;Prospective Studies;Risk Factors;Time Factors;Triage;United States;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH: SR-EPOC: SR-VASC
AB: DESIGNProspective, controlled, interventional trial using an alternate month study design.SETTINGA large teaching community hospital.PATIENTSCohort of 404 low-risk patients with chest pain for whom a diagnosis of myocardial infarction has been excluded and who have not sustained complications, required interventions, or developed unstable comorbidity.INTERVENTIONSDuring intervention months, private practitioners caring for low-risk patients in the coronary and intermediate care units were contacted 24 hours after admission. Physicians were informed that the transfer of low-risk patients to nonmonitored beds could probably be done safely, based on the results of a pilot study. The practitioner had the option of agreeing to or deferring patient transfer. During control months, physicians were not contacted in this way.MEASUREMENTS AND MAIN RESULTSUse of the triage criteria by private practitioners reduced lengths of stay in the intermediate and coronary care units by 36% and 53%, respectively. Bed availability increased by 744 intermediate and 372 coronary care unit bed-days per year. Charges decreased by $2.6 million per year and profits improved by $390,000 per year. There were not significant differences in complications between control and intervention patients and in no case (95% CI, 0% to 1.6%) did the triage criteria adversely affect quality of care.CONCLUSIONSThe early transfer triage criteria may be a safe and efficacious decision aid for improving bed utilization in intermediate and coronary care units. In addition, this study shows the feasibility of and potential benefits from applying practice guidelines at a community hospital.OBJECTIVETo determine whether providing private practitioners with triage criteria for their low-risk chest pain patients would safely enhance bed utilization efficiency in coronary and intermediate care units.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/161/CN-00069161/frame.html

Record #6 of 55
ID: CN-00106909
AU: Wesselink RM
AU: Staden RF
AU: Leusink JA
TI: Results of long-term intensive care in 223 patients
SO: Nederlands tijdschrift voor geneeskunde
YR: 1994
VL: 138
NO: 45
PG: 2247-2251
PM: PUBMED 7969611
PT: Clinical Trial; Controlled Clinical Trial; English Abstract; Journal Article
KY: Adolescent;Critical Care;Length of Stay;Mortality;Patient Discharge;Patient Transfer;Quality of Life;Retrospective Studies;Survival Analysis;Time Factors;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH
AB: DESIGN: Retrospective, descriptive.SETTING: Intensive care unit of the St. Antonius Hospital in Nieuwegein, the Netherlands.METHODS: All patients who required more than 30 consecutive days ICU treatment between January 1985 and January 1992 were included. With the aid of a computerised data base the medical records of all patients were analysed. If discharged, their family doctor was contacted for information about survival and quality of life. Kaplan-Meier survival curves were calculated.RESULTS: Among a total of 18,126 ICU admissions, 223 patients required more than 30 days ICU treatment; 25% died in the ICU; 14% died after discharge from the ICU, but still in the hospital; 31% of the patients were discharged to another hospital or nursing home. Of all patients 50% eventually reached home. Two months after ICU discharge 75% were alive, after 1 year 50%. Mean survival time was 36 months (SD: 3). Patients under 60 years of age and those who were discharged directly home had the best prognosis. 30% of the protracted IC patients could ultimately function independently at home.CONCLUSIONS: Patients who needed more than 30 days ICU treatment had a high ICU mortality; 2 months after discharge 75% were alive.OBJECTIVE: To determine survival rates of patients treated for more than 30 days in an intensive care unit (ICU).
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/909/CN-00106909/frame.html

Record #7 of 55
ID: CN-00468385
AU: Scheck T
AU: Kober A
AU: Bertalanffy P
AU: Aram L
AU: Andel H
AU: Molnár C
AU: Hoerauf K
TI: Active warming of critically ill trauma patients during intrahospital transfer: a prospective, randomized trial
SO: Wiener klinische wochenschrift
YR: 2004
VL: 116
NO: 3
PG: 94-97
PM: PUBMED 15008318
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Abdominal Injuries [surgery];Bedding and Linens;Body Temperature;Carbon;Critical Illness [therapy];Hypothermia [therapy];Intensive Care Units;Patient Transfer [methods];Postoperative Care;Postoperative Complications [diagnostic imaging] [therapy];Radiology Department, Hospital;Rewarming [methods];Tomography, X-Ray Computed;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-INJ
AB: METHODS: Thirty critically ill patients were randomized either to an actively warmed group, covered with a carbon-fiber heating blanket (set to 42 degrees C) during the entire transport including the time spent in the CT, or to a passively warmed group, covered with a carbon-fiber heating blanket (switched off) during the entire transport and in the CT. The carbon-fiber blanket was covered with a conventional wool blanket in both groups. Vital parameters and core temperatures were recorded.RESULTS: Patients' characteristics and vital parameters were similar in each treatment group. Initial average core temperature in group A was 36.4 degrees C +/- 0.2 degrees C and remained stable at 36.4 degrees C +/- 0.1 degrees C; core temperature in group B started at 36.4 degrees C +/- 0.2 degrees C but decreased to 34.7 degrees C +/- 0.6 degrees C.CONCLUSIONS: Hypothermia is common when critically ill trauma patients require intrahospital transport for diagnostic procedures. Resistive heating during intrahospital transport kept the core temperature stable and assured normothermia in all actively warmed patients. We therefore recommend active warming for critically ill trauma patients during intrahospital transport.OBJECTIVE: Hypothermia in trauma victims is a frequently observed phenomenon in acute care. Known complications of hypothermia are impaired wound healing, cardiac complications, hemodynamic instability, impaired immune function and increased blood loss. We compared active warming versus passive warming in hypothermia in critical-care patients undergoing intrahospital transfer from ICU to computer tomography (CT).
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/385/CN-00468385/frame.html

Record #8 of 55
ID: CN-01410803
AU: Gruther W
AU: Pieber K
AU: Steiner I
AU: Hein C
AU: Hiesmayr JM
AU: Paternostro-Sluga T
TI: Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness?: a Randomized Controlled Trial
SO: American journal of physical medicine & rehabilitation
YR: 2017
VL: 96
NO: 9
PG: 607-615
PM: PUBMED 28181920
PT: Journal Article; Randomized Controlled Trial
KY: APACHE;Critical Illness [rehabilitation];Early Ambulation [methods];Intensive Care Units;Intention to Treat Analysis;Length of Stay [statistics & numerical data];Pain Measurement;Patient Transfer;Patients' Rooms [statistics & numerical data];Physical Therapy Modalities;Primary Health Care [methods];Prospective Studies;Recovery of Function;Time Factors;Treatment Outcome;Walk Test;Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1097/PHM.0000000000000718
AB: DESIGN: This was a prospective randomized controlled trial. Fifty-three consecutive survivors of critical illness were included in the study. After discharge from the intensive care unit, the intervention group received an early rehabilitation program, and the standard-care group received physical therapy as ordered by the primary care team. Length of stay at the general ward after transfer from the intensive care unit was recorded. In addition, Early Rehabilitation Barthel Index, visual analog scale for pain, 3-minute walk test, Beck Depression Inventory, State-Trait Anxiety Inventory, and Medical Research Council scale were used.RESULTS: In the per-protocol analysis, length of stay at the general ward was a median 14 days (interquartile range [IQR], 12-20 days) in the early rehabilitation and 21 days [IQR, 13-34 days) in the standard-care group. This significant result could not be confirmed by the intention-to-treat analysis (16 days [IQR, 13-23 days] vs. 21 days [IQR, 13-34 days]). Secondary outcomes were similar between the groups. Hospital costs were lower in the intervention group. No adverse effects were detected.CONCLUSIONS: An early rehabilitation program in survivors of critical illness led to an earlier discharge from the hospital, improved functional recovery, and was also cost-effective and safe.TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) delineate the benefits of early rehabilitation on a general medicine ward after an intensive care unit stay, (2) recognize the safety of appropriately implemented early rehabilitation, and (3) incorporate early rehabilitation on the general medical ward as applicable.LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.OBJECTIVE: The aim of this study was to evaluate if an early rehabilitation program for survivors of critical illness improves functional recovery, reduces length of stay, and reduces hospital costs.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/803/CN-01410803/frame.html

Record #9 of 55
ID: CN-01119685
AU: Brown H
AU: Terrence J
AU: Vasquez P
AU: Bates DW
AU: Zimlichman E
TI: Continuous monitoring in an inpatient medical-surgical unit: a controlled clinical trial
SO: American journal of medicine
YR: 2014
VL: 127
NO: 3
PG: 226-232
PM: PUBMED 24342543
PT: Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: APACHE;Heart Rate;Hospital Mortality [trends];Hospital Units [statistics & numerical data];Intensive Care Units [statistics & numerical data];Internal Medicine;Length of Stay [statistics & numerical data];Monitoring, Physiologic;Patient Transfer [statistics & numerical data];Prospective Studies;Respiratory Rate;Surgery Department, Hospital [statistics & numerical data];Adult[checkword];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1016/j.amjmed.2013.12.004
AB: METHODSIn a controlled study, we have compared a 33-bed medical-surgical unit (intervention unit) to a "sister" control unit for a 9-month preimplementation and a 9-month postimplementation period. Following the intervention, all beds in the intervention unit were equipped with monitors that allowed for continuous assessment of heart and respiration rate.RESULTSWe reviewed 7643 patient charts: 2314 that were continuously monitored in the intervention arm and 5329 in the control arms. Comparing the average length of stay of patients hospitalized in the intervention unit following the implementation of the monitors to that before the implementation and to that in the control unit, we observed a significant decrease (from 4.0 to 3.6 and 3.6 days, respectively; P <.05). Total intensive care unit days were significantly lower in the intervention unit postimplementation (63.5 vs 120.1 and 85.36 days/1000 patients, respectively; P = .04). The rate of transfer to the intensive care unit did not change, comparing before and after implementation and to the control unit (P = .19). Rate of code blue events decreased following the intervention from 6.3 to 0.9 and 2.1, respectively, per 1000 patients (P = .02).CONCLUSIONSContinuous monitoring on a medical-surgical unit was associated with a significant decrease in total length of stay in the hospital and in intensive care unit days for transferred patients, as well as lower code blue rates.BACKGROUNDFor hospitalized patients with unexpected clinical deterioration, delayed or suboptimal intervention is associated with increased morbidity and mortality. Lack of continuous monitoring for average-risk patients has been suggested as a contributing factor for unexpected in-hospital mortality. Our objective was to assess the effects of continuous heart rate and respiration rate monitoring in a medical-surgical unit on unplanned transfers and length of stay in the intensive care unit and length of stay in the medical-surgical unit.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/685/CN-01119685/frame.html

Record #10 of 55
ID: CN-01073606
AU: Wang X
AU: Liu D
AU: He H
AU: Du W
AU: Zhang H
AU: Liu Y
AU: Chai W
AU: Zhang Q
AU: Zhou X
TI: Using critical care chest ultrasonic examination in emergency consultation: a pilot study
SO: Ultrasound in medicine & biology
YR: 2015
VL: 41
NO: 2
PG: 401-406
PM: PUBMED 25592456
XR: EMBASE 2015742291
PT: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Critical Care [methods];Emergency Service, Hospital [statistics & numerical data];Intensive Care Units [statistics & numerical data];Length of Stay [statistics & numerical data];Lung [diagnostic imaging];Lung Diseases [diagnostic imaging];Patient Transfer [statistics & numerical data];Pilot Projects;Referral and Consultation [statistics & numerical data];Reproducibility of Results;Ultrasonography;Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; article; clinical protocol; comparative study; computer assisted tomography; *consultation; controlled study; diagnostic accuracy; early diagnosis; early intervention; *echography; *emergency care; female; human; *intensive care; length of stay; major clinical study; male; patient transport; pilot study; *thorax examination; thorax radiography; treatment response
DOI: 10.1016/j.ultrasmedbio.2014.09.010
AB: The purpose of this study was to investigate the effects of critical care chest ultrasonic examination (CCUE) by intensivist on the diagnosis and treatment decisions in emergent consultation for patients who may have a problem-need transfer to an intensive care unit (ICU). A total of 130 patients who required emergent consultation in the ordinary wards were included in this study. Patients were randomly divided into conventional group (n= 63) and CCUE group (n=67, added CCUE). The two groups showed no significant differences in general clinical information or final diagnosis (p>0.05). The CCUE group had a shorter time to preliminary diagnosis, final diagnosis, treatment response and X-ray/computed tomography examination; a delay in ICU transfer and ICU stay days (3.9+/-1.2 vs. 5.4+/-1.9d, p<0.05) and a higher diagnostic accuracy than the conventional group (p<0.001). In conclusion, CCUE could help early diagnosis and therapy for the patient who may need to transfer to the ICU and reduce the ICU stay for in-hospital patients in emergent consultation.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/606/CN-01073606/frame.html

Record #11 of 55
ID: CN-00120823
AU: Messahel FM
TI: Post cholecystectomy admission to the intensive care unit. Comparison between open, mini-lap and laparoscopic techniques
SO: Anaesthesia
YR: 1995
VL: 50
NO: 10
PG: 901-904
PM: PUBMED 7485884
PT: Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article
KY: Age Factors;Cholecystectomy [methods];Cholecystectomy, Laparoscopic [adverse effects];Intensive Care Units [utilization];Length of Stay;Patient Transfer;Postoperative Complications;Prospective Studies;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH
AB: Admissions to the intensive care unit following techniques for cholecystectomy, the open, mini-lap and laparoscopic methods, were studied over an 18-month period. Of 1078 cases of operative cholecystectomy performed during that period, 28 cases (2.6%) from all groups were admitted to the intensive care unit. Cases in the open and mini-lap cholecystectomy groups were admitted for postoperative monitoring because of pre-existing medical diseases and were discharged after an average period of stay of 2.4 and 4.7 days respectively. In contrast, the average stay of patients in the laparoscopic group was 14.8 days and the majority were admitted as a result of complications related to the procedure. In this group, one patient died on the first day of admission to the unit (mortality of 8.3%). This study has shown that laparoscopic surgery, from the intensive care point of view, is a very costly surgical procedure.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/823/CN-00120823/frame.html

Record #12 of 55
ID: CN-00897072
AU: Chen HY
AU: Vanness DJ
AU: Golestanian E
TI: A simplified score for transfer of patients requiring mechanical ventilation to a long-term care hospital
SO: American journal of critical care
YR: 2011
VL: 20
NO: 6
PG: e122-30
PM: PUBMED 22045148
XR: EMBASE 22045148
PT: Journal Article; Randomized Controlled Trial
KY: Cross-Sectional Studies;Decision Making;Decision Support Techniques;Efficiency, Organizational;Forecasting;Hospitals, Community;Inpatients;Intensive Care Units;Long-Term Care;Models, Theoretical;Patient Transfer;Quality of Health Care;Regression Analysis;Reproducibility of Results;Respiration, Artificial;Retrospective Studies;United States;Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword]
DOI: 10.4037/ajcc2011775
AB: OBJECTIVESTo develop a predictive model and a simplified score for use on day 7 of hospitalization to assess whether a patient receiving mechanical ventilation is likely to require an additional 25 days of hospitalization (ie, would qualify for transfer to a long-term care hospital).METHODSA retrospective, cross-sectional study using hospital discharge and billing data from the 2005 Nationwide Inpatient Sample for 54 686 Medicare beneficiaries admitted to US community hospitals who met the study's eligibility criteria. The outcome was overall length of stay (≥32 vs <32 days). Split-sample validation was used. Multivariable survey-logistic regression analyses were performed to assess predictors and probability of the outcome. A simplified score was derived from the final predictive model.RESULTSThe discriminatory power of the predictive model was 0.75 and that of the simplified score was 0.72. The model calibrated well. All predictors were significantly (P < .01) associated with a hospitalization of 32 days or longer; having a tracheostomy was the strongest predictor (odds ratio, 4.74). The simplified scores ranged from -5 to 110 points and were categorized into 3 classes of risk.CONCLUSIONSEfforts to aid discharge decision making and optimize hospital resource planning could take advantage of our predictive model and the simplified scoring tool.BACKGROUNDLong-term care hospitals are Medicare providers of postacute care that have a mean length of stay of 25 days or more. Early identification and timely transfer of patients requiring mechanical ventilation to such hospitals may improve the efficiency of inpatient care.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/072/CN-00897072/frame.html

Record #13 of 55
ID: CN-00166679
AU: Bouvé LR
AU: Rozmus CL
AU: Giordano P
TI: Preparing parents for their child's transfer from the PICU to the pediatric floor
SO: Applied nursing research
YR: 1999
VL: 12
NO: 3
PG: 114-120
PM: PUBMED 10457621
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Adolescent;Anxiety [diagnosis] [etiology] [nursing] [prevention & control];Child, Hospitalized;Intensive Care Units, Pediatric;Nursing Evaluation Research;Parents [education] [psychology];Patient Transfer;Pediatric Nursing [methods];Surveys and Questionnaires;Teaching Materials;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
AB: The experimental study described here was conducted to examine a nursing intervention intended to diminish the anxiety level of parents of children being transferred from a pediatric intensive care unit (PICU) to a general pediatric floor. The convenience sample included 50 parents of patients in a PICU at a southeastern U.S. tertiary medical center. The sample was randomly assigned to control and experimental groups. All subjects' anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) 24 to 48 hours prior to the child's impending transfer. The experimental group subsequently was given a transfer-preparation letter along with a verbal explanation. Finally, both groups were retested using the STAI immediately prior to the child's transfer. After controlling for trait anxiety, the analysis of covariant results showed significantly lower anxiety levels among the subjects who received the transfer-preparation letter than among those who did not, F(1,47) = 18.65, p < .0005. The study concludes that effective transfer preparation can significantly reduce the anxiety experienced by parents who are facing the imminent transfer of their child out of the PICU.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/679/CN-00166679/frame.html

Record #14 of 55
ID: CN-00699055
AU: Chaboyer W
AU: Thalib L
AU: Alcorn K
AU: Foster M
TI: The effect of an ICU liaison nurse on patients and family's anxiety prior to transfer to the ward: an intervention study
SO: Intensive & critical care nursing
YR: 2007
VL: 23
NO: 6
PG: 362-369
PM: PUBMED 17681470
PT: Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Australia;Family Nursing;Intensive Care Units;Patient Care Planning;Patient Transfer;Professional-Family Relations;Stress, Psychological [prevention & control];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1016/j.iccn.2007.04.005
AB: While an admission to the Intensive Care Unit (ICU) is stressful, the impending transfer from ICU to the ward can also result in anxiety for patients and their families. The aim of this study was to identify the effect of an ICU liaison nurse on anxiety experienced by patients and their families just prior to transfer to the ward. This block intervention study used a repeated before and after design, with the first control and intervention periods of 4 months, a wash-out period of 1 month, and then a second control and intervention period of 4 months duration. That is, after 4 months of control and another 4 months of intervention, the liaison nurse services were withdrawn and no data collection occurred for a month (wash-out) then a second set of 4-month blocks of control and intervention were undertaken. A standard transfer protocol was followed during the control periods whereas during the intervention periods, the liaison nurse prepared patients and their families for transfer to the ward. The State Trait Anxiety Form Y (State) was used to measure anxiety just prior to physical relocation to the ward. A total of 115 patients (62 control, 53 intervention) and 100 families (52 control, 48 intervention) were enrolled in the study. There was no difference in anxiety scores between the control and intervention groups in either patients or family groups. This study did not demonstrate a statistically significant beneficial effect of the liaison nurse in terms of pre-transfer anxiety, however it highlights several methodological issues that must be considered for future research including sample size estimates, timing and measurement of transfer anxiety and finally the intervention itself.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/055/CN-00699055/frame.html

Record #15 of 55
ID: CN-00686109
TI: The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age
SO: Pediatrics
YR: 1998
VL: 101
NO: 4
PG: E1
PM: PUBMED 9521968
PT: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Developmental Disabilities [etiology];Disabled Children [statistics & numerical data];Extracorporeal Membrane Oxygenation;Follow-Up Studies;Hernia, Diaphragmatic [complications] [mortality] [therapy];Infant, Newborn;Intensive Care Units, Neonatal;Patient Transfer;Respiration, Artificial;Respiratory Insufficiency [complications] [mortality] [therapy];Risk;Severity of Illness Index;Survivors;Treatment Outcome;Vasodilator Agents [therapeutic use];Humans[checkword]
CC: SR-ANAESTH: SR-CHILD: SR-COLOCA: SR-NEONATAL
AB: METHODSThe criteria for trial entry were: an oxygenation index of >40 or arterial partial pressure of carbon dioxide (PaCO2) >12 kPa for at least 3 hours; gestational age at birth of 35 completed weeks or more; a birth weight of 2 kg or more; <10 days high-pressure ventilation; an age of <28 days; and no contraindication to ECMO such as previous cardiac arrest or intraventricular hemorrhage. Eligible infants were randomized either to be transferred to one of five ECMO centers in the United Kingdom or to continue conventional treatment. The principal outcome was death or severe disability at the age of 1 year. Severe disability was defined as an overall developmental quotient of <50 using the Griffiths Mental Development Scales, or blindness or a level of function so as to make assessment using the Griffiths Scales impossible. Families of surviving children were contacted at regular intervals during the first year and at the age of 1, and an assessment of the child was performed by one of three developmental pediatricians. This included a neurologic examination, assessment of hearing and vision, developmental level, general health, and health service use.RESULTSOf 185 infants recruited into the trial, 93 infants were in the ECMO arm and 92 were allocated conventional treatment. The groups were comparable at trial entry. Thirty of 93 (32%) ECMO infants died before the age of 1 year and 54 of 92 (59%) of the infants in the conventional group died. Two infants were lost to follow-up, 1 from each arm of the trial. Of the remaining 99 survivors, at the age of 1 year, 2 infants (1 in each arm) were still in the hospital, and 5 (3 in the ECMO arm and 2 conventional) still required supplementary oxygen. Fifteen infants had tone changes in the limbs, 10/62 (16%) in the ECMO arm and 5/37 (13.5%) in the conventional arm. These signs were more common on the left side in both groups. One infant (in the ECMO arm) had bilateral sensorineural deafness and 1 infant (also in the ECMO arm) had low vision. Overall, 2 infants were severely disabled (1 ECMO and 1 conventional), 16 others also had evidence of functional loss (12 vs 4), and 8 had impairment without functional loss (4 vs 5). There was a trend toward proportionately greater respiratory morbidity in the conventional group. Neurologic morbidity was more common in the ECMO group, reflecting the larger number of survivors. The lower rate of adverse primary outcome (death or severe disability at 1 year) was found among infants allocated ECMO in all the predefined stratified analyses. Disease severity at trial entry and type of referral center did not appear to alter the effects of ECMO. Only 4 of 18 infants with congenital diaphragmatic hernia survived and at age 1 year only 1 of the 4 survivors was considered normal.CONCLUSIONThese results are in accord with the earlier preliminary findings that a policy of ECMO support reduces the risk of death without a concomitant rise in severe disability. However, 1 in 4 survivors had evidence of impairment with or without disability. Further follow-up is planned at the age of 4 and 7 years.OBJECTIVETo evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation (ECMO), in terms of mortality and morbidity, in the treatment of cardiorespiratory failure in term infants.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/109/CN-00686109/frame.html

Record #16 of 55
ID: CN-00490509
AU: Mitchell ML
AU: Courtney M
TI: Reducing family members' anxiety and uncertainty in illness around transfer from intensive care: an intervention study
SO: Intensive & critical care nursing
YR: 2004
VL: 20
NO: 4
PG: 223-231
PM: PUBMED 15288876
PT: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Adolescent;Analysis of Variance;Anxiety [prevention & control];Australia;Family [psychology];Intensive Care Units;Pamphlets;Patient Transfer;Social Support;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
DOI: 10.1016/j.iccn.2004.05.008
AB: METHODSThe pre-test, post-test design purposively allocated family members to a control (n = 80) and intervention group (n = 82). The intervention group experienced a structured individualised transfer method whereas the control group received existing ad hoc transfer methods. Families were surveyed before and after transfer.RESULTSFamilies' uncertainty was significantly related to their state anxiety (P < 0.000), the relationship to the patient (P = 0.022), and the unexpected nature of patients' admission (P < 0.000). Anxiety increased significantly with reduced social support (P = 0.002). Following transfer, anxiety reduced significantly for both groups whereas uncertainty reduced significantly for the intervention group (P = 0.03).CONCLUSIONFamilies at the time of transfer experience uncertainty and anxiety, which are significantly related in this study. The intervention significantly reduced uncertainty scores. When the family member was a parent, when admissions were unexpected, and those with fewer social supports represent potential 'at risk' groups whose adaptation to transfer may limit their coping ability. The structured individualised method of transfer is recommended with further research of ICU families to further examine the dimension of uncertainty and how it affects patient outcomes.INTRODUCTIONThis intervention study examines anxiety and uncertainty in illness in families transferring from intensive care to a general ward.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/509/CN-00490509/frame.html

Record #17 of 55
ID: CN-00686137
AU: Rückoldt H
AU: Marx G
AU: Leuwer M
AU: Panning B
AU: Piepenbrock S
TI: Pulse oximetry and capnography in intensive care transportation: combined use reduces transportation risks
SO: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie
YR: 1998
VL: 33
NO: 1
PG: 32-36
PM: PUBMED 9530481
PT: Clinical Trial; English Abstract; Journal Article; Randomized Controlled Trial
KY: APACHE;Capnography;Critical Care [standards];Critical Illness [epidemiology];Incidence;Monitoring, Physiologic [methods];Oximetry;Prospective Studies;Quality Assurance, Health Care;Respiration, Artificial;Risk Factors;Transportation of Patients;Humans[checkword]
CC: HS-HANDSRCH
DOI: 10.1055/s-2007-994207
AB: METHODSIn a prospective clinical study 48 mechanically ventilated patients were allocated at random in 2 main study groups, 24 patients were investigated during interhospital transportation with an ambulance car, the other 24 patients during intrahospital transports. They were classified according to APACHE II and TISS. Blood pressure, heart rate and arterial blood gases were measured at eleven selected times. Twelve randomly chosen patients out of each main study group were monitored additionally with pulse oximetry and capnometry. The results were compared using the Mann-Whitney-U test. P < or = 0.05 was considered significant.RESULTSThirty-four patients had a TISS more than 40. The mean APACHE II-Score was 14 +/- 5. The overall incidence of potentially life-threatening mishaps was 9. Six out of these 9 occurred in the 24 patients with additional monitoring and were immediately detected by pulse oximetry or capnometry.CONCLUSIONSThe combination of pulse oximetry and capnometry offers the possibility to detect potentially life-threatening problems in ventilated patients during transport. This allows for early therapeutical consequences and may help to reduce the risk of transports.OBJECTIVEDue to the growing number of diagnostic and therapeutical procedures intensive-care patients must be transported intra- and interhospitally more often. These transports are among the most critical events during intensive-care therapy, with a high incidence of potentially life-threatening mishaps [23]. The aim of this study was to evaluate the possible benefit of the combined application of pulse oximetry and capnometry for patient safety during transport.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/137/CN-00686137/frame.html

Record #18 of 55
ID: CN-00125003
AU: Scuderi PE
AU: Mims GR
AU: Weeks DB
AU: Harris LC
AU: Lipscomb L
AU: James RL
TI: Oxygen administration during transport and recovery after outpatient surgery does not prevent episodic arterial desaturation
SO: Journal of clinical anesthesia
YR: 1996
VL: 8
NO: 4
PG: 294-300
PM: PUBMED 8695133
XR: EMBASE 26161502
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Ambulatory Surgical Procedures;Blood Gas Monitoring, Transcutaneous;Heart Rate;Oxygen [blood];Oxygen Inhalation Therapy [instrumentation] [methods];Postanesthesia Nursing;Postoperative Period;Recovery Room;Regression Analysis;Transportation of Patients;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; ambulatory surgery; arterial oxygen saturation; article; clinical trial; controlled clinical trial; controlled study; convalescence; female; human; male; *oxygen therapy; patient transport; postoperative period; priority journal; pulse oximetry; randomized controlled trial; *oxygen; *ambulatory surgery; *anesthesia; computer; extubation; *fatty acid desaturation; general anesthesia; hospital patient; methodology; nasogastric tube; operating room; outpatient; patient; pulse oximeter; *pulse oximetry; recording; *recovery room; surgical technique; therapy; university; upper respiratory tract; acetylsalicylic acid; oxygen
CC: SR-ANAESTH
AB: STUDY DESIGNRandomized, prospective, nonblinded comparison in patients.SETTINGOperating room and postanesthesia care unit (PACU) of a university outpatient surgery center.PATIENTS100 ASA status I and II adults, male and female, age greater than 18 years, undergoing outpatient surgical procedures not involving the upper airway.INTERVENTIONSGroup I received supplemental O2 administered by bag-valve-mask during transport, followed by 40% face shield in the PACU. Group 2 received supplemental O2 by nasal cannula at 4 L/min both during transport and during PACU stay.MEASUREMENTS AND MAIN RESULTSArterial O2 saturation (SpO2) was collected by computer from a recording pulse oximeter at 15-second intervals beginning before extubation and continuing until O2 administration was discontinued in PACU. Neither mode of therapy was successful in completely eliminating arterial desaturation defined as SpO2 less than 90%, nor was there any difference in efficacy between the two treatment groups. Group 1 had 8 patients desaturate on 9 different occasions (5 times during transport, 4 times in PACU). Group 2 had 5 patients desaturate on 9 different occasions (4 times during transport, 5 times in PACU).CONCLUSIONRoutine O2 administration during transport and PACU stay did not abolish episodic desaturation, even in healthy patients undergoing minor surgical procedures. Given the marked difference in acquisition cost, it would appear that O2 administration by nasal cannula is a more cost-effective alternative for routine postoperative O2 administration in certain groups of patients undergoing general anesthesia for outpatient surgery.STUDY OBJECTIVETo compare the efficacy of two different oxygen (O2) delivery systems in preventing episodic arterial desaturation in the immediate postoperative period.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/003/CN-00125003/frame.html

Record #19 of 55
ID: CN-00077998
AU: Hoffman C
AU: Nakamoto D
AU: Okal R
AU: Clochesy JM
TI: Effect of transport time and FiO2 on SpO2 during transport from the OR to the PACU
SO: Nurse anesthesia
YR: 1991
VL: 2
NO: 3
PG: 119-125
PM: PUBMED 1888786
PT: Clinical Trial; Journal Article; Randomized Controlled Trial
KY: Blood Gas Analysis;Hypoxia [blood] [prevention & control] [therapy];Oximetry;Oxygen Inhalation Therapy [standards];Postoperative Complications [blood] [prevention & control] [therapy];Recovery Room;Transportation of Patients [methods];Adult[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH
AB: Early postoperative hypoxemia may be due to a reduced functional residual capacity, hypoventilation, and ventilation-perfusion mismatch. These factors reduce the partial pressure of the arterial oxygen which ultimately reduces the oxygen transported to the tissues by decreasing the hemoglobin saturation. This may lead to cellular ischemia and death. Oxygen saturation may decrease during transport from the operating room to the postanesthesia care unit. The length of transport time in large operating suites may exceed 5 minutes, which may lead to inadequate oxygenation. This research used a pretest-posttest control group design on a convenience sample. Subjects were randomized into either the treatment or control group. At emergence, the SpO2 measured and the stopwatch started. The treatment group received 40% oxygen via a venturi mask during transport while the control group breathed room air. After a routine transport to the postanesthesia care unit, the SpO2 was again measured and the transport time was recorded. Oxygen saturation was found to be significantly greater in the group breathing supplemental O2 during transport.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/998/CN-00077998/frame.html

Record #20 of 55
ID: CN-01110544
AU: Akula VP
AU: Joe P
AU: Thusu K
AU: Davis AS
AU: Tamaresis JS
AU: Kim S
AU: Shimotake TK
AU: Butler S
AU: Honold J
AU: Kuzniewicz M
AU: DeSandre G
AU: Bennett M
AU: Gould J
AU: Wallenstein MB
AU: Meurs K
TI: A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy
SO: Journal of pediatrics
YR: 2015
VL: 166
NO: 4
PG: 856-61.e1-2
PM: PUBMED 25684087
PT: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
KY: Asphyxia Neonatorum [complications] [therapy];Body Temperature [physiology];Brain Diseases [etiology] [therapy];Follow-Up Studies;Hypothermia, Induced [methods];Infant, Newborn;Infant, Newborn, Diseases [therapy];Intensive Care Units, Neonatal;Prognosis;Transportation of Patients [methods];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-NEONATAL
DOI: 10.1016/j.jpeds.2014.12.061
AB: STUDY DESIGN: We performed a multicenter, randomized, nonmasked clinical trial in newborns with neonatal encephalopathy cooled during transport to 9 neonatal intensive care units in California. Newborns who met institutional criteria for therapeutic hypothermia were randomly assigned to receive cooling according to usual center practices vs device servo-regulated cooling. The primary outcome was the percentage of temperatures in target range (33°-34°C) during transport. Secondary outcomes included percentage of newborns reaching target temperature any time during transport, time to target temperature, and percentage of newborns in target range 1 hour after cooling initiation.RESULTS: One hundred newborns were enrolled: 49 to control arm and 51 to device arm. Baseline demographics did not differ with the exception of cord pH. For each subject, the percentage of temperatures in the target range was calculated. Infants cooled using the device had a higher percentage of temperatures in target range compared with control infants (median 73% [IQR 17-88] vs 0% [IQR 0-52], P < .001). More subjects reached target temperature during transport using the servo-regulated device (80% vs 49%, P <.001), and in a shorter time period (44 ± 31 minutes vs 63 ± 37 minutes, P = .04). Device-cooled infants reached target temperature by 1 hour with greater frequency than control infants (71% vs 20%, P < .001).CONCLUSIONS: Cooling using a servo-regulated device provides more predictable temperature management during neonatal transport than does usual care for outborn newborns with neonatal encephalopathy.OBJECTIVE: To determine if temperature regulation is improved during neonatal transport using a servo-regulated cooling device when compared with standard practice.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/544/CN-01110544/frame.html

Record #21 of 55
ID: CN-01046226
AU: Park HP
AU: Hwang JW
AU: Han SH
AU: Rhee KY
AU: Jeon YT
AU: Oh YS
TI: A Comparison of Manual and Mechanical Ventilation in Terms of the Adequacy of Ventilation during Intrahospital Transport of Neurosurgical Patients in the Immediate Postoperative Period
SO: Korean journal of anesthesiology
YR: 2005
VL: 48
NO: 6
PG: 624-629
CC: HS-HANDSRCH: SR-ACC: HS-KOREAMED: SR-ENT
AB: BACKGROUND: Ambu-bags and portable ventilators can provide intubated patients with ventilation during intrahospital transport, where it is desirable to maintain normocarbia. This study was designed to compare the amount of variation in ventilation that occur during the intrahospital transport of neurosurgical patients ventilated either manually or with a portable ventilator. METHODS: 40 patients were randomized to receive either manual ventilation (Group A, n = 20) during transport or ventilation by a portable ventilator (Group P, n = 20) during the immediate postoperative period. In group A, an adult laerdal resuscitator bag with a reservoir bag (2,600 ml) was used and oxygen (15 L/min) was supplied from a portable oxygen tank. In group P, a portable ventilator was set to controlled mechanical ventilation or synchronized intermittent mandatory ventilation mode, 8.5-10 ml/kg of tidal volume, 1:2 of inspiratory to expiratory ratio, and 100% oxygen concentration. Respiratory rates were adjusted to maintain normocarbia. Hemodynamic parameters were recorded before and during transport. Arterial blood gas levels were also obtained before and during transport. RESULTS: PaCO2 during transport was significantly lower in Group A than in Group P (P < 0.05). Manually ventilated patients showed greater deviations from normocarbia (35-45 mmHg) than mechanically ventilated patients (P < 0.01). PaO2 during transport was no different in the two groups. Blood pressure and heart rates during transport increased significantly in both groups versus before transport (P < 0.01). CONCLUSIONS: The use of a portable ventilator can effectively maintain normocarbia and produce the stable ventilatory pattern during the intrahospital transport of neurosurgical patients during immediate postoperative period. [By kind permission, KoreaMed, Korean Association of Medical Journal Editors.]
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/226/CN-01046226/frame.html

Record #22 of 55
ID: CN-00020074
AU: Schwartz LP
AU: Brenner ZR
TI: Critical care unit transfer: reducing patient stress through nursing interventions
SO: Heart & lung
YR: 1979
VL: 8
NO: 3
PG: 540-546
PM: PUBMED 254678
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Coronary Care Units;Critical Care [psychology];Evaluation Studies as Topic;Myocardial Infarction [nursing];Nurse-Patient Relations;Professional-Family Relations;Stress, Psychological [prevention & control];Aged[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH: SR-DEPRESSN: SR-EPOC: SR-VASC
AB: Thirty patients hospitalized with acute myocardial infarction were studied by means of comparison of randomized groups to determine the effectiveness of two different nursing interventions on reducing the stress associated with CCU transfer. In order to promote continuity of patient care, one intervention implemented a family centered nursing approach while the other established a staff nurse-patient relationship prior to transfer to the general medical unit. Inferences as to the relationship between each of the nursing interventions and reduction of patient stress during the CCU transfer period were based on a comparison of the mean scores of psychosocial and physiological measures for the experimental and control groups. Six variables were measured. Overall, experimental patients in each group scored lower than control patients for (1-3) patient stress as reported by patient, family, and nurse, (4) cardiovascular complications within 24 hours of transfer, and (5) cardiovascular complications 24 to 72 hours after transfer; no difference was found in (6) physical complaints reported by the patient the evening of transfer.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/074/CN-00020074/frame.html

Record #23 of 55
ID: CN-00298727
AU: Neu M
AU: Browne JV
AU: Vojir C
TI: The impact of two transfer techniques used during skin-to-skin care on the physiologic and behavioral responses of preterm infants
SO: Nursing research
YR: 2000
VL: 49
NO: 4
PG: 215-223
PM: PUBMED 10929693
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Birth Weight;Cross-Over Studies;Gestational Age;Heart Rate;Infant Behavior;Infant Care;Infant, Newborn;Infant, Premature [physiology] [psychology];Intensive Care Units, Neonatal;Nurses;Oxygen Consumption;Parents;Respiration, Artificial;Skin;Adult[checkword];Female[checkword];Humans[checkword];Male[checkword]
CC: SR-ANAESTH: SR-CHILD: SR-NEONATAL
AB: OBJECTIVESTo compare the impact of two different transfer techniques used in skin-to-skin care (nurse transfer and parent transfer) on physiologic stability and other descriptive measures of physiologic stability related to energy conservation in ventilated preterm infants during and after skin-to-skin care.METHODFifteen ventilated preterm infants weighing a mean of 1,094 g were randomly assigned to receive either parent or nurse-to-parent transfer on the first of 2 consecutive days and the alternate method the following day. Temperature was taken before and after skin-to-skin care. Oxygen saturation and heart rate were recorded minute by minute, and the Assessment of Behavioral Systems Observation (ABSO) scale scores was used to measure physiologic organization, motor organization, self-regulation, and need for caregiver facilitation during transfer to and from the parent and during pre, post, and skin-to-skin periods.RESULTSTemperature remained stable. Oxygen saturation decreased and heart rate increased when the infant was transferred to and from the parent, but returned to baseline levels during and after skin-to-skin care regardless of the transfer method. Infants showed more physiologic and motor disorganization, less self-regulation, and more need for caregiver facilitation during transfers to and from the parent than during the pre, post, and skin-to-skin care periods.CONCLUSIONSBoth transfer methods resulted in physiologic disorganization. However, during and after skin-to-skin care, infants exhibited no signs of energy depletion.BACKGROUNDConservation of energy assumes an important role in the care of infants requiring assisted ventilation, yet little research has been conducted on this group of infants in terms of thermoregulation, oxygenation, heart rate, or sleep states during skin-to-skin care.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/727/CN-00298727/frame.html

Record #24 of 55
ID: CN-00123884
AU: Cernaianu AC
AU: DelRossi AJ
AU: Flum DR
AU: Vassilidze TV
AU: Ross SE
AU: Cilley JH
AU: Grosso MA
AU: Boysen PG
TI: Lorazepam and midazolam in the intensive care unit: a randomized, prospective, multicenter study of hemodynamics, oxygen transport, efficacy, and cost
SO: Critical care medicine
YR: 1996
VL: 24
NO: 2
PG: 222-228
PM: PUBMED 8605792
XR: EMBASE 26065328
PT: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
KY: Adolescent;Anti-Anxiety Agents [economics] [therapeutic use];Cost-Benefit Analysis;Critical Illness;Drug Costs;Hemodynamics [drug effects];Hypnotics and Sedatives [economics] [therapeutic use];Intensive Care Units;Lorazepam [economics] [therapeutic use];Midazolam [economics] [therapeutic use];Oxygen Consumption [drug effects];Prospective Studies;Respiration, Artificial;Adult[checkword];Aged[checkword];Aged, 80 and over[checkword];Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword];adult; aged; agitation; anxiety; article; clinical trial; controlled clinical trial; controlled study; *cost benefit analysis; critical illness; drug cost; drug efficacy; drug safety; female; *hemodynamics; human; intensive care; intravenous drug administration; major clinical study; male; multicenter study; *oxygen transport; patient satisfaction; pharmacoeconomics; priority journal; randomized controlled trial; sedation; *tranquilizing activity; *lorazepam/ad [Drug Administration]; *lorazepam/cm [Drug Comparison]; *lorazepam/do [Drug Dose]; *lorazepam/pk [Pharmacokinetics]; *lorazepam/pd [Pharmacology]; *midazolam/ad [Drug Administration]; *midazolam/cm [Drug Comparison]; *midazolam/do [Drug Dose]; *midazolam/pk [Pharmacokinetics]; *midazolam/pd [Pharmacology]; continuous infusion; cost benefit analysis; *critical illness; critically ill patient; fiber optics; general aspects of disease; hemodynamic parameters; *intensive care; *intensive care unit; laboratory; *multicenter study; nurse; nursing; open study; patient; *pharmacoeconomics; pulmonary artery catheter; safety; satisfaction; *sedation; teaching hospital; ventilated patient; *benzodiazepine derivative; *lorazepam; *midazolam
CC: SR-ANAESTH
AB: DESIGNMulticenter, prospective, randomized, open-label study.SETTINGTeaching hospitals.PATIENTSNinety-five critically ill, mechanically ventilated patients with fiberoptic pulmonary artery catheters in place were randomly assigned to receive short-term (8 hrs) sedation with either intermittent intravenous injection lorazepam (group A, n = 50) or continuous intravenous infusion midazolam (group B, n = 45) titrated to clinical response.MEASUREMENTS AND MAIN RESULTSThe severity of illness, demographic characteristics, levels of anxiety and agitation, hemodynamic parameters, oxygen transport variables, quality of sedation, nursing acceptance, and laboratory chemistries reflecting drug safety were recorded. There were no significant differences with regard to demographic data, hemodynamic and oxygen transport variables, or levels of anxiety/agitation between the two groups at baseline, 5 mins, 30 mins, and 4 and 8 hrs after administration of sedation. There were no significant differences in the quality of sedation or anxiolysis. Midazolam-treated patients used significantly larger amounts of drug for similar levels of sedation and anxiolysis (14.4 +/- 1.2 mg/8 hrs vs. 1.6 +/- 0.1 mg/8 hrs, p = .001). Both drugs were safely administered and patient and nurse satisfaction was similar.CONCLUSIONSSedation and anxiolysis with lorazepam and midazolam in critically ill patients is safe and clinically effective. Hemodynamic and oxygen transport variables are similarly affected by both drugs. The dose of midazolam required for sedation is much larger than the dose of lorazepam required for sedation, and midazolam is therefore less cost-efficient.OBJECTIVESTo evaluate and compare the clinical efficacy, impact on hemodynamic and oxygen transport variables, safety profiles, and cost efficiency of sedation and anxiolysis with lorazepam vs. continuous infusion of midazolam in critically ill, intensive care unit patients.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/884/CN-00123884/frame.html

Record #25 of 55
ID: CN-00412740
AU: Nakamura T
AU: Fujino Y
AU: Uchiyama A
AU: Mashimo T
AU: Nishimura M
TI: Intrahospital transport of critically ill patients using ventilator with patient-triggering function
SO: Chest
YR: 2003
VL: 123
NO: 1
PG: 159-164
PM: PUBMED 12527617
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Critical Illness;Equipment Design;Respiration, Artificial [instrumentation] [methods];Transportation of Patients;Ventilators, Mechanical;Female[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-PREHOSP
AB: DESIGNProspective, randomized, single-center study.SETTINGICU in a university hospital.PATIENTSA total of 16 patients (22 transports) who were spontaneously breathing and required ventilatory assistance on excursions from the ICU.METHODSFor each transport, the patient was randomly assigned to receive either manual ventilation (group M) or mechanical ventilation (group V). For transports in group V, the ventilators were set the same as in the ICU. Respiratory and hemodynamic variables were measured 30 min before transport (T(0)), on arrival at the site of procedure (T(1)), on return to the ICU (T(2)), and 30 min after return the ICU (T(3)).RESULTSAfter transport, five patients in group M showed a significant deterioration in PaO(2)/fraction of inspired oxygen ratio, while one patient in group V showed deterioration (p = 0.056). The mean (+/- SD) respiratory rate in group M at T(2) (32 +/- 9 breaths/min) was significantly higher (p < 0.001) than at T(0) (19 +/- 6 breaths/min) and also was higher (p < 0.01) than in group V at T(2) (19 +/- 6 breaths/min). The mean tidal volume and positive end-expiratory pressure in group M at T(2) showed significantly larger variation (p < 0.05 and p < 0.001, respectively) than in group V.CONCLUSIONSThe transport ventilator that was recently approved by the US Food and Drug Administration reliably provides more stable ventilatory support than does manual ventilation. Generally, the use of this transport ventilator for intrahospital transport is preferable to manual ventilation.OBJECTIVETo compare a new transport ventilator to manual ventilation in terms of maintaining the respiratory and hemodynamic levels of critically ill patients.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/740/CN-00412740/frame.html

Record #26 of 55
ID: CN-00583063
AU: Ruckoldt H
AU: Marx G
AU: Leuwer M
AU: Panning B
AU: Piepenbrock S
TI: Pulse oximetry and capnography in intensive care transportation: combined use reduces transportation risks. German
SO: Anasthesiologie, intensivmedizin, notfallmedizin, schmerztherapie
YR: 1998
NO: 1
PG: 32-36
CC: SR-PREHOSP
AB: OBJECTIVE: Due to the growing number of diagnostic and therapeutical procedures intensive-care patients must be transported intra- and interhospitally more often. These transports are among the most critical events during intensive-care therapy, with a high incidence of potentially life-threatening mishaps [23]. The aim of this study was to evaluate the possible benefit of the combined application of pulse oximetry and capnometry for patient safety during transport. METHODS: In a prospective clinical study 48 mechanically ventilated patients were allocated at random in 2 main study groups, 24 patients were investigated during interhospital transportation with an ambulance car, the other 24 patients during intrahospital transports. They were classified according to APACHE II and TISS. Blood pressure, heart rate and arterial blood gases were measured at eleven selected times. Twelve randomly chosen patients out of each main study group were monitored additionally with pulse oximetry and capnometry. The results were compared using the Mann-Whitney-U test. P < or = 0.05 was considered significant. RESULTS: Thirty-four patients had a TISS more than 40. The mean APACHE II-Score was 14 +/- 5. The overall incidence of potentially life-threatening mishaps was 9. Six out of these 9 occurred in the 24 patients with additional monitoring and were immediately detected by pulse oximetry or capnometry. CONCLUSIONS: The combination of pulse oximetry and capnometry offers the possibility to detect potentially life-threatening problems in ventilated patients during transport. This allows for early therapeutical consequences and may help to reduce the risk of transports.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/063/CN-00583063/frame.html

Record #27 of 55
ID: CN-00122440
AU: Neviere R
AU: Mathieu D
AU: Chagnon JL
AU: Lebleu N
AU: Millien JP
AU: Wattel F
TI: Skeletal muscle microvascular blood flow and oxygen transport in patients with severe sepsis
SO: American journal of respiratory and critical care medicine
YR: 1996
VL: 153
NO: 1
PG: 191-195
PM: PUBMED 8542115
PT: Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article
KY: APACHE;Hemodynamics;Hyperemia [physiopathology];Intensive Care Units;Laser-Doppler Flowmetry;Leg [blood supply];Linear Models;Microcirculation;Muscle, Skeletal [blood supply];Oxygen [metabolism];Prospective Studies;Rest;Sepsis [metabolism] [physiopathology];Time Factors;Adult[checkword];Aged[checkword];Humans[checkword];Middle Aged[checkword]
DOI: 10.1164/ajrccm.153.1.8542115
AB: To compare skeletal muscle microvascular blood flow at rest and during reactive hyperemia in septic patients, a prospective, controlled trial was conducted on 16 patients with severe sepsis and a control group of 10 patients free of infection in the intensive care unit of a university hospital. Systemic hemodynamics, whole-body oxygen transport, and skeletal muscle microvascular blood flow at rest and during reactive hyperemia were measured. Reactive hyperemia was produced by arrest of leg blood flow with a pneumatic cuff; on completion of the 3 min ischemic phase the occluding cuff was rapidly deflated to 0. Hemodynamic and oxygen-derived variables were determined invasively. Skeletal muscle microvascular blood flow data were obtained using a laser Doppler flowmetry technique and values expressed in millivolts. Whole-body oxygen delivery in septic patients was increased compared with control subjects. Resting skeletal muscle blood flow was decreased in septic patients compared with control subjects (233 +/- 52 versus 394 +/- 93 mV; p < 0.05). Peak flow during reactive hyperemia was also decreased in septic patients compared with control subjects (380 +/- 13 versus 2,033 +/- 853 mV; p < 0.05). Cyclic variation in blood flow (vasomotion) was observed in control subjects but not in septic patients. Skeletal muscle microvascular perfusion is altered in patients with severe sepsis despite normal or elevated whole-body oxygen delivery. These microvascular abnormalities may further compromise tissue nutrient flow and may contribute to the development of organ failure in septic patients.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/440/CN-00122440/frame.html

Record #28 of 55
ID: CN-00201443
AU: Ruckoldt H
AU: Marx G
AU: Leuwer M
AU: Panning B
AU: Piepenbrock S
TI: Pulse oximetry and capnometry in intensive-care transportation: combined use reduces risk.
SO: Anasthesiologie intensivmedizin notfallmedizin schmerztherapie
YR: 1998
VL: 33
NO: 1
PG: 32-36
PM: PUBMED 9530481
XR: EMBASE 28076150
PT: Journal: Article
KY: adult; aged; article; artificial ventilation; *capnography; clinical article; clinical trial; controlled clinical trial; controlled study; *critical illness; female; heart rate; human; intensive care; male; *patient transport; *pulse oximetry; randomized controlled trial; ambulance; APACHE; arterial gas; blood pressure; car; clinical study; critical illness; diagnosis; *intensive care; monitoring; patient; patient safety; patient transport; rank sum test; *risk; *safety; therapy; *traffic and transport; venous pressure; ventilated patient
AB: Objective: Due to the growing number of diagnostic and therapeutical procedures intensive-care patients must be transported intra- and interhospitally more often. These transports are among the most critical events during intensive-care therapy, with a high incidence of potentially life-threatening mishaps [23]. The aim of this study was to evaluate the possible benefit of the combined application of pulse oximetry and capnometry for patient safety during transport. Methods: In a prospective clinical study 48 mechanically ventilated patients were allocated at random in 2 main study groups, 24 patients were investigated during interhospital transportation with an ambulance car, the other 24 patients during intrahospital transports. They were classified according to APACHE II and TISS. Blood pressure, heart rate and arterial blood gases were measured at eleven selected times. Twelve randomly chosen patients out of each main study group were monitored additionally with pulse oximetry and capnometry. The results were compared using the Mann-Whitney-U test. P < 0.05 was considered significant. Results: Thirty-four patients had a TISS more than 40. The mean APACHE II-Score was 14 +/- 5. The overall incidence of potentially life-threatening mishaps was 9. Six out of these 9 occurred in the 24 patients with additional monitoring and were immediately detected by pulse oximetry or capnometry. Conclusions: The combination of pulse oximetry and capnometry offers the possibility to detect potentially life-threatening problems in ventilated patients during transport. This allows for early therapeutical consequences and may help to reduce the risk of transports.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/443/CN-00201443/frame.html

Record #29 of 55
ID: CN-00582860
AU: Dockery WK
AU: Futterman C
AU: Keller SR
AU: Sheridan MJ
AU: Akl BF
TI: A comparison of manual and mechanical ventilation during pediatric transport. see comment
SO: Critical care medicine
YR: 1999
NO: 4
PG: 802-806
CC: SR-PREHOSP
AB: OBJECTIVE: To compare the amount of variability in ventilation during intrahospital transport of intubated pediatric patients ventilated either manually or with a transport ventilator. DESIGN: Prospective, randomized study. SETTING: Tertiary, multidisciplinary, pediatric intensive care unit. PATIENTS: Forty-nine pediatric postoperative heart patients who required transport while still intubated. INTERVENTIONS: Patients were randomized to receive either manual ventilation during transport or ventilation by a portable mechanical ventilator. Baseline ventilatory and hemodynamic parameters were recorded before and during transport. Before and after arterial blood gases were also obtained. All other aspects of care were identical. MEASUREMENTS AND MAIN RESULTS: There was a statistically significant greater amount of variation in ventilation during transport with manual technique as opposed to the mechanical ventilator. A Student's t-test on pre- to post-blood gas differences showed a significantly lower PetCO2 (p =.02) in the manually ventilated patients when compared with the mechanically ventilated patients. Values for PCO2 were higher, but only marginally significant (p =.08). Repeated measures analysis of variance using these same pre- and post blood gas values confirmed the significant decrease in PetCO2 (p =.05). Minute to minute variation in PetCO2 during transport was greater and the mean values significantly lower in the manually ventilated group (p <.05). Hemodynamic data were remarkably stable when examined both before and after transport and on a minute to minute basis during transport. CONCLUSIONS: Manual ventilation during intrahospital transport results in greater fluctuation of ventilatory parameters from an established baseline than does use of a transport ventilator. No clinically significant changes in status occurred during the brief period of transport studied.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/860/CN-00582860/frame.html

Record #30 of 55
ID: CN-01306465
AU: Joo KH
AU: Yoo IS
AU: Lee J
AU: Kim SW
AU: Ryu S
AU: You YH
AU: Cho YC
AU: Jeong WJ
AU: Ahn BJ
AU: Cho SU
TI: Reduction of intra-hospital transport time using the easy tube arrange device
SO: Clin exp emerg med
YR: 2016
VL: 3
NO: 2
PG: 81-87
CC: HS-KOREAMED
DOI: 10.15441/ceem.15.091
AB: OBJECTIVE: Critically ill patients sometimes require transport to another location. Longer intra-hospital transport time increases the risk of hemodynamic instability and associated complications. Therefore, reducing intra-hospital transport time is critical. Our objective was to evaluate whether or not a new device the easy tube arrange device (ETAD) has the potential to reduce intra-hospital transport time of critically ill patients. METHODS: We enrolled volunteers for this prospective randomized controlled study. Each participant arranged four, five, and six fluid tubings, monitoring lines, and therapeutic equipment on a cardiopulmonary resuscitation training mannequin (Resusci Anne). The time required to arrange the fluid tubings for intra-hospital transport using two different methods was evaluated. RESULTS: The median time to arrange four, five, and six fluid tubings was 86.00 (76.50 to 98.50), 96.00 (86.00 to 113.00), and 115.50 (93.00 to 130.75) seconds, respectively, using the conventional method and 60.50 (52.50 to 72.75), 69.00 (57.75 to 80.80), and 72.50 (64.75 to 90.50) seconds using the ETAD (all P<0.001). The total duration (for preparing the basic setting and organizing before and after the transport) was 280.00 (268.75 to 293.00), 315.50 (304.75 to 330.75), and 338.00 (319.50 to 360.25) seconds for four, five, and six fluid tubings, respectively, using the conventional method and 274.50 (261.75 to 289.25), 288.00 (271.75 to 298.25), and 301.00 (284.50 to 310.75) seconds, respectively, using the new method (P=0.024, P<0.001, and P<0.001, respectively). CONCLUSION: The ETAD was convenient to use, reduced the time to arrange medical tubings, and is expected to assist medical staff during intra-hospital transport.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/465/CN-01306465/frame.html

Record #31 of 55
ID: CN-00177999
AU: Shamian J
AU: Clarfield AM
AU: Maclean J
TI: A randomized trial of intra-hospital relocation of geriatric patients in a tertiary-care teaching hospital
SO: Journal of the american geriatrics society
YR: 1984
VL: 32
NO: 11
PG: 794-800
PM: PUBMED 6389653
XR: EMBASE 15219529
PT: Journal: Article
KY: age; aged; Canada; clinical article; clinical trial; controlled study; ecology; epidemiology; fatality; *geriatrics; *hospitalization; human; long term care; methodology; morbidity; mortality; *nursing; psychological aspect; randomized controlled trial; short survey; social aspect; teaching hospital; therapy
CC: SR-EPOC
AB: Growing numbers of aged patients are being cared for in both acute care and chronic care settings. It is often necessary to relocate elderly patients within the institution. Relocations are generally considered to increase mortality and morbidity among the elderly and to be detrimental to activities of daily living. Effects of relocation on long-term patients in an acute care institution are examined. Thirty-six patients were assigned to experimental and control groups. The experimental group (n = 20) was relocated for 9 wk, while members of the control group (n = 16) remained in their original units. The 2 groups were evaluated for differences in mortality, morbidity, activities of daily living, and drug management. The experimental group was managed by a geriatrics team during the 9-wk relocation period, while the control group remained under the supervision of a general medical surgical team. No statistically significant (P < 0.05) differences were found with respect to mortality and morbidity, activities of daily living, or drug management. Some clinical improvements were noticed in the experimental group under the geriatrics team's supervision. The authors conclude that if careful consideration is given to the relocation of long-term patients in an acute care setting, detrimental outcomes can be avoided.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/999/CN-00177999/frame.html

Record #32 of 55
ID: CN-00163003
AU: Dockery WK
AU: Futterman C
AU: Keller SR
AU: Sheridan MJ
AU: Akl BF
TI: A comparison of manual and mechanical ventilation during pediatric transport
SO: Critical care medicine
YR: 1999
VL: 27
NO: 4
PG: 802-806
PM: PUBMED 10321673
PT: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial
KY: Adolescent;Analysis of Variance;Blood Gas Analysis;Cardiac Surgical Procedures;Critical Care;Hemodynamics;Infant, Newborn;Patient Transfer [methods];Postoperative Care;Prospective Studies;Pulmonary Ventilation;Respiration, Artificial [methods];Severity of Illness Index;Transportation of Patients [methods];Virginia;Child[checkword];Child, Preschool[checkword];Humans[checkword];Infant[checkword]
CC: SR-ANAESTH: SR-CHILD: SR-VASC
AB: DESIGNProspective, randomized study.SETTINGTertiary, multidisciplinary, pediatric intensive care unit.PATIENTSForty-nine pediatric postoperative heart patients who required transport while still intubated.INTERVENTIONSPatients were randomized to receive either manual ventilation during transport or ventilation by a portable mechanical ventilator. Baseline ventilatory and hemodynamic parameters were recorded before and during transport. Before and after arterial blood gases were also obtained. All other aspects of care were identical.MEASUREMENTS AND MAIN RESULTSThere was a statistically significant greater amount of variation in ventilation during transport with manual technique as opposed to the mechanical ventilator. A Student's t-test on pre- to post-blood gas differences showed a significantly lower PetCO2 (p = .02) in the manually ventilated patients when compared with the mechanically ventilated patients. Values for PCO2 were higher, but only marginally significant (p = .08). Repeated measures analysis of variance using these same pre- and post blood gas values confirmed the significant decrease in PetCO2 (p = .05). Minute to minute variation in PetCO2 during transport was greater and the mean values significantly lower in the manually ventilated group (p < .05). Hemodynamic data were remarkably stable when examined both before and after transport and on a minute to minute basis during transport.CONCLUSIONSManual ventilation during intrahospital transport results in greater fluctuation of ventilatory parameters from an established baseline than does use of a transport ventilator. No clinically significant changes in status occurred during the brief period of transport studied.OBJECTIVETo compare the amount of variability in ventilation during intrahospital transport of intubated pediatric patients ventilated either manually or with a transport ventilator.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/003/CN-00163003/frame.html

Record #33 of 55
ID: CN-01334437
AU: Fuentes B
AU: Alonso De Lecinana M
AU: Ximenez-Carrillo A
AU: Martinez-Sanchez P
AU: Cruz-Culebras A
AU: Zapata G
AU: Ruiz-Ares G
AU: Garcia-Pastor A
AU: Gil-Nunez A
AU: Vivancos J
AU: Masjuan J
AU: Diez-Tejedor E
TI: Frequency and reasons of "Futile" interhospital transfer for endovascular recanalization treatment in acute ischemic stroke. The madrid stroke network
SO: Cerebrovascular diseases. Conference: 23th european stroke conference. France. Conference start: 20140506. Conference end: 20140509
YR: 2014
VL: 37
PG: 98
XR: EMBASE 614325636
PT: Journal: Conference Abstract
KY: artery; blood clot lysis; *brain ischemia; call center; cardiovascular risk; clinical protocol; clinical trial; controlled clinical trial; controlled study; demography; deterioration; hospital; human; major clinical study; multicenter study; National Institutes of Health Stroke Scale; neuroimaging; patient transport; *recanalization; register; revascularization; transference
AB: Objectives: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke (IS) and the small number of patients eligible to that treatment justifies the development of Stroke Center networks with interhospital transfers. But it is possible that this approach generate "futile" transfers generating unnecessary costs. Our aim is to analyze the frequency of this fact, the reasons for rejection for ERT and to identify the possible associated factors. Methods: We analyzed a prospective registry of ERT from a Stroke Network integrated by three hospitals with a common stroke treatment protocol and a weekly rotatory shift with interhospital transference to the on-call center for ERT in those patients in whom this therapy is indicated. We analyzed: demographic data, vascular risk factors, stroke severity, frequency of prior intravenous thrombolysis, time from stroke onset and reasons for rejection. Results: ERT protocol was activated in 199 patients, receiving ERT 129 (64.8%). 120 (60.3%) patients required hospital transfer, of which 50 (41%) were not followed by ERT (futile transfer). There were no differences in age, vascular risk factors, times from stroke onset or times of interhospital transfer, baseline NIHSS, baseline ASPECTS or rates of prior intravenous thrombolysis compared transferred patients treated with ERT. Reasons for rejection were: clinical improvement or arterial recanalization (42%), findings in neuroimaging (ASPECTS <7 or no mismatch; 38%), clinical deterioration (9%), delay in shipment (2%), and revocation of consent (1%). There were no complications during intrahospital transfer. Conclusions: 40% of shipments for ERT are "futile". None of the baseline patient characteristics predict this fact, being arterial recanalization and findings in neuroimaging test done in the hospital receiving the main reasons for ERT rejection.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/437/CN-01334437/frame.html

Record #34 of 55
ID: CN-00485731
AU: Scheck T
AU: Kober A
AU: Tschabitscher F
AU: Huber G
AU: Schiller E
TI: Active Warming of critical III trauma patients on intrahospital transfer
SO: European journal of trauma
YR: 2002
VL: 28
NO: Suppl 1
PG: 96
CC: HS-HANDSRCH
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/731/CN-00485731/frame.html

Record #35 of 55
ID: CN-00797452
AU: Lieshout E
AU: Binnekade J
AU: Haan RJ
AU: Vroom M
AU: Schultz MJ
TI: Intensive Care Physician Versus Qualified Nurse Based Critical Care Transport - A Randomized Controlled (IQ-Transport Trial
SO: American journal of respiratory and critical care medicine
YR: 2011
VL: 183
NO: Meeting Abstracts
PG: A6415
CC: HS-AIRWAYS: HS-HANDSRCH
AB: American Thoracic Society International Conference, May 13-18, 20011, Denver, Colorado
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/452/CN-00797452/frame.html

Record #36 of 55
ID: CN-01408767
AU: Grood C
AU: Parsons Leigh J
AU: Bagshaw SM
AU: Dodek PM
AU: Forster AJ
AU: Fowler RA
AU: Boyd J
AU: Stelfox HT
TI: Improving transfers from the intensive care unit to hospital ward: a multicenter qualitative study of barriers and facilitators to quality transfers
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617710359
PT: Conference Abstract
KY: clinical trial; cohort analysis; communication aid; content analysis; controlled clinical trial; *controlled study; DNA transcription; doctor nurse relation; doctor patient relation; family study; female; follow up; human; instrument validation; *intensive care unit; major clinical study; male; multicenter study; patient information; patient transport; *qualitative research; speech; structured interview
DOI: 10.1164/ajrccmconference.2017.D22
AB: RATIONALE The transfer of patients from the intensive care unit (ICU) to a hospital ward is one of the most challenging, high risk, and inefficient transitions of care because the patients are sick and complex, the level of care changes from high-intensity to lower-intensity, and many different professionals are involved. However, little is known about the perspectives of providers and patients regarding barriers and facilitators associated with these transfers. METHODS We conducted a mixed methods prospective multicenter observational cohort study of 451 patients transferred from an ICU to a hospital ward in 10 Canadian hospitals. From this study cohort we purposively recruited one ICU provider, one ward provider, one patient, and one patient family member from each of the 8 English-speaking study sites (n=32 participants). Semi-structured telephone interviews were conducted to capture individual experiences and identify perceived barriers and facilitators associated with high quality transfers. Two investigators conducted qualitative content analysis of the transcribed interviews to identify themes and subthemes, which were iteratively refined with axial coding. RESULTS ICU and ward providers (physicians, nurses) described three overarching themes for barriers and facilitators: Capacity Strain/Availability of Resources, Communication, and Culture. Subthemes from ICU providers included: Continuity of Communication, ICU Follow-Up, Bed Availability, and Attending to Attending Communication; subthemes from ward providers included Timing of Transfer, Collegiality between Providers, Human Resources, and Patient Information at Transfer. Patients and their family members described similar barriers and facilitators as providers: Availability of Resources, Patient-Provider Communication and Provider Culture. However, subthemes differed from those given by providers: Staff Availability, Family Engagement, Provider Follow-Up, Ward Orientation, and Communication Aids. Ten recommendations to improve ICU transfers were suggested by stakeholders. The top recommendation across all study sites and stakeholder groups was to implement Standardized Communication Tools that streamline provider-provider and provider-patient communication during ICU to ward transfers (e.g., script for verbal handover & template for written handover). Participants from most study sites recommended development of Procedures to Manage Delays in Patient Transfer (e.g., scheduled communication updates). CONCLUSIONS We identified common barriers and facilitators associated with perceived high quality ICU-to-ward transfers. Recommendations to improve transfers include implementation of standardized multi-modal communication tools and procedures to optimize communication when there are delays in patient transfer. These barriers, facilitators, and recommendations can inform development of standardized protocols to improve the transfer of patients from the ICU to the hospital ward.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/767/CN-01408767/frame.html

Record #37 of 55
ID: CN-01004993
AU: Brozen R
TI: An analysis of lack of available literature for pain management in air medical and critical care transport: a research opportunity
SO: Air medical journal
YR: 2012
VL: 31
NO: 4
PG: 169
XR: EMBASE 70816231
PT: Journal: Conference Abstract
KY: *intensive care; *analgesia; human; Medline; randomized controlled trial; pain; air medical transport; helicopter; search engine; neoplasm; patient care; hospital patient; acupuncture; patient; drug therapy; opiate
DOI: 10.1016/j.amj.2012.04.009
AB: Objective: Air Medical and Critical Care Transport (AMT/CCT) traditionally only use opiate pain medications to manage patients' pain during interfacility and scene transports. Many other methods of pain management are available to medical providers. We attempted to analyze the amount and quality of literature devoted specifically to pain management during AMT and CCT. Methods: A literature search was performed using combinations of traditional transport terms and pain management terms in MeSH Medline terminology on PubMed and Ovid. Results: When pain management is entered in PubMed, 19 subcategories, such as postoperative, acute, chronic, cancer, and so on, are suggested by the search engine. For pain management alone, there are 99,113 biomedical literature citations and abstracts. With limits set to include human and randomized controlled trial, there are 11,719. The 19 subcategories have a range of citations from 398 to 40,443 (average, 9,572). With limits set, the range is 20 to 7,554 (average, 1,420). Pairing the terms prehospital, EMS, HEMS, helicopter, air medical transport, and aeromedical, the range is 4 to 192 (average, 54), and with limits the range is 0 to 11 (average, 2). Pairing the terms alternative, nontraditional, and acupuncture, the average is 2,686, and 443 with limits. Conclusion: A dearth of published research exists on pain management in either AMT or CCT when compared with other areas of pain management. Helicopter, HEMS, aeromedical, and air medical transport pain management literature contains a single published human randomized controlled trial cited in Medline. Opportunity exists for further research and improvement in patient care.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/993/CN-01004993/frame.html

Record #38 of 55
ID: CN-01245317
AU: Pelter MM
AU: Loranger D
AU: Kozik TM
AU: Fidler R
AU: Hu X
AU: Carey MG
TI: Unplanned transfer from the telemetry unit to the intensive care unit in hospitalized patients with suspected acute coronary syndrome
SO: Journal of electrocardiology
YR: 2016
VL: 49
NO: 6
PG: 775-783
XR: EMBASE 612996769
PT: Journal: Article
KY: *acute coronary syndrome/di [Diagnosis]; adult; age; aged; angina pectoris; article; Caucasian; coronary artery disease; diagnostic test accuracy study; diaphoresis; diuretic therapy; dyspnea; electrocardiography; elevated blood pressure; female; gender; heart catheterization; heart muscle ischemia/di [Diagnosis]; Holter monitor; Holter monitoring; hospital admission; hospital discharge; hospital patient; human; hypotension; *intensive care unit; kidney failure; length of stay; liver failure; lung edema/dt [Drug Therapy]; major clinical study; male; medical history; medical record review; middle aged; *patient transport; percutaneous coronary intervention; priority journal; retrospective study; secondary analysis; silent myocardial ischemia/di [Diagnosis]; ST segment depression; ST segment elevation; symptom; telemetry; *telemetry unit; thorax pain; very elderly; *ward; diuretic agent/dt [Drug Therapy]; *acute coronary syndrome; clinical trial; controlled clinical trial; controlled study; documentation; *hospital patient; hospitalization; monitoring; nursing; single blind procedure; ST segment; *telemetry
DOI: 10.1016/j.jelectrocard.2016.08.010
AB: Background Most patients presenting with suspected acute coronary syndrome (ACS) are admitted to telemetry units. While telemetry is an appropriate level of care, acute complications requiring a higher level of care in the intensive care unit (ICU) occur. Purpose Among patients admitted to telemetry for suspected ACS, we determine the frequency of unplanned ICU transfer, and examine whether ECG changes indicative of myocardial ischemia, and/or symptoms preceded unplanned transfer. Method This was a secondary analysis from a study assessing occurrence rates for transient myocardial ischemia (TMI) using a 12-lead Holter. Clinicians were blinded to Holter data as it was used in the context research; off-line analysis was performed post discharge. Hospital telemetry monitoring was maintained as per hospital protocol. TMI was defined as >1 mm ST-segment or , in >1 ECG lead, >1 minute. Symptoms were assessed by chart review. Results In 409 patients (64 +/- 13 years), most were men (60%), Caucasian (93%), and had a history of coronary artery disease (47%). Unplanned transfer to the ICU occurred in 9 (2.2%), was equivalent by gender, and age (no transfer 64 +/- 13 years vs transfer 67 +/- 11 years). Four patients were transferred following unsuccessful percutaneous coronary intervention (PCI) attempt, four due to recurrent angina, and one due to renal and hepatic failure. Mean time from admission to transfer was 13 +/- 6 hours, mean time to ECG detected ischemia was 6 +/- 5 hours, and 8.8 +/- 5 hours for symptoms prompting transfer. In two patients ECG detected ischemia and acute symptoms prompting transfer were simultaneous. In five patients, ECG detected ischemia was clinically silent. All patients eventually had symptoms that prompted transfer to the ICU. In all nine patients, there was no documentation or nursing notes regarding bedside ECG monitor changes prior to unplanned transfer. Hospital length of stay was longer in the unplanned transfer group (2 days +/- 2 versus 6 days +/- 4; p = 0.018). Conclusions In patients with suspected ACS, while unplanned transfer from telemetry to ICU is uncommon, it is associated with prolonged hospitalization. Two primary scenarios were identified; (1) following unsuccessful PCI, and (2) recurrent angina. Symptoms prompting unplanned transfer occurred, but happened on average 8.8 hours after hospital admission; whereas ECG detected ischemia preceding unplanned transfer occurred on average 6 hours after hospital admission. Copyright © 2016 Elsevier Inc.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/317/CN-01245317/frame.html

Record #39 of 55
ID: CN-01248767
AU: Pelter MM
AU: Loranger D
AU: Kozik TM
AU: Fidler R
AU: Hu X
AU: Carey MG
TI: Unplanned transfer from the telemetry unit to the intensive care unit in hospitalized patients with suspected acute coronary syndrome
SO: Journal of electrocardiology
YR: 2016
VL: 49
NO: 6
PG: 775-783
XR: EMBASE 612996769
PT: Journal: Article
KY: *acute coronary syndrome; angina pectoris; Caucasian; clinical trial; controlled clinical trial; controlled study; documentation; female; gender; hospital admission; *hospital patient; hospitalization; human; *intensive care unit; kidney failure; length of stay; liver failure; major clinical study; male; medical record review; monitoring; nursing; percutaneous coronary intervention; secondary analysis; single blind procedure; ST segment; symptom; *telemetry
DOI: 10.1016/j.jelectrocard.2016.08.010
AB: Background Most patients presenting with suspected acute coronary syndrome (ACS) are admitted to telemetry units. While telemetry is an appropriate level of care, acute complications requiring a higher level of care in the intensive care unit (ICU) occur. Purpose Among patients admitted to telemetry for suspected ACS, we determine the frequency of unplanned ICU transfer, and examine whether ECG changes indicative of myocardial ischemia, and/or symptoms preceded unplanned transfer. Method This was a secondary analysis from a study assessing occurrence rates for transient myocardial ischemia (TMI) using a 12-lead Holter. Clinicians were blinded to Holter data as it was used in the context research; off-line analysis was performed post discharge. Hospital telemetry monitoring was maintained as per hospital protocol. TMI was defined as >1 mm ST-segment or , in >1 ECG lead, >1 minute. Symptoms were assessed by chart review. Results In 409 patients (64 +/- 13 years), most were men (60%), Caucasian (93%), and had a history of coronary artery disease (47%). Unplanned transfer to the ICU occurred in 9 (2.2%), was equivalent by gender, and age (no transfer 64 +/- 13 years vs transfer 67 +/- 11 years). Four patients were transferred following unsuccessful percutaneous coronary intervention (PCI) attempt, four due to recurrent angina, and one due to renal and hepatic failure. Mean time from admission to transfer was 13 +/- 6 hours, mean time to ECG detected ischemia was 6 +/- 5 hours, and 8.8 +/- 5 hours for symptoms prompting transfer. In two patients ECG detected ischemia and acute symptoms prompting transfer were simultaneous. In five patients, ECG detected ischemia was clinically silent. All patients eventually had symptoms that prompted transfer to the ICU. In all nine patients, there was no documentation or nursing notes regarding bedside ECG monitor changes prior to unplanned transfer. Hospital length of stay was longer in the unplanned transfer group (2 days +/- 2 versus 6 days +/- 4; p = 0.018). Conclusions In patients with suspected ACS, while unplanned transfer from telemetry to ICU is uncommon, it is associated with prolonged hospitalization. Two primary scenarios were identified; (1) following unsuccessful PCI, and (2) recurrent angina. Symptoms prompting unplanned transfer occurred, but happened on average 8.8 hours after hospital admission; whereas ECG detected ischemia preceding unplanned transfer occurred on average 6 hours after hospital admission. Copyright © 2016 Elsevier Inc.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/767/CN-01248767/frame.html

Record #40 of 55
ID: CN-01408759
AU: Nadig NR
AU: Sterba K
AU: Johnson E
AU: Goodwin AJ
AU: Ford DW
TI: Formative research to assess family experiences with inter-icu transfers of ventilator dependent respiratory failure patients -perspectives of multiple stakeholders
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617710401
PT: Conference Abstract
KY: adult; ambulance; anxiety; *artificial ventilation; awareness; clinical trial; controlled clinical trial; controlled study; depression; diet; DNA transcription; doctor patient relation; *family study; *female; helicopter; human; *male; money; multicenter study; patient transport; perception; posttraumatic stress disorder; publication; *respiratory failure; semi structured interview; sleep; South Carolina; spiritual care; survivor; tertiary care center; theoretical model; thinking; travel; university; waiting room
DOI: 10.1164/ajrccmconference.2017.D22
AB: Rationale- Patients with ventilator dependent respiratory failure (VDRF) are among the most seriously ill ICU patients and thus theoretically should benefit from treatment in centers with greater expertise necessitating transfer between ICUs and inter-ICU transfer is common.While intended to benefit patients,inter-ICU transfer may impact patient's family who are removed from their local support systems and may experience substantial travel burdens to be near their family member.It is widely recognized that family of ICU survivors experience depression,post-traumatic stress and anxiety at rates substantially higher than that of the US population but the influence that an inter-ICU transfer has on psychological outcomes in families is entirely unknown.Thus,our objective was to utilize a qualitative approach to gather insights into the psychological impact of inter-ICU transfer on families from multiple stakeholders in the transfer triad:1) family member undergoing transfer,2) transferring clinician 3) receiving clinician. Methods-We prospectively identified VDRF patients transferred to adult ICU's at the Medical University of South Carolina (MUSC) and then recruited stakeholders associated with the patient:1) family members 2) transferring ICU clinicians from referring hospitals and 3) receiving ICU clinicians at MUSC.We then used qualitative,semi-structured interviews that explored factors regarding the transfer including patient,family, health system,transfer timing,communication,coping and support factors.Interviews were transcribed and template analysis was used to identify key themes within and across stakeholder groups. Results-Our results suggest that clinicians viewed inter-ICU transfers as burdensome to family and perceived few family-centered resources available.Further, the role of tertiary care hospitals was seen as peripheral to routine critical care and sought primarily for highly specific reasons (e.g. need for certain specialist).Family members were rarely engaged in the decision to transfer and highlighted that psychological strains were time-dependent and most prominent during the care transition.Our interviewees offered examples of general awareness and strategies they felt would be most beneficial to improving the experiences of family members that undergo inter-ICU transfer.Illustrative quotes below: Key factors in inter-ICU transfer experiences of VDRF patients Transferring and Receiving clinicians Family members Patient factors "Most patients are transferred because the transferring physician can't figure out what is going on" "Very commonly it is for higher level care and second opinion" "I did not see any progress ,we were not doing anything. Family factors "Transfer recommendation when made is readily accepted by the family-not a discussion" "I fill out plenty of leave absence slips even after family members leave our ICU" "Families crave structure when they are coming to a new hospital" " I am embarrassed that I haven't thought about family members as much in the past" "It was a good diet program, not that I want one but I lost 10 pounds during the time frame of transfer" "I did not have an opinion about the transfer, it was something that needed to be done and so it was done" System factors "We have brochures, pamphlets but I am not sure they are helpful" "As a physician, I make good money but I can't afford a transfer and stay in a hotel for 2-3 weeks" "I think we are very good at transporting patients but not so good at transporting families" "Anxious about the ambulance ride and possibly an accident" "Why would a helicopter take longer than an ambulance" "We are going to get you a nice rate they said and it means 89 dollars for a room that's not a nice rate!" Communication factors "I try to appreciate the fact that they are not near home and that they might not have all the resources" "They do not know why they are transferred ,they have no clue" "Reality for families is a collection of perceptions from talking "The doctor hardly talked to me, I never knew what was going on" "The doctor said that, this is where we need to be and I said let's transfer" to various people" Coping/Support factors "People usually sleep out in the waiting room-can convert 5-6 hospital rooms to family rooms" "Hospitals do not have a system to ease the path of family transition/transfer-may be have a liaison for transfers" "We are in the computer age, we should have Facetime meeting before the family gets transferred" "Family and spiritual support was very helpful" "Even the GPS got confused with travel and coming to the right hospital" "We had family and the minister stay in contact but it is not influencing or impacting us one way or another" "They make enough money in the parking garage and ought to pay for some support services for family" Conclusions-Findings from the interviews indicated the reasons for patient transfers were driven by perspectives of clinicians,patients and families more so than clear clinical,organizational or health system factors.The study highlights the common lack of engagement of family members in the decision to transfer as well as financial challenges and inadequate support networks through the process of inter-ICU transfer for family members.In light of these findings, it is critical to develop and evaluate family-focused tools and resources to optimize family experiences with ICU transfer.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/759/CN-01408759/frame.html

Record #41 of 55
ID: CN-01001278
AU: Tsai JCH
AU: Weng S-J
AU: Huang C-Y
AU: Yen DHT
AU: Chen H-L
TI: Feasibility of using the predisposition, insult/infection, physiological response, and organ dysfunction concept of sepsis to predict the risk of deterioration and unplanned intensive care unit transfer after emergency department admission
SO: Journal of the chinese medical association
YR: 2014
VL: 77
NO: 3
PG: 133-141
PM: PUBMED 24495529
XR: EMBASE 52987225
PT: Journal: Article
KY: adolescent; adult; aged; article; body temperature; breathing rate; *conceptual framework; controlled study; *emergency ward; feasibility study; female; general condition deterioration; heart rate; hematologic disease; *hospital admission; human; hypotension; *intensive care unit; kidney dysfunction; leukocyte count; liver dysfunction; major clinical study; male; metabolic disorder; middle aged; observational study; patient transport; prediction; *predisposition insult response and organ dysfunction concept; randomized controlled trial; respiratory failure; risk assessment; *sepsis; very elderly; young adult; death; *deterioration; *disease predisposition; *emergency; hospital; hospital patient; *human; intensive care; model; mortality; patient; *patient transport; *risk; *risk factor
DOI: 10.1016/j.jcma.2013.12.001
AB: Background: Recognizing patients at risk for deterioration and in need of critical care after emergency department (ED) admission may prevent unplanned intensive care unit (ICU) transfers and decrease the number of deaths in the hospital. The objective of this research was to study if the predisposition, insult, response, and organ dysfunction (PIRO) concept of sepsis can be used to predict the risk of unplanned ICU transfer after ED admission. Methods: The ICU transfer group included 313 patients with unplanned transfer to the ICU within 48 hours of ED admission, and the control (non-transfer) group included 736 randomly sampled patients who were not transferred to the ICU. Two-thirds of the total 1049 patients in this study were randomly assigned to a derivation group, which was used to develop the PIRO model, and the remaining patients were assigned to a validation group. Results: Independent predictors of deterioration within 48 hours after ED admission were identified by the PIRO concept. PIRO scores were higher in the ICU transfer group than in the non-transfer group, both in the derivation group [median (mean+/-SD), 5 (5.7+/-3.7) vs. 2 (2.5+/-2.5); p<0.001], and in the validation group [median (mean+/-SD), 6 (6.0+/-3.4) vs. 2 (2.4+/-2.6); p<0.001]. The proportion of ICU transfer patients with a PIRO score of 0-3, 4-6, 7-9, and >10 was 14.1%, 46.5%, 57.3%, and 83.8% in the derivation group (p<0.001) and 12.8%, 37.3%, 68.2%, and 70.0% in the validation group (p<0.001), respectively. The proportion of inpatient mortality in patients with a PIRO score of 0-3, 4-6, 7-9, and >10 was 2.6%, 10.1%, 23.2%, and 45.9% in the derivation group (p<0.001) and 3.3%, 12.0%, 18.2%, and 20.5% in the validation group (p<0.001), respectively. Conclusion: The PIRO concept of sepsis may be used in undifferentiated medical ED patients as a prediction system for unplanned ICU transfer after admission. © 2014 .
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/278/CN-01001278/frame.html

Record #42 of 55
ID: CN-01215925
AU: Somme D
AU: Andrieux N
AU: Guerot E
AU: Lahjibi-Paulet H
AU: Lazarovici C
AU: Gisselbrecht M
AU: Fagon J-Y
AU: Saint-Jean O
TI: Loss of autonomy among elderly patients after a stay in a medical intensive care unit (ICU): a randomised study of the benefit of transfer to a geriatric ward
SO: Archives of gerontology and geriatrics
YR: 2010
VL: 50
PG: e36-e40
CC: SR-EPOC
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/925/CN-01215925/frame.html

Record #43 of 55
ID: CN-00187868
AU: Konrad F
AU: Schreiber T
AU: Hahnel J
AU: Kilian J
AU: Georgieff M
TI: Effect of theophylline on mucociliary transport in ventilated intensive-care patients.
SO: Der Anaesthesist
YR: 1994
VL: 43
NO: 2
PG: 101-106
PM: PUBMED 8141435
XR: EMBASE 24101091
PT: Journal: Article
KY: adult; aged; article; artificial ventilation; clinical article; clinical trial; controlled clinical trial; controlled study; female; human; *intensive care; intravenous drug administration; male; mucociliary clearance; *mucus secretion; *respiratory failure; fentanyl; histamine; macrosalb tc 99m; methacholine; midazolam; placebo; *theophylline/ct [Clinical Trial]; *theophylline/cr [Drug Concentration]; *theophylline/pk [Pharmacokinetics]; *theophylline/pd [Pharmacology]
DOI: 10.1007/s001010050038
AB: Mucociliary clearance represents an important protective mechanism of the upper and lower respiratory tracts whereby inhaled particles and micro-organisms are removed from the tracheobronchial system. In incubated intensive care unit (ICU) patients, impaired ciliary function and mucus transport are associated with pulmonary complications. Some authors have shown that theophylline increases mucus transport in healthy subjects and patients with chronic bronchitis. However, other investigators have found unconvincing or conflicting results. Therefore, we studied the influence of theophylline on bronchial mucus transport velocity (BTV) in ventilated ICU patients. Methods. The study was approved by the ethics committee of our hospital. In a placebo-controlled double-blind study, the effect of therapeutic serum concentrations (10-20 mug/ml) of theophylline on BTV in ventilated patients in a surgical ICU was investigated. Group I (n = 10) served as controls and received placebo. The patients of group 2 (n = 10) were given intravenous infusions of 5 mg/kg body weight theophylline over 20 min, followed by 1 mg/kg per hour. Before administration of theophylline and 1 h after starting the infusion BTV, serum theophylline concentrations, and arterial blood gases were measured. Heart rate and blood pressure were registered every 5 min. In an additional study, the effect of theophylline on BTV at subtherapeutic serum concentrations (5 mug/ml) was investigated. BTV was measured with a small volume (0.05-0.08 ml) of albumin microspheres labeled with technetium-99m, which was deposited on the dorsal surface at the lower ends of the right and left main bronchi via a catheter placed in the inner channel of a fibre-optic bronchoscope. The movement of the microspheres towards the trachea was visualised and recorded using a scintillation camera. Results. The theophylline treatment induced a significant improvement in BTV from 3.8 to 7.6 mm/min in the left main bronchus and from 0.5 to 5.4 mm/min in the right, while placebo was inactive. The increase in BTV, however, was associated with an increase in heart rate; in 3 patients the theophylline infusion had to be stopped because of severe tachycardia. Blood gases and blood pressures did not change. Theophylline at subtherapeutic concentrations had no effect on either BTV or heart rate. Conclusions. Theophylline at therapeutic concentrations improves bronchial mucus transport in intubated ICU patients. The increase in BTV may be associated with severe tachycardia, and therefore routine application cannot be recommended.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/868/CN-00187868/frame.html

Record #44 of 55
ID: CN-01134687
AU: Anand V
AU: Williams E
AU: Elgendi M
AU: Meakins L
AU: Cunningham C
AU: McCrady H
AU: Tawfiq G
AU: Devlin N
AU: Shine K
AU: Larsen B
AU: Rebeyka I
AU: Adatia I
TI: Parental presence at cardiac intensive care unit bedside transfer rounds reduces parental anxiety: results of a randomized controlled trial
SO: Circulation
YR: 2015
VL: 132
NO: no pagination
XR: EMBASE 72181275
PT: Journal: Conference Abstract
KY: *human; *patient care; *anxiety; *intensive care; *pediatric cardiology; *resuscitation; *intensive care unit; *randomized controlled trial; *medical society; child; ward; medication error; control group; hospital readmission; emergency; hypothesis; parent; patient; male; State Trait Anxiety Inventory; parental stress; gender; emergency ward; morbidity; patient safety; school; parental age; satisfaction; therapy; child care
AB: Introduction: The transfer of children from the pediatric cardiac intensive care unit (PCICU) to the ward is a time of great anxiety for the parents of children and medical vulnerability for children who are receiving complex therapies. Hypothesis: We assessed the hypothesis that parental presence at bedside transfer rounds would reduce parental anxiety and improve patient safety following transfer of children from PCICU to the ward. Methods: We undertook a randomized controlled trial of children discharged from the PCICU to the ward. Consenting parents were randomized to be absent (control group) or present (intervention group) at multidisciplinary face to face bedside transfer rounds. The primary outcome measure was parental stress measured by the validated Spielberger's State -Trait Anxiety Inventory (STAI) pre and post transfer. Secondary outcome measures included unplanned readmission to the PCICU, medication errors and emergency calls to the ward. We excluded patients being transferred between intensive care units. Results: We enrolled 230 subjects (control group n=93, intervention group n=91, failed to complete study n= 46). The 2 groups were matched with respect to gender (male 46% control vs 54% intervention), age (median age control 1.9 yrs (range 0.02 to 16.3) vs intervention 0.9 (0.02 to 17), parental age 32 yrs (18-64) vs 33 (20-60), parental years of schooling 15.5 years ( 7-26) vs 15 (9-24), presence of medical co-morbidities (33% each group). There was significantly greater reduction in trait (p=0.004, state (p=0.01) and total anxiety (p=0.0012) pre and post transfer in the intervention group vs the control group. There were no differences in minor medication errors (36 vs 33), unplanned PCICU re-admissions (11 vs 12) and emergency ward calls(7 vs 8) Conclusions: Parental presence at face to face multidisciplinary transfer rounds from the PCICU is associated with reduced parental anxiety without change in medication errors, readmission rates or emergency calls to the ward. Reduced parental anxiety may improve parental satisfaction with their child's care.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/687/CN-01134687/frame.html

Record #45 of 55
ID: CN-01409347
AU: Stelfox HT
AU: Parsons Leigh J
AU: Dodek PM
AU: Turgeon AF
AU: Forster AJ
AU: Lamontagne F
AU: Fowler RA
AU: Soo A
AU: Bagshaw SM
TI: A multi-centre prospective cohort study of patient transfers from the intensive care unit to the hospital ward
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617704199
PT: Conference Abstract
KY: adult; APACHE; artificial ventilation; clinical trial; cohort analysis; comorbidity; controlled clinical trial; *controlled study; diagnosis; doctor nurse relation; doctor patient relation; female; human; major clinical study; male; medical record review; middle aged; multicenter study; night; patient coding; *patient transport; *prospective study; resuscitation; surgery; *surgical intensive care unit; telephone; travel; writing
DOI: 10.1164/ajrccm-conference.2017.A25
AB: RATIONALE The transition of patient care from the intensive care unit (ICU) to a hospital ward is challenging because the patients are sick, the level of care changes from higher to lower intensity, and many professionals are involved. However, little is known about the perspectives of providers and patients involved in these transitions of care. METHODS In a prospective multicenter cohort study of 451 adult patients transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals, we assessed transfer procedures, and provider and patient experiences. For each enrolled patient, data were collected using standardized medical record review forms and surveys of five stakeholders (ICU physician, ICU nurse, ward physician, ward nurse, patient or delegate - 69% response rate). RESULTS The median patient age was 59 years (interquartile range [IQR] 49-69 years), 41% were female, 64% had comorbidities, 37% had a surgical diagnosis, and the median APACHE II score was 18 (IQR 13-23). Patients stayed a median of 120 hours (IQR 48-216) in the ICU, and most (67%) received mechanical ventilation. The median period from when a patient was ready for ICU discharge to when the patient left the ICU was 25 hours (IQR 6-52). Communication between ICU and ward providers was reported to be verbal over the telephone (75%), verbal face-to-face (48%) and/or in writing (34%). ICU physicians and nurses were more likely to report providing information than ward physicians and nurses were to respectively report receiving information. For example, whereas 92% of ICU physicians reported providing the ward physician with the patient's diagnosis, only 78% of ward physicians reported being informed of the patient's diagnosis by the ICU physician (p<0.001). Communication between ICU providers and patients was reported to be verbal (99%) and infrequently in writing (9%). ICU physicians were more likely than patients to report that most of the information communicated was understood by patients (90% and 80%, p<0.001). Two thirds of patients (67%) reported that ICU providers adequately addressed their questions and/or concerns before transfer. A minority of ICU (35%) and ward (26%) physicians reported reviewing resuscitation status with the patient before transfer. All stakeholder groups recommended improvements to ICU-to-ward transfers that included documenting the care plan and having it travel with the patient. Physicians recommended standardized face-to-face handover. Nurses recommended avoiding transfers at night. Patients requested being informed about pending transfers in advance. CONCLUSIONS Opportunities to improve ICU-to-ward transfers exist in several areas.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/347/CN-01409347/frame.html

Record #46 of 55
ID: CN-01408774
AU: Brown K
AU: Parsons Leigh J
AU: Kamran H
AU: Dodek PM
AU: Bagshaw SM
AU: Forster AJ
AU: Turgeon AF
AU: Fowler RA
AU: Lamontagne F
AU: Stelfox HT
TI: Textual analysis of physician progress notes for patients transferred from the intensive care unit to hospital ward
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617710326
PT: Conference Abstract
KY: clinical trial; cohort analysis; confidence interval; controlled clinical trial; controlled study; *doctor patient relation; *female; human; *intensive care unit; major clinical study; *male; medical record; multicenter study; purposive sample; qualitative analysis
DOI: 10.1164/ajrccmconference.2017.D22
AB: RATIONALE Transfer of patients from the intensive care unit (ICU) to a hospital ward is a risky period in healthcare delivery that relies on multiple forms of communication. Information entered into the medical record by physicians is particularly important because it is a durable source of information in the context of frequently changing care teams. However, little is known about the structure and content of physician documentation in the medical record during transfers of care. We therefore sought to describe physician progress notes before, during, and after ICU to hospital ward transfer. METHODS We conducted a prospective multicenter cohort study of 451 adult patients who were transferred from an ICU to a hospital ward in 10 Canadian hospitals. Anonymized physician progress notes were collected from each patient's medical record for 10 consecutive calendar days: two days before ICU transfer, the day of transfer, and seven days' after transfer to the hospital ward. Quantitative and qualitative (open coding by two reviewers) analyses were used to identify and compare textual communication structure and content in ICU and ward physician notes. RESULTS A total of 447 patient medical records that included 7,201 progress notes (mean of 16 notes per patient [95% confidence interval 14.0-18.9]) were collected. Of these notes 96% [91%-100%] were handwritten and 86% of these [77%-97%] were legible. Of all notes, 93% [88%-98%] included a date, 51% [42%-61%] included a time, and 55% [42%-68%] included the identification of the writer. Notes written by ICU physicians were significantly longer than those written by ward physicians (mean number of lines of text 23.5 vs. 15.3, p<0.001). Qualitative analysis of a purposive sample (n=30) of records revealed several differences between ICU and ward physicians' notes. ICU physician notes followed a standardized structure, and focused on multiple patient issues whereas ward physician notes were mainly focused on issues that pertained to their specialty. The initial notes written by the accepting ward physicians followed a structured format similar to that of the ICU physicians and largely informed the structure and content of subsequent notes. However, over the course of the patients' ward stay, notes became progressively shorter and less structured. CONCLUSIONS We identified differences in the structure and content of ICU and ward physician progress notes, whereby there are important differences in how information is recorded. A standardized progress note template may facilitate communication across care settings and physician specialities.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/774/CN-01408774/frame.html

Record #47 of 55
ID: CN-01402704
AU: Sprigg N
AU: Robson K
AU: Appleton J
AU: Bath P
TI: Patients transferred to an intensive care unit within seven days of stroke: data from the ongoing tranexamic acid for hyperacute primary intracerebral haemorrhage (TICH-2) trial
SO: European stroke journal
YR: 2016
VL: Conference: 2nd European Stroke Organisation Conference, ESOC 2016. Spain. 1
NO: 1 Supplement 1
PG: 93-94
XR: EMBASE 617000435
PT: Conference Abstract
CC: SR-STROKE
DOI: 10.1177/2396987316642909
AB: Background: Intracerebral haemorrhage is a medical emergency and can lead to reduced consciousness. Some patients may require support in intensive care units (ICU). Methods: TICH-2 records whether participants have been transferred to ICU by day 7. Baseline characteristics and outcomes were compared between those that had been transferred and those that had not. Results: Of 1116 participants, at day 90, in TICH-2, 117 (10.5%) had been transferred to ICU. The percentage of patients going to ICU ranged from 2% to 100% across all centres, median [IQR] 14.3% [7.7%, 20%]. Patients going to ICU were younger, male and had more severe strokes with lower GCS. Over 40% patients who went to ICU were also transferred for surgery and almost 60% received invasive ventilation. Day 90 modified Rankin Scale, Barthel Index and Euroqol-5D were significantly worse for the people who were transferred (all p-values < 0.0001); however, 11.1% of people that went to ICU had a mRS of 2 or less and 16.2% were home alone or home with family/ carers at discharge. Deaths by day 90 were also signifi-cantly higher for those who had been transferred (p-value: 0.0005). Conclusions: The proportion of patients going to ICU varies widely across centres. Only half have ventilation. Those going to ICU were more likely to have more severe strokes and worse outcomes, but some patients survive and live independently.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/704/CN-01402704/frame.html

Record #48 of 55
ID: CN-00848391
AU: Belohlavek J
AU: Kucera K
AU: Jarkovsky J
AU: Franek O
AU: Pokorna M
AU: Danda J
AU: Skripsky R
AU: Kandrnal V
AU: Balik M
AU: Kunstyr J
AU: Horak J
AU: Smid O
AU: Valasek J
AU: Mrazek V
AU: Schwarz Z
AU: Linhart A
TI: Hyperinvasive approach to out-of hospital cardiac arrest using mechanical chest compression device, prehospital intraarrest cooling, extracorporeal life support and early invasive assessment compared to standard of care. A randomized parallel groups comparative study proposal. "Prague OHCA study"
SO: Journal of translational medicine
YR: 2012
VL: 10
PG: 163
PM: PUBMED 22883307
PT: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
KY: Cardiopulmonary Resuscitation [instrumentation];Emergency Medical Services [organization & administration];Heart Arrest [therapy];Hyperthermia, Induced;Humans[checkword]
DOI: 10.1186/1479-5876-10-163
AB: METHODS: This paper describes methodology and design of the proposed trial. Patients with witnessed OHCA without ROSC (return of spontaneous circulation) after a minimum of 5 minutes of ACLS (advanced cardiac life support) by emergency medical service (EMS) team and after performance of all initial procedures (defibrillation, airway management, intravenous access establishment) will be randomized to standard vs. hyperinvasive arm. In hyperinvasive arm, mechanical compression device together with intranasal evaporative cooling will be instituted and patients will be transferred directly to cardiac center under ongoing CPR (cardiopulmonary resuscitation). After admission, ECLS inclusion/exclusion criteria will be evaluated and if achieved, veno-arterial ECLS will be started. Invasive investigation and standard post resuscitation care will follow. Patients in standard arm will be managed on scene. When ROSC achieved, they will be transferred to cardiac center and further treated as per recent guidelines.PRIMARY OUTCOME: 6 months survival with good neurological outcome (Cerebral Performance Category 1-2). Secondary outcomes will include 30 day neurological and cardiac recovery.DISCUSSION: Authors introduce and offer a protocol of a proposed randomized study comparing a combined "hyperinvasive approach" to a standard of care in refractory OHCA. The protocol is opened for sharing by other cardiac centers with available ECLS and cathlab teams trained to admit patients with refractory cardiac arrest under ongoing CPR. A prove of concept study will be started soon. The aim of the authors is to establish a net of centers for a multicenter trial initiation in future. ETHICS AND REGISTRATION: The protocol has been approved by an Institutional Review Board, will be supported by a research grant from Internal Grant Agency of the Ministry of Health, Czech Republic NT 13225-4/2012 and has been registered under ClinicalTrials.gov identifier: NCT01511666.BACKGROUND: Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further prospective multicenter studies to define population that would benefit from ECLS. We aim to perform a prospective randomized study comparing prehospital intraarrest hypothermia combined with mechanical chest compression device, intrahospital ECLS and early invasive investigation and treatment in all patients with OHCA of presumed cardiac origin compared to a standard of care.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/391/CN-00848391/frame.html

Record #49 of 55
ID: CN-01091748
AU: Zimlichman E
AU: Terrence J
AU: Argaman D
AU: Shinar Z
AU: Brown H
TI: Effect of contactless continuous patient monitoring in a medical-surgical unit on intensive care unit transfers: a controlled clinical trial
SO: American journal of respiratory and critical care medicine
YR: 2012
VL: 185
XR: EMBASE 71988366
PT: Journal: Conference Abstract
KY: *human; *patient monitoring; *American; *intensive care unit; *controlled clinical trial; *society; patient; hospital; monitoring; length of stay; emergency care; vital sign; morbidity; monitor; arm; mortality; sensor; rapid response team; technology; heart rate; nurse; nursing station; evaluation study; deterioration; breathing rate; control group; risk
AB: Rationale: Most patients in acute care hospitals are considered at low or average risk for life threatening events, and thus are hospitalized in non-intensive care units (ICUs). However, these patients might deteriorate clinically and require emergency care. For patients with unexpected clinical deterioration delayed or suboptimal intervention is associated with increased morbidity and mortality. Technology applications that allow for continuous vital sign monitoring designed for non-ICU settings may help hospitals achieve meaningful results when implementing as part of a rapid response system. The EarlySense system is a piezo-electric sensor based contact-less continuous measurement monitoring system for heart rate, respiration rate and bed motion. Objective: To determine the effects of continuous patient monitoring using the Earlysense monitor in a medical-surgical unit on ICU transfers and ICU length of stay for patients initially admitted to non-ICU units. Methods: The study was conducted in a 316 bed acute care hospital as a pre-post evaluation study. Earlysense monitors were implemented in a 36-bed medical-surgical unit including bed side monitors, central nursing station display and nurse pagers. We have used two control groups a historic control for the same unit pre-implementation and a oesister unit that did not go through the implementation. We have reviewed charts for co-morbidity, acuity level and study outcomes for patients in each study group. Results: We have reviewed a total of 4000 patient charts a 1000 patients in the intervention arm and 3000 for the three control arms. Patient's demographics data is presented on table 1. For the evaluation unit we have measured a 39.5% decrease in ICU transfers with a 36.4% decrease in total ICU days comparing pre to post intervention periods (borderline significance, p=0.07) (Table 2). Comparing the intervention to the control unit we did not find a statistical significant difference in transfers (26 vs. 20 respectively, p=0.3) but did find a statistically borderline decrease in total ICU days (p=0.07). Total hospital length of stay has decreased significantly in the evaluation unit following the intervention. Conclusions: Continuous monitoring of patients in a medical-surgical unit using the Earlysense contact less vital signs monitor has resulted in a statistically borderline reduction in number of patients transferred to the ICU and total number of ICU days with a reduction in average hospital length of stay. We believe, giving these clear trends, that a larger scale study will show significant effects and would also be able to assess effect on mortality.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/748/CN-01091748/frame.html

Record #50 of 55
ID: CN-01126698
AU: Dempsey A
AU: Legault R
AU: Mehl J
AU: Steyn J
AU: Hatton K
TI: A pilot study to evaluate the effect of peep during transport to the ICU following cardiac surgery
SO: Critical care medicine.
YR: 2015
VL: 43
NO: 12 SUPPL. 1
PG: 28
XR: EMBASE 72101627
PT: Journal: Conference Abstract
KY: *intensive care; *heart surgery; *society; *pilot study; human; patient; positive end expiratory pressure; population; sample size; randomized controlled trial (topic); extubation; lung; randomized controlled trial; operating room; methodology; procedures; gender; air conditioning; surgery; learning
DOI: 10.1097/01.ccm.0000473935.75901.6d
AB: Learning Objectives: We hypothesized that the use of PEEP during transport from the operating room to the ICU after cardiac surgery will decrease lung derecruitment. The primary objectives of this pilot study were 1) to assess the feasibility of performing a randomized controlled trial (RCT) to study PEEP during transport in this patient population, 2) to assess the impact on the change in PaO2/Fi02 ratio (P/F) and the time to extubation, and 3) if a favorable trend was noted, to predict the number of patients that would be needed to power a future and larger trial. Methods: This was a single-center, blinded, randomized, controlled pilot study performed in 30 patients. Patients were randomized prior to surgery to one of three groups to receive 0, 5, or 10 cm H2O of PEEP during transport. All OR and ICU clinicians were blinded to the PEEP valve setting. Intraoperative, transport, and postoperative ventilation was standardized according to the ARDSnet protocol. The delta P/F of each patient was defined as the difference in P/F immediately before and shortly after transport from the OR to the ICU, based on ABG results. Results: No patients experienced significant hemodynamic instability during transport. With the exception of gender, there were no statistically significant differences in multiple baseline patient and procedure characteristics. There was a non-statistically significant trend toward increased mean delta P/F with PEEP compared to no PEEP. The trend toward increased P/F was greatest with PEEP=10. In addition, there was also a non-statistically significant trend toward decreased time to extubation with PEEP compared to no PEEP. Conclusions: The results of this pilot study demonstrate that the methodology was feasible for a future RCT to study PEEP during transport in this population. In addition, we were able to calculate group sample size for a future trial using a two-tailed sample size calculation. According to our data, we will need to enroll at least 132 patients in a future study to detect a statistically significant difference when comparing 0 and 10 cm H2O of PEEP.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/698/CN-01126698/frame.html

Record #51 of 55
ID: CN-00158442
AU: Spies CD
AU: Kissner M
AU: Neumann T
AU: Blum S
AU: Voigt C
AU: Funk T
AU: Runkel N
AU: Pragst F
TI: Elevated carbohydrate-deficient transferrin predicts prolonged intensive care unit stay in traumatized men
SO: Alcohol and alcoholism (oxford, oxfordshire)
YR: 1998
VL: 33
NO: 6
PG: 661-669
PM: PUBMED 9872357
PT: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
KY: Adolescent;Alcoholism [blood];Biomarkers [blood];Critical Care;Double-Blind Method;Emergency Treatment;Prospective Studies;Transferrin [analogs & derivatives] [analysis];Adult[checkword];Humans[checkword];Male[checkword];Middle Aged[checkword]
CC: SR-ANAESTH: SR-UPPERGI
AB: Carbohydrate-deficient transferrin (CDT) is reported to have a higher specificity in alcoholism than conventional markers. As the morbidity and mortality rates amongst chronic alcoholics are raised following trauma, the objective was to investigate if CDT could be used to predict prolonged intensive care unit (ICU) stay and an increased morbidity in patients with multiple injuries admitted to the ICU. In this prospective double-blind study, 66 traumatized male patients were transferred to the ICU following admission via the emergency room and operative management. Blood samples for CDT determination were taken upon admission to the emergency room, the ICU and on days 2 and 4 following admission. The patients were allocated a priori to two groups: high CDT group (CDT >20 U/l on admission to the emergency room) and low CDT group (CDT < or = 20 U/l). CDT values were determined by microanion-exchange chromatography and radioimmunoassay. Thirty-six patients had an elevated CDT value on admission to the emergency room. The high CDT group had a significantly prolonged ICU stay (median high CDT group: 13 davs; median low CDT group: 5 days). Major intercurrent complications, such as alcohol-withdrawal syndrome, tracheobronchitis, pneumonia, pancreatitis, sepsis, and congestive heart failure, were significantly increased in the high CDT group. The increased risk of pneumonia in the high CDT group may be related to the significantly increased period of mechanical ventilation. As high CDT values were associated with an increased risk of intercurrent complications and a prolonged ICU stay, it seems reasonable to use CDT as a marker in intensifying research work into preventing alcoholism-associated complications.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/442/CN-00158442/frame.html

Record #52 of 55
ID: CN-01294941
AU: Lee S-H
AU: Dorman T
AU: Pronovost P
AU: Phan P
TI: ICU, ED, OR, MED doctors' perceptions of teamwork and patient transfers: evidence from HSOPS
SO: Critical care medicine. Conference: 46th critical care congress of the society of critical care medicine, SCCM 2016. United states. Conference start: 20170121. Conference end: 20170125
YR: 2016
VL: 44
NO: 12 Supplement 1
PG: 347
XR: EMBASE 613522976
PT: Journal: Conference Abstract
KY: clinical trial; controlled clinical trial; controlled study; cross-sectional study; doctor patient relation; human; learning; Likert scale; major clinical study; medicine; multicenter study; patient safety; *patient transport; *perception; predictor variable; Student t test; *teamwork; total quality management
DOI: 10.1097/01.ccm.0000509761.70669.66
AB: Learning Objectives: ICU doctors transfer patients with ED, OR, and Medicine units. We sought to understand better the perceived differences between ICU, ED, Medicine, and OR doctors in communication, learning, and supervisory support practices may improve interunit patient transfers. Methods: Design was a cross-sectional study utilizing data from the 2010 AHRQ Hospital Survey on Patient Safety Culture (HSOPS) for Individuals. Responses from doctors in ICU (n=333), ED (n=719), Medicine (n=1130), and OR (n=904) at 885 U.S. hospitals were analyzed using t-tests and hierarchical regressions. Outcome measures included respondents' perceptions of the degree of interunit teamwork and quality of interunit transfers. Predictor variables consisted of 5-point Likert scale composites. Results: Compared to ICU, ED, Medicine and OR doctors have lower perceived teamwork quality (ICU=4.3; ED=4.02; Med=4.01; OR=3.92; p<.001), communications about error (ICU=3.65; ED=3.56; Med=3.52; OR=3.47; p<.05), learning (ICU=3.89; ED=3.66; Med=3.73; OR=3.68; p<.001), and supervisory support practices (ICU=3.9; ED=3.76; Med=3.74; OR=3.7; p<.05) but higher perceived quality of interunit transfers (ICU=2.82; ED=3.01; Med=2.99; OR=2.96; p<.05). Regressions show that the quality of interunit teamwork depends on management support for patient safety (ICU=.32; ED=.4; Med=.29; OR=.37; p<.01), staffing adequacy (ICU=.17; ED=.14; Med=.09; OR=.1; p<.01), and intra-unit teamwork quality (ICU=.11; ED=.12; Med=.13; OR=.17; p<.01). Quality of interunit transfer depends on interunit teamwork quality (ICU=.54; ED=.54; Med=.56; OR=.7; p<.01), which explains about 50% of interunit transfer quality (ICU=48%; ED=54%; Med=51%; OR=58%; p<.01). Conclusions: Interunit transfers can be improved with better interunit teamwork from support of management, staffing adequacy, and teamwork culture as well as better understanding and accommodation of the practices and constraints faced by other units. Interunit differences in perceived teamwork and transfer quality may limit quality improvement efforts.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/941/CN-01294941/frame.html

Record #53 of 55
ID: CN-00477614
AU: Salamonson Y
AU: Kariyawasam A
AU: Heere B
AU: O'Connor C
TI: The evolutionary process of Medical Emergency Team (MET) implementation: reduction in unanticipated ICU transfers
SO: Resuscitation
YR: 2001
VL: 49
NO: 2
PG: 135-141
CC: SR-EPOC
AB: OBJECTIVE: To determine whether the introduction of the Medical Emergency Team (MET) system designed to provide immediate help for seriously ill patients: (i) changed the pattern of ICU patient transfers from the wards; and (ii) improved hospital survival rates. METHODS: Prospective information on MET calls and unanticipated ICU transfers was collected for 3 years in a suburban metropolitan hospital. RESULTS: A 3-year review of MET showed the number of MET calls doubled in the second and third year and the team was activated for more than just the most extremely ill patients. Whilst the frequency of calls for cardiopulmonary arrest remained constant (n = 16), increased use of the MET resulted in the proportion of calls for cardiopulmonary arrest dropping from 30% in year 1 to 13% in year 3. A slight decrease in the percentage of in-hospital deaths (0.74% in year 1 to 0.65% in year 3) was also demonstrated. The incidence of cardiopulmonary arrest per hospital admission also decreased slightly (0.08-0.07%). Although the overall number of ICU transfers remained constant, more seriously ill patients were transferred to ICU via the MET system. This was accompanied by a significant fall in unanticipated ICU transfers. Whilst the reduction in hospital deaths was encouraging, this study could not demonstrate whether the slight improvement in hospital survival rate over the 3 years was due to the MET system. CONCLUSION: More information is needed to demonstrate that the MET system improves patient survival. The study also highlights the importance of taking proactive measures, which should include providing in-service education on the benefits of early identification and treatment of patients who are at risk of acute deterioration, raising awareness and changing attitudes in hospitals when introducing system such as the MET
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/614/CN-00477614/frame.html

Record #54 of 55
ID: CN-01409346
AU: Kim B
AU: Barmaimon G
AU: Yudelevich E
AU: Bambrick-Santoyo G
AU: Basu A
AU: Shapiro J
TI: The challenge of ICU to floor transitions: a standardized transfer note improves documentation and resident satisfaction
SO: American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states
YR: 2017
VL: 195
NO: no pagination
XR: EMBASE 617704228
PT: Conference Abstract
KY: artificial ventilation; controlled clinical trial; controlled study; emergency; female; human; human experiment; intensive care unit; male; *medical record review; oxygenation; patient care; patient safety; phase 1 clinical trial; phase 2 clinical trial; phase 3 clinical trial; phase 4 clinical trial; *resident; *satisfaction
DOI: 10.1164/ajrccm-conference.2017.A25
AB: RATIONALE: Transitions of care require thorough transfer of information between providers. Resident work hour limitations, misuse of the electronic medical record (EMR), and the complexity of Intensive Care Unit (ICU) patients increase the risk of inadequate exchange of critical information, which can lead to adverse patient outcomes. We created a standardized transfer note (STN) in the EMR to improve exchange of information during ICU to medical floor transfers. METHODS: Mount Sinai St. Luke's-West ICUs are staffed by medical residents (PGY1-3), supervised by a fellow and an attending. During Phase 1 of our project, a housestaff survey was conducted to examine the current handoff process. Phase 2 consisted of reviewing 50 pre-intervention medical records to assess the inclusion of essential ICU information. In Phase 3, we created a STN to include essential domains of ICU care. Educational training sessions were held and the STN was implemented. In Phase 4, 57 post-intervention medical records were reviewed and the housestaff were re-surveyed. Chart review and survey results pre- and post-intervention were compared. RESULTS: Utilization of the STN was 100% for all transfers. Pre-intervention review revealed widespread deficits in documentation of essential information. Post-intervention, documentation improved for the following domains (Figure 1): mechanical ventilation 64% pre vs 86% post, current method of oxygenation 62% vs 82%, procedures 60% vs 82%, current IV access 50% vs 81%, transfusions 44% vs 79%, home medications continued 54% vs 82%, home medications held 38% vs 82%, relevant cultures 50% vs 86%, tests pending 64% vs 86%, goals of care 54% vs 74%, emergency contact information 62% vs 91%. The common practice of copy-paste was resolved by the design of the STN. Only 35% of the housestaff felt the pre-intervention transfer note was useful vs 64% post intervention. Overall, 86.7% of the housestaff felt the STN either moderately or significantly improved the handoff process and 92.7% felt that the STN led to an improvement in patient care and patient safety. CONCLUSION: Implementation of a standardized ICU transfer note led to substantial improvement in documentation of critical information, decreased redundancy and copy/pasting, and increased resident satisfaction with the handoff process. We believe that introduction of a STN optimizes documentation, facilitates more thorough transitions of care and may ultimately lead to improved patient care and safety. Transitions of care are challenging and require continued improvement; standardized documentation of critical information is just the first step. (Figure Presnted).
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/346/CN-01409346/frame.html

Record #55 of 55
ID: CN-01129514
AU: Heselmans A
AU: Krieken J
AU: Cootjans S
AU: Nagels K
AU: Filliers D
AU: Dillen K
AU: Broe S
AU: Ramaekers D
TI: Medication review by a clinical pharmacist at the transfer point from ICU to ward: a randomized controlled trial
SO: Journal of clinical pharmacy and therapeutics
YR: 2015
VL: 40
NO: 5
PG: 578-583
XR: EMBASE 605663227
PT: Journal: Review
KY: aged; Belgium; clinical evaluation; controlled study; disease severity; drug safety; *drug surveillance program; female; hospital readmission; human; *intensive care unit; interpersonal communication; length of stay; major clinical study; male; outcome assessment; *patient transport; *pharmacist; pharmacist attitude; program effectiveness; randomized controlled trial (topic); review; risk reduction; study; *clinical pharmacy; control group; *drug therapy; hospital; hospital discharge; hospital patient; *human; intensive care unit; logistic regression analysis; medical record; multicenter study; patient; *quality control; *randomized controlled trial; risk; *ward
DOI: 10.1111/jcpt.12314
AB: What is known and objective Drug-related problems (DRPs) occur frequently in hospitalized patients. Patient discharge from the intensive care unit (ICU) to a non-ICU ward is one of the most challenging and high-risk transitions of care due to the number of medications, and the complexity and acuity of the medical conditions that characterize this patient group. Pharmacists could play an important role in preventing DRPs. This study was undertaken to evaluate the impact on the number and severity of drug-related problems by assigning a clinical pharmacist to the transfer process from ICU to wards. Methods The study was a randomized controlled multicentre trial conducted at the Hospital Network of Antwerp between December 2010 and January 2012. The clinical pharmacist performed a medical review in both the intervention and control group. Recommendations for drug therapy changes were immediately communicated in the intervention group but were kept blinded in the control group. The primary outcome was expressed as the number of implemented recommendations for drug therapy changes. Differences between groups were calculated using mixed effects binary logistic regression. Results Drug-related problems were found in the medical records of 360 of the 600 participants (60%). A total of 743 recommendations could be made, 375 in the intervention group and 368 in the control group. 54.1% of these problems were adjusted on time in the intervention group vs. 12.8% in the control group. Of 743 recommendations, 24.8% were judged by the expert group as major, 13.1% as moderate, 53.4% as minor and 8.9% as having no clinical impact. The odds of implementing recommendations of drug therapy changes in the intervention group were 10 times the odds of implementing recommendations of drug therapy changes in the control group (odds ratio = 10.1; 95%CI [6.3-16.1]; P < 0.001), even after accounting for differences in types of DRP between the groups (odds ratio = 15.6; 95%CI [9.4-25.9]; P < 0.001). What is new and conclusion The integration of a clinical pharmacist at the transfer point from ICU to ward led to a significant reduction in DRPs. The odds of implementing recommendations of drug therapy changes in the intervention group were significant higher than the odds of implementing recommendations of drug therapy changes in the control group. Copyright © 2015 John Wiley & Sons Ltd.
US: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/514/CN-01129514/frame.html