Record #1 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00020074 AU - Schwartz, LP AU - Brenner, ZR TI - Critical care unit transfer: reducing patient stress through nursing interventions JA - Heart & lung PY - 1979 VL - 8 IS - 3 CC - Anaesthesia, Critical, and Emergency Care CC - Common Mental Disorders CC - Effective Practice and Organisation of Care CC - Heart SP - 540‐546 C3 - PUBMED 254678 M3 - Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial KW - Aged KW - Coronary Care Units KW - Critical Care [*psychology] KW - Evaluation Studies as Topic KW - Female KW - Humans KW - Male KW - Middle Aged KW - Myocardial Infarction [nursing] KW - Nurse‐Patient Relations KW - Professional‐Family Relations KW - Stress, Psychological [*prevention & control] 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00020074/full ER - Record #2 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie PY - 1998 VL - 33 IS - 1 CC - HS-HANDSRCH SP - 32‐36 C3 - PUBMED 9530481 M3 - Clinical Trial; English Abstract; Journal Article; Randomized Controlled Trial KW - APACHE KW - Capnography KW - Critical Care [*standards] KW - Critical Illness [epidemiology] KW - Humans KW - Incidence KW - Monitoring, Physiologic [methods] KW - Oximetry KW - Prospective Studies KW - Quality Assurance, Health Care KW - Respiration, Artificial KW - Risk Factors KW - Transportation of Patients DO - 10.1055/s-2007-994207 AB - 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. 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00686137/full ER - Record #3 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Anasthesiologie, intensivmedizin, notfallmedizin, schmerztherapie PY - 1998 IS - 1 CC - SR-PREHOSP SP - 32‐36 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00583063/full ER - Record #4 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Intensive & critical care nursing PY - 2004 VL - 20 IS - 4 SP - 223‐231 C3 - PUBMED 15288876 M3 - Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non‐U.S. Gov't KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Analysis of Variance KW - Anxiety [*prevention & control] KW - Australia KW - Family [*psychology] KW - Female KW - Humans KW - Intensive Care Units KW - Male KW - Middle Aged KW - Pamphlets KW - Patient Transfer KW - Social Support DO - 10.1016/j.iccn.2004.05.008 AB - METHODS: The 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. RESULTS: Families' 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). CONCLUSION: Families 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. INTRODUCTION: This intervention study examines anxiety and uncertainty in illness in families transferring from intensive care to a general ward. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00490509/full ER - Record #5 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Ultrasound in medicine & biology PY - 2015 VL - 41 IS - 2 SP - 401‐406 C3 - PUBMED 25592456,EMBASE 602221973 M3 - Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - *consultation KW - *echography KW - *emergency care KW - *intensive care KW - *thorax examination KW - Adult KW - Article KW - Clinical protocol KW - Comparative study KW - Computer assisted tomography KW - Controlled study KW - Critical Care [*methods] KW - Diagnostic accuracy KW - Early diagnosis KW - Early intervention KW - Emergency Service, Hospital [*statistics & numerical data] KW - Female KW - Human KW - Humans KW - Intensive Care Units [statistics & numerical data] KW - Length of Stay [statistics & numerical data] KW - Length of stay KW - Lung Diseases [*diagnostic imaging] KW - Lung [diagnostic imaging] KW - Major clinical study KW - Male KW - Middle Aged KW - Patient Transfer [statistics & numerical data] KW - Patient transport KW - Pilot Projects KW - Pilot study KW - Referral and Consultation [*statistics & numerical data] KW - Reproducibility of Results KW - Thorax radiography KW - Treatment response KW - Ultrasonography DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01073606/full ER - Record #6 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00120823 AU - Messahel, FM TI - Post cholecystectomy admission to the intensive care unit. Comparison between open, mini-lap and laparoscopic techniques JA - Anaesthesia PY - 1995 VL - 50 IS - 10 CC - Anaesthesia, Critical, and Emergency Care SP - 901‐904 C3 - PUBMED 7485884 M3 - Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article KW - Adult KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cholecystectomy [*methods] KW - Cholecystectomy, Laparoscopic [adverse effects] KW - Female KW - Humans KW - Intensive Care Units [*utilization] KW - Length of Stay KW - Male KW - Middle Aged KW - Patient Transfer KW - Postoperative Complications KW - Prospective Studies 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00120823/full ER - Record #7 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Critical care medicine PY - 1996 VL - 24 IS - 2 CC - Anaesthesia, Critical, and Emergency Care SP - 222‐228 C3 - PUBMED 8605792,EMBASE 26065328 M3 - Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Anti‐Anxiety Agents [economics, *therapeutic use] KW - Cost‐Benefit Analysis KW - Critical Illness KW - Drug Costs KW - Female KW - Hemodynamics [*drug effects] KW - Humans KW - Hypnotics and Sedatives [economics, *therapeutic use] KW - Intensive Care Units KW - Lorazepam [economics, *therapeutic use] KW - Male KW - Midazolam [economics, *therapeutic use] KW - Middle Aged KW - Oxygen Consumption [*drug effects] KW - Prospective Studies KW - Respiration, Artificial AB - DESIGN: Multicenter, prospective, randomized, open‐label study. SETTING: Teaching hospitals. PATIENTS: Ninety‐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 RESULTS: The 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. CONCLUSIONS: Sedation 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. OBJECTIVES: To 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00123884/full ER - Record #8 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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: PULSOXYMETRIE UND KAPNOMETRIE BEI INTENSIVTRANSPORTEN: KOMBINIERTER EINSATZ VERRINGERT DAS TRANSPORTRISIKO JA - Anasthesiologie intensivmedizin notfallmedizin schmerztherapie PY - 1998 VL - 33 IS - 1 SP - 32‐36 C3 - EMBASE 28076150 KW - Pulse Oximetry/ Capnography/ Patient Transport/ Critical Illness/ Intensive Care/ Artificial Ventilation/ Heart Rate/ Human/ Male/ Female/ Clinical Article/ Aged/ Adult/ Clinical Trial 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 less than or equal to 0.05 was considered significant. Results: Thirty‐four patients had a TISS more than 40. The mean APACHE II‐Score was 14 plus or minus 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. Copyright © 2011 Elsevier B. V., Amsterdam. All Rights Reserved. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00201443/full ER - Record #9 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of physical medicine & rehabilitation PY - 2017 VL - 96 IS - 9 SP - 607‐615 C3 - PUBMED 28181920,EMBASE 618206042 M3 - Journal Article; Randomized Controlled Trial KW - *physiotherapy KW - *procedures KW - *statistics and numerical data KW - APACHE KW - Aged KW - Controlled study KW - Convalescence KW - Critical Illness [*rehabilitation] KW - Critical illness/rh [Rehabilitation] KW - Early Ambulation [*methods] KW - Female KW - Health care facility KW - Human KW - Humans KW - Intensive Care Units KW - Intensive care unit KW - Intention to Treat Analysis KW - Intention to treat analysis KW - Length of Stay [*statistics & numerical data] KW - Length of stay KW - Male KW - Middle Aged KW - Middle aged KW - Mobilization KW - Pain Measurement KW - Pain measurement KW - Patient Transfer KW - Patient transport KW - Patients' Rooms [*statistics & numerical data] KW - Physical Therapy Modalities KW - Primary Health Care [methods] KW - Primary health care KW - Prospective Studies KW - Prospective study KW - Randomized controlled trial KW - Recovery of Function KW - Time Factors KW - Time factor KW - Treatment Outcome KW - Treatment outcome KW - Walk Test KW - Walk test DO - 10.1097/PHM.0000000000000718 AB - 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. 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01410803/full ER - Record #10 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Archives of gerontology and geriatrics PY - 2010 VL - 50 CC - Effective Practice and Organisation of Care SP - e36‐e40 UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01215925/full ER - Record #11 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01608049 AU - Swickard, S AU - Winkelman, C AU - Hustey, FM AU - Kerr, M AU - Reimer, AP TI - Patient Safety Events during Critical Care Transport JA - Air medical journal PY - 2018 VL - (no pagination) C3 - EMBASE 2000700379 M3 - Article In Press KW - *intensive care KW - *patient safety KW - Adult KW - Adverse event KW - Article KW - Case study KW - Controlled study KW - Correlational study KW - Female KW - Health care system KW - Human KW - Hypoxia KW - Licensing KW - Major clinical study KW - Male KW - Medical record review KW - Nurse KW - Randomized controlled trial KW - Retrospective study KW - United States DO - 10.1016/j.amj.2018.02.009 AB - Objective: Patient safety events (PSEs) occurring during interfacility transport have not been studied comprehensively in critical care transport (CCT) teams in the United States. The purpose of this research was to investigate the type and frequency of PSEs during CCT between hospitals; to explore the impact of patient stability, vulnerability, complexity, predictability, and resiliency; and to examine if the nurse factors of licensure or experience and transport factors of duration or mode of transport influence the frequency of PSEs. The study was conducted at a large hospital‐based quaternary health care system in the Midwestern United States. Methods: This was a retrospective, descriptive correlational study using chart review. The study selected 50 sequential qualifying cases with PSEs and randomly selected control cases reviewed at a single site over a 5‐month period. Results: The rate of PSEs was 27.7 events per 1,000 patient contacts. Of 9 reported adverse event types, new or recurrent hypoxia had the greatest frequency. Hypoxia, when present at the time of initial CCT contact, was associated with the PSE occurrence (P =.046). Duration of transport was a significant predictor of PSEs (P =.025). Conclusion: Pretransport hypoxia and duration of transport are independent predictors for intratransport PSEs, particularly intratransport hypoxia. Copyright © 2018 Air Medical Journal Associates UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01608049/full ER - Record #12 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00106909 AU - Wesselink, RM AU - van Staden, RF AU - Leusink, JA TI - Results of long-term intensive care in 223 patients JA - Nederlands tijdschrift voor geneeskunde PY - 1994 VL - 138 IS - 45 CC - Anaesthesia, Critical, and Emergency Care SP - 2247‐2251 C3 - PUBMED 7969611 M3 - Clinical Trial; Controlled Clinical Trial; English Abstract; Journal Article KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Critical Care KW - Female KW - Humans KW - Length of Stay KW - Male KW - Middle Aged KW - Mortality KW - Patient Discharge KW - Patient Transfer KW - Quality of Life KW - Retrospective Studies KW - Survival Analysis KW - Time Factors 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). UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00106909/full ER - Record #13 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00797452 AU - van Lieshout, E AU - Binnekade, J AU - de 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 JA - American journal of respiratory and critical care medicine PY - 2011 VL - 183 IS - Meeting Abstracts CC - HS-AIRWAYS CC - HS-HANDSRCH SP - A6415 AB - American Thoracic Society International Conference, May 13‐18, 20011, Denver, Colorado UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00797452/full ER - Record #14 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01527784 AU - NCT01054183, TI - The Use of the GlideScope Ranger in Pediatric Critical Care Transport JA - Https://clinicaltrials.gov/show/nct01054183 PY - 2010 KW - Respiratory Insufficiency AB - This study seeks to assess the role of the GlideScope Ranger video laryngoscope in facilitating successful neonatal/pediatric intubation by pediatric critical care transport teams. The central hypothesis of this study is that the GlideScope Ranger video laryngoscope reduces the rates of failed intubation attempts by pediatric critical care transport teams. The aims of this project are designed to specifically: (1) Establish competencies for GlideScope Ranger video laryngoscopy‐assisted intubation for pediatric and neonatal patients; and (2) Compare the intubation success rates for intubation using GlideScope Ranger video laryngoscopy and using conventional, direct laryngoscopy by pediatric and neonatal critical care transport teams. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01527784/full ER - Record #15 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Alcohol and alcoholism (oxford, oxfordshire) PY - 1998 VL - 33 IS - 6 CC - Anaesthesia, Critical, and Emergency Care CC - Upper GI and Pancreatic Diseases SP - 661‐669 C3 - PUBMED 9872357 M3 - Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non‐U.S. Gov't KW - Adolescent KW - Adult KW - Alcoholism [*blood] KW - Biomarkers [blood] KW - Critical Care KW - Double‐Blind Method KW - Emergency Treatment KW - Humans KW - Male KW - Middle Aged KW - Prospective Studies KW - Transferrin [*analogs & derivatives, analysis] 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00158442/full ER - Record #16 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Air medical journal PY - 2012 VL - 31 IS - 4 SP - 169 C3 - EMBASE 70816231 M3 - Journal: Conference Abstract KW - *analgesia KW - *intensive care KW - Acupuncture KW - Air medical transport KW - Drug therapy KW - Helicopter KW - Hospital patient KW - Human KW - Medline KW - Neoplasm KW - Opiate KW - Pain KW - Patient KW - Patient care KW - Randomized controlled trial KW - Search engine DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01004993/full ER - Record #17 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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. EINFLUSS VON THEOPHYLLIN AUF DIE MUKOZILIARE KLARFUNKTION BEATMETER INTENSIVPATIENTEN JA - Der anaesthesist PY - 1994 VL - 43 IS - 2 SP - 101‐106 C3 - EMBASE 24101091 KW - Theophylline ‐‐Pharmacology ‐‐Pd/ Theophylline ‐‐Pharmacokinetics ‐‐Pk/ T Heophylline ‐‐Drug Concentration ‐‐Cr/ Theophylline ‐‐Clinical Trial ‐‐Ct/ Midazolam/ Fentanyl/ Macrosalb Tc 99m/ Histamine/ Methacholine/ Placebo/ Intensive Care/ Respiratory Failure/ Mucus Secretion/ Artificial Ventilation/ Human/ Controlled Study/ Clinical Trial/ Male/ Female/ Aged/ Adult/ Intravenous Drug Administration/ Article/ Mucociliary Clearance/ Clinical Article 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 microg/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 microg/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. Copyright © 2011 Elsevier B. V., Amsterdam. All Rights Reserved. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00187868/full ER - Record #18 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 - et al. TI - Parental presence at cardiac intensive care unit bedside transfer rounds reduces parental anxiety: results of a randomized controlled trial JA - Circulation PY - 2015 VL - 132 IS - no pagination C3 - EMBASE 72181275 M3 - Journal: Conference Abstract KW - *anxiety KW - *human KW - *intensive care KW - *intensive care unit KW - *medical society KW - *patient care KW - *pediatric cardiology KW - *randomized controlled trial KW - *resuscitation KW - Child KW - Child care KW - Control group KW - Emergency KW - Emergency ward KW - Gender KW - Hospital readmission KW - Hypothesis KW - Male KW - Medication error KW - Morbidity KW - Parent KW - Parental age KW - Parental stress KW - Patient KW - Patient safety KW - Satisfaction KW - School KW - State Trait Anxiety Inventory KW - Therapy KW - Ward 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01134687/full ER - Record #19 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states PY - 2017 VL - 195 IS - no pagination C3 - EMBASE 617704199 M3 - Conference Abstract KW - *controlled study KW - *patient transport KW - *prospective study KW - *surgical intensive care unit KW - APACHE KW - Adult KW - Artificial ventilation KW - Clinical trial KW - Cohort analysis KW - Comorbidity KW - Controlled clinical trial KW - Diagnosis KW - Doctor nurse relation KW - Doctor patient relation KW - Female KW - Human KW - Major clinical study KW - Male KW - Medical record review KW - Middle aged KW - Multicenter study KW - Night KW - Patient coding KW - Resuscitation KW - Surgery KW - Telephone KW - Travel KW - Writing DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01409347/full ER - Record #20 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states PY - 2017 VL - 195 IS - no pagination C3 - EMBASE 617710326 M3 - Conference Abstract KW - *doctor patient relation KW - *female KW - *intensive care unit KW - *male KW - Clinical trial KW - Cohort analysis KW - Confidence interval KW - Controlled clinical trial KW - Controlled study KW - Human KW - Major clinical study KW - Medical record KW - Multicenter study KW - Purposive sample KW - Qualitative analysis DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01408774/full ER - Record #21 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of respiratory and critical care medicine PY - 2012 VL - 185 C3 - EMBASE 71988366 M3 - Journal: Conference Abstract KW - *American KW - *controlled clinical trial KW - *human KW - *intensive care unit KW - *patient monitoring KW - *society KW - Arm KW - Breathing rate KW - Control group KW - Deterioration KW - Emergency care KW - Evaluation study KW - Heart rate KW - Hospital KW - Length of stay KW - Monitor KW - Monitoring KW - Morbidity KW - Mortality KW - Nurse KW - Nursing station KW - Patient KW - Rapid response team KW - Risk KW - Sensor KW - Technology KW - Vital sign 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01091748/full ER - Record #22 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Journal of electrocardiology PY - 2016 VL - 49 IS - 6 SP - 775‐783 C3 - EMBASE 612996769 M3 - Journal: Article KW - *acute coronary syndrome KW - *hospital patient KW - *intensive care unit KW - *telemetry KW - Angina pectoris KW - Caucasian KW - Clinical trial KW - Controlled clinical trial KW - Controlled study KW - Documentation KW - Female KW - Gender KW - Hospital admission KW - Hospitalization KW - Human KW - Kidney failure KW - Length of stay KW - Liver failure KW - Major clinical study KW - Male KW - Medical record review KW - Monitoring KW - Nursing KW - Percutaneous coronary intervention KW - ST segment KW - Secondary analysis KW - Single blind procedure KW - Symptom DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01248767/full ER - Record #23 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01408767 AU - De 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 JA - American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states PY - 2017 VL - 195 IS - no pagination C3 - EMBASE 617710359 M3 - Conference Abstract KW - *controlled study KW - *intensive care unit KW - *qualitative research KW - Clinical trial KW - Cohort analysis KW - Communication aid KW - Content analysis KW - Controlled clinical trial KW - DNA transcription KW - Doctor nurse relation KW - Doctor patient relation KW - Family study KW - Female KW - Follow up KW - Human KW - Instrument validation KW - Major clinical study KW - Male KW - Multicenter study KW - Patient information KW - Patient transport KW - Speech KW - Structured interview DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01408767/full ER - Record #24 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - European stroke journal PY - 2016 VL - Conference: 2nd European Stroke Organisation Conference, ESOC 2016. Spain. 1 IS - 1 Supplement 1 CC - Stroke SP - 93‐94 C3 - EMBASE 617000435 M3 - Conference Abstract DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01402704/full ER - Record #25 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01542974 AU - NCT01883739, TI - Randomised Controlled Trial to Investigate the Effect of Parental Presence at Intensive Care Unit to Ward Transfer Bedside Rounds on Parental Anxiety and Children's Safety JA - Https://clinicaltrials.gov/show/nct01883739 PY - 2013 KW - Anxiety Disorders AB - The investigators shall conduct a randomized controlled trial to investigate the effect of parental presence at transfer rounds on parental anxiety and patient safety following transfer from the Pediatric Cardiac Intensive Care Unit (PCICU) to the ward. The investigators plan to test the hypothesis that parental involvement in the child's transfer, with the option of peer support, will result in measurable reductions in medication errors, unplanned nutritional and feeding management, and parental anxiety after transfer as compared to the control group. The investigators goal is to improve continuity of care by implementing multidisciplinary transfer rounds at the child's bedside in which patients and family share in the control of the management plan when a cardiac child is discharged from PCICU to the ward. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01542974/full ER - Record #26 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Wiener klinische wochenschrift PY - 2004 VL - 116 IS - 3 CC - Injuries SP - 94‐97 C3 - PUBMED 15008318 M3 - Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial KW - Abdominal Injuries [*surgery] KW - Adult KW - Bedding and Linens KW - Body Temperature KW - Carbon KW - Critical Illness [*therapy] KW - Female KW - Humans KW - Hypothermia [*therapy] KW - Intensive Care Units KW - Male KW - Middle Aged KW - Patient Transfer [*methods] KW - Postoperative Care KW - Postoperative Complications [diagnostic imaging, therapy] KW - Radiology Department, Hospital KW - Rewarming [*methods] KW - Tomography, X‐Ray Computed 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). UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00468385/full ER - Record #27 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Journal of the chinese medical association PY - 2014 VL - 77 IS - 3 SP - 133‐141 C3 - EMBASE 52987225 M3 - Journal: Article KW - *conceptual framework KW - *emergency ward KW - *hospital admission KW - *intensive care unit KW - *predisposition insult response and organ dysfunction concept KW - *sepsis KW - Adolescent KW - Adult KW - Aged KW - Article KW - Body temperature KW - Breathing rate KW - Controlled study KW - Feasibility study KW - Female KW - General condition deterioration KW - Heart rate KW - Hematologic disease KW - Human KW - Hypotension KW - Kidney dysfunction KW - Leukocyte count KW - Liver dysfunction KW - Major clinical study KW - Male KW - Metabolic disorder KW - Middle aged KW - Observational study KW - Patient transport KW - Prediction KW - Respiratory failure KW - Risk assessment KW - Very elderly KW - Young adult DO - 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 . UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01001278/full ER - Record #28 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Applied nursing research PY - 1999 VL - 12 IS - 3 SP - 114‐120 C3 - PUBMED 10457621 M3 - Clinical Trial; Journal Article; Randomized Controlled Trial KW - Adolescent KW - Adult KW - Anxiety [diagnosis, etiology, *nursing, *prevention & control] KW - Child, Hospitalized KW - Female KW - Humans KW - Intensive Care Units, Pediatric KW - Male KW - Middle Aged KW - Nursing Evaluation Research KW - Parents [education, psychology] KW - Patient Transfer KW - Pediatric Nursing [methods] KW - Surveys and Questionnaires KW - Teaching Materials 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00166679/full ER - Record #29 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - European heart journal. Acute cardiovascular care PY - 2014 VL - 3 IS - 2 SP - 105‐109 C3 - PUBMED 24337919 M3 - Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Aged KW - Coronary Care Units [statistics & numerical data] KW - Female KW - Follow‐Up Studies KW - Hospitals, Community [statistics & numerical data] KW - Humans KW - Male KW - Myocardial Infarction [physiopathology, *therapy] KW - Patient Transfer [*statistics & numerical data] KW - Percutaneous Coronary Intervention [statistics & numerical data] KW - Thrombolytic Therapy [statistics & numerical data] KW - Transportation of Patients [statistics & numerical data] KW - Treatment Outcome DO - 10.1177/2048872613516016 AB - METHODS The 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. RESULTS The 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). CONCLUSIONS The 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. AIMS Subjective 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). UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01119721/full ER - Record #30 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Intensive & critical care nursing PY - 2007 VL - 23 IS - 6 SP - 362‐369 C3 - PUBMED 17681470 M3 - Controlled Clinical Trial; Journal Article; Research Support, Non‐U.S. Gov't KW - Australia KW - Family Nursing KW - Female KW - Humans KW - Intensive Care Units KW - Male KW - Middle Aged KW - Patient Care Planning KW - Patient Transfer KW - Professional‐Family Relations KW - Stress, Psychological [*prevention & control] DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00699055/full ER - Record #31 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Medical education PY - 2013 VL - 47 IS - 8 SP - 832‐841 C3 - PUBMED 23837430 M3 - Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Attitude of Health Personnel KW - Canada KW - Child KW - Clinical Competence [*standards] KW - Communication KW - Humans KW - Intensive Care Units, Pediatric KW - Patient Handoff [*standards] KW - Patient Transfer [standards] KW - Regression Analysis KW - Students, Medical [*psychology] DO - 10.1111/medu.12212 AB - METHODS This 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. RESULTS The 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). CONCLUSIONS Using 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. OBJECTIVES To assess the impact of a written cognitive aid on expressed clinical reasoning and quantity and the accuracy of information transfer during resident doctor handover. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00963197/full ER - Record #32 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of critical care PY - 2011 VL - 20 IS - 6 SP - e122‐30 C3 - PUBMED 22045148 M3 - Journal Article; Randomized Controlled Trial KW - Aged KW - Aged, 80 and over KW - Cross‐Sectional Studies KW - Decision Making KW - Decision Support Techniques KW - Efficiency, Organizational KW - Female KW - Forecasting KW - Hospitals, Community KW - Humans KW - Inpatients KW - Intensive Care Units KW - Long‐Term Care KW - Male KW - Models, Theoretical KW - Patient Transfer KW - Quality of Health Care KW - Regression Analysis KW - Reproducibility of Results KW - Respiration, Artificial KW - Retrospective Studies KW - United States DO - 10.4037/ajcc2011775 AB - OBJECTIVES: To 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). METHODS: A 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. RESULTS: The 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. CONCLUSIONS: Efforts to aid discharge decision making and optimize hospital resource planning could take advantage of our predictive model and the simplified scoring tool. BACKGROUND: Long‐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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00897072/full ER - Record #33 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Annals of internal medicine PY - 1990 VL - 113 IS - 4 CC - Anaesthesia, Critical, and Emergency Care CC - Effective Practice and Organisation of Care CC - Heart SP - 283‐289 C3 - PUBMED 2115754,EMBASE 20254355 M3 - Clinical Trial; Controlled Clinical Trial; Journal Article KW - Aged KW - Aged, 80 and over KW - Bed Occupancy [*economics] KW - Chest Pain KW - Coronary Care Units [*economics, utilization] KW - Cost‐Benefit Analysis KW - Decision Trees KW - Emergency Medical Services KW - Female KW - Hospital Units [*economics, utilization] KW - Hospitals, Community KW - Humans KW - Length of Stay [*economics] KW - Male KW - Middle Aged KW - Patient Transfer [*economics] KW - Pilot Projects KW - Private Practice KW - Prospective Studies KW - Risk Factors KW - Time Factors KW - Triage KW - United States AB - DESIGN: Prospective, controlled, interventional trial using an alternate month study design. SETTING: A large teaching community hospital. PATIENTS: Cohort 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. INTERVENTIONS: During 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 RESULTS: Use 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. CONCLUSIONS: The 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. OBJECTIVE: To 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00069161/full ER - Record #34 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Nurse anesthesia PY - 1991 VL - 2 IS - 3 CC - Anaesthesia, Critical, and Emergency Care SP - 119‐125 C3 - PUBMED 1888786 M3 - Clinical Trial; Journal Article; Randomized Controlled Trial KW - Adult KW - Blood Gas Analysis KW - Female KW - Humans KW - Hypoxia [blood, prevention & control, *therapy] KW - Male KW - Middle Aged KW - Oximetry KW - Oxygen Inhalation Therapy [*standards] KW - Postoperative Complications [blood, prevention & control, *therapy] KW - Recovery Room KW - Transportation of Patients [*methods] 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00077998/full ER - Record #35 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Journal of clinical anesthesia PY - 1996 VL - 8 IS - 4 CC - Anaesthesia, Critical, and Emergency Care SP - 294‐300 C3 - PUBMED 8695133,EMBASE 26161502 M3 - Clinical Trial; Journal Article; Randomized Controlled Trial KW - Adult KW - Ambulatory Surgical Procedures KW - Blood Gas Monitoring, Transcutaneous KW - Female KW - Heart Rate KW - Humans KW - Male KW - Middle Aged KW - Oxygen Inhalation Therapy [instrumentation, methods] KW - Oxygen [*blood] KW - Postanesthesia Nursing KW - Postoperative Period KW - Recovery Room KW - Regression Analysis KW - Transportation of Patients AB - STUDY DESIGN: Randomized, prospective, nonblinded comparison in patients. SETTING: Operating room and postanesthesia care unit (PACU) of a university outpatient surgery center. PATIENTS: 100 ASA status I and II adults, male and female, age greater than 18 years, undergoing outpatient surgical procedures not involving the upper airway. INTERVENTIONS: Group 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 RESULTS: Arterial 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). CONCLUSION: Routine 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 OBJECTIVE: To compare the efficacy of two different oxygen (O2) delivery systems in preventing episodic arterial desaturation in the immediate postoperative period. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00125003/full ER - Record #36 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 - et al. TI - A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy JA - Journal of pediatrics PY - 2015 VL - 166 IS - 4 CC - Neonatal SP - 856‐61.e1‐2 C3 - PUBMED 25684087 M3 - Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non‐U.S. Gov't KW - Asphyxia Neonatorum [*complications, therapy] KW - Body Temperature [*physiology] KW - Brain Diseases [etiology, *therapy] KW - Female KW - Follow‐Up Studies KW - Humans KW - Hypothermia, Induced [*methods] KW - Infant, Newborn KW - Infant, Newborn, Diseases [*therapy] KW - Intensive Care Units, Neonatal KW - Male KW - Prognosis KW - Transportation of Patients [*methods] DO - 10.1016/j.jpeds.2014.12.061 AB - OBJECTIVE: To determine if temperature regulation is improved during neonatal transport using a servo‐regulated cooling device when compared with standard practice. 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01110544/full ER - Record #37 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of medicine PY - 2014 VL - 127 IS - 3 SP - 226‐232 C3 - PUBMED 24342543 M3 - Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non‐U.S. Gov't KW - *Heart Rate KW - *Internal Medicine KW - *Monitoring, Physiologic KW - *Respiratory Rate KW - APACHE KW - Adult KW - Aged KW - Female KW - Hospital Mortality [*trends] KW - Hospital Units [*statistics & numerical data] KW - Humans KW - Intensive Care Units [*statistics & numerical data] KW - Length of Stay [*statistics & numerical data] KW - Male KW - Middle Aged KW - Patient Transfer [*statistics & numerical data] KW - Prospective Studies KW - Surgery Department, Hospital [*statistics & numerical data] DO - 10.1016/j.amjmed.2013.12.004 AB - METHODS In 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. RESULTS We 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). CONCLUSIONS Continuous 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. BACKGROUND For 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01119685/full ER - Record #38 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00686109 TI - The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age JA - Pediatrics PY - 1998 VL - 101 IS - 4 CC - Anaesthesia, Critical, and Emergency Care CC - Child Health CC - Colorectal Cancer CC - Neonatal SP - E1 C3 - PUBMED 9521968 M3 - Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Developmental Disabilities [etiology] KW - Disabled Children [statistics & numerical data] KW - Extracorporeal Membrane Oxygenation KW - Follow‐Up Studies KW - Hernia, Diaphragmatic [complications, mortality, therapy] KW - Humans KW - Infant, Newborn KW - Intensive Care Units, Neonatal KW - Patient Transfer KW - Respiration, Artificial KW - Respiratory Insufficiency [complications, mortality, *therapy] KW - Risk KW - Severity of Illness Index KW - Survivors KW - Treatment Outcome KW - Vasodilator Agents [therapeutic use] AB - METHODS: The 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. RESULTS: Of 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. CONCLUSION: These 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. OBJECTIVE: To 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00686109/full ER - Record #39 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Nursing outlook PY - 2016 VL - 64 IS - 2 SP - 137‐145 C3 - PUBMED 26833250 M3 - Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Academic Medical Centers KW - Aged, 80 and over KW - Electronic Health Records KW - Female KW - Geriatric Assessment KW - Hospital Mortality KW - Hospital Units KW - Hospitalization KW - Humans KW - Intensive Care Units [utilization] KW - Length of Stay [statistics & numerical data] KW - Linear Models KW - Los Angeles KW - Male KW - Patient Care Planning KW - Patient Care Team [*organization & administration] KW - Patient Discharge KW - Patient Transfer [statistics & numerical data] KW - Quality Improvement KW - Vulnerable Populations DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01168314/full ER - Record #40 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00491745 AU - Arino, M AU - Barrington, JP AU - Morrison, AL AU - Gillies, D TI - Management of the changeover of inotrope infusions in children JA - Intensive & critical care nursing PY - 2004 VL - 20 IS - 5 CC - Child Health SP - 275‐280 C3 - PUBMED 15450616 M3 - Clinical Trial; Journal Article; Randomized Controlled Trial KW - Cardiac Surgical Procedures [adverse effects, nursing] KW - Cardiotonic Agents [*administration & dosage] KW - Child KW - Child, Preschool KW - Clinical Nursing Research KW - Dopamine [administration & dosage] KW - Drug Monitoring KW - Epinephrine [administration & dosage] KW - Female KW - Hospitals, Pediatric KW - Hospitals, University KW - Humans KW - Infusions, Intravenous [instrumentation, methods, *nursing] KW - Intensive Care Units, Pediatric KW - Male KW - New South Wales KW - Norepinephrine [administration & dosage] KW - Nursing Evaluation Research KW - Patient Transfer KW - Pediatric Nursing [*methods, standards] KW - Postoperative Care [*methods, nursing, standards] KW - Risk Factors KW - Time Factors DO - 10.1016/j.iccn.2004.06.003 AB - 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. 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00491745/full ER - Record #41 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01457830 AU - Franklin, D AU - Babl, FE AU - Schlapbach, LJ AU - Oakley, E AU - Craig, S AU - Neutze, J AU - Furyk, J AU - Fraser, JF AU - Jones, M AU - Whitty, JA AU - et al. TI - A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis JA - New England journal of medicine PY - 2018 VL - 378 IS - 12 SP - 1121‐1131 C3 - PUBMED 29562151 M3 - Journal Article; Multicenter Study; Randomized Controlled Trial KW - Bronchiolitis [*therapy] KW - Female KW - Humans KW - Infant KW - Infant, Newborn KW - Infant, Premature KW - Infant, Premature, Diseases [therapy] KW - Intensive Care Units KW - Kaplan‐Meier Estimate KW - Length of Stay KW - Male KW - Oxygen Inhalation Therapy [adverse effects, *methods] KW - Patient Transfer KW - Treatment Failure DO - 10.1056/NEJMoa1714855 AB - BACKGROUND: High‐flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high‐quality evidence of its efficacy. The efficacy of high‐flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODS: In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high‐flow oxygen therapy (high‐flow group) or standard oxygen therapy (standard‐therapy group). Infants in the standard‐therapy group could receive rescue high‐flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early‐warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTS: The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high‐flow group, as compared with 23% (167 of 733) in the standard‐therapy group (risk difference, ‐11 percentage points; 95% confidence interval, ‐15 to ‐7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard‐therapy group who had treatment failure, 102 (61%) had a response to high‐flow rescue therapy. CONCLUSIONS: Among infants with bronchiolitis who were treated outside an ICU, those who received high‐flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy. (Funded by the National Health and Medical Research Council and others; Australian and New Zealand Clinical Trials Registry number, ACTRN12613000388718 .). UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01457830/full ER - Record #42 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01600317 AU - Jensen, CS AU - Aagaard, H AU - Olesen, HV AU - Kirkegaard, H TI - A multicentre, randomised intervention study of the Paediatric Early Warning Score: study protocol for a randomised controlled trial JA - Trials PY - 2017 VL - 18 IS - 1 SP - 267 C3 - PUBMED 28595614 M3 - Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Age Factors KW - Algorithms KW - Blood Pressure KW - Blood Pressure Determination KW - Clinical Protocols KW - Consciousness KW - Critical Illness KW - Decision Support Techniques KW - Denmark KW - Disease Progression KW - Early Diagnosis KW - Health Status KW - Health Status Indicators KW - Heart Rate KW - Hospitals, University KW - Humans KW - Intensive Care Units, Pediatric KW - Oximetry KW - Oxygen Inhalation Therapy KW - Patient Transfer KW - Point‐of‐Care Systems KW - Point‐of‐Care Testing KW - Predictive Value of Tests KW - Research Design KW - Respiratory Rate DO - 10.1186/s13063-017-2011-7 AB - BACKGROUND: Patients' evolving critical illness can be predicted and prevented. However, failure to identify the signs of critical illness and subsequent lack of appropriate action for patients developing acute and critical illness remain a problem. Challenges in assessing whether a child is critically ill may be due to children's often uncharacteristic symptoms of serious illness. Children may seem relatively unaffected until shortly before circulatory and respiratory failure and cardiac arrest. The Bedside Paediatric Early Warning Score has been validated in a large multinational study and is used in two regions in Denmark. However, healthcare professionals experience difficulties in relation to measuring blood pressure and to the lack of assessment of children's level of consciousness. In addition, is it noteworthy that in 23,288‐hour studies, all seven items of the Bedside Paediatric Early Warning Score were recorded in only 5.1% of patients. This trial aims to compare two Paediatric Early Warning Score (PEWS) models to identify the better model for identifying acutely and critically ill children. The hypothesis is that the Central Denmark Region PEWS model is superior to the Bedside PEWS in terms of reducing unplanned transfers to intensive care or transfers from regional hospitals to the university hospital among already hospitalised children. METHODS/DESIGN: This is a multicentre, randomised, controlled clinical trial where children are allocated to one of two different PEWS models. The study involves all paediatric departments and one emergency department in the Central Denmark Region. The primary outcome is unplanned transfer to the paediatric intensive care unit or transfer from regional hospitals to the university hospital. Based on preliminary data, 14,000 children should be included to gain a power of 80% (with a 5% significance level) and to detect a clinically significant difference of 30% of unplanned transfers to intensive care or from regional hospitals to the paediatric department at the university department. A safety interim analysis will be performed after inclusion of 7000 patients. DISCUSSION: This is the first randomised trial to investigate two different PEWS models. This study demonstrates the safety and effectiveness of a new PEWS model and contributes to knowledge of hospitalised children's clinical deterioration. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02433327 . Registered on 27 April 2015. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01600317/full ER - Record #43 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Clin exp emerg med PY - 2016 VL - 3 IS - 2 CC - HS-KOREAMED SP - 81‐87 DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01306465/full ER - Record #44 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - J-AM-GERIATR-SOC PY - 1984 VL - 32 IS - 11 CC - Effective Practice and Organisation of Care SP - 794‐800 C3 - EMBASE 15219529 KW - Hospitalization/ nursing/ geriatrics. long term care/ teaching hospital/ morbidity/ mortality/ canada.LA:EN. 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. Copyright © 2011 Elsevier B. V., Amsterdam. All Rights Reserved. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00177999/full ER - Record #45 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01558545 AU - NCT02782871, TI - A RCT to Compare the Pneupac VR1 Portable Ventilator and Manual Ventilation Via a Mapleson C- Circuit During the Intra-hospital Transfers of Intubated Patients JA - Https://clinicaltrials.gov/show/nct02782871 PY - 2016 AB - Following major head and neck surgery it may be necessary to keep patients intubated and ventilated for at least 12 hours to allow the swelling associated with the operation to subside. Therefore patients (participants) are transferred to the intensive care unit anaesthetised, in‐tubated and ventilated. Current practice is that patients are manually ventilated, by hand, during transfer from the operating theatre to the intensive care unit. Studies show that use of manual ventilation causes variability in respiratory parameters and blood gas values due to inconsistent ventilation. A study in 2003 found that portable ventila‐tor provided more consistent ventilation and patients were less likely to have a disparity in their blood gases, oxygenation and ventilation.. However, conventional ventilators are bulky, heavy, expensive and few and far between in the hospital and, in particular, the pre‐hospital setting. The Pneupac VR1 ventilator is simple to use, small, portable and durable. It is easy to clean, low cost, light weight and magnetic resonance imaging (MRI) compatible. The study will aim to directly compare the efficiency and efficacy (ventilation rate and tidal volumes) of manual ventilation against a new device, VR‐1 portable ventilator, by Smith‐Medical. The device is CE approved. The RCT will compare the efficacy and efficiency during transfer of the patient from theaters to intensive care in our establishment. The endpoint will be arrival to the intensive care unit (ICU) and transfer onto the ICU ventilator. This will be measured by collecting the pCO2, taken from an already in‐situ arterial blood gas (ABG), at two time points ‐ (a) just before patient transfer from theaters to the intensive care unit and (b) upon arrival at the intensive care unit and just prior to transfer onto the ITU ventilator. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01558545/full ER - Record #46 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of respiratory and critical care medicine PY - 1996 VL - 153 IS - 1 SP - 191‐195 C3 - PUBMED 8542115 M3 - Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article KW - APACHE KW - Adult KW - Aged KW - Hemodynamics KW - Humans KW - Hyperemia [physiopathology] KW - Intensive Care Units KW - Laser‐Doppler Flowmetry KW - Leg [blood supply] KW - Linear Models KW - Microcirculation KW - Middle Aged KW - Muscle, Skeletal [*blood supply] KW - Oxygen [*metabolism] KW - Prospective Studies KW - Rest KW - Sepsis [metabolism, *physiopathology] KW - Time Factors DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00122440/full ER - Record #47 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Nursing research PY - 2000 VL - 49 IS - 4 CC - Anaesthesia, Critical, and Emergency Care CC - Child Health CC - Neonatal SP - 215‐223 C3 - PUBMED 10929693 M3 - Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't KW - Adult KW - Birth Weight KW - Cross‐Over Studies KW - Female KW - Gestational Age KW - Heart Rate KW - Humans KW - Infant Behavior KW - Infant Care KW - Infant, Newborn KW - Infant, Premature [*physiology, psychology] KW - Intensive Care Units, Neonatal KW - Male KW - Nurses KW - Oxygen Consumption KW - Parents KW - Respiration, Artificial KW - Skin AB - OBJECTIVES: To 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. METHOD: Fifteen 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. RESULTS: Temperature 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. CONCLUSIONS: Both transfer methods resulted in physiologic disorganization. However, during and after skin‐to‐skin care, infants exhibited no signs of energy depletion. BACKGROUND: Conservation 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00298727/full ER - Record #48 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01305154 AU - Hand, WR AU - Stoll, WD AU - McEvoy, MD AU - McSwain, JR AU - Sealy, CD AU - Skoner, JM AU - Hornig, JD AU - Tennant, PA AU - Wolf, B AU - Day, TA TI - Intraoperative goal-directed hemodynamic management in free tissue transfer for head and neck cancer JA - Head & neck PY - 2016 VL - 38 Suppl 1 CC - ENT SP - E1974‐80 C3 - PUBMED 26829494,EMBASE 608200084 M3 - Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't; Research Support, N.I.H., Extramural KW - *free tissue graft KW - *head and neck cancer/su [Surgery] KW - *head and neck surgery KW - *hemodynamic monitoring KW - Adult KW - Aged KW - Algorithm KW - Blood pressure KW - Cancer patient KW - Cancer surgery KW - Conference paper KW - Controlled study KW - Early Goal‐Directed Therapy KW - Female KW - Fluid therapy KW - Free Tissue Flaps [*transplantation] KW - Head and Neck Neoplasms [*surgery] KW - Hemodynamic parameters KW - Hemodynamics KW - Human KW - Humans KW - Hypervolemia/dt [Drug Therapy] KW - Hypotension/co [Complication] KW - Hypotension/dt [Drug Therapy] KW - Hypotension/th [Therapy] KW - Insulin/dt [Drug Therapy] KW - Intensive Care Units KW - Intensive care unit KW - Intraoperative period KW - Length of stay KW - Major clinical study KW - Male KW - Middle Aged KW - Middle aged KW - Outcome assessment KW - Patient monitor KW - Phenylephrine/dt [Drug Therapy] KW - Postoperative complication KW - Predictive value KW - Priority journal KW - Randomized controlled trial KW - Reconstructive Surgical Procedures KW - Standard KW - Vasoactive agent/dt [Drug Therapy] KW - Waveform DO - 10.1002/hed.24362 AB - BACKGROUND: The purpose of this study was to determine the effect of algorithmic physiologic management on patients undergoing head and neck free tissue transfer and reconstruction. METHODS: Ninety‐four adult patients were randomized to treatment and control groups. The blood pressure of the control group was managed consistent with contemporary standards. The treatment group was managed using an algorithm based on blood pressure and calculated physiologic values derived from arterial waveform analysis. Primary outcome was intensive care unit (ICU) length of stay. RESULTS: ICU length of stay was decreased in the treatment group (33.7 vs 58.3 hours; p = .026). The complication rate was not increased in the treatment group. CONCLUSION: The goal‐directed hemodynamic management algorithm decreased the ICU length of stay. Judicious use of vasoactive drugs and goal‐directed fluid administration has a role in improving perioperative outcomes for patients undergoing head and neck free tissue transfer. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1974‐E1980, 2016. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01305154/full ER - Record #49 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Critical care medicine. PY - 2015 VL - 43 IS - 12 SUPPL. 1 SP - 28 C3 - EMBASE 72101627 M3 - Journal: Conference Abstract KW - *heart surgery KW - *intensive care KW - *pilot study KW - *society KW - Air conditioning KW - Extubation KW - Gender KW - Human KW - Learning KW - Lung KW - Methodology KW - Operating room KW - Patient KW - Population KW - Positive end expiratory pressure KW - Procedures KW - Randomized controlled trial KW - Randomized controlled trial (topic) KW - Sample size KW - Surgery DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01126698/full ER - Record #50 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states PY - 2017 VL - 195 IS - no pagination C3 - EMBASE 617704228 M3 - Conference Abstract KW - *medical record review KW - *resident KW - *satisfaction KW - Artificial ventilation KW - Controlled clinical trial KW - Controlled study KW - Emergency KW - Female KW - Human KW - Human experiment KW - Intensive care unit KW - Male KW - Oxygenation KW - Patient care KW - Patient safety KW - Phase 1 clinical trial KW - Phase 2 clinical trial KW - Phase 3 clinical trial KW - Phase 4 clinical trial DO - 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). UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01409346/full ER - Record #51 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-00477614 AU - Salamonson, Y AU - Kariyawasam, A AU - van Heere, B AU - O'Connor, C TI - The evolutionary process of Medical Emergency Team (MET) implementation: reduction in unanticipated ICU transfers JA - Resuscitation PY - 2001 VL - 49 IS - 2 CC - Effective Practice and Organisation of Care SP - 135‐141 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 UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00477614/full ER - Record #52 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - 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 PY - 2016 VL - 44 IS - 12 Supplement 1 SP - 347 C3 - EMBASE 613522976 M3 - Journal: Conference Abstract KW - *patient transport KW - *perception KW - *teamwork KW - Clinical trial KW - Controlled clinical trial KW - Controlled study KW - Cross‐sectional study KW - Doctor patient relation KW - Human KW - Learning KW - Likert scale KW - Major clinical study KW - Medicine KW - Multicenter study KW - Patient safety KW - Predictor variable KW - Student t test KW - Total quality management DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01294941/full ER - Record #53 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Korean journal of anesthesiology PY - 2005 VL - 48 IS - 6 CC - HS-HANDSRCH CC - Cochrane Australia CC - HS-KOREAMED CC - ENT SP - 624‐629 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.] UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01046226/full ER - Record #54 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Critical care medicine PY - 1999 VL - 27 IS - 4 CC - Anaesthesia, Critical, and Emergency Care CC - Child Health CC - Heart SP - 802‐806 C3 - PUBMED 10321673 M3 - Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial KW - Adolescent KW - Analysis of Variance KW - Blood Gas Analysis KW - Cardiac Surgical Procedures KW - Child KW - Child, Preschool KW - Critical Care KW - Hemodynamics KW - Humans KW - Infant KW - Infant, Newborn KW - Patient Transfer [methods] KW - Postoperative Care KW - Prospective Studies KW - Pulmonary Ventilation KW - Respiration, Artificial [*methods] KW - Severity of Illness Index KW - Transportation of Patients [methods] KW - Virginia AB - 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. OBJECTIVE: To compare the amount of variability in ventilation during intrahospital transport of intubated pediatric patients ventilated either manually or with a transport ventilator. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00163003/full ER - Record #55 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Chest PY - 2003 VL - 123 IS - 1 CC - SR-PREHOSP SP - 159‐164 C3 - PUBMED 12527617 M3 - Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial KW - Critical Illness KW - Equipment Design KW - Female KW - Humans KW - Male KW - Middle Aged KW - Respiration, Artificial [*instrumentation, *methods] KW - Transportation of Patients KW - Ventilators, Mechanical AB - DESIGN: Prospective, randomized, single‐center study. SETTING: ICU in a university hospital. PATIENTS: A total of 16 patients (22 transports) who were spontaneously breathing and required ventilatory assistance on excursions from the ICU. METHODS: For 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)). RESULTS: After 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. CONCLUSIONS: The 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. OBJECTIVE: To compare a new transport ventilator to manual ventilation in terms of maintaining the respiratory and hemodynamic levels of critically ill patients. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00412740/full ER - Record #56 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - Critical care medicine PY - 1999 IS - 4 CC - SR-PREHOSP SP - 802‐806 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00582860/full ER - Record #57 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01129514 AU - Heselmans, A AU - Van Krieken, J AU - Cootjans, S AU - Nagels, K AU - Filliers, D AU - Dillen, K AU - De Broe, S AU - Ramaekers, D TI - Medication review by a clinical pharmacist at the transfer point from ICU to ward: a randomized controlled trial JA - Journal of clinical pharmacy and therapeutics PY - 2015 VL - 40 IS - 5 SP - 578‐583 C3 - EMBASE 605663227 M3 - Journal: Review KW - *drug surveillance program KW - *intensive care unit KW - *patient transport KW - *pharmacist KW - Aged KW - Belgium KW - Clinical evaluation KW - Controlled study KW - Disease severity KW - Drug safety KW - Female KW - Hospital readmission KW - Human KW - Interpersonal communication KW - Length of stay KW - Major clinical study KW - Male KW - Outcome assessment KW - Pharmacist attitude KW - Program effectiveness KW - Randomized controlled trial(topic) KW - Review KW - Risk reduction KW - Study DO - 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. 541% of these problems were adjusted on time in the intervention group vs. 128% in the control group. Of 743 recommendations, 248% were judged by the expert group as major, 131% as moderate, 53.4% as minor and 89% 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 = 101; 95%CI [63‐161]; P < 0001), even after accounting for differences in types of DRP between the groups (odds ratio = 156; 95%CI [94‐259]; P < 0001). 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01129514/full ER - Record #58 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - American journal of respiratory and critical care medicine. Conference: american thoracic society international conference, ATS 2017. United states PY - 2017 VL - 195 IS - no pagination C3 - EMBASE 617710401 M3 - Conference Abstract KW - *artificial ventilation KW - *family study KW - *female KW - *male KW - *respiratory failure KW - Adult KW - Ambulance KW - Anxiety KW - Awareness KW - Clinical trial KW - Controlled clinical trial KW - Controlled study KW - DNA transcription KW - Depression KW - Diet KW - Doctor patient relation KW - Helicopter KW - Human KW - Money KW - Multicenter study KW - Patient transport KW - Perception KW - Posttraumatic stress disorder KW - Publication KW - Semi structured interview KW - Sleep KW - South Carolina KW - Spiritual care KW - Survivor KW - Tertiary care center KW - Theoretical model KW - Thinking KW - Travel KW - University KW - Waiting room DO - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01408759/full ER - Record #59 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 JA - European journal of trauma PY - 2002 VL - 28 IS - Suppl 1 CC - HS-HANDSRCH SP - 96 UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00485731/full ER - Record #60 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 - et al. TI - Frequency and reasons of "Futile" interhospital transfer for endovascular recanalization treatment in acute ischemic stroke. The madrid stroke network JA - Cerebrovascular diseases. Conference: 23th european stroke conference. France. Conference start: 20140506. Conference end: 20140509 PY - 2014 VL - 37 SP - 98 C3 - EMBASE 614325636 M3 - Journal: Conference Abstract KW - *brain ischemia KW - *recanalization KW - Artery KW - Blood clot lysis KW - Call center KW - Cardiovascular risk KW - Clinical protocol KW - Clinical trial KW - Controlled clinical trial KW - Controlled study KW - Demography KW - Deterioration KW - Hospital KW - Human KW - Major clinical study KW - Multicenter study KW - National Institutes of Health Stroke Scale KW - Neuroimaging KW - Patient transport KW - Register KW - Revascularization KW - 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01334437/full ER - Record #61 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - CN-01537664 AU - NCT01687491, TI - Comparison of Anti-Xa Activity of ENOXA ® Versus LOVENOX ® in Acute Coronary Syndrome JA - Https://clinicaltrials.gov/show/nct01687491 PY - 2012 KW - Acute Coronary Syndrome KW - Dalteparin KW - Enoxaparin KW - Heparin, Low‐Molecular‐Weight KW - Syndrome AB - The patients included in this study with an acute coronary Syndrome be admitted to the emergency room and receive treatment with enoxaparin. Low molecular weight heparin (LMWH) treatment in this indication is usually spread over a week. The experience of the study intends to focus only on the first injection administered in selected patients. Two assays are carried out, including an assessment of the anti‐Xa activity initially before injection of enoxaparin, and 4 hours after administration of the first syringe. Clinical monitoring is intrahospital from the date of hospitalization of patients included until emergency exit (transfer to another service, or return home) Tolerance assessment (clinical and biological) is performed during follow‐up. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01537664/full ER - Record #62 of 62 Provider: John Wiley & Sons, Ltd. Content: text/plain; charset="UTF-8" TY - JOUR AN - 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 - et al. 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" JA - Journal of translational medicine PY - 2012 VL - 10 SP - 163 C3 - PUBMED 22883307 M3 - Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non‐U.S. Gov't KW - Cardiopulmonary Resuscitation [*instrumentation] KW - Emergency Medical Services [*organization & administration] KW - Heart Arrest [*therapy] KW - Humans KW - Hyperthermia, Induced DO - 10.1186/1479-5876-10-163 AB - 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. 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. UR - https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00848391/full ER -