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  • 1
    Online Resource
    Online Resource
    Posttraumatic stress disorder symptoms after respiratory and cardiovascular emergencies predict risk of hospital readmission: A prospective cohort study
    Wiley ; 2022
    In:  Academic Emergency Medicine Vol. 29, No. 5 ( 2022-05), p. 598-605
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 29, No. 5 ( 2022-05), p. 598-605
    Abstract: Twenty‐five percent of patients presenting to the emergency department (ED) for a respiratory or cardiovascular medical emergency develop clinically significant posttraumatic stress disorder (PTSD) symptoms. It is possible that development of PTSD symptoms in this cohort is associated with subsequent adverse physical health events. Our objective was to test whether clinically significant PTSD symptoms 30 days postdischarge are associated with increased risk for hospital readmission within 24 months after discharge among patients presenting to the ED for a respiratory or cardiovascular emergency. Methods This was a prospective cohort study conducted between January 1, 2018, and December 31, 2020, at a U.S. academic medical center, including adult patients presenting with acute respiratory failure or cardiovascular instability requiring a potentially life‐sustaining intervention in the ED. PTSD symptoms 30 days postdischarge were measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders‐5 . The primary outcome was all‐cause hospital readmission over the subsequent 24 months after hospital discharge from the index ED visit. Results Of the 99 patients included, 73% (95% confidence interval [CI] = 63% to 81%) had a hospital readmission within 24 months. In a multivariable Cox proportional hazards model adjusting for potential confounders (e.g., age, severity of illness during index ED visit, preexisting comorbid conditions) presence of clinically significant PTSD symptoms at 30 days was independently associated with increased risk for all‐cause hospital readmission at 24 months (hazards ratio = 2.19, 95% CI = 1.30 to 3.69). These results remained statistically significant across multiple sensitivity analyses. Conclusions Hospital readmission is common among survivors of acute respiratory failure and cardiovascular instability, and PTSD symptoms 30 days postdischarge are an independent predictor of hospital readmission. Survivors of medical emergencies may warrant follow‐up evaluation for PTSD symptoms, and future research is warranted to better understand the relationship between psychological trauma and hospital readmission.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v29.5
    DOI: 10.1111/acem.14438
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2029751-8
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  • 2
    Online Resource
    Online Resource
    Validation of a 5-item tool to measure patient assessment of clinician compassion in the emergency department
    Springer Science and Business Media LLC ; 2019
    In:  BMC Emergency Medicine Vol. 19, No. 1 ( 2019-12)
    Details
    In: BMC Emergency Medicine, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2019-12)
    Abstract: To test if the 5-item compassion measure (a tool previously validated in the outpatient setting to measure patient assessment of clinician compassion) is a valid and reliable tool to quantify a distinct construct (i.e. clinical compassion) among patients evaluated in the emergency department (ED). Methods Cross-sectional study conducted in three academic emergency departments in the U.S. between November 2018 and April 2019. We enrolled adult patients who were evaluated in the EDs of the participating institutions and administered the 5-item compassion measure after completion of care in the ED. Validity testing was performed using confirmatory factor analysis. Cronbach’s alpha was used to test reliability. Convergent validity with patient assessment of overall satisfaction questions was tested using Spearman correlation coefficients and we tested if the 5-item compassion measure assessed a construct distinct from overall patient satisfaction using confirmatory factor analysis. Results We analyzed 866 patient responses. Confirmatory factor analysis found all five items loaded well on a single construct and our model was found to have good fit. Reliability was excellent (Cronbach’s alpha = 0.93) among the entire cohort. These results remained consistent on sub-analyses stratified by individual institutions. The 5-item compassion measure had moderate correlation with overall patient satisfaction (r = 0.66) and patient recommendation of the ED to friends and family (r = 0.57), but reflected a patient experience domain (i.e. compassionate care) distinctly different from patient satisfaction. Conclusions The 5-item compassion measure is a valid and reliable tool to measure patient assessment of clinical compassion in the ED.
    Type of Medium: Online Resource
    ISSN: 1471-227X
    URL: Article
    DOI: 10.1186/s12873-019-0279-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2050431-7
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  • 3
    Online Resource
    Online Resource
    Awareness with paralysis and symptoms of post-traumatic stress disorder among mechanically ventilated emergency department survivors (ED-AWARENESS-2 Trial): study protocol for a pragmatic, multicenter, stepped wedge cluster randomized trial
    Springer Science and Business Media LLC ; 2023
    In:  Trials Vol. 24, No. 1 ( 2023-11-25)
    Details
    In: Trials, Springer Science and Business Media LLC, Vol. 24, No. 1 ( 2023-11-25)
    Abstract: Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1–0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3–7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a platform to test an intervention aimed at reducing AWP. The overall objective is to test the hypothesis that limiting ED rocuronium exposure will significantly reduce the proportion of patients experiencing AWP. Methods This is a pragmatic, stepped wedge cluster randomized trial conducted in five academic EDs, and will enroll 3090 patients. Per the design, all sites begin in a control phase, under observational conditions. At 6-month intervals, sites sequentially enter a 2-month transition phase, during which we will implement the multifaceted intervention, which will rely on use of nudges and defaults to change clinician decisions regarding ED NMB use. During the intervention phase, succinylcholine will be the default NMB over rocuronium. The primary outcome is AWP, assessed with the modified Brice questionnaire, adjudicated by three independent, blinded experts. The secondary outcome is the proportion of patients developing clinically significant symptoms of post-traumatic stress disorder at 30 and 180 days after hospital discharge. We will also assess for symptoms of depression and anxiety, and health-related quality of life. A generalized linear model, adjusted for time and cluster interactions, will be used to compare AWP in control versus intervention phases, analyzed by intention-to-treat. Discussion The ED-AWARENESS-2 Trial will be the first ED-based trial aimed at preventing AWP, a critical threat to patient safety. Results could shape clinical use of NMB in the ED and prevent more than 10,000 annual cases of AWP related to ED care. Trial registration ClinicalTrials.gov identifier NCT05534243 . Registered 06, September 2022.
    Type of Medium: Online Resource
    ISSN: 1745-6215
    URL: Article
    DOI: 10.1186/s13063-023-07764-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2040523-6
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  • 4
    Online Resource
    Online Resource
    Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection
    American Medical Association (AMA) ; 2023
    In:  JAMA Vol. 329, No. 22 ( 2023-06-13), p. 1934-
    Details
    In: JAMA, American Medical Association (AMA), Vol. 329, No. 22 ( 2023-06-13), p. 1934-
    Abstract: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID . Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. Design, Setting, and Participants Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. Exposure SARS-CoV-2 infection. Main Outcomes and Measures PASC and 44 participant-reported symptoms (with severity thresholds). Results A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%] ) were PASC positive at 6 months. Conclusions and Relevance A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
    Type of Medium: Online Resource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2023.8823
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 5
    Online Resource
    Online Resource
    Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study*
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Critical Care Medicine Vol. 50, No. 10 ( 2022-10), p. 1449-1460
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 10 ( 2022-10), p. 1449-1460
    Abstract: In mechanically ventilated patients, awareness with paralysis (AWP) can have devastating consequences, including post-traumatic stress disorder (PTSD), depression, and thoughts of suicide. Single-center data from the emergency department (ED) demonstrate an event rate for AWP factors higher than that reported from the operating room. However, there remains a lack of data on AWP among critically ill, mechanically ventilated patients. The objective was to assess the proportion of ED patients experiencing AWP and investigate modifiable variables associated with its occurrence. DESIGN: An a priori planned secondary analysis of a multicenter, prospective, before-and-after clinical trial. SETTING: The ED of three academic medical centers. PATIENTS: Mechanically ventilated adult patients that received neuromuscular blockers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All data related to sedation and analgesia were collected. AWP was the primary outcome, assessed with the modified Brice questionnaire, and was independently adjudicated by three expert reviewers. Perceived threat, in the causal pathway for PTSD, was the secondary outcome. A total of 388 patients were studied. The proportion of patients experiencing AWP was 3.4% ( n = 13), the majority of whom received rocuronium ( n = 12/13; 92.3%). Among patients who received rocuronium, 5.5% ( n = 12/230) experienced AWP, compared with 0.6% ( n = 1/158) among patients who did not receive rocuronium in the ED (odds ratio, 8.64; 95% CI, 1.11–67.15). Patients experiencing AWP had a higher mean ( sd ) threat perception scale score, compared with patients without AWP (15.6 [5.8] vs 7.7 [6.0] ; p 〈 0.01). CONCLUSIONS: AWP was present in a concerning proportion of mechanically ventilated ED patients, was associated with rocuronium exposure in the ED, and led to increased levels of perceived threat, placing patients at greater risk for PTSD. Studies that aim to further quantify AWP in this vulnerable population and eliminate its occurrence are urgently needed.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000005626
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2034247-0
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  • 6
    Online Resource
    Online Resource
    Early Interventions for the Prevention of Posttraumatic Stress Symptoms in Survivors of Critical Illness: A Qualitative Systematic Review
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Critical Care Medicine Vol. 46, No. 8 ( 2018-08), p. 1328-1333
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 8 ( 2018-08), p. 1328-1333
    Abstract: Posttraumatic stress disorder among survivors of critical illness is of public health importance, as it is common and reduces patient quality of life. The objective of this systematic review was to collate the world’s literature on interventions aimed at preventing posttraumatic stress disorder among survivors of critical illness. Data Sources: We performed a search of CENTRAL, MEDLINE, EMBASE, CINAHL, and clinical trials registry platforms, with no restriction to language using a comprehensive strategy. Study Selection: Study inclusion criteria were as follows: 1) adult human subjects, 2) patients treated in an ICU setting, 3) intervention arm aimed at reducing posttraumatic stress disorder symptoms, 4) use of a control arm, and 5) an outcome measure assessing development of acute stress or posttraumatic stress disorder symptoms. Data Extraction: We performed a qualitative analysis to collate and summarize effects of identified interventions according to the recommended methodology from the Cochrane Handbook. Data Synthesis: Seventeen studies met all inclusion and no exclusion criteria. There was heterogeneity in interventions and outcome measures used. All studies had some concern for risk of bias as per the Cochrane tool for assessing risk of bias. In eight of 12 studies (67%) testing early interventions (i.e., initiated in the ICU course) and one of five studies (20%) testing delayed interventions following ICU discharge, posttraumatic stress disorder symptoms were decreased among the intervention group compared with controls. Conclusions: Despite a paucity of high-quality clinical investigations, the preponderance of evidence to date suggests that 1) posttraumatic stress disorder among survivors of critical illness may be preventable and 2) early interventions may be the most effective.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000003222
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2034247-0
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  • 7
    Online Resource
    Online Resource
    Healthcare provider compassion is associated with lower PTSD symptoms among patients with life-threatening medical emergencies: a prospective cohort study
    Springer Science and Business Media LLC ; 2019
    In:  Intensive Care Medicine Vol. 45, No. 6 ( 2019-6), p. 815-822
    Details
    In: Intensive Care Medicine, Springer Science and Business Media LLC, Vol. 45, No. 6 ( 2019-6), p. 815-822
    Type of Medium: Online Resource
    ISSN: 0342-4642 , 1432-1238
    URL: Article
    DOI: 10.1007/s00134-019-05601-5
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 1459201-0
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  • 8
    Online Resource
    Online Resource
    Association Between Perceived Threat and the Development of Posttraumatic Stress Disorder Symptoms in Patients With Life‐threatening Medical Emergencies
    Wiley ; 2020
    In:  Academic Emergency Medicine Vol. 27, No. 2 ( 2020-02), p. 109-116
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 27, No. 2 ( 2020-02), p. 109-116
    Abstract: Our objectives were to test whether during a potentially life‐threatening medical emergency, perceived threat (a patient’s sense of life endangerment) in the emergency department (ED) is common and associated with the subsequent development of posttraumatic stress disorder (PTSD) symptoms. Methods This study was an ED‐based prospective cohort study in an academic hospital. We included adult patients requiring acute intervention in the ED for resuscitation of a potentially life‐threatening medical emergency, defined as respiratory or cardiovascular instability. We measured patient‐perceived threat in the ED using a validated patient self‐assessment measure (score range = 0 to 21, with higher scores indicating greater perceived threat). We performed blinded assessment of PTSD symptoms 30 days after discharge using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders‐Fifth Edition (PCL‐5). Results Ninety‐nine of 113 (88%) patients completed follow‐up, with 98% reporting some degree of perceived threat, median (interquartile range [IQR]) perceived threat score 12 (6 to 17), and 72% reported PTSD symptoms in relation to their ED visit (median [IQR] PCL‐5 score = 7 [0 to 30]). Patients with respiratory instability had higher median (IQR) perceived threat scores (16 [9 to 18] vs. 9 [6 to 14)] and PCL‐5 scores (10 [2 to 40] vs. 3 [0 to 17]) compared to patients without respiratory instability. In a multivariable linear regression model adjusting for potential confounders, greater perceived threat in the ED was independently associated with higher PCL‐5 scores (β = 0.79, 95% confidence interval [CI]  = 0.15 to 1.42). Among the individual perceived threat items, the feeling of helplessness during resuscitation had the strongest association with PCL‐5 score (β = 5.24, 95% CI = 2.29 to 8.18). Conclusions Perceived threat during potentially life‐threatening emergencies is common and independently associated with development of PTSD symptoms. Additional research to test whether reduction of perceived threat in the ED attenuates the development of PTSD symptoms following potentially life‐threatening emergencies is warranted.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v27.2
    DOI: 10.1111/acem.13877
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2029751-8
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  • 9
    Online Resource
    Online Resource
    Effects of hypercapnia in sepsis: A scoping review of clinical and pre‐clinical data
    Wiley ; 2021
    In:  Acta Anaesthesiologica Scandinavica Vol. 65, No. 4 ( 2021-04), p. 430-437
    Details
    In: Acta Anaesthesiologica Scandinavica, Wiley, Vol. 65, No. 4 ( 2021-04), p. 430-437
    Abstract: Perform a scoping review of (1) pre‐clinical studies testing the physiological effects of higher PaCO 2 levels in the setting of sepsis models and (2) clinical investigations testing the effects of hypercapnia on clinical outcomes in mechanically ventilated patients with sepsis. Methods We performed a search of CENTRAL, PUBMED, CINAHL, and EMBASE. Study inclusion criteria for pre‐clinical studies were: (1) bacterial sepsis model (2) measurement of PaCO 2 , and (3) comparison of outcome measure between different PaCO 2 levels. Inclusion criteria for clinical studies were: (1) diagnosis of sepsis, (2) receiving invasive mechanical ventilation, (3) measurement of PaCO 2 , and (4) comparison of outcomes between different PaCO 2 levels. We performed a qualitative analysis to collate and summarize the physiological and clinical effects of hypercapnia according to the recommended methodology from the Cochrane Handbook. Results Fifteen pre‐clinical and nine clinical studies were included. Among pre‐clinical studies, the individual studies found higher PaCO 2 augments tissue blood flow and oxygenation, and attenuates inflammation and lung injury; however, all pre‐clinical studies were found to have some degree of risk of bias. Six of the nine clinical studies were deemed to be good quality. Among clinical studies hypercapnia was associated with increased cerebral perfusion and oxygenation; however, there were conflicting results testing the association between hypercapnia and mortality. Conclusion While individual pre‐clinical studies identified potential mechanisms by which changes in PaCO 2 levels could affect pathophysiology in sepsis, there is a paucity of clinical data as to the optimal PaCO 2 range, demonstrating a need for future research. Registration PROSPERO number CRD42018086703.
    Type of Medium: Online Resource
    ISSN: 0001-5172 , 1399-6576
    URL: Issue
    URL: Article
    DOI: 10.1111/aas.v65.4
    DOI: 10.1111/aas.13763
    RVK:
    XA 11250
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2004319-3
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  • 10
    Online Resource
    Online Resource
    Adjuncts for Maximizing Resection : 5-Aminolevuinic Acid
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Neurosurgery Vol. 59, No. Supplement 1 ( 2012-10-1), p. 75-78
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 59, No. Supplement 1 ( 2012-10-1), p. 75-78
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1227/NEU.0b013e31826b2e8b
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1491894-8
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