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  • 1
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    Online Resource
    Characterizing Citizens’ Preferences for Engagement in Patient Care and Research in Adult and Pediatric Intensive Care Units
    SAGE Publications ; 2020
    In:  Journal of Intensive Care Medicine Vol. 35, No. 2 ( 2020-02), p. 170-178
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 35, No. 2 ( 2020-02), p. 170-178
    Abstract: Engagement promotes and supports the active participation of patients and families in health care and research to strengthen their influence on decision-making. We sought to characterize how citizens wish to be engaged in care and research in the intensive care unit (ICU). Methods: Interviewers administered questionnaires to visitors in 3 adult ICUs and 1 pediatric ICU. Results: We surveyed 202 (adult [n = 130] and pediatric [n = 72] ) visitors. Adults and pediatric visitors prioritized 3 patient care topics (family involvement in rounds, improving communication between family members and health-care providers, and information transmission between health-care practitioners during patient transfers) and 2 research topics (evaluating prevention and recovery from critical illness). Preferred engagement activities included sharing personal experiences, identifying important topics and outcomes, and finding ways to make changes that respected their needs. Both respondent groups preferred to participate by completing electronic surveys or comment cards and answering questions on a website. Few respondents ( 〈 5%) wanted to participate in committees that met regularly. Although adult and pediatric respondents identified common facilitators and barriers to participation, they ranked them differently. Although both groups perceived engagement to be highly important, adult respondents were significantly less confident that their participation would impact care (7.6 ± 2.2 vs 8.3 ± 1.8; P = .01) and research (7.3 ± 2.4 vs 8.2 ± 2.0; P = .01) and were significantly less willing to participate in care (5.6 ± 2.9 vs 6.7 ± 3.0; P = .007) and research (4.7 ± 3.0 vs ± 5.8 ± 3.0; P = .02). Conclusions: Adult and pediatric visitors expressed comparable engagement preferences, identified similar facilitators and barriers, and rated engagement highly. Adult visitors were significantly less confident that their participation would be impactful and were significantly less willing to engage in care and research.
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/0885066617729127
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2001472-7
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  • 2
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    Online Resource
    Critical Care Pharmacist Attitudes and Perceptions of Neuromuscular Blocker Infusions in ARDS
    SAGE Publications ; 2023
    In:  Annals of Pharmacotherapy Vol. 57, No. 11 ( 2023-11), p. 1282-1290
    Details
    In: Annals of Pharmacotherapy, SAGE Publications, Vol. 57, No. 11 ( 2023-11), p. 1282-1290
    Abstract: Current critical care pharmacist (CCP) practices and perceptions related to neuromuscular infusion (NMBI) use for acute respiratory distress syndrome (ARDS) maybe different with the COVID-19 pandemic and the publication of 2020 NMBI practice guidelines. Objective: To evaluate CCP practices and perceptions regarding NMBI use for patients with moderate-severe ARDS. Methods: We developed, tested, and electronically administered a questionnaire (7 parent-, 42 sub-questions) to 409 American College of Clinical Pharmacy (ACCP) Critical Care Practice and Research Network members in 12 geographically diverse states. The questionnaire focused on adults with moderate-severe ARDS (PaO 2 :FiO 2 〈 150) whose causes of dyssynchrony were addressed. Two reminders were sent at 10-day intervals. Results: Respondents [131/409 (32%)] primarily worked in a medical intensive care unit (ICU) 102 (78%). Compared to COVID-negative(-) ARDS patients, COVID positive(+) ARDS patients were twice as likely to receive a NMBI (34 ± 18 vs.16 ± 17%; P 〈 0.01). Respondents somewhat/strongly agreed a NMBI should be reserved until after trials of deep sedation (112, 86%) or proning (92, 81%) and that NMBI reduced barotrauma (88, 67%), dyssynchrony (87, 66%), and plateau pressure (79, 60%). Few respondents somewhat/strongly agreed that a NMBI should be initiated at ARDS onset (23, 18%) or that NMBI reduced 90-day mortality (12, 10%). Only 2/14 potential NMBI risks [paralysis awareness (101, 82%) and prolonged muscle weakness (84, 68%)] were frequently reported to be of high/very high concern. Multiple NMBI titration targets were assessed as very/extremely important including arterial pH (109, 88%), dyssynchrony (107, 86%), and PaO 2 : FiO 2 ratio (82, 66%). Train-of-four (55, 44%) and BIS monitoring (36, 29%) were deemed less important. Preferred NMBI discontinuation criteria included absence of dysschrony (84, 69%) and use ≥48 hour (72, 59%). Conclusions and Relevance: Current critical care pharmacists believe NMBI for ARDS patients are best reserved until after trials of deep sedation or proning; unique considerations exist in COVID+ patients. Our results should be considered when ICU NMBI protocols are being developed and bedside decisions regarding NMBI use in ARDS are being formulated.
    Type of Medium: Online Resource
    ISSN: 1060-0280 , 1542-6270
    URL: Article
    DOI: 10.1177/10600280231160437
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2053518-1
    SSG: 15,3
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  • 3
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    Online Resource
    Research Consent Models Used in Prospective Studies of Neurologically Deceased Organ Donors: A Systematic Review
    SAGE Publications ; 2020
    In:  Journal of Empirical Research on Human Research Ethics Vol. 15, No. 4 ( 2020-10), p. 244-251
    Details
    In: Journal of Empirical Research on Human Research Ethics, SAGE Publications, Vol. 15, No. 4 ( 2020-10), p. 244-251
    Abstract: Research to inform the care of neurologically deceased organ donors is complicated by a lack of standards for research consent. In this systematic review, we aim to describe current practices of soliciting consent for participation in prospective studies of neurologically deceased donors, including the frequency and justification for these various models of consent. Among the 74 studies included, 14 did not report on any regulatory review, and 13 did not report on the study consent procedures. Of the remaining 47 studies, 24 utilized a waiver of research consent. The most common justification for a waiver of research consent related to the fact that neurologically deceased donors are not considered human subjects. In conclusion, among studies of neurologically deceased donors, research consent models vary and are inconsistently reported. Consensus and standardization in the application of research consent models will help to advance this emerging field of research.
    Type of Medium: Online Resource
    ISSN: 1556-2646 , 1556-2654
    URL: Article
    DOI: 10.1177/1556264620904627
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2263068-5
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  • 4
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    Online Resource
    Practice Patterns in the Treatment of Patients With Severe Alcohol Withdrawal: A Multidisciplinary, Cross-Sectional Survey
    SAGE Publications ; 2020
    In:  Journal of Intensive Care Medicine Vol. 35, No. 11 ( 2020-11), p. 1250-1256
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 35, No. 11 ( 2020-11), p. 1250-1256
    Abstract: To characterize physicians’ stated practices in the treatment of patients with severe acute alcohol withdrawal syndrome (sAAWS) and to use intravenous (IV) phenobarbital as an adjuvant treatment for sAAWS. Methods: A multidisciplinary, cross-sectional, self-administered survey at 2 large academic centers specializing in inner-city healthcare. Results: We analyzed 105 of 195 questionnaires (53.8% response rate). On average, clinicians managed 32 cases of AAWS over a 6-month period, of which 7 (21.9%) were severe. Haloperidol (Haldol; 40 [39%]), clonidine (Catapres; 31 [30%] ), phenobarbital (Luminal, Tedral; 29 [27%]) and propofol (Diprivan; 29 [28%] ) were the most commonly used adjuvant medications for sAAWS. Sixty-three (60%) of respondents did not use phenobarbital in practice. Of phenobarbital users, 23 (55%) respondents used it early in patients who were refractory to symptom-triggered benzodiazepine treatment. Others waited until patients experienced seizures (5 [10%]) or required intensive care unit admission (8 [18%] ). Respondents who used phenobarbital preferred to use the IV versus oral form (66% vs 29%, P 〈 .001). Most respondents, however, were unfamiliar with the pharmacokinetics, side effects, contraindications, and evidence supporting phenobarbital use for sAAWS. Although many respondents (64 [61%]) expressed discomfort using phenobarbital, 87 (83%) expressed comfort or neutrality with enrolling patients in a trial to evaluate IV phenobarbital in sAAWS. Conclusions: Considerable stated practice variation exists in how clinicians treat patients with sAAWS. Our findings support conduct of a pilot trial to evaluate IV phenobarbital as an adjuvant treatment to symptom-triggered benzodiazepines for sAAWS and have informed trial design.
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/0885066619847119
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2001472-7
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  • 5
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    Online Resource
    Evidence Supporting Clinical Use of Proportional Assist Ventilation: A Systematic Review and Meta-Analysis of Clinical Trials
    SAGE Publications ; 2020
    In:  Journal of Intensive Care Medicine Vol. 35, No. 7 ( 2020-07), p. 627-635
    Details
    In: Journal of Intensive Care Medicine, SAGE Publications, Vol. 35, No. 7 ( 2020-07), p. 627-635
    Abstract: While proportional assist ventilation (PAV), generates pressure in proportion to effort without a preselected target, proportional assist ventilation plus (PAV+) measures compliance and resistance, calculates work of breathing, and adjusts support to a preset assistance level. Objective: To summarize randomized controlled trials (RCTs) comparing invasive or noninvasive PAV or PAV+ in critically ill patients. Data Sources: We searched multiple databases to April 2017 without language restrictions and conference proceedings from 5 meetings to identify randomized parallel-group and crossover RCTs that compared invasive or noninvasive PAV or PAV+ to another mode in critically ill adults or children and reported at least 1 clinically important outcome. Results: We identified 14 RCTs (11 parallel group and 3 crossover) assessing PAV (n = 7) and PAV+ (n = 7) involving 931 adult patients. We found no effect of noninvasive PAV (vs noninvasive pressure support [PS]) on intubation (risk ratio 0.92 [0.59 to 1.43] , I 2 = 0%) or invasive PAV (vs invasive PS) on percentage rapid eye movement sleep (mean difference [MD] −2.93% [−14.20 to ±8.34] , I 2 = 43%). Compared to invasive PS, invasive PAV+ showed a nonsignificant increase in weaning time (MD +0.54 [−0.67 to +1.75] hours, I 2 = 0%), but no effect on hospital mortality, reintubation, or tracheostomy. Conclusions: Current evidence does not support the use of invasive or noninvasive PAV or invasive PAV+ in critically ill adults. Amid low to moderate heterogeneity, we identified 3 promising areas for future research including assessing the role of noninvasive PAV as an initial support strategy in patients with acute respiratory failure, invasive PAV on sleep quality during invasive ventilation, and possibly invasive PAV+ for weaning.
    Type of Medium: Online Resource
    ISSN: 0885-0666 , 1525-1489
    URL: Article
    DOI: 10.1177/0885066618769021
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2001472-7
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  • 6
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    Online Resource
    Insufficient Antiretroviral Therapy in Pregnancy: Missed Opportunities for Prevention of Mother-To-Child Transmission of HIV in Europe
    SAGE Publications ; 2011
    In:  Antiviral Therapy Vol. 16, No. 6 ( 2011-08), p. 895-903
    Details
    In: Antiviral Therapy, SAGE Publications, Vol. 16, No. 6 ( 2011-08), p. 895-903
    Abstract: Although mother-to-child transmission (MTCT) rates are at an all-time low in Western Europe, potentially preventable transmissions continue to occur. Duration of antenatal combination antiretroviral therapy (ART) is strongly associated with MTCT risk. Methods Data on pregnant HIV-infected women enrolled in the Western and Central European sites of the European Collaborative Study between January 2000 and July 2009 were analysed. The proportion of women receiving no antenatal ART or 1–13 days of treatment was investigated, and associated factors explored using logistic regression models. Results Of 2,148 women, 142 (7%) received no antenatal ART, decreasing from 8% in 2000–2003 to 5% in 2004– 2009 (χ 2 =8.73; P 〈 0.01). A further 41 (2%) received 1–13 days of ART. One-third (64/171) of women with ‘insufficient’ (0 or 1–13 days) antenatal ART had a late HIV diagnosis (in the third trimester or intrapartum), but half (85/171) were diagnosed before conception. Pre-term delivery 〈 34 weeks was associated with receipt of no and 1–13 days antenatal ART (adjusted odds ratios [ORs] 2.9 [ P 〈 0.01] and 4.5 [ P 〈 0.01], respectively). History of injecting drug use was associated with an increased risk of no ART (adjusted OR 2.9; P 〈 0.01) and severe symptomatic HIV disease with a decreased risk (adjusted OR 0.2; P 〈 0.01). MTCT rates were 1.1% (15/1,318) among women with ≥14 days antenatal ART and 7.4% (10/136) among those with insufficient ART. Conclusions Over the last 10 years, around one in 11 women in this study received insufficient antenatal ART, accounting for 40% of MTCTs. One-half of these women were diagnosed before conception, suggesting disengagement from care.
    Type of Medium: Online Resource
    ISSN: 1359-6535 , 2040-2058
    URL: Article
    DOI: 10.3851/IMP1849
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2011
    detail.hit.zdb_id: 2118396-X
    SSG: 15,3
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  • 7
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    Online Resource
    Methods for Accumulating Data to Assess School Performance and Psychosocial Functioning of Patients With Pediatric Malignancies Who Are Off Therapy
    SAGE Publications ; 2000
    In:  Journal of Pediatric Oncology Nursing Vol. 17, No. 2 ( 2000-04), p. 95-95
    Details
    In: Journal of Pediatric Oncology Nursing, SAGE Publications, Vol. 17, No. 2 ( 2000-04), p. 95-95
    Type of Medium: Online Resource
    ISSN: 1043-4542 , 1532-8457
    URL: Article
    DOI: 10.1177/104345420001700217
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2000
    detail.hit.zdb_id: 3122666-8
    detail.hit.zdb_id: 2052954-5
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