Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome: results of an international survey

Background: Surveys have demonstrated a lack of physician awareness of intra-abdominal hypertension and abdominal compartment syndrome (IAH/ACS) and wide variations in the management of these conditions, with many intensive care units (ICUs) reporting that they do not measure intra-abdominal pressure (IAP). We sought to determine the association between publication of the 2006/2007 World Society of the Abdominal Compartment Syndrome (WSACS) Consensus Definitions and Guidelines and IAH/ACS clinical awareness and management. Methods: The WSACS Executive Committee created an interactive online survey with 53 questions, accessible from November 2006 until December 2008. The survey was endorsed by the WSACS, the European Society of Intensive Care Medicine (ESICM) and the Society of Critical Care Medicine (SCCM). A link to the survey was emailed to all members of the supporting societies. Participants of the 3rd World Congress on Abdominal Compartment Syndrome meeting (March 2007, Antwerp, Belgium) were also asked to complete the questionnaire. No reminders were sent. Based on 13 knowledge questions, an overall score was calculated (expressed as percentage). Results: A total of 2,244 of the approximately 10,000 clinicians who were sent the survey responded (response rate: 22.4%). Most of the 2,244 respondents (79.2%) completing the survey were physicians or physicians in training and the majority were residing in North America (53.0%). The majority of responders (85%) were familiar with IAP/IAH/ACS, but only 28% were aware of the WSACS consensus definitions for IAH/ACS. Three quarters of respondents considered the cut-off for IAH to be at least 15 mm Hg, and nearly two thirds believed the cut-off for ACS was higher than the currently suggested consensus definition (20 mm Hg). In 67.8% of respondents, organ dysfunction was only considered a problem with IAP of 20 mm Hg or higher. IAP was measured most frequently via the bladder (91.9%), but the majority reported that they instilled volumes well above the current guidelines. Surgical decompression was frequently used to treat IAH/ACS, whereas medical management was only attempted by about half of the respondents. Decisions to decompress the abdomen were predominantly based on the severity of IAP elevation and presence of organ dysfunction (74.4%). Overall knowledge scores were low (43 +/- 15%); respondents who were aware of the WSACS had a better score compared to those who were not (49.6% vs 38.6%, P < 0.001). Conclusions: This survey showed that although most responding clinicians claim to be familiar with IAH and ACS, knowledge of published consensus definitions, measurement techniques, and clinical management is inadequate

Outlook Magazine, Winter 2016

https://digitalcommons.wustl.edu/outlook/1200/thumbnail.jp

Interventions and outcomes in bronchiolitis clinical trials

Tese de doutoramento, Medicina (Pediatria), Universidade de Lisboa, Faculdade de Medicina, 2015Acute viral bronchiolitis is the most common acute infection of the lower respiratory tract during the first year of life. It is a major cause of clinical morbidity and financial health burden, and encompasses a spectrum of disease severity. This thesis addresses the uncertainties of current evidence on two widely used treatments for bronchiolitis, i.e. bronchodilators and corticosteroids, and how this evidence is limited by shortcomings in key areas of clinical trial design, namely disease definition and outcome selection and measurement. The thesis specific aims were: 1. to assess the comparative efficacy and safety of bronchodilators and corticosteroids, used alone or in combination; 2. to identify outcomes reported in previous clinical trials in bronchiolitis, and a. to assess which outcomes are considered most important to different physicians, and b. to study the measurement properties of two commonly used respiratory distress scales (Respiratory Distress Assessment Instrument - RDAI, and the Respiratory Assessment Change Score - RACS); and 3. to study how physicians define bronchiolitis. Chapter 1 presents an overview of relevant epidemiological, clinical and pathophysiological findings in bronchiolitis, preceded by a historical perspective. Chapter 2 describes the results of a comprehensive comparative effectiveness systematic review of bronchodilators and corticosteroids, including 48 trials (4897 patients and 13 comparisons), with network meta-analysis. Chapter 3.1 presents an exploratory study to identify outcome domains and measurement instruments reported in 90 clinical trials of bronchiolitis included in 11 Cochrane systematic reviews. In Chapter 3.2, we report on a measurement study which evaluates the validity, reliability and responsiveness of RDAI and RACS, including data from up to 1765 infants with bronchiolitis enrolled in pediatric emergency departments. Finally, in Chapter 4 we present results from a nationwide electronic survey of pediatricians and general practitioners, where we assessed physician perspectives on both definition of bronchiolitis, and relevant outcomes and outcome domains for future bronchiolitis trials.A bronquiolite aguda é a mais frequente infecção das vias aéreas inferiores durante o primeiro ano de vida, e tem um impacto clínico e económico substancial. Esta tese avalia a evidência actual sobre o uso de broncodilatadores e corticoesteróides, e de que forma essa evidência está limitada por dois aspectos metodológicos chave para o desenho de ensaios clínicos nesta área: a definição de bronquiolite, e a escolha e medição de “outcomes”. Os objectivos específicos incluem: 1. avaliar a eficácia e segurança comparativas de broncodilatadores e corticoesteróides, usados isoladamente ou em combinação; 2. identificar os “outcomes” reportados em ensaios clínicos de bronquiolite, e a. avaliar que “outcomes” são considerados mais relevantes por médicos, e b. estudar as propriedades de medida de duas escalas de dificuldade respiratória frequentemente usadas (Respiratory Distress Assessment Instrument - RDAI, e Respiratory Assessment Change Score - RACS); e 3. avaliar perspectivas médicas sobre a definição de bronquiolite. No Capítulo 1 revemos aspectos epidemiológicos, fisiopatológicos e clínicos da bronquiolite, enquadrados numa perspectiva histórica. No Capítulo 2 descrevemos os resultados de uma revisão sistemática comparativa sobre a eficácia e segurança de broncodilatadores e corticoesteróides, incluindo 48 ensaios (4897 doentes e 13 comparações), com meta-análise em rede. O Capítulo 3.1 apresenta um estudo exploratório que identifica domínios de “outcomes” e instrumentos de medida reportados em 90 ensaios clínicos de bronquiolite incluídos em 11 revisões sistemáticas Cochrane. No Capítulo 3.2 descrevemos um estudo de medição em que se avaliam a validade, fiabilidade e responsividade das escalas RDAI e RACS, incluindo dados de até 1765 crianças no contexto de bronquiolite na urgência pediátrica. Por fim, no Capítulo 4 apresentamos os resultados de um inquérito electrónico nacional a médicos pediatras e de medicina geral e familiar, avaliando as perspectivas médicas sobre definição de bronquiolite, e sobre quais os “outcomes” considerados relevantes para futuros ensaios clínicos nesta área

Physician Faculty Scholars Program 2005-2012

Describes the scope, goals, successes, challenges, and lessons of RWJF's career development program which supports physicians' academic careers with three-year research grants. Includes grantee profiles

Fusion, 2021

https://hsrc.himmelfarb.gwu.edu/smhs_fusion/1013/thumbnail.jp

Acceptance and Perception of Artificial Intelligence Usability in Eye Care (APPRAISE) for Ophthalmologists: A Multinational Perspective

Background: Many artificial intelligence (AI) studies have focused on development of AI models, novel techniques, and reporting guidelines. However, little is understood about clinicians' perspectives of AI applications in medical fields including ophthalmology, particularly in light of recent regulatory guidelines. The aim for this study was to evaluate the perspectives of ophthalmologists regarding AI in 4 major eye conditions: diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD) and cataract. Methods: This was a multi-national survey of ophthalmologists between March 1st, 2020 to February 29th, 2021 disseminated via the major global ophthalmology societies. The survey was designed based on microsystem, mesosystem and macrosystem questions, and the software as a medical device (SaMD) regulatory framework chaired by the Food and Drug Administration (FDA). Factors associated with AI adoption for ophthalmology analyzed with multivariable logistic regression random forest machine learning. Results: One thousand one hundred seventy-six ophthalmologists from 70 countries participated with a response rate ranging from 78.8 to 85.8% per question. Ophthalmologists were more willing to use AI as clinical assistive tools (88.1%, n = 890/1,010) especially those with over 20 years' experience (OR 3.70, 95% CI: 1.10–12.5, p = 0.035), as compared to clinical decision support tools (78.8%, n = 796/1,010) or diagnostic tools (64.5%, n = 651). A majority of Ophthalmologists felt that AI is most relevant to DR (78.2%), followed by glaucoma (70.7%), AMD (66.8%), and cataract (51.4%) detection. Many participants were confident their roles will not be replaced (68.2%, n = 632/927), and felt COVID-19 catalyzed willingness to adopt AI (80.9%, n = 750/927). Common barriers to implementation include medical liability from errors (72.5%, n = 672/927) whereas enablers include improving access (94.5%, n = 876/927). Machine learning modeling predicted acceptance from participant demographics with moderate to high accuracy, and area under the receiver operating curves of 0.63–0.83. Conclusion: Ophthalmologists are receptive to adopting AI as assistive tools for DR, glaucoma, and AMD. Furthermore, ML is a useful method that can be applied to evaluate predictive factors on clinical qualitative questionnaires. This study outlines actionable insights for future research and facilitation interventions to drive adoption and operationalization of AI tools for Ophthalmology

Policy Development: Stress Management and Critical Incident Debriefing

Abstract Workplace stress and associated disorders (occupational burnout, compassion fatigue, secondary traumatic stress, critical incident stress, posttraumatic stress disorder, etc.) disproportionately affect healthcare workers, especially those working in critical care and emergency environments. The financial cost of stress related after-effects experienced by health care workers exceeds $191 billion each year and includes the cost of associated decreased quality of patient care, missed diagnoses, medical errors, and sentinel events leading to patient disablement or mortality. Mental health interventions such as stress management education and critical incident debriefings have been proven effective in reducing workplace stress and building personal resilience. A gap in practice was identified in the lack of a formal stress management education process in the participating facility. The purpose of this DNP project was to obtain consensus from a multidisciplinary panel of content experts to determine pertinent components for inclusion in a Stress Management and Critical Incident policy brief. The theoretical model guiding this project was the transactional model of stress and coping, which provides an interactive approach to developing coping skills and resiliency. This policy draft may be used to develop a formal program of stress management education for leadership and staff, critical incident debriefing, and institutional changes to promote a safe and effective work environment. Keywords: stress, critical incident, debriefing, occupational burnout, compassion fatigue, secondary traumatic stress, posttraumatic stress disorder, coping, resilienc

11th European Headache Federation Congress jointly with 31st Congress of the Italian Society for the Study of Headaches : Rome, Italy. 01-03 December 2017

. Aims of the study were explore the relationship between peripheral chromatic and central visual dysfunction evaluating also the presence of functional receptor impairment in patients with migraine, with and without aura examined interictally

The feasibility of performing a randomised controlled trial of therapeutic hypothermia for neuroprotection after paediatric cardiac arrest in the UK

Cardiac arrest in paediatric patients often results in death or survival with severe brain injury. Therapeutic hypothermia, lowering of core body temperature to 32 to 34⁰C may reduce injury to the brain in the period after circulation has been restored. This thesis comprises studies related to the feasibility of performing a randomised controlled trial (RCT) of therapeutic hypothermia for neuroprotection after cardiac arrest in the UK. A systematic Cochrane review of paediatric evidence finds no published RCTs supporting or refuting the use of therapeutic hypothermia after cardiac arrest. Four on-going RCTs are identified which will add to the future evidence base; however, a future UK RCT is recommended. Additional support for a RCT is demonstrated by two UK surveys of paediatric intensive care and emergency care clinicians. Current UK practice is varied and clinical equipoise exists regarding post cardiac arrest temperature management. A national, retrospective study of all admissions to paediatric intensive care after out of hospital (OHCA) and in hospital cardiac arrest (IHCA) shows an overall survival of 76 and 50% respectively. Important differences between IHCA and OHCA populations are identified, recommending separation in a RCT. The incidence rate of cardiac arrest admissions to PICU in the UK is too low to recruit to a UK only RCT, after consideration of sample size requirements. A large, multi-centre, retrospective, observational study of OHCA patients identified multiple factors associated with survival. A survival prediction model, incorporating: pupillary reaction, blood lactate level and duration of cardiac arrest, is described. The model could be used as a tool for stratified randomisation within a RCT. Finally, therapeutic hypothermia is retrospectively compared with standard, normothermic temperature management after OHCA. In a limited population, no difference in survival is found; however, important information on application, logistics and safety of the intervention are evaluated

Predictors of Dental Students’ Behavioral Intention Use of Teledentistry: An Application of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model

Shortages of dental professionals and access barriers to dental care are challenges to improving oral health and decreasing the burden of dental diseases. There are more than 57 million individuals in the U.S. who live in dental health professional shortage areas (DHPSA). The U.S. DHPSA areas need 9,951 dental practitioners to overcome the obstacles to oral care access. Due to dental care needs for these populations, it is imperative to find a new method to reach these underserved populations. Teledentistry is an innovative technology that can be used to improve access to care and oral health outcomes. Unfortunately, there is still limited utilization of teledentistry in dental practice in the U.S. Many studies have investigated factors associated with the applications of telehealth and telemedicine; however, limited investigations have addressed the barriers to the use and implementation of teledentistry. The overarching purpose of this dissertation was to explore factors associated with the future use of teledentistry among predoctoral dental students. To achieve this purpose, three interrelated projects were conducted. The first project involved a systematic review to investigate the validity of using teledentistry in dental practice. The second project examined demographics, individual characteristics, and prior experience with teledentistry associated with U.S. dental students’ intention to use teledentistry in their dental practice. The final project utilized the unified theory of acceptance and use of technology model (UTAUT) to predict the future use of teledentistry by evaluating U.S dental students’ behavioral intention to use teledentistry in practice. The systematic review confirmed that a teledentistry oral diagnosis was comparable to face-to-face diagnosis and suggests the need for methodologically designed studies with appropriate statistical tests to further investigate the validity of teledentistry. Project II results indicated that dental students with prior teledentistry experience were more likely to utilize this technology in their future practice. Project III identified that the UTAUT model significantly predicted dental students’ behavioral intention to use teledentistry. All the UTAUT constructs were significantly associated with dental students’ behavioral intention. Findings from these three projects indicate that exposure to teledentistry while in dental school increases the likelihood of use as a licensed dentist