13 research outputs found
Une application pour tĂ©lĂ©phones intelligents facilitant lâaccueil au dĂ©but des stages en unitĂ© de soins intensifs
Implication Statement
The Department of Critical Care at Dalhousie University developed a smartphone app to improve the quality of learner orientation to the intensive care unit (ICU). The app increased satisfaction with orientation and was perceived as useful. It was ranked as the second most valued resource for orientation after other residents. There is potential to improve the experience of learners with this popular technology.ĂnoncĂ© des implications de la recherche
Le dĂ©partement des soins critiques de l'UniversitĂ© Dalhousie a mis au point une application pour tĂ©lĂ©phones intelligents en vue d'amĂ©liorer la qualitĂ© de lâaccueil des apprenants Ă l'unitĂ© de soins intensifs (USI). L'application a permis d'augmenter la satisfaction par rapport Ă lâaccueil et elle a Ă©tĂ© jugĂ©e utile. Elle a Ă©tĂ© classĂ©e la deuxiĂšme ressource dâorientation la plus apprĂ©ciĂ©e aprĂšs « les autres rĂ©sidents ». L'expĂ©rience des apprenants peut ĂȘtre amĂ©liorĂ©e Ă lâaide de cette technologie populaire
My patient is short of breath: is the problem in the lung tissue?
Undifferentiated dyspnoea is a common patient presentation in the intensive care unit, medical and surgical floors, and in the emergency department. Physical examination and chest radiography are notoriously insensitive for detection and differentiation of various lung pathologies while computed tomography consumes significant resources and exposes the patient to ionizing radiation. Point-of-care ultrasound (PoCUS) is a highly sensitive and specific diagnostic tool that, with appropriate operator experience, is capable of diagnosing and differentiating between the various causes of dyspnoea. PoCUS machines are readily available, images are rapidly generated and repeatable, and technical skills are easily taught during short training sessions. Furthermore, the development of PoCUS skills in one specific area enables and enhances the development of skills in other non-related areas. This article describes the benefits, technical aspects, and challenges associated with using PoCUS to examine the lung parenchyma in the acutely dyspnoeic patient
My patient is short of breath: is there pleural fluid, and will PoCUS help drain it safely?
Pathological pleural fluid is common in patients presenting to the emergency department, occurring in as many as 17% of
patients presenting with shortness of breath, and as many as 20% of patients with blunt thoracic trauma. A typical chest X-ray may fail to identify as much as 175 mL of pleural fluid in the erect position, and as much as 500 mL in the supine position. Point-of-care ultrasound (PoCUS) on the other hand can detect as little as 20 mL of pleural fluid, and has consistently been shown to have sensitivities and specificities for the detection of pleural fluid close to 100% in both the trauma and critically ill populations. In addition, ultrasound identifies pleural fluid more rapidly than chest X-ray. PoCUS can be used to guide thoracentesis, resulting in improved success rates with decreased complications. Here we describe the evidence supporting the use of PoCUS in the management of pleural fluid collections
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and lowâmiddle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of âsingle-useâ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for lowâmiddle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both highâ and lowâmiddleâincome countries
Opioid and Sedative Coprescription: Prescribing Patterns after an ICU Admission
Background: Opioid misuse constitutes a health care crisis in Canada, and coprescription of opioids with sedatives has been associated with adverse events. Opioids and sedatives are frequently administered in the intensive care unit (ICU). The rate of continuation of opioidâsedative combinations after an ICU admission at the study institution was unknown.
Objectives: To determine the rates of opioid and sedative coprescriptions following an ICU admission and to identify factors associated with continuation of hospital-initiated opioidâsedative coprescriptions at ICU transfer and hospital discharge.
Methods: This retrospective chart review involved patients admitted to ICUs at a tertiary care centre between April 1, 2018, and March 31, 2019. Baseline characteristics were obtained from a clinical database and medication information from medication reconciliation forms. An opioid coprescription was defined as prescription of an opioid in combination with a sedative (benzodiazepine, z-drug, gabapentinoid, tricyclic antidepressant, or antipsychotic), and hospital-initiated coprescriptions encompassed various predefined scenarios of therapy started or modified before ICU transfer. Factors associated with hospital-initiated opioid coprescription were analyzed by multivariable logistic regression.
Results: A total of 735 patients met the inclusion criteria. At ICU transfer, 23.0% (169/735) of the patients had an opioid coprescription, and 87.0% (147/169) of these coprescriptions were hospital-initiated. At hospital discharge, 8.6% (44/514) of the patients had an opioid coprescription, and 56.8% (25/44) of these coprescriptions were hospital-initiated. Male sex, home opioid coprescription, surgical patient, prolonged hospital stay, and in-hospital death were significantly associated with hospital-initiated opioid coprescription at the time of ICUÂ transfer. Home opioid coprescription was significantly associated with opioid coprescription at the time of hospital discharge.
Conclusions: Hospital-initiated opioid coprescriptions accounted for the majority of opioid coprescriptions at ICU transfer and hospital discharge. Pharmacists should assess all opioid coprescriptions to determine whether discontinuation and/or dose reduction is appropriate.
RĂSUMĂ
Contexte : Lâabus dâopioĂŻdes est une crise sanitaire au Canada, et les opioĂŻdes coprescrits avec des sĂ©datifs ont Ă©tĂ© associĂ©s Ă des Ă©vĂ©nements indĂ©sirables. Les opioĂŻdes et les sĂ©datifs sont frĂ©quemment utilisĂ©s en unitĂ© de soins intensifs (USI). Sur le lieu de lâĂ©tude, on ne connaissait pas le taux de maintien de lâutilisation de la combinaison opioĂŻdes-sĂ©datifs aprĂšs une admission en USI.
Objectifs : DĂ©terminer les taux de coprescription dâopioĂŻdes et de sĂ©datifs suite Ă une admission en USI et identifier les facteurs associĂ©s au maintien de lâutilisation des coprescriptions dâopioĂŻdes et de sĂ©datifs amorcĂ©es par lâhĂŽpital au moment du transfert hors de lâUSI et du congĂ© hospitalier.
MĂ©thodes : Cet examen rĂ©trospectif des dossiers portait sur des patients admis en USI dâun centre de soins tertiaires entre le 1er avril 2018 et le 31 mars 2019. Les caractĂ©ristiques de base ont Ă©tĂ© obtenues Ă partir dâune base de donnĂ©es clinique et des informations sur les mĂ©dicaments Ă partir des formulaires de bilan comparatif des mĂ©dicaments. Une coprescription dâopioĂŻdes a Ă©tĂ© dĂ©finie comme « La prescription dâun opioĂŻde associĂ©e Ă un sĂ©datif (benzodiazĂ©pine, mĂ©dicament z, gabapentinoĂŻde, antidĂ©presseur tricyclique ou antipsychotique) ». Les « coprescriptions amorcĂ©es par lâhĂŽpital » correspondaient Ă des coprescriptions initiĂ©es ou modifiĂ©es avant le transfert hors de lâUSI, selon des scĂ©narios prĂ©alablement dĂ©finis. Les facteurs associĂ©s Ă la coprescription dâopioĂŻdes amorcĂ©e par lâhĂŽpital ont Ă©tĂ© analysĂ©s par rĂ©gression logistique multivariĂ©e.
RĂ©sultats : Au total, 735 patients rĂ©pondaient aux critĂšres dâinclusion. Lors du transfert hors de lâUSI, des opioĂŻdes Ă©taient coprescrits Ă 23,0 % (169/735) dâentre eux; de ces coprescriptions, 87,0 % (147/169) Ă©taient amorcĂ©es par lâhĂŽpital. Au moment du congĂ© hospitalier, des opioĂŻdes Ă©taient coprescrits Ă 8,6 % (44/514) dâentre eux; de ces coprescriptions, 56,8 % (25/44) Ă©taient amorcĂ©es par lâhĂŽpital. Le sexe masculin, la coprescription dâopioĂŻdes Ă domicile, lâadmission en chirurgie, le sĂ©jour prolongĂ© Ă lâhĂŽpital et le dĂ©cĂšs Ă lâhĂŽpital Ă©taient fortement associĂ©s Ă la coprescription dâopioĂŻdes amorcĂ©e par lâhĂŽpital au moment du transfert hors de lâUSI. La coprescription dâopioĂŻdes Ă domicile Ă©tait fortement associĂ©e Ă la coprescription dâopioĂŻdes au moment du congĂ© de lâhĂŽpital.
Conclusions : Les coprescriptions dâopioĂŻdes amorcĂ©es par lâhĂŽpital reprĂ©sentaient la majoritĂ© des coprescriptions au moment du transfert hors de lâUSI et au moment du congĂ© de lâhĂŽpital. Les pharmaciens doivent Ă©valuer toutes les coprescriptions dâopioĂŻdes pour dĂ©terminer si lâarrĂȘt et/ou la rĂ©duction de la dose est appropriĂ©e
My patient has got abdominal pain: identifying biliary problems
General view of the fountain at play; With Pietro Bernini
Needs and expectations for artificial intelligence in emergency medicine according to Canadian physicians
Abstract Background Artificial Intelligence (AI) is recognized by emergency physicians (EPs) as an important technology that will affect clinical practice. Several AI-tools have already been developed to aid care delivery in emergency medicine (EM). However, many EM tools appear to have been developed without a cross-disciplinary needs assessment, making it difficult to understand their broader importance to general-practice. Clinician surveys about AI tools have been conducted within other medical specialties to help guide future design. This study aims to understand the needs of Canadian EPs for the apt use of AI-based tools. Methods A national cross-sectional, two-stage, mixed-method electronic survey of Canadian EPs was conducted from January-May 2022. The survey includes demographic and physician practice-pattern data, cliniciansâ current use and perceptions of AI, and individual rankings of which EM work-activities most benefit from AI. Results The primary outcome is a ranked list of high-priority AI-tools for EM that physicians want translated into general use within the next 10Â years. When ranking specific AI examples, âautomated charting/report generationâ, âclinical prediction rulesâ and âmonitoring vitals with early-warning detectionâ were the top items. When ranking by physician work-activities, âAI-tools for documentationâ, âAI-tools for computer useâ and âAI-tools for triaging patientsâ were the top items. For secondary outcomes, EPs indicated AI was âlikelyâ (43.1%) or âextremely likelyâ (43.7%) to be able to complete the task of âdocumentationâ and indicated either âa-great-dealâ (32.8%) or âquite-a-bitâ (39.7%) of potential for AI in EM. Further, EPs were either âstronglyâ (48.5%) or âsomewhatâ (39.8%) interested in AI for EM. Conclusions Physician input on the design of AI is essential to ensure the uptake of this technology. Translation of AI-tools to facilitate documentation is considered a high-priority, and respondents had high confidence that AI could facilitate this task. This study will guide future directions regarding the use of AI for EM and help direct efforts to address prevailing technology-translation barriers such as access to high-quality application-specific data and developing reporting guidelines for specific AI-applications. With a prioritized list of high-need AI applications, decision-makers can develop focused strategies to address these larger obstacles
Protocol for a scoping review of sepsis epidemiology
Introduction
Sepsis is a common, life-threatening syndrome of physiologic, pathologic, and biochemical abnormalities that are caused by infection and propagated by a dysregulated immune response. In 2017, the estimated annual incidence of sepsis around the world was 508 cases per 100,000 (95% confidence interval [CI], 422â612 cases per 100,000), however, reported incidence rates vary significantly by country. A scoping review will identify knowledge gaps by systematically investigating the incidence of sepsis.
Methods and analysis
This scoping review will be guided by the updated JBI (formerly Joanna Briggs Institute) methodology. We will search the following electronic databases: MEDLINE, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews/Central Register of Controlled Trials. In addition, we will search websites of trial and study registries. We will review titles and abstracts of potentially eligible studies and then full-texts by two independent reviewers. We will include any study that is focused on the incidence of sepsis or septic shock in any population. Data will be abstracted independently using pre-piloted data extraction forms, and we will present results according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews.
Ethics and dissemination
The results of this review will be used to create a publicly available indexed and searchable electronic registry of existing sepsis research relating to incidence in neonates, children, and adults. With input from stakeholders, we will identify the implications of study findings for policy, practice, and research. Ethics approval was not required given this study reports on existing literature.Medicine, Faculty ofNon UBCMedicine, Department ofReviewedFacultyResearche