Developing a team performance framework for the intensive care unit

Objective: There is a growing literature on the relationship between teamwork and patient outcomes in intensive care, providing new insights into the skills required for effective team performance. The purpose of this review is to consolidate the most robust findings from this research into an intensive care unit (ICU) team performance framework. Data Sources: Studies investigating teamwork within the ICU using PubMed, Science Direct, and Web of Knowledge databases. Study Selection: Studies investigating the relationship between aspects of teamwork and ICU outcomes, or studies testing factors that are found to influence team working in the ICU. Data Extraction: Teamwork behaviors associated with patient or staff-related outcomes in the ICU were identified. Data Synthesis: Teamwork behaviors were grouped according to the team process categories of "team communication," "team leadership," "team coordination," and "team decision making." A prototype framework explaining the team performance in the ICU was developed using these categories. The purpose of the framework is to consolidate the existing ICU teamwork literature and to guide the development and testing of interventions for improving teamwork. Conclusions: Effective teamwork is shown as crucial for providing optimal patient care in the ICU. In particular, team leadership seems vital for guiding the way in which ICU team members interact and coordinate with others

Combined myocardial stress perfusion imaging and myocardial stress tagging for detection of coronary artery disease at 3 Tesla

Abstract Background Adenosine stress perfusion is very sensitive for detection of coronary artery disease (CAD), and yields good specificity. Standard adenosine cine imaging lacks high sensitivity, but is very specific. Myocardial tagging improves detection of wall motion abnormalities (WMAs). Perfusion and tagging cardiovascular magnetic resonance (CMR) both benefit from high field imaging (improved contrast to noise ratio and tag persistence). We investigated the diagnostic impact of a combined stress perfusion-tagging protocol for detection of CAD at 3 Tesla. Methods Stress perfusion and tagging images were acquired in 3 identical short axis locations (slice thickness 8 mm, FOV 320–380 mm, matrix 2562). A positive finding at coronary angiography was defined as stenosis or flow limiting restenosis > 50% in native and graft vessels. A true positive CMR – finding was defined as ≥ 1 perfusion deficit or new WMA during adenosine-stress in angiographically corresponding regions. Results We included 60 patients (males: 41, females: 19; 21 suspected, 39 known CAD). Myocardial tagging extended stress imaging by 1.5–3 min and was well tolerated by all patients. Sensitivity and specificity for detection of significant CAD by adenosine stress perfusion were 0.93 and 0.84, respectively. The sensitivity of adenosine stress tagging was less (0.64), while the specificity was very high (1.0). The combination of both stress perfusion and stress tagging did not increase sensitivity. Conclusion The combined adenosine stress perfusion-tagging protocol delivers high sensitivity and specificity for detection of significant CAD. While the sensitivity of adenosine stress tagging is poor compared to perfusion imaging, its specificity is very high. This technique should thus prove useful in cases of inconclusive perfusion studies to help avoid false positive results.</p

Safety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T

BACKGROUND: Recent studies suggest that magnetic resonance (MR) imaging of the brain and spine may safely be performed in patients with pacemakers (PMs) and implantable cardioverter/defibrillators (ICDs), when taking adequate precautions. The aim of this study was to investigate safety, feasibility, and diagnostic value (DV) of MR imaging in cardiac applications (cardiac MR [CMR]) in patients with PMs and ICDs for the first time. METHODS: Thirty-two PM/ICD patients with a clinical need for CMR were examined. The specific absorption rate was limited to 1.5 W/kg. Devices were reprogrammed pre-CMR to minimize interference with the electromagnetic fields. Devices were interrogated pre-CMR and post-CMR and after 3 months. Troponin I levels were measured pre-CMR and post-CMR; image quality (IQ) and DV of CMR were assessed. RESULTS: All devices could be reprogrammed normally post-CMR. No significant changes of pacing capture threshold, lead impedance, and troponin I were observed. Image quality in patients with right-sided devices (RSD) was better compared with that in patients with left-sided devices (LSD) (P < .05), and less myocardial segments were affected by device-related artefacts (P < .05). Diagnostic value was rated as sufficiently high, allowing for diagnosis, or better in 12 (100%) of 12 patients with RSD, and only in 7 (35%) of 20 patients with LSD. CONCLUSIONS: Cardiac MR may be performed safely when limiting specific absorption rate, appropriately monitoring patients, and following device reprogramming. Cardiac MR delivers good IQ and DV in patients with RSD. Cardiac MR in patients with RSD may therefore be performed with an acceptable risk/benefit ratio, whereas the risk/benefit ratio is rather unfavorable in patients with LSD. Copyright © 2011 Mosby, Inc. All rights reserved