Prognostic importance of distressed (Type D) personality and shocks in patients with an implantable cardioverter defibrillator

AbstractBackgroundClinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice.MethodsThis prospective follow-up study included 589 patients with an ICD (mean age=62.6±10.1years; 81% men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers.ResultsAfter a median follow-up of 3.2years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p=0.52) or cardiac (p=0.99) death. However, appropriate shocks (HR=2.60, 95% CI 1.47–5.58, p=0.001) and Type D personality (HR=1.85, 95% CI 1.12–3.05, p=0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes.ConclusionVulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice

A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes

Introduction: Despite recommendations from professional societies and patient safety organizations, the majority of ICU patients worldwide are not routinely monitored for delirium, thus preventing timely prevention and management. The purpose of this systematic review is to summarize what types of implementation strategies have been tested to improve ICU clinicians' ability to effectively assess, prevent and treat delirium and to evaluate the effect of these strategies on clinical outcomes. Method: We searched PubMed, Embase, PsychINFO, Cochrane and CINAHL (January 2000 and April 2014) for studies on implementation strategies that included delirium-oriented interventions in adult ICU patients. Studies were suitable for inclusion if implementation strategies' efficacy, in terms of a clinical outcome, or process outcome was described. Results: We included 21 studies, all including process measures, while 9 reported both process measures and clinical outcomes. Some individual strategies suc

Why we should sample sparsely and aim for a higher target: lessons from model-based therapeutic drug monitoring of vancomycin in intensive care patients

Aims To explore the optimal data sampling scheme and the pharmacokinetic (PK) target exposure on which dose computation is based in the model-based therapeutic drug monitoring (TDM) practice of vancomycin in intensive care (ICU) patients. Methods We simulated concentration data for 1 day following four sampling schemes,C-min,C-max+C-min,C-max+Cmid-interval+C-min, and rich sampling where a sample was drawn every hour within a dose interval. The datasets were used for Bayesian estimation to obtain PK parameters, which were used to compute the doses for the next day based on five PK target exposures: AUC(24)= 400, 500, and 600 mg center dot h/L andC(min)= 15 and 20 mg/L. We then simulated data for the next day, adopting the computed doses, and repeated the above procedure for 7 days. Thereafter, we calculated the percentage error and the normalized root mean square error (NRMSE) of estimated against "true" PK parameters, and the percentage of optimal treatment (POT), defined as the percentage of patients who met 400 <= AUC(24)<= 600 mg center dot h/L andC(min)<= 20 mg/L. Results PK parameters were unbiasedly estimated in all investigated scenarios and the 6-day average NRMSE were 32.5%/38.5% (CL/V, whereCLis clearance andVis volume of distribution) in the trough sampling scheme and 27.3%/26.5% (CL/V) in the rich sampling scheme. Regarding POT, the sampling scheme had marginal influence, while target exposure showed clear impacts that the maximum POT of 71.5% was reached when doses were computed based on AUC(24)= 500 mg center dot h/L. Conclusions For model-based TDM of vancomycin in ICU patients, sampling more frequently than taking only trough samples adds no value and dosing based on AUC(24)= 500 mg center dot h/L lead to the best POT.Pharmacolog

Optimizing predictive performance of bayesian forecasting for vancomycin concentration in intensive care patients

This article was updated to correct Figs. 1 and 4 as author corrections were overlooked during the production process.Pharmacolog

Comparison of outcome and characteristics between 6343 COVID-19 patients and 2256 other community-acquired viral pneumonia patients admitted to Dutch ICUs

Purpose: Describe the differences in characteristics and outcomes between COVID-19 and other viral pneumonia patients admitted to Dutch ICUs. Materials and methods: Data from the National-Intensive-Care-Evaluation-registry of COVID-19 patients admitted between February 15th and January 1th 2021 and other viral pneumonia patients admitted between January 1st 2017 and January 1st 2020 were used. Patients' characteristics, the unadjusted, and adjusted in-hospital mortality were compared. Results: 6343 COVID-19 and 2256 other viral pneumonia patients from 79 ICUs were included. The COVID-19 patients included more male (71.3 vs 49.8%), had a higher Body-Mass-Index (28.1 vs 25.5), less comorbidities (42.2 vs 72.7%), and a prolonged hospital length of stay (19 vs 9 days). The COVID-19 patients had a significantly higher crude in-hospital mortality rate (Odds ratio (OR) = 1.80), after adjustment for patient characteristics and ICU occupancy rate the OR was respectively 3.62 and 3.58. Conclusion: Higher mortality among COVID-19 patients could not be explained by patient characteristics and higher ICU occupancy rates, indicating that COVID-19 is more severe compared to other viral pneumonia. Our findings confirm earlier warnings of a high need of ICU capacity and high mortality rates among relatively healthy COVID-19 patients as this may lead to a higher mental workload for the staff. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)

Draagvlak creëren voor de ouderenzorg:Zes aanbevelingen voor het nieuwe kabinet

De komende jaren neemt de zorgvraag en de multimorbiditeit toe hetgeen samen met andere factoren leidt tot steeds meer zorgkosten en de vraag hoe het huidige kwaliteitsniveau van de Nederlandse gezondheidszorg te handhaven. Dit baart ons zorgen als zorgprofessional, opleider en bestuurder in de zorg. De Nederlandse overheid is op zoek naar een goede balans. De Taskforce “Zorg op de Juiste Plek” bracht een beweging op gang die als katalysator moest leiden tot toename van de kwaliteit van passende zorg. Echter, de nota “Zorg voor de Toekomst” constateerde dat er meer nodig is om de toekomstbestendigheid van de zorg te realiseren. De nota “Wissels omzetten voor een Veerkrachtige Samenleving” werkte de gevoerde discussie uit in diverse prioriteiten. We destilleren uit deze drie initiatieven zes aanbevelingen voor het nieuwe kabinet welke bijdragen aan de vormgeving van passende zorg: stimuleer bewustwording van de vergrijzing bij de jonge generatie, start preventie op alle leeftijdsniveaus, pak kansenongelijkheid aan, vorm duurzame samenwerkingscontracten tussen zorgaanbieders en verzekeraars, ondersteun eigen regie voor zorgprofessionals, en bevorder een duurzame samenwerking tussen departementen voor betere opleidingen in de ouderenzorg. Dit zal leiden tot zorg op de juiste plek, waardegedreven en met toename van werkplezier voor zorgprofessionals

Draagvlak creëren voor de ouderenzorg: Zes aanbevelingen voor het nieuwe kabinet

De komende jaren neemt de zorgvraag en de multimorbiditeit toe hetgeen samen met andere factoren leidt tot steeds meer zorgkosten en de vraag hoe het huidige kwaliteitsniveau van de Nederlandse gezondheidszorg te handhaven. Dit baart ons zorgen als zorgprofessional, opleider en bestuurder in de zorg. De Nederlandse overheid is op zoek naar een goede balans. De Taskforce “Zorg op de Juiste Plek” bracht een beweging op gang die als katalysator moest leiden tot toename van de kwaliteit van passende zorg. Echter, de nota “Zorg voor de Toekomst” constateerde dat er meer nodig is om de toekomstbestendigheid van de zorg te realiseren. De nota “Wissels omzetten voor een Veerkrachtige Samenleving” werkte de gevoerde discussie uit in diverse prioriteiten. We destilleren uit deze drie initiatieven zes aanbevelingen voor het nieuwe kabinet welke bijdragen aan de vormgeving van passende zorg: stimuleer bewustwording van de vergrijzing bij de jonge generatie, start preventie op alle leeftijdsniveaus, pak kansenongelijkheid aan, vorm duurzame samenwerkingscontracten tussen zorgaanbieders en verzekeraars, ondersteun eigen regie voor zorgprofessionals, en bevorder een duurzame samenwerking tussen departementen voor betere opleidingen in de ouderenzorg. Dit zal leiden tot zorg op de juiste plek, waardegedreven en met toename van werkplezier voor zorgprofessionals