Research without prior consent in paediatric emergency and critical care medicine

2020 ◽  
Vol 30 (2) ◽  
pp. 74-78
Author(s):  
Aled Picton ◽  
Kerry Woolfall ◽  
Mark D. Lyttle ◽  
Stuart Hartshorn
Keyword(s):  
Critical Care ◽  
Critical Care Medicine ◽  
Paediatric Emergency ◽  
Prior Consent

scholarly journals Seven-step framework to enhance practitioner explanations and parental understandings of research without prior consent in paediatric emergency and critical care trials

2020 ◽  
pp. emermed-2020-209488
Author(s):  
Louise Roper ◽  
Mark D Lyttle ◽  
Carrol Gamble ◽  
Amy Humphreys ◽  
Shrouk Messahel ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Treatment ◽  
Comprehensive Description ◽  
Telephone Interviews ◽  
Paediatric Emergency ◽  
Prior Consent ◽  
Clear Explanation ◽  
Recruitment Practice ◽  
Trial Intervention ◽  
Parent Trial

BackgroundAlternatives to prospective informed consent enable the conduct of paediatric emergency and critical care trials. Research without prior consent (RWPC) involves practitioners approaching parents after an intervention has been given and seeking consent for their child to continue in the trial. As part of an embedded study in the ‘Emergency treatment with Levetiracetam or Phenytoin in Status Epilepticus in children’ (EcLiPSE) trial, we explored how practitioners described the trial and RWPC during recruitment discussions, and how well this information was understood by parents. We aimed to develop a framework to assist trial conversations in future paediatric emergency and critical care trials using RWPC.MethodsQualitative methods embedded within the EcLiPSE trial processes, including audiorecorded practitioner–parent trial discussions and telephone interviews with parents. We analysed data using thematic analysis, drawing on the Realpe et al (2016) model for recruitment to trials.ResultsWe analysed 76 recorded trial discussions and conducted 30 parent telephone interviews. For 19 parents, we had recorded trial discussion and interview data, which were matched for analysis. Parental understanding of the EcLiPSE trial was enhanced when practitioners: provided a comprehensive description of trial aims; explained the reasons for RWPC; discussed uncertainty about which intervention was best; provided a balanced description of trial intervention; provided a clear explanation about randomisation and provided an opportunity for questions. We present a seven-step framework to assist recruitment practice in trials involving RWPC.ConclusionThis study provides a framework to enhance recruitment practice and parental understanding in paediatric emergency and critical care trials involving RWPC. Further testing of this framework is required.

scholarly journals Evaluation of Clinical Outcomes after Introduction of a Dedicated Infectious Diseases- Critical Care Medicine Service in Critical Care Units

2021 ◽  
Author(s):  
Polina Trachuk ◽  
Vagish Hemmige ◽  
Ruth Eisenberg ◽  
Kelsie Cowman ◽  
Victor Chen ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Clinical Outcomes ◽  
Broad Spectrum ◽  
Critical Care Medicine ◽  
Care Hospital ◽  
Intervention Period ◽  
Broad Spectrum Antibiotics ◽  
Antibiotic Utilization ◽  
The Impact

Abstract Objective Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Method In this single site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICUs during the pre-intervention period from January 1, 2015 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam and cefepime during the intervention period. When compared to pre-intervention period there was no difference in-hospital mortality, hospital length of stay and re-admission. Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

scholarly journals Systematic review and bibliometric analysis of African anesthesia and critical care medicine research part II: a scientometric analysis of the 116 most cited articles

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ulrick Sidney Kanmounye ◽  
Joel Noutakdie Tochie ◽  
Aimé Mbonda ◽  
Cynthia Kévine Wafo ◽  
Leonid Daya ◽  
...  
Keyword(s):  
Critical Care ◽  
South African ◽  
Web Of Science ◽  
Descriptive Analysis ◽  
World Journal ◽  
Critical Care Medicine ◽  
Scientometric Analysis ◽  
Medicine Research ◽  
Qualitative Descriptive ◽  
The Impact

Abstract Background Scientometrics is used to assess the impact of research in several health fields, including Anesthesia and Critical Care Medicine. The purpose of this study was to identify contributors to highly-cited African Anesthesia and Critical Care Medicine research. Methods The authors searched Web of Science from inception to May 4, 2020, for articles on and about Anesthesia and Critical Care Medicine in Africa with ≥2 citations. Quantitative (H-index) and qualitative (descriptive analysis of yearly publications and interpretation of document, co-authorship, author country, and keyword) bibliometric analyses were done. Results The search strategy returned 116 articles with a median of 5 (IQR: 3–12) citations on Web of Science. Articles were published in Anesthesia and Analgesia (18, 15.5%), World Journal of Surgery (13, 11.2%), and South African Medical Journal (8, 6.9%). Most (74, 63.8%) articles were published on or after 2013. Seven authors had more than 1 article in the top 116 articles: Epiu I (3, 2.6%), Elobu AE (2, 1.7%), Fenton PM (2, 1.7%), Kibwana S (2, 1.7%), Rukewe A (2, 1.7%), Sama HD (2, 1.7%), and Zoumenou E (2, 1.7%). The bibliometric coupling analysis of documents highlighted 10 clusters, with the most significant nodes being Biccard BM, 2018; Baker T, 2013; Llewellyn RL, 2009; Nigussie S, 2014; and Aziato L, 2015. Dubowitz G (5) and Ozgediz D (4) had the highest H-indices among the authors referenced by the most-cited African Anesthesia and Critical Care Medicine articles. The U.S.A., England, and Uganda had the strongest collaboration links among the articles, and most articles focused on perioperative care. Conclusion This study highlighted trends in top-cited African articles and African and non-African academic institutions’ contributions to these articles.

Applications of 3D printing in critical care medicine: A scoping review

2021 ◽  
pp. 0310057X2097665
Author(s):  
Natasha Abeysekera ◽  
Kirsty A Whitmore ◽  
Ashvini Abeysekera ◽  
George Pang ◽  
Kevin B Laupland
Keyword(s):  
Critical Care ◽  
Scoping Review ◽  
A Priori ◽  
Three Dimensional ◽  
Critical Care Medicine ◽  
Future Research ◽  
Care Practice ◽  
Three Dimensional Printing ◽  
Wide Range ◽  
Dimensional Printing

Although a wide range of medical applications for three-dimensional printing technology have been recognised, little has been described about its utility in critical care medicine. The aim of this review was to identify three-dimensional printing applications related to critical care practice. A scoping review of the literature was conducted via a systematic search of three databases. A priori specified themes included airway management, procedural support, and simulation and medical education. The search identified 1544 articles, of which 65 were included. Ranging across many applications, most were published since 2016 in non – critical care discipline-specific journals. Most studies related to the application of three-dimensional printed models of simulation and reported good fidelity; however, several studies reported that the models poorly represented human tissue characteristics. Randomised controlled trials found some models were equivalent to commercial airway-related skills trainers. Several studies relating to the use of three-dimensional printing model simulations for spinal and neuraxial procedures reported a high degree of realism, including ultrasonography applications three-dimensional printing technologies. This scoping review identified several novel applications for three-dimensional printing in critical care medicine. Three-dimensional printing technologies have been under-utilised in critical care and provide opportunities for future research.

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