scholarly journals Device and Medication Preferences of Canadian Physicians for Emergent Endotracheal Intubation in Critically Ill Patients

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 186-197
Author(s):  
Robert S. Green ◽  
Dean A. Fergusson ◽  
Alexis F. Turgeon ◽  
Lauralyn A. McIntyre ◽  
George J. Kovacs ◽  
...  
Keyword(s):  
Critically Ill ◽  
Direct Laryngoscopy ◽  
Critically Ill Patients ◽  
Response Rate ◽  
Web Based ◽  
Usual Practice ◽  
Survey Response Rate ◽  
Macintosh Blade ◽  
First Choice ◽  
Icu Physicians

AbstractObjectivesVarious medications and devices are available for facilitation of emergent endotracheal intubations (EETIs). The objective of this study was to survey which medications and devices are being utilized for intubation by Canadian physicians.MethodsA clinical scenario-based survey was developed to determine which medications physicians would administer to facilitate EETI, their first choice of intubation device, and backup strategy should their first choice fail. The survey was distributed to Canadian emergency medicine (EM) and intensive care unit (ICU) physicians using web-based and postal methods. Physicians were asked questions based on three scenarios (trauma; pneumonia; heart failure) and responded using a 5-point scale ranging from “always” to “never” to capture usual practice.ResultsThe survey response rate was 50.2% (882/1,758). Most physicians indicated a Macintosh blade with direct laryngoscopy would “always/often” be their first choice of intubation device in the three scenarios (mean 85% [79%-89%]) followed by video laryngoscopy (mean 37% [30%-49%]). The most common backup device chosen was an extraglottic device (mean 59% [56%-60%]). The medications most physicians would “always/often” administer were fentanyl (mean 45% [42%-51%]) and etomidate (mean 38% [25%-50%]). EM physicians were more likely than ICU physicians to paralyze patients for EETI (adjusted odds ratio 3.40; 95% CI 2.90-4.00).ConclusionsMost EM and ICU physicians utilize direct laryngoscopy with a Macintosh blade as a primary device for EETI and an extraglottic device as a backup strategy. This survey highlights variation in Canadian practice patterns for some aspects of intubation in critically ill patients.

scholarly journals Management of complex renal cysts in Canada: Results of a survey study

2020 ◽  
Author(s):  
Félix Couture ◽  
Antonio Finelli ◽  
Amélie Tétu ◽  
Bimal Bhindi ◽  
Rodney H. Breault ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Practice Patterns ◽  
Response Rate ◽  
Renal Cysts ◽  
Survey Study ◽  
Management Option ◽  
Web Based ◽  
Survey Response Rate ◽  
Risk Of Malignancy ◽  
Mass Surveillance

Abstract Background Bosniak III and IV cysts have a high risk of malignancy and have traditionally been managed surgically. However, growing evidence suggests that many can be managed by active surveillance. The main objective of this study was to characterize the use of surveillance in the management of complex renal cysts. Methods A web-based survey was sent to all registered, active members of the Canadian Urological Association (N=583) in October 2018. Results The survey response rate was 24.7%. Management of Bosniak III cysts varied considerably. A large proportion of respondents (33.1%) offered active surveillance in >50% of cases. Only 13.7% of respondents reported never or rarely (<5% of cases) offering surveillance. In contrast, for Bosniak IV cysts, 60.1% of urologists never or rarely offered surveillance, while only 10.1% offer it in >50% of cases. A significantly greater proportion of academic urologists, compared to non-academic urologists, viewed surveillance as a management option for patients with a Bosniak III or IV cyst. The most commonly reported barriers to a greater adoption of surveillance were concerns regarding its oncologic safety, the lack of data to support surveillance in this population, and the lack of triggers for discontinuation of active surveillance and intervention. Conclusions Despite active surveillance being included as a management option in guidelines, many Canadian urologists are reluctant to offer surveillance to patients with Bosniak III or IV cysts. Practice patterns are heterogeneous among those offering surveillance. High-quality studies are required to better define the benefits and risks of cystic renal mass surveillance.

scholarly journals Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses to Reduce Nonbeneficial Intensive Care Unit Treatments: Protocol for a Multicenter Quality Improvement Study (Preprint)

2019 ◽  
Author(s):  
Dong Chang ◽  
Jennifer Parrish ◽  
Nader Kamangar ◽  
Janice Liebler ◽  
May Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Decision Makers ◽  
Care Planning ◽  
Improvement Strategy ◽  
Icu Patients ◽  
Family Meetings ◽  
Planning Approach ◽  
Icu Physicians

BACKGROUND Invasive intensive care unit (ICU) treatments for patients with advanced medical illnesses and poor prognoses may prolong suffering with minimal benefit. Unfortunately, the quality of care planning and communication between clinicians and critically ill patients and their families in these situations are highly variable, frequently leading to overutilization of invasive ICU treatments. Time-limited trials (TLTs) are agreements between the clinicians and the patients and decision makers to use certain medical therapies over defined periods of time and to evaluate whether patients improve or worsen according to predetermined clinical parameters. For patients with advanced medical illnesses receiving aggressive ICU treatments, TLTs can promote effective dialogue, develop consensus in decision making, and set rational boundaries to treatments based on patients’ goals of care. OBJECTIVE The aim of this study will be to examine whether a multicomponent quality-improvement strategy that uses protocoled TLTs as the default ICU care-planning approach for critically ill patients with advanced medical illnesses will decrease duration and intensity of nonbeneficial ICU care without changing hospital mortality. METHODS This study will be conducted in medical ICUs of three public teaching hospitals in Los Angeles County. In Aim 1, we will conduct focus groups and semistructured interviews with key stakeholders to identify facilitators and barriers to implementing TLTs among ICU patients with advanced medical illnesses. In Aim 2, we will train clinicians to use protocol-enhanced TLTs as the default communication and care-planning approach in patients with advanced medical illnesses who receive invasive ICU treatments. Eligible patients will be those who the treating ICU physicians consider to be at high risk for nonbeneficial treatments according to guidelines from the Society of Critical Care Medicine. ICU physicians will be trained to use the TLT protocol through a curriculum of didactic lectures, case discussions, and simulations utilizing actors as family members in role-playing scenarios. Family meetings will be scheduled by trained care managers. The improvement strategy will be implemented sequentially in the three participating hospitals, and outcomes will be evaluated using a before-and-after study design. Key process outcomes will include frequency, timing, and content of family meetings. The primary clinical outcome will be ICU length of stay. Secondary outcomes will include hospital length of stay, days receiving life-sustaining treatments (eg, mechanical ventilation, vasopressors, and renal replacement therapy), number of attempts at cardiopulmonary resuscitation, frequency of invasive ICU procedures, and disposition from hospitalization. RESULTS The study began in August 2017. The implementation of interventions and data collection were completed at two of the three hospitals. As of September 2019, the study was at the postintervention stage at the third hospital. We have completed focus groups with physicians at each medical center (N=29) and interviews of family members and surrogate decision makers (N=18). The study is expected to be completed in the first quarter of 2020, and results are expected to be available in mid-2020. CONCLUSIONS The successful completion of the aims in this proposal may identify a systematic approach to improve communication and shared decision making and to reduce nonbeneficial invasive treatments for ICU patients with advanced medical illnesses. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16301

Abstract 13704: Simulation-based Uptraining Improves Provider Comfort in the Management of Critically Ill Patients With Covid-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
James M Horowitz ◽  
Eugene Yuriditsky ◽  
Sunil Nair ◽  
Brian S Kaufman
Keyword(s):  
Critically Ill ◽  
Nurse Practitioners ◽  
Critically Ill Patients ◽  
Simulation Training ◽  
Icu Patients ◽  
Large Numbers ◽  
Simulation Based ◽  
Critical Care Ultrasound ◽  
Simulation Session ◽  
Icu Physicians

Introduction: The COVID-19 surge at our institution required deployment of large numbers of non-intensive care unit (ICU) physicians and advanced practice providers to assist in the management of the critically ill. A 3-hour “uptraining” simulation session was offered to these providers that focused on various aspects of ICU care. Hypothesis: We hypothesized that following a 3-hour simulation session, providers would feel more comfortable in managing critically-ill patients with COVID-19. Methods: One hundred and seventy-five providers underwent a 3-hour simulation-based session focused on management of shock, acute respiratory distress syndrome, and critical care ultrasound. All participants were sent surveys to assess their comfort with various aspects of ICU care following return to their usual work environments. Results: One hundred and eight providers of 175 (62%) completed the surveys. Cardiology fellows and faculty accounted for 36% of the responders, acute care nurse practitioners (NPs) accounted for 16%, while other NPs, residents, and fellows accounted for the remainder. Prior to simulation training, 31% regularly managed patients in the ICU and 28% occasionally managed ICU patients. Following training, 71% of participants were deployed to a COVID-19 ICU as part of their workflow. Overall, 104/108 responders (96%) felt training either significantly or somewhat improved their knowledge in the management of ICU patients. Ninety-four participants (91%) felt training impacted their care of critically ill patients with COVID-19. Table 1 is a display of specific ICU skillsets taught in the session and if the participants felt better equipped to utilize what was covered post deployment. Conclusions: Simulation-based training improved provider comfort in the management of critically ill patients with COVID-19. Table 1: Participants response to “if they felt better equipped to utilize ICU skills following simulation training”

scholarly journals SURvival PRediction In SEverely Ill Patients Study—The Prediction of Survival in Critically Ill Patients by ICU Physicians

2021 ◽  
Vol 3 (1) ◽  
pp. e0317
Author(s):  
Marijke M. Ros ◽  
Hester J. van der Zaag-Loonen ◽  
José G.M. Hofhuis ◽  
Peter E. Spronk
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Survival Prediction ◽  
Prediction Of Survival ◽  
Icu Physicians

scholarly journals COVID 19 CRITICAL CARE TRAINING SURGE EXPERIENCE FOR PHYSICIANS IN RIYADH HEALTH CLUSTER ONE, SAUDI ARABIA

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
AF Mady ◽  
O Ramdan ◽  
R Al Yousef ◽  
A Ishag ◽  
G Bakirova ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Setting ◽  
Basic Knowledge ◽  
The World ◽  
Medical City ◽  
Care Training ◽  
Icu Physicians

As the COVID-19 pandemic spreads, the number of critically ill patients is expected to surge in hospitals across the world. This may result in non-ICU clinicians being needed to care for critically ill patients, In line with Pandemic COVID – 19 situations that we are facing currently; the Critical Care Department Training Committee of King Saud Medical City in collaboration with the Riyadh Health Cluster One, Saudi Arabia conducted a series of training projects. Its goal is to help non – ICU Physicians to be equipped and be more competent to handle critically ill patients when the situation will have the need for it. We aim to provide basic knowledge and skills to successfully manage critically ill patients with suspected or confirmed COVID – 19 cases in a critical care setting.

scholarly journals Implementation of the OSTRC Handball Injury Prevention Exercises in Professional Handball

2021 ◽  
Vol 21 (2) ◽  
pp. 136-141
Author(s):  
Wesam Saleh A. Al Attar ◽  
Nawaf Al Masoudi ◽  
Ali Al Zubeadi ◽  
Ahmed Qasem
Keyword(s):  
Injury Prevention ◽  
Response Rate ◽  
P Value ◽  
Web Based ◽  
Trauma Research ◽  
Gcc Countries ◽  
Survey Response Rate ◽  
Significant Difference ◽  
The Mean ◽  
Implementation Level

Purpose. The Oslo Sports Trauma Research Center (OSTRC) handball injury prevention exercise is an evidence-based injury prevention exercise designed to prevent handball injury. This study aimed to assess the implementation of the OSTRC handball injury prevention exercises among professional handball players in the Gulf Cooperation Council (GCC) countries. Materials and methods. A web-based survey to acquire information regarding the implementation of OSTRC handball injury prevention exercises was distributed to 267 professional handball players in six GCC countries.  Results. A total of 250 handball players from the GCC countries responded to the survey (response rate 93.6%). The mean (±SD (Standard Deviation)) of the total implementation score was 13 (±2.558), with no statistically significant difference between the GCC countries, with a P-value of 0.123. The highest mean score was shown from Bahrain at 13.60 (±2.614), while the lowest was from Qatar at 12.10 (±2.427). Conclusions. A low implementation level of the OSTRC handball prevention exercises among the handball players in the GCC countries was reported in the current study.

scholarly journals Video-laryngoscopy versus direct laryngoscopy in critically ill patients: a pilot randomized trial

2012 ◽  
Vol 59 (11) ◽  
pp. 1032-1039 ◽  
Author(s):  
Donald E. G. Griesdale ◽  
◽  
Anthony Chau ◽  
George Isac ◽  
Najib Ayas ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Critically Ill ◽  
Direct Laryngoscopy ◽  
Critically Ill Patients ◽  
Video Laryngoscopy

Choice of resuscitation fluid

2016 ◽  
Author(s):  
John Myburgh ◽  
Naomi E. Hammond
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Current Evidence ◽  
Common Side Effect ◽  
Risk Of Death ◽  
Increased Risk ◽  
First Choice ◽  
Resuscitation Fluid ◽  
Almost All

Fluid resuscitation is a ubiquitous intervention in critically-ill patients. There is wide variation in practice and emerging evidence that the choice of resuscitation fluid may affect outcome in selected patient populations. It is likely that beneficial or adverse effects relate not only to the physicochemical properties of the fluid but also to the volume (dose) and rate of administration. Interstitial oedema is a common side-effect associated with all fluids and its development is associated with organ dysfunction. Crystalloids should be first-choice resuscitation fluids for almost all patients, with evidence that balanced salt solutions confer any benefit over saline being limited to observational data. Consideration of serum sodium (or osmolality), pH, renal function and coagulation status may affect selection of a specific crystalloid solution. On the balance of evidence, colloids do not confer any clinical advantage over crystalloids and they should be used with caution, if at all. Albumin is contraindicated for the resuscitation of patients with severe traumatic brain injury. Hydroxyethyl starch is associated with increased risk of death and acute kidney injury in critically-ill patients, particularly those with severe sepsis and septic shock. Current evidence does not support the use of other semi-synthetic colloids for resuscitation.

Attrition in Otolaryngology Residency

2011 ◽  
Vol 145 (5) ◽  
pp. 753-754 ◽  
Author(s):  
Jeremy D. Prager ◽  
Charles M. Myer ◽  
Charles M. Myer
Keyword(s):  
General Surgery ◽  
Career Paths ◽  
Response Rate ◽  
Training Programs ◽  
Attrition Rate ◽  
Limited Data ◽  
Web Based ◽  
Survey Response Rate ◽  
Residency Program Directors ◽  
Medical Programs

Attrition is a disruptive problem in residency training programs. Resident attrition has been more thoroughly investigated and reported in other medical fields with limited data specific to otolaryngology. Using a Web-based survey of otolaryngology residency program directors, information regarding a 5-year cohort of residents was collected. The survey response rate was 61% (59 of 97 programs), representing 779 of 1239 training positions (63%). Forty-two percent of responding programs (25 of 59) lost a total of 47 residents (range, 1-7; mode 1). The overall attrition rate was 6% for the 5-year cohort (47 of 779) or 1.2% annually. Involuntary attrition affected 6 residents. Eighteen residents voluntarily left for other medical programs. Four left medicine entirely. The remaining 19 residents’ career paths were not described. Attrition within otolaryngology occurs with less frequency than general surgery and is likely comparable to other surgical subspecialties.

scholarly journals Patients’ Use and Perceptions of a Drug-Drug Interaction Database: A Survey of Janusmed Interactions

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 23
Author(s):  
Hanna Justad ◽  
Ylva Askfors ◽  
Tero Shemeikka ◽  
Marine L. Andersson ◽  
Tora Hammar
Keyword(s):  
Drug Interaction ◽  
General Population ◽  
Healthcare Professionals ◽  
Response Rate ◽  
Personal Account ◽  
Web Based ◽  
The Public ◽  
Interaction Database ◽  
Survey Response Rate ◽  
High Health Literacy

Janusmed interactions is a drug-drug interactions (DDI) database available online for healthcare professionals (HCP) at all levels of the healthcare system including pharmacies. The database is aimed at HCP but is also open to the public for free, for those individuals who register for a personal account. The aim of this study was to investigate why and how patients use the database Janusmed interactions, how they perceive content and usability, and how they would react if they found an interaction. A web-based questionnaire was sent by email to all users who had registered for Janusmed interactions as a “patient” (n = 3219). A total of 406 patients completed the survey (response rate 12.6%). The study shows that there is an interest among patients to use a DDI database to check their own or a relative’s medication. The respondents found the database easy to use and perceive they understand the information aimed at HCP. Most patients stated they would talk to their HCP if they found an interaction and not adjust their treatment by themselves. However, the respondents in this study are actively searching for information and seem to have high health literacy. Thus, the findings are not generalizable for the general population.

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