scholarly journals Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248475
Author(s):  
Giulio DiDiodato ◽  
Samah Hassan ◽  
Kieran Cooley
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Q Methodology ◽  
Community Hospital ◽  
A Priori ◽  
Healthcare Providers ◽  
Second Phase ◽  
Medical Cannabis ◽  
Convenience Sample ◽  
Care Community

Objectives To determine acceptability of medical cannabis research in critically ill patients. Design Q-methodology survey. Setting Convenience sample of healthcare providers and the general public were recruited at an acute care community hospital in Ontario, Canada. Participants In the first phase, 63 respondents provided 197 unique viewpoints in response to a topic statement about medical cannabis use in critically ill patients. Twenty-five viewpoints were selected for the q-sample. In the second phase, 99 respondents ranked these viewpoints according to an a priori quasi normal distribution ranging from +4 (most agree) to -4 (least agree). Factor analysis was combined with comments provided by survey respondents to label and describe the extracted factors. Results The factor labels were hoping and caring (factor 1), pragmatic progress (factor 2), and cautious/conservative and protectionist (factor 3). Factor 1 describes a viewpoint of unequivocal support for medical cannabis research in this population with few caveats. Factor 2 describes a viewpoint of cautious support with a need to monitor for unintended adverse effects. Factor 3 describes a viewpoint of ensuring that current analgosedation techniques are optimized before exposing patients to another potentially harmful drug. Conclusions Using a q-methodology design, we were able to sample and describe the viewpoints that exist about medical cannabis research in critically ill patients. Three factors emerged that seemed to adequately describe the relative ranking of q-statements by the majority of respondents. Combining the distinguishing statements along with respondent comments allowed us to determine that the majority support medical cannabis research in critically ill patients.

scholarly journals Evaluation of bedbath in critically ill patients: impact of water temperature on the pulse oximetry variation

2010 ◽  
Vol 44 (4) ◽  
pp. 1039-1045 ◽  
Author(s):  
Aretha Pereira de Oliveira ◽  
Dalmo Valério Machado de Lima
Keyword(s):  
Water Temperature ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Age Groups ◽  
University Hospital ◽  
Convenience Sample ◽  
Level Ii ◽  
Before And After ◽  
Quasi Experimental ◽  
Water Temperature Data

This is a participant study, quasi-experimental, of a before and after type. A quantitative approach of biophysiological measures was used, represented by the saturation of oxygen measured by pulse oximeter (SpO2), and recorded on three occasions: before, during and after the bedbath in critically ill patients hospitalized at the ICU of a University Hospital in Brazil. Objective: to compare the SpO2 in various stages of the bath, with and without control of water temperature. Data collection was performed between December 2007 and April 2008 on a convenience sample consisting of 30 patients aged over 18 who had classification in TISS-28 from level II. Results show that water temperature control means a lower variation of SpO2 (p<0.05). No marked differences in variation of saturation between men and women or between age groups were established. In conclusion, heated and constant water temperature during the bedbath is able to minimize the fall of SpO2 that occurs while handling patients during procedures.

The need to know: experiences of critically ill patients

2000 ◽  
Vol 9 (3) ◽  
pp. 192-198 ◽  
Author(s):  
JE Hupcey ◽  
HE Zimmerman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Critically Ill ◽  
Nursing Staff ◽  
Critically Ill Patients ◽  
Second Phase ◽  
The Past ◽  
Intensive Care Unit Nurses ◽  
Vivid Memories

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.

Implementation of a pet visitation program in critical care

1999 ◽  
Vol 19 (3) ◽  
pp. 43-50 ◽  
Author(s):  
KK Giuliano ◽  
E Bloniasz ◽  
J Bell
Keyword(s):  
Critically Ill ◽  
Emotional Support ◽  
Critically Ill Patients ◽  
Quantitative Research ◽  
Therapeutic Option ◽  
Healthcare Providers ◽  
Research Data ◽  
Staff Members ◽  
Common Problems ◽  
Patients Experience

We have no quantitative research data to document that these visits are actually helpful to patients in any measurable way, although we certainly hope to have some soon. However, observations of staff members and evaluations from participants in the program have been quite positive thus far. The program has been in place for more than 2 years, and about 30 pets have visited so far, including 28 dogs and 2 cats. Implementing a pet visitation program for critically ill patients affords healthcare providers the opportunity to offer a unique and humanistic therapeutic intervention to appropriate patients. Although it is a time-consuming endeavor, it has been well received by those patients and families that have participated in pet visits. Critically ill patients are often denied many simple pleasures because they are in physiological crisis. Such patients experience loneliness, isolation, depression, and lack of emotional support. Pet visitation is one way to address these common problems of ICU patients. For this reason, pet visitation will remain a therapeutic option for the support of our critically ill patients.

scholarly journals Identifying the effects of an upgraded ‘fever clinic’ on COVID-19 control and the workload of emergency department: retrospective study in a tertiary hospital in China

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039177
Author(s):  
Jiangshan Wang ◽  
Liang Zong ◽  
Jinghong Zhang ◽  
Han Sun ◽  
Joseph Harold Walline ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Disease Transmission ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
College Hospital ◽  
Upper Respiratory Infection ◽  
Number Of Patients ◽  
Screening And Prevention

ObjectiveCOVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH).DesignA retrospective cohort study.ParticipantsA total of 6365 patients were screened in the FC.MethodsThe FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed.Results6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected.ConclusionThe workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.

Differences in Glucose Values Obtained From Point-of-Care Glucose Meters and Laboratory Analysis in Critically Ill Patients

2009 ◽  
Vol 18 (1) ◽  
pp. 65-72 ◽  
Author(s):  
Anjannette Cook ◽  
Delyla Laughlin ◽  
Margery Moore ◽  
Doreen North ◽  
Kathleen Wilkins ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Method Comparison ◽  
Venous Catheter ◽  
Laboratory Analysis ◽  
Hematocrit Level ◽  
Convenience Sample ◽  
Indwelling Catheters ◽  
The Difference

Background Blood for glucose analysis is often obtained interchangeably from indwelling catheters and fingersticks. Objectives To determine the level of agreement between glucose values obtained by laboratory analysis and with a point-of-care device for blood from 2 different sources: fingerstick and a central venous catheter. Methods A method-comparison design was used. Point-of-care values for blood from fingersticks and catheters were compared with laboratory values for blood from catheters in a convenience sample of 67 critically ill patients. The effects of hematocrit level and finger edema on differences in glucose values between the 2 methods were also evaluated. A t test was used to determine differences in glucose values obtained via the 2 methods. Differences and limits of agreement were also calculated. Results Laboratory glucose values for blood from a catheter differed significantly from point-of-care values for blood from the catheter (t1,66 = −9.18; P &lt; .001) and from a fingerstick (t1,66 = 6.53; P &lt; .001). Glucose values for the 2 methods differed by 20 mg/dL or more for 1 of 6 patients (15%) for catheter samples and for 1 of 5 (21%) for fingerstick samples. Point-of-care glucose values for fingerstick and catheter samples did not differ (P = .98). Hematocrit level significantly explained the difference in glucose values between the 2 methods for both catheter (R2 = 0.288; P &lt; .001) and fingerstick (R2 = 0.280; P = .02) samples. Conclusions Use of a commonly used point-of-care device when precise glucose values are needed may lead to faulty treatment decisions.

scholarly journals Electrolytes in the ICU

2021 ◽  
Author(s):  
Syed Zaidi ◽  
Rahul Bollam ◽  
Kainat Saleem
Keyword(s):  
Adverse Events ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Healthcare Providers ◽  
Electrolyte Disorders ◽  
Sodium Potassium ◽  
Sodium Homeostasis ◽  
Neurologic Symptoms ◽  
Calcium Bicarbonate ◽  
Cardiac Manifestations

Electrolyte disorders is an imbalance of certain ionized salts (sodium, potassium, calcium, bicarbonate, chloride) in the blood. Healthcare providers should be familiar with the principles of electrolyte physiology and pathophysiology. Disturbances in sodium homeostasis are primarily caused by volume abnormalities leading to primarily neurologic symptoms. Dyskalemias frequently present with cardiac manifestations therefore should be treated promptly before evaluating its cause. Ion deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be corrected as they are associated with increased adverse events in critically ill patients.

Measurement of Sleep in Critically Ill Patients

2000 ◽  
Vol 8 (2) ◽  
pp. 131-144 ◽  
Author(s):  
Kathy C. Richards ◽  
Patricia S. O’Sullivan ◽  
Robin L. Phillips
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Gold Standard ◽  
Reliability And Validity ◽  
Internal Consistency Reliability ◽  
Efficiency Index ◽  
Single Factor ◽  
Analog Scale ◽  
Convenience Sample ◽  
Sleep Measurement

Research to evaluate interventions to promote sleep in critically ill patients has been restricted by the lack of brief, inexpensive outcome measures. This article describes the development and testing of an instrument to measure sleep in critically ill patients. A convenience sample of 70 alert, oriented, critically ill males was studied using polysomnography (PSG), the gold standard for sleep measurement, for one night. In the morning the patients completed the Richards-Campbell Sleep Questionnaire (RCSQ), a five-item visual analog scale. Internal consistency reliability of the RCSQ was .90 and principal components factor analysis revealed a single factor (Eigenvalue = 3.61, percent variance = 72.2). The RCSQ total score accounted for approximately 33% of the variance in the PSG indicator sleep efficiency index (p < .001). The data provide support for the reliability and validity of the RCSQ.

scholarly journals Amikacin Initial Dose in Critically Ill Patients: a Nonparametric Approach To Optimize A Priori Pharmacokinetic/Pharmacodynamic Target Attainments in Individual Patients

2019 ◽  
Vol 63 (11) ◽  
Author(s):  
Clément Boidin ◽  
Laurent Bourguignon ◽  
Sabine Cohen ◽  
Claire Roger ◽  
Jean-Yves Lefrant ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
A Priori ◽  
Predictive Performance ◽  
Compartment Model ◽  
Population Pharmacokinetic ◽  
Time Curve ◽  
Data Set ◽  
Nonparametric Approach ◽  
The Right

ABSTRACT Amikacin is commonly used for probabilistic antimicrobial therapy in critically ill patients with sepsis. Its narrow therapeutic margin makes it challenging to determine the right individual dose that ensures the highest efficacy target attainment rate (TAR) in this setting. This study aims to develop a new initial dosing approach for amikacin by optimizing the a priori TAR in this population. A population pharmacokinetic model was built with a learning data set from critically ill patients who received amikacin. It was then used to design an initial dosing approach maximizing a priori TAR for a target ratio of ≥8 for the peak concentration to the MIC (Cmax/MIC) or of ≥75 for the ratio of the area under the concentration-time curve from 0 to 24 h to the MIC (AUC0–24/MIC). In the 166 patients included, 53% had amikacin Cmax of ≥64 mg/liter with a median dose of 23.4 mg/kg. A two-compartment model with creatinine clearance and body surface area as covariates best described the data and showed good predictive performance. Our dosing approach was successful in optimizing TAR for Cmax/MIC, with a rate of 92.9% versus 67.9% using a 30-mg/kg regimen, based on an external subset of data and assuming a MIC of 8 mg/liter. Mean optimal doses were higher (3.5 ± 0.5 g) than with the 30-mg/kg regimen (2.1 ± 0.3 g). Suggested doses varied with the MIC, the target index, and desired TAR threshold. A dosing algorithm based on the method is proposed for a large range of patient covariates. Clinical studies are necessary to confirm efficacy and safety of this optimized dosing approach.

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