scholarly journals Cross-sectional study of the ambulance transport between healthcare facilities with medical support via telemedicine: Easy, effective, and safe tool

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257801
Author(s):  
Carlos H. S. Pedrotti ◽  
Tarso A. D. Accorsi ◽  
Karine De Amicis Lima ◽  
Jose R. de O. Silva Filho ◽  
Renata A. Morbeck ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Complexity ◽  
Cross Sectional Study ◽  
Medical Support ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Ambulance Transport ◽  
Study Population ◽  
Coronary Syndromes

Background Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine are unknown. Methods This was a retrospective study with a single telemedicine center reference for satellite emergency departments of the same hospital. The study population was all critically ill patients admitted to one of the peripheral units from November 2016 to May 2020 and who needed to be transferred to the main building. Telemedicine-assisted transportation was performed by an emergency specialist. The inclusion criteria included patients above the age of 15 and initial stabilization performed at the emergency department. Unstable, intubated, ST-elevation myocardial infarction and acute stroke patients were excluded. There was a double-check of safety conditions by the nurse and the remote doctor before the ambulance departure. The primary endpoint was the number of telemedicine-guided interventions during transport. Results 2840 patients were enrolled. The population was predominantly male (53.2%) with a median age of 60 years. Sepsis was the most prevalent diagnosis in 28% of patients, followed by acute coronary syndromes (8.5%), arrhythmia (6.7%), venous thromboembolism (6.1%), stroke (6.1%), acute abdomen (3.6%), respiratory distress (3.3%), and heart failure (2.5%). Only 22 (0.8%) patients required telemedicine-assisted support during transport. Administration of oxygen therapy and analgesics were the most common recommendations made by telemedicine emergency physicians. There were no communication problems in the telemedicine-assisted group. Conclusions Telemedicine-assisted ambulance transportation between healthcare facilities of stabilized critically ill patients may be an option instead of an onboard physician. The frequency of clinical support requests by telemedicine is minimal, and most evaluations are of low complexity and easily and safely performed by trained nurses.

Cross-sectional Study of the Ambulance Transport Between Healthcare Facilities With Medical Support via Telemedicine: Easy, Effective, Low-cost, and High-security Tool

2020 ◽  
Author(s):  
Carlos Pedrotti ◽  
Tarso A. D. Accorsi ◽  
Karine De Amicis ◽  
Jose R. de O. Silva Filho ◽  
Renata A. Morbeck ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Low Cost ◽  
Cross Sectional Study ◽  
Medical Support ◽  
Cross Sectional ◽  
Healthcare Facilities ◽  
Ambulance Transport ◽  
Coronary Syndromes ◽  
Hospital Study

Abstract Background: Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine is unknown. Methods: This was a retrospective study with a single telemedicine center reference for satellite emergency departments of the same hospital. Study population was all critically ill patients admitted to one of the peripheral units, from November 2016 to May 2020, and who needed to be transferred to the main building. Telemedicine-assisted transportation was performed by an emergency specialist. For inclusion, the criteria demanded the patients above the age of 15 years and initial stabilization be performed at the emergency department. Unstable, intubated, ST-elevation myocardial infarction, and acute stroke patients were excluded. The primary endpoint was the number of telemedicine-guided interventions during transport. Results: 2840 patients were enrolled. The population was predominantly male (53.2%) with a median age of 60 years. Sepsis was the most prevalent diagnosis in 28% of patients, followed by acute coronary syndromes (8.5%), arrhythmia (6.7%), venous thromboembolism (6.1%), stroke (6.1%), acute abdomen (3.6%), respiratory distress (3.3%), and heart failure (2.5%). Only 22 (0.8%) patients required telemedicine-assisted support during transport. Administration of oxygen therapy and analgesics were the main remotely-oriented interventions. There were no communication problems in the telemedicine-assisted group. Conclusions: Telemedicine-assisted ambulance transportation of stabilized critically ill patients can effectively and safely substitute an onboard physician on most transfers between same-institution locations.

scholarly journals Varying association of laboratory values with reference ranges and outcomes in critically ill patients: an analysis of data from five databases in four countries across Asia, Europe and North America

2021 ◽  
Vol 28 (1) ◽  
pp. e100419
Author(s):  
Haoran Xu ◽  
Louis Agha-Mir-Salim ◽  
Zachary O’Brien ◽  
Dora C Huang ◽  
Peiyao Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Specific Reference ◽  
Reference Ranges ◽  
Cross Sectional ◽  
Laboratory Values ◽  
Laboratory Results ◽  
The Usa

BackgroundDespite wide usage across all areas of medicine, it is uncertain how useful standard reference ranges of laboratory values are for critically ill patients.ObjectivesThe aim of this study is to assess the distributions of standard laboratory measurements in more than 330 selected intensive care units (ICUs) across the USA, Amsterdam, Beijing and Tarragona; compare differences and similarities across different geographical locations and evaluate how they may be associated with differences in length of stay (LOS) and mortality in the ICU.MethodsA multi-centre, retrospective, cross-sectional study of data from five databases for adult patients first admitted to an ICU between 2001 and 2019 was conducted. The included databases contained patient-level data regarding demographics, interventions, clinical outcomes and laboratory results. Kernel density estimation functions were applied to the distributions of laboratory tests, and the overlapping coefficient and Cohen standardised mean difference were used to quantify differences in these distributions.ResultsThe 259 382 patients studied across five databases in four countries showed a high degree of heterogeneity with regard to demographics, case mix, interventions and outcomes. A high level of divergence in the studied laboratory results (creatinine, haemoglobin, lactate, sodium) from the locally used reference ranges was observed, even when stratified by outcome.ConclusionStandardised reference ranges have limited relevance to ICU patients across a range of geographies. The development of context-specific reference ranges, especially as it relates to clinical outcomes like LOS and mortality, may be more useful to clinicians.

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

scholarly journals VALUE OF CLINICAL PULMONARY INFECTION SCORE IN CRITICALLY ILL PATIENTS: BETWEEN THE USE OF CHLORHEXIDINE AND PIPER BETLE LINN MOUTHWASH

2018 ◽  
Vol 4 (1) ◽  
pp. 76-82
Author(s):  
Irfany Nurul Hamid ◽  
Rr Sri Endang Pujiastuti ◽  
Dwi Ari Widigdo ◽  
Djenta Saha
Keyword(s):  
Treatment Group ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pulmonary Infection ◽  
Cross Sectional Study ◽  
Piper Betle ◽  
Ventilator Associated Pneumonia ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Mean

Background: One of the complications of ventilator use in patients in Intensive Care Unit (ICU) is Ventilator-Associated Pneumonia (VAP). Oral hygienes is one of the methods to prevent VAP.Objective: The objective of this study was to compare the value of clinical infection score (CPIS) in critically ill patients after given oral hygiene using chlorhexidine and Piper betle Linn mouthwash.Methods: This was an observational study with cross-sectional study design, which consisted of two intervention groups. Thirty respondents were selected using total sampling, with 15 respondents randomly assigned in each group. Independent t-test was used for data analysis.Results: Findings showed that  the mean of CPIS in the Piper betle Linn group was 3.80 and the mean of CPIS in the chlorhexidine group was 4.07.Conclusion: CPIS in the treatment group using Piper betle Linn mouthwash was lower than the mean of CPIS in the treatment group using clorhexidine. 

Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

2020 ◽  
Vol 52 (09) ◽  
pp. 660-668
Author(s):  
Israel Khanimov ◽  
Meital Ditch ◽  
Henriett Adler ◽  
Sami Giryes ◽  
Noa Felner Burg ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Glucose Monitoring ◽  
Cross Sectional Study ◽  
Nutritional Risk ◽  
Blood Glucose Monitoring ◽  
Cross Sectional ◽  
Hospitalization Period ◽  
Diabetes Mellitus Status

AbstractThe objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61–84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011–2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387–0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072–2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

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