Telemedicine in Intensive Care Units: A Scoping Review. (Preprint)

BACKGROUND The role of telemedicine in intensive care has been increasing steadily. Tele ICU interventions are varied and can be employed in different levels of treatment, often with direct implications for the intensive care processes. While a significant body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. OBJECTIVE This scoping review aims to provide a map of existing evidence on tele ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. METHODS A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA extension for scoping reviews (PRISMA-ScR). A core research team was assembled to provide feedback and discuss findings. RESULTS We were able to characterize the context of tele ICU studies and identify three use cases for tele ICU interventions. The first use case is Extending Coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is Improving Compliance, which includes interventions targeted at improving patient safety, intensive care best practices and quality of care. The third use case, Facilitating Transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. CONCLUSIONS The benefits of tele ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele ICU intervention. INTERNATIONAL REGISTERED REPORT RR2-10.2196/19695

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Telemedicine in Intensive Care Units: Protocol for a Scoping Review (Preprint)

10.2196/preprints.19695 ◽

2020 ◽

Author(s):

Camille Guinemer ◽

Martin Boeker ◽

Bjoern Weiss ◽

Daniel Fuerstenau ◽

Felix Balzer ◽

...

Keyword(s):

Intensive Care ◽

Systematic Reviews ◽

Scoping Review ◽

Care Delivery ◽

Management Tool ◽

Future Research ◽

Extensive Literature ◽

Hospital Organization ◽

Scoping Reviews ◽

Implementation Context

BACKGROUND Telemedicine has been deployed to address issues in intensive care delivery, as well as to improve outcome and quality of care. Implementation of this technology has been characterized by high variability. Tele-intensive care unit (ICU) interventions involve the combination of multiple technological and organizational components, as well as interconnections of key stakeholders inside the hospital organization. The extensive literature on the benefits of tele-ICUs has been characterized as heterogeneous. On one hand, positive clinical and economical outcomes have been shown in multiple studies. On the other hand, no tangible benefits could be detected in several cases. This could be due to the diverse forms of organizations and the fact that tele-ICU interventions are complex to evaluate. The implementation context of tele-ICUs has been shown to play an important role in the success of the technology. The benefits derived from tele-ICUs depend on the organization where it is deployed and how the telemedicine systems are applied. There is therefore value in analyzing the benefits of tele-ICUs in relation to the characteristics of the organization where it is deployed. To date, research on the topic has not provided a comprehensive overview of literature taking both the technology setup and implementation context into account. OBJECTIVE We present a protocol for a scoping review of the literature on telemedicine in the ICU and its benefits in intensive care. The purpose of this review is to map out evidence about telemedicine in critical care in light of the implementation context. This review could represent a valuable contribution to support the development of tele-ICU technologies and offer perspectives on possible configurations, based on the implementation context and use case. METHODS We have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the recommendations of the Joanna Briggs Institute methodology for scoping reviews. The scoping review and subsequent systematic review will be completed by spring 2021. RESULTS The preliminary search has been conducted. After removing all duplicates, we found 2530 results. The review can now be advanced to the next steps of the methodology, including literature database queries with appropriate keywords, retrieval of the results in a reference management tool, and screening of titles and abstracts. CONCLUSIONS The results of the search indicate that there is sufficient literature to complete the scoping review. Upon completion, the scoping review will provide a map of existing evidence on tele-ICU systems given the implementation context. Findings of this research could be used by researchers, clinicians, and implementation teams as they determine the appropriate setup of new or existing tele-ICU systems. The need for future research contributions and systematic reviews will be identified. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19695

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Telemedicine in Intensive Care Units: Protocol for a Scoping Review

JMIR Research Protocols ◽

10.2196/19695 ◽

2020 ◽

Vol 9 (12) ◽

pp. e19695

Author(s):

Camille Guinemer ◽

Martin Boeker ◽

Bjoern Weiss ◽

Daniel Fuerstenau ◽

Felix Balzer ◽

...

Keyword(s):

Intensive Care ◽

Systematic Reviews ◽

Scoping Review ◽

Care Delivery ◽

Management Tool ◽

Future Research ◽

Extensive Literature ◽

Hospital Organization ◽

Scoping Reviews ◽

Implementation Context

Background Telemedicine has been deployed to address issues in intensive care delivery, as well as to improve outcome and quality of care. Implementation of this technology has been characterized by high variability. Tele-intensive care unit (ICU) interventions involve the combination of multiple technological and organizational components, as well as interconnections of key stakeholders inside the hospital organization. The extensive literature on the benefits of tele-ICUs has been characterized as heterogeneous. On one hand, positive clinical and economical outcomes have been shown in multiple studies. On the other hand, no tangible benefits could be detected in several cases. This could be due to the diverse forms of organizations and the fact that tele-ICU interventions are complex to evaluate. The implementation context of tele-ICUs has been shown to play an important role in the success of the technology. The benefits derived from tele-ICUs depend on the organization where it is deployed and how the telemedicine systems are applied. There is therefore value in analyzing the benefits of tele-ICUs in relation to the characteristics of the organization where it is deployed. To date, research on the topic has not provided a comprehensive overview of literature taking both the technology setup and implementation context into account. Objective We present a protocol for a scoping review of the literature on telemedicine in the ICU and its benefits in intensive care. The purpose of this review is to map out evidence about telemedicine in critical care in light of the implementation context. This review could represent a valuable contribution to support the development of tele-ICU technologies and offer perspectives on possible configurations, based on the implementation context and use case. Methods We have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and the recommendations of the Joanna Briggs Institute methodology for scoping reviews. The scoping review and subsequent systematic review will be completed by spring 2021. Results The preliminary search has been conducted. After removing all duplicates, we found 2530 results. The review can now be advanced to the next steps of the methodology, including literature database queries with appropriate keywords, retrieval of the results in a reference management tool, and screening of titles and abstracts. Conclusions The results of the search indicate that there is sufficient literature to complete the scoping review. Upon completion, the scoping review will provide a map of existing evidence on tele-ICU systems given the implementation context. Findings of this research could be used by researchers, clinicians, and implementation teams as they determine the appropriate setup of new or existing tele-ICU systems. The need for future research contributions and systematic reviews will be identified. International Registered Report Identifier (IRRID) DERR1-10.2196/19695

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Pediatric Chronic Critical Illness: Protocol for a Scoping Review

JMIR Research Protocols ◽

10.2196/30582 ◽

2021 ◽

Vol 10 (10) ◽

pp. e30582

Author(s):

David Zorko ◽

James Dayre McNally ◽

Bram Rochwerg ◽

Neethi Pinto ◽

Rachel Couban ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Scoping Review ◽

Clinical Characteristics ◽

Case Definition ◽

Critically Ill Children ◽

Data Abstraction ◽

Chronic Critical Illness ◽

Scoping Reviews ◽

Citation Screening

Background Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition. Objective This study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies. Methods We will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes. Results The database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021. Conclusions This scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review’s results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews. International Registered Report Identifier (IRRID) DERR1-10.2196/30582

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Continuous infusion ketamine as analgesia or sedation in mechanically ventilated adults in the intensive care unit: a scoping review

10.21203/rs.3.rs-910472/v1 ◽

2021 ◽

Author(s):

Nicholas David Richards ◽

Simon Howell ◽

Mark Bellamy ◽

Ruben Mujica-Mota

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Continuous Infusion ◽

Scoping Review ◽

Evidence Synthesis ◽

Meta Analysis ◽

Flow Diagram ◽

Mechanically Ventilated ◽

Scoping Reviews ◽

Review Protocol

Abstract IntroductionMechanical ventilation (MV) is a common and often live-saving intervention on the Intensive Care Unit (ICU). In order to facilitate this intervention, the majority of patients require medical sedation. Optimising sedation is one of the fundamentals of ICU care, and inadequate sedation (predominantly too deep) has consistently been associated with worse outcomes for patients.This article presents the protocol for a scoping review of published literature on the use of ketamine as a sedative to facilitate MV on ICU.The scoping review has been designed to answer the question ‘What is known about the use of ketamine as a continuous infusion to provide sedation in mechanically ventilated adults in the intensive care unit, and what gaps in the evidence exist?’ MethodsThe scoping review protocol has been designed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) checklist and the JBI manual for evidence synthesis. Data will be extracted using a dedicated form, and reviewed by 2 reviewers.Results Results will be tabulated and presented along side descriptive summaries. A PRISMA flow diagram will also be generated.Ethics and DisseminationThis scoping review is designed to map out the literature using existing published articles and does not require ethical approval.Results will be submitted for publication in relevant peer-reviewed journals and to international meetings as well as disseminated to relevant professional groups.

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Nursing interventions in intensive care unit patients with breathing difficulties: A scoping review of the evidence

Nordic Journal of Nursing Research ◽

10.1177/2057158520948834 ◽

2020 ◽

Vol 40 (4) ◽

pp. 176-187

Author(s):

Renate Slang ◽

Lene T. Finsrud ◽

Brita F. Olsen

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Scoping Review ◽

Bed Rest ◽

Evidence Base ◽

Nursing Interventions ◽

Early Exercise ◽

Beneficial Effects ◽

Scoping Reviews ◽

Training Position

For patients in intensive care units, long periods of bed rest and restricted physical activity can result in adverse side effects. One of the conditions many patients experience during intensive care unit stays is breathing difficulty. Here, we aimed to identify and evaluate the evidence base for nonpharmacological or nontechnical interventions targeting breathing difficulties, and to propose interventions needing further investigations. This study is reported in accordance with PRISMA for Scoping Reviews. A systematic search was conducted in MEDLINE, EMBASE, and Cochrane. A scoping review was undertaken using the Arksey and O’Malley framework. In all, 1190 records were found and 27 of them were included in the review. Interventions targeting breathing difficulties were chest physiotherapy, breathing techniques, inspiratory muscle training, early exercise training, position-specific optimization, and other nonpharmacological interventions. Several of the interventions showed minor beneficial effects. However, because of limitations in the studies, the findings are inconclusive and need further research.

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Intensive care units follow-up: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2020-037725 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037725

Author(s):

Danielle Prevedello ◽

Marco Fiore ◽

Jacques Creteur ◽

J C Preiser

Keyword(s):

Quality Of Life ◽

Intensive Care ◽

Scoping Review ◽

Grey Literature ◽

Icu Discharge ◽

Scoping Reviews ◽

The Impact

IntroductionIncreasing numbers of patients are surviving critical illness, leading to growing concern about the potential impact of the long-term consequences of intensive care on patients, families and society as a whole. These long-term effects are together known as postintensive care syndrome and their presence can be evaluated at intensive care unit (ICU) follow-up consultations. However, the services provided by these consultations vary across hospitals and units, in part because there is no validated standard model to evaluate patients and their quality of life after ICU discharge. We describe a protocol for a scoping review focusing on models of ICU follow-up and the impact of such strategies on improving patient quality of life.Methods and analysisIn this scoping review, we will search the literature systematically using electronic databases (MEDLINE - from database inception to June 15th 2020) and a grey literature search. We will involve stakeholders as recommended by the Joanna Briggs Institute approach developed by Peters et al. The research will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.Ethics and disseminationThis study does not require ethics approval, because data will be obtained through a review of published primary studies. The results of our evaluation will be published in a peer-reviewed journal and will also be disseminated through presentations at national and international conferences.

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Pediatric Chronic Critical Illness: Protocol for a Scoping Review (Preprint)

10.2196/preprints.30582 ◽

2021 ◽

Author(s):

David Zorko ◽

James Dayre McNally ◽

Bram Rochwerg ◽

Neethi Pinto ◽

Rachel Couban ◽

...

Keyword(s):

Intensive Care ◽

Critical Illness ◽

Scoping Review ◽

Clinical Characteristics ◽

Case Definition ◽

Critically Ill Children ◽

Data Abstraction ◽

Chronic Critical Illness ◽

Scoping Reviews ◽

Citation Screening

BACKGROUND Improvements in the delivery of intensive care have increased survival among even the most critically ill children, thereby leading to a growing number of children with chronic complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at a significant risk of recurrent and prolonged critical illness, with higher morbidity and mortality, making them a unique population described as having chronic critical illness (CCI). To date, pediatric CCI has been understudied and lacks an accepted consensus case definition. OBJECTIVE This study aims to describe the protocol and methodology used to perform a scoping review that will describe how pediatric CCI has been defined in the literature, including the concept of prolonged PICU admission and the methodologies used to develop any existing definitions. It also aims to describe patient characteristics and outcomes evaluated in the included studies. METHODS We will search four electronic databases for studies that evaluated children admitted to any PICU identified with CCI. We will also search for studies describing prolonged PICU admission, as this concept is related to pediatric CCI. Furthermore, we will develop a hybrid crowdsourcing and machine learning (ML) methodology to complete citation screening. Screening and data abstraction will be performed by 2 reviewers independently and in duplicate. Data abstraction will include the details of population definitions, demographic and clinical characteristics of children with CCI, and evaluated outcomes. RESULTS The database search, crowd reviewer recruitment, and ML algorithm development began in March 2021. Citation screening and data abstraction were completed in April 2021. Final data verification is ongoing, with analysis and results anticipated to be completed by fall 2021. CONCLUSIONS This scoping review will describe the existing or suggested definitions of pediatric CCI and important demographic and clinical characteristics of patients to whom these definitions have been applied. This review’s results will help inform the development of a consensus case definition for pediatric CCI and set a priority agenda for future research. We will use and demonstrate the validity of crowdsourcing and ML methodologies for improving the efficiency of large scoping reviews. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30582

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Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00871-x ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Yulia Rosa Saharman ◽

Anis Karuniawati ◽

Juliëtte A. Severin ◽

Henri A. Verbrugh

Keyword(s):

Intensive Care ◽

Antimicrobial Resistance ◽

Intensive Care Units ◽

Scoping Review ◽

Open Science ◽

High Income ◽

Middle Income ◽

Middle Income Countries ◽

Scoping Reviews ◽

Science Framework

Abstract Background Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework. Main body of the abstract Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective. Conclusions Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings. Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)

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The extent to which off-patent registered prescription medicines are used for off-label indications in Australia: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0261022 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261022

Author(s):

Katrina Howe ◽

Siobhan Bourke ◽

Lloyd Sansom

Keyword(s):

Scoping Review ◽

South Australia ◽

Community Setting ◽

Public Hospitals ◽

Clinical Settings ◽

Off Label ◽

Australian State ◽

Scoping Reviews ◽

Prescription Medicines ◽

Label Indication

Aim The aim of this scoping review was to determine the extent of off-patent prescription medicine use beyond registered indications in various Australian clinical settings. Method The review followed the Joanna Briggs Institute approach and reported using PRISMA Extension for Scoping Reviews. Online databases were used to identify published literature about off-patent registered prescription medicines used for off-label indications in Australian public hospital, community and primary healthcare settings. In addition, empirical data from the Queensland and the South Australian state-wide medicine formularies were screened for the same medication/off-label indication dyads identified in the literature, and other locally approved uses. Results Overall, fourteen studies were included, conducted in public hospitals (n = 11), palliative care units (n = 2) and the community setting (n = 1). There were 213 reports extracted from the literature describing off-patent registered prescription medicines used for off-label indications, representing 128 unique medication/off-label indication dyads and 32 different medicines. Of these, just five medication/off-label indication dyads were approved for use on both the Queensland and South Australian state-wide medicine formularies, with 12 others only approved for use in Queensland and 16 others only approved for use in South Australia. Further examination of these state-wide formularies demonstrated that the use of off-patent registered prescription medicines beyond registered indications is more extensive than has been reported to date in the literature. There were 28 additional medication/off-label indication dyads approved on the Queensland state-wide medicine formulary and 14 such examples approved for use in South Australia. Of these, just two medication/off-label indication dyads were approved for use on both formularies. Conclusion The extent to which off-patent registered prescription medicines have been repurposed in clinical settings for off-label indications in Australia is greater than previously reported in the literature. Usage and funded availability of certain medication/off-label indication dyads, varies across Australia. These results further expose the two tiered system of medicines regulation in Australia, and its impact on equity of access to medicines. Further research is required to support policy change to encourage submission of registration updates for off-patent prescription medicines.

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Factors Influencing Public Attitudes towards COVID-19 Vaccination: A Scoping Review Informed by the Socio-Ecological Model

Vaccines ◽

10.3390/vaccines9060548 ◽

2021 ◽

Vol 9 (6) ◽

pp. 548

Author(s):

Ghadir Fakhri Al-Jayyousi ◽

Mohamed Abdelhady Mabrouk Sherbash ◽

Lamees Abdullah Mohammed Ali ◽

Asmaa El-Heneidy ◽

Nour Waleed Zuhair Alhussaini ◽

...

Keyword(s):

Scoping Review ◽

Ecological Model ◽

Public Attitudes ◽

Organizational Factors ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

The Public ◽

Factors Influencing ◽

Scoping Reviews ◽

Meta Analyses

Major hindrances to getting a COVID-19 vaccine include vaccine hesitancy, skepticism, refusal, and anti-vaccine movements. Several studies have been conducted on attitudes of the public towards COVID-19 vaccines and the potential influencing factors. The purpose of this scoping review is to summarize the data available on the various factors influencing public attitudes towards COVID-19 vaccination. This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. PubMed, Embase, Web of Science, and Cochrane Central were searched without restrictions to reclaim all publications on the factors that shape individuals’ attitudes towards COVID-19 vaccines from 1 January 2020 to 15 February 2021. Fifty studies were included. The scoping review revealed that the factors influencing public attitudes towards COVID-19 vaccines were embedded within the different levels of the socio-ecological model. These factors included the sociodemographic characteristics of the individuals, individual factors, social and organizational factors. In addition, certain characteristics of COVID-19 vaccines themselves influenced public attitudes towards accepting the vaccines. Understanding various population needs and the factors shaping public attitudes towards the vaccines would support planning for evidence-based multilevel interventions in order to enhance global vaccine uptake.

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