scholarly journals Outcome Measures Following Critical Illness in Children With Disabilities: A Scoping Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Julia A. Heneghan ◽  
Sarah A. Sobotka ◽  
Madhura Hallman ◽  
Neethi Pinto ◽  
Elizabeth Y. Killien ◽  
...  
Keyword(s):  
Critical Illness ◽  
Outcome Measures ◽  
Scoping Review ◽  
Children With Disabilities ◽  
Pediatric Intensive Care ◽  
Population Data ◽  
Post Discharge ◽  
Developmental Domains ◽  
Multi Stakeholder ◽  
Stakeholder Consensus

Children with disabilities compose a substantial portion of admissions and bed-days in the pediatric intensive care unit (PICU) and often experience readmissions over time. Impacts of a PICU admission on post-discharge health status may be difficult to distinguish from pre-existing disability in this population. Efforts to standardize outcome measures used for children with disabilities may help identify morbidities associated with PICU hospitalizations. Although a scoping review of outcome measures to assess children after episodes of critical illness has recently been published, it is not known to what extent these measures are appropriate for use in children with disabilities. This limits our ability to effectively measure long-term outcomes following critical illness in this important patient population. Through mixed methodology of scoping review and multi-stakeholder consensus, we aimed to identify and describe instruments previously utilized for this purpose and to explore additional tools for consideration. This yielded 51 measures across a variety of domains that have been utilized in the PICU setting and may be appropriate for use in children with disabilities. We describe characteristics of these instruments, including the type of developmental domains assessed, availability of population data, validation and considerations regarding administration in children with disabilities, and ease of availability of the instrument to researchers. Additionally, we suggest needed alterations or accommodations for these instruments to augment their utility in these populations, and highlight areas for future instrument development.

scholarly journals Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

2021 ◽  
Vol 15 ◽  
Author(s):  
Ashley D. Turner ◽  
Travis Sullivan ◽  
Kurt Drury ◽  
Trevor A. Hall ◽  
Cydni N. Williams ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Animal Models ◽  
Critically Ill ◽  
Cognitive Dysfunction ◽  
Functional Outcomes ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Post Discharge

In the midst of concerns for potential neurodevelopmental effects after surgical anesthesia, there is a growing awareness that children who require sedation during critical illness are susceptible to neurologic dysfunctions collectively termed pediatric post-intensive care syndrome, or PICS-p. In contrast to healthy children undergoing elective surgery, critically ill children are subject to inordinate neurologic stress or injury and need to be considered separately. Despite recognition of PICS-p, inconsistency in techniques and timing of post-discharge assessments continues to be a significant barrier to understanding the specific role of sedation in later cognitive dysfunction. Nonetheless, available pediatric studies that account for analgesia and sedation consistently identify sedative and opioid analgesic exposures as risk factors for both in-hospital delirium and post-discharge neurologic sequelae. Clinical observations are supported by animal models showing neuroinflammation, increased neuronal death, dysmyelination, and altered synaptic plasticity and neurotransmission. Additionally, intensive care sedation also contributes to sleep disruption, an important and overlooked variable during acute illness and post-discharge recovery. Because analgesia and sedation are potentially modifiable, understanding the underlying mechanisms could transform sedation strategies to improve outcomes. To move the needle on this, prospective clinical studies would benefit from cohesion with regard to datasets and core outcome assessments, including sleep quality. Analyses should also account for the wide range of diagnoses, heterogeneity of this population, and the dynamic nature of neurodevelopment in age cohorts. Much of the related preclinical evidence has been studied in comparatively brief anesthetic exposures in healthy animals during infancy and is not generalizable to critically ill children. Thus, complementary animal models that more accurately “reverse translate” critical illness paradigms and the effect of analgesia and sedation on neuropathology and functional outcomes are needed. This review explores the interactive role of sedatives and the neurologic vulnerability of critically ill children as it pertains to survivorship and functional outcomes, which is the next frontier in pediatric intensive care.

scholarly journals Pediatric Chronic Critical Illness: A Protocol for a Scoping Review

2021 ◽  
Author(s):  
David J Zorko ◽  
James Dayre McNally ◽  
Bram Rochwerg ◽  
Neethi Pinto ◽  
Rachel Couban ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Scoping Review ◽  
Significant Risk ◽  
Pediatric Intensive Care ◽  
Case Definition ◽  
Future Research ◽  
High Risk Population ◽  
Working Definition ◽  
Chronic Critical Illness

Due to improvements in the delivery of intensive care, survival of even the most critically ill of children has increased, leading to a growing proportion of children with chronic and/or complex medical conditions in the pediatric intensive care unit (PICU). Some of these children are at significant risk of recurrent critical illness and persistent long-term morbidity, and become ‘superusers’ of PICU resources. These children are increasingly recognized as a unique high-risk population in the PICU referred to as children with chronic critical illness (CCI). To date, this population has been understudied, in part due to pediatric CCI being a novel concept without an accepted definition to consistently identify these children. This scoping review is the first step in the development of a consensus case definition for pediatric CCI. This comprehensive literature review will seek to first evaluate existing or suggested definitions of pediatric CCI, and in their absence, identify key terms and constructs to inform the development of a working definition of pediatric CCI for future research.

scholarly journals Developing an evidence assessment framework and appraising the academic literature on migrant health in Malaysia: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041379
Author(s):  
Allard Willem de Smalen ◽  
Zhie X Chan ◽  
Claudia Abreu Lopes ◽  
Michaella Vanore ◽  
Tharani Loganathan ◽  
...  
Keyword(s):  
Scoping Review ◽  
Multiple Correspondence Analysis ◽  
Population Data ◽  
Good Health ◽  
Migrant Health ◽  
High Quality ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Academic Literature

BackgroundA large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies.MethodsA scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables.Results67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality.ConclusionThis study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making.

scholarly journals Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 745
Author(s):  
Wenjuan Cong ◽  
Ak Narayan Poudel ◽  
Nour Alhusein ◽  
Hexing Wang ◽  
Guiqing Yao ◽  
...  
Keyword(s):  
Critical Illness ◽  
Scoping Review ◽  
Clinical Evidence ◽  
Length Of Hospital Stay ◽  
Severity Of Illness ◽  
Antibiotic Prescribing ◽  
Antimicrobial Use ◽  
Clinical Scenarios ◽  
Scoping Reviews ◽  
The Impact

This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.

scholarly journals Practice of Telehealth in Otolaryngology: A Scoping Review in the Era of COVID-19

2021 ◽  
pp. 019459982110137
Author(s):  
Joseph N. Gonzalez ◽  
Lucas G. Axiotakis ◽  
Victoria X. Yu ◽  
David A. Gudis ◽  
Jonathan B. Overdevest
Keyword(s):  
Outcome Measures ◽  
Scoping Review ◽  
Medical Center ◽  
Randomized Study ◽  
Marked Change ◽  
Policy Decision ◽  
Columbia University ◽  
Group Assignment ◽  
Scoping Reviews ◽  
Full Text Review

Objective The COVID-19 pandemic has spurred widespread adoption and advancement in telehealth activities, representing a marked change in otolaryngology practice patterns. The present study undertakes a scoping review of research focused on telehealth in otolaryngology (teleotolaryngology) to identify key themes and commonly utilized outcome measures that will assist future development in this growing field. Data Sources PubMed, Embase, and Cochrane databases and reference review. Review Methods Per guidelines of the PRISMA Extension for Scoping Reviews, we performed database queries using a comprehensive search strategy developed in collaboration with research librarians at the Columbia University Irving Medical Center. We identified 596 unique references to undergo title and abstract review by 2 independent reviewers, leaving 439 studies for full-text review. Results We included 285 studies for extraction of notable findings, leaving 262 unique studies after accounting for content overlap. We identified core outcome measures, including patient and provider satisfaction, costs and benefits, quality of care, feasibility, and access to care. Publication volume increased markedly over time, though only 4% of studies incorporated randomized study group assignment. Using an iterative approach to thematic development, we organized article content across 5 main themes: (1) exploration of teleotolaryngology evolution, (2) role in virtual clinical encounters, (3) applications in interdisciplinary care and educational initiatives, (4) emerging and innovative technologies, and (5) barriers to implementation. Conclusion This scoping review of teleotolaryngology documents its evolution and identifies current use cases, limitations, and emerging applications, providing a foundation from which to build future studies, inform policy decision making, and facilitate implementation where appropriate.

scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

scholarly journals coreNASH: Multi‐stakeholder Consensus on Core Outcomes for Decision Making About Nonalcoholic Steatohepatitis Treatment

2021 ◽  
Author(s):  
Elizabeth Clearfield ◽  
Veronica Miller ◽  
Joseph Nadglowski ◽  
Katherine Barradas ◽  
Jennifer Al Naber ◽  
...  
Keyword(s):  
Decision Making ◽  
Nonalcoholic Steatohepatitis ◽  
Core Outcomes ◽  
Multi Stakeholder ◽  
Stakeholder Consensus

A Multi-Stakeholder Consensus-Driven Research Agenda for Better Understanding and Supporting the Emotional Impact of Harmful Events on Patients and Families

2018 ◽  
Vol 44 (7) ◽  
pp. 424-435 ◽  
Author(s):  
Sigall K. Bell ◽  
Jason M. Etchegaray ◽  
Elizabeth Gaufberg ◽  
Elizabeth Lowe ◽  
Madelene J. Ottosen ◽  
...  
Keyword(s):  
Research Agenda ◽  
Emotional Impact ◽  
Multi Stakeholder ◽  
Stakeholder Consensus

1082: POST-DISCHARGE OUTCOMES IN CRITICAL ILLNESS SURVIVORS WITH MEDICAID INSURANCE STATUS

2016 ◽  
Vol 44 (12) ◽  
pp. 346-346
Author(s):  
Carmela Socolovsky ◽  
Ryan Cauley ◽  
Clare Horkan ◽  
Kenneth Christopher
Keyword(s):  
Critical Illness ◽  
Insurance Status ◽  
Post Discharge ◽  
Discharge Outcomes

scholarly journals Early interventions for the prevention of post-traumatic stress symptoms in survivors of critical illness: protocol for a systematic review

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e018270 ◽  
Author(s):  
Lindsey J Glaspey ◽  
Michael B Roberts ◽  
Anthony Mazzarelli ◽  
Stephen Trzeciak ◽  
Brian W Roberts
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Critical Illness ◽  
Outcome Measures ◽  
Traumatic Stress ◽  
Early Interventions ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Registration Number ◽  
Post Traumatic

IntroductionPost-traumatic stress disorder (PTSD) is being increasingly reported among survivors of critical illness and injury. Previous work has demonstrated that PTSD reduces patient quality of life and ability to return to work, as well as increases healthcare costs. As such, identifying interventions aimed at preventing the development of critical illness-related PTSD could have an important public health impact. The objective of this systematic review is to collate the world’s literature on early interventions aimed at preventing PTSD among survivors of critical illness.Methods and analysisWe will perform a qualitative systematic review of human clinical trials of interventions aimed at preventing or reducing critical illness-related PTSD symptoms. We will methodically search CENTRAL, MEDLINE, Embase and CINAHL. We will also search websites containing details on clinical trials registration (National Library of Medicine’s ClinicalTrials.gov and the WHO’s International Clinical Trials Registry Platform), as well as screen reference lists of the articles we select for inclusion to identify additional studies for potential inclusion. Two authors will independently review all search results. After identification and inclusion of articles, we will use a standardised form for data extraction. We will use tables to describe the study type, populations, interventions tested and timing of interventions, outcome measures and effects of interventions on outcome measures compared with control groups. This review will be completed between 1 August 2017 and 31 August 2017.Ethics and disseminationThe proposed systematic review will not collect individual patient level data and does not require ethical approval. Results of this study will contribute to the understanding of critical illness-related PTSD and help prompt future research aimed at further developing interventions to prevent PTSD symptoms in survivors of critical illness.PROSPERO registration numberThis systematic review is registered in the PROSPERO international prospective register of systematic reviews (registration number CRD42017069672).

Sign in / Sign up

Export Citation Format

Share Document